Posts by Rachel

March 28, 2014

Why Contraception is a Health Issue for Everyone

Photo “ritual” by Monik Markus used under CC BY-2.0 from https://flic.kr/p/8YaubV

Some of the media coverage of Tuesday’s arguments before the Supreme Courton the contraception mandate tended to pit women’s rights activists against social conservatives, making contraception seem like a lifestyle choice that only benefits some women — you know, the ones who have sex.

What often gets lost in the debate is why contraception is considered a preventive health issue — and why treating it as such is beneficial for everyone.

During the healthcare debate, the Department of Health and Human Services charged the Institute of Medicine (IOM) with reviewing preventive services that are important to public health and well-being, and recommending which ones should be considered in the development of comprehensive guidelines.

IOM came up with this evidence-based list of preventive services for adults and children, all of which are now covered by insurers with no required co-payment. Take a look at the IOM report, which explains the selection process.

For women, this includes annual well-woman visits, testing for STIs and HIV, support for breastfeeding, and screening and counseling for domestic violence.

It also includes FDA-approved contraception methods, as well as patient education and counseling on contraception. What makes contraception a health issue? Well, with all due respect to Mike Huckabee, it’s not about women’s libidos.

Here’s the deal: When women use contraception, they can avoid unwanted pregnancies and space planned pregnancies to promote optimal birth outcomes.

When a pregnancy is planned, women can start prenatal care, including increasing their intake of folic acid; work with their healthcare providers to address relevant medical conditions, as well as substance abuse; and take other steps that lead to healthier outcomes for both the mother and the infant.

Pregnancies that are unplanned are more likely to be affected by delayed prenatal care, maternal depression, low birth weight, poorer childhood physical and mental health, and other complications. Breastfeeding rates are also lower after unintended pregnancies.

Social conservatives should also take note that 40 percent of unintended pregnancies end in abortion. And there is an economic cost: Two-thirds of unintended pregnancies are paid for by publicly funded insurance programs, usually Medicaid. For more information, Guttmacher Institute has a terrific fact sheet on unintended pregnancies that explains the incidence rate, demographics, outcomes and costs.

When you look at the facts, contraception is smart public health policy.

Of course, for some women, birth control is essential for other health reasons, including acne, fibroids, endometriosis and to reduce problems associated with irregular or very heavy periods.

Despite the proven health benefits — and the benefits to society as a whole — Hobby Lobby and Conestoga Wood claim that the requirement to provide health insurance that includes no-cost contraception violates their religious freedom.

Not surprisingly, the Court’s three female justices were most skeptical of their position. As Jeffrey Toobin writes in The New Yorker:

After Paul Clement, the lawyer for Hobby Lobby, began his argument, twenty-eight of the first thirty-two questions to him came from Ruth Bader Ginsburg (four questions), Sonia Sotomayor (eleven), and Elena Kagan (thirteen). The queries varied, of course, but they were all variations on a theme. The trio saw the case from the perspective of the women employees. They regarded the employer as the party in the case with the money and the power. Sotomayor asked, “Is your claim limited to sensitive materials like contraceptives, or does it include items like blood transfusion, vaccines? For some religions, products made of pork? Is any claim under your theory that has a religious basis, could an employer preclude the use of those items as well?” Clement hedged in response. When Clement asserted that Hobby Lobby’s owners, because of their Christian values, did care about making sure that their employees had health insurance, Kagan shot back:

“I’m sure they want to be good employers. But again, that’s a different thing than saying that their religious beliefs mandate them to provide health insurance, because here Congress has said that the health insurance that they’re providing is not adequate, it’s not the full package.”

At Talking Points Memo, Sahil Kapur wrote:

The most forceful was Justice Elena Kagan, who repeatedly asked aggressive questions throughout the 90-minute argument about the legal dangers of exempting certain entities from laws on the basis of religion.

“There are quite a number of medical treatments that religious groups object to,” she said, positing that a ruling against the Obama administration could empower business owners to seek exemptions from laws about sex discrimination, family leave and the minimum wage. “You’d see religious objectors come out of the woodwork,” Kagan warned, arguing that it’s problematic for judges to test the centrality of a belief to a religion or the sincerity of beliefs that are invoked in court.

Much of the argument also centers around whether companies really have religious freedom, or if that really only applies to people — whether corporations count as “people” has been a major issue before the Court in the recent past. In “The Hobby Lobby Case Represents The Worst Kind Of Anti-Choice Arrogance,” Sarah Erdreich writes:

But even if the owners do have a religious commitment, Hobby Lobby is not pretending that it is a religion. It is a business. That any business should have power over what can literally be the life-and-death health decisions of its employees, well, that’s another issue for another day. But as long as Hobby Lobby sells its supplies to saints and sinners alike, it has no business questioning what its employees do when they go to see the doctor.

Access to birth control is important for everyone — for preventing pregnancies, and to allow women and families to best time and plan healthy pregnancies. Hopefully the male members of the Supreme Court will see it that way, too.

To catch up on the issue, check out this coverage:


March 18, 2014

Experts Discuss Women’s Health Movement and Healthcare Reform

“We are a very rich country, but we have rationed healthcare in a way that is unconscionable.”

Judy Norsigian, Our Bodies Ourselves co-founder and executive director, doesn’t hold back in this March 6 discussion on women’s health with Sonia Pressman Fuentes, National Organization for Women (NOW) co-founder.

Luz Corcuera, program director of Healthy Start Coalition of Manatee, Fla., hosts the dynamic conversation, which covers the history of the women’s health movement and the founding of Our Bodies Ourselves and NOW, as well as current healthcare issues, the effect of poverty on health, and more.

At about half-way in, Fuentes talks about joining the the Equal Employment Opportunity Commission in the late 1960s and being the first female lawyer in the general counsel’s office, where she encountered reluctance to enforce the sex discrimination aspect of the Civil Rights Act of 1964 prohibiting discrimination on the basis of race, color, religion, sex or national origin.

Fuentes wasn’t an activist at the time, but as one of the few women at the Commission, she found herself frequently in the position of representing women’s interests.

“Whenever an issue came up, I always said, ‘Well what about sex discrimination?’ So my boss, the general counsel, took to calling me a sex maniac because I always raised the issue of sex discrimination.”

The whole interview is well-worth watching. Thanks to Manatee Educational TV in Florida for hosting the conversation!


March 12, 2014

Teen Voices Magazine is Back, Improving the World for Girls Through Media

For 25 years, Teen Voices magazine has provided a place for journalism and other writing created by and for teenage girls. This great publication, originally based in Boston, was on the brink of shutting down last year, but Women’s eNews took it under its wing, with plans to build upon its mission of improving the world for female teens through media.

The first stories published by the new Teen Voices are now online and tackle diverse issues including recovering from anorexiawhy some women wear hijab and others don’tfeeling unworthy; and letters to celebrities as role models.

design contest for the new Teen Voices logo is currently open to 12-19 year olds; the deadline is April 3. You can also follow Teen Voices on FacebookTwitter and tumblr.

And if you’d like to support Teen Voices, there’s an IndieGoGo campaign running now through the end of March to raise funds for a “virtual newsroom,” including mentorship and paid writing assignments for teen girls.

We’re excited to see Teen Voices not only keep going, but expand the opportunities for its writers. Women’s eNews explains the need for this program and the goals:

Teen Voices at Women’s eNews will provide opportunities for education and interaction so that young women can develop and amplify their voices and contribute to issues that personally affect them.

Young women in the U.S. and around the globe often have limited knowledge of the policies, practices and rituals that influence their lives directly, giving them little opportunity to voice their approval or objection. Consider this:

  • Alongside nudity and hypersexualization in film, female teens and women between the ages of 13 and 20 are more likely than others to be referred to as “attractive” as their main attribute, according to theWomen’s Media Center’s 2012 Status of Women in the U.S. Media report.
  • Young female characters are outnumbered by boys 3-to-1 among the top-grossing G-rated family films, according to the Geena Davis Institute on Gender in the Media. This trend makes young women invisible, removes role models and results “in negative gender stereotypes imprinting over and over.”
  • Female teens surveyed by the Girl Scouts in 2011 accepted that their lives should be like that of women on reality TV shows and expected a higher level of drama, aggression and bullying in their own lives. The media is influencing young women to believe that “it’s in girls’ nature to be catty and competitive with one another.”

Teen Voices at Women’s eNews will provide honest and objective information about issues directly affecting female teens around the world, and serve as a powerful outlet for young women to express their views on issues of particular concern to them.

The project is being led by Lori Sokol, Ph.D., the new publisher of Teen Voices at Women’s eNews, theWomen’s eNews editorial, marketing and development staff and a diverse board of teenagers who will consult and advise on the issues being covered.

Don’t forget to check out the IndieGoGo campaign today!
Also! Our Bodies Ourselves has multiple back issues of the print edition of Teen Voices that we would like to give away. They are available for the cost of postage, $13 per box. If you are interested, send a check made out to “OBOS” to: Our Bodies Ourselves, 5 Upland Road #3, Cambridge, MA 02140. Be sure to include the address where the magazines should be sent. For more information, email: office AT bwhbc.org


February 20, 2014

New Data Shows IVF Use Has Steadily Grown

Photo: IVF Capillary Tube Insertion by ZEISS Microscopy licensed under CC BY-NC-ND 2.0

The Society for Assisted Reproductive Technology has released new data on in vitro fertilization (IVF) use in the United States during 2012, and the numbers are up — way up.

The organization, which represents IVF providers, reports that more than 165,000 cycles of IVF were performed in 2012, making it the biggest year ever in terms of both IVF procedures and the resulting babies born. By comparison, doctors performed about 113,000 cycles in 2003.

More than 61,000 babies were conceived using this technology in 2012, amounting to about 1.5 percent of the 3.9 million births that year.

Another number is on the decline: the number of high-risk multiple births from IVF.

“If we dig deeper into the data, there has been a marked reduction in triplets,” Charles Coddington III, an OB-GYN at the Mayo Clinic in Rochester and president of SART, told NPR. “Everyone is really attuned to reducing triplets.”

In 2003, women between the ages of 35 and 40 had about a 6 percent chance of having triplets during a successful IVF procedure. Now the odds have dropped to 0.7 percent.

The reason for the decline, Coddington says, is that couples and their doctors are choosing to use fewer embryos during each cycle. “It isn’t across the board,” Coddington says. “There are still outliers. But the trend is really good. So we’ve had a better year in terms of triplets.”

The chance for twins is also less than it was a decade ago. But the rate is still high, especially for women younger than 40. About a quarter of all successful IVF cycles for women in this age group resulted in twins during 2012, the study reported.

The problem with twins and triplets, Coddington says, is that they raise the health risks for both moms and babies.

Single embryo transfer is the most effective way to reduce riskier multiple births.

Unfortunately, as the newly released numbers show, many cycles of IVF never result in a baby.

Miriam Zoll, an Our Bodies Ourselves board member and author of “Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies,” noted in a Reuters article this week that women over age 35 have higher percentages of failures with IVF and that “these treatments have consistently failed two-thirds of the time since 1978,” when the first “test tube baby” was born.

For more information on IVF and related issues such as egg donation, surrogacy and related topics, read our blog posts on reproductive technology, including “What’s Wrong With Fertility Clinics and Online Advertising” and “Truth in Medicine: Vast Majority of Assisted Reproductive Technologies Fail.”


February 14, 2014

New Study Raises More Questions About the Value of Mammograms

This chart, published in British Medical Journal, shows that the breast cancer mortality of patients who underwent mammogram screening vs. those who did not is practically equal.

new, long-term study in BMJ provides perhaps the most compelling argument to date that screening mammograms may not be effective in reducing the death rate from cancer and may in fact cause harm from overtreatment in some women.

The study is based on results from the Canadian National Breast Screening Study. For this research, 89,835 women ages 40 to 59 were randomly assigned to receive either annual mammograms for five years, or no mammograms during the study period. All of the women received breast exams by trained nurses. The women were followed for up to 25 years to see which of them died of breast cancer.

Based on the data, the authors report that there was no difference between those who had screening mammography and those who didn’t in terms of their likelihood of dying from breast cancer. The authors conclude:

Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available. Overall, 22% (106/484) of screen detected invasive breast cancers were over-diagnosed, representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial.

Put simply, this means that one in five cancers do not pose a deadly threat, yet these women may still undergo treatment, including surgery, chemotherapy and radiation.

A New York Times article this week summarizes the research, and provides some commentary from doctors. Among them, Dr. Russell P. Harris, a screening expert and professor of medicine at the University of North Carolina, Chapel Hill, commented that the results “will make women uncomfortable, and they should be uncomfortable.”

“The decision to have a mammogram,” he added, “should not be a slam dunk.”

New York Times reporter Gina Kolata explains that the number of cancers treated unnecessarily would be even higher if a precancerous condition had been included in the study:

Many cancers, researchers now recognize, grow slowly, or not at all, and do not require treatment. Some cancers even shrink or disappear on their own. But once cancer is detected, it is impossible to know if it is dangerous, so doctors treat them all.

If the researchers also included a precancerous condition called ductal carcinoma in situ, the overdiagnosis rate would be closer to one in three cancers, said Dr. Anthony B. Miller of the University of Toronto, the lead author of the paper. Ductal carcinoma in situ, or D.C.I.S., is found only with mammography, is confined to the milk duct and may or may not break out into the breast. But it is usually treated with surgery, including mastectomy, or removal of the breast.

These findings are unlikely to result in any immediate change in what doctors recommend to women, and are likely to cause controversy among experts.

An accompanying editorial in BMJ, “Too Much Mammography,” explains the strengths and limitations of the study, and notes that it is difficult to make changes around screening mammography practices “because governments, research funders, scientists, and medical practitioners may have vested interests in continuing activities that are well established.”

Indeed, the American College of Radiology — which represents radiologists who perform and interpret mammograms — has issued a statement criticizing the study. This organization also objected to the 2009 recommendations on routine mammography, put forth by the U.S. Preventive Services Task Force, which we discussed here.

The National Partnership for Women and Families also provides a summary of the research, and Breast Cancer Action has issued a response as well, noting that the findings may not apply equally to all women:

The information that we have seen from this study does not let us draw conclusions for specific communities, many of which are most affected by higher morbidity rates. Given the unequal burden that women of color bear when it comes to breast cancer morbidity and mortality, questions remain as to whether there are different findings for difference communities. Absent this evidence, there are no clear answers for women of color. The growing body of evidence, of which this study is part, continues challenge long-standing and commonplace assertions that mammograms are a driving factor in reducing death rates.

What this research makes clear, however, is that we need more effective methods for detecting breast cancer, and new ways of determining which cancers need treatment.

Previous posts on the evidence about mammograms include:


February 11, 2014

In Memoriam: Dr. Gary Romalis

Dr. Gary Romalis, a major proponent of women’s reproductive health and rights, died on Jan. 30 at age 76.

Dr. Romalis was dedicated to helping women by providing abortion. In a 2008 speech at University of Toronto, Romalis addressed some of the horrible consequences he had witnessed of unsafe abortions, and explained why he chose to provide abortions:

I can take an anxious woman, who is in the biggest trouble she has ever experienced in her life, and by performing a five-minute operation, in comfort and dignity, I can give her back her life.

Dr. Romalis life was threatened multiple times by anti-abortion extremists. In 1994, Romalis was shot by a sniper while eating breakfast in his home. In 2000, he was stabbed by a man as he was entering his Vancouver office. After recovering, Romalis kept working — in fact, after 2000, he limited his practice to only abortions.

Judy Norsigian, Our Bodies Ourselves executive director, remembered the effect this violence had on Romalis and his family:

Dr. Romalis was not only a brave physician who continued to provide abortion services after two frightening attempts to kill him, he was a constant role model for medical students and residents considering a career in the reproductive health field.

I will never forget the day my late husband, Irv Zola, chair of the sociology department of Brandeis, came home after comforting Dr. Romalis’s daughter, then a student in my husband’s class. She was so shaken and bewildered that anyone would want to attack her sensitive and caring father, and being 3,000 miles away from him made it even harder.

Renee Ghert-Zand, a family member of Dr. Romalis, writes in The Forward:

My cousins have lost an exceptionally warm, loving and involved father and grandfather. The Vancouver Jewish community has lost a compassionate and committed member. Canada has lost a courageous physician who let nothing stand in the way of his doing the right thing.

Toward the end of his 2008 speech, Gary said: “After an abortion operation, patients frequently say ‘Thank You Doctor.’ But abortion is the only operation I know of where they also sometimes say ‘Thank you for what you do.’”

Thank you for what you did, Gary.

Our condolences are with Dr. Romalis’s family, as is our gratitude for his lifetime of service.

Remembrances of Dr. Gary Romalis:
NAF Mourns the loss of Member Dr. Gary Romalis
Department of Obstetrics and Gynecology Mourns an Iconic Member
In Memoriam – Dr. Gary Romalis


February 7, 2014

U.S. Abortion Rate Drops, But What Do the Numbers Mean?

The U.S. abortion rate has declined to its lowest levels in four decades, according to a new report from the Guttmacher Institute.

As of 2011, the rate had declined to 16.9 abortions per 1,000 women aged 15–44, almost half of what it was in 1981 (29.3 per 1,000 women) and the lowest since 1973 (16.3 per 1,000).

While the record number of abortion restrictions passed in 2011 may come to mind as a possible cause, the data used largely predate those restrictions.

The Guttmacher report also notes that even states that did not implement new restrictions during the study period also saw declines:

It is crucial to note that abortion rates decreased by larger-than-average amounts in several states that did not implement any new restrictions between 2008 and 2010, such as Illinois (18%) and Oregon (15%). So, even in states like Louisiana and Missouri, we cannot assume that the new restrictions were responsible for the decline in abortion incidence.

More plausible explanations, according to the report, might be the increase in long-acting, highly effective methods of contraception such as IUDs; increasing use of birth control among young women in general; and overall declines in the pregnancy and birth rate.

This doesn’t mean, however, that the surge of restrictions enacted over the past several years will not have a negative impact on women’s access to abortions — it just doesn’t show yet in the data.

Judy Norsigian, Our Bodies Ourselves executive director, had this to say about the numbers:

At this point, it is misleading to suggest that restrictions don’t make a difference.  The restrictions that we are seeing now, after this study was done, are of an entirely different order, because they are causing a dramatic rise in the closing of clinics. Just look at the crisis in Texas now. We know that abortion providers in Texas and other impacted states will continue to do their best to meet the needs of the most vulnerable women who can’t afford to travel to places where abortion services are available, but these providers will face huge obstacles.

It is also important to recognize that although there may be a reduction in the abortion rate overall, the rate rose nearly 18 percent among the country’s poorest women — a trend that might reflect the growing economic challenges facing women now. Of the more than 1.2 million legal abortions reported in 2008, women whose family income fell below the national poverty level accounted for 42 percent of these abortions.

For further exploration of Guttmacher’s results and the reasons behind the numbers, see:


February 5, 2014

Does Viewing an Ultrasound Deter Women from Having an Abortion?

ultrasound viewing study

Source: Relationship Between Ultrasound Viewing and Proceeding to Abortion / Obstetrics & Gynecology January 2014

We all know what forcing women to undergo and view ultrasounds prior to an abortion is supposed to do — influence women to carry their pregnancies to term.

That’s why crisis pregnancy centers, which operate with an anti-abortion agenda, offer ultrasounds even though most are not equipped to provide medical services, and anti-abortion mobile buses park near schools and offer free ultrasounds to pregnant women.

But does viewing an ultrasound really deter women from choosing abortion?

According to research findings, bolstered by a new study, the answer is probably no.

Researchers from University of California, San Francisco and Planned Parenthood looked at data for more than 15,000 women seeking abortions at a Los Angeles Planned Parenthood clinic in 2011. All patients underwent a pre-procedure ultrasound, which can be standard in abortion care, and all were offered the opportunity to view the ultrasound screen. (Mandating that women undergo an ultrasound, view it, and listen to a description of the fetus is a whole other issue.)

Less than half, 6,346 women, chose to view it. Almost all of them, regardless of their viewing choice, went on to have abortions (98.8 percent).

Researchers also considered how certain the women felt about their decisions to have an abortion. Women who were highly certain about their decision did not waver, regardless of whether they viewed the ultrasound.

As might be expected, women who were were less certain of their decision to abort the pregnancy and who viewed the ultrasound were slightly less likely to have an abortion than like-minded women who did not view it (95.2 percent of those who viewed it continued with the abortion compared with 97.5 percent of those who did not).

Other factors, such as gestational age, weighed more heavily on the decision. Women who were 17 to 19 weeks pregnant, for example, were almost 20 times more likely to continue the pregnancy than women up to nine weeks pregnant, regardless of whether or not they viewed the ultrasound. The authors suggest that this may have to do with women’s feelings about terminating a pregnancy earlier vs. later.

The authors caution that their findings may be different from situations in which the ultrasound is forced, but they conclude that mandatory viewing should be avoided:

Finally, these results cannot be generalized to women’s experience of ultrasound viewing in settings where it is mandatory, although given the very high percentage of women proceeding with abortion after viewing the ultrasound image, it is unlikely that mandatory viewing would substantially affect the number of abortions performed. It may, however, affect patient satisfaction and health outcomes, which research shows are enhanced when patients feel control over decisions related to their care. Mandating that women view their ultrasound images may have negative psychological and physical effects even on women who wish to view.

The clinical implications of this study are twofold. First, women should be offered the opportunity to voluntarily view their ultrasound images before abortion. However, because fewer than half of women select this option, mandatory viewing should be avoided. Second, health care providers engaged in ultrasound viewing should be sensitive to how patients react to their images but avoid making assumptions about the effect of viewing on patient decision-making. Patients with low decisional certainty about the abortion decision may need more time and support in reaching a decision about whether abortion is the correct decision for them.

For more on the use of ultrasounds in the context of abortion, read this excellent commentary by Tracy Weitz, one of the study’s authors and director of the Advancing New Standards in Reproductive Health (ANSIRH) at UCSF (and a contributor to “Our Bodies, Ourselves”). Written last March, during the height of political battles around mandating transvaginal ultrasounds, Weitz takes a closer look at the weak rationale for anti-abortion activists thinking that ultrasound viewing would reduce the number of abortions.

To date, she notes, “no peer-reviewed empirical data has supported this proposition that viewing an ultrasound image discourages women from abortion. In fact, what limited information does exist suggests that women seeking abortions have a range of experiences associated with viewing their ultrasound and any mind-changing occurs in a complex context that may or may not include ultrasound viewing along with other factors.”

Conversations about mandatory ultrasound, Weitz argues, should be focused on how these laws drive up costs, make providing abortion care more difficult, do not improve health outcomes, and eliminate patient autonomy.

To learn more about situations and states in which ultrasounds are regulated in the context of abortion, view this fact sheet from Guttmacher Institute. Currently, three states mandate that an abortion provider perform an ultrasound and show and describe the image; eight states mandate the ultrasound and require the provider to offer the patient the opportunity to view the image.


January 23, 2014

Free, Online Course on International Women’s Health and Human Rights

International Women's Health and Human Rights Course

Interested in learning more about women’s health and human rights? A free, online course offered by Stanford University kicks off Friday, Jan. 24.

The course is open to everyone — you just need an interest in health and social justice and an online connection.

Anne Firth Murray, founding president of the Global Fund for Women and a consulting professor in human biology at Stanford, is leading the course. A contributor to “Our Bodies, Ourselves,” Murray moderated a panel on global activism at OBOS’s 40th anniversary symposium.

Participants can join in as their schedule allows. Course materials will be released Friday afternoons at 5 p.m. PST, and you can watch lectures and interviews with scholars and NGO leaders, complete interactive activities, and join fellow students in the forum on your own time.

In the video below, Murray explains how this class uses a lens of human rights to look at health issues, going beyond the traditional material on maternal and infant health.

“I knew there were many more issues than that, that women were concerned with,” says Murray.

Here’s the course write-up:

This course provides an overview of women’s health and human rights, beginning in infancy and childhood, then moving through adolescence, reproductive years and aging. We consider economic, social, political and human rights factors, and the challenges women face in maintaining health and managing their lives in the face of societal pressures and obstacles.

We focus on critical issues, namely those that may mean life or death to a woman, depending on whether she can exercise her human rights. These critical issues include: being born female and discrimination; poverty; unequal access to education, food, paid work and health care; and various forms of violence. Topics discussed include son preference, education, HIV/AIDS, reproductive health, violence in the home and in war and refugee circumstances, women’s work, sex trafficking, and aging.

Our open online course (often abbreviated as a “MOOC”) will have a special focus on creating an international network of engaged students. We will ask students to take part in interactive discussions and cooperative exercises and to share their own experiences. We also ask students to engage with the communities they live in, in order to deepen their understanding of the issues and tie academic ideas to real-life circumstances.

The course textbook will be Murray’s book “From Outrage to Courage: Women Taking Action for Health and Justice,” a terrific resource that Our Bodies Ourselves Executive Director Judy Norsigian used when teaching a women’s health advocacy course at Suffolk University. Individual chapters will be posted online.

Participants who complete the course will receive a statement of accomplishment from Stanford University.

Interested? Learn more at InternationalWomensHealth.org.

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January 22, 2014

On The Anniversary of Roe v. Wade, Get Informed and Get Active

Today marks the 41st anniversary of the Roe v. Wade decision making abortion legal throughout the United States.

As we have seen, however, legality does not equal access. Many states have chipped away at Roe v. Wade; in 2012 alone, 22 states enacted 70 new abortion restrictions, making abortion much more difficult to obtain

There have been numerous stories lately on state abortion battles and where the push will be in 2014 to further reduce abortion access, as (mostly male) politicians, seeking to boost their midterm election profiles, will try to enact more barriers.

Abortion rights activists are going on the offensive. So should you.

For this anniversary of Roe, make a plan to support reproductive choice in 2014. Connect with supporters in your area.

Contact your senators and representatives and let them know you support the Women’s Health Protection Act (S 1696/HR 3471), which would prohibit many restrictions that intrude on a woman’s decision and make it more difficult for physicians to provide abortion services.

Learn about abortion restrictions in your state, and check to see if bills proposing new restrictions have been introduced.

We need to talk more openly about abortion as a health issue for women, and we need to work together to ensure it remains a legal option in the years to come.


January 17, 2014

The Real Danger of the NuvaRing

If you read the recent Vanity Fair article about NuvaRing contraception, “Danger in the Ring,” you could be excused for coming away with the conclusion that NuvaRing is deadly and should be yanked off the market immediately.

But hold on.

NuvaRing, a hormonal birth control that is inserted into the vagina, contains estrogen and etonogestrel, a form of progestin that’s different from what’s in the most common low-dose combined birth control pills. As the Vanity Fair article describes, it is also the subject of ongoing lawsuits about dangerous blood clots.

Marie Brenner’s article focuses heavily those lawsuits alleging harms from the device. What it doesn’t do is put the risk of harms from NuvaRing in the context of other hormonal birth control options, or discuss real magnitude of risk of any of these options.

All hormonal birth control with estrogen carries some risk of blood clots. These are referred to as venous thromboembolism, or VTE, and can be fatal. The risks of the most common combined oral contraceptives are quite small.

The latest FDA safety announcement (2012) estimates that for every 10,000 women taking birth control pills over the course of one year, between three and nine cases of blood clots may occur. In fact, the risks are thought to be higher during pregnancy (five to 20 cases per year for every 10,000 women), and much higher right after birth. By comparison, among non-pregnant women who do not take birth control pills, the number of cases per year ranges from one to five.

Some types of birth control, such as the newer types of pills (like Yasmin and Yaz) containing the progestin drospirenone, are thought to cause a greater risk. These pills have come under more scrutiny in Europe and the United States, with Europe taking a more active role in reviewing the risks. Some women’s health advocates, including Our Bodies Ourselves, have questioned allowing these newer pills to remain on the market because they pose a greater clot risk without offering any major benefits over older types of pills.

The factors to consider when weighing the risks and benefits of NuvaRing or other non-pill alternatives may be different, however, because non-pill alternatives offer more convenience and less chance of missing a dose.

Part of the problem in determining what’s “best” for any individual is the lack of clarity surrounding the increased risk that comes with using NuvaRing. Indeed, different studies have yielded different results: A BMJ study included in the Vanity Fair article found about a 90 percent increase in risk; a FDA paper reports a 56 percent increased risk; other studies have reported “similar” rates of venous thromboembolism between the ring and the regular oral contraceptives.

Looking at the BMJ study, which seems most alarming, lets consider the actual numbers. The researchers explain a 90 percent increased risk would result in 7.8 incidents of VTE per 10,000 exposure years. That means, for example, if 1,000 women each used NuvaRing for 10 years, there would be about 8 incidents of VTE among them in that decade (1,000 women x 10 years = 10,000 exposure years).

So, while different methods of hormonal birth control carry different levels of risk, in general hormonal birth control is very safe for most women. Of great concern, however, is that women aren’t given this information to help in their decision-making.

recent article in Huffington Post describes the FDA approval process for NuvaRing and alleges that Organon — the company that made NuvaRing, which pharmaceutical giant Merck now owns —  maneuvered to keep clot risk information off the product label. To date, the NuvaRing label does not feature the same “black box warning” that the birth control patch carries, which notes a higher risk than the pill. Instead, the NuvaRing product label simply notes that smokers who use the ring may have “serious cardiovascular events.” The NuvaRing website does include some information on comparing the risk to combined oral contraceptives, but the FDA-approved label does not make this as clear by not including it in the black box warning that carries the most important safety information.

Cindy Pearson, executive director of the National Women’s Health Network, and a strong advocate for close review of drug safety, has responded to the concerns:

The most heartbreaking part of the Vanity Fair article are the accounts of women who never knew that the contraceptive ring was delivered a higher dose of hormones and is slightly more risky than pills. No clinician should offer women these products without fully disclosing the risks, and encouraging women to try alternative, safer forms of contraception if they haven’t already done so.

Agreed. While the risk to an individual woman may be low with any of these birth control methods, women must be informed that newer options — including the ring, the patch, and the newer pills — may be more risky than older-style combined oral contraceptives.

In addition, health care providers need to stay on top of the evidence, and should make a point of discussing the benefits and the risks. All women should have the information they need to make good choices for their own health.

Related: Hormonal Contraception and Heart Risks


January 13, 2014

A Woman’s Life Has Ended, but Hospital Insists on Life Support for Fetus Against Family’s Wishes

Right now in Fort Worth, Texas, 33-year-old Marlise Munoz lies in a hospital bed, brain dead after experiencing a blood clot in her lungs. Munoz’s family has been prohibited from honoring her wishes to be removed from life support.

Why? Munoz is pregnant.

When her clot happened, Munoz was 14 weeks pregnant; she’s now 20 weeks pregnant. Texas is one of 12 states in which a pregnancy at any stage invalidates a woman’s advance directive for her end-of-life care. The other states are Alabama, Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, South Carolina, Utah, Washington, and Wisconsin.

According to the Center for Women Policy Studies, additional states can invalidate a pregnant woman’s wishes and force her to be kept on life support if it’s “probable” that the fetus will develop to the point of live birth. A few more states have similar rules but limit them to women whose fetuses are already viable.

The New York Times notes that some experts in medical ethics have said they believe the hospital is misinterpreting Texas state law prohibiting medical officials from cutting off life support to a pregnant patient. At this point, Munoz’s fetus is not viable outside of her uterus, and it’s unclear whether it was compromised by the amount of time she went without medical attention following her collapse or the subsequent deterioration of her body: 

Mrs. Munoz’s parents and her husband, Erick Munoz, 26, remain in limbo, even as they and other relatives help care for the Munozes’ 15-month-old son, Mateo. Mr. Munoz has returned to his job as a firefighter but continues to sit by his wife’s side at the hospital. She had been due to give birth in mid-May, but the hospital’s plans for the fetus — as well as its health and viability — remain unknown. Mr. Machado [Marlie Munoz's father] said he had been told by the hospital’s medical team that his daughter might have gone an hour or longer without breathing before her husband woke and discovered her, a situation he believes has seriously impaired the fetus. “We know there’s a heartbeat, but that’s all we know,” he said.

Mrs. Machado said the doctors had told her that they would make a decision about what to do with the fetus as it reached 22 to 24 weeks, and that they had discussed whether her daughter could carry the baby to full term to allow for a cesarean-section delivery. “That’s very frustrating for me, especially when we have no input in the decision-making process,” Mr. Machado added. “They’re prolonging our agony.”

Lynn Paltrow of the National Advocates for Pregnant Women has commented:

What is quite stunning about these statutes for women is that they don’t even take into account a woman’s pain. A woman could be in excruciating pain and near death’s door and they still would force her to suffer. These are extraordinary laws creating separate unequal status for pregnant women in which they lose control of medical decision making, the right to bodily integrity and right to be free of excruciating pain.

Not being allowed to die in peace, or watching a family member be denied their wishes, is the stuff of nightmares. This extreme situation, however, isn’t the only one in which pregnant women’s freedoms have been restricted.

In October, there was some media coverage of Alicia Beltran’s case. Beltran had beaten a drug addiction and was 14 weeks pregnant when her doctor and a social worker tried to force her to take an anti-addiction drug and took her to court when she refused.

The National Advocates for Pregnant Women has documented hundreds of U.S. cases of pregnant women who were subjected to or threatened with incarceration, detention, or forced medical or other interventions that the state decided were in the best interest of the fetus — not the woman.

A petition has been launched asking Texas Attorney General Greg Abbott to leave this decision to Marlise Munoz’s family. To learn more about “pregnancy exclusion laws,” read “Marlise Munoz Case Shines Light on Dehumanizing ‘Pregnancy Exclusion’ Laws,” by Lynn Paltrow and Katherine Taylor.


January 8, 2014

False Alarms Remain a Huge Problem with Mammograms Used for Breast Cancer Screening

Breast cancer detection has become a more controversial subject over the past several years, with routine screening mammograms — the kind many women are encouraged to undergo starting in their 40s — drawing more scrutiny.

More and more, researchers and clinicians are acknowledging that screening mammography has a high rate of false alarms, causing worry along with sometimes unnecessary treatment.

annual mammogram benefit harm tradeoff chartH. Gilbert Welch, a professor at the Dartmouth Institute for Health Policy and Clinical Practice, recently wrote an excellent New York Times op-ed exploring the difficult science around breast cancer screening. Explaining the findings of a study on the benefits and harms of screening mammography that he and Honor J. Passow, also of the Dartmouth Institute, published last month in JAMA Internal Medicine, Welch asks how much overdiagnosis we’re willing to tolerate compared to the possibility of reducing deaths from breast cancer.

Using data from radiologists who perform mammograms, Welch and Passow concluded that among 1,000 40-year-old American women screened annually over the course of a decade, between 0.1 and 1.6 women will avoid dying from breast cancer. (See chart at left; click to view full size.) A staggeringly high number — between 510 and 690 women — will have at least one false alarm (60-80 of whom will undergo a biopsy), and up to 11 women will be overdiagnosed and treated needlessly with chemotherapy or radiation therapy, or surgeries such as lumpectomy or mastectomy.

For 50-year-old women screened annually for 10 years, the numbers are as follows:
* 0.3-3.2 women will avoid dying from breast cancer.
* 490-670 women will have at least one false alarm (70-100 will undergo a biopsy).
* 3-14 women will be overdiagnosed and treated needlessly.

And for 60-year-old women screened annually for 10 years:
* 0.5-4.9 women will avoid dying from breast cancer.
* 390-540 women will have at least one false alarm (50-70 will undergo a biopsy).
* 6-20 women will be overdiagnosed and treated needlessly.

“Overtreatment” sometimes occurs when women receive treatments for cancers that would never have gone on to grow, spread, or cause health problems. In those cases, surgery, chemotherapy, and other treatments don’t provide any health benefit, but there are clear harms. Unfortunately, there is no way to know which cancers would go on to be deadly.

Meanwhile, there is little public awareness that routine screening can lead to both false alarms and overtreatment. A recent online survey of middle-aged Americans, notes Welch, suggests that acceptance of routine screening would diminish if the facts were more readily available.

Welch argues that more research is needed, especially on whether older findings showing that early detection might save lives still matter, now that treatment for breast cancer has changed and improved. He is, however, pessimistic about whether trials will happen that would help answer these questions, or explore outcomes when women choose more or less screening:

Two randomized trials could begin to answer the central question of mammography interpretation: How hard should the radiologist look? Women who view mammography favorably might be willing to be screened under either the current approach or a high-threshold approach — meaning their radiologist would ignore small, likely harmless abnormalities found on a mammogram.Those who view it less favorably might choose that high-threshold approach (knowing that the harms of false alarms and overdiagnosis would be minimized) or forgo mammography completely.

Putting the two trials together, we could finally learn what level of screening minimizes false alarms and overdiagnosis while saving the most lives. Most experts would say that it’s never going to happen. It would cost too much, take too long and need too many subjects.

Maybe they are right. But maybe not. Sure, it would cost millions of dollars. But that’s chicken feed compared with the billions of dollars we spend on breast cancer screening every year. Sure, it would take 10 to 15 years. But it would help our daughters know more. Sure, it would take tens of thousands of women to participate. But maybe they would want to be part of the effort to help sort out the morass surrounding what is one of the most common medical interventions done to American women.

We agree with Welch that more needs to be done — both in terms of research and educating the public about the real risks and benefits of their routine screening decisions.

“A screening program that falsely alarms about half the population is outrageous,” writes Welch, adding:

To be sure, many women are quickly reassured by a second test that their breast is normal. But others — while told they don’t have cancer — are told that their breast is somehow abnormal, that they have dysplasia or atypia, that they are at ‘high risk.’ Whether you blame the doctors or the system or the malpractice lawyers, it’s a problem that needs to be fixed.

Plus: For more information, read our previous posts on breast cancer, including several on what is known about the benefits and risks of routine mammography. Good starting points are: “New Mammogram Guidelines Are Causing Confusion, But Here’s Why They Make Sense,” “Do Screening Mammograms Do More Harm Than Good?“, and “The Benefits and Harms of Routine Mammograms.”


December 30, 2013

Want the Facts About Women’s Health?

"Our Bodies, Ourselves" Goes to Washington

Members of Congress received copies of “Our Bodies, Ourselves” in 2013.

When people hear that I write for Our Bodies Ourselves, they often share stories of their first encounter with the book. Time and again, people credit “Our Bodies, Ourselves” with helping them to better understand their own bodies, empowering them to make choices for their own health, and alerting them to political issues and sexism around women’s health.

All of us at OBOS absolutely love hearing these stories, from long-time supporters and new readers alike.

If you’re reading this post, though, you already know that Our Bodies Ourselves is more than a book. This blog is where we provide information on current research and public policy, and promote action alerts and responses to health topics making news. Along with our outreach on Twitter, Facebook and other platforms, this is where we publish crucial updates between book editions, and where we dive deeper into important topics.

Your contributions to Our Bodies Ourselves support the work we do here on the blog, and so much more.

Earlier this year, thanks to you, we delivered copies of “Our Bodies, Ourselves” to every member of Congress, capping off the Educate Congress road trip and campaign, inspired by the epically misinformed Todd Akin. In 2014, we will educate more policy makers at the state level, and expand access access to “Our Bodies, Ourselves” on college campuses and health clinics across the country.

Plans for the new year also include a brand new website and boosting coverage of important topics like contraceptionpregnancy and childbirthbody imageabortion and reproductive rights, and politics.

When the first edition of “Our Bodies, Ourselves” was published, the organization couldn’t have imagined the impact of new technologies on women’s health. Today, we’re covering complex advances such as BRCA1 and BRCA2 breast cancer gene patents, reviews of mammography guidelines and methods, and updates on assisted reproductive technology (ART) services, and we’re advocating for a database to track the health of young women providing eggs for those using ART.

In conjunction with our global partners, OBOS is also working to address the health and rights of women serving as paid gestational mothers in domestic and cross-border commercial surrogacy arrangements.

The work of Our Bodies Ourselves continues in books and beyond. All of us at OBOS would like to thank each and every one of you for reading, sharing, and supporting this valuable work.

We hope you will consider a year-end donation to Our Bodies Ourselves to help ensure that we can continue to provide much-needed information and analysis, and share it with readers around the globe.

Tibetan nuns reading "Our Bodies, Ourselves"

Tibetan nuns reading “Our Bodies, Ourselves”


December 17, 2013

When Off-Label is Safer for Women: The Politics of Medication Abortion

Among the numerous tactics used to restrict abortion access, several states have proposed or implemented laws that impose unnecessary restrictions on medication abortion. These restrictions interfere with evidence-based practices that are considered safer for women’s health.

Some states are requiring that medication abortions follow the exact regimen approved by the FDA back in 2000, though research has since proven that lower doses are safer and just as effective. (The FDA has approved updated labeling since 2000, but these updates have not addressed the commonly used lower-dose regimen; it is not clear whether the drug company plans to submit new data and request these changes.)

The FDA protocol calls for a clinician to provide 600 mg of the first drug, mifepristone, for the patient to take orally, followed 48 hours later by 400 mcg of oral misoprostol. More modern, evidence-based regimens call for only 200 mg of mifepristone, followed later by 800 mcg of misoprostol that is held in the cheek until it dissolves instead of swallowed. The newer regimen also allows for the misoprostol dose to be taken at home.

Guttmacher Institute: State Policies on Medication AbortionBut states looking to make abortions more difficult for women to obtain are requiring physicians to administer the second dose in person. This mean women are forced to make an additional clinic visit — a significant hardship for many patients.

It’s common practice for doctors to prescribe drugs “off-label,” which means in a different way or for a different purpose than what the FDA has specifically approved. This allows doctors to use the most current evidence and their own judgment. Indeed, a new study accepted for publication in the journal Contraception illustrates how the practice of medicine can change to improve patient safety after a drug has been approved by the FDA.

The researchers reviewed Planned Parenthood data from the five years prior to 2006 — the year Planned Parenthood clinics changed their protocol for medication abortion from vaginal to oral administration of misoprostol, and added additional steps (such as STI testing and routine antibiotics) to reduce infection risk — and the five years after.

They found three deaths out of 218,928 abortions before the change, and no deaths among 711,556 abortions after the change. The Planned Parenthood study used the common reduced dose regimen of 200 mg mifepristone followed by 800 mcg of misoprostol. Other studies have also demonstrated the safety and effectiveness of the reduced mifepristone dose.

When politicians insist on the outdated FDA-approved regimen, they are prohibiting the use of the safer approaches.

The outdated FDA regimen, says Rachael Phelps, medical director for Planned Parenthood in Rochester and Syracuse, is “dramatically less effective, has more side effects, is harder for women to use, and increases the likelihood of an additional invasive procedure compared to the evidence based regimen. Mandating the FDA regimen forces doctors to provide substandard medical care and is just plain bad medicine.”

A case challenging such a law in Oklahoma had been set to go before the Supreme Court, but was dismissed following a state Supreme Court ruling that the law would effectively ban all medication abortion in the state. Texas’s controversial HB 2 law also requires adherence to the outdated FDA-approved regimen.

For a quick guide to additional states with restrictions requiring the old regimen or barring remote doctors from supervising medication abortion via telemedicine, view this fact sheet from Guttmacher Institute.

The federal Women’s Health Protection Act (S1696 / HR 3471) introduced this year would prohibit such restrictions. Among provisions addressing telemedicine abortion, hospital admitting privileges, and other targets of recent legislation, the bill would forbid any “limitation on an abortion provider’s ability to prescribe or dispense drugs based on her or his good-faith medical judgment, other than a limitation generally applicable to the medical profession.” Contact your senator or representative to support this Act.