Posts by OBOS

June 28, 2013

Emergency Contraception Can Be Free, But it Takes Planning – And a Prescription

By Michelle Andrews, Kaiser Health News

Women of all ages will soon be able to pick up emergency contraceptive pills at pharmacies and other stores without a prescription or proof of age. What many may not realize, however, is that they can get the pricey pills free under the Affordable Care Act. Doing so, however, may take time and forethought.

“Women may be faced with a tradeoff between timeliness and coverage/cost,” says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a reproductive health research and policy organization.

When it comes to emergency contraception, timing is important. The pills, which delay or inhibit ovulation, generally need to be taken within three days of unprotected sex or they lose their effectiveness. (One prescription-only pill now available is effective for up to five days after a sexual encounter.)

Like other types of birth control, emergency contraceptives are required to be covered as a preventive benefit without cost sharing in health plans that aren’t grandfathered under the health law or don’t meet certain religious exclusions. But consumers can only receive reimbursement from their insurer for over-the-counter products if they get them through a prescription from a medical provider.

Since it can be difficult to get a prescription immediately, women’s health advocates suggest that women may want to get a prescription ahead of time, perhaps at an annual well-woman visit.

“Then you have it in hand, and you can just go to the pharmacy and fill it when you need it,” says Gretchen Borchelt, senior counsel at the National Women’s Law Center.

This month, the Obama administration announced it will no longer fight a judge’s order to make emergency contraceptives available to women of all ages over the counter without a prescription. Officials, including President Barack Obama, had argued that parents should be involved in their minor daughters’ health care, but the court disagreed. The decision was applauded by women’s health advocates.

There are a number of one- and two-pill brand name and generic emergency contraceptives on the market. The FDA last week approved an application for Plan B One-Step to make the drug available without restrictions over the counter.

Plan B One-Step, a popular emergency contraceptive, isn’t cheap. The product generally costs between $35 and $60, say advocates.

About half of all pregnancies in the United States are unplanned. Use of emergency contraception has increased markedly in recent years. Between 2006 and 2010, 11 percent of women between the ages of 15 and 44 said they had used emergency contraception, according to the Centers for Disease Control and Prevention. In 2002, the figure was 4.2 percent.

Young adult women between 20 and 24 were most likely to report that they had used emergency contraception; 23 percent said they had done so.

The administration’s decision to allow over-the-counter emergency contraceptive sales without age restrictions may have the most profound impact on teenagers. But even though they can least afford a $50 pill, privacy worries may stop young women who are on their parents’ health plans from trying to get reimbursed for it.

“They’d rather not go that extra step,” says Allison Guarino, 19, who finished her freshman year at Boston University this spring and volunteers in a program that teaches pregnancy prevention in Boston high schools. “They’ll just go to the pharmacy and purchase it, keep it a little hush hush.”

That’s not surprising, say experts. The number one reason teenagers give for not using contraception in the first place is that they’re afraid their parents will find out, says Bill Albert, the chief program officer for the National Campaign to Prevent Teen and Unplanned Pregnancy.

Even though these young women can consent to receive contraceptive services on their own, health insurers frequently send insurance “Explanation of Benefits” forms to their parents, the policyholders, describing the medical services covered family members have received.

Cost barriers will continue to be a problem for the forseeable future, but advocates suggest that will change.

Even if Plan B One-Step is the only product on the shelves for a time, “We know it’s part of a longer path to get more of these products available, and that the cost will come down eventually,” says Susannah Baruch, interim president of the Reproductive Health Technologies Project.

Plus: Read about efforts to encourage the FDA to make lower-cost, generic versions of emergency contraception available without age restriction, and view OBOS’s full coverage of emergency contraception.

Provided by Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. 


March 15, 2013

Our Bodies Ourselves Heads to Austin and Chicago With “Absolutely Safe”

Absolutely Safe

Hey Austin and Chicago! Judy Norsigian, founder and executive director of Our Bodies Ourselves, and film director Carol Ciancutti-Leyva are heading to your cities to host a screening and discussion of the acclaimed documentary “Absolutely Safe,” examining the controversy over breast implant safety. The screenings are free and open to the public.

The Austin event kicks off at 6 p.m. on Tuesday, March 19, at the University of Texas at Austin AVAYA Auditorium (ACE 2.302).

The Chicago screening takes place on Thursday, March 21, at 5:30 p.m. at the UIC School of Public Health auditorium. Registration is requested by UIC.

Interested in learning more about OBOS’s work and women’s health issues? Attend a private house party with Judy Norsigian in Austin (Monday, March 18) or in Chicago (Wednesday, March 20), where she’ll be joined by Christine Cupaiuolo, managing editor of the 2011 edition of “Our Bodies, Ourselves.” To learn more about these special events, email office AT bwhbc.org or call (617) 245-0200 x10. 

Here’s more about this unforgettable film; also read what Ciancutti-Leyva wrote about why and how she undertook this project. Hope you’ll join us in person!

Absolutely Safe screenshot

At a time when more women than ever are getting breast implants, fewer voices than ever seem to be asking “Why?” And fewer still are asking “Are they safe?” ABSOLUTELY SAFE takes an open-minded, personal approach to the controversy over breast implant safety. Ultimately, ABSOLUTELY SAFE is the story of everyday women who find themselves and their breasts in the tangled and confusing intersection of health, money, science and beauty.

At its heart, ABSOLUTELY SAFE is driven by the experience of the filmmaker’s own mother. Diagnosed in 1974 with breast tumors, Audrey Ciancutti underwent a double mastectomy with silicone-implant reconstruction surgery. A year later, her implants ruptured, and soon after, her health steadily declined. Like thousands of other women, Audrey believes her debilitating illnesses—joint pain, chronic fatigue, scleroderma — are linked to her breast implants; however, most doctors and researchers deny this link. Among the debate by plastic surgeons, toxicologists, attorneys, implant manufacturers, whistle blowers, government officials and activists, ABSOLUTELY SAFE introduces more everyday women like Audrey who make choices about their breasts in our appearance driven culture.


March 11, 2013

FDA Approves Silicone Gel Breast Implant Without Public Meeting

In late February, the FDA approved the Natrelle 410 Highly Cohesive Anatomically Shaped Silicone-Gel Filled Breast Implant for breast augmentation in women age 22 and older and breast reconstruction in women of any age.

It surprises us that the FDA did not hold a public Advisory Committee Meeting prior to approval. All we found was the press release, which notes the FDA based its approval on seven years of data from 941 women, a relatively small number:

Most complications and outcomes reflect those found in previous breast implant studies including tightening of the area around the implant (capsular contracture), re-operation, implant removal, an uneven appearance (asymmetry), and infection. In addition, investigators observed fissures (cracks) in the gel of some Natrelle 410 implants. This is a characteristic called gel fracture and is unique to this implant.

The issue was not reported in a six-year study of the Natrelle silicone gel implant, published in the August 2012  issue of  Aesthetic Surgery Journal.

That study was funded by Allergan (and led by a researcher who is a paid consultant, royalty recipient and stockholder in Allergan). Studies paid for by manufacturers are not uncommon, but it makes it harder to tell what sorts of biases there might be in the results. In this case, researchers noted that between 19 and 43 percent of women required additional surgery — the number varied by whether the implants were for augmentation, revision or reconstruction. The researchers also reported that between 5 and 14 percent of patients experienced an implant rupture.

The FDA also did not post approval documents online, so the seven-year data, which would possibly include newer research results, is not readily available to the public.

The FDA has long known about the temporary nature of silicone gel breast implants. In 2011, the FDA released a report on their safety, urging women to “assume that you will need to have additional surgeries” — a point the FDA reiterated in the press release announcing approval of the Naturelle 401:

“It’s important to remember that breast implants are not lifetime devices. Women should fully understand the risks associated with breast implants before considering augmentation or reconstruction surgery, and they should recognize that long-term monitoring is essential,” said Jeffrey Shuren, M.D., director of the FDA’s Center for Devices and Radiological Health.

“The data we reviewed showed a reasonable assurance of safety and effectiveness,” said Shuren. “We will be looking at the results from post-approval studies that will focus on their long-term safety and effectiveness.”

Diana Zuckerman, president of the National Research Center for Women & Families, criticized the approval, questioning why a public meeting wasn’t held and noting that “Allergan has not done a good job of doing post-market studies once their implants have been approved.”

“It seems likely that the FDA decided it was better to hide this information than to make it public at a meeting where implant patients could talk about the health problems that have been caused by these implants,” wrote Zuckerman, who has written frequently about the safety of breast implants.

The FDA is requiring additional “post-approval” studies on several aspects of the Natrelle 410, including study of long-term outcomes in more than 2,000 patients followed over 10 years; rare adverse events in a study to include at least 11,500 women; collection of additional safety and effectiveness data; improvement of the format and content of the patient labeling; and analysis of implants that are removed and returned to the manufacturer.

The additional studies will help determine the risks of these implants. Unfortunately, the results won’t be known for years. In the meantime, women will have implants in their bodies  that have not undergone a rigorous review.


March 4, 2013

Hospitals Clamp Down On Dangerous Early Elective Deliveries

By Phil Galewitz | Kaiser Health Newskaiser health news logo

For decades, doctors have been warned about the dangers of delivering babies early without a medical reason. But the practice remained stubbornly persistent.

Now, with pressure on doctors and hospitals from the federal government, private and public insurers and patient advocacy groups, the rate of elective deliveries before 39 weeks is dropping significantly, according to latest hospital survey from The Leapfrog Group, a coalition of some of the nation’s largest corporations that buy health benefits for their employees.

The national average of elective early deliveries fell to 11.2 percent last year from 14 percent in 2011 and 17 percent in 2010. Nearly 800 U.S. hospitals report their data to Leapfrog, about a third of U.S. facilities offering maternity services.

“This data shows more hospitals are responding to the evidence,” said Cindy Pellegrini, senior vice president of the March of Dimes, which has been educating women and working with hospitals and doctors to lower early delivery rates. “This means babies are being born healthier and having a better start in life, and have a much greater likelihood of avoiding health consequences later on in life.”

Babies born before 39 weeks are more likely to have feeding and breathing problems and infections that can result in admissions to neonatal intensive care units than those who are born later, studies show. The elective deliveries can also cause developmental problems that show up years after birth.

Inducing labor early also carries risks for mothers because it increases the chances they will need cesarean sections.

Since 1979, the American College of Obstetricians and Gynecologists has recommended against deliveries or induced labor before 39 weeks unless there is a medical indication, such as the mother’s high blood pressure or diabetes or signs that the fetus may be in distress.

Still, an estimated 10 to 15 percent of U.S. babies continued to be delivered early without medical cause, according to a report last year by the Department of Health and Human Services.

Leapfrog Chief Executive Officer Leah Binder said she’s encouraged by the latest figures, but says rates are still too high at many hospitals — with some as high as 40 percent. “This is a move in right direction, but more needs to be done,” Binder said.

Leapfrog wants to see rates no higher than 5 percent of all deliveries, a target achieved by nearly half of the reporting hospitals – up from 39 percent of hospitals in 2011.

State averages varied from a high of 26 percent in Pennsylvania to a low of 5.9 percent in Massachusetts and New York. Only states with at least 10 hospitals reporting data were counted toward a state average.

One reason some hospitals have been slow to lower their rate is a reluctance to pressure doctors to change their practice, she said.

Some rural hospitals may also have higher rates because doctors in solo practice sometimes schedule to deliver babies early to stagger their workload. Women who are unaware of the higher risks may also ask to deliver early out of convenience.

Average Early Elective Delivery Rates
State averages for states with more than 10 hospitals reporting
State 2011 Avg. 2012 Avg.
Alabama 22.5%
Arizona 19.5% 9.5%
California 11.3% 8.8%
Colorado 11.8% 7.4%
Florida 13.2% 18.2%
Georgia 16.1% 14.8%
Illinois 13.7% 7.2%
Indiana 11.3%
Maine 11.9% 6.9%
Massachusetts 9.6% 5.9%
Michigan 9.2% 7.9%
Nevada 17.1% 10.7%
New Jersey 11.7% 12.1%
New York 19.8% 5.9%
North Carolina 7.8%
Ohio 7.6% 7.9%
Pennsylvania 26.2%
South Carolina 19.4% 10.4%
Tennesee 14.9% 18.2%
Texas 17.3% 18.3%
Virginia 12.5% 13.1%
Washington 14.9% 7.2%
Wisconsin 20.6%
Individual Hospitals
Rates of early elective deliveries by hospital from The Leapfrog Group

Some of the most dramatic improvements last year came from states such as South Carolina and Illinois where business groups and insurers have exerted pressure to decrease high-risk deliveries. In Illinois, the rate has been cut almost in half to about 7 percent through efforts by organizations such as the Midwest Business Group on Health.

Employers and insurers have gotten involved partly to reduce health costs, since stays in neonatal intensive care units can average well over $60,000.

This year, the South Carolina Medicaid program and BlueCross BlueShield of South Carolina stopped reimbursing providers for performing early deliveries without medical cause. In 2012, the state, working with the March of Dimes and other groups, asked hospitals voluntarily to reduce their rate of early deliveries. The rate of early elective deliveries in South Carolina hospitals fell to 10 percent last year from 19 percent in 2011, the Leapfrog data show.

“We are pleased to see these improved health outcomes,” said Kim Cox, spokeswoman for the South Carolina Department of Health and Human Services.

Texas Medicaid stopped paying for early elective deliveries in 2011, and New York and New Mexico are considering similar actions, according to state officials.

Some hospitals are moving on their own. Boston Medical Center reduced its rate to 5.3 percent last year from 22.5 percent in 2011 by reminding doctors that delivering babies even one or two days before 39 weeks would not be allowed without medical cause. The hospital also informed women about the policy during prenatal care.

“All of the nurses, midwives and doctors on Labor and Delivery are aware that decreasing elective deliveries prior to 39 weeks is an important goal for our service,” said Dr. Ronald Iverson, director of quality improvement for OB/GYN at Boston Medical Center.

Provided by Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.


February 19, 2013

New Coverage May Spur Younger Women To Use Long-Acting Contraceptives

by Michelle Andrews | Kaiser Health Newskaiser health news logo

Even though they’re more effective at preventing pregnancy than most other forms of contraception, long-acting birth-control methods such as intrauterine devices and hormonal implants have been a tough sell for women, especially younger ones.

But changes in health-care laws and the introduction of the first new IUD in 12 years may make these methods more attractive. Increased interest in the devices could benefit younger women because of their high rates of unintended pregnancy, according to experts in women’s reproductive health.

IUDs and the hormonal implant – a matchstick-sized rod that is inserted under the skin of the arm that releases pregnancy-preventing hormones for up to three years — generally cost between $400 and $1,000. The steep upfront cost has deterred many women from trying them, women’s health advocates say, even though they are cost-effective in the long run compared with other methods, because they last far longer.

Under the Affordable Care Act, new plans or those that lose their grandfathered status are required to provide a range of preventive benefits, including birth control, without patient cost-sharing. Yet even when insurance is covering the cost of the device and insertion, some plans may require women to pick up related expenses, such as lab charges.

Long-acting reversible contraceptives (LARCs) require no effort once they’re put into place, so they can be an appealing birth-control option for teens and young women, whose rates of unintended pregnancy are highest, experts say.

Across all age groups, nearly half of pregnancies are unintended, but younger women’s rates are significantly higher, according to a 2011 study from the Guttmacher Institute, a reproductive health research organization. Eighty-two percent of pregnancies among 15- to 19-year-olds were unintended in 2006, and 64 percent of those among young women age 20 to 24 were unintended, the study found.

Although the use of LARCs has more than doubled in recent years, it is a small part of the contraceptive market. Among women who use birth control, 8.5 percent of women used one of those methods in 2009, according to the Guttmacher Institute. The use of LARCs by teenagers was significantly lower at 4.5 percent, while 8.3 percent of 20- to 24-year-olds chose this type of contraception.

In October, the American College of Obstetricians and Gynecologists reiterated its strong support for the use of LARCs in young women.

Yet many young women are unaware that long-acting methods could be good options for them, in part because their doctors may be reluctant to prescribe them, experts say. That is partly the legacy of the Dalkon Shield, an IUD that was introduced in the 1970s whose serious defects caused pain, bleeding, perforations in the uterus and sterility among some users. The problems led to litigation  that resulted in nearly $3 billion in payments to more than 200,000 women.

In addition, providers may hesitate because there’s a slightly higher risk that younger women will expel the device, experts say.

But expulsion is a problem more likely associated with the size of the uterus, which is not necessarily related to a patient’s age, says Tina Raine-Bennett, research director at the Women’s Health Research Institute at Kaiser Permanente Northern California and chairwoman of the ACOG committee that released the revised opinion on LARCs. “Expulsion is only a problem if it goes unrecognized.” (Kaiser Health News is not affiliated with Kaiser Permanente.)

The new IUD Skyla became available in mid-February. It is made by Bayer, the same company that makes Mirena, another IUD sold in the United States. Unlike Mirena, which is recommended for women who have had a child, Skyla has no such restrictions (nor does ParaGard, the third type of IUD sold here). Mirena is currently the subject of numerous lawsuits alleging some complications, such as device dislocation and expulsion.

Skyla is slightly smaller than the other two IUDs on the market and is designed to protect against pregnancy for up to three years, a shorter time frame than the others.

This shorter time frame may make Skyla more attractive to younger women who think they may want to get pregnant relatively soon, some experts say, although any IUD can be removed at any time.

“More providers are spreading the word that it’s okay, and more young women are demanding it,” says Eve Espey, a professor of obstetrics and gynecology at the University of New Mexico.

This article was produced by Kaiser Health News with support from The SCAN Foundation. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.


February 6, 2013

In Armenia, Abortion Rates are High and Access to Contraception is Limited

Taleen MoughamianTaleen K. Moughamian, a women’s health nurse practitioner in Philadelphia, traveled to Armenia in the fall of 2012. Working with the Children of Armenia Fund, she conducted  health exams, including breast and cervical cancer screenings, and provided contraceptive counseling. The following account is based on her work and conversations with Armenian women.

 

by Taleen K. Moughamian

The differences between Armenia’s capital, Yerevan, and the rest of the country are vast. While Yerevan has most of the modern-day conveniences you could ask for, the villages I visited in the Armavir region have populations between 300 and 1,000, mostly comprised of women.

Their husbands have gone –- off to neighboring countries, especially Russia, to find work. They usually stay away for 10 months out of the year. Some men have even started new families in their work countries.

It was not uncommon to meet women who needed to be treated for sexually transmitted infections (STIs) because their husbands are having extra marital affairs while abroad. They are upfront about this, though it surprised me how openly they talked about it.

I heard so many of them say, “They are men. They have needs. What can we do?”

This has created a huge problem and is one of the reasons why STIs, including HIV, are on the rise in Armenia.

There is limited access to effective contraception, so the rate of abortion, which is legal up to 12 weeks, is high. Most of the women who seek an abortion are married, already have two or three children, and do not feel they can provide for a larger family.

Sex-Selective Abortions
For some women, this means having three or four or even 15 abortions over the course of their lives as they struggle to create a family they can support. The median number of abortions for women over 40 is eight, according to a 1995 study conducted at a Yerevan abortion clinic.

Sex-selection has also become a huge issue. Since women leave their homes and join their husband’s family after marriage, a son provides a source of security for his parents. I met so many women who have had multiple abortions because the sex of the child was not what they had wished; for more data, see this UNFPA report on sex selection in Armenia and this story in The Armenian Weekly.

If you look at recent family planning data, it appears the number of abortions is going down, but from what I observed, that is not necessarily the case. Rather, more abortions are going unreported.

Rise in Unsupervised Abortions
Women are using an over-the-counter medication called Cytotec (the brand name for misoprostol) to induce abortions at home without the supervision of a trained medical professional. Cytotec’s indication is to treat ulcers, but it also acts as an abortifacient. Fifty cents worth of Cytotec can induce an abortion, whereas a surgical abortion usually costs about $35-$50.

When used properly, Cytotec is very safe, even without clinical supervision. But it is most effective when used in combination with a second drug, mifepristone (see more on this below).

Women in the villages I visited were not familiar with the World Health Organization guidelines now used by women all over the world. (Note: Women on Waves offers guidance, based on the WHO research, on how to do an abortion with pills.)

Many Armenian women are therefore in a dangerous situation, as they are using Cytotec without the relevant information about its efficacy or side effects, which can range from an incomplete abortion to bleeding to death.

Barriers to Contraception
As part of my work with the Children of Armenia Fund (COAF), I counseled women on birth control options. This has been quite a challenge, as there are so many myths surrounding birth control, and it’s expensive for rural women. One pack of birth control pills costs about $15-20 a month in Armenia. For a village family barely making $100 a month, it is completely unaffordable.

Besides the cost and access issues, social factors also influence a woman’s reproductive health. Although many husbands are supportive, others do not allow their wives to use birth control.

Sometimes the mother-in-law gets involved, too. When a woman in Armenia gets married, she moves in with her husband and his mother. The mother-in-law is usually the matriarch of the family, so she has a lot of pull in decision-making, even when it comes to her daughter-in-law’s reproductive health.

Changing Patterns, Changing Lives
During my last week in Armenia, I met a woman who had come to her village clinic for an abortion. She had two children and this was going to be her fourth abortion. She told me that her husband wants to have another child, but that he’s an alcoholic -– has been since the day they got married –- and he beats her.

She doesn’t think it’s right to bring a child into this world when her life at home is so unstable, and yet she is completely dependent on him for financial security. Living in the village, there are very few resources for either of them to get any help.

Stories like this are difficult to hear; you quickly realize how vital organizations like COAF are to these women. COAF provides free screenings for breast and cervical cancer and free treatment for STIs. With the help of the UNFPA, I inserted intrauterine devices (IUDs) for free to eligible women. This provides them with one of the most effective forms of birth control for up to 10 years.

On my final day working with COAF, one of the women was so thankful that as soon as the IUD procedure was complete, she jumped up and gave me a big kiss. She had had six surgical abortions, and she could not remember how many times she had taken Cytotec to end her other pregnancies.

It amazed me how much the women opened up to me. They are yearning for accurate information and resources, and they are deeply grateful not only for the health care that is provided but for the conversations about their bodies and their health.

Some women may not change their minds about birth control right away, but I know they at least have the information they need to consider it, and sometimes that is enough to start changing attitudes.

Despite all the economic and cultural barriers, I believe things are changing for women in Armenia -– slowly, of course, but moving in the right direction. There is no reason why Armenian women should have to keep relying on abortions for family planning, or why they should be misinformed about their reproductive health.

My hope is that educating women about their health and family planning options will empower them to take control of future. At the very least, they know where and when to seek care if they need it.

Related: 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.
——

Ed. note about mifepristone and misoprostol:
Mifepristone and misoprostol are now frequently used together to produce what is called “medication abortion” for women who are less than eight weeks pregnant. The drugs are not identical and perform different actions. Mifepristone, often known by its manufacturing name RU-486, is almost always used for abortion or to end missed miscarriages. Misoprostol has wider applications and may be used in place of prostaglandins to create cervix softening prior to birth. It can also help prevent stomach ulcers that are caused when people take non-steroidal anti-inflammatory drugs (NSAIDS).

Under the supervision of a health care provider, women choosing a medication abortion typically use an oral dose of mifepristone first, followed by either an oral or vaginal suppository dose of misoprostol several hours later. In slightly more than 90 percent of women, this induces abortion within two days, provided it is used in early pregnancy. Misoprostol becomes increasingly less effective in more advanced pregnancies, and other, more effective drugs may be chosen for pregnancies that are more than eight weeks along.

The different actions of mifepristone and misoprostol explain their effectiveness in inducing abortion. Mifepristone works to separate the placenta from the uterine lining, and it causes uterine contractions. Additionally, the drug has some effect on the cervix and may cause it to soften.


February 4, 2013

Getting Personal: What It’s Really Like Living With a Sexually Transmitted Infection

Jenelle Marie, STD advocateby Jenelle Marie

When you hear the term STD (sexually transmitted disease) or STI (sexually transmitted infection), what do you think of first?

Grotesque pictures of maimed genitalia displayed on a projector during yesteryear’s sex-ed class geared toward frightening you into abstinence? That scene from ” The Hangover” where Sid says, “What happens in Vegas stays in Vegas … except for herpes. That shit will come back with you”?

Whatever first comes to your mind is not likely to include your neighbor, professor, or best friend living with an STI, having an incredible sex life, and otherwise prospering. That is, of course, unless you’re also living with an STI and you know better.

I am your neighbor, a professor at a community college, and am enjoying a wonderfully healthy sex life with a man who thinks the world of me and nothing of my STI. I’ve been living with genital herpes for over 14 years now; I’ve also contracted HPV, scabies, and vaginitis throughout the years. And yet not once did an STI hinder my relationships or happiness once I stopped allowing it to dictate my self worth.

Embracing Stigma

At 16, when our family doctor peered at me with a lazy eye, through thick glasses, and accompanied by a partially missing ear to tell me my genital herpes outbreak was the worst case he’d ever seen, I was devastated. Embarrassment coursed through me as he handed me a prescription and sent my mother and me on our way – sans brochures, additional information, and references to resources, support groups or even a mention of the vast number of people living with an STI everywhere. I was a pariah – a leper – even the doctor was disgusted by my condition.

For years, I accepted my fate and considered myself as being punished for having been sexually active before marriage. As a high-schooler, I was called a slut or a whore and “friends” of mine forewarned men who took interest in me that I would merely infect them, hurt them, and they should steer clear entirely. I actually maintained some of those friendships for a period of time, not knowing otherwise about STIs and those who contract them, thinking myself deserving of such treatment.

A Long Overdue Paradigm Shift

It wasn’t until a few years ago I began to see myself for who I truly was: a beautiful, intelligent, thoughtful, and valuable individual who just happened to contract a long-term infection. In fact, my infection had not stopped me from obtaining two honors degrees, getting married, conquering my fear of heights by going skydiving – not once, but three times – or pursuing my dreams by auditioning for “American Idol.”

While I’m not the next American Idol, I learned an invaluable lesson throughout that period of self-discovery: I am not deserving of poor treatment, cruel friendships, or snide remarks; the stigma placed upon those living with an STI is inaccurate, ignorant, and illogical. And I have the power to change that. We all do.

In order to change the status quo, though, one has to first understand where the misunderstandings and wrongful judgments originate. Rather than be angry at my doctor for leaving me with nothing more than a crass diagnosis or at my childhood friends for mistreating our relationship, I am choosing to delve into why those perceptions persist.

Part of the problem came from within. I didn’t challenge what little I knew about STIs, and I embraced the negative opinions for years before I was able to distinguish between the laymen’s view of STIs and the reality behind the array of people who contract them. STIs do not define one’s character; they’re merely a reflection of an experience – an experience that is as individually unique as are the people who contract the STIs themselves.

Consequently, I’m not angry or frustrated by the amount of time it took for me to finally find solace in my infection. Rather, I have a holistic appreciation for the process one undergoes when being diagnosed with any type of taboo condition (infection or otherwise). Not only have I taken great pains to find myself in a place of self-love and self-respect, I want very much for others to have an opportunity to feel the same fortitude after their diagnosis as I do now and over a far shorter time table.

Becoming an Advocate

Hence, I have become an advocate.

Due to the immense stigma behind contracting an STI, most people don’t speak openly about their experiences. However, as people, we learn best through community. Naturally, we are pack animals – we nurture our young for years beyond most other mammals and we develop complex (and hopefully, healthy) relationships with others outside of our family nucleus. It makes sense then we need others to help overcome obstacles and boundaries – in this case, contracting an STI and/or living with an STI.

So, I’m willing to tell you how horrible my experience has been at times, and how I’ve found incredible happiness, love, success, and rewarding relationships despite living with an STD all in hopes you can move through the process with much more clarity, community, and understanding than I once endured.

Join me, and I welcome you.

Jenelle Marie is the founder and administrator of The STD Project, a website geared toward eradicating the sigma associated with having a sexually transmitted infection. This entry was originally posted at BlogHer and is reposted with permission.


January 18, 2013

Fixing Persistent Liability Concerns in Maternity Care: We Can Do It!

by Carol Sakala, Director of Programs, Childbirth Connection

One of most commonly cited barriers to improving maternity care is the risk of providers and hospitals being held liable for bad outcomes. Whether it is reining in overuse of tests and procedures, honoring women’s preferences, or increasing interdisciplinary collaboration, good ideas often cannot move forward once the issue of liability is raised.

If we cannot make progress toward more evidence-based, woman-centered care because of liability concerns, then the liability system is functioning poorly. But what are the aims of a high-functioning liability system? Is it just to avoid lawsuits and hold liability insurance premiums down?

In our new report, Maternity Care and Liability, we hold 25 possible liability reforms up to a framework that addresses the needs and interests of all of the system stakeholders: those who deliver care, those who pay for care, and most importantly, the women and newborns who receive care.

We developed this framework based on maternity care and liability studies and with the input of clinicians, legal scholars, consumer advocates, policy makers, and others. For each possible reform, we asked whether it does or would likely:

  • promote safe, high-quality maternity care that is consistent with best evidence and minimizes avoidable harm
  • minimize maternity professionals’ liability-associated fear and unhappiness
  • avoid incentives for defensive maternity practice
  • foster access to high-value liability insurance policies for all maternity caregivers without restriction or surcharge for care supported by best evidence
  • implement effective measures to address immediate concerns when women and newborns sustain injury, and provide rapid, fair, efficient compensation
  • assist families with responsibility for costly care of infants or women with long-term disabilities in a timely manner and with minimal legal expense
  • minimize the costs associated with the liability system

The proposed framework has the potential to move discourse and policy forward. When options for reform are held up to criteria in the framework, many that have been widely implemented do not appear to meet any of the criteria. Most notably, the best available evidence shows that tort reforms fare poorly against these aims, despite the fact that they are the most widely advocated and enacted liability reforms.

On the other hand, various reforms have the potential to be win-win-win solutions for women and newborns, providers, and payers. Strategies are needed both to prevent harm and ensure that it is rare and to respond appropriately to harm or claims of harm when they occur. For preventing negligent injury and related lawsuits, these reforms include rigorous quality improvement programs and shared decision making initiatives.

A series of recent reports clarifies the “business case” for quality improvement initiatives: successful programs with strong leadership are achieving better care, better health outcomes, and rapid substantial declines in liability claims, payouts, and premiums. Among redress approaches, disclosure and apology programs were the most promising, but have not yet been evaluated in maternity care.

The report includes summary tables with the full list of more promising and less promising strategies assessed and their demonstrated or plausible impact on the various areas addressed in the framework.

To achieve the high-performing maternity care system that stakeholders need, we cannot allow longstanding liability concerns to continue to rankle. By seeking guidance from the best available evidence about the nature of liability problems in maternity care and the effectiveness of possible solutions, we can move constructively beyond belief and entrenched positions.

It is time to pilot and evaluate the most promising strategies and scale up those that are effective, beginning with routine maternity care quality improvement initiatives. They have the potential to transform the quality and value of maternity care, and to ensure that maternity care work offers the joy and honor that draws talented, passionate individuals to the profession and keeps them caring for women, babies, and families.

For the full report, a set of 10 fact sheets, links to three related open-access Women’s Health Issues articles and an invited commentary from legal scholars Sara Rosenbaum and William Sage, and other resources, please visit http://transform.childbirthconnection.org/reports/liability.

This entry was originally posted at Transforming Maternity Care and is republished with permission.

Carol Sakala, director of programs at Childbirth Connection, is a long-time contributor to “Our Bodies, Ourselves.” She has worked on maternity care issues as an advocate, educator, researcher, author, and policy analyst for more than 25 years, with a continuous focus on meeting the needs of childbearing women and their families.


December 19, 2012

Some Doctors Use Risky Drug, Aiming to Shape Girls’ Genitals and Behaviors

by Alice Dreger

Dr. Mark Sloan, a pediatrician based in northern California, has written a very helpful overview of a controversial fetal engineering intervention: prenatal dexamethasone for pregnant women considered at risk of giving birth to a daughter with congenital adrenal hyperplasia (CAH). The article has been posted on the Our Bodies Ourselves website .

Although CAH is relatively rare, the use of this prenatal intervention should interest and concern all women’s health advocates for two reasons:

  • This fetal intervention has been pushed through the use of highly problematic sexist and heterosexist stereotypes.
  • The unscientific and unethical ways in which the intervention has been deployed send up all sorts of red flags with regard to patient safety and patients’ rights to informed consent.

CAH is a serious inborn endocrine disease; newborns are screened for it, and people who have it usually require lifelong hormonal management. One “side effect” of CAH is atypical (different from average) sex development in some females.

In an effort to prevent that atypical sex development, some doctors have offered prenatal dexamethasone, a synthetic steroid, to pregnant women identified through genetic analysis as being at risk of having a child with CAH. Giving a pregnant woman dexamethasone cannot prevent CAH or cure her offspring of CAH. The intervention is offered only in an attempt to ensure typical sex development in the offspring who are genetic females.

A genetic female fetus with CAH may develop differently from average females because CAH can result in high levels of masculinizing hormones. The process is called virilization, because it leaves a female skewed more toward the middle or even the male end of the genital development spectrum. (For an animated primer on genital development, click here.)

A female with CAH may be born with a large clitoris, even one that looks something like a penis; her labia may be joined like a scrotum; and her vagina and urethra in some cases will form joined together, which can put her at increased risk for infection and, at sexual maturity, difficulties with intercourse and giving birth.

Although in theory ensuring typical genital development may sound reasonable, in practice, this off-label use of dexamethasone has been a high-risk game. For the drug to work, doctors must give it starting by about week 7 of fetal life, before the genitals sexually differentiate. At this early stage, doctors cannot know if the woman is carrying a male or female fetus or whether the fetus even has CAH.

Only about 10 percent of the fetuses exposed will actually turn out to be females with CAH, meaning about 90 percent of those exposed will bear all the risk of fetal biochemical engineering with no chance to benefit.

As Dr. Sloan explains, the CAH-affected population of girls and women also shows signs of having their brains “virilized” during development. They are more likely than non-CAH girls to be tomboyish, and more likely to grow up to be lesbian, bisexual, or to identify as male in terms of their gender. (This population contributes to the idea that gender identity and sexual orientation have a biological component.)

I find it disturbing that the chief clinical-researcher proponent of the intervention has indicated that she’s interested in seeing if the intervention can “successfully” prevent this “behavioral masculinization” — in other words, she’s interested in seeing whether the fetal intervention can lower the rates of tomboyism, lesbianism, and bisexuality in this population.

As University of Michigan pediatric psychologist David Sandberg told Time magazine, “Maybe this gives clinicians the idea that the treatment goal is normalizing behavior. To say you want a girl to be less masculine is not a reasonable goal of clinical care.” (I agree.)

Most troublingly, as Dr. Sloan notes in his article, there has been shockingly little study of what this intervention does to the exposed children’s health.

After nearly 30 years of use, we have stunningly little data on efficacy and safety on this off-label use. It appears that, in many cases, women have been offered this drug without the protections of being enrolled in formal studies, after being lured into the intervention with claims that it “has been found safe for mother and child.”

Dr. Sloan discusses a paper I recently authored on this matter with my colleagues Ellen Feder, PhD, of American University, and Anne Tamar-Mattis, JD, of Advocates for Informed Choice. I encourage you to read Dr. Sloan’s article, and then, if you want to learn more about how this history unfolded, read our article, which is available for free download.

I also encourage you to read the “Dex Diaries” series I have mounted at fetaldex.org. There you’ll find a series of short essays unpacking this story from a personal point of view.

Kiira Triea (who recently died of cancer) wrote there about her own experience of having been changed in the womb; Fran Howell has relayed about how hard it is to watch this after herself being exposed to DES in the womb; Ellen Feder has expressed sympathy for the poorly informed mothers; Aron Sousa has analyzed the game that has apparently been played here with regard to federal funding; and Anne Tamar-Mattis has reported on the real silent majority of doctors who are troubled by how this population has historically been treated.

Finally, I encourage you to watch the videos at The Interface Project, where real people born with uncommon forms of sex development explain why no body is shameful.

Alice Dreger is Professor of Clinical Medical Humanities and Bioethics at Northwestern University’s Feinberg School of Medicine. Her personal website is alicedreger.com, and you can follow her on Twitter @AliceDreger.


July 26, 2012

What’s in the New Health Care Law for Women? Well-Woman Visits That Can Improve Your Health

What's in it for women?

Countdown to Coverage is a campaign to help women understand the concrete ways that the Affordable Care Act can improve our health. This blog entry is the first in a series designed to answer the question, What’s in it for women?

by Leana S. Wen, MD

As an emergency physician, I tend to work on the other side of preventive care services. I see what happens when women don’t know about safer sex and birth control, and end up with complications from sexually transmitted infections. I see what happens when women do not get routine screening for cervical cancer and struggle with life-threatening cancer. I see what happens with out-of-control hypertension and diabetes, and the heart attacks and strokes that are detected far too late.

These experiences have shown me that prevention is the best medicine. That’s one big reason why the Affordable Care Act provision requiring new insurance plans to cover women’s preventive care without any extra charges or co-pays is a real victory for women. These requirements, which go into effect Aug. 1, will be phased into existing insurance plans over time.

Because of this change, women will be able to obtain complete contraceptive care, screening for sexually transmitted infections, and screening and counseling for intimate partner violence. This builds upon earlier requirements that insurance companies cover — at no additional cost to women — mammograms and screenings for cervical cancer. It’s clear to me that these mandates will significantly improve women’s health and lives and ultimately lead to a reduction in health care costs.

The Well-Woman Visit
One of the easiest ways to obtain preventive services is through a well-woman visit. These visits, which will soon be covered with no co-pay, give you the opportunity to ask key questions about birth control, sexually transmitted infections, and other reproductive issues, along with questions about diet and exercise and any health concerns you may have. You can also discuss changes in your family’s medical history that are important for your health care provider to consider. For example, when my mother was diagnosed with breast cancer, my doctor recommended that I get earlier screenings.

Along these same lines, your health care provider may have questions or issues to discuss with you. Smoking, drinking and recreational drug use can create and contribute to health problems, and often need to be discussed and addressed multiple times before change happens. Well-women visits also give your health care provider a chance to screen for potential high blood pressure, diabetes, depression, domestic violence, and more.

The well-woman visit is important for another reason: It gives you and your health care provider a chance to get to know each other. Most people go to their provider or to a clinic only when there’s a problem, but the best time to get to know your provider isn’t when you’re in distress from a painful or troublesome condition. Studies have shown that health care providers make more accurate diagnoses when they know their patients and can put the symptoms in the context of your life. A well-woman visit is a precious opportunity to build this trusted relationship.

As an emergency physician, I am excited about the new provisions taking effect Aug. 1, which include annual well-women visits for those who want them. I would much rather women regularly visit their health care providers than come to the E.R. later suffering from preventable problems. So please take this opportunity and make an appointment with your provider. The importance of investing in your health is too crucial to ignore.

Plus: Want to learn more about the Affordable Care Act? These resources from Countdown to Coverage provide detailed information about coverage for women, including specific information for LGBT people, women of color, young women, older women, moms and families, and more. 

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Leana S. Wen, M.D., is an emergency physician at Brigham & Women’s Hospital and Massachusetts General Hospital and a clinical fellow at Harvard Medical School. She is the author of a forthcoming book on patient advocacy, “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.” For more information, visit her blog When Doctors Don’t Listen or her website. You can also follow her on Twitter @DrLeanaWen.


July 25, 2012

Live in Massachusetts? Take 2 Minutes to Support Bill Regulating Certified Professional Midwives

Our Bodies Ourselves has partnered with The Big Push for Midwives in support of this important legislation. Please take a moment to learn how you can help improve the health of mothers and infants in Massachusetts. Thank you! – Judy Norsigian, OBOS Executive Director

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If you care about mothers and babies, the Commonwealth needs your help TODAY to PASS HB 4253, An Act Relative to Certified Professional Midwives.

We have just a few days left to pass this important legislation that will regulate Certified Professional Midwives.

Currently, there is no state oversight, which means ANYONE — even an 18-year-old car mechanic — can hang out a shingle and practice as a midwife. Hairdressers must be licensed to practice in Massachusetts, but midwives do not.

Should a “cut and color” be regulated and have professional practice requirements while MA midwives currently have none?

How to Help

  • CALL your own STATE REPRESENTATIVE
    You can find contact information for your representative here: http://wheredoivotema.com/bal/myelectioninfo.php
  • GIVE them an update on the bill, HB 4253 — An Act Relative to Certified Professional Midwives — and let them know the bill is now with the House Ways and Means committee.
  • ASK them to contact Chairman Dempsey’s office (617-722-2990) (representing Haverill and Chair, House Ways & Means Committee) to REQUEST that HB 4253 BE RELEASED TO THE HOUSE FLOOR FOR A VOTE ASAP.
  • ASK them to then support the bill when it reaches the House Floor.
  • URGE them to tell their colleagues to support the bill on the House Floor.
    The calls will take TWO minutes or less. Please pass this on to friends, family, neighbors and anyone else to also make calls. We need to flood the State House!

Want to do even more?
PLEASE reach out to Massachusetts HOUSE LEADERSHIP (see listing at the end of this message), letting them know:

  • This bill is important to you
  • That this bill is being supported by House leaders

Also, we will be at the State House on Wednesday and Thursday afternoons this week (7/25 and 7/26). Please join us! Drop a quick email to Ann Sweeney at ann AT annsweeney.com, and we’ll let you know where to rendezvous with us.

Please help us in spreading the word and passing this legislation into law! Keep the calls coming! We need EVERYONE to call to get this done! Make a difference! Make it count!

Thank you for your support!
- Ann Sweeney (Mass Friends of Midwives)
ann AT annsweeney.com
- Miriam Khalsaak (Mass Midwives Alliance)
akmidwife AT gmail.com

========================

To help out even more:
CALL more Massachusetts House Leadership

Other Important Representatives in House Leadership to call:
Rep. Haddad—very supportive—617-722-2600
Speaker DeLeo—he is aware of the bill—seems to understand need for it—617-722-2500
Rep. Reinstein—very supportive and a co sponsor—617-722-2180
Rep. Moran (Boston and Brookline)—supportive and a co-sponsor— 617-722-2006
Rep. Story (Amherst)—very supportive—617-722-2012
Rep. Donato—seems supportive—617-722-2040
Rep. Mariano—has always supported licensure bills—617-722-2300
Rep. Jones—aide seems supportive—617-722-2100
Rep. Rushing—617-722-2783
Rep. Bradley—617-722-2520


July 2, 2012

How I Talk About Sex With My Kids

By Annie Brewster

My 13-year-old daughter is now in the throes of seventh grade Sex-Ed. Yesterday, while lingering at the table after dinner, just the two of us left, she asked: “Rubbing the clitoris is what makes sex feel good, right?”

I swallowed hard, hesitated for half a second, and then said “Yes. That’s a big part of it.” And the door was open for further discussion. What are the other ingredients of sex that “feel good”?

We have always talked openly about sex and the human body. I am not squeamish on these topics, perhaps in part because I am a doctor, and when my children (now ranging in age from 5 to 15) ask questions, I believe in answering directly and honestly.

My now 13-year-old, a relatively uninhibited and curious child, asked about how babies are made when she was 3. Her favorite book was “It’s So Amazing” by Robie Harris, and she begged me to read it to her over and over again, so I did. She asked questions, and I answered. We talked about the sperm and the egg, the penis and the vagina, and how the sperm and egg meet up (i.e., the penis goes into the vagina), and for a while, we stopped there.

At some point, she discovered my diaphragm in the bathroom drawer, and, more than once, I found her using it as a frisbee. “That’s not a toy,” I would tell her. “That’s mommy’s.”

For a while, that was enough, and she would obediently put it away. It was a few more years before she pressed for more details, and I told her about birth control, after explaining that grown-ups sometimes have sex even when they don’t want to make babies. Now, we have moved on to the clitoris and the concept of pleasure.

In our house, we are not shy about nakedness, or at least I’m not. And I am not ashamed of how my body works. All of my children, at a young age, have watched me change a tampon–not a planned demonstration, but an incidental one–and have asked about what it is I am doing. Why the blood? I want my daughters, and my son, to know that menstruation is a normal, healthy part of growing up for females.

“This is something that happens to teenage girls and women about once a month,” I tell them. “It doesn’t hurt, and it is a good sign that my body is working the way it is supposed to.”

Listen to your body. Love your body. Respect your body, and respect others, too. This is part of my message, and I want my children to hear it, loud and clear.

Research backs me up. A 2009 study on parent-child talks about sex and sexuality found that “more than 40 percent of adolescents had had intercourse before talking to their parents about safe sex, birth control or sexually transmitted diseases.” Time magazine reported on the research noting:

That trend is troublesome, say experts, since teens who talk to their parents about sex are more likely to delay their first sexual encounter and to practice safe sex when they do become sexually active. And, ironically, despite their apparent dread, kids really want to learn about sex from their parents, according to study after study on the topic.

“The results didn’t surprise me,” says Dr. Mark Schuster, one of the authors of the new study, published in Pediatrics, and chief of general pediatrics at Children’s Hospital Boston. “But there’s something about having actual data that serves as a wake-up call to parents who are not talking to their kids about very important issues until later than we think would be best.”

I understand the “sex talk” is tough, and I know not everyone is comfortable with my approach. When I brought home a how-babies-are-made book from the library at age 5, my mother had an uncontrollable laughing fit. When my 13-year-old asked my husband about his own puberty last night, he was embarrassed and slightly stunned.

“What was the hardest thing for you to adjust to in puberty, a) facial hair; b) your voice changing; or c) ejaculation?” she asked.

Hmmm. His initial response was that none of these things were hard (unhelpful, in my daughter’s opinion). But he later came around to “facial hair” because this required a behavior change (i.e., the onset of shaving). Still wanting, my daughter told me about this discussion, and we talked more about the potential challenges of adjusting to change.

Some parents don’t believe that conversations about sex are appropriate for young children, and, understandably, they want to decide when these conversations take place. I respect this, but I am not sure silence is the answer. Sex is everywhere in our society, and kids are going to hear about it one way or another, either from friends or from the media. Isn’t it better for us, as parents, to help them make sense of what they are hearing?

Frankly, I am much more comfortable talking about sperm and egg, penis and vagina with my 5-year-old than I am hearing her parrot the pop song “I’m Sexy and I Know it,” after listening to the radio with her teenage sisters in the car. Disturbing images of “Toddlers in Tiaras” come to mind.

On the one hand, our prudish silence suggests to kids that sex is shameful. On the other hand, the over-sexualized media portrays sex as power. What about everything in between these extremes? What about nuance? As parents, it is our job to help kids interpret what they are hearing, and formulate new definitions. This is an opportunity. Silence isn’t going to shield our children from hearing about sex, in the same way that preaching abstinence isn’t necessarily going to stop teenagers from having sex.

According to a 2009 study in a large urban school district, 12 percent of 12-year-olds had had vaginal sex, 7.9 percent oral sex, 6.5 percent anal sex, and 4 percent all three types of sex. By age 19, 7 in 10 teenagers have had sexual intercourse. Moreover, 15- to 24-year-olds account for nearly half of the 19 million new sexually transmitted infections each year.

And let’s not forget teen sexual violence, and teen pregnancy. Our job is to give kids the tools they need to protect themselves and to make smart choices, and this requires dialogue. Healthy knowledge can be power.

Here’s what I want my children to know: Sex is not shameful. Sex between two mature, consenting, caring (ideally, loving) individuals can be a beautiful thing, but sex is intimate and vulnerable, emotional as well as physical, and should be respected. Sex requires maturity. Listen to your own voice. Trust yourself. Never compromise yourself.

Bottom line: We need to talk to our kids. I am not suggesting parents should give impromptu lectures on sexuality and human development. Rather, we should follow our children’s lead. They will ask the questions when they are ready for the answers.

Annie Brewster is a Boston internist and a former Our Bodies Ourselves board member. This blog entry was previously published at CommonHealth and is reposted with permission.


June 21, 2012

Want to Help Make History? Join Us in Demanding Female Condoms!

by Anna Forbes

Sign for Female CondomsHave you ever been part of an attempt to set a new record in the “Guinness Book of World Records”? Want to help break an existing world record while also helping to increase access to HIV prevention tools?

If so, your message can be featured in what we hope will become the world’s longest chain of paper dolls.

Universal Access to Female Condoms Joint Programme (UAFC) is working with CHANGE, Our Bodies Ourselves, and dozens of other organizations around the world to collect 30,000 individually completed paper dolls to display in one massive chain at the International AIDS Conference, scheduled for July 22-27 in Washington, D.C.

To participate, just go to Sign4FemaleCondoms.org by July 27 and write a message about why you think female condoms are important. Your message and paper doll will be included in the chain. Together, we’ll break the world record.

This extraordinary visual statement will illustrate the broad-based, urgent demand for female condoms that exists all around the world. Right now, only 1 percent of all condoms used worldwide are female condoms (FC). Most people either don’t know about FCs or have never used them because they are poorly promoted, expensive and/or unavailable. Meanwhile, more than half of all people living with HIV worldwide are women.

Female condoms are just as effective as male condoms in preventing HIV and pregnancy—and they allow women to protect themselves when male condoms aren’t being used.

Participation is free, it’s fast, and you will contribute to a powerful visual statement urging policy-makers and funders to invest more in making the FC, an under-utilized, highly effective HIV prevention tool, accessible to all women and men who need it.

Learn more about this project by visiting Facebook.com/zawadi.smartlove. Thanks for taking part!

Anna Forbes is an advocate, organizer, and writer who has worked in HIV/AIDS since 1985 and on women’s health and rights since 1977.  Now an independent consultant with an international client base, her work centers around women, HIV, gender, health, and rights.


May 17, 2012

Physicians Speak Out: A High Profile Call to Arms in the Abortion War

by Carole Joffe

 [T]here is now an unprecedented and sweeping legal assault on women’s reproductive rights. New legislation is being introduced, and sometimes passed, in state after state that would roll back access to abortion and contraception, mainly by intruding on the relationship between doctor and patient. [...] But where are the doctors? They have been strangely silent about this legal assault, even though it directly interferes with medical practice.

The above statement is important not just because of the insightful words being said, but because of who is writing these words, and where these words are published. The writers are Marcia Angell and Michael Greene, and the piece they wrote on current abortion restrictions appears in USA Today, the newspaper with the largest circulation in the United States.

Dr. Angel, a senior lecturer at Harvard Medical School, is the former editor-in-chief of the “New England Journal of Medicine”; Dr. Greene is professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and chief of obstetrics at Massachusetts General Hospital.

Why do the credentials of the writers, and the place of publication, matter? The significance of these issues becomes clear if one takes into account the longstanding marginalization of abortion — and abortion providers — in the United States. As I learned in researching a book on the first generation of doctors who provided abortion after Roe vs. Wade, these pioneers acutely felt their isolation from mainstream medicine.

Most hospitals did not establish abortion services, most professional organizations did not set guidelines for abortion care, very little training of residents in abortion procedures was taking place, and many individual providers told me of sanctions they experienced because of their involvement with the abortion issue. I heard numerous stories of academic advancement denied, difficulty in getting research published, but perhaps most poignant of all, the lack of colleague-ship they felt with their fellow physicians.

As I speculated, the memories of the “back alley abortionists” were still so strong in the period immediately after Roe that even ethical and competent doctors, such as those I interviewed, were tainted with that legacy. In short, a majority of physicians then (as now) have supported legal abortion — but there was less support for the abortion provider.

To be sure, much has changed for the better since 1973 in U.S. medicine with respect to abortion. The number of training sites has considerably improved; such technological developments as medication abortion (formerly known as RU-486) and an improved device for Manual Vacuum Aspiration have brought many primary care doctors and, where legally permitted, nurse practitioners, midwives and physician assistants to offer early abortion care; perhaps most importantly, organizations such as Medical Students for Choice and PRCH (Physicians for Reproductive Choice in Health) have facilitated collegial contact between numerous clinicians who go on to become abortion providers, or who are already doing so, and clinicians in other fields who, while not performing abortions themselves, firmly support those who do.

However, while the stigma surrounding abortion within medicine may have lessened, in the larger society it has only worsened — as we see from the unprecedented number, and character, of the restrictions proposed in the last year and a half.

In fact, numerous states even mandate that abortion patients be told misleading or downright untrue facts, such as the links between abortion and breast cancer or infertility — while a number of states have passed, or are proposing, laws that shield doctors from lawsuits if they withhold accurate information, such as the results of prenatal diagnosis that might lead a pregnant woman to seek an abortion.

Back to the forceful statement by doctors Angell and Greene. They are not the only voices within medicine to object to these egregious measures. The Pennsylvania Medical Society and the Wisconsin Medical Society, for example, are on record as opposing restrictive laws in those states because they interfere with the doctor-patient relationship. Pippa Abston, a pediatrician in Alabama, has become an outspoken critic of Alabama’s mandated ultrasound law, speaking at rallies and making a video of her opposition, and others have voiced objection as well.

But given the cultural stigma that now surrounds abortion, the fact of two high profile physicians at one of the country’s leading medical institutions, speaking out in such a widely read newspaper, is a particularly welcome blow against the legislative persecution of abortion providers. To me, it is especially encouraging,  given the past marginalization of this field that I have described, that the two physician-writers have not themselves built careers around abortion.

Angell and Greene mince no words in denouncing the assault on medical ethics that such laws represent, and make clear their understanding that the stakes in these battles go well beyond abortion care. “Physicians…have ethical commitments to patients that they cannot and should not be required by state law to set aside. Prominent among them is the responsibility to place the welfare of their patients above all other considerations.”

But their statement does not only call for the proper treatment for patients. They end their piece with a call for the relevant medical professional organizations — too timid till now, in their view — to support their members who are caught in this war on those who serve women.

Carole Joffe is a professor at the Bixby Center for Global Reproductive Health at the University of California, San Francisco. NOTE: The views and opinions of the participant expressed here on this site do not necessarily state or reflect those of the Regents of the University of California, UCSF, UCSF Medical Center. This article was originally published at  RH Reality Check and is reposted with permission.


May 13, 2012

What Mothers Really Want: Right to Care for Family Members and Selves

by Ellen Bravo

My favorite Mother’s day gifts from my sons were their original stories, songs and poems. But what I needed when they were infants and toddlers was something children can’t deliver: affordable time off when they were born and when they were sick.

So for all those candidates and elected officials interested in the women’s vote and eager to prove their support for motherhood and families, here’s a sampling of what mothers want and need, not just one day a year but every day:

The right to care for a sick child or personal illness without losing our paychecks or our jobs. Moms need leaders to actively support the right for workers to earn paid sick days and champion local, state and federal policies that would guarantee this protection. Make sure no one has to choose between being a good parent and being a good employee — and that no one has to serve you flu with your soup.

The right to coverage under the Family and Medical Leave Act. Half of private sector workforce employees aren’t covered by this law because they work for an employer with fewer than 50 workers, haven’t been on the job for at least 12 months or work less than 25 hours a week. Moms need Members of Congress to work to expand FMLA to cover all employees after 90 days of employment.

The ability to afford leave under the Family and Medical Leave Act. Many who are covered under FMLA can’t afford to take the time without pay. As a result, nearly 3 million eligible workers a year who need leave to care for their health or the health of a loved one don’t take it, according to a 2000 Labor Department survey. And nearly 9 percent of those who do (including 20 percent for low-income families) are forced to rely on public assistance to keep food on the table, according to a 1995 Department of Labor report. Moms need leaders to voice their support for policies to create family leave insurance funds like those that are working in California and New Jersey so that caring for a new or seriously ill child doesn’t trigger financial catastrophe.

The right to care for one’s partner regardless of their gender. Being able to marry who you love — and being able to care for one another in sickness as well as in health — shouldn’t be a gift, it should be a right. Moms are glad to see more of our leaders standing up for the rights of all families by supporting marriage equality legislation and bills to expand FMLA access to same-sex partners.

The right to attend children’s school activities. Far too many children in this country never see their mom at a school play or sporting event because employers won’t let them take off work or rearrange their schedules. Mothers need leaders to support the right to use family leave to do what’s best for raising our children.

A recognition that men are parents, have parents and also need time to care. All the policies listed above are gender-neutral. Moms — and dads — need leaders to end on-the-job punishment of men who want to be good fathers, sons and husbands. That will also boost women’s efforts to get men to share the work at home.

This list flows from deeply held American values: that no one should have to risk a job to be a good family member or put a loved one at risk in order to keep a job. Mothers want basic standards that guarantee these rights to everyone.

And candidates, if you don’t believe me, check the polls. More and more voters — from all political perspectives — say they’re more likely to support candidates who’ll make sure family values don’t end at the workplace door, and who understand that for the economy to recover, we need policies like these to help people stay employed and have money to spend at local businesses.

Doing the politically smart thing for moms is also doing the right thing for families and for our nation.

Ellen Bravo directs Family Values @ Work, a network of state coalitions organizing to win paid sick days and paid family leave. The former director of 9to5, National Association of Working Women, Ellen also teaches Women’s Studies at the University of Wisconsin-Milwaukee. Her most recent book is “Taking on the Big Boys, or Why Feminism is Good for Families, Business and the Nation” (Feminist Press, 2007).