NWHN Director Cindy Pearson, in response to the award, reminds us of how widespread HRT was in the recent past, and how little was really known at that time about the potential harms of the therapy:
You remember what she was talking about: until just about 10 years ago, it was routine practice to prescribe hormone therapy to women during menopause. This was justified by claims that it would keep us young and healthy, despite the lack of evidence supporting those claims and despite evidence suggesting that hormone therapy might increase the risk of breast cancer. But the Network knew that what the medical establishment believed had not been proven by science. And we wouldn’t stop saying that – even when the response was rolled eyes and smug looks.
Kudos to the NWHN for their persistence, getting the message out to women who needed it, and this much-deserved recognition.
Last week, the U.S. Food & Drug Administration (FDA) published a perspective piece on the long-term use of bisphosphonates for reducing bone fracture risk in the New England Journal of Medicine, describing findings from the agency’s September 2011 review of these drugs. The agency had reviewed data from a few studies on longer term (>3 years) use of the drugs, including whether they increased bone mineral density and decreased bone fractures.
We wrote about that review in more detail here. Essentially, the agency reported that long-term safety of these drugs was still something of a mystery, but there was concern about rare but serious complications – jaw osteonecrosis, atypical femoral fractures, and esophageal cancer. The agency has also previously stated that there was no apparent benefit of continuing the drug beyond 5 years for fracture prevention.
In the NEJM piece, agency authors reiterated both these concerns and the reality that more research and information is still needed on questions such as how long most people really should take the drugs, whether certain groups of patients are more likely to benefit from longer term use of the drugs, how long benefits of the drugs last after stopping them, and whether there are reliable measures to help make that decision in individual patients. While they don’t focus on it, there is also considerable concern and controversy about whether women who do not actually have osteoporosis (or who are classified as having “osteopenia”) should be getting these drugs in an attempt to prevent it.
The NEJM piece is likely to draw more attention to this issue than the previous FDA documents alone, and bolster advocates’ push to reconsider practices and get the information gaps filled. The National Women’s Health Network, a longtime advocate of looking closely at these issues, writes in response:
NWHN agrees with the FDA that long-term use of bisphosphonates isn’t helpful for most women, and urges women and their clinicians to seriously consider stopping these drugs after 3-5 years. Are there some women who should continue bisphosphonates beyond 3-5 years?…We will advocate for more studies to answer this important question.
Now that the FDA has acknowledged the problems of long-term use of these drugs, it should take the next step and address the important question – Which women should start taking bisphosphonates in the first place? We have urged the agency to change its recommendations to end the practice of prescribing bisphosphonates to healthy women for prevention. Too many women are handed a prescription for bisphosphonates after getting a bone density scan that shows normal age-related bone loss, even though they have no other risk factors for fracture. Those women are very unlikely to have a serious fracture in the next few years – and taking bisphosphonates isn’t likely to do them any good.
The NWHN has also recently sent a letter to FDA Commissioner Margaret Hamburg urging the agency “to remove the prevention indication for bisphosphonates and to take steps to alert women and their health care providers that these drugs are no longer recommended for prevention of osteoporosis.”
Below is the text of President Obama’s remarks at Barnard College’s commencement ceremony (as provided by the White House Office of Communications). Let us know what you think!
THE PRESIDENT: Thank you so much. (Applause.) Thank you. Please, please have a seat. Thank you. (Applause.)
Thank you, President Spar, trustees, President Bollinger. Hello, Class of 2012! (Applause.) Congratulations on reaching this day. Thank you for the honor of being able to be a part of it.
There are so many people who are proud of you — your parents, family, faculty, friends — all who share in this achievement. So please give them a big round of applause. (Applause.) To all the moms who are here today, you could not ask for a better Mother’s Day gift than to see all of these folks graduate. (Applause.)
I have to say, though, whenever I come to these things, I start thinking about Malia and Sasha graduating, and I start tearing up and — (laughter) — it’s terrible. I don’t know how you guys are holding it together. (Laughter.)
I will begin by telling a hard truth: I’m a Columbia college graduate. (Laughter and applause.) I know there can be a little bit of a sibling rivalry here. (Laughter.) But I’m honored nevertheless to be your commencement speaker today — although I’ve got to say, you set a pretty high bar given the past three years. (Applause.) Hillary Clinton — (applause) — Meryl Streep — (applause) — Sheryl Sandberg — these are not easy acts to follow. (Applause.)
But I will point out Hillary is doing an extraordinary job as one of the finest Secretaries of State America has ever had. (Applause.) We gave Meryl the Presidential Medal of Arts and Humanities. (Applause.) Sheryl is not just a good friend; she’s also one of our economic advisers. So it’s like the old saying goes — keep your friends close, and your Barnard commencement speakers even closer. (Applause.) There’s wisdom in that. (Laughter.)
Now, the year I graduated — this area looks familiar — (laughter) — the year I graduated was 1983, the first year women were admitted to Columbia. (Applause.) Sally Ride was the first American woman in space. Music was all about Michael and the Moonwalk. (Laughter.)
AUDIENCE MEMBER: Do it! (Laughter.)
THE PRESIDENT: No Moonwalking. (Laughter.) No Moonwalking today. (Laughter.)
We had the Walkman, not iPods. Some of the streets around here were not quite so inviting. (Laughter.) Times Square was not a family destination. (Laughter.) So I know this is all ancient history. Nothing worse than commencement speakers droning on about bygone days. (Laughter.) But for all the differences, the Class of 1983 actually had a lot in common with all of you. For we, too, were heading out into a world at a moment when our country was still recovering from a particularly severe economic recession. It was a time of change. It was a time of uncertainty. It was a time of passionate political debates.
You can relate to this because just as you were starting out finding your way around this campus, an economic crisis struck that would claim more than 5 million jobs before the end of your freshman year. Since then, some of you have probably seen parents put off retirement, friends struggle to find work. And you may be looking toward the future with that same sense of concern that my generation did when we were sitting where you are now.
Of course, as young women, you’re also going to grapple with some unique challenges, like whether you’ll be able to earn equal pay for equal work; whether you’ll be able to balance the demands of your job and your family; whether you’ll be able to fully control decisions about your own health.
And while opportunities for women have grown exponentially over the last 30 years, as young people, in many ways you have it even tougher than we did. This recession has been more brutal, the job losses steeper. Politics seems nastier. Congress more gridlocked than ever. Some folks in the financial world have not exactly been model corporate citizens. (Laughter.)
No wonder that faith in our institutions has never been lower, particularly when good news doesn’t get the same kind of ratings as bad news anymore. Every day you receive a steady stream of sensationalism and scandal and stories with a message that suggest change isn’t possible; that you can’t make a difference; that you won’t be able to close that gap between life as it is and life as you want it to be.
My job today is to tell you don’t believe it. Because as tough as things have been, I am convinced you are tougher. I’ve seen your passion and I’ve seen your service. I’ve seen you engage and I’ve seen you turn out in record numbers. I’ve heard your voices amplified by creativity and a digital fluency that those of us in older generations can barely comprehend. I’ve seen a generation eager, impatient even, to step into the rushing waters of history and change its course.
Breast Cancer Action is offering a free, one-hour webinar examining the racial and socio-economic factors that influence the health of individuals and communities.
Titled “Inequities in Breast Cancer: Race and Place Matter,” the webinar will take place Tuesday, May 15, at 2 p.m. PDT/5 p.m. EST (register here) and again on Wednesday, May 16, at 11 a.m. PDT/2 p.m. EST (register here).
“Inequities in breast cancer risk and outcomes vary among different racial and ethnic communities and are well documented,” writes Sahru Keiser, BCA program associate of education and mobilization. “In our efforts to address and end this disease, health activists, practitioners, and legislators must focus on the social and economic context in which the disease arises.”
Keiser is presenting the webinar with Irene Yen, associate professor of medicine and associate director of the Experiential Learning, Health & Society Pathway at University of California, San Francisco. Among the questions they’ll address:
Why are white women more likely to develop breast cancer, yet African American, Latina and Samoan women are more likely to die from the disease? Why do women of color tend to develop more aggressive breast cancers at earlier ages than white women? Why are we seeing the sharpest rise in breast cancer rates in Japanese women in Los Angeles?
Topics covered will include:
• How where we live, work and play defines our access to good health
• Breast cancer inequities in under-served communities
One of the current campaigns takes on Eli Lilly, the only company in the world making and distributing rBGH, an artificial growth hormone found in many dairy products that is linked to increased risk of breast cancer. BCA is working to remove rBGH from the food supply completely. Free Think Before You Pink toolkits featuring resources and information are available here.
My favorite Mother’s day gifts from my sons were their original stories, songs and poems. But what I needed when they were infants and toddlers was something children can’t deliver: affordable time off when they were born and when they were sick.
So for all those candidates and elected officials interested in the women’s vote and eager to prove their support for motherhood and families, here’s a sampling of what mothers want and need, not just one day a year but every day:
The right to care for a sick child or personal illness without losing our paychecks or our jobs. Moms need leaders to actively support the right for workers to earn paid sick days and champion local, state and federal policies that would guarantee this protection. Make sure no one has to choose between being a good parent and being a good employee — and that no one has to serve you flu with your soup.
The right to coverage under the Family and Medical Leave Act. Half of private sector workforce employees aren’t covered by this law because they work for an employer with fewer than 50 workers, haven’t been on the job for at least 12 months or work less than 25 hours a week. Moms need Members of Congress to work to expand FMLA to cover all employees after 90 days of employment.
The ability to afford leave under the Family and Medical Leave Act. Many who are covered under FMLA can’t afford to take the time without pay. As a result, nearly 3 million eligible workers a year who need leave to care for their health or the health of a loved one don’t take it, according to a 2000 Labor Department survey. And nearly 9 percent of those who do (including 20 percent for low-income families) are forced to rely on public assistance to keep food on the table, according to a 1995 Department of Labor report. Moms need leaders to voice their support for policies to create family leave insurance funds like those that are working in California and New Jersey so that caring for a new or seriously ill child doesn’t trigger financial catastrophe.
The right to care for one’s partner regardless of their gender. Being able to marry who you love — and being able to care for one another in sickness as well as in health — shouldn’t be a gift, it should be a right. Moms are glad to see more of our leaders standing up for the rights of all families by supporting marriage equality legislation and bills to expand FMLA access to same-sex partners.
The right to attend children’s school activities. Far too many children in this country never see their mom at a school play or sporting event because employers won’t let them take off work or rearrange their schedules. Mothers need leaders to support the right to use family leave to do what’s best for raising our children.
A recognition that men are parents, have parents and also need time to care. All the policies listed above are gender-neutral. Moms — and dads — need leaders to end on-the-job punishment of men who want to be good fathers, sons and husbands. That will also boost women’s efforts to get men to share the work at home.
This list flows from deeply held American values: that no one should have to risk a job to be a good family member or put a loved one at risk in order to keep a job. Mothers want basic standards that guarantee these rights to everyone.
And candidates, if you don’t believe me, check the polls. More and more voters — from all political perspectives — say they’re more likely to support candidates who’ll make sure family values don’t end at the workplace door, and who understand that for the economy to recover, we need policies like these to help people stay employed and have money to spend at local businesses.
Doing the politically smart thing for moms is also doing the right thing for families and for our nation.
Ellen Bravo directs Family Values @ Work, a network of state coalitions organizing to win paid sick days and paid family leave. The former director of 9to5, National Association of Working Women, Ellen also teaches Women’s Studies at the University of Wisconsin-Milwaukee. Her most recent book is “Taking on the Big Boys, or Why Feminism is Good for Families, Business and the Nation” (Feminist Press, 2007).
The CDC recently released a report on sexual experience and birth control use among female teenagers in the United States. The agency used data from the National Survey of Family Growth for 1995, 2002, and 2006-2010 to look at sexual activity and birth control use among girls ages 15-19.
The percentage of teen girls who reported that they had never had vaginal intercourse rose from 48.9% in 1995 to 56.7% in the 2006-2010 period.
Of the girls who had had sex in the month before the interview, 59.8% used a highly effective contraceptive method (IUD or hormonal contraception), 16.3% used a moderately effective method (i.e., condoms alone), 6.1% used a less effective method (withdrawal, rhythm method, cervical cap, diaphragm, etc.). 17.9% did not use any contraception.
There was a trend over time toward more use of the highly effective contraceptives, but racial disparities exist. White teens were more likely than Black or Hispanic teens to use a highly effective contraceptive, and to use a contraceptive at all.
The study is limited somewhat in that the teenagers reported on their own sexual activity and contraceptive use. And since the researchers defined “sexual activity” as only heterosexual vaginal intercourse, the study also doesn’t give us information about overall trends in teen sexual activity.
The editors of the report note that the teen birth rate has also fallen to its lowest rate in several decades, and provide several suggestions for further reducing teen pregnancy, including:
Providing evidence-based sexual and reproductive health education in schools
Connecting teens to reproductive health services
Having health care providers encourage use of highly effective contraceptives along with condoms
Also having health-care professionals provide culturally competent, evidence-based sexual and reproductive health counseling on the importance of correct and consistent use of contraception and a variety of contraceptive methods.
Random note: the Policy Report links to Healthy People 2020 goals for reducing teen pregnancy; I created the PubMed searches for those and other HP2020 family planning objectives. For any objective, click on “View Details” and then on the PubMed search link to find citations in the medical literature about the specific topic.
Many women going through perimenopause and in menopause either don’t have have flashes and night sweats that bother them or are able to ease them with self-help approaches. However, between 7 and 9 percent of women have symptoms severe enough to interfere with their quality of life.
In the past, the primary treatment for hot flashes and night sweats (called vasomotor symptoms) was estrogen-plus-progestin or estrogen-alone hormone therapy—both effective therapies. But as the Women’s Health Initiative (WHI) trials demonstrated, these hormone regimens unfortunately increase the risk of heart disease, stroke, blood clots and breast cancer.
Because of these risks, new treatment options for vasomotor symptoms are needed. A new study published in the journal Menopause by the Centre for Menstrual Cycle and Ovulation Research looks at the safety and effectiveness of progesterone-only therapy for alleviating hot flashes and night sweats. (Progesterone is a hormone produced in the body, while progestin, which was used in the WHI, is a synthetic form of progesterone).
In this trial, the researchers randomized 133 healthy, postmenopausal women with vasomotor symptoms to Prometrium, a brand of oral micronized progesterone, or placebo, and had them report on the frequency and severity of their night sweats and hot flashes over three months.
The researchers (one of whom, Jerilynn Prior, co-wrote the menopause chapter in the 2011 edition of Our Bodies, Ourselves) found that symptoms improved in both the progesterone and placebo groups over the course of the study. Scores, however, improved significantly more in the progesterone group, suggesting that the hormone provided greater relief of symptoms than placebo. There were few adverse effects reported in this brief trial, none of which were considered serious.
It is not clear what the breast cancer implications of progesterone-alone therapy might be – the Women’s Health Initiative trials found an increased risk of breast cancer with estrogen-plus-progestin therapy but not with estrogen-alone. In their article, the authors briefly address this issue, noting varying findings in other studies and remarking that:
Although there is reason to believe that progesterone has a more favorable safety profile than medroxyprogesterone [used in the WHI study], large safety trials of progesterone as postmenopausal monotherapy are lacking.
OBOS contacted researcher Jerilynn Prior to ask her if she had any additional comments about the potential increased risk of breast cancer. Prior answered that a large observational study in France called E3N found that estrogen with progesterone was not associated with increased breast cancer risk, while estrogen alone and estrogen with progestin were. “This suggests that progesterone alone would be safe in terms of breast cancer risk,” Prior noted.
In the published study, the researchers address certain limitations of their work, including the racial/ethnic makeup of their study population (primarily white), and participants being overall leaner and healthier than the general population. Additionally, while the placebo was identical to the active drug and neither the researchers or women could guess by the look or feel of the pill which they were taking, over time 54% of those receiving progesterone and 60% of those getting placebo were able to correctly guess their group assignment. In correspondence with OBOS, Prior said that this was likely due to the fact that many of those taking progesterone experienced improvement in their sleep.
The researchers also note that their population were postmenopausal, having not menstruated for 1-10 years, so their findings are not applicable to women transitioning into menopause.
The bottom line is that progesterone-alone may be a useful treatment for relieving hot flash and night sweat symptoms of menopause, although more investigation is needed. Many of the benefit and harms of hormone therapy may turn out to depend on the type of hormone, who’s using it, in what form, when and for how long. I hope to see more studies on this in coming years.
While there has been considerable attention in the United States to political moves intended to reduce access to women’s health services, our neighbors to the north are also experiencing conservative-led cuts that affect women’s health. Six Canadian organizations focused on research and communication in women’s health have been told that their funding will be cut off next spring.
The six organizations forming the Women’s Health Contribution Programfocus on issues including: the women’s health implications of the federal government’s regulation of toxic chemicals; the hyper-sexualization of girls; the inter-generational legacy of residential schools on Aboriginal women and their families; the need for trauma-informed counselling for women with addictions; a working guide for conducting sex and gender-based analysis in health research; and a critical analysis of funding for the HPV vaccine. The Program’s work has also focused broadly on how to best deliver prevention and health care programs to women and their children.
Staff and directors managing the centres and networks add their voices to the growing body of Canadians who are shocked and outraged by the short-sightedness of the federal government cuts to programs, services and the federal civil service. These cuts are in direct contradiction to the pledges regarding gender equality that Canada has made both in international commitments and to Canadians. Women are being hit particularly hard with these cuts, and, because the research being eliminated generated proactive, preventative strategies for health promotion, these cuts will cost everyone in the long term. The end of this work will be most strongly felt by the disadvantaged and the disempowered.
A spokesperson for Canada’s Health Minister has said that the organizations should compete for funding for individual projects via the $33 million budgeted for “gender health research” through the Canadian Institutes for Health Research (CIHR). Critics of the cut have suggested that the move is one more sign that the current administration, led by Conservative Party leader and Canadian Prime Minister Stephen Harper, is not interested in receiving the groups’ policy advice on women’s health (the non-CIHR groups being cut had a mandate to advise the federal government on policy).
Set adrift will be researchers and staff with specific expertise; lost will be the opportunity for better and more-effective care and prevention programs for two of the poorest and most vulnerable groups in Canada – elderly women and children growing up in poverty.
Federal budget cuts are also directly affecting programs targeting the health of Aboriginal women in Canada. The Native Women’s Association of Canada points out tremendous health disparities faced by Aboriginal women, calls on the government to rethink its decision, and directly addresses how the move further hurts a vulnerable population:
…more is needed to help local communities struggling with health disparities, but cutting the head off the national voice for Aboriginal women’s health shows a lack of commitment to address the issues that affect the most marginalized population in this country — a country that is envied by many other nations across the globe for its ‘great’ health care system and quality of life
Researchers from a number of universities and the National Institute of Environmental Health Sciences recently published an article in the journal Endocrine Reviews that explores how much exposure to certain chemicals is needed to cause harm, and suggests that “fundamental changes in chemical testing and safety determination are needed to protect human health.”
The researchers, led by Laura Vandenberg, looked at endocrine-disrupting chemicals (EDCs) – chemicals like BPA and DES that interfere with the body’s hormone systems. In their review, they explore complex issues around dose – the effects of low doses, how “low dose” is defined, and what happens when effects of a chemical aren’t directly correlated to the dose.
As the authors explain:
For decades, studies of endocrine-disrupting chemicals (EDCs) have challenged traditional concepts in toxicology, in particular the dogma of “the dose makes the poison,” because EDCs can have effects at low doses that are not predicted by effects at higher doses.
As a result, what we know about exposure to a chemical from following people after a one-time large exposure might not predict what happens when people are exposed to very small amounts of a chemical over a longer time.
The implications are that some of our assumptions about harms from low doses, the reliability of current testing methods, and safe thresholds might be incorrect, because harmful effects of chemicals might vary in unexpected ways at different doses, in different people, or at different stages of development. The authors point out several things researchers should do to improve our understanding of these issues, like carefully considering dose ranges and timing to study.
For the general public, the regulatory implications of the review may be most important. As the authors explain:
For decades, regulatory agencies have tested, or approved testing, of chemicals by examining high doses and then extrapolating down [from where observable effects are thought to start] to determine safe levels for humans and/or wildlife. As discussed earlier, these extrapolations use safety factors that acknowledge differences between humans and animals, exposures of vulnerable populations, interspecies variability, and other uncertainty factors. These safety factors are informed guesses, not quantitatively based calculations. Using this traditional way of setting safe doses, the levels declared safe are never in fact tested. Doses in the range of human exposures are therefore also unlikely to be tested.This has generated the current state of science,where many chemicals of concern have never been examined at environmentally relevant low doses.
In other words, for many chemicals, regulations are based on best guesses about safety, rather than specific safety data. Additionally, the authors suggest that guessing about low doses based on higher doses really doesn’t work for endocrine-disrupting chemicals, and new approaches to assessing their safety should be developed. The authors also call for greater testing at low doses when new chemicals are developed and approved:
We further recommend greatly expanded and generalized safety testing and surveillance to detect potential adverse effects of this broad class of chemicals. Before new chemicals are developed, a wider range of doses, extending into the low-dose range, should be fully tested.
A related editorial from the director of the National Institute of Environmental Health Sciences also calls for “appropriate actions to protect human and wildlife populations from these harmful chemicals and facilitate better regulatory decision making.”
In an opinion piece, lead author Vandenberg writes more about their research and implications of EDCs for women:
We found overwhelming evidence that these hormone-altering chemicals have effects at low levels, and that these effects are often completely different than effects at high levels. For example, a large amount of dioxin would kill you, but a very small dose, similar to what people are exposed to from eating contaminated foods, increases women’s risk of reproductive abnormalities.
[Note: this post and the linked materials contain graphic discussion of sexual abuse, rape, and prison genital searches.]
A Michigan women’s prison that was practicing a particularly degrading type of visual body cavity search on prisoners has agreed to stop the searches.
Earlier this month, the ACLU sent a letter to the Michigan Department of Corrections demanding that they end the practice of performing spread-labia vaginal searches at the Women’s Huron Valley Correctional Facility. During such searches, women were required to sit on a chair or table and spread their own labia for inspection by prison guards. The women were sometimes forced to undergo such inspection in view of other prisoners, and if they objected, could “be forced to submit through physical force or punished with solitary confinement.”
Our Bodies Ourselves signed on to the ACLU’s letter objecting to these practices, along with several other organizations.
Despite the invasiveness of the inspections, no apparent attention was given to hygiene or to the women’s health. From the letter:
In addition, measures to assure sanitation during these invasive searches are often incomplete or ignored entirely, resulting in women being exposed to the menstrual blood or other bodily fluids of other prisoners when they sit on the chair, including those suffering from serious communicable conditions such as HIV and hepatitis. A disposable liner for use on the chair is rarely if ever provided, and women are seldom permitted to sanitize the chair or wash their hands after the search. At least one woman has suffered a vaginal infection which she believes was contracted during a spread-labia vaginal search.
These searches were not just performed on women newly entering the facility or on those suspected of hiding contraband – they occurred every time the women had visitors, even legal representation or religious workers, and after prison work shifts or receipt of medical care. No considerations were apparently made regarding the actual seriousness of the threat if there was suspected contraband, or for individual women’s physical or psychological needs. For example:
On one occasion, four kitchen workers were subjected to spread-labia vaginal searches in full view of one another because a guard believed that some chicken might have been stolen from the kitchen. No exceptions are made for women who are menstruating, pregnant, ill, or have been sexually abused, whether prior to or during their incarceration.
The ACLU received letters from more than 60 prisoners about these searches; some of their stories have been shared online. Here and elsewhere, women have described not wanting to receive any visitors (because of the search afterward); the discomfort of being forced to touch their own genitals in front of others or of having their PTSD triggered; and feeling that they are being raped when subjected to these exams.
The Michigan Department of Corrections said it had ended the practice in December, while the ACLU said it continued to get complaints about it more recently. Last week, the ACLU confirmed that the practice has now been stopped.
Such spread-labia searches are apparently *not* the norm in prisons nationwide. Even a spokesperson for the state prison stated (emphasis added):
“Corrections officers didn’t think it was necessary, prisoners felt it was an irritant, the prison psychiatric staff thought it was a stressor and, in nearly two years, it didn’t find any contraband.”
An editorial at the Detroit Free Press called the practice “demeaning and unnecessary,” and notes that follow-up is needed to ensure compliance with the halt:
Warden Warren deserves credit for taking the initiative to investigate the policy and end it, at least officially. But given the department’s history of sexual abuse, Corrections must now take additional measures to ensure the new policy is followed, as well as review its polices on strip searches in general to determine if they are necessary and conducted in the least degrading manner possible.
Kudos to the women who wrote letters to the ACLU and to the ACLU for bringing this invasive, unnecessary, and traumatizing practice to light.
BarbaraSeaman, co-founder of the National Women’s Health Network, noted feminist, women’s health activist, and author, died in 2008, but her work advocating for women’s health remains as an influence and inspiration.
Seaman’s influential works include her 1969 book, “The Doctors’ Case against the Pill,” which led to Congressional hearings on oral contraception and ultimately to the labeling of birth control pills, and her 2003 book, “The Greatest Experiment Ever Performed on Women: Exploding the Estrogen Myth,” an important work on estrogen use and misuse.
A new book, “Voices of the Women’s Health Movement,” edited by Seaman with Laura Eldrigde, has just been published. The book, the second in a two-part series, includes classic essays and contemporary works on topics including birth control, pregnancy and birth, aging and menopause, abortion, LGBT health, sex, mental health, chronic illness, violence against women, and body image. The role of the Boston Women’s Health Book Collective and Our Bodies, Ourselves in the women’s health movement is also addressed.
The book features more than 200 contributors, including Jennifer Baumgardner, Susan Brownmiller, Phyllis Chesler, Angela Davis, Barbara Ehrenreich, Germaine Greer, Shulamith Firestone, Charlotte Perkins Gilman, Erica Jong, Molly Haskell, Shere Hite, Susie Orbach, Judith Rossner, Alix Kates Shulman, Gloria Steinem, Sojourner Truth, Rebecca Walker, and many others, including Seaman herself.
Library Journal called it “a valuable work for anyone interested in the women’s health movement.” OBOS co-founder Judy Norsigian adds, “Barbara was one of the founding mother’s of the current women’s health movement and her prolific writings remain as testimonials to her indefatigable spirit and ability to inspire others to much-needed action.”
We are offering signed copies of both “Voices of a Women’s Health Movement” and the new edition of “Our Bodies, Ourselves” for donations of $150 or more. To receive your copies, donate online and then email your name and mailing address to office@bwhbc.org.
Native American women are subjected to much higher levels of sexual violence than other women in the United States; the Department of Justice estimates that more than 1 in 3 Native American women will be raped in their lifetime, and they are often denied access to justice.
According to a new report, Native American women are also denied access to emergency contraception through the Indian Health Service (IHS). The report, from the Native American Women’s Health Education Resource Center, includes the personal experiences with sexual assault and the perspectives of women of a diverse number of Tribes. It describes the barriers Native American women face when attempting to access emergency contraception and outlines steps that should be taken in order to provide them with on-demand access to emergency contraception.
According to the organization’s 2009 research:
1) Only 10% of IHS unit pharmacies surveyed have Plan B available over the counter (OTC); 2) 37.5% of pharmacies surveyed offer an alternative form of emergency contraception; and 3) The remaining have no form of EC available at all.
At Change.org, a petition has been created to ask IHS Director Dr. Yvette Roubideaux to issue a directive to all IHS service providers to make emergency contraception available on demand without a prescription or doctor visit to all women 17 or older.
In the report’s introduction, Charon Asetoyer the Center’s director writes:
As the country debates the access to Plan B as an OTC for women 16 years and younger, Native American women 17 years and older have yet to receive access to Plan B as an OTC by their primary health care provider, the Indian Health Service. No one but Native American women are concerned about this denial of service. As Native American women we are the only race of women that is denied this service based on race. To make an exception to a legal form of contraception based on race is not acceptable. To deny a Native American woman access to Plan B as an OTC when every other woman in this country can access it is a denial to a basic health care service, which violates her human rights. It is a direct violation to her sovereign right to make decisions for her own health care, it removes her from the decision making process concerning a potential pregnancy resulting from a rape and puts that responsibility of decision in the hands of a government agency.
Sign the petition to support Native American women’s right to access emergency contraception.
See also: Why Native American Women Are Battling for Plan B – at Colorlines, an interview with Charon Asetoyer. In it, Asetoyer notes that another possible solution is for the Department of Health and Human Services to mandate that all Indian Health Service providers to make Plan B or its generic form available OTC. Contacting HHS on this issue may be another avenue for action.
DES Action, an organization that provides information, education, and support related to DES exposure, is conducting a health history survey to learn more about the health issues faced by women who took DES and the daughters and granddaughters and sons and grandsons of those women.
DES (diethylstilbestrol) is a drug that used to be prescribed to women to prevent miscarriages and preterm births, and is now known to increase the risk of certain cancers and other adverse effects in the sons and daughters of women who took the drug. Researchers are now starting to look for possible effects in the women’s granddaughters and grandsons.
June 15th is the deadline for all surveys to be completed and returned. The survey is not a formal scientific study, so there is not the usual informed consent process with privacy information. DES Action hopes the collecting these surveys will help them to identify some trends and concerns to share with researchers who may be able to follow-up with further study.
Related information on DES: DES: 40 Years of Research with More to Learn – recent article in the newsletter of the National Women’s Health Network The DES Follow-up Study – DES timeline, health risks, and information in the National Cancer Institute’s “Linkage” newsletter.
In the interview, Monroe talks about health benefits of breastfeeding, notes the lower breastfeeding rates among black women, and encourages black women to breastfeed for a year or longer. She says:
…we only hear people telling black women to get a mammogram—I’ve never heard anyone tell black women that if you breastfeed for one year it can reduce your breast cancer risk. So that’s important…
By breastfeeding, it delays your onset of Type 2 diabetes. This can be major, when you have a high diabetic rate within the black community in Portland, and more black women dying from late-stage breast cancer.
Monroe goes on to note that breastfeeding needs to be made “more acceptable in the normal life of African American families, so they feel there’s no shame that comes from doing it. And that the black community should embrace women who breastfeed and make them feel comfortable in all areas.”
The question of why more black women don’t breastfeed is an important one. The CDC identifies a number of potential factors, including “social and cultural norms, social support, guidance and support from health-care providers, work environment, and the media.” Christine talked about the need for support at work and among friends and family members in a previous post as well. Kimberly Seals Allers at BlackandMarriedWithKids asks, Is Slavery Behind Our Low Breastfeeding Rates?, exploring the ways women in slavery in the U.S. were forced to stop own breastfeeding infants and forced to breastfeed white infants.
A couple of online resources are intended to support black women in breastfeeding. One is Black Breastfeeding 360, which has tips, information, and women’s stories about breastfeeding. Another is the Black Women Do Breastfeed blog and Facebook page, which also feature black women’s stories of breastfeeding, including how they overcame challenges they faced after choosing to breastfeed their children. Finally, the federal Office on Women’s Health has a PDF guide, Your Guide to Breastfeeding for African American Women, which teaches about the importance of breastfeeding, how to do it, and how to handle some common challenges.
…with all the news reports about Beyonce, and all the breastfeeding “advocates” talking about its impact on the nursing world, not one advocate mentioned the particular significance to black women — which is so striking since many claim to be interested in our breastfeeding plight.
Shame on you…some of you white breastfeeding advocates, one of you, should have pointed that out. If not for us then please for our babies. Black babies are still 2.4 times more likely to die before their first birthday and the CDC says increased breastfeeding among black women could reduce this needless disparity by as much as 50%.
Having Beyonce as our black breastfeeding moment potentially means that more African American women will know that breastfeeding is mainstream and beautiful and actively practiced by the celebrities we admire. The celebrities from our community. It means that more black women, particularly young women, may consider breastfeeding their babies–something our community urgently needs.
President Obama on Monday said he was “confident” the Supreme Court will uphold the Affordable Care Act, adding that overturning it would be an “unprecedented, extraordinary step.”
I think it’s important — because I watched some of the commentary last week — to remind people that this is not an abstract argument. People’s lives are affected by the lack of availability of healthcare, the inaffordability of healthcare, their inability to get healthcare because of preexisting conditions.
The law that’s already in place has already given 2.5 million young people healthcare that wouldn’t otherwise have it. There are tens of thousands of adults with preexisting conditions who have healthcare right now because of this law. Parents don’t have to worry about their children not being able to get healthcare because they can’t be prevented from getting healthcare as a consequence of a preexisting condition. That is part of this law.
And, as of 2014, adults would also be protected. Women could no longer be denied coverage based on pre-existing conditions such as pregnancy or domestic violence. The law would also eliminate gender rating, in which women end up paying more than men for insurance coverage.
Millions of seniors are paying less for prescription drugs because of this law. Americans all across the country have greater rights and protections with respect to the insurance companies, and are getting preventive care because of this law.
So, that’s just the part that’s already been implemented. That doesn’t speak to the 30 million people who stand to gain coverage once it’s fully implemented in 2014.
And I think it’s important, I think the American people understand and I think the justices should understand that in the absence of an individual mandate, you cannot have a mechanism to ensure that people with preexisting conditions can actually get healthcare.
We have to wait until sometime in June to find out if Obama is right, but there’s been no shortage of guess work underway to determine 1.) whether the Supreme Court will uphold the individual mandate requiring almost every American to buy health insurance; and 2.) what will become if health care reform if it does not.
Writing in The New Yorker, Jeffrey Toobin notes that the “heavy burden” of justification for the mandate — which Justice Anthony M. Kennedy asked Donald Verrilli, the solicitor general, to address — should instead be placed on the law’s challengers.
“The involvement of the federal government in the health-care market is not unprecedented; it dates back nearly fifty years, to the passage of Medicare and Medicaid,” writes Toobin. “The forty million uninsured Americans whose chances for coverage are riding on the outcome of the case are already entered ‘into commerce,’ because others are likely to pay their health-care costs.”
“Acts of Congress, like the health-care law, are presumed to be constitutional,” he later adds, “and it is—or should be—a grave and unusual step for unelected, unaccountable, life-tenured judges to overrule the work of the democratically elected branches of government.” Toobin then demonstrates how the justices’ questions reflected a troublesome meddling in policies set by Congress.
The Individual Mandate – A Not-So-Brief History
The individual mandate, as explained in this NPR story, has Republican roots dating back to 1989. Rachel Maddow discussed the party-line history during a recent segment, summed up as: “When Republicans proposed it — great idea, a conservative solution. When a Democrat has the idea, it’s socialism, tyranny and unconstitutional.”
Though Republicans circa 2012 would like Americans to believe the individual mandate is indeed “unprecedented,” Linda Greenhouse, who covered the Supreme Court for The New York Times for 30 years and who now writes a column on legal issues, applies the description to the politics of this debate:
What’s unprecedented is the singular determination of the Republicans both on Capitol Hill and in the statehouses to deprive President Obama of his major domestic achievement. Republican officeholders in all 26 states joined together in the case now known as United States Department of Health and Human Services v. State of Florida. In 22 of those states, the officeholder was the attorney general. In four states with Democratic attorneys general (Nevada, Wyoming, Iowa and Mississippi), Republican governors filed in their own names. If any of them noted any irony in the fact that not so long ago, the individual mandate was an idea cooked up by conservative policy wonks to counter more fundamental reform sought by the Clinton administration, they offer no sign.
The countless unprecedented things that Congress has done over the centuries were not, for that reason, unconstitutional. Social Security, Medicare, the Employee Retirement Income Security Act (Erisa), and the Emergency Medical Treatment and Labor Act, the 1986 law passed to prevent hospitals from refusing to care for uninsured patients in acute distress, all come to mind. (From the perspective of today’s toxic politics, it’s a miracle that any of these laws actually got passed, but that’s a separate issue.) So there must be some problem with the Affordable Care Act other than “never before.”
There are other federal mandates involving health care already on the books, including the Medicare payroll tax on workers and employers, and the 1996 Newborns’ and Mothers’ Health Protection Act, which requires plans offering maternity coverage to pay for at least a 48-hour hospital stay (96 hours following a c-section).
Isn’t It Ironic (Don’t You Think)
Some Republicans who can’t help but fly into an apoplectic rage upon hearing the term “mandate” in the context of health care reform remain surprisingly calm when mandating medical procedures for women.
Yes, I’m referring to government-mandated ultrasounds. Currently, seven states — most recently Virginia — mandate that an abortion provider perform an ultrasound on a woman seeking to have an abortion. These states, along with more than a dozen others, also require the provider to ask the woman if she’d like to view the image.
The Guttmacher Institute notes: “Since routine ultrasound is not considered medically necessary as a component of first-trimester abortion, the requirements appear to be a veiled attempt to personify the fetus and dissuade a woman from obtaining an abortion. Moreover, an ultrasound can add significantly to the cost of the procedure.”
The Road Ahead
The question of whether other parts of the Affordable Care Act can proceed without the individual mandate will continue to be debated until June. If the mandate alone is struck, insurance premiums would likely increase because insurance companies won’t have the built-in benefit of a broader insurance pool.
“Republicans would blame Obama for making health insurance more expensive. Democrats would blame insurers for the higher premiums. In other words: Déjà vu and total gridlock,” writes Jennifer Haberkorn of Politico. Her story explains what’s likely to happen if the Supreme Court strikes just the mandate, or the mandate and insurance reforms, along with the political fall-out if most of the law falls or is upheld.
Josh Gerstein, also of Politico, looks at the effects beyond health care reform: “If the justices knock out key parts of the law or bring down the whole thing, the reverberations could be felt across the legal landscape for generations to come, radically reining in the scope of federal power, according to supporters of the law and others who closely track the high court. And if the justices decide the individual mandate is a constitutional overreach, these observers say, federal labor and environmental laws could be the next on the firing line.”
If you think that seems too dire a prediction, consider Dahlia Lithwick’s reaction to comments made by the court’s conservative justice’s last week: “[A]s the justices pondered whether the individual mandate—that part of the Affordable Care Act that requires most Americans to purchase health insurance or pay a penalty—is constitutional, we got a window into the freedom some of the justices long for. And it is a dark, dark place.”
Those who would welcome the disintegration of health care reform include The Cato Institute’s Michael Cannon. He told NPR that if the entire law were to go away, “we would have just dodged this whole nasty debate over religious freedom and abortion.”
Meaning: There would be no increased access to preventive health care such as contraception, breastfeeding support, and screening for breast and cervical cancers and HIV. But hey, women’s health is so darn offensive when you get down to it, better to just cast it off. Thanks, but we’ve been there.
On the other hand, maybe a defeat at the hands of the Supreme Court will open new doors, for everyone.
Subscribe to this blog's feed
