A new study in the journal Contraception reveals the power of a simple conversation: When trained counselors at family planning clinics ask young women if they have experienced reproductive coercion, it reduces the odds of their male partners forcing them to become pregnant.

The Family Violence Prevention Fund responded enthusiastically to the results of the study:

A brief intervention was associated with a 70 percent reduction in the odds of male partner pregnancy coercion among women who recently had experienced intimate partner violence. Study participants who were asked about reproductive coercion and then counseled about harm-reduction strategies — including switching to longer-acting contraceptives and contacting domestic and sexual-assault resources — were also 60 percent more likely to report ending a relationship because it felt unsafe or unhealthy.

“There is a strong, indisputable link between domestic and dating violence and unintended pregnancy. This study is extremely important because it identifies an effective solution that can be implemented relatively easily,” said Family Violence Prevention Fund President and Founder Esta Soler. “We need to build on these results by making this intervention the norm in health care settings throughout the nation as quickly as possible.”

The study was funded by the National Institute of Child Health and Human Development; the intervention was designed by reproductive health experts, UC Davis School of Medicine, the Harvard School of Public Health, and the FVPF.

An earlier study this year, also published in Contraception, concluded that 20 percent of women experienced pregnancy coercion and 15 percent experienced birth control sabotage.

The FVPF is calling for immediate action based on this latest evidence: “This study is extremely important because it identifies an effective solution that can be implemented relatively easily,” said Soler. “We need to build on these results by making this intervention the norm in health care settings throughout the nation as quickly as possible.”

Go to FVPF’s Know More Say More website for more information and opportunities for action. The site includes resources for healthcare providers, including suggestions on how to assess for reproductive coercion [PDF], including sample scripts, and how to integrate assessments into clinical practice [PDF].

The National Institute of Environmental Health Sciences (NIEHS) has long studied the various potential health effects of low-level exposure to chemicals called endocrine disruptors that interfere with development and function. These substances, both natural and man-made, include pharmaceuticals, dioxin and dioxin-like compounds, polychlorinated biphenyls, DDT and other pesticides, and plastics such as bisphenol A (BPA).

Very little action has been taken on the basis of these studies, but new legislation working its way through Congress aims to change that.

The Endocrine Disruption Prevention Act of 2009 was introduced last December in the Senate (S-2828 [pdf]) by  Sen. John Kerry (D-Mass.) and in the House of Representives (HR-4190 [pdf]) by Rep. Jim Moran (D-Va.).

TEDX , the Endrocine Disruption Exchange, provides a thorough overview:

Simply put, the main purpose of the program proposed in the bill is to develop reliable and reproducible methods to identify chemicals that can disrupt the human endocrine system. These protocols will:

• address the full range of possible health outcomes (including reproductive, behavioral, intellectual, metabolic, and endocrine disorders);
• be sensitive enough to detect effects at exposure levels relevant to human exposure (and not rely on the assumption that a lower dose produces less effect);
• consider the effects of exposure to multiple chemicals

The program will rely on a panel of scientific experts, free of conflict of interest, to design research efforts that will be conducted at the NIEHS and on academic campuses across the country. The panel will then evaluate the findings and determine their level of concern (taking into account routes and sources of exposure).

Kerry recently sent a letter to other members of the Senate looking for co-sponsors of the bill. TEDX is urging everyone to call their senators and encourage their sponsorships. And while the House bill has several co-sponsors, more is always better. See “How You Can Help.”

To get a feel for the full political context, read Elizabeth Grossman’s call for “Fixing Our Broken Chemicals Policy,” inspired by the introduction of the bill.

The news today was celebratory, but the battle over Proposition 8 is far from over. From The New York Times:

Saying that it discriminates against gay men and women, a federal judge in San Francisco struck down California’s voter-approved ban on same-sex marriage on Wednesday, handing supporters of such unions at least a temporary victory in a legal battle that seems all but certain to be settled by the Supreme Court.

Wednesday’s decision is just the latest chapter in what is expected to be a long battle over the ban — Proposition 8, which was passed in 2008 with 52 percent of the vote. Indeed, while striking down Proposition 8, the decision will not immediately lead to any new same-sex marriages being performed in California. Vaughn R. Walker, the chief judge of the Federal District Court in San Francisco, immediately stayed his own decision, pending appeals by proponents of Proposition 8, who seem confident that higher courts would be less accommodating than Judge Walker.

But on Wednesday the winds seemed to be at the back of those who feel that marriage is not, as the voters of California and many other states have said, solely the province of a man and a woman.

“Proposition 8 cannot withstand any level of scrutiny under the Equal Protection Clause,” wrote Judge Walker. “Excluding same-sex couples from marriage is simply not rationally related to a legitimate state interest.”

Continue reading …

Related:

* Judge Vaughn Walker’s 136-page ruling against Prop. 8. One of my favorite sections:

The evidence shows that the movement of marriage away from a gendered institution and toward an institution free from state-mandated gender roles reflects an evolution in the understanding of gender rather than a change in marriage. The evidence did not show any historical purpose for excluding same-sex couples from marriage, as states have never required spouses to have an ability or willingness to procreate in order to marry.

Rather, the exclusion exists as an artifact of a time when the genders were seen as having distinct roles in society and in marriage. That time has passed.

* More on the judge’s “findings of fact” at ColorLines.

* Lots of links and good info at Pam’s House Blend (start with this open discussion).

* NYT editorial: “The decision [...] is a stirring and eloquently reasoned denunciation of all forms of irrational discrimination, the latest link in a chain of pathbreaking decisions that permitted interracial marriages and decriminalized gay sex between consenting adults.

“As the case heads toward appeals at the circuit level and probably the Supreme Court, Judge Walker’s opinion will provide a firm legal foundation that will be difficult for appellate judges to assail.”

* San Francisco Chronicle’s archive of the November 2008 California ballot measure and the state Supreme Court challenge to Prop. 8.

* Timeline of the 10-year battle over same-sex marriage in California.

* Finally, for your viewing pleasure, a look back at “Prop 8: The Musical” …

What are you reading on Prop 8?

Boston Review recently produced a special issue entitled “Big Pharma, Bad Medicine” — and it is well worth reading.

Marcia Angell, former editor of the New England Journal of Medicine (NEJM) and author of “The Truth About Drug Companies,” wrote the lead article — to which many other academics, health writers and industry representatives responded.

Angell’s opening critique of the cozy relationship between the pharmaceutical industry and medical research institutions is devastating. Summarinzing an argument she made in her book — and in many prominent op-eds, interviews and in a NEJM editorial, “Is Academic Medicine for Sale?” — Angell outlines the steps through which big pharma influences, and in many cases controls, the entire process of medical research — from clinical trials of new drugs to continuing education of doctors.

By putting profit before public good, big pharma’s power distorts the medical mission of many universities:

Academic medical centers are charged with educating the next generation of doctors, conducting scientifically important research, and taking care of the sickest and neediest patients. That’s what justifies their tax-exempt status. In contrast, drug companies — like other investor-owned businesses — are charged with increasing the value of their shareholders’ stock. That is their fiduciary responsibility, and they would be remiss if they didn’t uphold it. All their other activities are means to that end. The companies are supposed to develop profitable drugs, not necessarily important or innovative ones, and paradoxically enough, the most profitable drugs are the least innovative. Nor do drug companies aim to educate doctors, except as a means to the primary end of selling drugs. Drug companies don’t have education budgets; they have marketing budgets from which their ostensibly educational activities are funded.

This profound difference in missions is often deliberately obscured — by drug companies because it’s good public relations to portray themselves as research and educational institutions, and by academics because it means they don’t have to face up to what’s really going on.

Angell’s most pointed criticism is not at the drug companies, however, who, apologists could argue, are just trying to do right by their investors. Rather, she is most bothered by the complicity of the academic institutions. Angell ultimately recommends three specific reforms:

First, members of medical school faculties who conduct clinical trials should not accept any payments from drug companies except research support, and that support should have no strings attached. In particular, drug companies should have no control over the design, interpretation, and publication of research results. Medical schools and teaching hospitals should rigorously enforce this rule and should not themselves enter into deals with companies whose products are being studied by members of their faculty.

Second, doctors should not accept gifts from drug companies, even small ones, and they should pay for their own meetings and continuing education. Other professions pay their own way, and there is no reason for the medical profession to be different in this regard.

Finally, academic medical centers that patent discoveries should put them in the public domain or license them inexpensively and non-exclusively.

Several of the respondents in the Boston Review pick up on one of Angell’s points and pursue it with more depth. In  ”The Case of H1N1,” Howard Brody, director of the Institute for the Medical Humanities at University of Texas and author of “Hooked: Ethics, the Medical Profession and the Pharmaceutical Industry,” explains how the pharmaceutical company Roche was able to obscure negative or neutral research on the drug Tamiflu while public health agencies around the world stockpiled large supplies. Later, the research in support of Tamiflu was found to be unconvincing.

David Bollier, author of “Viral Spiral: How the Commoners Built a Digital Republic of Their Own” and co-editor of Onthecommons.org, takes Angell’s recommendations a step further with his call to “Restore Medicine to the Commons“:

Understanding academic medicine as a commons helps us appreciate more clearly why it is so important to protect the non-market paradigm of research, education, and clinical care. In this mode, medicine harnesses the power of the scientific method through a transparent, ethical, merit-based process. It mobilizes community judgment and ethical scrutiny. It is insulated from the corrupting influences and self-dealing associated with an unregulated market economy.

Unfortunately, we have not been attentive to the value of academic medicine as a commons. We are suffering mightily as a result.

Suzanne Gordon, author of “When Chicken Soup Isn’t Enough: Stories of Nurses Standing Up for Themselves, Their Patients and Their Profession,” reminds us: “Don’t Forget Nurses.” She notes that nurse-practioners, who prescribe a great deal of medicine, have not been overlooked by the pharmaceutical industry, even if they are often forgotten in this type of discussion:

Today nurses no longer have to beg to get noticed. Like medical conferences, nursing conferences are now heavily supported by pharmaceutical and medical-equipment companies, which, like the corporations advertising on public television and radio, demand more and more of the spotlight. Nurses, like physicians, are flown to exotic spots and showered with so-called educational presentations. When I mentioned this phenomenon to a very respected nurse-academic, I expected her to share my concern. Her response: “It’s about time we got ours.”

Perhaps the most poignant — and funny — response comes from Adriane Fugh-Berman, associate professor of physiology and family medicine at Georgetown University Medical Center and director of Pharmedout.org. To show how continuing medical education (CME) is, in Angell’s words, “marketing masquerading as education,” Fugh-Berman creates a fictional scenario:

The gurgles and rumbles of an empty stomach are called, in medical-speak, borborygmi (it is one of the few onomatopoeic medical words). Let’s imagine that a company is developing a drug that prevents borborygmi. The first step would be to encourage people to take the disease state seriously. Marketing messages developed while the drug is still undergoing testing might include:

• While the occasional growling stomach is not a cause for concern, regular episodes could indicate the presence of CLASS (Chronic Loud Atypical Stomach Sounds).

• CLASS is not always benign. The distinction between normal stomach rumbling and a symptom of a serious disease can only be made by a physician.

• CLASS sufferers may limit their travel, work, and recreational activities out of embarrassment; some may become reclusive, fearing social stigmatization.

• CLASS can lead to overeating and obesity because sufferers may eat constantly to prevent audible stomach rumbling.

A pharmaceutical company may then begin to recruit physicians to act as mouthpieces for specific marketing messages …

Fugh-Berman continues the story all the way to the point where other companies are attempting to create “me-too” drugs that piggy-back on the original company’s success.

Angell, in her response to the responders, notes that Fugh Berman’s scenario “would be hilarious if it were an exaggeration, but it’s not. Drug companies frequently engage in such campaigns to prepare the way for a new drug or a new use for an old one. One example was the creation of an epidemic of ’social anxiety disorder,’ formerly known as shyness, and the marketing of Paxil to treat it.”

*In related news, Harvard Medical School just last week announced new restrictions on relationships between its 11,000 faculty members and pharmaceutical and medical device makers. Here’s a summary of the changes.

_ _ _ _ _ _ _ _ _ _

Plus: Drugs, of course, can’t solve everything. Writing in The New Yorker, Atul Gawande explores (in a very humanizing and moving way) how our healthcare system, which can do a great job of prolonging life, is often at a loss when it comes to care for the dying.

“People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others,” writes Gawande. “Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars.”

When the U.S. Preventive Services Task Force (USPSTF) released new recommendations in 2009 calling for less frequent screening mammograms for women under age 50, the news caused quite a ruckus.

Many women’s health organizations, such as Our Bodies Ourselves, National Women’s Health Network and Breast Cancer Action, applauded the new guidelines — and had, in fact, been recommending the same approach for pre-menopausal women for many years. But understanding the science behind the logical, if somewhat counter-intuitive, recommendations requires a nuanced analysis.

Now, a New York Times examination of breast cancer cases explains, in very personal terms, the problems with diagnosing breast cancer — especially early detection methods, which are “prone to both outright error and case-by-case disagreement over whether a cluster of cells is benign or malignant.”

As a result, pathologists are over-diagnosing and doctors are over-treating small growths in the breasts that are often benign.

While the initial reaction might be, “Wait, isn’t it better to treat all potential signs of cancer than leave them untreated?” the NYT does a good job explaining the very real dangers that can result. Moreover, the root problem is that we still don’t have a truly accurate diagnostic tool, and diagnosis can vary depending on one person’s reading of a tiny speck.

As the Times explains, ductal carcinoma in situ, or DCIS (also called Stage 0 or non-invasive cancer) was a rare diagnosis before the 1980s, but today more than 50,000 women per year in the United States alone are told they have DCIS. Typically the abnormal cells in the breast ducts are removed via surgery — which can result in disfiguration of the breast — along with drugs and radiation. DCIS may progress to a more invasive cancer about 30 percent of the time, according to estimates in the Times article, but in some women it can take decades to do so.

Stephanie Saul’s reporting chiefly concerns pathologists, who are responsible for determining whether cells from a biopsy are malignant:

Advances in mammography and other imaging technology over the past 30 years have meant that pathologists must render opinions on ever smaller breast lesions, some the size of a few grains of salt. Discerning the difference between some benign lesions and early stage breast cancer is a particularly challenging area of pathology, according to medical records and interviews with doctors and patients.

Diagnosing D.C.I.S. “is a 30-year history of confusion, differences of opinion and under- and overtreatment,” said Dr. Shahla Masood, the head of pathology at the University of Florida College of Medicine in Jacksonville. “There are studies that show that diagnosing these borderline breast lesions occasionally comes down to the flip of a coin.”

There is an increasing recognition of the problems, and the federal government is now financing a nationwide study of variations in breast pathology, based on concerns that 17 percent of D.C.I.S. cases identified by a commonly used needle biopsy may be misdiagnosed. Despite this, there are no mandated diagnostic standards or requirements that pathologists performing the work have any specialized expertise, meaning that the chances of getting an accurate diagnosis vary from hospital to hospital.

In the face of studies that have shown the high risk of misdiagnosis (in anywhere from 7.8 to 20 percent of cases, depending on the study), the College of American Pathologists is vowing to start a voluntary certification program for pathologists who read breast tissue. But as Saul notes, “Some pathologists have found the response to these types of studies slow and inadequate” — especially since studies going back as far as 2002 have revealed the problem.

The physical and psychological scarring that ensues is, in many cases, unnecessary — along with the potential long-term effects of radiation therapy.

Where you live and what kind of insurance coverage you have can also affect the accuracy of the diagnosis. Rural, community hospitals are more likely to have less experienced pathologists on staff. And insurers have not encouraged second opinions.

“Some insurance plans pay as little as $10 to pathologists who are performing second opinions on DCIS,” Saul notes in response to a comment left by “MK,” who made an excellent point: “If insurers had a requirement that any slides in which cancer was suspected were automatically sent to a board-certified pathologist, it would save patients having to search for a second opinion and save the insurers the cost of unnecessary treatment.”

It should be noted that percentages of misdiagnosis, as Saul reminds “MK,” includes both false negatives and false positives. Under-diagnosis and under-treatment is also an issue. The danger of a positive diagnosis, however, goes beyond whether it is false:

Fear compounds the confusion, and even though D.C.I.S. is 90 percent curable, there is growing concern that women and their doctors opt for more aggressive surgery, radiation and drug therapy than is needed.

A mastectomy is sometimes offered as an option for D.C.I.S., although experts say it is usually not advisable unless the D.C.I.S. is large or appears in several sites in the breast.

Yet more women who are faced with the diagnosis of D.C.I.S. become so fearful that they elect to have both breasts removed, often against their doctor’s recommendations.

“The patient gets paralyzed with a fear of cancer,” Dr. Masood said. “They want the breast off.”

Among women who had surgery for D.C.I.S., the rate of double mastectomy rose to 5 percent in 2005, from 2 percent in 1998, according to a study last year.

Dr. Ira J. Bleiweiss, chief of surgical pathology at Mount Sinai Medical Center in New York, said that ideally, all breast cancer diagnoses would be referred for a second opinion. He warns patients and their doctors: “Don’t rush to the operating room.”

In related news …

New Study Links Breast Cancer Risk, Household Products: Speaking of caution and prevention, a new study in Environmental Health found a higher breast cancer risk among women with higher use of household cleaning products.

The study by Silent Spring Institute was based on telephone interviews with 787 women diagnosed with breast cancer and 721 comparison women. Many of the products contain endocrine disrupting chemicals or mammary gland carcinogens, making them suspect as contributors.

There are, of course, limitations inherent to this type of study, including the potential for recall bias. Researchers recommend further study.

Julia Brody, executive director of the Silent Spring Institute, said, “When women are diagnosed with breast cancer, they often think about what happened in the past that might have contributed to the disease. As a result, it may be that women with breast cancer more accurately recall their past product use or even over-estimate it. Or, it could also be that experience with breast cancer influences beliefs about its causes. For example, women diagnosed with breast cancer are less likely to believe heredity contributes ‘a lot’, because most are the first in their family to get the disease.”

Plus: Interested in taking action — personally and politically? The Silent Spring Institute offers a number of action kits full of helpful information, including how to reduce risks in your home.

Recommendation to Revoke Avastin: An FDA advisory committee has recommended revoking approval of the drug Avastin, for which the FDA had given conditional approval in 2008 to treat breast cancer (part of an accelerated process for drugs that treat life-threatening diseases but have less than complete evidence of effectiveness).

If the FDA, which usually follows these recommendations, takes the very unusual step of revoking approval of a drug, Avastin will still be available, since it is approved for a variety of other cancers. This would leave it open to “off-label” use for breast cancer, but insurers would be reluctant to pay for it and it would no longer be part of a program that caps its annual cost to patients.

Breast Cancer Action program manager Kimberly Irish responds to the decision: “We agree with the committee’s recommendation, and we’re saddened that after all this time there’s still no good option to offer patients when current treatments have failed.” Read the written comments BCA sent to the committee here (PDF).

The image of pregnant women heading to the delivery room with handcuffs, leg shackles and belly chains is almost inconceivable. Yet as we have documented here before, it has been common practice in the United States prison system for decades and is still legal (and commonly practiced) in all but 10 states.

Efforts against shackling, led by a coalition that includes the ACLU and The Rebecca Project, have gained significant ground recently. Colorado, West Virginia, Washington state and Pennsylvania passed laws in 2010 banning the practice.

And the American Medical Association (AMA) voted in June to develop model legislation states can use to pass their own anti-shackling laws. The AMA resolution condemned the practice, calling it “barbaric” and “medically hazardous.”

But recent stories by Colleen Mastony of The Chicago Tribune and Andrea Hsu of NPR offer vivid and personal reminders of the entrenched and widespread use of shackling — even in a state like Illinois that has supposedly banned the practice.

In fact, more than 20 lawsuits have been filed by women against the Cook County sheriff’s office since 2008, even though Illinois became the first state to ban the practice in 1999. The lawsuits were granted class-action status last month; attorneys told Hsu that there ultimately could be up to 150 women included in the case.

From the Tribune:

Latiana Walton went through most of her labor at Stroger Hospital with an arm and leg chained to her bed, she remembers.

As contractions surged through her body, she could not move or change position to relieve the pain. A Cook County correctional officer repeatedly refused to remove the restraints, she said, even when a doctor objected, saying that he was unable to administer an epidural.

“I actually said to the guard, ‘Where am I going?’ I’m crying. I’m in pain,” recalled Walton, 26. “‘I’m not going to get up and run out of the hospital.’”

On Aug. 27, 2008, Walton, who had been arrested after she missed a court date on a retail theft charge, became one of an estimated 50 women who give birth every year while in the custody of the Cook County Jail. [...]

In Walton’s case, she did not get an epidural and the guard agreed to remove the leg shackle only 10 minutes before she gave birth to her son, Darrion, she said. The handcuff remained on through the delivery, and the leg shackle was replaced immediately after the birth, she said.

“I couldn’t push the placenta out because I couldn’t position my legs,” Walton said. “It is not fair to treat a person like this. I did a crime … but I’m not willing to be treated like a dog. I was treated like I wasn’t human.”

Almost all of the women are low-level, non-violent offenders — their crimes include drug possession and forged checks. Yet the Cook County Sheriff’s office believes it is following the law in these cases:

A pregnant woman can be restrained, according to the policy, until a medical official confirms that she is, in fact, in labor. “When does ‘labor’ begin? Our officers aren’t trained to know, the state law doesn’t say, so we rely on medical personnel to advise us,” Steve Patterson, a spokesman for the sheriff’s office, wrote in an e-mail. “Once a medical person advises us someone is in labor, restraints of whatever sort are removed.”

But the plaintiffs’ attorney argues that restraints were, in his clients’ cases, removed too late or not at all. He contends that sheriff’s officials interpret “labor” as the moments immediately before birth, and that guards sometimes deny requests by doctors and nurses to remove the handcuffs and shackles. “When you talk to these women, they say, ‘Yeah, when I’m delivering and I’m pushing, that’s what they consider labor,’” said plaintiffs’ attorney Thomas G. Morrissey. “They remain in shackles and handcuffs until the baby is about to be delivered.”

The ignorance and stupidity on the part of the sheriff’s department is mind-boggling. Besides the harm and humiliation of the shackles, some women also had to put up with a stranger’s presence at one of the most intense and intimate moments:

Melissa Hall, 32, held on a drug possession charge, said that not only did she give birth in shackles in 2007 but, all through her labor, the guard sat next to her bed watching the NBA Finals, cheering and yelling at the television despite her repeated pleas that he leave.

“My legs were open, and my baby’s head was crowning,” she recalled. “And that’s when he walks out of the room.”

State law requires that a correctional officer be posted outside the delivery room. The policy of the sheriff’s office, according to Patterson, states that “an officer (preferably female) must provide security for the subject and be posted discreetly near the head of subject’s bed.” He contends that this policy does not violate the law because the law “does not say anywhere that an officer cannot be in the room.”

While the focus is on Illinois because of the class action lawsuit, it is equally disturbing that the policies of other states, including the 40 that do not ban shackling, are not widely known.

NPR interviewed Ginette Ferszt, associate professor and psychiatric clinical nurse specialist at the University of Rhode Island College of Nursing, who sent questionnaires to wardens in all 50 states about how they treat pregnant inmates. She received 19 replies.

Ferszt says she was quite surprised to find that two facilities continue to use leg irons, belly chains and handcuffs during transport to prenatal visits.

She also learned that among the 19 prisons that responded, six of them cuff either a woman’s hands or her ankle when labor begins. During the delivery of the baby, one prison says that handcuffs stay on, and four reported back that an ankle shackle remains on.

While disturbed by the findings, Ferszt did find hope in conversations with two wardens, when she realized their shackling policies weren’t something they’d thought much about.

“For many rules and policies whether for women or men, they’ve existed for them a long time,” Ferszt says. “It hadn’t really occurred to these two wardens that this could potentially be a health problem, a health issue.”

She says the two wardens have since said they’ll sit down and make changes.

Despite the arrogant rationalizations and depressing ignorance of the responses from the powers-that-be, one inspiring story comes from some of the first inmates who spoke out about the abuse. Their age-old strategy: female solidarity. Again from the Trib:

In Illinois, the first movement against shackling came in 1999, after a former inmate named Warnice Robinson testified before a group of female legislators, explaining how, while pregnant and imprisoned for shoplifting, she had been shackled to a hospital bed through seven hours of labor. “The women legislators kind of expressed disbelief because it was so horrifying,” recalled Gail Smith, director of Chicago Legal Advocacy for Incarcerated Mothers, who had helped organize the day’s testimony. “There was a minor disruption, because the women who had been formerly incarcerated started shouting, ‘Believe her!’”

The New York Times has published online an extensive article about “The New Abortion Providers” (it will appear in print in Sunday’s Magazine), which I highly recommend reading. Such detailed reporting from a mainstream publication on the struggles of individual medical students and doctors to make abortion an accepted, integrated part of healthcare is quite welcomed.

The story provides both a historical and personal context for understanding the challenges — and the courageous dedication — of women’s health advocates on the frontlines of reproductive health for the past four decades.

Unfortunately, this ground-breaking journalism appears the same week in which we learned the Obama administration is denying abortion coverage for women whose pre-existing conditions will place them in “high risk pools” that have been established through the recent health care reform legislation.

More on that lack of courage in a moment.

But it’s worth pausing on Emily Bazelon’s story. She first outlines the depressing marginalization of abortion providers in the United States that occurred in the decades after Roe v. Wade. In 1973, hospitals made up 80 percent of abortion facilities. Fifteen years later, 90 percent of abortions were performed in clinics. At the same time, medical schools increasingly refused to make abortion training part of their curriculum. By 1995, “the number of OB-GYN residencies offering abortion training fell to a low of 12 percent.”

Even though it was the hard work of the feminist movement that made abortion widely available through clinics, those clinics were never intended to replace the key role of hospitals. And as we’ve seen all too often, clinics are ground zero for harassing patients and abortion providers.

As Bazelon notes, “This was never the feminist plan.”

This is a story, though, with an encouraging ending. While anti-abortion forces forced this marginalization through very public protests and acts of violence, a quieter, grassroots movement has taken hold that is starting to reverse these trends:

Over the last decade, abortion-rights advocates have quietly worked to reverse the marginalization encouraged by activists like Randall Terry. Abortion-rights proponents are fighting back on precisely the same turf that Terry demarcated: the place of abortion within mainstream medicine. This abortion-rights campaign, led by physicians themselves, is trying to recast doctors, changing them from a weak link of abortion to a strong one.

Its leaders have built residency programs and fellowships at university hospitals, with the hope that, eventually, more and more doctors will use their training to bring abortion into their practices. The bold idea at the heart of this effort is to integrate abortion so that it’s a seamless part of health care for women — embraced rather than shunned.

The article goes on to tell many compelling stories and reveal complex personal negotiations and sacrifices.

The comments section of the article is also an essential read, as it provides some key corrective points and additional context. “sadpatient” points out that the article, despite its “sympathetic” stance, still participates in the demonization of second trimester abortions, even though “many women are driven to terminate a dearly wanted pregnancy due to poor prenatal diagnosis.”

“Jenny K,” a member of Nursing Students for Choice, was “disappointed” that the article didn’t mention the role of nurse practitioners and physician assistants. And “CM,” through a personal anecdote, discusses the continuing difficulties of terminating a pregnancy in hospitals that are unwilling to provide separate, specialized facilities.

But the gains noted in the article are undeniable. Unfortunately, the Obama administration’s decision this week to prohibit abortion coverage in Pre-Existing Condition Insurance Pools (PCIPs) — also known as high-risk pools — is a disheartening setback for all those fighting to make abortion accessible and affordable.

The Hill reports that the decision ”came as the National Right to Life Committee and others argued the pools being set up in Pennsylvania and New Mexico would cover elective abortions — something that wasn’t prohibited by the healthcare reform law or the president’s executive order on abortion.”

Jessica Aron, in her enlightening breakdown of the political machinations behind the decision, explains why denying coverage to women in this group is particularly devastating:

Women entering these plans are, by definition, those who have experienced serious medical conditions — so serious that insurers are unwilling to sell them insurance. In other words, those who get pregnant are already at a heightened risk for needing an abortion for health reasons when compared to the general population.

Aron also explains in detail why, even with the executive order that Obama signed as a compromise with anti-abortion Democrats like Bart Stupak, “nothing in the law requires such action” restricting abortion in PCIPs.

It is understandable that the Administration might now feel the need to honor the “spirit” of the compromise that resulted in the Executive Order.  But the whole point of the compromise was to preserve the status quo, which included both restricted and unrestricted spheres of abortion funding.  Moreover, the terms of the agreement were carefully negotiated.  Abortion opponents who participated in the bargaining did not raise concerns about high risk pools or other specific potential sources of federal funding, and they should be able to live with the deal they made.

The worst of it is that the Administration could have at the very least set up something akin to the Hyde Amendment and the PPACA by giving states the option of using state or private money to cover abortion care costs.  Instead, the Administration cited the Federal Employees Health Benefits Plan specifically as the controlling precedent for the PCIPs.

The reaction from women’s health advocates has been swift. Judith L. Lichtman, senior advisor of the National Partnership for Women and Families, released this statement:

For the next few years, temporary insurance plans for those with pre-existing conditions will be the best and only way that millions of Americans — including many women of child-bearing age — can get health insurance coverage. It is unnecessary and punitive for the Obama Administration to adopt rules that prevent women from using their own private resources to purchase coverage for abortion services in these plans.

Cecile Richards, president of the Planned Parenthood Federation of America, stated:

The very women who need to purchase private health insurance in the new high-risk pools are likely to be more vulnerable to medically complicated pregnancies. It is truly harmful to these women that the administration may impose limits on how they use their own private dollars, limiting their health care options at a time when they need them most. This decision has no basis in the law and flies in the face of the intent of the high-risk pools that were meant to meet the medical needs of some of the most vulnerable women in this country.

Raising Women’s Voices and the National Women’s Health Network are providing avenues for action and key talking points to use when contacting the White House (202-456-1111) and Health and Human Services Secretary Kathleen Sebelius (877-696-6775).

Earlier this week, we wrote about the groundbreaking “Friday Nights Lights” episode that dealt more honestly with abortion than most television shows in the past 30 years. We’re pleased to include this reflection by Gloria Feldt, activist, author, blogger and past president and CEO of Planned Parenthood Federation of America. We hope you’ll follow through on her suggestions to thank NBC for allowing this episode to air.

On a personal note, it pleases me no end that this truth-telling episode appeared on “Friday Night Lights.” The show is based on Buzz Bissinger’s book of that same name, a sociology of the very West Texas town (Odessa, Texas) where I lived for 20 years and the high school (Permian) from which my three children graduated.

Not only do I know Dillon/Odessa and its hardscrabble culture all too well; it was where I moved as a 15-year-old pregnant teen with my new husband. We hailed from an even smaller West Texas town, where our football team was truly the only game around (my high school classmates still play the 8-millimeter film of our state championship game at every reunion, if that gives you a clue). At least Odessa has supermarkets and movie theaters!

Odessa was also where my growing understanding of the complexity of childbearing decisions came full circle — and why, though I loved my children more than anything, I came to realize I would have been a much better parent if I’d waited 10 or 20 years to have them.

My 30-year career with Planned Parenthood began when I became executive director of the fledgling affiliate there in 1974 — an affiliate now headed by a woman who was in my older daughter’s Permian High graduating class.

Sadly, I know from stories I still get from young women that the same time-warped pattern repeats itself: Teen girl wants to please football player boyfriend and gets pregnant. The good news is that these stories now — regardless of what the girl decided to do about the pregnancy — are much more likely to end in a statement of appreciation for having had choices in the first place.

This particular episode of FNL is a testament to the fact that regardless of the reactionary, shaming culture and a media with a rightward tilt, real life women will find a way to save their own lives — even in unlikely places like the fictional Dillon and the very real Odessa.

I’ve sent NBC a note of appreciation and urge all of you to do same. We’re good at reacting when we don’t like something, but less so when there’s a show worthy of applause. Here’s where you can go to send a comment: http://www.nbc.com/contact/general/

The series is executive produced by Peter Berg (the film “Friday Night Lights,” “Hancock”), who also wrote and directed the pilot. Joining Berg as executive producers are Jason Katims (“Roswell”), Brian Grazer (“Frost/Nixon,” “The Da Vinci Code”), David Nevins (“Arrested Development”), Sarah Aubrey (“The Kingdom”) and Jeffrey Reiner (“Caprica”). “Friday Night Lights” is a production of Universal Media Studios, Imagine Entertainment and Film 44, in case you want to target a specific individual.

The tube has long had tunnel vision when it has come to portraying women. Recently, though, television shows have been broadening their point of view by addressing previously taboo subjects — abortion and body image — with surprising maturity and subtlety.

“Friday Night Lights,” one of my long-time favorite series, has paid attention to women’s health since its inception, from its diverse portrayal of teenager’s sexual lives to its confrontation of sexual violence. And, yes, it even book-dropped “Our Bodies, Ourselves” at the end of its first season.

But it truly out-did itself (and almost every other work in the history of television — or film) with an episode that aired last week on NBC that traced one character’s decision to have an abortion.

Fifteen-year-old Becky (Madison Burge), pregnant after one sexual encounter with a high school football player, turns to Tami Taylor (Connie Britton), a high school principal (but not at Becky’s school) and trained guidance counselor, to help her sort through her feelings of whether she can manage a baby at her age:

Becky: I have an appointment for my abortion tomorrow. Why do I feel so weird?

Tami: Because it’s a hard decision. Have you thought about what you want?

Becky: We don’t have any money. I’m in the 10th grade. It was my first time. I threw it away, and I don’t want to throw my life away. It’s just really obvious that my mom wants me to have this abortion because I was her mistake and she has just struggled and hurt and everyday she wanted better. And I knew better. I was just thinking forget about what she wants, what do I want? Maybe I could take care of this baby. And maybe I would be good at it and I could love it and be there for it. Then I think about how awful it would be if I had a baby and I spent the rest of my life resenting him or her. Do you think I’m going to hell if I had an abortion?

Tami: No honey, I don’t.

Becky: What would you tell your daughter?

Tami: I would tell her to think about her life, think about what’s important to her and what she wants and I would tell her she’s in a real tough spot and then I would support whatever decision she made.

Becky: I can’t take care of a baby … I can’t.

Writing in The New York Times, Ginia Bellafante discusses the significance of the episode:

With those words Becky decides to have an abortion. This took place on Friday’s episode of “Friday Night Lights” and was remarkable — abortions have been rare on serial television since the early ’70s. But the effect was particularly resonant this week. On Monday Bristol Palin, America’s most famous teenage mother, briefly appeared as herself on the ABC Family soap opera “The Secret Life of the American Teenager,” bringing greater attention to a popular series that for three seasons has performed didactic and soulless cheerleading for anti-abortion sentiments.

Bellafante goes on to describe numerous instances in which television has “leaned to the right on the subject of unwanted pregnancy,” including a  shocking (even for a soap opera) turn of events on “All My Children”:

In the most bizarre instance of revisionism on the issue, four years ago “All My Children” reversed Erica Kane’s 1973 abortion, a milestone in television history when it occurred 11 months after the passage of Roe v. Wade. A character named Josh Madden learned that although Erica had initially conceived him, he had been kidnapped as an embryo and transferred to the womb of another woman by the obviously deranged doctor who had raised him. Fans were outraged, on one level because the story line was ludicrous, even by the measure of daytime television, and on another because the twist had gone a long way toward eradicating the show’s progressive politics, and, in some sense, an entire era.

What makes the portrayal on “Friday Night Lights” even more surprising is we see the hardships of obtaining an abortion — from coming up with the money for the procedure to the time and money lost when faced with a mandatory waiting period.

And unlike an abortion episode from the short-lived WB series “Jack & Bobby” (see Jenn Pozner’s summary), FNL doesn’t dwell on issues of divided teens/parents. Becky’s mother, Cheryl (played brilliantly by Alicia Witt), supports the decision, though she’s emotionally unavailable to her daughter. The boy’s parents, though, want Becky to have the baby, noting that Mary and Joseph toughed it out — to which their son, Luke, retorts: “Becky and me are not Mary and Joseph.”

Having seen this season of FNL during its earlier broadcast on DirecTV, I don’t want to offer any spoilers, but know there will be fall-out from Becky’s decision. Meanwhile, another character is pregnant and lacks health insurance. Her storyline is also compelling and is yet one more reason you should be watching this intelligent show.

In other TV news, Los Angeles Times TV critic Mary McNamara also sees something virtually unprecedented in the recent portrayals of fat people on television who, at least three new shows have discovered, “are human after all, with a panoply of dreams, desires, foibles and stories that often have nothing to do with their weight”:

Lifetime’s “Drop Dead Diva” broke the ice last year. Lit up by newcomer Brooke Elliott, the show wrangled its iffy conceit — an afterlife mix-up leaves a thin girl trapped in a fat girl’s body — into a surprisingly edgy comedy. This summer, ABC Family debuted “Huge,” a vehicle for “Hairspray” star Nikki Blonsky, which was no doubt the cause for much rejoicing among plus-sized thespians. Set at a fat camp, “Huge” is essentially a teen drama — with the requisite rebel, pretty girl, shy boy, tough jock, etc. — but one that also explores the complexities of childhood obesity with a clear eye and dark humor.

And this fall, pound-power comes to the networks. In CBS’ romantic comedy “Mike and Molly,” Melissa McCarthy and Billy Gardell play a fourth-grade teacher and a Boston cop, respectively, who meet at an Overeaters Anonymous meeting. All three of these shows take on the emotional, social and physical difficulties of being overweight, but none of them get bogged down in the slippery excess of parody or pathos that so often accompanies current tales from the top of the scale.

McNamara also makes an important clarification: “When I said television has discovered that fat people are human, I mean it’s discovered that fat women and children are human. Men have always been allowed to be fat on TV.”

She gives props to the one great exception — “Roseanne” — in which Roseanne Barr herself was remarkable for rarely remarking on any of these issues at all.

Gretchen Reynolds, writing for the Well blog at The New York Times, reports that gender still matters a great deal in health research. It’s just difficult for some scientists to remember that.

Reynolds focuses on a pair of studies by David Rowlands, MD, a senior lecturer with the Institute of Food, Nutrition and Human Health at Massey University in New Zealand, in which he attempted to determine the importance of protein in the recovery from hard exercise. The first study, completed in 2008, involved only male cyclists and found that ingesting protein had a significant long-term effect on overall athletic performance.

After Rowlands published those results, which were in line with conventional wisdom, female cyclists asked him to include them in any further studies. To his credit, he decided to repeat the entire experiment again with the female cyclists.

The results completely contradicted the original study. Not only did women fail to see benefits from ingesting protein — their legs actually felt more tired and sore.

The reason for the discrepancy — and what role estrogen plays in all this — still puzzles Rowland. In any case, the bigger lesson was obvious: excluding women from research is scientifically unsound.

The danger of using male bodies to represent all bodies became very clear once again last week when Northwestern Medicine in Chicago announced a new formula for figuring out a women’s maximum heart rate, considered a critical number in constructing an optimum workout.

The traditional formula (subtract a person’s age from 220) has led some women to experience frustration and exhaustion from workouts that should have been exhilarating, writes Tara Parker-Pope. The new formula for women, based on new research, is 206 minus 88 percent of age.

The new formula will also more accurately predict the risk of heart-related death during a stress test.

“Now we know for the first time what is normal for women, and it’s a lower peak heart rate than for men,” said Martha Gulati, MD, assistant professor of medicine and preventive medicine and a cardiologist at Northwestern Medicine and lead author of a study published June 28 in the journal Circulation. “Using the standard formula, we were more likely to tell women they had a worse prognosis than they actually did.”

“Women are not small men,” Gulati added. “There is a gender difference in exercise capacity a woman can achieve. Different physiologic responses can occur.”

Next up for Gulati: an iPhone app that will make quick calculations using the new formula.

Plus: For some historical context, the Society for Women’s Health Research provides a brief outline of efforts waged in the late 1980s and early 1990s to require that women be included in federally funded clinical research. It ended in the NIH Revitilization Act, which was signed into law in 1993.

Back in 2007, we reported on the release of a devastating report from the American Psychological Association’s Task Force on the Sexualization of Girls. Its findings about the impact of sexualized images on young women weren’t necessarily revelatory for long-time activists, but the thoroughness and precision with which it outlined the cultural crisis provided a renewed foundation of evidence and authority.

Inspired by the report, a coalition of organizations — Hardy Girls Healthy Women, TrueChild, Women’s Media Center, Hunter College and the Ms. Foundation for Women — is convening the SPARK Summit: Challenging the Sexualization of Girls and Women, on Oct. 22 at Hunter College in New York City.

The event will include “girls and media professionals, thought leaders and funders, researchers and activists” and “serve as a national call to action and campaign for change.”

You can follow the build-up to the summit on Facebook and on Twitter (@SPARKsummit). You can even help decide on the meaning of the SPARK acronym by voting on the Hardy Girls blog.

A recent collection of essays out of Australia, “Getting Real: Challenging the Sexualisation of Girls,” edited by Melinda Tankard Reist, also strikes a tone of urgency in its insistence that the problem is only increasing and activism must rise to meet it.

Noni Hazlehurst writes in the preface:

The insistent and ubiquitious presentation of this unbalanced view of the world is nothing less than a form of child abuse. Why is it we kick up such a fuss about junk food and obesity, but are unwilling or unable to tackle the lack of quality sustenance for child’s minds and spirits? [...]

In my view our children’s imaginations are dying. Their sense of themselves as worthy, strong individuals who are valued because they are unique is constantly being undermined. Only a few can withstand that sort of pressure. And very few will be in a position to be encouraged to be different, as many of today’s young parents don’t remember when there were alternative ways of looking at the world and other ways to value an individual’s noteworthiness.

Media critic Jean Kilbourne, among others, provides a rousing endorsement of “Getting Real” — and Kilbourne has just updated her landmark film series, “Killing Us Softly,” on the same subject. “Killing Us Softly 4″ can be previewed and purchased at Media Education Foundation. From the film’s description:

The film marshals a range of new print and television advertisements to lay bare a stunning pattern of damaging gender stereotypes — images and messages that too often reinforce unrealistic, and unhealthy, perceptions of beauty, perfection, and sexuality. By bringing Kilbourne’s groundbreaking analysis up to date, Killing Us Softly 4 stands to challenge a new generation of students to take advertising seriously, and to think critically about popular culture and its relationship to sexism, eating disorders, and gender violence.

Kilbourne also continually updates her definitive list of “Resources for Change” — which provides an exhaustive, clearly categorized set of links to useful reports, websites and allied organizations.

Despite the availability of all these resources and the continual, varied calls to action, however, many young women on the frontlines of this cultural crisis remain conflicted and confused, caught in an impersonal media machine. Possibly the most prominent example of this struggle is, yes, Miley Cyrus.

In his review of her latest album, “Can’t Be Tamed,” Jon Caramanica of The New York Times discusses the difficulty 17-year-old Cyrus has coming of age as a woman and an artist, negotiating her well-established Disney “Hannah Montana” identity and her need to assert her adulthood.

In her now infamous 2008 Vanity Fair photo shoot (remember the outcry — and response to the outcry?), and in the literally wild video for the title track of her new album, the seemingly inevitable sexualization of her image is well underway.

But Caramanica sees a much more hesitant and haphazard construction of identity. Instead of solidifying a new sexualized Miley, the album as a whole reveals the “frayed seams of her identity”:

Ms. Cyrus’s metamorphosis isn’t nearly as radical as “Can’t Be Tamed” — the title track, the video, the title — would suggest. Rather, she’s evolving into something far less controversial: a pop star, confused like all the rest of them.

This confusion is most clearly evident in one of the later songs:

On “Permanent December,” written with Claude Kelly — who also helped write “Party in the U.S.A.” — Ms. Cyrus tries out a sneering type of sing-rapping, à la Fergie: “Don’t call me a Lolita/’Cause I don’t let ’em through.”

On a more coherent album, that idea would be explored further. But the fact that Ms. Cyrus feels little need to assert her sexuality, or lack thereof, is consistent with her rejection of a single new identity in favor of a cluster of experiments. Perhaps she hasn’t had time to think it through, or maybe she’s realized that evading the subject for now is a more flexible strategy than tackling it head-on.

Of course, presuming that Miley’s original Disney identity didn’t involve its own form of sexualization would be naive. And I’m not just talking about the crazy Mickey Mouse underwear ads that debuted in China a couple of years ago, or the “dive in” underwear for girls that Disney wrote off as an “oversight.”

Last month, according to the Orange County Register (more here), the YWCA of Australia sought “a PG rating for tween magazines Disney Girl, Barbie Magazine and Total Girl, saying that the publications teach young girls that their bodies need to be improved upon.”

UPDATE: The New York Times reports that young fans of Miley Cyrus aren’t super thrilled with her new path. Also, see the comments for great information about the Healthy Media for Youth Act, H.R. 4925. The Girl Scouts is a strong supporter.

Judy Norsigian, executive director of Our Bodies Ourselves, and Timothy R. B. Johnson, MD, chair of the Department of Obstetrics and Gynecology at the University of Michigan and an OBOS advisory board member, have penned an op-ed in today’s Boston Globe on the high cost of medically unnecessary caesarean sections, both in terms of a mother’s health and rising medical costs:

Even though caesareans are associated with higher rates of complications than vaginal births, they are becomingly increasingly common. Problems range from infections, including the more serious antibiotic-resistant ones, to blood clots, prematurity, respiratory problems for the baby, and more complications with subsequent pregnancies. There is even a small but measurably higher risk of death for the mother.

Between 2000 and 2006, while the Massachusetts caesarean rate climbed from 16th to 10th highest among all states, the state’s ranking on neonatal mortality has slipped from 4th best to a tie for 9th. Six hospitals in the state have caesarean rates greater than 40 percent for first time mothers, yet none of these hospitals is designated as a high-risk center. So much for the argument that high-risk pregnancies are the reason for these rates.

There are also cost consequences for taxpayers — the caesarean rate for Massachusetts mothers on Medicaid is increasing at a faster pace than among privately insured mothers. Nationally, in 2008, average hospital charges for an uncomplicated caesarean section were $14,894, while such charges for an uncomplicated vaginal birth were $8,919.

In the United States, about one in three births are via c-section, and in some communities the rate is much higher.  Childbirth Connection explains the myriad conditions that have led to the increase, including: low priority of enhancing women’s own abilities to give birth; side effects of common labor interventions; refusal to offer the informed choice of vaginal birth; casual attitudes about surgery and cesarean sections in particular; limited awareness of harms that are more likely with cesarean section; providers’ fears of malpractice claims and lawsuits; and incentives to practice in a manner that is efficient for providers.

In the op-ed, Norsigian and Johnson argue that while the media often focuses on how extreme obesity can raise the risk of having a caesarean, more emphasis is needed on “system-based approaches” — steps that hospitals and obstetricians can take, such as instituting policies that restrict the induction of labor, unless there is a good medical reason, and following the new National Institute of Health recommendations to offer the option of vaginal birth after a caesarean for women who want to avoid repeat surgery.

Finally, they note, hospitals should expand access to nurse-midwifery care:

Enhancing access to midwifery care might well be the most effective approach to safely reducing the overall caesarean rate — and could lead to significant cost savings and improvement in other priority areas such as breastfeeding. It would also address the impending shortage of obstetric providers. The Legislature should pass a bill to expand access to midwifery care in Massachusetts. We must finally make midwives more central in maternity care — as do all other countries whose birth outcomes are superior to ours.

Read the full op-ed here.

Related:
* Vaginal Birth after Cesarean — What the NIH has to say

* ACOG on VBAC: In Their Own Words

Our Bodies, Our Blog is delighted to be included on Forbes magazine’s top 100 websites for women – a list of “the most dynamic, inspiring and helpful websites for women.” We were cited for educating readers on women’s health issues through “topical, newsy content.”

Meghan Casserly and Jenna Goudreau write in the intro: “To determine which sites and blogs made the cut we looked for compelling and decidedly female-oriented content, outstanding design, an active community and frequent updates. In short, sheer clickyness.”

What’s really cool is the number of feminist sites on the list, including Catalyst, Feministing, Feministe, Hello Ladies, Jezebel, Salon’s Broadsheet and Women’s eNews. It’s no surprise to us that these sites provide readers with essential news and analysis, but it’s a real delight to see a  media giant recognize their importance and reach — and to know that this list was created with the help of Forbes readers.

Update: In the excitement over being named to the Forbes list, we failed to note the fairly obvious exclusion of a variety of women’s voices. I agree completely with the response that my co-blogger, Rachel, wrote at Women’s Health News, and I’m re-posting it here:

Finally, Renee at Womanist Musings points out that that Forbes list of top 100 websites for women didn’t do much to be inclusive of women of color, trans women, women with disabilities, or other marginalized communities of women, and I think this is a fair criticism of the list, and of those of us (like me, as Our Bodies Our Blog was on it) who were included but didn’t immediately notice/point out how others were excluded or how the list was focused. It’s certainly a kind of privilege that it was an issue that was too easy for me to overlook in my “omg, we got noticed” glee, and something I should be better about.

Read Womanist Musings for the full critique and suggestions of sites that deserve notice.

An FDA advisory panel last week unanimously recommended not to approve a new drug that purports to treat hypoactive sexual desire disorder (HSDD) in women, which is defined as “low or no sexual interest to the point of distress in otherwise healthy people.”

According to Julia Johnson, the panel’s chairwoman and head of the department of obstetrics and gynecology at the University of Massachusetts Medical School, the impact of the drug flibanserin (proposed trade name: Girosa), developed by the German pharmaceutical company Boehringer Ingelheim, was “not robust enough to justify the risks.”

Indeed, this is the point many women’s health advocates have stressed all along. The flibanserin trials were considered a success by Boehringer, but the results seem less than stellar.

In a study of 1,378 premenopausal women who had been in a monogamous relationship for 10 years on average, women were randomly assigned to take 100 mg of flibanserin or a placebo daily and to record daily whether they had sex, and whether it was satisfying. Via Time magazine:

Women in the flibanserin group self-reported 2.8 sexually satisfying events in the four-week baseline period; in the final four weeks of the 24-week study period, those women reported 4.5 sexually satisfying events, a more than 50% increase. Women in the placebo group reported an increase from 2.7 events to 3.7. The difference in effect between flibanserin and the placebo — about 0.8 sexually satisfying events — was statistically significant, the drug company said, and the side effects from the drug, which included dizziness and fatigue, among others, were mild to moderate and transient.

So women taking the drug had less than one additional “sexually satisfying event” (orgasm not required) than women taking a placebo. And in the meantime, the drug caused dizziness, nausea and fatigue, particularly with long-term daily use, in some women — hardly the recipe for sexual excitement.

The FDA also considered whether the drug had increased women’s desire — a crucial element of the HSDD diagnosis, which involves low or no sexual interest to the point of distress in people who are physically healthy and not depressed — and found that the drug failed in this area.

And that’s the trickiest part. Erectile dysfunction is treated by increasing blood flow to the penis, which leads to an erection. But for women, it’s not about being physically unable to have sex — it’s that there’s little interest in sex altogether, especially troubling when one has the same long-term partner.

The construction of this as a disorder is a classic case of “disease mongering,” according to clinical psychiatrist and researcher Leonore Tiefer. The hope for a female Viagra, one pill that will “cure” women’s sexual disease, ignores the social and historical context that has a tremendous effect on female attitudes toward sex and is often part of a larger attempt to medicalize the sex lives of women.

Time magazine’s Catherine Elton interviewed Judy Norsigian, executive director of OBOS, who outlined the concern:

Attempting to treat low libido with a pill ignores the fact that many women’s level of desire is deeply affected by everyday life stress and interpersonal relationships. Add to that a cultural milieu that at once promotes shame and ignorance about women’s sexuality while wildly inflating their expectations for sex. In many cases, says Norsigian, the proper solution to a lack of sexual desire would involve a number of non-drug approaches, such as therapy, mind-body techniques and getting partners involved in the solution.

“That could be equally successful while at the same time not exposing women to the [potential] long-term adverse effects of drugs,” says Norsigian, who suggests testing drugs like flibanserin against drug-free therapies. “Moreover, the non-medication approaches often address root causes for lack of libido and thus reflect a prevention approach that is usually much wiser.”

For similar reasons, the New View Campaign has been active in opposing flibanserin, as well as previous drugs such as Intrinsa, a testosterone patch from Procter & Gamble that failed to receive FDA approval in 2004. The Campaign provides several insightful fact sheets that explain the history and side effects of flibanserin.

Particularly revealing is the fact sheet on the marketing of flibanserin [PDF], which shows how Ogilvy Public Relations, on behalf of Boehringer, has promoted HSDD as a chief cause of women’s sexual dissatisfaction — through celebrities, celebrity sexuality experts and promotional websites. Most unsettlingly, Boehringer was able to sponsor and provide editorial input for a Discovery Channel documentary — “Understanding Female Sexual Desire: The Brain Body Connection” — which has acted, in its repeated showing on TV and the web, as an infomercial for the drug.

A better film to watch would be “Orgasm Inc.: The Strange Science of Female Pleasure,” a behind-the-scenes expose of the pharmaceutical industry’s flimsy construction of female sexual dysfunction as a curable disease and the attempt to develop and market a Viagra-type solution.

by Kiki Kalkstein, Center for Health and Gender Equity (CHANGE)

Earlier this month, I attended the Women Deliver Conference in Washington, D.C ., on behalf of the Center for Health and Gender Equity (CHANGE). After a jam-packed three days of plenary sessions, chairman’s sessions, and more than 100 concurrent sessions, participants left the conference reinvigorated and ready to take action to work toward fulfilling Millennium Development Goal #5: Reduce maternal mortality and achieve universal access to reproductive health.

After speaking with hundreds of participants, one thing was made very clear to me — people not only want female condoms, but they believe that female condoms are a vital tool in decreasing maternal death, improving maternal health, and promoting sexual and reproductive health and rights.

I had countless conversations with participants from all over the world who were thrilled we were there talking about and promoting the female condom. As I shared information about the Prevention Now! Campaign (CHANGE’s initiative to increase access to existing prevention methods, especially female and male condoms), their message came through loud and clear — we want female condoms, and we want them now.

I spoke with men and women of all ages, and again and again they expressed interest in female condoms and inquired about how to increase access in their own countries. A doctor from Kenya said that women who come to his clinic consistently ask for female condoms, and he doesn’t have any to offer. A doctor from Nepal took all the information he could from our booth, and came back with his colleagues to get more. Some participants asked how they could launch a female condom program in their own countries. Female condoms are in demand.

Access to contraception is critical for preventing maternal deaths, but sometimes high-level decision makers do not make that connection. The female condom puts women in control of their own health by enabling women to delay pregnancy and space out births, all of which decrease the risk of maternal death and disability.

Effective family planning programs are not only fundamental to maternal health, they also allow women and families to better manage household and natural resources, secure education for all family members, and address each family member’s healthcare needs. Participants at Women Deliver conference acknowledged the benefits of the female condoms and recognized it as a vital tool for improving maternal health globally.

Related posts:
* Expanding the Female Condom Market
* FC2 Female Condom Available in the U.S.

Kiki Kalkstein is the program assistant at the Center for Health and Gender Equity (CHANGE). She previously designed and implemented public health education programs both domestically and internationally, including a rural community outreach program with the Uganda Village Project focused on increasing awareness around obstetric fistula. She also designed and implemented at the University of California at Berkeley “Sex and Sustainability: Reconnecting Population and Women’s Empowerment,” a campus program designed to increase awareness about unmet family planning needs in developing countries.