A partir de este año los votantes deberán presentar una identificación del estado para poder votar, y existe una lista de identificaciones válidas que pueden presentar, pero dos de ellas (licencia de manejar e identificación estatal) requieren ir a una oficina del NCDMV

La entrada Votantes en áreas rurales: con menor acceso a un ID para votar en 2023 se publicó primero en Enlace Latino NC.

By Jennifer Fernandez

More North Carolina babies are being born with syphilis, and state health officials are urging women to get tested before they give birth to help catch the sexually transmitted illness early.

In December, North Carolina Department of Health and Human Services issued a public health alert on the rise of syphilis in women and children.

Reported cases among women rose 538 percent between 2012 and 2021, DHHS said in that alert. During that same time period, there was an associated 4,100 percent increase in babies born with congenital syphilis.

Health officials say a rise in riskier sexual behaviors, especially among younger adults, coupled with a drop in overall concern or awareness about sexually transmitted infections, has led to increases in STIs such as syphilis. Syphilis is a bacterial infection transmitted by sexual contact.

They also stress that syphilis is treatable. The earlier the infection is addressed, the better — especially for babies.

“Congenital syphilis can have long-lasting effects on a child’s health and development,” said Matt Jenkins, HIV/STD director for Mecklenburg County Public Health.

Newborns at risk

Sexually transmitted infections had all been rising for several years, even before the COVID-19 pandemic led people to delay or skip testing and treatment, according to the Centers for Disease Control and Prevention.

While it isn’t seen with as much frequency as other STIs, such as chlamydia and gonorrhea, syphilis more often leads to severe health issues or death when passed on to a baby.

Easily transmittable, syphilis presents initially as sores in the genital area and later as a rough, red rash, according to the CDC. Later stages can have no symptoms, but left untreated, syphilis can cause damage to the brain, heart and other organs.

A newborn may not show any signs of infection but can develop serious problems within a few weeks — or even years — if not treated. Likely health issues include developmental delays, hearing loss, vision problems, bone abnormalities and neurological issues, among others.

In pregnant people, syphilis can lead to premature birth, low birth weight, stillbirth or a newborn’s death shortly after birth.

Mecklenburg County accounted for 12 of the state’s 55 cases of congenital syphilis last year, Jenkins said. Through June this year, seven cases have been reported in the county, he said.

Kimberly Newton, a family medicine doctor and OB-GYN with Cone Health who also serves as medical director for Alamance County, didn’t have exact numbers for Alamance or Guilford counties, where she works.

She did say she has seen more cases in recent years.

CDC statistics show that men account for most syphilis cases, with the majority of those cases among gay men, bisexual men and other men who have sex with men.

However, the number of cases in women and newborns has been rising in recent years — a worrying trend, health officials say. 

“The good news is that sexually transmitted infections are preventable,” said Evelyn Foust, chief of NCDHHS Division of Public Health’s Communicable Disease Branch, in a statement in April during STI Awareness Month. “We need to empower ourselves to learn about them, how to talk about them, when to test for them and where to go for care and treatment.”

Barriers to care

A variety of factors put pregnant people at risk of contracting syphilis, according to the CDC. They include having sex for compensation, with multiple partners or while using drugs; getting late or no prenatal care; using methamphetamine or heroin; being incarcerated (or having an incarcerated partner); and having unstable housing or being homeless.

Lack of knowledge about STIs may also be playing a role, Newton said. She said generations of people have now had only abstinence-only or non-comprehensive sex ed classes in the state’s public schools, so they may not have complete information about how these infections get passed around and how to protect themselves.

Multiple screenings are important if there is a chance a mother may have contracted syphilis during the pregnancy. One of the hardest conversations is having to tell someone who previously tested negative that they are now positive during their pregnancy, Newton said.

“The most common question is, ‘Is my baby going to be OK?’ with any prenatal diagnosis,” she said. “With congenital syphilis, it’s really hard to know until your baby is born. And that is really hard (to share) as a practitioner and really hard to hear as a family.”

There are several reasons women may be delaying a syphilis test while pregnant, Jenkins said. 

It could be lack of knowledge about the importance of early prenatal care, limited access to health care services, financial constraints, fear, stigma associated with seeking care, or even logistical challenges in scheduling appointments, he said in an email to NC Health News. 

Newton added that even in areas where there are plenty of providers, access may still be limited if they are not accepting new patients. And she agreed that financial constraints often delay care.

“The economic reality of all of our patients is when you have your prenatal visit, you basically have to take a half day off work,” she said. “And for an hourly worker, that is huge.”

Historically marginalized communities may be more hesitant to get care because of bad experiences with health care among members of their communities, Newton said. 

“If you are a transgender man walking into an OB-GYN office, it might not feel the most welcoming,” she said.

Language can be another barrier, Newton said.

“How do you explain how bacteria work when people have never even heard the word in their language?” she asked.

Newton said people may want to just blame the patient for not getting care earlier, but there are usually barriers keeping them away.

“There is no patient that I have ever met that is positive for syphilis that was volitionally trying not to get care,” she said. 

Jenkins said addressing the many barriers and promoting early and consistent prenatal care is “crucial in preventing congenital syphilis.”

With the General Assembly approving Medicaid expansion, more people will be covered for routine testing and treatment, including STIs, once the policy goes into effect.

Missed opportunities

In 2021, 43 percent of congenital syphilis mothers in North Carolina had little or no prenatal care before delivery, DHHS reported. 

Earlier care would have allowed for earlier detection and treatment for both mother and baby.

However, a national study released that same year showed that some newborns are going home without being diagnosed with syphilis, despite testing protocols.

The overall number of congenital syphilis cases in the country increased from 462 to 1,306 between 2014 and 2018, according to the study published in Pediatrics, the journal of the American Academy of Pediatrics.

The authors found reports of 67 children with symptoms of congenital syphilis a month after their birth during that four-year span. 

As the number of congenital syphilis cases in the country is higher than it has been in more than 20 years, “many pediatric providers may be evaluating and treating infants with [congenital syphilis] for the first time in their careers and should be prepared to do so,” the authors wrote.

Among their recommendations, the authors said pediatric providers should review maternal records and confirm maternal syphilis status, advocate for maternal testing at delivery, and consider a congenital syphilis diagnosis regardless of maternal history.

Funding cut

While cases of STIs rise across the country, funding to stem that growth is decreasing. During the pandemic, Congress funneled more than $1 billion into strengthening the public health workforce over a five-year period. In June, as part of a debt limit deal to avoid defaulting on U.S. obligations, lawmakers clawed back $400 million of that health funding, even as the Biden administration had recently issued a multi-agency plan to combat rising STI rates.

The money had been used to hire 3,000 disease intervention specialists — public health workers who do contact tracing, investigate disease outbreaks and connect people to testing and treatment services.

Newton didn’t have an exact number on the local impact of those cuts. But she said a systematic defunding of public health over the past three decades has trickled down to local health departments, which are indirectly funded by these federal programs.

Yet, as public health departments, they’re mandated to provide the care, even when they do not have the staffing or other resources, she said. 

David C. Harvey, executive director of the National Coalition of STD Directors, called the funding cut a “devastating blow to the fight against rising STI rates” and pledged to fight to get the funding back.

“This will be an uphill battle,” he said in a statement, “but it’s a battle the nation needs us to fight.”

The post Delayed testing, limited access to care, and lack of sexual health literacy contribute to rise in syphilis cases in newborns, health officials say appeared first on North Carolina Health News.

El objetivo es aumentar la educación digital para la comunidad de trabajadores agrícolas en Carolina del Norte.

La entrada ¿Cómo es el programa gratuito que enseña a trabajadores agrícolas a utilizar herramientas digitales? se publicó primero en Enlace Latino NC.

Luego de casi un mes de ocurrida la inundación, algunas familias pudieron regresar a sus casas pero necesitarán repararlas, mientras que otras deberán encontrar un nuevo lugar para vivir debido a las condiciones en que quedaron sus hogares.

La entrada Asistencia a familias afectadas por inundaciones en Kannapolis   se publicó primero en Enlace Latino NC.

Las elecciones locales se estarán realizando este año en 90 condados de Carolina del Norte.

La entrada Elecciones municipales en 90 condados de Carolina del Norte se publicó primero en Enlace Latino NC.

Sin la aprobación del presupuesto bienal 2023-2025., la expansión de Medicaid en Carolina del Norte se encuentra en el limbo.

La entrada En el limbo, expansión de Medicaid en Carolina del Norte se publicó primero en Enlace Latino NC.

By Rachel Crumpler

Beverly Gray, an OB-GYN at Duke Health who provides abortion care, expects that turning away people seeking abortions in North Carolina will be a daily occurrence beginning tomorrow, when the state’s new restrictions passed by Republican lawmakers take effect.

Overnight, abortion access will significantly diminish as the time frame for seeking most abortions in the state drops from 20 weeks of pregnancy to 12 weeks. 

Gray said cutting weeks of access in the state will make turning patients away from care — which already happened under the 20-week ban — more frequent. 

That’s devastating to her, to her colleagues and to many women, she said. 

“I think about when we turn someone away, will they be able to make it to another state?” Gray asked. “And if they can’t, what is their life going to be like? What is their child’s life going to be like?”

It’s not lost on Gray why she will be turning more people away — timelines set by North Carolina lawmakers over the objections of medical professionals and a veto by Gov. Roy Cooper. Gray still has the same skills to help patients in an array of situations, but her hands will be newly tied — taking previously available options for reproductive health care off the table.

Amy Bryant, another OB-GYN and abortion provider, knows the new North Carolina law will put care out of reach for many patients, such as a 17-year-old whom she treated a few weeks ago. The teen, who was just finishing high school, sought an abortion when she was 13 weeks and one day pregnant. Tomorrow, that patient would be left to carry the pregnancy to term or travel out of state.

“That’s just going to happen so much more,” Bryant said. “It’s just unfair.”

While most abortions occur before 12 weeks, Bryant said, there are plenty of scenarios when that’s not possible. At least 1,878 North Carolinians obtained abortions after 12 weeks of pregnancy in 2021 out of a total 27,305 who had abortions, according to the latest data available from the state health department.

North Carolina’s new law does provide some exceptions — for rape, incest, fetal anomalies and risk to the mother — that allow an abortion after 12 weeks. Still, Bryant said, some of the most vulnerable patients will be outside the window of care, such as teenagers with irregular periods who often identify pregnancy later, or those who need more time to pull resources together.

Gray has similar concerns about access to care. 

“There are a lot of complex social reasons that impact why people need care,” Gray said. “I think a lot of those patients don’t fall into the exceptions — patients who may be living in poverty, who are working multiple jobs, who already have kids, who have delays in care because they at baseline don’t have access to health care.”

As a result of the new restrictions, Bryant anticipates that North Carolina will face increased birth complications and elevated maternal and infant mortality rates — trends seen in other states with restrictive abortion policies.

“My colleagues and I want to abide by the laws, and we want to provide the best possible care,” Bryant said. “There are times where that really does come into conflict, and it’s gotten worse.” 

New era of care

Since the Supreme Court’s Dobbs decision in June 2022 handed the authority to regulate abortion back to states and their elected officials, North Carolina providers working in reproductive health care have faced a challenging year navigating the shifting legal landscape. Tomorrow, they will enter a new era, adjusting their practices to conform to the added constraints on their work.

In addition to cutting by eight weeks the time window allowed for most abortions, lawmakers placed more requirements on women seeking abortions and on their providers.  

One of the biggest changes is requiring an in-person appointment for state-mandated counseling at least 72 hours before an abortion. Previously, this pre-procedure counseling could occur over the phone or online. Gray said for patients and providers, this will be one of the most difficult requirements to adjust to and, she emphasized, it’s not medically necessary.

As a result, patients will be required to visit clinics at least twice — many needing to travel long distances to reach one of the state’s 14 abortion clinics spread over nine counties. The additional appointment will necessitate extra time off work, miles driven, hotel stays and child care costs.

“We expect that to be a significant barrier for many patients, and probably an insurmountable one,” Molly Rivera, Planned Parenthood South Atlantic spokesperson, told NC Health News in May. “Especially for folks in rural parts of the state who have to already drive hours to get to an abortion clinic. Especially for folks that don't have paid time off of work. Especially for people who already have kids at home.”

For providers and clinics, adding an extra appointment to an already busy workload will create another layer of complexity to scheduling. There also are new reporting requirements that physicians say will be burdensome.

“I would rather spend that time with my patient and their family,” said Caledonia Buckheit, an OB-GYN in the Triangle. “I don't want my time and effort to be towards paperwork and legal — these things that are not patient-centered.”

Several other provisions in Senate Bill 20 are being challenged by Planned Parenthood South Atlantic and Gray in a lawsuit that was filed June 16 in U.S. District Court. The health care providers argue that specific provisions are so vague or contradictory that doctors are uncertain about what’s lawful.

After the lawsuit was filed, lawmakers at the General Assembly revised several of the challenged abortion provisions this week by passing amendments to a separate bill. For example, one revision clarified that medication abortions are permitted up to 12 weeks in the state. Previously, language in Senate Bill 20 stated in one place that the age of the fetus could be “no more than 70 days,” or 10 weeks.

Gov. Cooper signed the revised provisions into law Thursday afternoon, less than 48 hours before the new restrictions take effect.

"In addition to being dangerous for women, the rushed abortion ban was so poorly written that it is causing real uncertainty for doctors and other health care providers,” Cooper wrote in a statement about signing House Bill 190. “This bill is important to clarify the rules and provide some certainty, however we will continue fighting on all fronts the Republican assault on women’s reproductive freedom."

At a federal court hearing for the lawsuit heard in Greensboro on Wednesday, the plaintiffs and defendants agreed that the new language resolves issues with several provisions. However, the passage does not resolve the entirety of the lawsuit. The remaining differences likely will be addressed through future legal proceedings.

“Our lawsuit was never going to be able to give North Carolinians the bodily autonomy that they deserve,” Rivera said after the court hearing. “This law passed. It's happening. But we did come to the court to get clarity so that we know how to comply with this sweeping law so that we can help patients navigate this reality.”

Other portions of the bill, such as the mandate that any abortion after 12 weeks be provided in a hospital and the implementation of any new, potentially stringent licensing rules on the state’s abortion clinics, will not go into effect until October. 

How sick is sick enough?

The new law about abortion does provide some exceptions for rape, incest, fetal anomalies and risk to the mother that allow abortions later in pregnancy, but physicians have concerns about how workable those are in practice.

Lisa Carroll, a high-risk pregnancy OB-GYN worries about her patients — many of whom have chronic illnesses that are exacerbated by pregnancy. Many conditions are not immediately life-threatening, but pregnancy could cause long-term health risks.

For example, Carroll recently treated a pregnant patient with kidney disease. Carrying the pregnancy caused significant dysfunction to the woman’s kidneys, for which she required dialysis. Carroll had a long conversation about her options to continue the pregnancy or terminate. The patient chose to continue the pregnancy, but Carroll said she’s unsure if the same situation presented next week would be considered life-threatening enough to meet the law’s exception.

‘Particular wording’

Carroll spends most of her time screening for and diagnosing fetal anomalies in pregnancies, and the law allows abortions up to 24 weeks in cases where a “life-limiting” anomaly is found. 

Medical professionals have voiced concern over the phrase “life-limiting” anomaly, calling it broad and open to interpretation. 

“What is life-limiting?” Carroll asked. “Does that mean that the fetus isn't expected to live a month after birth? Isn't expected to live a year after birth? Isn't expected to live to the age of 10?”

Rachel Veazey, a reproductive genetic counselor in the Triangle, agrees that “life-limiting” is ambiguous. 

“It’s ​​really particular wording that, I think, is going to throw our field for a loop,” Veazey said.

Veazey explained that very few conditions are considered definitively lethal — or always causing a newborn baby to die. Many fetal anomalies are a spectrum that often catch expecting parents by surprise. Often, she said, they result in a child with such profound disabilities that their quality of life is severely diminished. 

“With a lot of families, we end up having conversations about quality of life versus life-limiting,” Veazey said. “There's a lot of anomalies or genetic conditions that very much alter the picture of what families imagine when they enter into a pregnancy that is not compatible with their life, and they would view it as life-limiting. But we know that's not what the rough definition of what the law is going for.”

‘Counseling conundrum’

In some ways, though, Carroll said not having a definitive list of conditions is helpful because individual physicians and health care institutions can determine what they are comfortable deeming life-limiting based on the context of each individual case.

Operating in this gray area is also problematic, she said. 

“It is good to allow for physician judgment, but the problem is that physician judgment is now open to criminalization,” Carroll said. “If there are other physicians who disagree, or who say that it's not life-limiting, or it's not life-limiting in all cases, or wasn't life-limiting in that particular case — then I may be criminalized for that individual judgment. 

“That is not something that is normal or appropriate or fair in the practice of medicine, and it may lead physicians to be counseling patients based not on the patient's best interest or the fetus’ best interest.”

Veazey said the patients she counsels with identified fetal anomalies regularly choose to terminate the pregnancy. While she expects a good portion of fetal anomalies to be detected by 24 weeks, it will not encompass all conditions, nor necessarily account for those who are delayed starting prenatal care or who face delays due to the state’s new abortion restrictions. That’s why she believes her job may become more focused on grief counseling in the months ahead as she sees more patients who may be carrying pregnancies to term who would have — in a different legal landscape — opted for abortion.

“A lot of the conversations we have with families that are continuing with pregnancy are helping them understand what the health care management looks like for that child or individual with a birth defect or genetic condition,” Veazey said. “Imagining doing that with or for someone who wouldn't have on their own volition decided to continue a pregnancy is a different kind of counseling.”

Although medical professionals see potential ambiguity with other conditions, the law does make one thing clear in regard to fetal anomalies: New language bans abortions at any gestational age due to the identification of the fetal abnormality of trisomy 21, known as Down syndrome — one of the most common genetic differences in a human embryo.

“It's going to create a very strange counseling conundrum for high-risk OB doctors, for all general providers, anybody who provides prenatal care,” Carroll said.

Loss of options

Tomorrow North Carolina will join the ranks of about 20 other states across the country that have banned or increasingly restricted abortion access since Dobbs. Before this legal change, the state served as one of the last remaining abortion access points in the South.

In states with new restrictions, there were fewer abortions, while the numbers show that many women traveled to other states for procedures. In sum, though, the Society for Family Planning has collected data on abortions across the country and found that in the first nine months after the Supreme Court overturned Roe, there were a cumulative 25,640 fewer abortions in the U.S.  

“We know that bans or restrictions on abortion care don't stop abortions from happening,” Rivera from Planned Parenthood South Atlantic said. “They just make it harder for people to do it, which inevitably pushes them further into their pregnancy. 

“So even a patient who has decided long ago that not only did they realize they were pregnant but they decided they didn't want to be, they are not able to get an abortion right away. They first have to figure out whether or not they can get it in their home state. And if they learn that they cannot, they have to figure out where to get it next. And that's complicated.” 

Gray wishes that lawmakers would trust women to make their own reproductive health decisions.

“Patients are really the experts of their lives, and they know what they're able to handle and not able to handle,” Gray said. “I think they make really thoughtful decisions, and this law makes it harder for them to be thoughtful. It makes it harder for us to provide evidence-based care and just creates chaos for an already busy and taxed medical system. It doesn't improve care.”

The post NC’s new abortion restrictions take effect tomorrow. Here’s what to expect. appeared first on North Carolina Health News.

The new requirement, considered part of a larger trend of voter suppression efforts in North Carolina, has drawn criticism from civil rights groups, experts, and nonprofit voting organizations in the state, as it is believed to make it more difficult for minority voters to cast their votes.

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