We have written several times here about concerns about bisphosphonates – a drug intended to prevent bone fractures – and the possibility that these drugs increase the risk of a type of femur fracture. While these fractures are relatively rare and not well understood, the FDA has said that patients should be made aware of the potential risk, especially with long-term use of the drugs. There is also debate over how much these drugs actually help prevent fractures and whether they should be used for prevention in people with “lower than normal” bone density who do not have osteoporosis.

The HealthCentral website has just published an interview on on spontaneous femur fractures with Dr. Jennifer Schneider, a physician who had been taking a bisphosphonate for several years when her thigh bone fractured as she stood on a New York City subway. In it, Dr. Schneider tells her story and explains the controversy over widespread use of bisphosphonates for osteoporosis prevention, the recovery process from drug-associated fractures, her testimony to the FDA, and other information about the drugs.

The new issue of the National Women’s Health Network’s newsletter, The Women’s Health Activist, also includes an article on this topic by Cindy Pearson. She writes about other women who told their stories of broken thigh bones to the FDA:

“They talked about turning to put a piece of paper in the trash can, stepping away from the kitchen sink, or walking down the sidewalk — and suddenly collapsing in agonizing pain as their leg gave way. All of these women had been healthy and active before their leg broke.”

The organization is working to get the FDA to make changes in how drug companies are allowed to market the drugs to healthy women. NWHN also recommends that healthy women under 65 with no risk factors for fragile bones avoid bone density scans because of concerns about accuracy and overtreatment; the US Preventive Services Task Force also focuses their recommendation for screening in women under 65 on those women who have risk factors.

On a related topic, I also have an article in this issue of NWHN’s newsletter about confusion over the risks and benefits of calcium supplements.

A recent Boston Globe Magazine feature “The C-Section Boom,” written by obstetrician Adam Wolfberg, discusses the high rate of cesarean sections as well as the variable rate between providers and facilities, possible reasons for the high rate, and potential approaches for reduction.

Wolfberg believes that the factors that contribute to the high rates include doctors’ convenience, fear of litigation, overdiagnosis of fetal distress, and previous cesareans. One particular statement laid out the power dynamic operating in many birth situations with a clarity I’ve rarely seen:

The truth is, an obstetrician can persuade almost any patient at any time that a caesarean is the best choice. I could have told this woman that the transient dips in the heart rate concerned me and that I recommended surgery to prevent her baby from being harmed. Few patients, hearing those words, would refuse.

Letters in response to the piece point to issues not fully explored by Woflberg. In her letter with Gene Declerq, a professor in Maternal and Child Health and the assistant dean for doctoral education at the Boston University School of Public Health, OBOS co-founder and director Judy Norsigian writes that while Wolfberg says previous cesareans often lead to future cesareans, he does not describe changes in the official ACOG position (2010) on previous cesareans, which presumably will allow for more vaginal births – and which potential patients could benefit from being aware of.

Wolfberg also doesn’t really discuss potential adverse health effects of cesarean, focusing instead on institutional costs as a downside. Another letter-writer, Beth Shearer, raises these concerns and advises doctors to be as wary of surgical risks during unnecessary surgery as they might be of the legal risks of not doing cesareans.

Meanwhile, the CDC’s preliminary birth data for 2010 shows the first – tiny – decline in the U.S. cesarean rate in more than a decade, after reaching an all-time high. From 32.9% to 32.8% of all births. And the rate actually went up for Black (35.4% to 35.5%) and Hispanic (31.6% to 31.8%) women. Here’s what the overall rate looks like over the last fifteen years:

As mentioned in yesterday’s post on the new book “What You Really Really Want,” this past weekend’s New York Times Magazine carried an amazing article  – Teaching Good Sex — that uses a Philadelphia private school’s approach to sex ed to illustrate a simple but controversial question: What if we actually taught young people about pleasure, orgasms, healthy relationships, and the wide variety of what is normal in both sexual desire and physical appearance?

I want to highlight one specific issue raised in the article — the lack of awareness among high school students about what women’s genitalia look like. While there has been little fanfare about the elective class so far, its instructor, Al Vernacchio, a well-liked and respected sex scholar who also teaches English at the school, notes that some lessons do draw more attention than others:

The lessons that tend to raise eyebrows outside the school, according to Vernacchio, are a medical research video he shows of a woman ejaculating — students are allowed to excuse themselves if they prefer not to watch — and a couple of dozen up-close photographs of vulvas and penises. The photos, Vernacchio said, are intended to show his charges the broad range of what’s out there. “It’s really a process of desensitizing them to what real genitals look like so they’ll be less freaked out by their own and, one day, their partner’s,” he said. What’s interesting, he added, is that both the boys and girls receive the photographs of the penises rather placidly but often insist that the vulvas don’t look “normal.” “They have no point of reference for what a normal, healthy vulva looks like, even their own,” Vernacchio said.

One female student remarked that when the class covered a biology unit, she was surprised she knew quite a bit about the opposite sex: “I probably would’ve been able to label just as many of the boys’ body parts as the girls’, which is sad. I mean, you should know about the names of your own body.”

Compounding the problem of a lack of education is that many students are relying on the most readily accessible photos of women’s naked bodies — media-distorted images and online pornography — and these images don’t exactly promote a realistic view.

I recall that my own sex education experiences involved uniform line drawings of healthy genitals and graphic photos of STI-affected genitals, but nothing visual, and especially not photographs, to indicate that there really is a wide range of what healthy genitalia look like. At Our Bodies Ourselves, we have a long history of encouraging people to grab a mirror and take a look at their own genitals, advice that shows up from the earliest to the most recent editions. Another good resource about women’s genitals is this article over at Scarleteen, which talks realistically about normal variation in size, shape, and color.

Meanwhile, there’s a petition at SignOn.org calling for better tracking of cosmetic genital surgery. The petition also wants surgeons who offer these services to “provide full information on genital diversity” when working with women who have concerns about the appearance of their genitals. “Without this information, women cannot make an informed choice,” the petition reads. It continues:

Most surgeons’ websites are loaded with photographs that misinform the public about female genital diversity. The “before” photos in the before-and-after online photo galleries depict a range of genitals as abnormal, but scientific studies show that many different shapes, sizes, and colors are normal. The photo galleries not only misinform, but they increase women’s and girls’ self-consciousness and add to anxiety. Photos may even be photoshopped or retouched.

This is a topic Heather Corinna also covers in the Scarleteen article, explaining that while some women do have physical discomfort or other medical reasons for wanting genital surgery, “for the most part, for nearly all women, your labia ARE normal, however much they vary. Beauty — as ever — remains in the eye of the beholder.”

That’s a lesson all students could benefit from.

The November/December issue of the Journal of Midwifery & Women’s Health has an article on nitrous oxide by Judith Rooks, a nurse-midwife and epidemiologist who has long advocated for making nitrous oxide available as a pain relief option for U.S. women in labor.

Nitrous oxide (N2O) is a gas that a laboring woman can breathe in through a mask.  It works very quickly, taking effect in about a minute, and wears off quickly.  Because it is administered by the laboring woman herself, it allows her to obtain a short burst of relief only when needed, as an alternative to an epidural. It is the most commonly used form of analgesia in the United Kingdom.

However nitrous oxide is not widely available in the U.S., despite the endorsement of various childbirth advocacy organizations, including the American College of Nurse Midwives.

In her article, Rooks reviews the research and literature on the safety and risks of nitrous use. She discusses questions around high and low doses of the gas, labor progress, maternal and fetal/newborn effects, and occupational hazards.  She notes that:

Because N2O/O2 labor analgesia does not have adverse effects that could threaten the safety of the mother or fetus, laboring women who use it do not need routine intravenous access, continuous electronic fetal monitoring, or other procedures that are intrusive and restrict the mother’s freedom of movement during labor. Nitrous oxide labor analgesia is safe for the mother, fetus, and neonate and can be made safe for caregivers.

The review points out several health concerns,  including that women who have had recent ear surgery (because of potential vomiting and inner ear pressure issues) and women who at increased risk of vitamin B12 deficiency may need special review before using nitrous, and that workplaces should take care to make sure the appropriate safety measures are taken to limit birth workers’ exposure. She also points to the need for additional research on issues like brain effects and occupational exposure in birth settings.

Although it’s only available to members, the American College of Nurse-Midwives also covered nitrous oxide in their recent Quickening newsletter. In it, they speak to Michelle Collins, CNM at Vanderbilt, who was instrumental in pushing for nitrous to be an option there. Collins explains several reasons women might choose nitrous: to take the edge off contractions, reduce anxiety, relieve discomfort while waiting on an epidural or during other procedures, or simply to delay epidural and keep more time available when the woman can be mobile.

Collins shares that in one month this summer, “35 women used the nitrous during labor at Vanderbilt, and of those, 22 used it as their sole analgesia. The remain­ing 13 used it and later had an epidural.”

For more on this topic, see this previous post with further discussion from Judith Rooks.

Tara Parker-Pope at the New York Times’s Well blog begins a recent post with a provocative question: Has the power of the mammogram been oversold?

It’s not a question that has been completely ignored – considerable debate erupted in late 2009 when the US Preventive Services Task Force released new guidelines recommending that women without higher risk wait until age 50 to begin routine mammograms.

Our Bodies Ourselves, the National Women’s Health Network and Breast Cancer Action all have previously raised concerns about the right timing and use of mammograms, especially in women without an elevated risk of breast cancer, but working against a popular myth that more mammograms sooner are always better for women’s health is a challenging task.

Parker-Pope explains:

…many doctors say it’s also time to set the record straight about mammography screening for breast cancer. While most agree that mammograms have a place in women’s health care, many doctors say widespread “Pink Ribbon” campaigns and patient testimonials have imbued the mammogram with a kind of magic it doesn’t have. Some patients are so committed to annual screenings they even begin to believe that regular mammograms actually prevent breast cancer, said Dr. Susan Love, a prominent women’s health advocate.

Her post also explains a study just released in the Archives of Internal Medicine, “Likelihood That a Woman With Screen-Detected Breast Cancer Has Had Her ‘Life Saved’ by That Screening.”

The Dartmouth researchers conducted a series of calculations estimating a woman’s 10-year risk of developing breast cancer and her 20-year risk of death, factoring in the added value of early detection based on data from various mammography screening trials as well as the benefits of improvements in treatment. Among the 60 percent of women with breast cancer who detected the disease by screening, only about 3 percent to 13 percent of them were actually helped by the test, the analysis concluded.

Translated into real numbers, that means screening mammography helps 4,000 to 18,000 women each year. Although those numbers are not inconsequential, they represent just a small portion of the 230,000 women given a breast cancer diagnosis each year, and a fraction of the 39 million women who undergo mammograms each year in the United States.

Do check out the rest of Parker-Pope’s post for further exploration of this controversial topic; the full text of the journal article has also been made available online for free.

Somewhat relatedly, Shira Sternberg writes at Public Responsibility in Medicine and Research’s Ampersand blog (no, not that Ampersand…) about breast cancer from her perspective as the daughter of daughter of “longtime PRIM&R friend” Pat Barr, who died of breast cancer eight years ago. Shira reminds us that there is still work to be done:

In 1991, 119 women died a day of breast cancer, today it is about the same, 110 women die daily of the disease. And this year alone over 230,000 women will be diagnosed with the disease. We gathered at the White House because we know we can do better.

A recent article in the journal Human Reproduction has attracted a fair bit of attention because it suggests a possible link between in vitro fertilization (IVF) and later increased risk of ovarian cancer.

Certain factors increase a woman’s risk of getting ovarian cancer, including a family history of reproductive cancers, personal history of cancer, certain gene mutations, increasing age, hormone replacement therapy, and infertility itself.  Right now, it’s still very hard to determine how much fertility treatments – such as the ovarian stimulation used in IVF – may contribute to increased risk.

For the current study, researchers in the Netherlands identified about nineteen thousand women with fertility problems who received in vitro fertilization, and about six thousand women who had fertility problems before IVF was in common use and so did not receive it. The researchers used questionnaires and medical and cancer records to follow the women for fourteen to sixteen years, from the time of their first IVF treatment or first infertility diagnosis.

The authors found a two-fold risk of ovarian cancer in women who had IVF. Most of this increased risk, however, was for “borderline ovarian tumors,” a noninvasive type that may require surgery but typically has a good prognosis. There was no significant difference in rates of invasive ovarian cancer between the two groups. The authors also note that even larger studies are needed to confirm or refute their findings and to examine any possible relationship between the dose of ovarian stimulation treatments and increased ovarian cancer risk.

They also make this important point:

Knowledge about the magnitude of the risks associated with ovarian stimulation is important for women considering starting or continuing IVF treatment, as well as their treating physicians.

A 2006 review of existing literature on the topic also observed “a stronger association…between fertility drug use and borderline tumors of the ovary,” but called the finding “not consistent among the available studies to date.”

See also: The Politics of Women’s Health: Egg Donation for IVF and Stem Cell Research: Time to Weigh the Risks to Women’s Health.

Pinkwashing is the selling of potentially harmful or cancer-causing products through pink ribbon promotions, many of which were active in October, which is national breast cancer awareness month.

Breast Cancer Action is running their “Raise a Stink!” campaign in response to concerns about one particular product, the “Promise Me” perfume marketed by Komen. BCA raised concerns that some ingredients in the product could be potential carcinogens, and objected to the small amount of money donated for each bottle of perfume.

Komen released a statement saying that its ingredients meet industry standards and applicable FDA guidelines, but the organization apparently plans to reformulate the perfume next year.

The FDA does not require cosmetic products to be tested and approved before they go on the market, and relies on voluntary industry disclosures of ingredients.

BCA also published a list of additional questions after reviewing Komen’s response, and is asking supporters to send a letter to Susan G. Komen for the Cure’s CEO, Chief Marketing Officer, and Vice President to request removal of the perfume from the market. BCA is also asking Komen to more carefully evaluate which products are marketed with pink ribbon promotions.

Last year, the American College of Obstetricians and Gynecologists released new guidelines on vaginal birth after cesarean (VBAC). ACOG’s stance on VBAC is considered extremely important, because it can have a strong influence on whether hospitals and individual providers are willing or able to offer VBAC as an option. The organization’s 2004 statement is widely considered to have drastically reduced the availability of VBAC in the United States.

The 2010 guideline place a greater emphasis on women’s right to be part of the decision-making process and to refuse cesareans, and indicated that women with two previous low transverse incisions, carrying twins, or with single previous cesarean with an unknown type of incision may be candidates for a trial of labor.

One thing that has always bothered me about from a research perspective is how ACOG guidelines are treated once they are updated. Once a new version is out, the old guidelines are essentially disappeared from all the online sources. As I wrote after speaking to an ACOG rep about this issue, it makes it really difficult to compare the old and new version if one wants to see them side by side and compare documents/changes. Immediate removal is probably great for clinicians and liability reasons, but it’s not so great for historical research and understanding changing policies and influences on birth practices over time.

Childbirth Connection has released a document that gives a very basic overview of changes related to VBAC in the 2010 ACOG practice bulletin compared to the 2004 VBAC and 2006 induction of labor for VBAC documents. While this comparison doesn’t have the full details, caveats, and discussion of having the ACOG documents in hand side-by-side, it’s a good starting point for understanding what has changed.

In Memphis, TN, Title X family planning funds have been awarded to Christ Community Health Services, a religious health provider that has indicated that it may refuse to provide information, referrals, and some kinds of health care to Shelby County’s women.

Title X funds have historically gone to Planned Parenthood in Memphis; the move to give the funds to an anti-choice organization is part of nationwide efforts to defund Planned Parenthood because PP provides abortions. Existing laws already clearly prohibit Title X or other federal funds from being used for abortion services – the money goes to provide necessary services like contraception and cancer screenings.

Reports indicate that Christ Community has no intention of providing referrals to women who choose to have abortions, whether that is for personal or medical reasons. From a report by a Memphis newspaper (emphasis added):

[Christ Community CEO] Waller initially said the clinic refers patients to abortion providers if they request it, but he and Dr. Rick Donlon, a founding physician at the clinic, later called the newspaper to change that statement.

“We really try to provide women with other options and make sure they have those possibilities. And if they at the end still want a pregnancy termination, we know they know where to go,” Donlon said.

“They know where to go.” That doesn’t exactly sound like a professional provider of medical services to me. The clinic leaders obviously made a point of contacting the newspaper to make sure it was clear that they would *not* provide referrals, demonstrating a clear intent to put religious belief ahead of the medical care of women who may consider or require abortions.

Christ Community has also said it will not provide emergency contraception, only doing so through a third party. No details are available about how this will happen in practice, and how much additional time, travel and cost women may be subjected to in order to access this legal, previously available, and non-abortifacent medical care. This change clearly creates an additional burden for women seeking emergency contraception, and the women of Memphis currently have no guarantees that the third party provision will happen in a timely way, while timely administration of emergency contraception drugs is absolutely crucial for them to work.

I have not seen this discussed elsewhere, but it is also not readily apparent to me whether Christ Community would or could ever decide that any other forms of birth control are off-limits because of purely theoretical possibilities of preventing fertilized egg implantation. If we’re already providing the Title X money to a provider who can pick and choose services because of religious beliefs, I don’t see that refusing other forms of contraception is completely out of the question.

The organization also is reportedly working to install “crisis pregnancy centers” at its locations; these centers are well known for providing false and misleading information about abortion and exist to convince women not to choose abortion. Title X rules require “nondirective” counseling about abortion, and Planned Parenthood and other reputable providers who do provide abortions (using other, non-federal money) have processes and counselors in place to check whether women are certain of their decisions without pushing them in either direction.

Given the interest in installing deliberately biased in-house counseling and the stated intention to refuse to refer women out to other providers for abortion, it seems unlikely that Christ Community will be able to or has any intention of meeting the rules requiring factual, nondirective counseling. Women who cannot afford to access family planning care elsewhere will be subjected to a provider who clearly wishes to influence women’s choices, rather than providers who are committed to medical accuracy and offer women a full range of choices, supporting their right to individual decision-making about their bodies.

One woman reports that “Christ Community provides high-quality medical services, but that they sometimes come with a ‘sermon.’” She says she was told by a Christ Community provider, “If only my relationships with people and God were right, I would have fewer health problems.”

In addition to these concerns, there may be other issues with Christ Community’s administration of the Title X funds. I’m not personally familiar with CCHS’s existing health clinics and services on the ground. A Memphis local informed me Christ Community does not take appointments – patients must show up first thing in the morning and wait to be seen, and may even have to come back the next day if too many people show up. This is obviously not a good model for providing family planning services, especially when emergency contraception or other urgent services are needed or when women must take time off from jobs, school, or childcare in order to wait around for care. Although the organization’s website does have an “appointment line,” it indicates that this is to find out which clinics provide which services; I’d like to hear from others about whether this matches their experience at Christ Community clinics.

Another serious concern is that Christ Community’s proposal to provide these services clearly indicated that they would provide less care to fewer women than would Planned Parenthood. Steve Ross, of Memphis and blogging at Vibinc, has an excellent series chronicling the whole debacle, from the Tennessee state government pressuring the Memphis health department to take the funds despite their lack of capacity for family planning through to the current funding of Christ Community (parts 1, 2, 3, and 4). In part 2, he lays out the numbers and apparent relative deficiencies of the Christ Community proposal, including their lower numbers for proposed services and inconsistencies in how the proposals from Christ Community and Planned Parenthood were scored by local officials.

In Part 3, Steve points to the questions asked by the potential providers – Christ Community, Planned Parenthood, and a third non-religious applicant. Although they are unattributed, we can only assume that the following questions were asked by Christ Community, the only applicant with an explicit religious mission and on the record about refusing services because of beliefs. I think these are very telling about the intentions of the leadership of the organization that asked these questions, and how they plan to approach women’s health:

In providing information about pregnancy termination, is it sufficient to have the referral information in writing? [My interpretation: In other words, do we even have to bother to actually have a conversation with women about this?]

If the information about pregnancy termination is provided, is the contractor allowed to indicate in wiriting (NOT coerce) – on a referral sheet or in the office that it does not provide that service because of its beliefs.

If a contraceptive method is not provided on site by a provider because of the provider’s ethical beliefs, can the provider refer the client to another Title X provider who offers this method? If so, does the referring provider have to pay for the service?

The answers to these questions explicitly state that emergency contraception must be provided, the organization cannot choose not to provide forms of contraception because of its beliefs, and they are not allowed to talk about refusing abortion and referrals because of beliefs. Yet everything we’ve heard – as mentioned above – indicates that Christ Community plans to do exactly that.

As Steve writes:

To be honest, these three questions left me flabbergasted. Certainly individuals and associations of people are allowed to hold their own beliefs. Certainly, different physicians and networks of physicians have different preferred treatment plans. There’s plenty of room for this diversity out there in the private sector. However, when you choose to enter the public sector by seeking a contract for public dollars, you are bound by the requirements those public dollars place on you. If those requirements are unpalatable to you, then perhaps you shouldn’t seek them.

Honestly, I’m sure this whole thing will end in lawsuits, and I wouldn’t be unhappy if HHS would intervene. In the meantime, poor women suffer.

I will leave you with this excellent rant from Sig at DowntownMemphisBlog:

Public policy needs to be based on reason and fact, not feelings and faith. Abortion is a legal medical procedure. Any organization that aspires to hold a government contract in the area of family planning needs to present all options and perform all medical procedures, not just the ones it agrees with or likes. Not just the ones that make them feel warm and fuzzy inside. Not just the ones that fit into the narrow world view defined by their archaic religious beliefs.

See also: Aunt B

[cross-posted from Women's Health News]

This week, Lauren Sandler published “The Mother Majority” at Slate, and pointedly asks the question, “Women with children have more abortions than anyone else, and by an increasingly wide margin. So why is the topic taboo?”

According to the CDC’s 2007 data, 58.6% of women choosing abortion had 1 or more previous child; a third of women (32.3%) had two or more previous children. Sandler provides more recent numbers from the National Abortion Federation: “every year since 2008, a whopping 72 percent of NAF clients looking to terminate a pregnancy were already mothers, up at least 10 percent from the years before the economy crashed.”

The fact that the majority of women who choose abortion are already mothers flies in the face of anti-abortion rhetoric that falsely portrays women who have abortions as irresponsible and uninformed teenagers or, especially recently, Black women “endangering” Black children, rather than women trying to protect and support the children they already have. Popular stereotypes about women and abortion don’t fit well with the common notion of mothers as selfless caregivers, but many women are likely thinking about the care they can provide their existing children when they choose abortion.

Sandler likewise points to one study of the issue, “which found that most mothers who abort say they are doing so to protect the kids they already have… that rationale is tough to demonize politically, especially when you consider that most women making this choice are contending with some combination of low income, unemployment, and a lack of health insurance, or are struggling to raise kids on their own.”

Sandler’s article also explores pieces of the continuum of the abortion stigma. Gloria Feldt tells her “The less in control of a woman’s life she is, the more the public supports her right to make that choice [to have an abortion]. The more she is in control of her life, saying this is the life I choose, the less people support it.” By contrast, Anne Baker points to “a growing number of women…who are ‘less apologetic than they used to be about saying they’re a good mom and for them to continue to be a good mom, they choose [abortion].’”

For more on this issue, see this post at the Motherlode blog, Guttmacher’s fact sheet on U.S. abortions, this RH Reality Check piece on abortion and stigma, and our previous post on abortion stigma and stereotypes.

This weekend, the New York Times ran a lengthy article on “The Pinking of America,” framed as a discussion of pink-themed marketing campaigns related to breast cancer awareness.

In it, they describe the numerous pink products on sale, especially in October, which is Breast Cancer Awareness month, noting that these campaigns have “become a multibillion-dollar business, a marketing, merchandising and fund-raising opportunity that is almost unrivaled in scope.” NFL teams, tires, mascara, blenders, and many more products have gotten a pink makeover to raise money for screening and treatment research.

As we’ve written here before, and as Breast Cancer Action’s Think Before You Pink campaign works to remind us, there are many criticisms of these pink campaigns, including the relatively small amounts actually being contributed through each pink purchase; pinkwashing – the selling of potentially harmful or cancer-causing products through pink ribbon promotions; the focus on mammograms and treatment rather than prevention; and the possibility that promoting aggressive early screening may lead to harm from unneeded treatments.

The Times piece, however, gives relatively brief and shallow coverage to these criticisms, each one counterbalanced by news of new Komen initiatives and remarks like, “Until we make more progress on the treatment side, on the understanding of what’s causing breast cancer, what would people like us to do, stop talking about it?”

Of course not. But there’s a tremendous gap between asking people not to talk about breast cancer and questioning whether the existing marketing machine is really channeling its efforts in the best possible way. I was heartened, however, by the comments, which raise critical questions not explored in the article. A few examples:

Komen’s willingness to help the NFL avoid the consequences of it’s players’ behavior toward women should not be excused.

I am a breast cancer “survivor” (so far) and I too dislike the pink. Emphasis on “the cure” and no emphasis at all on the cause: pollutants in the air water, food — caused by the same corporations who donate to the pink campaign….Fact is: if you don’t have health insurance, you won’t be able to afford the cure. And many insurers no longer pay for some of the most effective (and expensive) cancer treatments.

Instead of asking grown women to lick the lids of yogurt containers and mail them in like some school fundraising effort, companies that want to donate money can just do so—explaining to consumers that X% of sales for October will go to disease research.

Unless you’re close to someone who is suffering or has been suffering from breast cancer, you don’t see the emotional trauma that is brought on by chemo, hair loss and mastectomies. It’s time that Komen makes the reality of breast cancer less taboo. It shouldn’t just be about cute pink teeshirts and umbrellas.

As a final note, this quote from Komen’s CEO just grossed me out (emphasis mine): “America is built on consumerism. To say we shouldn’t use it to solve the social ills that confront us doesn’t make sense to me.” Ugh.

Yesterday, the House passed HR 358, the “Protect Life Act” which would interfere with women’s ability to choose and pay for their own health insurance plans with abortion coverage. As so clearly outlined in the dissent from the House Energy and Commerce Committee:

…this bill clearly goes further than the regulation of federal funds. Its effect would be to harass and intimidate women and their families in their use of their own money. It makes the job of private insurance companies so artificially complicated and unworkable as to force them from the market. It takes anti-abortion politics far beyond where they have been for the decades of the Hyde Amendment and to put them right in the middle of private homes and workplaces and squarely in private citizens’ paychecks and premiums. Its very essence is to create an undue burden on how people can exercise their own choices with their own money, and it creates a substantial obstacle to a woman seeking abortion services.

…For those members of Congress who have regularly said that they are opposed to federal funding of abortion, this bill is absolutely unnecessary.

President Obama has vowed to veto the bill, stating, “…the legislation intrudes on women’s reproductive freedom and access to health care and unnecessarily restricts the private insurance choices that women and their families have today.”

The Rachel Maddow Show had a nice piece on this last night which called out the Republicans for focusing on an ongoing war against women’s rights instead of focusing on the current unemployment situation. It includes another impassioned speech from Jackie Speier, who spoke so strongly against the bill earlier in the year. Speier also appears as a guest on the show in this clip.

Visit msnbc.com for breaking news, world news, and news about the economy

A recent study published in The Lancet Infectious Diseases drew attention and controversy this month because of its finding that women using injectable types of contraception (known by the brand name Depo Provera) had twice the risk of acquiring HIV from their infected partners.

Heterosexual couples in which one partner had HIV were studied in seven African countries. The participants were sexually active, not pregnant, and not on antiretroviral medicines. Women were HIV-tested quarterly and asked at those times about their contraceptive use.

The researchers found that unprotected sex and sex with other partners was more likely when women used a hormonal contraceptive, but even when they controlled for this, the risk of HIV infection was higher in women using injectable contraceptives compared to oral or no hormonal birth control. Risk of infection in uninfected men from their infected partners was also higher.

The study was limited in that it relied on women’s self-reporting of contraception use and methods. The way participants were selected could have biased the results, and condom use was also self-reported. The study did not randomize women to a birth control method, nor was it designed from the outset as a test of HIV risk and specific types of contraceptive use. It also could not clearly evaluate any risk associated with oral birth control, because there were not enough users of the pill in the study.

Despite these limitations, there is reason to be concerned about whether there is a link between Depo Provera or its generic forms and risk of HIV infection. There are several ideas about how the drugs could potentially increase risk, but the HIV question has been around since at least 1996. That year, researchers working with monkeys and implantable contraceptives published a study suggesting increased risk of a similar virus. Researchers involved with early work on this subject have responded:

How many years has it been that the non-human primate model, and other researchers, have been warning about this and being ignored? What, 15 years now? Shocking.
and
It’s not like we did our work and it was published in an obscure journal. There’s absolutely no excuse for people doing contraceptive work to not have known this, and not to have taken this forward in the late ’90s. We should have had this answered [in humans] ten years ago.

Global health programs often promote long-acting methods like Depo Provera for women in areas where access to regular medical care is difficult and maternal mortality is high. These same areas often have high rates of HIV. I find it unacceptable that the question of contraceptive use and HIV risk has been around for years, and we don’t appear to be much closer to a clear answer. As Charles Morrison wrote in an accompanying editorial:

The question of hormonal contraceptive use and risk of HIV acquisition remains unanswered after more than two decades. Active promotion of DMPA in areas with high HIV incidence could be contributing to the HIV epidemic in sub-Saharan Africa, which would be tragic. Conversely, limiting one of the most highly used effective methods of contraception in sub-Saharan Africa would probably contribute to increased maternal mortality and morbidity and more low birthweight babies and orphans—an equally tragic result. The time to provide a more definitive answer to this crucial public health question is now; the donor community should support a randomised trial of hormonal contraception and HIV acquisition.

Such a trial would require careful design in order to minimize any risk to participants and to stop as soon as any increased risk of one method is clear. It might be impossible to get funding for, but we owe it to women, who deserve clear and accurate information about the potential risks of injectable and all forms of contraception.

As we reflect on our 40th anniversary symposium with its focus on global initiatives, this excellent plenary address delivered by Sylvia Estrada Claudio at the 11th International Women’s Health Meeting (IWHM) in Brussels in September on women’s health and globalization is especially relevant.

In it, Claudio touches on many important themes: human rights, reproductive justice, body image and media, class, race, heterosexism, the environment, corporate greed, and more. There is much to consider in this piece. In particular, she speaks of the need for the women’s health movement to work at the intersections of many forms of oppression:

…this is the 11th IWHM, we are on our 34th year of the contemporary women’s health movement since the very first IWHM was held in Europe in 1977. On the one hand we have achieved much as a movement. And yet on another, whether it be in Asia or Europe we are experiencing backlash and the continuing control of our bodies.

In 1977 and today regimes of control determine the way we work, love and live. Then and now, women have resisted. As long as there is a need for resistances there is a need for a movement. Where women work together to free themselves from class, caste, race, colonial, neo-colonial, heterosexist, and other regimes of control, there we shall find our movement.

She writes that we should not all stop noting differences between us that cause divisions, but should instead move beyond a focus on ourselves and the bigotry encouraged by our larger systems, and work against oppression by refusing to divide into “us” and “others:”

What is the problem, is my ability to accept the world according to their making. Where I exclude myself from others and their struggles, there is where I fall into error. Where I conceive of the women’s health movement as not also a movement against globalization; where I conceive of the movement against sexism as not also a movement against heterosexism, where I conceive the movement against racism as not a movement against caste—that is where I fall into error.

…It is wrong to think that world poverty comes about from the lack of democracy and equity in the area of production and not in the area of reproduction. The women’s health movement must not feel itself out of its depth when it engages the movement against globalization. At the very least we must recognize that the medicalization of the bodies of women who can afford the expensive drugs and procedures, something I have seen discussed well in this meeting, comes from the same logic that denies life saving drugs to those who cannot afford to pay.

Just read the whole thing!

And sometime soon we will have archived video from our own event available online, where you will be able to see and hear our global partners discuss their inspiring women’s health work around the world, including the need to work at the intersection of many oppressions and to frame women’s health in the context of human rights. We’ll post something as soon as the videos become available.

Today at Boston University’s Tsai Performance Center, Our Bodies Ourselves is celebrating the 40th anniversary of the publication of the original “Our Bodies, Ourselves” book, editions of which have informed and inspired women ever since.

To mark this milestone, the organization is holding a free public symposium, with speakers including Loretta Ross of SisterSong, Byllye Avery of the Black Women’s Health Imperative, and OBOS’s own Judy Norsigian. Jacyln Friedman of Women, Action, & the Media is the emcee.

There will also be panels on global activism featuring OBOS’s network partners from 12 countries who will discuss their experiences transforming ‘Our Bodies, Ourselves’ for their own countries (meet some of them here on the blog).

Here’s the full agenda and program guide (pdf).

Last but not least, the 40th anniversary edition of the landmark book, a completely revised ninth edition, will be released today.

I’m super-excited.

Realizing that everybody who might be interested in these sessions — which include a great deal of international representation — might not be able to attend, the event will be live-streamed online starting at 9 a.m. today.

If you’re following along at home and want to tweet about it, the hashtag we’re using is #obos40. There will be a post-event round-up at here at Our Bodies Our Blog.

Be sure to check out three new stories about OBOS posted today. And thanks for celebrating with us!