Shafia Monroe of the International Center for Traditional Childbearing was recently interviewed for a nice piece in The Skanner on the topic of Breastfeeding: A Wellness Issue for African American Families. Currently, black women start and continue breastfeeding at at much lower rates than other measured races/ethnicities. According to the CDC, rates are:

In the interview, Monroe talks about health benefits of breastfeeding, notes the lower breastfeeding rates among black women, and encourages black women to breastfeed for a year or longer. She says:

…we only hear people telling black women to get a mammogram—I’ve never heard anyone tell black women that if you breastfeed for one year it can reduce your breast cancer risk. So that’s important…

By breastfeeding, it delays your onset of Type 2 diabetes. This can be major, when you have a high diabetic rate within the black community in Portland, and more black women dying from late-stage breast cancer.

Monroe goes on to note that breastfeeding needs to be made “more acceptable in the normal life of African American families, so they feel there’s no shame that comes from doing it. And that the black community should embrace women who breastfeed and make them feel comfortable in all areas.”

The question of why more black women don’t breastfeed is an important one. The CDC identifies a number of potential factors, including “social and cultural norms, social support, guidance and support from health-care providers, work environment, and the media.” Christine talked about the need for support at work and among friends and family members in a previous post as well. Kimberly Seals Allers at BlackandMarriedWithKids asks, Is Slavery Behind Our Low Breastfeeding Rates?, exploring the ways women in slavery in the U.S. were forced to stop own breastfeeding infants and forced to breastfeed white infants.

A couple of online resources are intended to support black women in breastfeeding. One is Black Breastfeeding 360, which has tips, information, and women’s stories about breastfeeding. Another is the Black Women Do Breastfeed blog and Facebook page, which also feature black women’s stories of breastfeeding, including how they overcame challenges they faced after choosing to breastfeed their children. Finally, the federal Office on Women’s Health has a PDF guide, Your Guide to Breastfeeding for African American Women, which teaches about the importance of breastfeeding, how to do it, and how to handle some common challenges.

Relatedly, Kimberly Seals Allers (of Black Breastfeeding 360) has a great piece on media and other coverage issues around this topic, in Dear White Women: Beyonce is OUR Breastfeeding Moment. Please Step Aside. She writes:

…with all the news reports about Beyonce, and all the breastfeeding “advocates” talking about its impact on the nursing world, not one advocate mentioned the particular significance to black women — which is so striking since many claim to be interested in our breastfeeding plight.

Shame on you…some of you white breastfeeding advocates, one of you, should have pointed that out. If not for us then please for our babies. Black babies are still 2.4 times more likely to die before their first birthday and the CDC says increased breastfeeding among black women could reduce this needless disparity by as much as 50%.

Having Beyonce as our black breastfeeding moment potentially means that more African American women will know that breastfeeding is mainstream and beautiful and actively practiced by the celebrities we admire. The celebrities from our community. It means that more black women, particularly young women, may consider breastfeeding their babies–something our community urgently needs.

Escrito por Rachel. Traducido del orginial en inglés August 9, 2011.

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

La semana pasada, el Centro para el Control y la Prevención de Enfermedades dio a conocer un reporte que muestra una baja tasa de amamantamiento en los Estados Unidos, así como la importancia de tener hospitales que asuman un papel positivo en animar y apoyar esta práctica. La información del reportaje viene de una encuesta nacional sobre prácticas y políticas de maternidad.

Los investigadores encontraron que aproximadamente el 90% de los hospitales reportan que proveen educación prenatal para el amamantamiento para enseñar técnicas para amamantar, pero menos de la mitad siguen el resto de las recomendaciones de Los Diez Pasos para Amamantar con Éxito, la lista de políticas y acciones requeridas para ser un hospital o un centro de natalidad adecuado para los recién nacidos. Solo alrededor del 3.5% de los hospitales implementan al menos 9 de las 10 prácticas, las cuales son consideradas como las causantes del aumento en la tasa del amamantamiento, gracias al apoyo que reciben las madres.

Entre los pasos menos seguidos están el tener una política modelo para el amamantamiento (14.4% lo hizo); limitar el uso de formula, agua, o suplementos de glucosa en bebes saludables y apropiadamente amamantados (21.5%); y proveer apoyo adecuado de amamantamiento para madres que están dando de lactar, cuando el hospital les da de alta (26.8%).

Información adiciónale sobre el tema:

• Diez Pasos hacia una feliz lactancia natural – de La Iniciativa Hospital Amigo del Nino (UNICEF/OMS)
• 125 Hospitales y Centros de Maternidad Amigos del Niño en Estados Unidos – de La Iniciativa Hospital Amigo del Nino (UNICEF/OMS)
• Los hospitales necesitan mejorar prácticas de cuidados maternos – de Especiales CDC
• Mejoramiento del apoyo a la lactancia en hospitales – de Especiales CDC
• Los hospitales de EEUU dan poco respaldo a la lactancia – de Reuters España

Last week, the Centers for Disease Control and Prevention released a report pointing to low rates of breastfeeding in the United States and the importance of having hospitals play a positive role in encouraging and supporting the practice. Data in the report comes from a national survey of maternity care practices and policies.

The researchers found that about 90% of hospitals report providing prenatal breastfeeding education teaching breastfeeding techniques, but fewer than half follow the other recommendations in the Ten Steps to Successful Breastfeeding, the list of required policies and actions for being a Baby-Friendly hospital or birth center. Only about 3.5% of hospitals have implemented at least 9 of the 10 practices, which are thought to increase breastfeeding rates by supporting mothers.

Among the least-followed of the ten steps were having a model breastfeeding policy (14.4% did so); limiting use of formula, water, or glucose supplements for healthy, full-term breastfed infants (21.5%); and providing adequate breastfeeding support to breastfeeding mothers at hospital discharge (26.8%).

For more information, see the CDC’s press release, Vital Signs report, more detail on the survey results in the MMWR publication, and advice for what state and local governments, hospitals, doctors and nurses, and mothers and their families can do to encourage hospital support of breastfeeding.

Today, the U.S. Department of Health and Human Services announced that it is adopting the Institute of Medicine’s recommendations for preventive care services for women. This will ensure that women have access to the following services under health insurance plans without having to pay a co-payment, co-insurance or deductible:

• well-woman visits
• screening for gestational diabetes
• HPV testing
• STI counseling
• HIV screening and counseling
• contraception methods and counseling
• breastfeeding support, supplies, and counseling
• screening and counseling for domestic and interpersonal violence

Coverage for these services is expected to begin Aug. 1, 2012.

There is one caveat for some women regarding access to contraception without a co-pay — a provision that “Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services.”

An announcement at the HealthCare.gov site indicates that public comment is welcome on this provision. Although I haven’t yet been able to locate it on Regulations.gov, instructions for comment and more detail about the exemption is provided in this document.

Good news! You may remember that the health care reform legislation enacted last year included provisions for preventive health care services to be fully covered without requiring patients to have copayments.

It was not clear, however, whether birth control would be included as a preventive service. It seems obvious to us, but the Institute of Medicine was asked to make some recommendations about which preventive services for women should be included, and included birth control in those recommendations, released yesterday.

If they are adopted, preventive services including birth control could become much more affordable and accessible to women in the United States.

The Institute, after reviewing the rate and consequences of unintended pregnancy, effectiveness of birth control, and cost and access concerns, concluded:

The committee recommends for consideration as a preventive service for women: the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.

In addition to copay-free coverage of birth control, the Institute recommended:

• screening for gestational diabetes
• human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
• counseling on sexually transmitted infections
• counseling and screening for HIV
• lactation counseling and equipment to promote breast-feeding
• screening and counseling to detect and prevent interpersonal and domestic violence
• yearly well-woman preventive care visits to obtain recommended preventive services

You can view the Institute’s press release, recommendations, report brief, and full report, “Clinical Preventive Services for Women: Closing the Gap,” online. The Department of Health and Human Services will still need to adopt this list of recommendations for the care to be covered under the Affordable Care Act.

Some other coverage and discussion of this topic:

• NLIRH Applauds Panel’s Counsel to Cover Birth Control Under Health Reform – from the National Latina Institute for Reproductive Health
• Anti-Choicers Gear Up To Fight Guidelines on Preventive Care for Women – Jodi Jacobson at RHRealityCheck discusses the inevitable anti-choice backlash
• A Preventive Health Care Game-Changer for Women – at the Ms. Blog
• Statement from the March of Dimes commending the recommednations
• Doctors to HHS: Adopt Contraception Recommendations, Improve Women’s Health, Save Money – Press release from Physicians for Reproductive Choice and Health<
• Women’s Preventive Health Coverage Information Central – lots of news and resources on this topic from Raising Women’s Voices
• Women Should Get Free Birth Control, HHS-Backed Group Urges – at The Rundown, a PBS NewsHour blog

Seen other good links on this news? Leave ‘em in the comments!

Publicado por Rachel / del orginial en inglés June 14, 2011

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

Yo no suelo tener la revista “Wired” en mente cuando busco interesantes historias de salud femenina; simplemente me encontré con su reciente artículo virtual sobre la leche materna humana.

En Oro Liquido: El Mercado Floreciente para la Leche Materna Humana (Liquid Gold: The Booming Market for Human Breast Milk), la autora Judy Dutton explora cómo y por qué las mujeres van a las páginas de la internet para comprar, vender y donar leche materna a otras mujeres (y algunos hombres), e investiga las preocupaciones de seguridad y los beneficios de la leche materna.  Ella también examina si se debe permitir que las personas vendan leche materna directamente a otros individuos sin el uso de un banco de leche materna.

Según el artículo, aparentemente la leche materna es considerada comida en los Estados Unidos y no es regulada como lo son los tejidos y la sangre; la compra y venta de la leche materna es aparentemente legal en la mayoría de estados.

Dutto explica algunas razones por la cual las mujeres podrían querer usar la internet para este fin.  Algunas mujeres prefieren donar leche directamente a otra mujer en lugar de que esta sea revendida por un banco de leche.  Otras razones incluyen la posibilidad de solventar dificultades financieras por la venta de leche sobrante, los chequeos y las restricciones propios de una donación a bancos, los altos costos asociados a la compra de leche a un banco de leche, la falta de cobertura de seguro para obtener leche donada, y el actualizado atractivo, en el siglo 21, de esta antigua practica de dar de lactar a los bebes de otras mujeres.

¿Qué piensa usted? ¿Deben los individuos poder comprar y vender leche materna? ¿Cómo se siente en cuanto a los riesgos de contaminación y la falta de control en las ventas o donaciones personales? ¿Es esto algo que usted consideraría hacer? ¡Háganoslo saber en los comentarios!

Información adiciónale sobre el tema:

• Leche Materna, Bancos de Leche Materna, Leche Infantil Artificial

I don’t typically have “Wired” magazine in mind when I look for interesting women’s health stories, so I just stumbled across their recent piece on the online market for human breast milk.

In Liquid Gold: The Booming Market for Human Breast Milk, author Judy Dutton explores how and why women come to online sites to buy, sell and donate breast milk to other women (and a few men) as well as safety concerns and the benefits of breast milk. She also examines the question of whether individuals should be allowed to sell breast milk directly to other individuals, without going through a breast milk bank.

According to the piece, breast milk is apparently considered a food in the U.S. and so is not as regulated as tissues and blood are; buying and selling breast milk is apparently legal in most states.

Dutton explains a few reasons why women might want to go online for this need. Some women prefer to donate milk directly to another woman rather than have it be resold by a milk bank. Other reasons include the ability to alleviate financial difficulties by selling extra milk, screening and restrictions involved in donating to banks, the high costs associated with purchasing milk through a milk bank, lack of insurance coverage for obtaining donor milk, and the appeal of this simple 21st century update of the age old practice of women feeding each other’s babies.

What do you think? Should individuals be able to buy and sell breast milk? How do you feel about the risk of contamination and the lack of screening in person-to-person sales or donations? Is this something you would consider? Let us know in the comments!

The IRS has ruled that breast pumps and supplies that assist in lactation do quality as medical care and are therefore deductible medical expenses that can be paid for through Flexible Spending Accounts (FSAs) and other medical spending accounts.

The American Academy of Pediatrics had previously requested that the IRS rule that these supplies be added to the list of qualifying FSA items, but received a denial stating that breastfeeding did not constitute medical care. The new ruling does not decide that breastfeeding is medical care of an infant, but rules that the supplies are medical because “they are for the purpose of affecting a structure or function of the body of the lactating woman.” The AAP has applauded the change as “an important victory for the health of women and children across the country by making breastfeeding a more practical option for new and working mothers.”

In other news, the Associated Press has covered the issue of access to nitrous oxide for women in labor. The piece explains that some institutions (including my own) are currently working to make nitrous oxide an option; it’s commonly available to laboring women in some other countries. The item notes at the end that “the federal Agency for Healthcare Research and Quality is reviewing the effectiveness and safety of nitrous oxide compared to other pain relief methods” – I’m on the team for this project at work, so we’ll be sure to let you know as soon as that report is available.

Escrito por Raquel; traducido por Ema Rosero del orginial en inglés Jan 24, 2011

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

La semana pasada la Dra. Regina M. Benjamín, Cirujana General de los Estados Unidos, expidió “Llamado a la acción en apoyo a la lactancia materna de la cirujana general” (The Surgeon General’s Call to Action to Support Breastfeeding). El informe describe los obstáculos y las tasas de lactancia materna en los Estados Unidos y los beneficios de salud, los beneficios económicos, sicológicos y ambientales de la lactancia materna. El informe es un llamado de acción a toda persona para tomar medidas que faciliten las opciones disponibles a madres para amamantar a sus bebés.

En lugar de únicamente invitar a las mujeres a amamantar a sus hijos(as), el informe hace un llamado a que los padres y las abuelas sean educados sobre la lactancia materna, a que se fortalezca el apoyo comunitario entre madres, a que las madres aborden cómo  está mercadeando la leche de fórmula, asegurar que guarderías que cuidan infantes apoyen la lactancia, que haya consultores(as) de lactancia accesible para madres y que se continúen haciendo estudios de investigación.

El continuo apoyo de madres en lugares de trabajo y en la comunidad es importante porque los factores por los cuales mujeres dejan de amamantar más temprano de lo que ellas quisieran se debe a factores externos tales como la falta de descansos para empleados durante horas laborables y la falta de instalaciones para extraer la leche materna en los lugares de trabajo. Al presente tres cuartas partes de las mujeres estadounidenses que intentan continuar lactando pero menos de la mitad, han continuado amamantando por un mínimo de seis meses. La Dra. Benjamín indicó lo siguiente:

Existen muchas barreras para madres que quisieran lactar por lo que estas madres no deberían confrontar estos desafíos a solas. Así usted sea un/a médico/a, un miembro de familia, amigo/a, o empleado/a, uno puede colaborar en ayudar a las madres que desean dar de pecho a sus bebés.

En la medida en que nos mantenemos vigilantes con respecto al retroceso de provisiones para la reforma de salud, hemos de mantener los ojos abiertos con respecto a la lactancia materna ya que la legislación aprobada el año pasado incluyó para enmendar la Ley de Normas Razonables de Trabajo (Fair Labor Standards Act)  para asegurar que los empleadores provean descansos razonables para madres lactantes y en áreas privadas que no sean los baños.

Last year, the Fair Labor Standards Act (FLSA) was amended to require employers to provide a reasonable break time and a non-bathroom private place for nursing mothers to express breast milk for one year after their child’s birth. The requirement became effective when the Affordable Care Act was signed into law on March 23, 2010.

A notice in the December 21, 2010 Federal Register indicates that employers have asked for further guidance on this measure, and asks for public comment on aspects such as what is “reasonable” break time. The National Partnership for Women and Families translates the key questions for public comment into the following terms, less technical than wading through the Federal Register document.

1. Have you ever had to use a room connected to a bathroom to pump breast milk at work? Was it completely closed off or private? Was it a good or bad environment — and why?

2. Have you ever had to pump breast milk in a room normally used for something else — like a locker room, storage room or closet, or a manager’s office? Was it a good or bad environment — and why?

3. Have you ever had to pump breast milk in a shared space — one shared by other employees or employees from other nearby employers, like in a shopping mall or airport? What provisions for privacy worked or didn’t work?

4. Have you tried to keep breastfeeding/pumping in a job that requires you to be on the move—like driving a vehicle, visiting clients off-site, or patrolling a neighborhood? How did you make this work and how did your employer help (or fail to) support you?

The organization also provides a way to submit comments directly through their website. You may also submit your comments individually by going directly through Regulations.gov, where the link to a PDF of the Federal Register document detailing questions and issues related to the provision is available for download.

Comments are due by February 22, 2011.

Last week, U.S. Surgeon General Dr. Regina M. Benjamin issued “The Surgeon General’s Call to Action to Support Breastfeeding ” [PDF]. The report describes barriers to and rates of breastfeeding in the United States and the health, economic, psychosocial and environmental benefits of breastfeeding.  The report is a call to action for all people to take steps to make the choice to breastfeed easier for mothers.

Rather than simply exhorting women to breastfeed, the report calls for educating fathers and grandmothers about breastfeeding; strengthening of community-based mother-to-mother and peer support; addressing the way infant formula is marketed; ensuring that maternity care providers and systems are supportive of breastfeeding and lactation consultants are accessible; improving maternity leave and workplace support for lactating mothers; and conducting further research.

The inclusion of workplace and community supports is important, because the factors that lead many women not to breastfeed or to stop breastfeeding earlier than they would like are often external ones, such as a lack of sufficient breaks and facilities for pumping milk in the workplace. Three quarters of U.S. women currently attempt breastfeeding, but fewer than half have kept it up by six months. As Dr. Benjamin stated for the press release:

Many barriers exist for mothers who want to breastfeed. They shouldn’t have to go it alone. Whether you’re a clinician, a family member, a friend, or an employer, you can play an important part in helping mothers who want to breastfeed.

As we keep watch on efforts to roll back provisions of health care reform, this is yet another issue to keep an eye on, as the legislation passed last year included a provision to amend the Fair Labor Standards Act to ensure that employers provide reasonable break time for nursing mothers in a private place other than a bathroom.

Additional resources for mothers and employers are provided at http://www.surgeongeneral.gov/topics/breastfeeding/index.html.

The CDC released a new breastfeeding report card [PDF] yesterday, reporting that 3 out of 4 new mothers in the now U.S. start out breastfeeding, meeting the Healthy People 2010 national objective for breastfeeding initiation for the first time.

However, rates of breastfeeding at other time points remain lower than the HP2010 objectives and have been stagnant for the past three years.  The target rates are 50% at 6 months (currently 43%), 25% at 12 months (now 22.4%), 40% exclusively breastfed through 3 months (now 33.0%), and 17% exclusively breastfed at 6 months (now 13.3%).

Rates vary widely by state – for example, the percent of women who initiated breastfeeding was >80% in several Western states (California, Utah, and Washington, for example), but only 52.5% in Mississippi.

A CDC press release on the report emphasizes the role of hospitals in increasing the rate, with a CDC representative stating that, “High initiation rates tell us that a lot of moms plan to breastfeed, but these rates do not indicate that a birth facility is doing what it needs to support them in their effort.”

The release also notes that <4% of U.S. births occur at facilities designated as Baby-Friendly, a designation indicating that the facility takes steps to encourage breastfeeding initiation. Another CDC rep notes the importance of support in workplaces and communities; see these previous posts for our past discussions related to workplace and economic pressures and breastfeeding.

A recent issue of the CDC’s Morbidity & Mortality Weekly Report publication included a piece on racial and ethnic differences in breastfeeding, describing rates of breastfeeding initiation and continuation to six and twelve months by survey respondents’ status as Hispanic, non-Hispanic white, or non-Hispanic black.

The report finds that “National estimates for breastfeeding initiation and duration to 6 months and 12 months were 73.4%, 41.7%, and 21.0%, respectively (Table 1). Breastfeeding estimates varied by race/ethnicity, participation in the WIC supplemental nutrition program, and mother’s age and education.”

When examined by race/ethnicity, it was found that non-Hispanic blacks generally had the lowest prevalence of breastfeeding initiation, followed by Hispanics, with non-Hispanic whites having the highest rates. The authors note that “Most states were not meeting the HP2010 targets for breastfeeding duration for any racial/ethnic group.” HP2010 refers to national goals for health status and healthy behaviors; HP2010 had a goal of having 75% of women initiate breastfeeding, with targets of 50% and 25% for six and twelve months.

The report also provides geographic data, with a good chart of breastfeeding data by state and race/ethnicity, and some maps showing geographic differences in breastfeeding rates. For example, you can see that breastfeeding rates are pretty low in the Southeast where I live, but are a fair bit higher in OBOS’s home state of Massachusetts. The report notes wide racial/ethnic gaps here as well, indicating that “in the southeastern United States…13 states had a prevalence of breastfeeding initiation that was ≥20 percentage points different between non-Hispanic blacks and non-Hispanic whites.” In Massachusetts, however, that gap is just 11 percentage points.

The report concludes that: “Breastfeeding should be promoted through comprehensive clinical and social supports starting in pregnancy, and including the birth, delivery, and postpartum periods.”

Of course, no discussion of breastfeeding rates is complete without consideration of all of the workplace, societal and other barriers to breastfeeding for women who choose to do so. The CDC report offers, among other factors, “returning to work sooner (where support for breastfeeding often is insufficient) and lack of social or partner support” as barriers that may prevent women who want to initiate and continue breastfeeding from doing so.

The recent health care reform legislation should help women with at least the workplace barriers. As we mentioned in a previous post, the legislation includes a provision which requires employers with more than 50 employees to provide “reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth each time such employee has need to express the milk; and a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.”

It’s unpaid break time, but at least it’s a start.

Although the just-passed health reform bill has generated considerable debate about abortion (see Christine’s previous post), at least two other reproductive health components of the bill are worth mentioning — provisions related to freestanding birth centers and certified nurse midwives.

We have written previously about the Medicaid Birth Center Reimbursement Act, a bill supported by the American Association of Birth Centers. We’re pleased to report it was included in the health reform bill (section 2301 for those interested in reading the text). As the AABC notes, the reform bill includes provisions for Medicaid payment to freestanding birth centers in states where those centers are licensed.

Now that President Obama has signed the bill, it will go to the Centers for Medicare and Medicaid Services (CMS), which issues Medicaid rules and regulations and pays the federal percentage of Medicaid payments that states might make to birth centers.

The bill also includes a provision to increase Medicare Part B coverage for certified nurse midwife services from 65 percent to 100 percent as of Jan. 1, 2011 (section 3114).

Other relevant provisions include: coverage of tobacco cessation counseling and pharmacotherapy for pregnant women receiving Medicaid (section 4107); establishment of a fund to award grants to states to higher education institutions to enable them to establish, maintain or operate services for pregnant and parenting students (section 10212/3); and amendment of the Fair Labor Standards Act to require reasonable (but unpaid) break time for nursing mothers for one year each time the employee needs to express the milk, in a private place other than a bathroom (section 4207).

Citizens for Midwifery talks more about the effects of the legislation in this release from the MAMA campaign. I, for one, am still attempting to digest all of the bill’s content. Seen any other positive reproductive health items in the bill? Let us know in the comments.

Hope you’re all relaxing today, at least for a little bit. Here are a few articles that seem fitting in honor of Labor Day …

- At Women’s eNews, Kate Kelly describes the work of Lillian Moller Gilbreth, also known as the Mother of Modern Management, who was an industrial engineer and a pioneer in creating work environments that met the needs of the disabled. This is the first I’ve heard of Gilbreth, a mother of 12, and continued to read more about her incredible life at Webster and Wikipedia. Gilbreth’s papers are at Smith College.

- From Plain Dealer columnist Connie Schultz: “Last week, in a 5-1 ruling, the highest court here ruled that an Ohio law that bans discrimination against pregnant women does not protect them from punishment for taking unauthorized breaks to use a breast pump after they birth those babies. And you thought we were a trendsetter only in presidential election years.” Read on.

- “Mad Men,” my favorite TV show of the moment, offers a poignant look at the trials of women in the workplace in the early 1960s. The series is set at a growing ad agency on Madison Avenue (that’s copywriter Peggy Olson, played by Elisabeth Moss, above), and it’s full of cringe-worthy moments. Seven of the show’s nine writers are women, which Amy Chozick notes is a rarity in Hollywood television.

Joan Wickersham, who worked as a copywriter in a Boston ad agency in the 1980s, writes in the Boston Globe that “long after the 1960s, the workplace was still stuck in the same cultural blind spot satirized in ‘Mad Men.’” She shares this story of a client presenting prototypes of two computer games — the one targeted to boys involved building a railway empire; the one targeted to girls involved deciding where to put furniture in a house.

I suggested to the client that maybe the girls’ game needed a little more substance. The boys’ game was ambitious, intellectually challenging – couldn’t something similar be devised for the girls? Or maybe they didn’t need their own game. Maybe they’d be just as excited as the boys about building a railway empire. Maybe . . .

One of the men I worked with gave me a look. A look that said: “You’re being a pest, and a troublemaker. Shut up.’’

And I did.

Fast forward another 25 years, and consider Wal-Mart’s gendered back-to-school commercials, as described by Claire Mysko:

Boy version with Mom voiceover: “I can’t go to class with him. I can’t do his history report for him, or show the teachers how curious he is. That’s his job. My job is to give him everything he needs to succeed while staying within a budget…I love my job.” Cut to boy with his new affordable laptop. He’s getting applause from his teacher and the students in the class as he delivers a report.

Girl version with Mom voiceover:“I can’t go to school with her. I can’t introduce her to new friends.” Cut to girl nervously asking “Can I sit here?” to a group of girls sitting together at lunch. “Sure, I like your top!” one of them answers. “Or tell everyone how amazing she is. But I can give her what she needs to feel good about herself without breaking my budget. All she has to do is be herself.” Cut to smiling girls walking arm-in-arm down the hallway.

It appears that much work still needs to be done.