Posts by Judy Norsigian

January 31, 2014

Your Ad Here: Help Our Bodies Ourselves Advertise in The Boston Globe!

Boston Globe GRANT program

Can you imagine if Our Bodies Ourselves took out an ad in The Boston Globe? We could announce the launch of our new website (coming soon!) and the important work OBOS is doing to develop and promote accurate information about girls’ and women’s sexual and reproductive health!

If you’re a Boston Globe subscriber, print or digital, you can help make that ad a reality — and it won’t cost a thing.

All subscribers are being sent an email or letter — look for the silver envelope — from the Globe about its new GRANT program (Globe Readers and Non-Profits Together), which enables readers to select a group to receive free advertising in the Globe.

Please write in the name of Our Bodies Ourselves on the GRANT gift check so we can inform the public about our valuable programs in the United States and abroad. And encourage friends and family members to do the same!

Boston Globe GRANT programSeven-day newspaper subscribers’ vouchers are valued at $100; all other subscribers (including web-only readers) have been sent vouchers valued at $50. Nonprofits will be given free advertising space based on the total amount readers allocate.

The deadline for submissions is March 1, 2014. If you are a subscriber and did not get a silver envelope or have misplaced yours, please email customer service (natalie.bean@globe.com), or call the Globe (617-929-3198) to get another one.

Other questions? Here’s a FAQ for subscribers.

Thank you so much from all of us at OBOS!


January 30, 2014

“Voice Male”: New Book on the Social Transformation of Masculinity

When I first started reading Voice Male magazine some years back, I felt a strong sense of appreciation and urgency about this magazine being widely read.

Here at Our Bodies Ourselves, we have long worked with male allies who share common values and goals, but too often their work has been under the radar — both both in terms of media recognition, and visibility within women’s and community organizations that would welcome them as collaborators.

We know some tremendous work is being done around issues of masculinity and, of course, in the arena of gender-based violence. Voice Male has been at the forefront of promoting these efforts.

As my colleague Jackson Katz has written, Voice Male is for the anti-sexist men’s movement what Ms. magazine has been for the women’s movement.

Now comes the new book, “Voice Male: The Untold Story of the Profeminist Men’s Movement,” in which the magazine’s editor, Rob Okun, introduces readers to, as he puts it, “one of the most important social justice movements you’ve never heard of — the social transformation of masculinity.”

It’s a welcome addition to the canon on gender justice. Tackling a topic as comprehensive as the pro-feminist men’s movement is a daunting task, especially when we consider the movement began in the late 1970s. Okun’s approach is both inviting and instructive.

I admit I’m biased (I reviewed the book before publication and provided advance praise), but outside reviews also have been excellent. Publishers Weekly has a good write-up, and Library Journal concluded: “A very worthwhile introduction to the profeminist movement among men. It will reward both casual readers and serious students of the subject.”

Following a forward by well-known sociologist Michael Kimmel, Okun uses the first chapter to tell the story of the movement, offering compelling highlights that bring to life its rich history. And, showing his activist roots (for many years he was executive director of the Men’s Resource Center for Change in Amherst, Mass., one of the earliest men’s centers in the country), he brings the narrative into the here and now, presenting short profiles of 20 of the most effective pro-feminist men’s organizations in North America, and a few overseas.

The next 11 chapters feature around 140 essays, articles and moving first-person stories by both men and women, some famous, some not, spanning three decades of the magazine. The writing runs the gamut — boys to men, men of color, GBTQ issues, fathering, men and feminism, men’s heath, male survivors, overcoming violence, what is healthy masculinity, and manhood after the school shooting in Newtown, Conn. The book includes nearly 15 pages of resources on all of these topics, and has nearly that many pages in a comprehensive index.

“Voice Male” will be eye-opening and inspiring to students in gender studies programs, and a powerful organizing tool for activist organizations. Hopefully, too, it will find its way onto the bookshelves in homes where anyone interested in social justice lives.

Please join OBOS in getting the word out about this new resource, and get a copy for every young man in your life.


January 27, 2014

Bill Regulating Certified Professional Midwives Needs a Push

Once again, a bill that would license and regulate certified professional midwives, or CPMs, has been introduced in the Massachusetts legislature. And it’s time for the Commonwealth to join the 28 other states in this country that already have adopted such regulation.

CPMs are educated to develop hands-on expertise in the home or birth center setting. Maternity care professionals with many decades of experience as well as prominent consumer organizations are supporting this bill because they believe it will increase the safety of home birth for families choosing this option.

Among these professionals writing to the legislature are pediatricians, obstetricians, midwives and academic researchers. Below are excerpts from some of their letters:

Martha Richardson, MD, practicing obstetrician in the Boston area for 33 years: “Home birth is an option in some states and in many countries including some where the overall birth outcomes are better than in the U.S. Bringing home birth under public surveillance in Massachusetts is unlikely to worsen outcomes and could help us address our lack of reliable information.”

Robyn Churchill, former director of midwifery at Mt. Auburn Hospital: “I am a Certified Nurse Midwife with over 20 years of clinical and research experience in maternal health care. I…am now at the Harvard School of Public Health, working on a large trial of the WHO Safe Childbirth Checklist in India … My experience and research has shown that safe childbirth can occur in many settings, within a well-coordinated system, with regulation and oversight of providers.”

Lisa Paine, a certified nurse-midwife and DrPH long involved at the national level with policy development to improve health education and regulation: “For nearly 30 years I have been involved in a variety of clinical, academic and administrative roles related to maternity care, midwifery and public health … My policy and advocacy experiences are numerous and have led to several publications and testimonies, including undertakings directly relevant to my support of this legislation … these fully support House Bill 2008/Senate Bill 1081.”

In its testimony opposing this legislation, the Mass Medical Society (MMS) makes several incorrect statements. For example, it asserted that “CPMs have not adopted a set of criteria based on generally accepted medical evidence or public safety for patients who may be appropriate candidates for home birth, relying instead on the decision of the individual midwife and patient.”

This is not true. Although CPMs respect a women’s right to informed consent in childbirth (as all health professionals should do), the CPM profession, through the National Association of Certified Professional Midwives, has clearly defined professional guidelines and standards. Also, many state midwifery organizations have developed extensive practice guidelines because licensure laws were passed in their states.

One good example is New Mexico, where CPMs are regulated and licensed by the Department of Health. Extensive clinical guidelines have been developed by the state midwifery association and are enforced by the New Mexico state licensing and disciplinary authority. House Bill 2008/Senate Bill 1081 would allow Massachusetts to place similar guidelines on CPM practice here.

No state adopting the regulation and oversight of CPMs has reversed its policy. Some states — Texas, Colorado, and California, for example — have more recently reaffirmed these earlier legislative decisions.

CPMs are specifically educated to develop hands-on expertise in the home or birth center setting.  The CPM credential is overseen and certified by the same national organization that validates the CNM credential for nurse-midwives.

The Massachusetts Medical Society also states: “The curriculum, clinical skills training, and experiences of CPMs have not been approved by any authority recognized in certifying knowledge and skills associated with the practice of obstetrics, including the American Board of Obstetrics and Gynecology, the American Midwifery Certification Board (AMCB), and the American Board of Family Medicine.”

These three entities do not engage in the approval of curricula for other professionals in their fields, so this comment is not actually relevant.

The Committee on Public Health should report this bill out favorably, so it can advance to the next step in the legislative process, and eventually be released to the floor for a vote and enable the state to oversee this growing health profession. 

Failure to license CPMs will make the several hundred home births that occur in Massachusetts every year less safe by failing to create an integrated maternal health care system with enhanced collaboration among all care providers. This bill would affirm that all Massachusetts maternal health care providers are committed to practicing with state oversight and public accountability.

Please make your voice heard by contacting your legislator and by signing a petition in support of the Massachusetts Midwifery Bill, sponsored by the Massachusetts Midwives Alliance and the Massachusetts Friends of Midwives.

This article was originally posted at Cognoscenti, WBUR Boston’s ideas and opinions section, and is re-posted with permission.


December 24, 2013

Striving for Gender Equity: My Journey to Armenia

Dilijan Armenia workshop Oct 2013

Judy Norsigian and Dr. Meri Khachikyan, coordinator of the Armenian edition of “Our Bodies, Ourselves,” present organizers with copies of the book.

Looking back on 2013, one of the highlights for me was a trip to Armenia where I spoke about gender equity and witnessed a dozen young women organizing around the lack of sexuality education in their community.

I was a featured speaker at a discussion on “Promoting Gender Equity and Breaking Gender Stereotypes,” hosted by the American University of Armenia (AUA), the Women’s Support Center in Yerevan, and the Armenian International Women’s Association. Dr. Bruce Boghosian, AUA president, and Dr. Meri Khachikyan, coordinator of the Armenian “Our Bodies, Ourselves” translation/adaptation project, attended, along with students, faculty, Peace Corps volunteers, and NGO staff and directors,

Domestic violence is a major concern in this small country — as it is in all of the countries where OBOS has global partners. As part of OBOS’s efforts to encourage men’s engagement in violence prevention, we connected a young man on the AUA panel with staff at Jane Doe Inc., the Massachusetts Coalition Against Sexual Assault and Domestic Violence, which provided him with slides about the role men can play in stopping violence.

Another concern addressed by panelists was the growing problem of sex-selective abortion in Armenia (also common in the neighboring countries of Georgia and Azerbaijan). Approximately 115 boys are born for every 100 girls; only China has a more skewed rate.

Following the AUA event, I attended several meetings with members of groups involved in the Coalition to Stop Violence Against Women in Armenia. In a country where government officials and church leaders have at times endorsed or congratulated those committing homophobic and sexist acts of violence, these courageous activists have been known to disrupt high-level meetings to draw attention to women’s and LGBT rights in Armenia.

I also traveled to rural Dilijan with Dr. Khachikyan, where I witnessed the initial organizing efforts of about a dozen young women (and one young man) concerned about the lack of sexuality education in their conservative community. They came up with several excellent ideas about meeting venues that would be safe spaces for young women, as well as ideas for outreach via social media, and were ready to take on problematic cultural practices.

For example, many parents of young women still do a “check the bed for blood” test after a newly married couple spends its first night together, looking for signs their daughter remained a virgin before marriage. If they find blood, they take a basket of red apples to the groom’s parents to acknowledge the young woman’s “purity.” Plastic surgeons now do a brisk business with hymen reconstruction in many parts of the country, even though this is technically illegal.

Despite the numerous issues women face in Armenia, the intergenerational advocacy and critical support provided by a number of European and American funders contribute to the continued growth of a grassroots movement that will improve the health and well-being of women and girls.

Before leaving, Dr. Khachikyan presented each of the young organizers with their own copy of the latest Armenian edition of “Our Bodies, Ourselves.” I was moved by their enthusiasm — as I have been so many times when talking with women about how the book changed their lives.

Plus: Earlier this year, Taleen K. Moughamian, a women’s health nurse practitioner in Philadelphia, wrote about her experience providing health services in Armenia. Learn more about OBOS’s partner in Armenia, “For Family and Health” Pan Armenian Association (PAFHA), and efforts to adapt and distribute women’s health information based on “Our Bodies, Ourselves.” The preface to the Armenian edition is available in English.


May 20, 2013

“Educate Congress” Accomplished: Every Member Now Has a Copy of “Our Bodies, Ourselves”

Our Bodies, Ourselves Goes to Washington

Every member of Congress has pages of accurate information on women’s health at their fingertips – more than 900 pages to be exact – now that they have the latest edition of “Our Bodies, Ourselves.”

Thanks to supporters of OBOS’s Educate Congress campaign – inspired by a road trip to deliver “Our Bodies, Ourselves” to then-Rep. Todd Akin – we hand-delivered or mailed the newest edition and a letter signed by prominent health policy experts to all members of the U.S. House and Senate.

Educate Congress launched with a simple premise: Everyone deserves access to accurate information concerning women’s reproductive and sexual health – especially those who write the laws.

Deliveries began Feb. 28, when I spent the day meeting with members on Capitol Hill. It was the day that the House finally passed the Violence Against Women Act, which made the trip particularly poignant.

Joining me were Christy Turlington Burns, founder of Every Mother Counts (EMC), and Erin Thornton, EMC executive director. We collaborated on scheduling and delivered EMC materials along with “Our Bodies, Ourselves,” including a special petition for women members of Congress congratulating them on their leadership role and asking them to affirm support of policies that protect the health and well-being of girls and women around the world, especially those that will reduce infant and maternal mortality rates.

Two National Women’s Health Network (NWHN) interns, Alysson Reddy and Grace Adofoli, provided invaluable logistics support and shoulder-bag transport of the rather hefty copies of “Our Bodies, Ourselves.” We received warm receptions not only from those who know the book and OBOS’s work, but also from members who want to be better prepared to address key reproductive health concerns.

Our first meeting was with Rep. Jim McGovern (MA), a consistent advocate of evidence-based policies. Christy and Erin presented a copy of EMC’s excellent documentary about maternal mortality, “No Woman, No Cry.”

Alysson and Grace helped me walk the corridors of three House office buildings in record time, with stops in the offices of Representatives Adam Kinzinger (IL), Steven Horsford (NV), Gary Peters (MI), Kay Granger (TX), Betty McCollum (MN), Chellie Pingree (ME), Michael Capuano (MA), Marsha Blackburn (TN), James Clyburn (SC), Jackie Speier (CA), Nita Lowey (NY), Anne Kirkpatrick (AZ), Joseph Kennedy (MA), and Cheri Bustos (IL).

The day ended on the Senate side, with visits to Senators Jeanne Shaheen (NH) and Elizabeth Warren (MA). Diana Zuckerman, president of the National Research Center for Women and Families (NRCWF), joined me in discussing women’s health with Sen. Warren and her chief of staff, Mindy Myers.

Time was running short, so Allyson and Grace returned later that week to deliver books and letters to Senators Mitch McConnell (KY), Rob Portman (OH), Carl Levin (MI), Mark Begich (AK) Charles Grassley (IA), Pat Toomey (PA), Jeff Flake (AZ), and Christopher Coons (DE).

OBOS has already received personal thank-you notes from several members of Congress who indicated that the book will be a useful resource. We’re confident it will be of value to staff members working on policy issues.

If you visit the D.C. office of your representative or senator in the coming months, let us know if you get a chance to ask about how “Our Bodies, Ourselves” might have been referenced. Establishing sound, science-based policy about reproductive health is no easy feat, but it will be all the more likely if each of us finds ways to promote this goal.

OBOS will continue to monitor where information interventions are needed. Please help fund our efforts to send books to state legislators, educational leaders, and other public officials.

* * *
Photo, clockwise: EMC’s Erin Thornton and Christy Turlington Burns, Rep. Gary Peters, OBOS’s Judy Norsigian, and NWNH interns Alysson Reddy and Grace Adofoli; Judy and Christy with Sen. Jeanne Shaheen; Judy, Sen. Elizabeth Warren and NRCWF’s Diana Zuckerman; Rep. Chellie Pingree; Judy and Christy with Rep. Jim McGovern (center). 


May 17, 2013

Angelina Jolie, Breast Cancer, and You: How to Make the Right Decisions for YOUR Health

Angelina Jolie on the cover of Time magazineAngelina Jolie certainly has good intentions in sharing her experience with breast cancer genetic testing and her decision to have a prophylactic mastectomy, and her announcement marks another welcomed example of well-known women coming forward about personal health issues.

But it is now up to women’s health advocates to ensure that the media coverage and public debate that follows does not offer false information or false hope — which I fear it will, if women are not fully informed about all the issues involved before imagining that Jolie’s decisions would be the right ones for them.

Already, women in the United States undergo a higher rate of mastectomies than women in other countries. “Breast cancer experts believe that many women undergoing mastectomies don’t need them and are getting them out of fear, not because of the real risks,” Diana Zuckerman, president of both the National Research Center for Women and Families and the Cancer Prevention and Treatment Fund, wrote this week.

First, women need to remember that BRCA1 and BRCA2 mutations occur in less than 1 percent of the population. To decide whether testing for breast cancer genetic mutations makes sense for them, it is important to speak with a knowledgeable health care provider. According to the National Cancer Institute:

The likelihood that a breast and/or ovarian cancer is associated with a harmful mutation in BRCA1 or BRCA2 is highest in families with a history of multiple cases of breast cancer, cases of both breast and ovarian cancer, one or more family members with two primary cancers (original tumors that develop at different sites in the body), or an Ashkenazi (Central and Eastern European) Jewish background. However, not every woman in such families carries a harmful BRCA1 or BRCA2 mutation, and not every cancer in such families is linked to a harmful mutation in one of these genes. Furthermore, not every woman who has a harmful BRCA1 or BRCA2 mutation will develop breast and/or ovarian cancer.

The steep price tag of testing, around $3,300, is of concern, though some women considered appropriate candidates for testing may be covered, all or in part, through their insurance. Under the Affordable Care Act, genetic counseling and BRCA testing, if appropriate, are considered preventive services and are covered without cost-sharing.

If a woman does seek testing, she needs to consider the pros and cons of all possible approaches to positive test results. While a bilateral mastectomy reduces the risk of getting the disease by 90 percent, about 10 out of 100 women who have their breasts removed will still get breast cancer in the underlying tissue. And there are numerous potential problems with such surgery that need to be fully discussed, such as infection and mobility impairment.

For those who choose this radical surgery, there is also the decision about whether to pursue breast reconstruction and, if so, what kind. Despite widespread assumptions to the contrary, there are major unresolved safety issues, especially for silicone breast implants.

Some women choose to forgo reconstruction entirely, though most media fail to mention this. The truth is, some women have no problems with their “breastless” bodies, nor do their sexual/intimate partners. Some women also find that modern prostheses are comfortable and offer a satisfying appearance.

Moreover, not all choices — even what might be ideal in a given circumstance — will be possible given financial constraints and lack of adequate medical coverage or support. As Cheryl Lemus, managing editor of Nursing Clio, a blog on gender and medicine, writes:

In order for all women to have the right to red carpet healthcare [...] then all women don’t just need money and insurance, but also the other resources Jolie highlighted in her op-ed, which include the supportive partner/spouse, family, an understanding employer, reliable transportation and childcare, and “time” in general.

Sadly, we know this is often not the case.

We also need to be honest about what we know and don’t know about breast cancer and risk. According to the NCI, women who have inherited a harmful mutation in BRCA1 or BRCA2 gene are approximately five times more likely to develop breast cancer than women who do not carry the mutation.

The way the numbers break down, about 12 percent of the general population — or about 120 women out of 1,000 — will develop breast cancer at some point during their lives, compared with about 60 percent — 600 out of 1,000 — who have inherited a harmful BRCA1 or BRCA2 gene mutation.

Yet there are other factors, such as environmental exposure, that influence breast cancer risk. Some women living in communities with high levels of toxic exposure may have elevated breast cancer risk for a non-heritable reason.

The NCI also notes that the risk factor for those carrying the mutated gene is based on research on large families in which many individuals have been affected by cancer. We still have many questions to answer about genetic and environmental influence:

Because family members share a proportion of their genes and, often, their environment, it is possible that the large number of cancer cases seen in these families may be due in part to other genetic or environmental factors. Therefore, risk estimates that are based on families with many affected members may not accurately reflect the levels of risk for BRCA1 and BRCA2 mutation carriers in the general population. In addition, no data are available from long-term studies of the general population comparing cancer risk in women who have harmful BRCA1 or BRCA2 mutations with women who do not have such mutations. Therefore, the percentages given above are estimates that may change as more data become available.

This heightened interest in breast cancer genetic testing caused an uptick in the stock of Myriad Genetics, which has a monopoly on BRCA1 and 2 testing. OBOS is a co-plaintiff in the lawsuit challenging Myriad Genetic’s patenting of human genes, along with the ACLUBreast Cancer Action, a number of scientific organizations and researchers, and Lisbeth Ceriani, a single mother whose circumstances led her to seek breast cancer genetic testing and who felt stymied by Myriad’s monopoly.

The Supreme Court heard arguments in the case last month and is expected to issue a ruling this summer. Its decision will have a major impact on whether or not scientists will be able to improve upon the current test as well as the future price tag for such testing. In the meantime, let’s hope that thousands of women don’t make hasty decisions about testing and treatment without careful consideration of all the issues involved.

As Zuckerman writes:

As an actress whose appeal has focused on her beauty, surgically removing both her breasts when she didn’t have cancer was a very gutsy thing to do. But if we care about women’s health, we need to stop thinking of mastectomy as the “brave” choice and understand that the risks and benefits of mastectomy are different for every woman with cancer or the risk of cancer. In breast cancer, any reasonable treatment choice is the brave choice.


December 13, 2012

Our Bodies Ourselves Goes to Nepal: Women’s Health Activists Discuss Cross-Border Surrogacy

Women in Udaipur, eastern Nepal with WOREC founder Dr. Renu Rajbhandari (far left) and the OBOS Nepali booklets to which they contributed. Photo / Judy Norsigian

In early October, I had the honor of co-leading a workshop in Kathmandu on the growing popularity of cross-border surrogacy arrangements with two colleagues from the New Delhi-based Sama Resource Group for Women and Health and Dr. Renu Rajbhandari, founder of the Women’s Rehabilitation Centre (WOREC).

Already a booming business in India, where estimates suggest that 25,000 couples a year travel to arrange surrogacy contracts and there are about 1,000 surrogacy centers, this practice is soon expected to extend to Nepal, where poor women with limited economic opportunities will likely be attracted by the prospect of earning money by bearing children for others.

In some parts of India, women are now offered fees ranging from $5,000 to $7,000, amounts that represent up to 10 years of earnings for people in rural areas.

The workshop, hosted by WOREC, OBOS’s global partner in Nepal, brought together women’s right activists from across the country to better understand the growing market in cross-border reproductive health care, its implications for Nepal, and the most effective strategies to educate and empower women.

Surrogacy Legislation in India
Participants included two nurses from the Kathmandu-based IUI (intrauterine insemination) clinic, several health counselors, a psychosocial counselor for women with fistulas, a family planning coordinator, the editor of a quarterly women’s magazine, several members of Women’s Human Rights Defenders, a nursing professor, an advocate with Save the Children, and a staff person from a rural women’s radio station in eastern Nepal. Languages used during the workshop were primarily Hindi and Nepali, with English translation offered as needed.

Sarojini and Preeti, our colleagues at Sama, provided an excellent overview of surrogacy in India, including a description of assisted reproductive technology (ART) legislation now being hotly debated in Parliament. One provision in the controversial bill would require that a woman entering into a contract surrogacy agreement undergo an embryo transfer rather than be inseminated with the intended father’s sperm.

Since insemination would be much safer, many workshop participants felt that a choice should be offered. An embryo transfer places the woman at greater risk by exposing her to powerful hormones that prepare her body for the pregnancy and to surgical procedures required to physically transplant the embryo into her uterus.

The proposed law assumes that a woman using her own eggs will be more likely to change her mind at birth and decide she wants to keep the baby than a woman who becomes pregnant with an embryo created with another woman’s eggs. There is poor evidence to support this assumption.

Participants at the Kathmandu workshop on cross-border surrogacy arrangements.

Preparation in Nepal
By their very nature, commercial surrogacy arrangements are created by contracting couples and agencies whose primary interests typically do not reflect the needs and concerns of women recruited as gestational mothers.

This is why groups like Sama and WOREC are advocating for public policies that will protect gestational mothers and ensure they receive evidence-based information about risks and benefits in a manner they fully understand. Policies must also ensure follow-up care and effective recourse if things go wrong.

The women at the workshop want to be better prepared in case a similar bill is introduced in Nepal. Sarojini, Preeti and I shared practical information about the various ART techniques involved in surrogacy and explored, with our Nepali colleagues, ways to preserve the health and rights of women agreeing to be surrogates. Most participants were quite unfamiliar with the whole topic of ARTs and asked many questions about the medical, social and economic impacts.

Why Language Matters
We also screened two documentary films about surrogacy – Made in India, by New York City-based filmmakers Vaishali Sinha and Rebecca Haimowitz, and Would Like to See Baby Bump Please, a new film just released in India by Sama — and discussed the importance of using language sensitive to all the parties involved in a surrogacy arrangement.

For example, the term “reproductive tourism” carries the image of couples vacationing in their pursuit of parenthood. In most cases, these trips are stressful and a far cry from the typical tourist experience. Using alternative language such as “cross-border commercial surrogacy” is one way to avoid such innuendo.

Similarly, referring to a gestational mother as a “surrogate mother” or “gestational carrier” can belittle and objectify her central role as the woman carrying a pregnancy for nine months and then giving birth. Many at the workshop preferred the descriptive, less diminishing term “gestational mother.”

At the end of the workshop, we developed a number of recommendations for moving forward.

Meeting Local Activists
After the workshop, I traveled with Renu to Udaipur in eastern Nepal, where she introduced me to many younger women at the WOREC center, including some who contributed to WOREC’s set of six Nepali health booklets, recently adapted from Our Bodies, Ourselves.

I also visited a group of young women who are the sole staff for a radio station in Udaipur, where egg cartons provide the sound proofing in their recording studio. They frequently address women’s health topics in their programming and invite community conversations about sexuality, domestic violence and the environment.

Although I had met Renu briefly when she traveled to Boston for OBOS’s 40th anniversary symposium in 2011, the many hours of chatting while we drove over mountainous terrain cemented a special friendship I now treasure. I have a new appreciation of her remarkable leadership over the past several decades and was deeply impressed by her efforts to pass the torch to a younger generation.

A trip to a fairly remote mountain village was particularly inspiring. The women had successfully lobbied for village development council funds to create a small multipurpose women’s center. Though a bit run-down, it was getting a lot of use and clearly a sign of how effective some women’s groups have been over the past decade.

The provisional constitution for the country still has not passed, but its contents – including funding for legal abortion – offer great hope for the future of women’s reproductive rights and justice in Nepal.

This article was originally published in the winter 2012/2013 Our Bodies Ourselves newsletter. View the full newsletter.


December 12, 2012

Do Screening Mammograms Do More Harm Than Good?

A sweeping U.S. study published on Nov. 22, 2012 in the New England Journal of Medicine shows that mammograms have done surprisingly little to catch deadly cancers before they spread. At the same time, they have led more than a million women to be treated for growths that never would have threatened their lives. 

Women over 40 are routinely advised to have yearly mammograms, and it’s widely believed that having one is key to protecting a woman’s health.

Although experts agree that diagnostic mammograms are beneficial (cases where there is a breast lump or other symptoms), there is much controversy about screening mammograms, which are performed on women with no signs of cancer. Mammograms detect breast cancer, although many people believe mistakenly that they prevent breast cancer. We now know that the mortality benefits remain quite small.

Eight trials performed in the United States, Canada and Europe have evaluated the ability of screening mammograms to decrease the death rate from breast cancer, as well as overall mortality. Looking at the overall death rate, not just death from breast cancer, is essential, because this approach also evaluates whether the screening test and any subsequent treatment may be causing other harms.

Overall, the early studies showed a 30 percent reduction in the risk of dying from breast cancer in women who were screened by mammography. In 2001, a critical review of all eight trials by the Cochrane Collaboration found that six of them were sufficiently flawed to invalidate their results. The Cochrane Collaboration then pooled the results of the two remaining studies and found no evidence to support the use of screening mammography.

The U.S. Preventive Services Task Force (USPSTF) evaluated the trials also. Although recognizing many of the same flaws, the USPSTF felt only one trial was sufficiently flawed to be invalidated. They pooled the results of the remaining trials and found a 16 percent reduction in the risk of dying of breast cancer in the women in the screened group.

The meta-analysis published in 2006 by the Cochrane Collaboration confirmed that screening does slightly reduce breast cancer mortality, but that it also leads to over-diagnosis and overtreatment of breast cancer. They concluded:

(F)or every 2000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm.

In a recent issue of the New England Journal of Medicine, Dr. Archie Bleyer and Dr. Gilbert Welch summarized the latest analyses as follows:

Despite substantial increases in the number of cases of early-stage breast cancer detected, screening mammography has only marginally reduced the rate at which women present with advanced cancer.

And this is the key to meaningful breast cancer screening — that we reduce the rate at which women have to be treated for late stage cancer.

When the data for women under 40 were studied (these are women who generally don’t get regular mammograms), Dr. Welch and Bleyer wrote:

There was a larger relative reduction in mortality among women who were not exposed to screening mammography than among those who were exposed. We are left to conclude, as others have, that the good news in breast cancer — decreasing mortality — must largely be the result of improved treatment, not screening.

Dr. Susan Love, a long time clinician and researcher, would like to see less emphasis on screening and more focus on cancer prevention and treatment for the most aggressive cancers. (Roughly 15 percent to 20 percent of breast cancers are deadly.)

“There are still 40,000 women dying every year,” Dr. Love notes. “Even with screening, the bad cancers are still bad.”

As Donald Berry, a biostatistician at M.D. Anderson Cancer Center in Houston, has pointed out:

Most breast cancers are not lethal, however found. Screening mammograms preferentially find cancers that are slowly growing, and those are the ones that are seldom deadly. Getting something noxious out of the body as soon as possible leads women to think screening saved their lives. That is most unlikely.

The challenge now is to make more widespread the use of techniques that help clinicians identify biological markers that will distinguish between the lethal and benign types of tumors. This appears to be the next big advance in reducing mortality from breast cancer.

Mammography, like other detection tools, is imperfect (it misses about 20 percent of lumps due to dense breasts and other factors). Some would consider it a very weak detection tool, and given the harms of overtreatment (for example, unnecessary chemotherapy and radiation treatments), it is not surprising that some women will want to forego screening mammography.

Women need to carefully consider these factors and decide for themselves what would be best, although friends, caregivers, and even commercial interests may tell them that having routine mammograms is the only rational choice. What really helps is knowledgeable and supportive counseling.

This article was originally posted at Cognoscenti, WBUR Boston’s ideas and opinions section, and is re-posted with permission.


February 3, 2012

Now, About Planned Parenthood and the Bishops …

by Ellen Shaffer and Judy Norsigian

This week, we all learned a lot about Susan G. Komen for the Cure, and Planned Parenthood, and breast cancer. Now that Komen has caved (sort of; Planned Parenthood’s response), we might start to learn what it will take to mobilize an outcry to really stop the attacks on women’s health.

As Komen was committing a huge PR failure, it became clear via Facebook, Twitter and a new Tumblr site, Planned Parenthood Saved Me, that many women value and rely on Planned Parenthood for breast cancer exams and other preventive health services. A slam-dunk week for Planned Parenthood.

We need to make it a slam-dunk month. What Komen, and the evangelicals, and Republican Rep. Cliff Stearns, who launched the pointless political inquiry, and the U.S. Conference of Catholic Bishops are really mad at Planned Parenthood about is this:

Part of what they do is help people plan. Parenthood. You know. They support birth control. In some cases, they provide it. Like your corner drugstore, but better.

And this week, the bishops are howling about it because the Obama administration refused to grant a broad religious exemption to contraception coverage.

Never mind that virtually all Catholics use birth control, that the Church itself only began to oppose it in 1968, that the Pope recently conceded that condoms are useful, and approved condom use for stopping the transmission of AIDS.

Never mind that most Catholic-affiliated hospitals, schools and charities cover birth control in their health plans — health plans that come out of the wages employees earn themselves.

Never mind that undergraduate and graduate students are fighting for coverage — and are still being denied, even for medical reasons.

Close to every cent the Church has not spent settling lawsuits against priests who sexually molested children has gone into this week’s media campaign to rile up opposition to covering birth control.

So far they’re doing a pretty effective job of it. The Obama administration is standing firm, but Congress is still on the warpath.

You can send a message that you stand against attacks on birth control and with Planned Parenthood. The organization just launched a TV ad campaign in support of contraception coverage (watch below).

And learn more about the men behind the war on women. They’re not going away anytime soon.

Ellen Shaffer is co-director of the Trust Women/Silver Ribbon Campaign, a project of the Center for Policy Analysis. Judy Norsigian is co-founder and executive director of Our Bodies Ourselves.


November 3, 2011

Finally, Some Consensus on Home Birth: The Nine Statements of Agreement

At an historic Home Birth Consensus Summit in Virginia last month on “The Future of Home Birth in the United States: Addressing Shared Responsibility,” a group of 68 national and international experts developed nine key common ground statements that provide a foundation for continued dialogue and collaboration across sectors in the maternity care field.

The statements were posted this week at homebirthsummit.org, along with comment about the scope and context of the meeting. The site also includes information about why the summit was necessary and the process involved in reaching consensus. Action plans relating to these statements will be posted soon.

As one of the participants in the three-day summit, I was impressed with our collective commitment — despite different perspectives and areas of disagreement about out-of-hospital birth — to a common goal of improving maternal and newborn care for families choosing to give birth at home or in freestanding birth centers.

Mark Sloan, a pediatrician and writer who attended the summit, briefly explains the history of home birth in United States, offering context for why the summit marks a significant moment: “The representatives of all the major midwifery organizations — MANA (Midwives Alliance of North America) and ACNM (American College of Nurse-Midwives) — as well as ACOG (American College of Obstetricians and Gynecologists), FIGO (International Federation of Gynecology and Obstetrics), and the AAP (American Academy of Pediatrics) sat together in the same room to discuss home birth for probably the first time in history.”

One of the agreed-upon statements emphasized our belief that “collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.”

The ninth and last statement reads: “We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.”

Other statements address improving the current liability system, the licensure of maternity care professionals, increased participation by consumers in multi-stakeholder initiatives, and the creation of an equitable maternity care system without disparities in access, delivery of care, or outcomes. See below for the full list.

The remarkable collegiality and constructive dialogue among the stakeholders present enabled the group to develop these nine core principles as well as commit to a variety of future collaborations. This is an important first step towards achieving improved outcomes for childbearing women and their families in this country.

As Saraswathi Vedam, director of the Division of Midwifery at the University of British Columbia and chair of the Home Birth Consensus Summit Steering Committee, noted: “When you have an issue as controversial as home birth, there are always going to be differences of opinion among various types of providers, policy-makers and even among consumers. But all of us recognize that for women who choose home birth, it’s our shared responsibility to work toward policies that will make that choice as safe as possible.”

Summit participants included obstetricians, family physicians and midwives, non-professionals serving in advocacy roles, insurers, attorneys, ethicists, administrators, policy makers, researchers, and others with expertise in epidemiology, public health, midwifery, obstetrics, pediatrics, nursing, sociology, medical anthropology, law, and health policy research.

We invite your comments on the statements below.

STATEMENT 1
We uphold the autonomy of all childbearing women.

All childbearing women, in all maternity care settings, should receive respectful, woman-centered care. This care should include opportunities for a shared decision-making process to help each woman make the choices that are right for her. Shared decision making includes mutual sharing of information about benefits and harms of the range of care options, respect for the woman’s autonomy to make decisions in accordance with her values and preferences, and freedom from coercion or punishment for her choices.

STATEMENT 2
We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.

STATEMENT 3
We are committed to an equitable maternity care system without disparities in access, delivery of care, or outcomes. This system provides culturally appropriate and affordable care in all settings, in a manner that is acceptable to all communities.

We are committed to an equitable educational system without disparities in access to affordable, culturally appropriate, and acceptable maternity care provider education for all communities.

STATEMENT 4
It is our goal that all health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice.

We believe that guidelines should:

allow for independent practice
facilitate communication between providers and across care settings
encourage professional responsibility and accountability, and
include mechanisms for risk assessment.

STATEMENT 5
We believe that increased participation by consumers in multi-stakeholder initiatives is essential to improving maternity care, including the development of high quality home birth services within an integrated maternity care system.

STATEMENT 6
Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings.

To achieve this, we believe that all health professional students and practitioners who are involved in maternity and newborn care must learn about each other’s disciplines, and about maternity and health care in all settings.

STATEMENT 7
We are committed to improving the current medical liability system, which fails to justly serve society, families, and health care providers and contributes to:

inadequate resources to support birth injured children and mothers;
unsustainable healthcare and litigation costs paid by all;
a hostile healthcare work environment;
inadequate access to home birth and birth center birth within an integrated health care system, and;
restricted choices in pregnancy and birth.

STATEMENT 8
We envision a compulsory process for the collection of patient (individual) level data on key process and outcome measures in all birth settings. These data would be linked to other data systems, used to inform quality improvement, and would thus enhance the evidence basis for care.

STATEMENT 9
We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.


November 5, 2010

Share Your Story: What Have You Learned About Your Body from a Women’s Health Nurse-Practitioner Or Other OB-GYN Clinician?

Our Bodies Ourselves recently received a wonderful picture of pre-teen girls watching one of their moms get a pelvic exam, complete with mirror and flashlight, along with a note about how the nurse-practitioner conducting the exam explained everything that was being done in simple, straightforward language.

As a way to underscore how much young women across the country are able to learn about their bodies through such critically important show-and-tell learning, we are inviting women to share with us (anonymously is fine) stories of how nurse-practitioners and other ob-gyn clinicians (including nurse-midwives, family physicians and obstetrician-gynecologists) have taken the time to teach them more about their bodies through use of speculums (some with flashlights built in!) and mirrors, participation in the “whiff” tests, and other approaches that directly engage women in the learning process.

In an era where the “yuck” factor is used to inappropriately encourage risky douching practices and use of scent-filled vaginal products that may be harmful to overall vaginal health, it is important to remember how valuable this kind of education during a clinical pelvic exam can be.

Moreover, clinicians who incorporate these recommended educational practices are helping to offset a conservative trend toward restricting information about women’s reproductive and sexual health. Access to books like “Our Bodies, Ourselves” is denied in some schools and libraries; self-knowledge is considered shameful or even dangerous.

Please share with us your stories as clinicians who provide such exams or as women who may have benefited from them. You can either add your story in the comments below, or email office@bwhbc.org. And feel free to share and re-post this call

We plan to post these anonymously on the Our Bodies Ourselves website so that young women will be encouraged to respond with a “Yes” the next time their ob-gyn clinician might offer them the option of seeing their own cervix or learning more about their vaginal secretions.

We would also welcome emails and letters from ob-gyn clinicians who might be able to cite articles in the medical literature that point to the benefits of this kind of education. Our mailing address is available here.

Thank you for taking part in this discussion!


July 28, 2010

Live in Massachusetts? Support Midwives? Call Your Legislator Today

If you’re in Massachusetts, please ask your state representative to urge House Speaker Robert DeLeo to bring an important midwifery bill to a vote. Text of the bill — House 4810: An Act Relative to Certified Professional Midwives and Enhancing the Practice of Nurse-Midwives – can be found here.

The bill was just released from the House Policy and Steering Committee and is now in Third Reading, chaired by Rep. Vincent Pedone of Worcester.  The legislative session closes on Saturday, July 31. If it’s not voted on by then, the bill would die and have to be reintroduced in the next legislative session.

If you’re able to discuss the bill with your legislator or a staff member, please be aware that some legislators have misinformation about the midwifery bill’s content, especially regarding the items below. Here’s some background:

1. The Massachusetts Medical Society strongly objects to CNMs functioning without direct MD supervision, yet has articulated no sound basis for this objection. Nationally, ACOG already supports the elimination of direct supervision of CNMs by physicians, acknowledging that it is not required for safe practice, and 44 other states no longer have such requirements.

2. Some legislators incorrectly think that the bill would provide new prescription-writing privileges for nurse-midwives — this is not really the case. Nurse-midwives already have prescription-writing privileges but can now exercise these privileges only if an MD is technically providing supervision, which amounts merely to a review of sample prescriptions on a quarterly basis.

Because of hospital accrediting rules, this clause prevents CNMs from admitting patients in labor under the midwives’ own names; prevents CNMs from serving on hospital committees that determine maternity care policies; and bars them from control of their own practice environment. This undermines the ability of CNMs to provide the most effective care. (CNMs already have independent prescription authority in most other states, including New Mexico, New Hampshire, Washington, Arkansas and Oregon, and the District of Washington.)

3. Although the legislation has already been rewritten to accommodate concerns about the age at which a midwife could begin training (it was changed from 18 to 21), legislators are still being misled about this fact. There are, by the way, no such age requirements that we have been able to find in the Massachusetts statutes with respect to the education of nurses.

4. Another objection is that the bill does not require a midwife to carry malpractice insurance. In almost all states, malpractice insurance is not required by statute, and it would be unfair to single out one professional group in this regard. Some would argue that such a requirement would violate equal protection clauses.

Because the “risk pool” of homebirth midwives across the country is small, malpractice insurance has never been available for homebirth midwives, despite the concerted efforts of national and local organizations over several decades. Requiring CPMs to adhere to a standard that is impossible is another mechanism to restrain trade and prevent access to home birth midwives.

Childbearing women who want to be protected by malpractice insurance have the option of delivery in facilities, where such insurance coverage is required. Moreover, the Massachusetts legislature could follow a few other states in making disclosure of this absence of malpractice insurance coverage part of a required informed consent procedure. The malpractice insurance issue is not a credible objection to this bill.

Please share this news, and thanks for taking the time to take action on this important piece of legislation!


October 6, 2009

Support OBOS: Know an Employer in Massachussetts Interested in Charitable Giving?

As an Our Bodies, Our Blog reader, you know that the specific interests of women and health are intricately connected to broader issues of social change. For just this reason, OBOS has been a proud, longtime member of Community Works, a cooperative fundraising effort involving more than 30 Massachussetts social justice organizations.

Community Works is currently offering a special incentive that I wanted to share with our Massachusetts friends. You might be able to directly support OBOS’s work without even making a donation yourself.

community_worksCommunity Works receives donations largely through the convenience of payroll deductions at 52 private, public and nonprofit employers in the greater Boston area, representing more than120,000 employees. Such payroll deduction contributions to Community Works help to support the work of member organizations such as OBOS.

Any member group that enlists a new workplace that will offer Community Works as one of its employee charitable giving options will receive half of the proceeds of the first year’s campaign. So if you help OBOS enlist a new employer, you will help raise valuable funds for OBOS in the coming year.

The set-up is simple: Visit the Community Works website to see where campaigns are already underway. Then contact your friends in workplaces that don’t already offer Community Works as a charitable option. If you know anyone who can help bring Community Works to their workplace, please email me: judy (at) bwhbc (dot) org

If we are successful in securing the workplace you suggest, OBOS co-founders (myself included) will send inscribed copies of any of OBOS’s books to the person or institution of your choice.

This is a wonderful opportunity for those of you who value what OBOS does to provide concrete support to both our organization and the other social change groups that are part of Community Works. Whether working to address environmental justice, sexual assault, youth and community violence or health care access, each Community Works member operates within a framework of equality, justice and peace.

Remember, it takes a village and more to sustain the work of public interest organizations like ours. Take a look at the current employer partner list and let us know who’s missing. Your help with this effort is much appreciated!

Judy Norsigian is executive director of Our Bodies Ourselves.


August 26, 2009

Remembering Senator Kennedy’s Work on Behalf of All

It is with heavy heart that so many of us receive the news of Sen. Ted Kennedy’s death. Although I have been anticipating this moment for weeks now, the reality is still such a shock.

I know that for so many women’s health activists, Kennedy’s passing will only strengthen our resolve to continue his valiant fight for meaningful health care reform. I have started writing letters to several more liberal Republicans, beseeching them to honor his memory by breaking ranks with the Republican Party and its current efforts to eliminate the public health insurance option from any bill coming out of Congress.

As a tribute to this tireless advocate for the millions who had no political power, each of us can think of one gesture we can carry out in the coming weeks.

In 2002, I testified before the Senate HELP Committee on the topic of somatic cell nuclear transfer (which involves creating cloned human embryos to serve as a source of embryonic stem cells for scientific research; it poses health risks for women who provide eggs for such research). Kennedy, who was co-chairing that particular HELP Committee hearing, was ever so gracious, even though I knew he did not agree with the position of Our Bodies Ourselves at that time.

And when my late husband, Irving Kenneth Zola, died in 1994, shortly after he was appointed to the National Council on Disability, Kennedy’s remarks at a special memorial service for Irv in Washington, D.C., brought tears to everyone’s eyes. His compassion, tenacity and commitment to the needs of all remain an inspiration to me both personally and professionally.

We will miss you terribly, Ted, and we will all fight even harder for the causes you championed for more decades than some of us have even been alive.

Judy Norsigian is executive director of Our Bodies Ourselves.


June 3, 2009

Support & Honor Women’s Health Care Providers and the George Tiller Memorial Fund

Dr. George Tiller’s murder offers us all an opportunity to reflect upon and honor the work of so many women’s health care professionals who continue to offer abortion services despite ongoing threats to themselves and their families.

That such a kind and dedicated human being could be attacked and killed like this sends all of us reeling once again. How is it that those who purport to care about life can spew forth the kind of hateful rhetoric that foments destructive passions in already unstable individuals like Dr. Tiller’s attacker?

I think about a few physicians I know who have had to walk around their communities wearing bullet-proof vests. Even though there has not been a shooting like this one in some years, they are well aware of the recent increase of harassment and violent incidents related to abortion clinics in this country.

Terrorist behavior like this is designed to deter other women’s health care practitioners from providing abortion services. And it is precisely because of this that we must all be outspoken in our support of all physicians willing to provide such services — and of the women who seek these services.

Widespread community resolve and solidarity will be key to our ability to restore a civil society in which such acts of violence will not be met with so many cheers by those who would use any means to stop women from having abortions. We now need to find more ways to honor and support women’s health providers like Dr. Tiller.

This week I re-read the moving speech of Dr. Garson Romalis, an obstetrician-gynecologist in Vancouver, British Columbia, who was attacked twice (in 1994 and again in 2000). He spoke last January at a University of Toronto Law School symposium marking the 20th anniversary of R. vs. Morgentaler about why he continued to provide abortions despite two attempts upon his life. It is a speech I think that all of us need to read again.

His courage, commitment and resolve will help inspire many of us to keep working toward a world in which women are respected and supported in their times of need. One concrete action we can all take is to support the George Tiller Memorial Fund, established by the National Network of Abortion Funds to provide assistance to the same women Dr. Tiller served, or any of a number of groups now working to preserve women’s access to comprehensive reproductive health services. Here’s more info (pdf) about the fund.

- Judy Norsigian, Our Bodies Ourselves Executive Director