The U.S. Preventive Services Task Force has updated its statement on breastfeeding promotion following a review of the evidence, and recommends that “health care settings use strategies that work with women and families both before and after delivery to encourage and support breastfeeding.” The previous review, published in 2003, did not address prenatal support and had found insufficient evidence for interventions such as counseling by primary care providers.

The Task Force is part of a government agency and focuses on better informing healthcare providers by reviewing evidence of effectiveness and developing recommendations for clinical services. Its recommendation in this case is Grade B, meaning that “There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.”

In the recommendation, the reviewers note that there is evidence that breastfeeding may have health benefits for women and children, and that interventions to support breastfeeding have been found to increase the rates of initiation, duration, and exclusivity of breastfeeding, while the harms of such interventions are thought to be minimal.

The commentary on these potential harms specifically addresses the empowerment of women to make informed choices. The reviewers explain (emphasis added):

“No studies identified for the USPSTF reported harms from interventions to promote and support breastfeeding. Nonetheless, there are potential harms, such as making women feel guilty. Breastfeeding interventions, like all other health care interventions designed to encourage healthy behaviors, should aim to empower individuals to make informed choices supported by the best available evidence. As with interventions to achieve a healthy weight or to quit smoking, breastfeeding interventions should be designed and implemented in ways that do not make women feel guilty when they make an informed choice not to breastfeed.”

The reviewers also note that additional research is needed on issues such as exclusive vs. partial breastfeeding, costs and cost benefits of interventions to promote breastfeeding, the effectiveness of compliance with the World Health Organization’s Baby-Friendly Hospital Initiative in the United States, the effects of individual components of breastfeeding support, and “to allow the tailoring of interventions to the needs of individual women and families.”

The agency’s Recommendation Statement is freely available online, and links to supporting documents are provided here.

A post at Well this week about a new breastfeeding study provides several lessons in language and privilege — and it also serves as a reminder of the importance of collective action.

The study, published in the August issue of the Journal of Human Lactation, found that while three-quarters of new mothers try breastfeeding, only 36 percent of babies are breastfed through six months. The recommendation from the American Academy of Pediatrics is to breastfeed exclusively for six months, with continued breastfeeding for one year or more. WHO recommends continuing for two years or more.

Despite those recommendations, the United States famously lags behind other countries in providing much-needed support for nursing mothers. Factors include the absence of breastfeeding training and support after hospital discharge; the high percentage of hospitals handing out free infant formula samples; the lack of paid maternity leave (only 51 percent of new mothers receive any paid maternity leave, and even among companies considered the best for working mothers [PDF], the statistics aren’t good); and the difficulties women encounter upon returning to work, including a lack of time and privacy to express milk in a safe, clean environment.

One of the first commenters on the Well post described her own experience:

I can tell you why breast feeding drops off before 6 months: Women have to work! As I type, I’m hooked up to a beast pump in my nice office with a locking door. It would not be possible for me to breastfeed if I didn’t have these small perks.

As a prosecutor, I’ve had to make some sacrifices to continue to breastfeed my daughter. For example, I can’t take any cases to trial because I can’t be away from my office for an entire day. Luckily, I have a supportive work environment.

I don’t know what one of my secretaries would do if she wanted to breastfeed. They are all stuck in cubicle land. [...]

Which prompted this response a few comments later:

Perhaps the prosecutor - and other women with the privileges and perks she cites - ought to stand up for the secretaries and others who don’t have those perks. Rather than wondering what those in cubicle land would do, she might ask those women what they do, and what the workplace as a whole could do to support them. There must be some space that could be used periodically by any woman needing to pump, and advocating for that would be a nice way for the poster, or anyone else (male or female!) to support working mothers. [...]

The commenter makes a great point, but really it’s the responsibility of all of us to advocate for these changes. Here’s another comment from a mother whose workplace seems to offer the ideal supportive environment that should be available to all women:

After returning to work when he was 3 months, I pumped three times a day in my work place’s “Mom’s rooms” which were a couple of small rooms in different buildings where we could plug in our pumps and store milk if needed in a fridge. Now 10 years later, we have more rooms and also company provided hospital grade pumps so Moms can just bring their own attachments instead of carting around the pump. I know being able to pump at work was a huge factor in me staying in the work force and not quitting to stay home. [...]

This amenity is available to all workers at our location - both manufacturing technicians in our plants and office (we only have cubes) employees. I will say, it took a lot of work to pump, deal with the bottles, skip outside lunches etc but it was worth it to me and my family. Meeting other Moms who were also pumping was another factor in sticking with it, so now I try to give this info to any new Moms in my group. I try to be non-judgemental when I mention this, just letting them know what is out there and thats its possible.

A number of commenters also took issue with the headline of the post: “Most Moms Give Up on Breastfeeding.” I think this response best sums up the critique:

“Giving up” definitely implies failure by the person doing the giving up — and yes, how you express the fact of abbreviated nursing periods DOES matter, a great deal.

Blame for the failure should be shared by many overlapping systems (and, of course, in some cases, the particular families involved). But when the problem is expressed in terms that frame it as a matter of personal, individual responsibility, the solutions to the problem end up focusing on improving individual behavior.

Even though the evidence of the benefits of avoiding artificial feeding continues to accumulate, we fail SYSTEMICALLY to allow all women and children to enjoy these benefits. So yes, some families “give up”. But this article isn’t about a few individual women or families who choose badly, it’s about the many hurdles faced by breastfeeding women in this country.

If you’re looking for a place to get started, Moms Rising has a statement you can sign in support of the Breastfeeding Promotion Act, which was introduced by Rep. Carolyn Maloney (D-N.Y.) in 2007 and now seems stuck. These are the major provisions:

• amends the Civil Rights Act of 1964 to protect breastfeeding women from being fired or discriminated against in the workplace
• provides tax incentives for businesses that establish private, lactation areas in the workplace
• provides for a performance standard for breast pumps
• allows breastfeeding equipment to be tax deductible for families

Rachel has more details about the bill here (along with a smart quibble!). And check out more campaigns sponsored by Moms Rising concerning family leave, health care and fair pay.

Plus: For anyone interested in the history of campaigns to increase breastfeeding rates, I came across this interesting article in the American Journal of Public Health that describes infant feeding practices and public health campaigns in the early 20th and 21st centuries.

Several organizations working on reproductive and other health topics are now sharing their message via online video. I’ve listed several examples below; feel free to suggest others in the comments.

Ipas has a video on abortion in Brazil, and explains that “Abortion in Brazil is highly restricted, allowed only in cases of rape, or to save the life or health of the mother. Women who break the law can be imprisoned for up to three years.” Their website also provides more information on the topic and their work in the nation.

World Breastfeeding Week starts today; a video contest was held on the theme of supporting breastfeeding women, and the winning entries are now available.

Consumer Reports Health has been conducting a “Cover America Tour,” in which they interview people about their struggles with paying for healthcare. The resulting videos from across America can be viewed here.

Finally, in a previous post, I mentioned the recent Wide Angle program, “Birth of a Surgeon,” on Mozambique midwives being trained to offer emergency surgical care to obstetric patients; the full episode is now available for online viewing.

Aisha Qaasim, a civil rights attorney, often advocates on behalf of others.

Today, in an essay published at Women’s eNews, Qaasim takes on the insults hurled at women who breastfeed in public and argues that the negativity surrounding breastfeeding is hurting the health of children and mothers, particularly in African-American families, where the rate of breastfeeding is the lowest.

Women who breastfeed lower their risk of developing uterine cancer, osteoporosis, Type 2 diabetes and breast cancer over their lifetimes.

But the irony is that in today’s ambitious parenting climate — where millions of dollars are being spent on educational toys and organic baby products — breastfeeding as the most important developmental head-start is often neglected.

Among African American women that’s particularly true. In 2004, 74 percent of U.S. women initiated breastfeeding soon after giving birth. Among black women it was 60 percent.

By the time infants reached 6 months of age — a key health target — only 14 percent of U.S. infants were breastfed exclusively. Among black infants it was 7 percent.

Only 36 percent of U.S. babies received breast milk in combination with formula or other foods at 6 months of age. For African American babies make that 29 percent.

Black women are the least likely to breastfeed, even those of us with a college education, health insurance and a nice paying job. African American women across the spectrum breastfeed less than women who have only a high school education, less than women who live below the poverty line and less than adolescent mothers, according to the Centers for Disease Control 2004 National Immunization Survey.

It’s not an abstract issue for Qaasim. As a black women, she has weathered overtly racist insults, much of which she could brush off. But Qaasim couldn’t shake a comment she heard while breastfeeding her 2-month-old daughter at a suburban Maryland mall.

“That is the most disgusting thing I have ever seen,” the woman said.

“A nameless woman at a mall was somehow the one to find the insult that I could not toss onto the neat pile of words that would never hurt me. It did hurt. And, these attitudes toward breastfeeding are making our children sick, especially African American children, who are the least likely to get the benefit of mothers’ milk,” writes Qaasim.

And when she complained about the ridicule — which she said almost always came from other women — friends and family didn’t offer much support.

The response is not uncommon. Among the many public obstacles women face with regard to breastfeeding — including a lack of privacy and time to pump breast milk at work and a lack of knowledge concerning laws in most states granting mothers the right to breastfeed in public spaces — discouragement from friends and family is also a major deterrent.

A recently published study of 88 new or soon-to-be mothers, mostly Hispanic and African-American, found that the opinions of family and friends are the most significant factor in determining whether low-income mothers breastfeed their children. The study, titled “Breast-feeding Intentions Among Low-Income Pregnant and Lactating Women,” appeared in the March-April 2008 issue of The American Journal of Health Behavior.

Interestingly, researchers found no statistical relationship between positive attitudes held by pregnant women concerning breastfeeding and their intent to breastfeed. The views of family members closest to them mattered the most. The researchers concluded that education about breastfeeding include the “opinion-shapers” as well as pregnant women.

“In the study, women were most significantly influenced by what they perceived to be the opinions of people close to them such as their husband or partner, siblings, friends and parents,” said Gina Jarman Hill, assistant professor of nutritional sciences at Texas Christian University. “Husbands or partners were the most influential.”

Henry Hale gets it. The 25-year-old African-American father of a 3-year-old daughter named Miracle is the first male certified breast-feeding peer counselor at Rush University Medical Center in Chicago. He may even be the first in Illinois (or anywhere?).

“No one knows for sure, because calls to organizations that track this type of thing are met with befuddled silence,” writes Bonnie Miller Rubin in the Chicago Tribune. A photo of Hale is on the Trib’s front page today.

His interest in lactation began after the birth of his now 3-year-old daughter, Miracle, who was born at 24 weeks, weighing only 1 pound, 3 ounces. Hale and Miracle’s mother, Jackie Scott, attended Mother’s Milk Club, a weekly support group for parents of babies in the neonatal intensive-care unit, and learned about the health health benefits of breast feeding.

Although dads may make occasional appearances, Hale never missed a meeting, said Paula Meier, Rush’s director for clinical research and lactation.

“A lot of dads find it repulsive,” she said. “But Henry was just so outspoken and inspiring.”

That’s when Meier had a lightbulb moment: She’d recruit Hale to extol the virtues of breast-feeding — especially to the African-American community, which traditionally nurses at lower rates than other groups. [...]

“When I heard all the good things about breast milk,” Hale said, “my first thought was, ‘C’mon, let’s get it out. Let’s get going.’ ”

So Scott started pumping. For the first seven months, Miracle consumed nothing else.

“At the beginning, it was really hard,” Scott said to the group, which meets weekly to discuss every aspect of lactation, from inadequate milk supply to how nipple-piercing affects the process. “There were a couple of days when I just wanted to stop. But Henry really helped.”

How Hale assisted isn’t immediately clear given the basic anatomy involved. However, he picks up the thread of the discussion smoothly, explaining how he’d bring the pump to Scott at all hours and wash the equipment when she was done.

“It’s about focusing on what we — as men — can do,” he said.

Hale and Scott have a second daughter now, and both completed a five-day certification course that qualified them to volunteer as peer counselors. Rush is now looking at hiring Hale part-time to lead a male-only group.

Can you imagine? Think of how that education might translate to support at home — and more acceptance in public. The results could literally be life-saving.

Edwina Froehlich, who helped found La Leche League to support breast-feeding, died earlier this month at the age of 93.

The organization was founded in the 1950s, when Froehlich and six other women met in Franklin Park, Ill., to share information on how to successfully breastfeed their babies.

“In those days you didn’t mention ‘breast’ in print,” Froehlich once said. “We knew that if we were ever going to get anything in the paper we would have to find a name that wouldn’t actually tell people what our organization was about.”

From The New York Times:

A pioneer on several fronts of motherhood, she worked for Young Christian Workers, a Roman Catholic lay organization, before marrying John Froehlich when she was in her early 30s. She had her first child a couple of years later, making her comparatively old to have a first child at the time, and she made the controversial decision to forgo giving birth in a hospital in favor of a more natural delivery in her Franklin Park, Ill., home, with an obstetrician attending.

At a time when most pediatricians encouraged formula and bottle-feeding and when there were few scientific studies demonstrating the health benefits of breast milk, Mrs. Froehlich chose to breast-feed all of her babies, said another La Leche founder, Mary White.

“We used to tell the mothers the three main obstacles to successful breast-feeding were doctors, hospitals and social pressure,” Mrs. White said.

As Rachel noted yesterday, some hospitals, particularly in the south, are still engaging in practices that are not considered supportive of breastfeeding …

Update: The Dallas Morning News calls Edwina Froehlich a feminist pioneer in today’s editorial, which also describes regional prejudices against breastfeeding:

Local breastfeeding activists say many Texans think of the breast only in sexual terms, hence the anxiety over public breastfeeding. State law grants the right to breastfeed in public, but it has never been tested in court. And the risk of public humiliation is a powerful incentive to stay closeted.

That must change, and will. Even so, countless women are more free, and their babies better off, because a 1950s suburban mom refused to accept that one of the most natural things in the world is shameful or retrograde. Edwina Froehlich was ahead of her time.

The CDC has released a new summary of findings with regards to how well U.S. hospitals and birth centers meet Healthy People 2010 goals for supporting breastfeeding.

First, a little background. Healthy People 2010 is a series of health improvement objectives for the nation, with goals of increasing life expectancy, improving quality of life, and eliminating health disparities. Specific targets to reach by 2010 have been established in areas such as tobacco use, maternal health, nutrition, oral health, overweight, mental health, injury and violence prevention, and the like. The breastfeeding objective is to increase early postpartum breastfeeding from 64% to 75%, breastfeeding at 6 months from 29% to 50%, and the one-year rate from 16% to 25%.

In 2007, a survey was distributed to hospitals and birth centers to assess how well they were addressing these targets. They were asked about practices related to 1) labor and delivery, 2) breastfeeding assistance, 3) mother-newborn contact, 4) newborn feeding practices, 5) breastfeeding support after discharge, 6) nurse/birth attendant breastfeeding training and education, and 7) structural and organizational factors related to breastfeeding.

2,687 facilities (2,546 hospitals and 121 birth centers) from 50 states, Puerto Rico, and D.C. returned the surveys, and were assigned scores from 1 to 100, with 100 being the most supportive of breastfeeding.

Among the findings:

• Regional variation was apparent. Out of context, you’d probably think this was an election map. My southern sisters are being served least well with regards to breastfeeding support.
• 99% of facilities had documented the feeding decisions of the majority of mothers in facility records
• 88% “taught the majority of mothers techniques related to breastfeeding”
• “65% of facilities advised women to limit the duration of suckling at each breastfeeding, and 45% reported giving pacifiers to more than half of all healthy, full-term breastfed infants, practices that are not supportive of breastfeeding” (see report online for references for these statements).
• 70% of facilities reported providing discharge packs containing infant formula samples to breastfeeding mothers (another practice considered “not supportive of breastfeeding”)
• This is something I didn’t expect - “postpartum home visits were reported by 22% of facilities.” However, breastfeeding support after discharge received the lowest mean score of all measures.
• “24% of facilities reported giving supplements (and not breast milk exclusively) as a general practice with more than half of all healthy, full-term breastfeeding newborns”
• “In addition, 17% of facilities reported they gave something other than breast milk as a first feeding to more than half the healthy, full-term, breastfeeding newborns born in uncomplicated cesarean births.”

Findings from birth centers are also included - in general, they scored higher overall than hospitals (mean of 86 vs. 62 for hospitals).

The authors note that participating facilities will receive a benchmarking report in July of this year illustrating how they stack up against other facilities in their state, similarly sized facilities, and the nation.

[Cross-posted at Women's Health News]

Bush Ally Orr Leaves Just as Domestic Gag Rule Is Reconsidered: RH Reality Check has good coverage of the surprise resignation of Dr. Susan Orr, the assistant deputy secretary for population affairs. Orr previously worked for the Family Research Council — one of several conservative groups now pressuring President Bush to cut Title X family planning funding for clinics who also provide abortion services.

“Her most notable accomplishment in the year she has served is to defend the abstinence-until-marriage approach in the face of incontrovertible evidence it has failed,” writes Cristina Page. “Now that the Unplanned Family Research Council is within days of hitting another nail into Title X’s coffin, Dr. Orr suddenly and quietly resigns from her post so, one suspects, to not appear to have orchestrated the undermining of her own program from within.”

Read related posts by Amie Newman and Emily Douglas, and here’s more on the domestic gag rule by Marilyn Keefe of the National Partnership for Women & Families.

Plus: The Hill reports on how a group of centrist House Republicans are squaring off with GOP conservatives over modifying Title X regulations.

Domestic Partners Can Wed Without Dissolution: “Same-sex couples who are registered as domestic partners do not have to dissolve that union before getting married, attorneys that advise the state Legislature said Thursday, just as county clerks and other local officials met to determine how they will enact last week’s historic state Supreme Court ruling,” reports the San Francisco Chronicle.

Of course, there’s still the possibility of voters this November approving a constitutional amendment to limit marriage to opposite-sex couples. State Sen. Carole Migden, D-San Francisco warned that in light of future uncertainty, couples should not dissolve their domestic partnerships until that question is settled.

“It would be foolhardy to dissolve because it would create a period of vulnerability” for couples, Migden said.

For answers to more questions on the legality and logistics of same-sex marriage in California, check out this special news section.

FDA Warns Mothers About Nipple Cream: The Food and Drug Administration issued a warning to nursing mothers on Friday not to use or purchase Mommy’s Bliss Nipple Cream, marketed by MOM Enterprises Inc. of San Rafael, Calif., The product label says there’s no need to remove the cream before nursing, but it contains ingredients that may cause respiratory distress, vomiting and diarrhea in infants. Whoa.

The potentially harmful ingredients in the cream are chlorphenesin and phenoxyethanol. From the FDA release:

“Chlorphenesin relaxes skeletal muscle and can depress the central nervous system and cause respiratory depression (slow or shallow breathing) in infants. Phenoxyethanol is a preservative that is primarily used in cosmetics and medications. It also can depress the central nervous system and may cause vomiting and diarrhea, which can lead to dehydration in infants.”

“FDA is particularly concerned that nursing infants are being unwittingly exposed by their mothers to this product with dangerous side effects,” said Janet Woodcock, director of the Center for Drug Evaluation and Research. “Additionally, these two ingredients may interact with one another to further compound and increase the risk of respiratory depression in nursing infants.”

The FDA said it has not received any reports of injury to infants. The company has stopped selling the cream.

Chemicals in Nail Salons Affect Workers: A new survey from the Northern California Cancer Center and Asian Health Services of Oakland has found that Vietnamese nail salon workers suffer from acute health effects associated with the chemicals they use in that work, according to this release. Toxic and potentially hazardous ingredients, including solvents, plasticizers, resins and acids, are commonly found in nail care products.

“A majority of the workers reported health concerns from exposures to workplace chemicals,” reports Dung Nguyen of Asian Health Services who directed the face-to-face interviews with 201 Vietnamese nail salon workers at 74 salons. “Many of them reported having some health problem after they began working in the industry, particularly skin and eye irritation, breathing difficulties and headaches.” said Nguyen.

“Our findings highlight a critical need for further investigation into the breast cancer risk of nail salon workers, underscored by the workers’ routine use of carcinogenic and endocrine-disrupting chemicals, their prevalent health concerns about such chemicals, and their high level of acute health problems,” adds Thu Quach, MPH, of the Northern California Cancer Center.

The study was published online and is scheduled to appear in the October issue of Journal of Community Health.

New Safety Program to Monitor Medicare Drug Use: “Federal health officials will begin monitoring prescription drug usage by millions of Medicare participants in an effort to identify potential safety problems,” reports the Associated Press. Kevin Freking writes:

The Food and Drug Administration has been under increasing pressure to develop a comprehensive drug surveillance system since the painkiller Vioxx was pulled from the market in 2004 after it was linked to increased risk of stroke and heart attack.

New regulations announced Thursday by the Health and Human Services Department will enable the FDA, states and academic researchers to screen the Medicare claims data. Under the regulation, the Medicare data can be made available in 30 days.

My favorite quote from the story: “The era of wait and see is going to become the era of tell me right now,” the FDA commissioner, Dr. Andrew von Eschenbach, said.

At first glance it sounds great. But then you read that only general details about the cost of enacting this new “Sentinel Initiative” were provided and, as Rep. Rosa DeLauro, D-Conn., said, it’s still in the planing states. Our verdict: We’ll wait and see.

Legal Rights of the Uninsured: The Chicago Tribune blog Triage, written by Judith Graham, covers issues related to the health-care industry. Here’s an interesting post on the legal rights of the uninsured — which in Illinois refers to 1.75 million people, almost 60 percent of whom are employed. For starters:

There is no such thing as a “right to care” for people who don’t have health insurance, with one major exception.

If you’re experiencing a medical emergency, you can go to any hospitals and get treatment. Hospitals are enjoined from turning you away under the Emergency Medical Treatment and Active Labor Act (EMTALA), a federal act passed by Congress in 1986.

Plus: For up-to-date statistics and analysis of health care coverage and the uninsured, visit this section of the Kaiser Family Foundation. And check out the new Kaiser Fast Facts.

My Veggie Hero: Meet Johanna McCloy, who is taking on one ballpark at a time, trying to get vegetarian hot dogs added to the menu so all baseball fans can experience the joy of filling a bun with sauerkraut and mustard (ketchup? yeah, right). Check out her site, SoyHappy.org. And go Cubs!

When Chick Flicks Get Knocked Up: “Eventually, your female friends — the ones who married late and retained youthful obsessions with Yo La Tengo and graphic art books until forty — may shock you by having children,” writes Alissa Quart at Mother Jones. “This year, at least, they have cinematic alter egos; those millennium Mary Tyler Moores Sarah Jessica Parker and Helen Hunt have left their cosmos and canned laughter behind and gotten knocked up onscreen too. In the process, they have created a new genre: The Fertility Film. But are the new fertility film stars actually feminists?” (via Feministing)

Silicone Gel Implants May Lose Approval: From our enlightened neighbor to the north … “Health Canada may have to reverse its controversial 2006 decision to allow women to get silicone gel-filled breast implants if it proceeds with a plan to declare key chemicals found in them to be toxic, experts say,” reports The Ottawa Citizen. (via Beauty and the Breast)

South Carolina Supreme Court Overturns Conviction: “A South Carolina woman convicted of homicide by child abuse after her stillborn baby tested positive for cocaine should get a new trial because of several mistakes her attorneys made, the state Supreme Court ruled Monday,” reports the Associated Press. “Attorneys for Regina McKnight did not introduce the baby’s autopsy report into evidence and failed to rebut the prosecution’s medical expert, the court said in the unanimous decision.”

Prosecutors have 15 days to decide whether to appeal. From the Myrtle Beach Online:

Attorneys for the National Advocates for Pregnant Women and the S.C. Civil Liberties Union became involved in McKnight’s case when she asked for post-conviction relief.

“The groups got involved because there is complete consensus that prosecuting pregnant women is bad for mothers and babies,” said Lynn Paltrow, with the National Advocates for Pregnant Women. “Regina McKnight was convicted on junk science and was not fairly represented at trial.”

A Place to Pump: “Washington area women have hooked up electric or manual versions in parked cars, restrooms, a telephone booth and the basement storage room of the National Zoo visitors center, where a box of panda costumes doubled this spring as a table on which one woman set her pump, bottles and other equipment,” writes Rebecca Adams at the Washington Post.

“Not perhaps what the D.C. Council had in mind when it passed a law in December requiring employers to provide female workers a private, clean space, outside a restroom, to express milk. The Child’s Right to Nurse Act also gives a woman the right to breast-feed, covered or not, in any place, public or private, where she has a right to be.”

Maternal Exposure to Persistent Organic Pollutants Linked to Urologic Conditions in Boys: This release from the American Urological Association summarizes studies that confirm existing hypotheses that maternal exposure to endocrine-disrupting chemicals – including total polychlorinated biphenyls (PCBs, such as Arochlor) and organochlorinated pesticides (such as dichlorodiphenyl-trichloroethane, or DDT) may contribute to an increased incidences of congenital anomalies.

Mammograms Coupled with Ultrasounds: Deborah Katz of U.S. News & World Report looks at new research on combining mammography and ultrasounds, which may be better for finding cancers in some women, but it also greatly increases the rate of false-positive results. Plus: Check out our analysis on routine mammograms for premenopausal women.

The Business of Bacteria: The L.A. Times reports on the popularity of probioitics, live "friendly" bacteria that is showing up in more foods, like Dannon’s Activia yogurt. “Companies claim that the daily consumption of probiotics can provide consumers with benefits such as a boost to the immune system and relief from intestinal distress — and researchers think that certain probiotic strains hold promise in a number of areas,” writes Brendan Borrell. “But how significant these benefits are is a matter of debate. And it can be tough to decipher which products offer verifiable health claims and which are piggybacking on the hype of the booming industry.

Doctors Start to Say “I’m Sorry” Long Before “See You in Court”: The New York Times reports on a change in hospital policy: full disclosure when a doctor makes a mistake. Kevin Sack writes:

For decades, malpractice lawyers and insurers have counseled doctors and hospitals to “deny and defend.” Many still warn clients that any admission of fault, or even expression of regret, is likely to invite litigation and imperil careers.

But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach.

By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.

Malpractice lawyers say that what often transforms a reasonable patient into an indignant plaintiff is less an error than its concealment, and the victim’s concern that it will happen again.

Culture Affects How Teen Girls See Harassment: “Teenage girls of all ethnic and socioeconomic backgrounds still experience sexism and sexual harassment – but cultural factors may control whether they perceive sexism as an environmental problem or as evidence of their own shortcomings,” according to this release from the University of Kentucky summarizing a study of 600 girls, ages 12 to 18, in California and Georgia.

Ninety percent of the girls reported experiencing at least one incident of sexual harassment, the researchers from University of Kentucky and University of California Santa Cruz found.

Specifically, 67 percent of girls reported receiving unwanted romantic attention, 62 percent were exposed to demeaning gender-related comments, 58 percent were teased because of their appearance, 52 percent received unwanted physical contact and 25 percent were bullied or threatened with harm by a male. 52 percent of girls also reported receiving discouraging gender-based comments on the math, science and computer abilities, usually from male peers, and 76 percent of girls reported sexist comments on their athletic abilities, again
predominantly from male peers.

The researchers found that girls have different levels of understanding of sexism and sexual harassment, which may affect reporting data. Older girls and those from a lower socioeconomic background reported more sexism than did their peers. Latin and Asian American girls reported less sexual harassment than did girls of other ethnic groups. Girls who had been exposed to feminist ideas, either through the media or an adult such as a mother or teacher, were more likely to identify and report sexist behavior than were girls who had no information about feminism. Girls who reported feeling pressure from their parents to conform to gender stereotypes were also more likely to perceive sexism. Girls who felt atypical for their gender and/or were unhappy with stereotypical gender roles were most likely to report sexism and harassment.

The study appears in the May/June issue of Child Development.

Federal Agencies Can Now Offer Secret Input on EPA Chemical Reviews: The Washington Post reports on changes the Bush administration has made to Environmental Protection Agency reviews of chemicals — changes that officials with the Government Accountability Office say will delay scientific assessments of health risks and open the process to politicization.

Richard Wiles, executive director of the Environmental Working Group, called the EPA process a “bureaucratic quagmire,” adding, “With these rules in place, it’s now official: The Bush White House is where all good public health protections go to die.”

Death in Childbirth a Health Scourge for Afghanistan: Reuters takes a close look at the staggering maternal death rate in Afghanistan, where about 1,600 Afghan women die in childbirth out of every 100,000 live births.

“In some of the most remote areas, the death rate is as high as 6,500. In comparison, the average rate in developing countries is 450 and in developed countries it is 9,” writes Tan Ee Lyn. “Virtually everyone in Afghanistan can recount a story about a relative dying in childbirth, often from minor complications that can be easily treated with proper medical care.”

Plus: Read our previous posts on Afghanistan and maternal health — and how the United States has mismanaged funding and programs intended to improve hospital conditions.

The Disney Hyprocrisy: From Slate: Forget Miley Cyrus. Check out Disney’s Chinese underwear ad. Just go.

Plus: There’s a new book out on the sexualization of ‘tween girls: “The Lolita Effect,” by Gigi Durham, a University of Iowa journalism professor.

“I’m criticizing the unhealthy and damaging representations of girls’ sexuality, and how the media present girls’ sexuality in a way that’s tied to their profit motives,” said Durham in this release. “The body ideals presented in the media are virtually impossible to attain, but girls don’t always realize that, and they’ll buy an awful lot of products to try to achieve those bodies. There’s endless consumerism built around that.”

Divorce Leads to Job Loss: So imagine you’re a professor and you’re going through a divorce. Your college requires that you talk with a staff member to see whether the grounds for divorce meet Biblical standards. If you don’t, you’ll lose your job. Yep, that’s what happened to a popular English professor who has taught at Wheaton College in Illinois for 20 years. From the Chicago Tribune:

Many theological conservatives say the New Testament permits divorce only in cases of adultery or desertion. Wheaton requires faculty and staff to sign a faith statement and adhere to standards of conduct in areas including marriage, said Provost Stan Jones.

Still, every year, the college has dealt with several cases in which it must evaluate the divorce of a job applicant or a staff or faculty member and consider whether it matches the exceptions laid out in Matthew 19 and the writings of the Apostle Paul.

I admit I’m not up on Bible readings, but what about, say, domestic abuse — along with a host of other very good reasons?

Genetic Link to Osteoporosis: “Researchers have identified two common genetic mutations that increase the risk of osteoporosis and related bone fractures, according to a study released Tuesday,” reports Reuters.

U.S. Federal Funding for HIV/AIDS: The Kaiser Family Foundation has released a new fact sheet on federal funding for HIV/AIDS in the President’s Fiscal Year 2009 budget request, and comparisons over time, with key funding highlights for domestic and global HIV/AIDS programs. It also includes additional information on federal funding for global TB, malaria and other global health efforts.

Can I Get A May Day for Immigrant Women’s Health?: “May Day, May 1st, has come to hold the promise of rallies for immigrant rights staged across the United States. And this year is no different. But with McCain’s more-of-the-same health care plan having just been released, it’s a perfect time to focus on why women’s reproductive health care must be a crucial part of any discussion about immigration reform,” begins Amie Newman’s essay at RH Reality Check.

Rescue Us From Our Bodies: Here’s a nice round-up of responses to Midol’s new “Reverse the Curse” campaign.

Stop the Mommy Madness: Salon talks with feminist activist Amy Richards, whose new book is titled “Opting In: Having a Child Without Losing Yourself.”

Plus: Rachel Fudge reviews “Opting In” for Mother Jones.

More Mothers Breast-Feed, in First Months at Least: “About 77 percent of new mothers breast-feed their infants at least briefly, the highest rate seen in the United States in more than a decade, according to a government survey released on Wednesday,” reports The New York Times. Enthusiasm, however, was tempered.

Breast-feeding experts said that they were cheered by the report’s numbers but noted that rates of breast-feeding at 6 months of age have remained unchanged and are significantly lower than goals set by government agencies. The most recent C.D.C. survey did not report breast-feeding rates at 6 months because of a lack of data. [...]

In the most recent survey, breast-feeding rates increased among non-Hispanic black women to 65 percent from 36 percent in 1993 and 1994. Eighty percent of Mexican-American infants and 79 percent of non-Hispanic white infants had been breast-fed.

The age and income of mothers played important roles. Just 57 percent of poor mothers and only 43 percent of mothers under 20 breast-fed their infants, the survey found.

Dr. Barbara L. Philipp, associate professor of pediatrics at Boston University, said the C.D.C. survey had not asked mothers whether they breast-fed exclusively. “One sip was positive, so they set the bar very low,” Dr. Philipp said.

Celebrate International Women’s Day: Happy IWD to everyone! Here’s the 100-year history and hundreds of events taking place in more than 50 countries.

Lucinda Marshall has reflections on the importance of IWD — and plenty more at Feminist Peace Network. Women’s eNews’ weekly Cheers & Jeers focuses on equality gains and disappointments around the world. Carolyn Byerly writes about the lack of U.S. media coverage.

State of Black America: The State of Black America report was issued this week by the National Urban League. The 2008 edition is subtitled “In the Black Woman’s Voice” and includes essays on the economic, social, psychological and medical challenges that black women face. An executive summary, abstracts and order form can be found in the Urban League’s publication section.

This AP story describes some of the essays. Julianne Malveaux’s “The Status of African-American Women” was republished in Diverse: Issues in Higher Education.

Legislation on Drive-By Mastectomies Stuck in Neutral: “Despite an online petition with 20 million signatures supporting federal legislation that could prevent insurance companies from covering only these so-called drive-through — or outpatient — mastectomies, Congress has been slow to act,” reports the Chicago Tribune. “But after more than 10 years of proposing similar legislation, proponents of the Breast Cancer Patient Protection Act are hoping that with Democrats controlling Congress, the measure might finally be approved.”

Conflict of Interest Much?: “A dispute over food industry influence has resulted in the resignation of the incoming president of the Obesity Society,” reports The New York Times. It seems that Dr. David B. Allison came under fire after the society, which represents obesity doctors and researchers, learned Allison had written an affidavit “as a paid consultant on behalf of the restaurant industry, which is trying to block new rules in New York City that at the end of March will require fast-food and other restaurant chains to list the calories of menu items.”

Plus: “According to some experts whose views are public health heresy, the jury is still out on how dangerous it is to be fat. ‘The obesity epidemic has absolutely been exaggerated,’ said Dr. Vincent Marks, emeritus professor of clinical biochemistry at the University of Surrey,” reports the AP.

Maternal Instinct Wired into the Brain: That’s the headline, anyway, on this incomplete New York Times summary of a study that appeared in Biological Psychiatry. On the upside, it’s a great example of the added-value of commenters, who smartly question the lack of context and potential implications.

Texas Twofer: Rachel points to two Texas stories — the first about a woman kicked out of a mall’s salon for breastfeeding (a violation of company policy and a state statute), and the other about a mother pushing for a policy change after the teenager who raped her now 12-year-daughter was allowed to return to school.

What’s in a Name?: Last month, the Rape Crisis & Abuse Center in Ohio switched back to its old name - Women Helping Women, with the added tagline “Serving Women & Men Who are Victims of Domestic Violence, Sexual Assault & Stalking.”

The change was originally made because the agency also helped male victims of domestic violence, but the new name was considered too off-putting and fundraising dropped, reports the Cincinnati Enquirer. “It was the word,” said Executive Director Ann McDonald. “The word rape scares people.”

An editorial in support of the agency’s decision reads in part:

Besides clouding the fact that the center also works heavily with victims of domestic violence, the old name created distance - the very thing a victims’ advocacy group can’t afford. “We need people to hear us,” McDonald says.

Critics may say the center should have maintained its name on principle, that refusing to back off the word is one way to shatter the stigma. But in this case, a challenge to semantics isn’t as important as keeping a vital service viable and alive.

Call for Abstracts: The Black Women’s Health Imperative invites abstracts from individuals interested in presenting a workshop at the national black women’s health conference, June 20, 2008. The abstract must address topics within one of the three conference tracks: mental health, HIV/AIDS and overweight and obesity. The deadline is March 28.

Pro-Choice Carnival: The first Pro-Choice Carnival was recently published at Abortion is a Woman’s Right. Two of Rachel’s posts are featured: “More Disturbing Ballot Initiatives - Abortion Access in Missouri,” from Our Bodies Our Blog, and “How Operation Rescue and National Right to Life Spin Abortion Research,” from Women’s Health News.

The second edition will be posted at the same blog Feb. 28; submissions deadline is Feb. 27. Check here for more information.

21 Leaders Worth Getting to Know: Women’s eNews has announced its 21 Leaders for the 21st Century 2008: “20 women and one man who are dedicated to improving the lives of women in their homes, in their communities, in their nations and across the globe.” Included among them are four women being honored for their work on behalf of women’s health.

Civil Unions Spark Excitement as Well as Yawns: On Jan. 1, New Hampshire became the fourth state — behind Vermont, Connecticut and New Jersey — to allow civil unions, and the first to do so without legal challenge. Massachusetts remains the only state that allows gays and lesbians to marry.

This Boston Globe editorial page notes that “the event was met with a collective yawn,” adding: “There are several reasons for this change, but the most important is that residents of New Hampshire have had a chance to observe Vermont and Connecticut’s civil unions and Massachusetts’ same-sex marriage, and realized that extending rights to a minority is no threat to the majority — or to the institution of marriage.”

Prescription Plan Includes Pill: In Oregon, a state law that went into effect Jan. 1 requires health insurance plans that cover prescription drugs to include contraception and requires hospitals to offer emergency contraceptives to women who seek care after a sexual assault, reports The Oregonian.

A separate Oregonian story describes a state law requiring employers with 25 or more workers to provide a separate space and adequate time for mothers to pump breast milk.

“This law is national-precedent setting,” said Amelia Psmythe, executive director of the Nursing Mothers Counsel of Oregon. “It is the most detailed, toughest mandate of its kind in the country, so all eyes are on Oregon.”

Most Free Products Go to the Insured: “Free drug samples are more likely to go to wealthy and insured people than to poor or uninsured Americans, according to a study by Boston-area doctors that conflicts with the view that giving away prescription medications forms a safety net for low-income patients,” reports the Boston Globe.

“That finding suggests that the samples were a marketing tool and not a safety net because the poor and uninsured patients were not finding their way to where the samples were,” said lead author Dr. Sarah L. Cutrona. The study appears in the February issue of the American Journal of Public Health.

Doctors Connect with the Mind-Body: The Chicago Tribune reports on the medical community’s growing acceptance of the mind-body connection. In fact, “About 75 percent of medical schools now have some CAM [complementary and alternative medicine] courses in the curriculum, and the Consortium of Academic Health Centers for Integrative Medicine includes 39 academic health centers, including the Mayo Clinic plus Harvard, Stanford, Columbia, Duke and Yale Universities.”

Blog for Choice: The annual Blog for Choice Day takes place Jan. 22, the 35th anniversary of Roe v. Wade. This year’s topic — why it’s important to vote pro-choice.

FDA Panel Rejects Breast Cancer Drug: “A Food and Drug Administration panel dealt a sharp blow to biotech giant Genentech Inc. on Wednesday by refusing to recommend approval for the company’s high-profile drug Avastin as a treatment for breast cancer,” reports the L.A. Times. “The cancer drugs are controversial: They extend patients’ lives in some cases only by several months, and they can cost as much as $100,000 per patient per year. In recent years, federal regulators have been willing to approve drugs even if the benefits were only marginal. But that may be changing.”

Health Care Debate Needs to Include Women: “As Gov. Arnold Schwarzenegger and the Democratic leadership in the Legislature negotiate a health care proposal that they hope everyone can agree upon, it’s important to consider a California constituency that hasn’t received enough attention during this debate: women,” writes Carlina Hansen, executive director of the Women’s Community Clinic in San Francisco, in an op-ed published in the Sacramento Bee.

The op-ed was co-signed by other representatives of the Women’s Working Group on Universal Health Care, a California-based organization that focuses on educating and involving women and women’s organizations in state and local health reform efforts. Check them out.

The Doctor Will Email You Now: “Unlike the banking, restaurant and travel industries, the medical profession has been slow to embrace the Internet’s potential customer service benefits,” reports the Chicago Tribune. “But despite concerns about patient privacy, costs and time constraints, a growing number of physicians are encouraging patients to go online to do things such as check lab results and immunization records, request refills and appointments, and e-mail their physicians with non-urgent medical questions.”

What Says Love Like Diamonds in the Delivery Room? In another example of All The News That’s Fit for Wealthy Heterosexual White Women, the New York Times turns attention to “push presents,” given to the mother following childbirth. Art commemorating the baby’s birth — I get that. I also understand, as one commenter points out, the desire to celebrate the birth with something that can be passed down for generations. But the materialism depicted in this story is disturbing. What’s nine months of pregnancy and labor worth? How about at least six months of paid maternity leave — now that’s priceless.

Plus: New word association game — read the word “push,” visit Pushed Birth.

Environmental Toxin Can Collect in Breast Milk: “Scientists have discovered the mechanism by which a chemical known as perchlorate can collect in breast milk and cause cognitive and motor deficits in newborns,” reports HealthDay News. “Used since the 1940s to manufacture explosives and rocket fuel, the contaminant is still widely present in the water and food supply, experts say.”

The study by scientists at the Albert Einstein College of Medicine of Yeshiva University appeared in the Dec. 3-7 advance online issue of the Proceedings of the National Academy of Sciences. Here’s more from the EPA on perchlorate.

A Special Delivery: “‘Juno’ is the only film in recent history in which the protagonist seriously considers termination,” writes Jennie Yarbroff in Newsweek. Of course if you’ve read any of the reviews (which are almost uniformly stellar) you know that consideration is as far as it goes.

EW’s Lisa Schwarzbaum writes in her review: “The old-school feminist in me wishes Juno spent more time, even a tart sentence or two, acknowledging that the options taken for granted by this one attractive, articulate teen are in fact hard-won, precious rights, and need to be guarded by a new-generation army of Junos and Bleekers, spreading the word by text message as well as by hamburger phone. Separate but equal truth: This movie is so delightful and good-hearted a portrait of the kind of new-generation army I’d like to hang with that I accept the admonition ‘Silencio, old woman.’”

Plus: NPR’s “All Things Considered” interviews crush-worthy Ellen Page, and critic Bob Mondello finds this season’s films are where the girls are.

Environmental and Occupational Causes of Cancer: Scientists at the University of Massachusetts Lowell & Boston University last month published an updated scientific review, Environmental and Occupational Causes of Cancer: New Evidence, 2005-2007. According to the Collaborative on Health and the Environment, the report concludes that “mounting evidence linking unintentional exposures to toxins in our workplaces and general environment contribute to the nearly one and a half million new cases of cancer in the U.S. in just 2007 alone.”

The report synthesizes the recent peer-reviewed scientific literature and finds compelling new evidence linking cancer with specific exposures, namely:

* Breast cancer from exposure to the pesticide DDT before puberty;
* Leukemia from exposure to 1,3-butadiene;
* Lung cancer from exposure to air pollution;
* Non-Hodgkin’s lymphoma from exposure to pesticides and solvents;
* Prostate cancer from exposure to pesticides and metal working fluids;
* Brain cancer from exposure to non-ionizing radiation; and
* A range of cancers from exposure to pesticides based on early findings from the Agricultural Health Study

Here’s the executive summary and the full 45-page report (PDF).