[This report will be discussed Wednesday, July 20, at a public briefing beginning at 10 a.m. EDT, in the First Amendment Room of the National Press Club, 529 14th St., N.W., Washington, D.C.  A live audio webcast of the briefing will be available at www.nationalacademies.org.]

Date:  July 19, 2011


IOM Report Recommends Eight Additional Preventive Health Services to Promote Women's Health 

WASHINGTON — A new report from the Institute of Medicine (IOM) recommends that eight preventive health services for women be added to the services that health plans will cover at no cost to patients under the Patient Protection and Affordable Care Act of 2010 (ACA).  The ACA requires plans to cover the services listed in the U.S. Department of Health and Human Services' (HHS) comprehensive list of preventive services.  At the agency's request, an IOM committee identified critical gaps in preventive services for women as well as measures that will further ensure women's health and well-being. 


The recommendations are based on a review of existing guidelines and an assessment of the evidence on the effectiveness of different preventive services.  The committee identified diseases and conditions that are more common or more serious in women than in men or for which women experience different outcomes or benefit from different interventions.  The report suggests the following additional services:


·                     screening for gestational diabetes

·                     human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30

·                     counseling on sexually transmitted infections

·                     counseling and screening for HIV

·                     contraceptive methods and counseling to prevent unintended pregnancies

·                     lactation counseling and equipment to promote breast-feeding

·                     screening and counseling to detect and prevent interpersonal and domestic violence

·                     yearly well-woman preventive care visits to obtain recommended preventive services


"This report provides a road map for improving the health and well-being of women," said committee chair Linda Rosenstock, dean, School of Public Health, University of California, Los Angeles.  "The eight services we identified are necessary to support women's optimal health and well-being.  Each recommendation stands on a foundation of evidence supporting its effectiveness."


Deaths from cervical cancer could be reduced by adding DNA testing for HPV, the virus that can cause this form of cancer, to the Pap smears that are part of the current guidelines for women's preventive services, the report concludes.  Cervical cancer can be prevented through vaccination, screening, and treatment of precancerous lesions and HPV testing increases the chances of identifying women at risk. 


Although lactation counseling is already part of the HHS guidelines, the report recommends comprehensive support that includes coverage of breast pump rental fees as well as counseling by trained providers to help women initiate and continue breast-feeding.  Evidence links breast-feeding to lower risk for breast and ovarian cancers; it also reduces children's risk for sudden infant death syndrome, asthma, gastrointestinal infections, respiratory diseases, leukemia, ear infections, obesity, and Type 2 diabetes. 


HHS should consider screening for gestational diabetes in pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.  The United States has the highest rates of gestational diabetes in the world; it complicates as many as 10 percent of U.S. pregnancies each year.  Women with gestational diabetes face a 7.5-fold increased risk for the development of Type 2 diabetes after delivery and are more likely to have infants that require delivery by cesarean section and have health problems after birth. 


To reduce the rate of unintended pregnancies, which accounted for almost half of pregnancies in the U.S. in 2001, the report urges that HHS consider adding the full range of Food and Drug Administration-approved contraceptive methods as well as patient education and counseling for all women with reproductive capacity.  Women with unintended pregnancies are more likely to receive delayed or no prenatal care and to smoke, consume alcohol, be depressed, and experience domestic violence during pregnancy.  Unintended pregnancy also increases the risk of babies being born preterm or at a low birth weight, both of which raise their chances of health and developmental problems.


HHS's guidelines on preventive health services for women will need to be updated routinely in light of new science.  As part of this process, HHS should establish a commission to recommend which services health plans should cover, the report says.  The commission should be separate from the groups that assess evidence of health services' effectiveness, and it should consider cost-effectiveness analyses, evidence reviews, and other information to make coverage recommendations.


The report addresses concerns that the current guidelines on preventive services contain gaps when it comes to women's needs.  Women suffer disproportionate rates of chronic disease and disability from some conditions.  Because they need to use more preventive care than men on average due to reproductive and gender-specific conditions, they face higher out-of-pocket costs, the report notes. 


The study was sponsored by the U.S. Department of Health and Human Services.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  For more information, visit http://national-academies.org or http://iom.edu.  A committee roster follows.



Christine Stencel, Senior Media Relations Officer

Luwam Yeibio, Media Relations Assistant

Office of News and Public Information

202-334-2138; e-mail news@nas.edu


Additional resources:

Report in Brief

Project Website


Pre-publication copies of Clinical Preventive Services for Women: Closing the Gaps are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu.  Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).


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Board on Population Health and Public Health Practice


Committee on Preventive Services for Women

Linda Rosenstock, M.D., M.P.H. (chair)
School of Public Health
University of California
Los Angeles

Alfred O. Berg, M.D., M.P.H.
Department of Family Medicine
School of Medicine
University of Washington

Claire D. Brindis, Dr.P.H.
Professor of Pediatrics and Health Policy
Department of Pediatrics and Department of Obstetrics, Gynecology, and Reproductive Health Services; and
Philip R. Lee Institute for Health Policy Studies
School of Medicine
University of California
San Francisco

Angela Diaz, M.D., M.P.H.
Jean C. and James W. Crystal Professor of Adolescent Health
Department of Pediatrics and Community Preventive Medicine
Mount Sinai Medical Center
New York City

Francisco Garcia, M.D., M.P.H.
National Center of Excellence in Women's Health;

Distinguished Outreach Professor of Obstetrics and

Gynecology, Public Health, and Pharmacy; and
Cancer Disparities Institute
Arizona Cancer Center
University of Arizona

Kimberly Gregory, M.D. M.P.H.
Vice Chair of Women's Healthcare Quality and Performance Improvement
Department of Obstetrics and Gynecology

Cedars-Sinai Medical Center
Los Angeles


Paula A. Johnson, M.D., M.P.H.
Executive Director
Connors Center for Women's Health and Gender Biology, and
Division of Women's Health
Brigham and Women's Hospital

Anthony Lo Sasso, Ph.D.
Professor and Senior Research Scientist
Division of Health Policy and Administration
School of Public Health
University of Illinois

Jeanette H. Magnus, M.D., Ph.D.
Cecile Usdin Professor in Women's Health and Chair
Department of Community Health Sciences
School of Public Health and Tropical Medicine
Tulane University
New Orleans

Heidi Nelson, M.D., M.P.H., FACP
Research Professor
Medical Informatics and Clinical Epidemiology
Oregon Health and Science University


Roberta B. Ness, M.D., M.P.H.

Dean and M. David Low Chair in Public Health

School of Public Health

University of Texas



Magda Peck, Sc.D.

Associate Dean for Community Engagement and Public Health Practice

College of Public Health

University of Nebraska Medical Center


E. Albert Reece, M.D., Ph.D., M.B.A.
Vice President for Medical Affairs, John Z. and Akiko K. Bowers Distinguished Professor, and Dean
School of Medicine
University of Maryland

Alina Salganicoff, Ph.D.
Vice President and Director of Women's Health Policy
Kaiser Family Foundation
Menlo Park, Calif.


Sally Vernon, Ph.D.
Division Director
Health Promotion and Behavioral Sciences,
Professorship in Mind-Body Medicine and Public Health, and
Professor of Epidemiology and Behavioral Sciences
School of Public Health
University of Texas

Carol S. Weisman, Ph.D.

Distinguished Professor of Public Health Sciences and Obstetrics and Gynecology, and

Associate Dean for Faculty Affairs

College of Medicine

Pennsylvania State University





Karen L. Helsing, M.H.S.

Study Director