Interested in learning more about Our Bodies Ourselves and the beginning of a worldwide movement for women’s health? Judy Norsigian, OBOS co-founder and executive director, is going to be on WBAI radio (99.5 FM in New York) this Thursday (Nov. 5) from 10 to 11a.m. EST. You can stream the interview at www.wbai.org.

Norsigian’s appearance is part of a special two-hour edition of the Joy of Resistance, WBAI’s multicultural feminist radio show. Expect her to weigh in on health care reform, the state of maternity care and many other urgent issues.

Joy of Resistance will offer copies of “Our Bodies, Ourselves” signed by Norsigian as a fundraiser premium, along with two award-winning documentary DVD’s: “Absolutely Safe” by Carol Leyva, which examines the safety of breast implants, and “Killing Us Softly: Advertising’s Image of Women-3” by Jean Kilbourne, a look at the pressures on today’s women to conform to commercial standards of beauty.

WBAI is part of the Pacifica Radio Network, which includes five radio stations (the other four are in Berkeley, Los Angeles, Houston, and Washington, D.C.) and more than 50 affiliate stations.

ABC News has an interesting article up on the withdrawal symptoms some women are reporting after stopping Depo-Provera (medroxyprogesterone acetate), an quarterly injectable progesterone-only contraceptive method.

An internet search on Depo withdrawal turns up multiple online postings, suggesting that some women are concerned about or report experiencing a number of symptoms, including nausea, breast tenderness and fatigue.

As the piece indicates, there is not currently a lot of understanding of these withdrawal symptoms; a quick search of the medical literature doesn’t turn up much on the topic. One woman in the article reported that her physicians “shrugged their shoulders” in response to her complaints, and there is uncertainty as to whether cessation of the drug itself causes the symptoms in some women, or if perhaps the drug had been masking some symptoms that return once the injections are stopped.

A physician interviewed for the article used one of my least favorite analogies – comparing women’s bodies to a car to be worked on. Dr. Louis Weinstein, head of obstetrics and gynecology at Philadelphia’s Thomas Jefferson University Hospital, said: “It’s like you don’t know why your car won’t start. Most of [the symptoms] have nothing to do with Depo-Provera. There may be a lot of other things going and to blame that on Depo-Provera is just not fair. We don’t know.”

While existing labeling for the drug does not address potential withdrawal symptoms, it does include (in addition to other side effects) a boxed warning on potential adverse effects on bone mineral density:

Women who use Depo-Provera Contraceptive Injection may lose significant bone mineral density. Bone loss is greater with increasing duration of use and may not be completely reversible. It is unknown if use of Depo-Provera Contraceptive Injection during adolescence or early adulthood, a critical period of bone accretion, will reduce peak bone mass and increase the risk for osteoporotic fracture in later life. Depo-Provera Contraceptive Injection should be used as a long-term birth control method (e.g. longer than 2 years) only if other birth control methods are inadequate.

Have you taken Depo and then stopped? If you have, please let us know your experience in the comments.

Serra Sippel, CHANGE; Aziza Ahmed, Harvard School of Public Health; Grace Sedio, Bomme Isago Association (Botswana); Sergia Galván, Colectiva Mujer y Salud (Dominican Republic); Massachusetts Representative Kay Khan; Dr. Fisseha Mekonnen, Family Guidance Association of Ethiopia

by Kimberly Whipkey, Center for Health and Gender Equity

“At Colectiva Mujer y Salud, we view each woman as a complete person. If a woman comes seeking an HIV test, we will make sure she also receives information about contraception, screening for gender-based violence, education about her sexual health and a better understanding of her rights.”
– Sergia Galván, Executive Director, Colectiva Mujer y Salud, Dominican Republic

Reproductive health care that is comprehensive, accessible and woman-centered is far from a common reality — anywhere in the world. Global women’s health advocates are campaigning for a more holistic approach that better serves women and their families.

In mid-October, the Center for Health and Gender Equity (CHANGE) invited reproductive health experts from the Dominican Republic, Ethiopia and Botswana to participate in CHANGE’s Reproductive Justice Ambassadors Tour. The tour made stops in Boston, Philadelphia and Washington, D.C., to meet with NGO leaders, activists and key decision-makers.

At each venue, experts discussed why investing in comprehensive sexual and reproductive health and rights is critical at this moment, and they offered suggestions on how the United States can strengthen human rights-based care overseas that breaks down the divisions among HIV/AIDS, reproductive health, and maternal and child health.

The three health experts — Dr. Fisseha Mekonnen Alemu, Grace Sedio and Sergia Galván — offered hope that it is possible to provide comprehensive and rights-based care, even in the face of poverty, a weak health infrastructure and social, political and legal environments hostile to reproductive rights. The obstacles, however, are formidable.

Dr. Mekonnen, executive director of the Family Guidance Association of Ethiopia, discussed his country’s dire maternal health statistics. Only 6 percent of pregnant women have a skilled attendant at delivery, and an estimated 100,000 Ethiopian women suffer obstetric fistula — an entirely preventable condition. Rural women have little or no access to modern health care. And 30 percent of women who die as a result of pregnancy or childbirth do so as a result of unsafe abortion.

Women living with HIV in many countries face layers of stigma and discrimination. Grace Sedio, project officer at Bomme Isago Association in Botswana and member of the International Community of Women Living with HIV/AIDS, spoke about HIV-positive women — especially those who are pregnant— being blamed by public officials in Botswana for spreading the virus. They are often treated as vectors of disease rather than as women with reproductive health needs and rights.

While Sergia Galván, executive director of Colectiva Mujer y Salud in the Dominican Republic, provides comprehensive care through her feminist health center, serious challenges to attaining critical reproductive health services remain. Legislators recently ratified an article within Constitutional reform that prevents liberalization of abortion laws, which currently prohibit abortion under any circumstance. The Constitutional changes were largely influenced by ideological opposition to abortion from conservative factions, including the Catholic Church.

“One Cardinal said he would rather see two deaths [the woman and the embryo or fetus] than one abortion,” Galván said at a Congressional briefing in Washington, D.C.

For eight years under President Bush, the global gag rule stifled NGO advocacy around safe and legal abortion, creating a vacuum in the Dominican Republic that helped enable the Constitutional reform. So, whether a woman is raped, a victim of incest, or suffering life-threatening complications of an ectopic pregnancy, she cannot legally access abortion care, and the situation is unlikely to change anytime soon.

The Ambassadors often highlighted how decisions made in the United States have had major impacts in their countries. They also offered suggestions for how people in the United States can promote reproductive justice globally. For example, Congress is in the early stages of re-writing the Foreign Assistance Act of 1961, which governs how foreign assistance is spent.

One immediate action step is to contact your members of Congress and urge them to support the inclusion of comprehensive reproductive health. For more information, we encourage you to read CHANGE’s new report: “Investing in Reproductive Justice for All: Toward a U.S. Foreign Policy on Comprehensive Sexual and Reproductive Health and Rights.”

At an NGO breakfast meeting in Philadelphia with the Ambassadors, a participant said, “At our health center in Philadelphia we view every woman as an opportunity.”

So, too, should U.S.-funded domestic and international programs see each woman as an opportunity to provide comprehensive and rights-based health services — and an opportunity to improve the health of women worldwide.

Kimberly Whipkey is a senior associate for advocacy and outreach at the Center for Health and Gender Equity in Washington, D.C.

New York Times columnist Gail Collins appeared on The Colbert Report earlier this week to discuss her new book, “When Everything Changed: The Amazing Journey of American Women from 1960 to the Present.”

in 1960, women were prohibited from serving on juries and it was perfectly legal to not hire women because of their sex. The book opens with the story of a woman who was kicked out of traffic court for daring to wear pants (and she was there to pay her boss’s ticket).

One of today’s biggest problems, said Collins, is that “half the workforce is female now, and we still haven’t figured out who’s supposed to take care of the kids.”

Colbert appeared shocked. “The women take care of the kids,” he said.

The reason, he added, is simply biological.

“I cannot produce milk. I’ve tried. It’s painful and it doesn’t work.”

Enjoy.

A new, freely available, open-access journal that launched this month reflects a position Our Bodies Ourselves has long held: Healthcare is better, and people are healthier and more empowered, when individuals are informed and can actively participate in their own care.

The Journal of Participatory Medicine, launched at last week’s Connected Health Symposium in Boston, will publish online peer-reviewed articles that “explore the extent to which shared decision-making in health care, and deep patient engagement, affect outcomes.” The inaugural issue includes articles from all stakeholders, including patients, healthcare providers, payers, and others.

The journal’s significance is underscored by the fact that current or former editors of three of the most prominent medical journals – JAMA, BMJ, and the Annals of Family Medicine – also contributed to the first issue. As Amy Romano at Science & Sensibility points out, even the journal’s peer review process is participatory and values the input of all stakeholders, especially patients themselves.

The journal is being published by the relatively new Society for Participatory Medicine. The organization also has a blog, e-patients.net, which focuses on and includes stories from patients becoming informed, connecting with other patients, finding support, and exploring potential treatments for their healthcare concerns.

The existence of this organization and its publications reflect a growing trend toward patient involvement in health care that has been inspired and enabled by the internet. The Pew Internet and American Life Project released a report earlier this year indicating that 61 percent of American adults look online for health information, and that “six in ten e-patients … say their most recent search had an impact, mostly minor, on their own health or the way they care for someone else.”

More than half said information they found online lead them to ask their physician new questions or to get a second opinion on their care.

The internet is also enabling access to personal health records and new ways of collecting and sharing health data. The Society and the Journal will promote efforts to encourage these developments while protecting patient confidentiality.

As one physician wrote of the e-patient phenomenon in 2008:

Patients want information, ideally tailored to their needs. They want to discuss this with their physicians without being shooed away, and would appreciate getting pointers. They even want access to their test results and medical records. Although many physicians feel threatened by all this, engaging the patient as a partner in her own care can be quite gratifying, improves patient satisfaction, and may even lead to better outcomes.

As an organization that has long held that women can become their own health experts and that women, as informed health consumers, are catalysts for social change, we agree.

Those of you who are engaged in conversations with opponents to a public health insurance option might want to try pulling them away from Fox News for a moment and ask them to read Ellen Shaffer’s new piece, “U.S Health Care: Myths and Facts.”

Schaffer is co-director of the Center for Policy Analysis, which runs the EQUAL Health listserv (Equitable, Quality, Universal, Affordable Health). List members contributed to this comprehensive document, which answers such questions as:

• Who’s More Efficient, Government or the Private Insurance Market?
• Are We Spending Too Much on Health Care?
• Do We Pay Too Much for Drugs?
• Could Importing Drugs Reduce Prices?
• Can Prevention Programs Reduce Health Care Costs?
• Is Health Information Technology a Silver Bullet for Reducing Costs?
• Are there really 46 Million Americans Who Can’t Get Health Care?
• Can Universal Coverage Be Achieved by Mandating Everyone to Buy Insurance?
• Do We Need More Government Programs to Cover Low-Income People?

Action Items:
- If you or your friends live in states where Democrats (or pretend-Democrats) are hesitating over the public option, call or write your elected officials and urge support.

- Starting Oct. 28 and running at least through Nov. 4, Healthcare-NOW is organizing Patients Not Profit Sit-Ins. Learn more at MobilizeForHealthcare.org.

- Raising Women’s Voices has coverage of a teach-in on health reform held at Columbia University on Oct. 22. Sponsored by the Student Committee of the Public Health Association of NYC and the Black and Latino Caucus of the Mailman School of Public Health, the event drew nearly 60 students, faculty and members of the community.

If you want to sponsor a teach-in on a college campus, contact RWV: info [at] raisingwomensvoices [dot] org for sample materials and programs. And check RWV’s calendar for upcoming events and speak-outs.

- Organizing for America received around a thousand videos made by healthcare advocates; here are the 20 finalists for your vote. The winner’s video will air on national television.

A commentary in the current issue of the journal JAMA addresses breast and prostate cancer screening and the complexities and limitations of current screening approaches. The authors explain that while screening for the two diseases has increased, “the absolute numbers of more advanced disease have not decreased nearly as much as hoped for either cancer,” and that mortality has not decreased as much as expected.

It’s a complicated topic, even without getting into issues of access to screening and racial disparities in screening and treatment (which the JAMA piece does not). Essentially, the key limitations of screening are that widespread screening with current methods may sometimes detect slow-growing or inconsequential tumors, resulting in unnecessary treatment (because it’s not yet possible to predict which tumors present little risk), while in other cases, early detection doesn’t decrease mortality rates, because certain aggressive cancers, even when caught early, will not respond to treatment.

These messages are not easy message to convey or understand, and some worry that the related headlines may lead people to think screening is unwarranted. In a New York Times article on the commentary one biostatistician expressed concern that “the complex view of a changing landscape will be distilled by the public into yet another ‘screening does not work’ headline. The fact that population screening is no panacea does not mean that it is useless.”

The authors of the JAMA commentary don’t propose abandonment of breast and prostate cancer screening, however – they propose an improved approach consisting of determining validation tools that can identify and differentiate high and low risk cancers, reduction of treatment for minimal-risk disease,  improved clinical and patient support tools to help guide decision-making, and identification of the the highest-risk patients for prevention initiatives. They suggest that there should be investment of significant funds – perhaps 10-20% of the $20 billion spent each year on screening – in these four areas “to improve screening, accelerate prevention research, and reduce harm from breast cancer and prostate cancer deaths.”

The New York Times article on the commentary also generated some controversy when it characterized the American Cancer’s Society’s response to the commentary as “saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated” and that the organization was as a result “reconsider[in] its message about the risks as well as potential benefits of screening.”

The American Cancer Society has issued multiple responses to this characterization, explaining that it is standing by its screening guidelines. Organization representatives stated that they have long acknowledged that cancer screening isn’t perfect, but that “The bottom line is that mammography has helped avert deaths from breast cancer, and we can make more progress against the disease if more women age 40 and older get an annual mammogram.”

However, this research adds more fodder to the question of whether and how effective mammograms are. The Cochrane Collaboration, which creates meta-analysis of high quality systematic reviews, states in its review Screening for breast cancer with mammography that while screening likely reduces breast cancer mortality, ” it is not clear whether screening does more good than harm.”

For more on this topic, see our online content, Mammography Screening Controversy.

by Meg Young
Our Bodies Ourselves intern

The Sexuality Information and Education Council of the United States (SEICUS) would like you to get REAL about sex education.

SEICUS has declared October “Sex Ed Month of Action,” and the organization is encouraging young people to raise awareness for the need for comprehensive sex ed — and specifically the Responsible Education About Life (REAL) Act [pdf].

Introduced by Sen. Frank Lautenberg (D-N.J.) and Rep. Barbara Lee (D-Calif.), the legislation (S.611, HR.1551) calls for a dedicated federal funding stream ($50 million) that would cover state grants for developing comprehensive sexuality education programs. A petition in support of the REAL Act is online at AmplifyYourVoice.org.

Reviewing these quick facts about the need for comprehensive sex education, I was reminded of my own “real” sex education.

Picture this: It’s Sunday morning, and I’m competing in a condom-stretching contest in the basement of a pre-school. Other kids are trying to blow up the largest condom-balloon, shoot a condom the farthest (rubber-band style), or beat my record of 24-inches for the condom-stretch (all the way from the floor to my hip). Four adults are recording scores and announcing winners. In the center of the room, next to a few condom-clad bananas, sits a box of donuts, a subtle bribe to get us out of bed so early on a weekend.

I was in eighth grade, and I was a reluctant student in Our Whole Lives.

Our Whole Lives (OWL), a sexuality education curriculum developed jointly by the Unitarian Universalist Association and the United Church of Christ, was first published in 1999, and subsequently updated in 2005. The class provides a comprehensive, interactive, unabashed look at sexuality, offering six sets of curricula for age groups spanning kindergarten to adulthood.

The “big curriculum” for seventh-to-ninth graders is predominantly offered outside of schools (I took OWL as part of Sunday school at my local UU church), and tends to take a more personal angle than classroom based sex-ed classes, offering time for discussion, games and unlimited questions.

The first sessions of the curriculum focus on building rapport between the instructors and the students, as well as creating a high level of comfort between the students themselves. One of my OWL classmates recently said: “Because of the intimate environment of OWL, it felt really awkward at times, but in the end was really effective in achieving its purpose… There was room for open discussion, and questions arose that never would have when surrounded by 22 random kids from school.”

This “intimate environment,” as well as the fact that, by virtue of being taught outside of the school system, OWL does not need to conform to any state or federally-imposed limitations, means that OWL can address sexuality education more broadly. Topics include everything from anatomy and physiology (I clearly remember being ejaculated on by a working model of a penis built by a class-mate), to gender roles in dating (we had a long argument about who should pay for dinner and a movie).

There was a whole session devoted to “love making,” and another devoted to masturbation. Trading colored m&ms taught us about the terrifying ease of spreading sexually transmitted diseases. We played with condoms, diaphragms, female condoms and spermicidal gels. We discussed our feelings about abortion at length. We spent three weeks discussing sexual orientation and gender identity. At an all-class sleepover, as part of our unit on responsible sexual behavior, we watched “American Pie.”

When I took OWL at age 14, issues like herpes, emergency contraception and “responsible sexual decisions” often seemed remote to the point of irrelevance, and I can’t deny that my high school health class served as somewhat of a necessary refresher. However, what I really absorbed from OWL at the time, and what I have carried with me ever since, is an outlook on sexuality that was strikingly absent from my sex-ed unit in health class: OWL taught me that sexuality is not something to be ashamed of, to be hidden or feared. It is something to be questioned and explored, respected and protected. It is nuanced and complex, and sometimes infuriatingly confusing.

Most of all, it is an essential part of the human experience that last from birth until death – Our Whole Lives.

So, am I bitter that I had to be up by 9 a.m. every Sunday for a year? Yes. I’m I glad my parent made me do it? Absolutely.

Meg Young recently graduated from high school in Middlebury, Vt., and will enroll at Tufts University in the fall of 2010 after taking a gap year.

Under the unfortunate headline, “Which Side Are You On?,” the Washington Post has published an interesting article about the struggle to define gender and how that struggle has played out in legal cases around the country.

The article discusses the now well-known story of 18-year-old South African runner Caster Semenya, “who has been put through ‘gender verification’ amid suspicion about her muscular physique and low voice.” Testing was ordered after Semenya’s won the 800 meters at the World Athletics Championships back in August in record time. Though physical exams indicated that Semenya has both male and female characteristics, family members stressed her gender is not in question.

“This is a woman who was raised a female. She will always be female, no matter what people say,” said Semenya’s uncle.

Semenya’s case may be unique for the publicity it attracted — including embarrassing scrutiny and harsh comments from her fellow runners. Yet private battles are waged every day over issues such as sex designation on a driver’s license, or the legality of marriage when a person is transgender.

“These cases have left judges, doctors and athletics officials — those tasked with drawing a bright line between the sexes — struggling to find a reliable gender test, some trait that divides all men from all women,” writes David A. Fahrenthold. “But scientists say they don’t have one yet.”

That’s because “male” and “female” is not always an either/or classification. The story details the perhaps surprisingly high occurrence — one in every 100 people — of “disorder of sex development,” which refers to “congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical.” Conditions may include androgen insensitivity syndrome, in which people do not respond to testosterone despite the presence of XY chromosomes. (The continuum of AIS is explained more fully at the Androgen Insensitivity Syndrome Support Group; here is AISSG’s U.S. chapter. Our Bodies Ourselves also recommends the Accord Alliance, which offers a useful glossary and identifies advocacy and support groups for specific DSDs.)

Alice Dreger, a professor of clinical medical humanities and bioethics at Northwestern University, tells the Post that officials could look at whether an athlete was raised as a boy or a girl, or they could look at some laboratory threshold, such as the amount of male hormones in an athlete’s blood.

Then she delivers the best quote in the piece: “To me, it’s no different than deciding where the foul line is … The line is not drawn by nature, it’s a line we draw on nature.”

Gender, after all, is as much a social construction as it is a biologically determined “fact.” And it can be as much of a performance as it is an irrevocable identity.

A tangent: Visit Dreger’s website. She wrote a terrific “Media Advisory on Sex Verification” to help reporters understand the issues at play in Semenya’s case. It’s a very accessible FAQ that should be required reading for all. For more on the importance of language, here’s her summary of a 2007 talk delivered at the Kinsey Institute on the history and politics of the term “intersex”; the adaptation of alternative terms, including “disorders of sex development”; and the whole trouble with nomenclature.

As debates over sex and gender identity continue, the state you live in may determine your gender. The Post story includes these examples:

In the D.C. suburbs, for instance, many authorities have decided on a simple test: Surgery makes the gender. In Maryland and Virginia, for instance, officials will alter the sex on a driver’s license if presented with proof of sex-reassignment surgery. The District, by contrast, doesn’t inquire about surgery: It requires that a medical provider or social worker attest that a person has a new “gender identity.”

But nationally, legal experts say that some courts have balked at the very idea of a sex change. Some state appeals courts have said someone born a man remains so, no matter how their bodies have changed.

In one 2002 case — voiding a marriage between a man and a transgender woman — the Kansas Supreme Court based its gender test in part on . . . Webster’s New Twentieth Century Dictionary. Male, the dictionary said, meant “designating or of the sex that fertilizes the ovum and begets offspring: opposed to female.”

By that logic, the court said, the transgendered woman was not female, at least not in Kansas.

“Judges are very anxious; you can feel their anxiety,” said Katherine Franke, a director of the Gender and Sexuality Law Program at Columbia University Law School. “They don’t want to pick a rule, because they know it’s arbitrary.”

The matter of how much personal information to share with patients comes up frequently for practitioners, and there are times when it can be most helpful. But it is a difficult decision.

In an essay online at WBUR public radio, Our Bodies Ourselves board member Anne Brewster, an internist who works at Massachusetts General Hospital, discusses her decision to disclose something about herself to a 30-year-old patient diagnosed with multiple sclerosis, an autoimmune disease of the central nervous system. When Brewster calls to give her the news, she shares that she has the same disease:

In revealing personal information, physician to patient, I had crossed a line. I did so intentionally, in an effort to bring compassion to our exchange, but still today, I cannot shake the slightly uneasy feeling that I have somehow breached medical etiquette.

When we enter medical school and don our white coats for the first time, the division between doctor and patient begins – “us” and “them.” We start our education by dissecting a human corpse, and in so doing, learn early on to separate the body from the person. We master the parts — the Ischial Tuberosity, the Latissimus Dorsi, the Sternocleidomastoid, the Flexor Digitorum Longus. We think about lymphatic drainage, muscle insertions, arterial supply, and nerve innervation. We divide the body into sections: distal and proximal, dorsal and ventral, lateral and medial.

We go on to study disease processes — so many that our heads spin. Eventually, we begin to take care of patients and are encouraged to remember the person behind the disease. We are instructed to make eye contact, to sit on the edge of the bed when we speak to a hospitalized patient, and to use touch when appropriate, by holding a hand or squeezing a shoulder. Empathy is cultivated, but at the same time, explicitly and implicitly, we are taught to keep an emotional distance. Sharing personal information is taboo.

Part of this is for survival. None of us could bear to feel all of the pain, the fear, the loss that we encounter daily in medical practice. If we allowed ourselves to realize that we are vulnerable to all of the diseases we treat, all the time, we could not function. And part of this is about being a good doctor. Emotions can cloud judgment, and the preservation of professional boundaries is essential to quality care.

But true objectivity is a myth.

Continue reading this excellent essay.

Earlier this month, California Governor Arnold Schwarzenegger signed into a law a bill, AB 1317, which requires advertisements seeking egg donors for fertility treatment to include a notice about the possible adverse health effects of egg donation.

Such advertisements must contain standard warning language that there may be risks associated with human egg donation, and advise potential donors that they are required to receive specifics on the known risks before signing a legally binding contract. The required language also recommends consulting with one’s physician prior to donation.

The state already had a law requiring such a warning summary be provided to women donating eggs for research purposes. That existing law also sets out the specifics of the warning to be provided to women prior to signing a contract for donation. The warning needs to consist of “medically accurate disclosures” concerning the potential risks associated with the surgical procedure for egg retrieval as well as the “drugs, medications, and hormones” prescribed for ovarian stimulation during the process.

Relatedly, one publisher of classroom materials has recently released a book on the topic of egg donation intended for a young audience. Egg Donation: The Reasons and the Risks is listed as being intended for grades 7-12, and at a 6th grade reading level. The book seems focused on egg donation for fertility (not research) purposes, with the description noting that it “explains the current controversy” as well as “the basic science behind egg harvesting and in vitro fertilization and describing the process donors go through to help other women conceive.” Potential health risks and ethical issues are also apparently covered.

For more on the potential health concerns associated with egg donation, see Christine’s previous post on the topic, and Egg Donation for IVF and Stem Cell Research: Time to Weigh the Risks to Women’s Health.

On the heels of Rachel’s post yesterday on the medicalization of sex and sexual healing (vibrator/egg beater? oh my), I wanted to mention a petition we just learned about to honor psychologist Virginia Johnson for her pioneering work on sexuality.

Johnson teamed with William Masters in the 1950s to study the nature of sexual response and sexual disorders. Together they wrote “Human Sexual Response” (1966) and “Human Sexual Inadequacy” (1970). Though they began their work at Washington University Medical School, the university has not celebrated their contributions to the field.

Masters died in 2001, and Washington University’s Student Forum on Sexuality, a student group dedicated to promoting the discussion of sexuality on campus, wants to make sure Johnson is honored in 2010, as she turns 85.

From the petition (which is open to anyone to sign):

Despite the controversial nature of their work, Virginia Johnson and William Masters revolutionized the way the world thought about the physiology of sex. Yet their names remain virtually unknown as a part of Washington University history. We want to uncover the legacy of this innovative duo, and more specifically, we want to honor Virginia Johnson’s lasting contributions to the field of sex therapy by requesting that she receive an honorary degree from the place she started her work, Washington University in St. Louis. Please show your support in this effort by signing this petition.

Some of the controversy relates to their studies in the 1960s and 1970s on whether homosexual men and women could be converted. Their contributions to demystifying female sexual response and legitimizing sexual responsiveness among older adults, however, are cornerstones of contemporary sex therapy.

Masters and Johnson’s work led to the four-stages of the human sexual response: excitement phase; plateau phase; orgasm; resolution phase. Their findings also revealed that while men undergo a refractory period following orgasm during which ejaculation is not possible, there is no refractory period in women. Bottom line: We can thank Johnson for confirming our ability to have multiple orgasms.

An article in the current issue of The Nation, Sexual Healing, comments on the history of the medicalization of sex, from vibrating devices used by physicians in the 1800s to “treat” (ahem) women for what ailed them to more modern incarnations of medical sexual fixes in the form of drug prescriptions and genital surgery.

The first paragraph succinctly describes the progression:

In the beginning there was sex. And sex begat skill, and skill (or its absence) begat judgment, and judgment begat insecurity, and insecurity begat doctors’ visits, which begat treatments, which have flourished into a multibillion-dollar industry, so that sex between men and women is today almost inconceivable without the shadow of disorder, dysfunction, the “little blue pill” or myriad other medical interventions designed to bring sex back to some longed-for beginning: a state of certified healthfulness, the illusion of normal.

One sex therapist interviewed for the piece argues that sexual concerns should not necessarily be medical concerns, that sex is “…more like dancing or cooking. Yes, you do it with your body. You dance with your body, too. That doesn’t mean there’s a department of dance in the medical school. You don’t go to the doctor to learn to dance.”

The author refers to a couple of resources on the topic for further exploration, including the new documentary “Orgasm, Inc.” by Liz Canner, which examines the role of pharmaceutical companies in creating a market for drugs for “female sexual dysfunction.” Also mentioned is the book “The Technology of Orgasm: ‘Hysteria,’ the Vibrator, and Women’s Sexual Satisfaction” by Rachel Maines, which further details the history of physician approaches to “hysteria” and women’s sexuality. Readers may also want to check out “Passion and Power: the Technology of Orgasm,” a film inspired by Maines’s work.

One line in The Nation piece I couldn’t let pass without sharing: “Sears marketed a home vibrator with attachments for beating eggs, churning butter, operating a fan.” Now that’s a multi-purpose tool!

An Arizona woman’s dispute with her local hospital over its refusal to allow a VBAC (vaginal birth after cesarean), even though she has already undergone a VBAC at the same hospital, has caught the attention of CNN, which featured the story on its homepage today.

Joy Szabo, 32, told CNN she is grateful for the c-section performed during her second delivery, when doctors feared the baby wasn’t getting enough oxygen, but her third son was a vaginal birth and she thought this delivery would be, too (assuming there were no complications). Page Hospital has since changed its policy and no longer allows VBACs.

VBACs carry a less-than-1-percent increased risk of a uterine rupture, which could cause brain damage in the baby or even death, according to the American College of Obstetrics and Gynecologists. Childbirth Connection, a nonprofit organization that advocates for evidenced-based maternity care, notes that research “suggests that about 1.4 extra babies die due to problems with the scar in every 10,000 VBAC labors, compared with planned c-section deliveries.”

C-section risks to the baby include breathing problems around the time of birth and asthma later in life. The mother is at greater risk for more severe pain and infection. The bottom line, based on the latest research, is that if you “do not have a clear and compelling need for a cesarean in the present pregnancy, having a VBAC rather than a repeat c-section is likely to be safer for you in this pregnancy (and) far safer for you and your babies in any future pregnancies,” according to Childbirth Connection.

“I know there’s a risk with a VBAC, but we think the risks of surgery are worse,” said Joy Szabo. “And I don’t want to have to recover from surgery when I’ll have four children at home, at least not voluntarily.”

From CNN:

After their discussion with their doctor, the Szabos made an appointment to speak with Page Hospital’s CEO, Sandy Haryasz. When the couple told her about their desire for a vaginal birth, they say Haryasz would not budge, even telling them she would get a court order if necessary to ensure Joy delivered via C-section.

“I was a bit flabbergasted, because that seemed rather extreme,” Joy says. “I’d already had a VBAC at Page and it went fine. And if something happened, I know they can do an emergency C-section, because they did one for Michael.”

At issue are ACOG’s recommended guidelines concerning physician and anesthesiologist staffing for VBACs. Banner Health, which owns Page Hospital, released a statement that said ACOG guidelines recommend “24/7 coverage of both physician and anesthesiologist,” and that “two physicians be immediately available during the entire period of labor.” But an ACOG spokesperson disputed that interpretation, noting that physician and anesthesia availability are only two criteria to consider.

Still, ACOG’s guidelines have scared many hospitals away from allowing VBACs (which in turn has inspired suggestions on how to protest a VBAC denial). International Cesarean Awareness Network conducted a survey earlier this year of 3,000 hospitals and found that 821 ban VBACs outright, and and 612 have “de facto” bans, meaning surveyors were unable to identify any doctors practicing at the hospital who would provide VBAC support.

The information gathered led to the creation of a VBAC Policy Database, which can be searched by VBAC policy, or browsed by state.

Another report, Hospitalizations Related to Childbirth, which examined data on childbirths occurring in U.S. community hospitals in 2006, found that childbirths by c-section increased from 21 percent  in 1997 to 31.6 percent in 2006, a jump of 51 percent. Meanwhile, there was a 73 percent decline in VBACs, from 35 percent of childbirth-related hospitalizations in women with a previous c-section in 1997 to almost 10 percent in 2006. (Rachel discusses the report here.)

As for the Szabos, rather than agree to a surgical delivery regardless of medical need, Joy Szabo plans on driving 350 miles a week or so before her Nov. 21 due date to be near a hospital in Phoenix that will allow a VBAC. It is unlikely her husband, Jeff, who is staying behind with their three sons, will be able to make it to the hospital for the delivery.

The Szabos’ story was first covered by a local newspaper, the Lake Powell Chronicle (via The Unnecessrean), and has caused an uproar. It’s unlikely we’ve heard the last of this …

For more reading:
In addition to visiting Childbirth Connection, “Our Bodies, Ourselves: Pregnancy and Birth” has a section on VBACs and repeat c-sections. Lamaze International also offers articles on healthy birth practices supported by research studies examining the benefits and risks of maternity care practices.

A new blog, FWD/Forward, has recently launched.  The About section of the site explains:

FWD/Forward is a group blog written by feminists with disabilities. It is a place to discuss disability issues and the intersection between feminism and disability rights activism. The content here ranges from basic information which is designed to introduce people who are new to disability issues or feminism to some core concepts, to more advanced topics, with the goal of promoting discussion, conversation, fellowship, and education.

Although the site just launched on October 6th, there are a number of posts up already on a variety of topics, such as inclusionary language and the use of words such as “lame” and “hysterical.” One post that particularly caught my eye was this one on outrage about pre-existing condition exclusions in health insurance, noting the attention c-sections and domestic violence have recently received as compared to many other conditions that lead to such exclusions.

The blogroll is also well worth exploring; the site contributors explain that it is focused on including blogs that cover disabilities and feminist sites that explore disability issues fairly often.

For other disability resources, you might check out disability.gov. Primarily for a U.S. audience, this government-run website provides information on disability laws and benefits, assistive technology, filing complaints related to civil right/ADA violations, emergency preparedness, health care, grants, education and scholarships, housing, transportation, and other topics.

There is also an associated Twitter account, @disabilitygov, which provides news and resources on a number of disability-related topics.