Women in the developing world are the focus of the Aug. 23 edition of The New York Times Magazine.

The main feature is an essay adapted from a new book by Times columnist Nicholas Kristoff and former Times correspondent Sheryl Wudunn. Titled “Half the Sky: Turning Oppression into Opportunity for Women Worldwide,” the book and its companion website look at three major abuses against women: sex trafficking and forced prostitution; gender-based violence including honor killings and mass rape; and maternal mortality. Here’s the intro:

In the 19th century, the paramount moral challenge was slavery. In the 20th century, it was totalitarianism. In this century, it is the brutality inflicted on so many women and girls around the globe: sex trafficking, acid attacks, bride burnings and mass rape.

Yet if the injustices that women in poor countries suffer are of paramount importance, in an economic and geopolitical sense the opportunity they represent is even greater. “Women hold up half the sky,” in the words of a Chinese saying, yet that’s mostly an aspiration: in a large slice of the world, girls are uneducated and women marginalized, and it’s not an accident that those same countries are disproportionately mired in poverty and riven by fundamentalism and chaos. There’s a growing recognition among everyone from the World Bank to the U.S. military’s Joint Chiefs of Staff to aid organizations like CARE that focusing on women and girls is the most effective way to fight global poverty and extremism. That’s why foreign aid is increasingly directed to women. The world is awakening to a powerful truth: Women and girls aren’t the problem; they’re the solution.

Change, however, may not be that simple. In a separate article, “The Daughter Deficit,” Tina Rosenberg probes why discrimination against girls persists even among wealthier, more developed areas:

To be sure, development can eventually lead to more equal treatment for girls: South Korea’s birth ratios are now approaching normality. But policymakers need to realize that this type of development works slowly and mainly indirectly, by softening a son-centered culture. The solution is not to abandon development or to stop providing, say, microcredit to women. But these efforts should be joined by an awareness of the unintended consequences of development and by efforts, aimed at parents, to weaken the cultural preference for sons.

Other stories in this magazine issue look at women and philanthropy; a Q & A with Secretary of State Hilary Clinton on plans to push women’s rights issues on the international stage; a reporter returns to a school for girls in Afghanistan that was the site of a violent attack; an interview with Liberian President Ellen Johnson Sirleaf, the only female head of state in Africa; a look at the “feminist hawk” position that advocates the use of force to aid women; and a poignant “Lives” column that concludes with an HIV-positive 16-year-old’s simple plea: a safe place to be a girl.

Plus: If you want to share the work that you’re doing to educate and empower women, Kristof is collecting personal stories on his blog that describe efforts by individuals and organizations worldwide. Some of the submissions will be highlighted in future columns; three winners will be chosen to receive a signed copy of the book. You can also submit photos that capture the theme of women’s empowerment.

Have you seen this video?

I think Flashmobs are the the coolest. What first appears as spontaneous and organic comes to be understood by the bystanders as something orchestrated and substantial. It’s grassroots. It’s guerrilla. And it can be an incredibly effective way of making a point.

From the text that appears in the video clip above — “Worldwide, 1,400 women die everyday in pregnancy and childbirth due to lack of basic healthcare” — the point here is to raise awareness of maternal health in poor countries and around the world. Who couldn’t groove to that?

Is it just me, though, who finds the action less than convincing? The description of the YouTube clip makes the intentions clear:

If you think this is dangerous, try giving birth in poor countries without a midwife, hospital or medicine. This flashmob is one of a series happening in Paris, Berlin, Utrecht and across Canada to highlight the scandal that millions of women in poor countries and around the world aren’t getting the healthcare they need for a safe and healthy pregnancy.

But if you were in the crowd in London or elsewhere, would you get that? Or would you respond, as several YouTube commenters have, with statements like: “I’m so proud of those women doing that pregnant! GO GIRLS!!!!!” or “who said pregnant ladies can’t get down!”

A blog post on Oxfam’s website notes that the actual dancers were not really pregnant (and it’s mentioned in a parenthetical note in the YouTube description, but you have to click “more info” to see it) — and other YouTube commenters are quick to point that out to the uninformed.

But if the action itself doesn’t have that context or conversation, is it effective?

Maybe I’m being too critical here. As on YouTube, I’m sure most bystanders were sparked to have a conversation — and maybe literature was passed around afterwards. And it’s the cognitive dissonance of pregnant women dancing that grabs everyone’s attention. It’s difficult to construct a creative action that will inspire people to think about such a difficult-to-think-about issue, but I’m not convinced this hits the mark.

(hat-tip: Wendy, thanks!)

News outlets, especially in Britain, have been abuzz with discussions of the appropriate precautions against (H1N1) swine flu infection for pregnant women. While pregnant women may be slightly more vulnerable to flu because pregnancy compromises the immune system, some of the suggestions for limiting exposure and preventing infection (aside from basic handwashing and hygiene) sound impractical and unworkable for most women.

In Australia, several medical groups suggested that pregnant women wear masks, and some U.K. health agencies have suggested that women “limit the movements” of their children to prevent their bringing the virus home, and avoid public transportation, as well as crowds and unnecessary travel.

Dr. Annabel Bentley, writing at BMJ Group Blogs, calls the advice “at best confusing and at worst completely impractical and non evidence-based.”

Facemasks, for example, are sometimes suggested to prevent an infected person from transmitting the disease to others, but are not generally recommended for widespread prevention. Bentley also wonders how, exactly, women should define “unnecessary travel” and avoid crowded places, and she alludes to the certain amount of privilege necessary to even contemplate staying home and avoiding others:

Perhaps now is the time to switch from travelling to work on the underground and finally hire a chauffeur (one that’s already had swine flu preferably) to keep you away from the virus-breathing hordes?

Some advice on the topic does at least acknowledge the problem with these recommendations — that “complete isolation at home would be regarded as extreme for most women” — although the advice provides little help for women hoping to find a reasonable balance.

A U.S. News blog post also illustrates the confusion pregnant women face over a swine flu vaccine, when it becomes available:

On the one hand, healthy pregnant women who get infected with the flu are at increased risk of serious illness and hospitalization. In fact, the second H1N1 flu death in the United States was a pregnant woman. Because of this greater risk, pregnant women are advised to get annual flu vaccinations. On the other hand, pregnant women also are advised to be very cautious when taking any medications — especially the newest ones — because of unknown health risks to the developing fetus [...] Just today, public health experts said that there’s no way to know if any rare side effects will occur in the new vaccine until millions of people are vaccinated. Those unknowns would make an expectant mom especially nervous.

Swine flu concerns also arise when it’s time for women to give birth. One statement (from RAZCOG, linked below) highlights a potential problem with the recommendations, with regards to pregnant women limiting their potential to infect others: “Whilst women with possible influenza should avoid crowded antenatal clinics (to avoid transmission to others), they will still need to attend hospital for birth” — where they could presumably infect others, but which also goes against the advice to stay home and avoid crowded places.

In the United States, some home birth midwifery advocates have also suggested that women may prefer to stay away from hospitals when rates of infection are high. The Midwives Alliance of North America, for example, has suggested that out-of-hospital births may be preferable or necessary in some cases during pandemic flu.

Meanwhile, in the UK, where midwives and home births are better-integrated into pregnancy care, hospitals are drawing up emergency plans in which “Home births would be refused and planned caesarean sections abandoned if there were not enough staff to carry them out safely.”

Here’s guidance from health agencies on swine flu and pregnant women:

The American College of Nurse Midwives also has links to a number of additional resources.

Added: According to AP, a federal vaccine advisory panel is meeting Wednesday to discuss priorities for who should be first to receive swine flu vaccination, and pregnant women are likely to be high on the list [hat tip to the Daily Women's Health Policy Report]

Supreme Court Decisions and You: The National Women’s Law Center has released an analysis of 2008-2009 Supreme Court decisions that have a direct effect on women’s lives. Here’s the report (pdf); more discussion at the NWLC blog, Womenstake:

In Fitzgerald v. Barnstable School Committee, the Supreme Court safeguarded women’s and girls’ rights by allowing them to pursue remedies for gender discrimination in schools under both Title IX and the Constitution. In Crawford v. Metropolitan Government of Nashville and Davidson County, Tennessee, the Court ruled that employees are protected from being subject to retaliation for cooperating with an employer’s internal investigation of discrimination. “The Court’s decisions in these two cases kept hard-won protections in place,” [NWLC Co-President Marcia] Greenberger said.

But not all outcomes were positive:

“In AT&T Corp. v. Hulteen, the Supreme Court ignored the realities of the workplace and the intent of Congress and ruled against female workers,” Greenberger said. As Justice Ginsburg noted in a strong dissent in the case, the Court’s decision permitted AT&T to pay women lower pension benefits for the rest of their lives.

Gag on Global Gag Rule: Ever since President Ronald Reagan instituted the “global gag rule” in 1984, its existence has been dependent on which party is in the White House. If it’s a Democrat, it’s revoked; if it’s Republican, it’s reinstated. On Thursday, the Senate Appropriations Committee voted 17-10 to approve an amendment to a Department of State and foreign affairs appropriations bill that would make permanent President Obama’s reversal of the global gag rule. Emily Douglas has more.

The global gag rule, also known as the Mexico City policy (the site of the United Nations International Conference on Population where it was first announced), prohibits international family planning groups that receive U.S. aid from offering abortion services or providing information about safe abortion, even if they use other funding. It would be great to see it gone, for good.

New NIH Director: President Obama has nominated Francis Collins, best known for leading the public effort to sequence the human genome, to be director of the National Institutes of Health. Chris Wilson at Slate looks at how Collins, an evangelical Christian, has combined his faith in God with his faith in science.

New Violence Against Women Advisor: “Vice President Joe Biden’s June 26 announcement of a White House Advisor on Violence Against Women stirred some public grumbling about President Barack Obama’s recent ‘czar frenzy,’” writes Kayla Hutzler at Women’s eNews.

“But at a time of rising pressure on domestic violence shelters, representatives of two of the largest advocacy groups for ending domestic violence were far more enthusiastic about the creation of the post. They were also excited at the naming of Lynn Rosenthal, a former executive director at the New Mexico Coalition against Domestic Violence in Albuquerque, with a substantial resume of safety advocacy and working ties to Biden.”

Here’s the White House announcement, and a New York Times editorial in favor of the appointment.

The Last Word on Sarah Palin (Fingers Crossed): Go read “Palin’s Long March to a Short-Notice Resignation,” then head over to Slate for Dahlia Lithwick’s parting shot: “[Wh]en the dust settles, the lesson may be that she was simply a woman who made no sense.”

Looking Ahead to 2012: Jill Miller Zimon wonders, “Could we see a female-female GOP ticket for president and vice president in 2012?”

Update on Conscience Clause: Kay Steiger has written a good round-up of efforts at the state level to pass legislation that allows medical professionals to refuse to provide services that violate their religious or moral beliefs.

Speaking of conscience clauses, anyone remember the federal rule instituted in the final days of the Bush administration? It cut off federal funding for state and local governments, hospitals, health plans and clinics that did not fully accommodate doctors, nurses, pharmacists or other employees who refuse to provide care they feel violates their beliefs. Aimed at abortion and family planning services, it went beyond laws that already provide for healthcare workers and threatened access to many health services, including infertility treatment, end-of-life care, blood transfusions and mental health counseling.

President Obama moved to rescind the rule, as expected, but the process has been very slow. The 3o-day public comment period on rule changes ended in April; Health and Human Services Department is still reviewing the hundreds of thousands of comments received.

Administration officials acknowledged early on that they were looking for a compromise, but we haven’t heard much more on the subject until President Obama told a group of religion reporters earlier this month that the new policy would “certainly not be weaker” than what existed before President Bush’s expansion:

We will be coming out with I think more specific guidelines.  But I can assure all of your readers that when this review is complete there will be a robust conscience clause in place.  It may not meet the criteria of every possible critic of our approach, but it certainly will not be weaker than what existed before the changes were made.

David Brody has the full transcript of Obama’s remarks.

We’ve written about the female condom – including the recently approved FC2 – several times in the past. Serra Sippel of the Center for Health and Gender Equity has an update on this topic at RH Reality Check, noting that Uganda is working on plans to reintroduce female condoms, with that nation’s government planning to promote the device beginning this fall.

Sippel explains that the Center for Health and Gender Equity and the Global Campaign for Microbicides recently met with:

…local leaders from HIV/AIDS, reproductive health, domestic violence, human rights and women’s rights groups in Kampala for an advocacy training targeted at donors and national government to ensure successful reintroduction of female condoms in Uganda. As part of the training, participants met with members of the Health Development Partnership Group, which USAID heads; with UNFPA and the Ministry of Health, demonstrating civil society support for the prevention method. Participants also learned about the history of the female condom in Uganda and how to move forward with advocacy efforts beyond the training.

After having received FDA approval to market the device in March, the FC2 female condom is expected to be available in the United States this September. PreventionNow! has additional resources on the topic of female condoms, including news and global promotion efforts.

Maternal mortality and morbidity is a large problem worldwide, and one we’ve written about here in various contexts in the past. According to the World Health Organization, 1,500 women die from pregnancy- or childbirth-related complications every day, mostly in developing countries, and most of these deaths are avoidable.

In an attempt to focus international attention on this problem, The United Nations Human Rights Council included in its recent session a resolution on maternal mortality and morbidity.  According to the agency’s press release the resolution calls for the following:

• a study on preventable maternal mortality and morbidity, including identification of human rights aspect
• an overview of initiatives and activities within the United Nations system to address all causes of preventable maternal mortality and morbidity
• identification of how the Human Rights Council can add to existing efforts by providing human rights analysis, including efforts to achieve the Millennium Development Goal on improving maternal health
• recommended options for better addressing the human rights dimension of preventable maternal mortality and morbidity throughout the United Nations system.

In a joint release responding to the resolution, the Center for Reproductive Rights notes that “This is a groundbreaking step towards ensuring every woman’s basic human right to a safe and healthy pregnancy and childbirth. Governments should heed the call of the Human Rights Council and take urgent action to prevent women from dying needlessly in pregnancy and childbirth.”

A representative of Action Canada for Population and Development quoted for the release described the importance of the resolution thusly: “By supporting this resolution, governments have affirmed the right of women and girls to receive care before, during, and after pregnancy and childbirth, and to survive these experiences without illness or disability.”

Last month, a marathon in Tel Aviv drew runners raising money for a number of different causes — including an adaptation of “Our Bodies, Ourselves.”

Sophie Walsh, a clinical psychologist who moved from London to Tel Aviv in 1994, ran in support of Women and Their Bodies: The Women’s Association for Health Action and Responsibility. Founded in Israel in 2005, Women and Their Bodies (WTB) is an Israeli-Palestinian initiative that is adapting “Our Bodies, Ourselves” into Hebrew and Arabic.

“This version will be up-to-date for this decade, making it available to all women in Israel regardless of their native tongue,” Walsh told the Haaretz newspaper.

The OBOS global translation/adaptation program was recently featured in On the Issues magazine. The story explains how each international project is specific to the community’s health needs and social and political conditions.

We haven’t discussed the Israeli-Palestinian project in detail here before, so here’s some news about the effort.

WTB has more than 40 Hebrew and Arabic chapters in progress, and the goal is to publish the Hebrew edition in 2010. The Arabic edition will appear first online and as booklets — two of which will be published by the end of the year — with a book publication date to be announced soon.

The organization is working with Jewish and Arab groups to localize the material and has collaborated with numerous women’s and human rights organizations. WTB has also recruited teams of volunteers, Hebrew and/or Arabic-speaking, between the ages of 21 and 65, to conduct interviews for the personal narratives present in every chapter.

A graphics committee is charged with making sure that the book’s images are representative of women’s bodies in the Middle East and include women of varied religious and ethnic backgrounds. According to WTB’s 2008 annual report, dozens of women have already volunteered images, including those shown here.

In addition to the Arabic and Hebrew publications, WTB is creating an online action and resource center, with links to women’s organizations and blogs providing updates on health legislation.

The organization also runs community outreach workshops on women’s health rights and sexuality. Facilitator Suzaan Abu-Waasel led a workshop on women’s body image and empowerment for the older women’s club at the Arab Jewish Community Center in Jaffa. Here’s what she said at the end of the session:

Asking the women aged 45-60 to put their social commitments aside and focus on their own bodies and wellbeing, was an extremely challenging task. Much patience is needed to raise taboo topics.

Many of the participants focused on good parenting, or their relationships with their in-laws; the concept of taking care of ones’ self was rather alien at first … I am thrilled to tell you that their group coordinator now reports an overflow of critical discussions.

It costs approximately $5,000 to produce each chapter. If you and a group of friends or an organization want to sponsor a chapter in the Hebrew or Arabic adaptation, you can make a secure electronic donation, or write a check to “Women and Their Bodies,” and mail it to 34 Kfar Etzion St. Jerusalem, Israel 93392.

Smaller sums go directly to support sections of chapters, such as the narrative collection, or the linguistic editing in the chapter of your choice.

For a U.S. tax deduction (minimum $100), make out a check to “New Israel Fund.” Write in the memo line that it is a donor advised contribution to Women and Their Bodies – Fund ID #5459, and mail it to NIF, 1101 14th St, 6th Floor, Washington D.C. 20005-5639.

Let us know if you want additional information about this or other OBOS adaptations. Projects are currently also underway in China, India, Nepal, Nigeria, Russia, Tanzania and Turkey.

Philip Smucker of McClatchy Newspapers has written a must-read story about a search for a midwife in an Afghan war zone. American soldiers hope the woman will help open a health clinic in Paktika, described as one of the poorest and most dangerous of Afghanistan’s eastern provinces.

Yes, the effort is part propaganda. But it sure beats the CIA handing out Viagra to Afghan tribal leaders.

Afghanistan has devastatingly high infant and maternal mortality rates, and war has made access to health care more difficult. Every 26 minutes, an Afghan woman dies giving birth; the rate is second only to Sierra Leone. Midwives are critical to any public heath effort, yet even the training poses a real risk.

“Frequently the distance between home and a health care center is a two- to 10-hour walk,” Kathrin Lauer, a medical administration expert with the U.S. Agency for International Development in Afghanistan, said. “Midwives with good training are critical if you want to reduce the maternal and neonatal mortality rates. This is one way to help win the war.”

A Chicago Tribune story last year on an Afghan midwife training program noted that militants shot and killed a midwife, allegedly for  handing out condoms and birth control. One midwife said women feared even taking part in the training program, originally created by a Dutch relief agency, because the school was near an American base. The women didn’t want to be associated with Americans, or give the impression that they were.

In the McClatchy story, soldiers received the name of a midwife from a local pharmacist. One of the soliders, Maj. Yince Loh, is a brain surgeon from Los Angeles.

“Right now, we can’t help the Afghan government come in here and build a big Afghan clinic,” Loh said. “But we have some options and we are still looking for midwives to help. Our goals are incremental: to improve infant mortality step by step. That will certainly help improve perceptions of the government.”

But when they found the woman, named Shamshad, 45, she was terrified. The Taliban had previously abducted her for two weeks — punishment for providing a bandage to a wounded Afghan government soldier. Smucker writes:

“Please help me, but don’t bring me anything yourself; send it at night through someone else,” Shamshad pleaded as the Americans greeted her.

Sgt. Eric Pollock, a National Guardsman from San Diego, asked Shamshad whether she could work at an Afghan medical clinic, but she said she couldn’t.

“If I work in an official clinic, they (the Taliban) will behead me,” she said, demurring from having her photo taken out of fear that the Taliban might see it.

“I’ve been interested in medicine for a long time,” said Shamshad, who wasn’t covering her hair as Afghan and many other Muslim women traditionally do. “My husband would not let me work in a government clinic, so I opened my own clinic here. But when I was arrested in Pakistan by the Taliban and fell ill, thieves ransacked the clinic and took everything, including my stethoscope, hot water heater and blankets.”

Loh said he’d think about how he might help Shamshad as he emptied his medical supplies onto the counter for her and prepared to return to base.

Thoughts on how the U.S. can do good as our presence complicates the situation even more?

Plus: Read our previous coverage of maternal health conditions in Afghanistan and U.S. involvement, including stories about Afghanistan’s largest women’s hospital, Rabia Balkhi, home to the Laura Bush Maternity Ward.

And over at Feministing, Courtney ponders military escalation in Afghanistan and what it means to Afghan women.

The DC Developing Families Center in Washington, D.C., is notable for its comprehensive approach to women’s health. Three facilities co-exist under one roof: the Family and Birth Center, a medical center where women can obtain physical exams, family planning services and give birth in a free-standing birth room; the Healthy Babies Project, which offers parenting and life skills as well as a food pantry; and an early childhood development center, with classrooms for children age 6 months to 2 years.

What makes it truly remarkable is that this model is not in every community.

Consider its success: “Studies show that compared to other African Americans in D.C., clients at the Developing Families Center have one third the rate of preterm birth (7 percent versus 24 percent) and half the rate of low birth weight and C-section (6 percent versus 14 percent and 13 percent versus 32 percent). Compared to black mothers nationwide, they are 30 percent more likely to try breastfeeding,” writes Molly M. Ginty in Women’s eNews.

Ruth Watson Lubic, a nurse-midwife who won a prestigious MacArthur Foundation “genius” grant in 1993, opened the Developing Families Center to meet the needs of women and their families living in D.C.’s Ward 5. (Read more about Lubic, now 82, at OBOB.)

“She hoped to create a one-stop center where families could get all the medical care they needed — and to get it in a revolutionary way: at one central site so access was not a problem; in a loving, supportive environment devoid of discrimination; and coupled with the social services they needed such as counseling and food provision,” writes Ginty.

“Our facility is the only model of its kind,” said Dr. Linda Randolph, president and CEO of the Developing Families Center. “Other health entities may have social services, but they are usually more medically-oriented. We seek not just to treat health problems, but to solve them by addressing their root cause.”

Randolph, formerly the director of New York State’s Office of Public Health, will be honored as one of Women’s eNews 21 Leaders for the 21st Century Thursday in New York City. All the honorees are pretty amazing; go take a look.

Plus: I’m several hours late in noting that May 5 is International Day of the Midwife. This year’s theme is “The World Needs Midwives Now More Than Ever.”

That’s not hyperbole. Midwives are essential if we ever want to reach United Nations Millennium Development Goal 5 — to reduce maternal mortality by 75 percent and to achieve universal access to reproductive health services by 2015. We’re quite far behind.

Sarah Brown writes at Huffington Post about the need to train health workers, including midwives, to improve maternal and newborn health. Learn more at Mothers Day Everyday, a campaign calling for greater U.S. leadership to strengthen health systems and increase skilled health workers in communities where pregnant women die for lack of care.

Finding “Common Ground” on Abortion – How’s That Working?:  “President Obama has accomplished a lot in his first 100 days in office, but one campaign promise he’s been unable to keep is a vow to make peace in one of the most polarizing issues in all of American politics: abortion,” reports NPR.

Lines in the Sand: Speaking of the elusive common ground, On the Issues magazine chose “lines in the sand” as the theme for its current issue.

An email to readers said the choice was “provoked by today’s too-prevalent sentiment to compromise principles in the interests of seeking ‘common ground’ and reconciliation with opposing views. In these articles we explore the feminist and progressive values that must be held tightly, the ‘lines in the sand’ that we refuse to erase.”

Publisher and Editor-in-Chief Merle Hoffman says reproductive freedom is “the front line, the bottom line and the everlasting line in the sand,” in her editorial “Higher Ground, Not Common Ground.”

Also look for essays by Gloria Feldt, Loretta Ross and many more writers and artists.

Economics, Race and Pollution: A study by researchers at the University of Massachusetts and the University of Southern California tracking toxic emissions from factories confirms what we already know: poor, minority communities are disproportionately affected by harmful pollution. The Milwaukee Journal Sentinel reports on the findings. View the full report (PDF) here.

Public Attitudes Toward HIV/AIDS as a Health Issue: Kaiser Family Foundation has released its 2009 Survey of Americans on HIV/AIDS. In the United States, the sense of urgency about HIV/AIDS as a national health issue has decreased significantly. Residents’ concerns about the disease as a personal risk also has declined, even among some high-risk groups. This press release summarizes the findings. The study comes less than a year after the CDC  announced that there were 40 percent more new HIV infections each year than previously believed.

Egypt’s FGM Ban, One Year Later: In the year since Egypt outlawed female genital mutilation, the government hasn’t prosecuted a single case, Iman Azzi writes at Women’s eNews. Still, some activists say the law is a tool, among others, for gradually dismantling an ancient tradition.

Legalization – The “X” Factor: On May 1, thousands of activists took to the streets in favor of expanding immigrants rights. Suman Raghunathan, an immigration and public policy analyst, describes what immigrant women, particularly those who are undocumented, need: “A legalization program that’s broad, fair and workable for both immigrants and immigration officials.”

Raghunathan goes on to note that current federal immigration policy leaves it up to states to decide whether to provide free or low-cost health care to their undocumented residents. Several states, including New York, have expanded prenatal and neonatal care to undocumented women and children.

“Legal status,” she writes, “would mean that undocumented women are no longer left to the mercy of state legislatures and no longer denied appropriate nursing and doctoring.”

Plus: The L.A. Times reports on how some California counties are eliminating non-emergency health services for undocumented immigrants.

“We are mortgaging the future to scrape through the present,” said David Hayes-Bautista, professor of medicine and director of UCLA’s Center for the Study of Latino Health and Culture.

HRT and Heart Health: A study in the May issue of the journal Medical Care (abstract) looks at whether the decreased use of HRT has affected the rate of cardiovascular health outcomes, according to this release. The number of heart attacks in menopausal women has decreased, though it’s not conclusive that there’s a link. Researchers did not find a difference in the rate of strokes.

Before 2002, physicians believed HRT reduced the risk of coronary heart disease by up to 50 percent in menopausal women. As a result, physicians prescribed it broadly to treat many of the symptoms of menopause, as well as to protect women against cardiovascular disease. However, a report by the Women’s Health Initiative in 2002 revealed that HRT actually had the opposite effect — it increased the risk of heart attack in these women.

“After the 2002 report, the use of HRT in women aged 50 to 69 declined from more than 30 percent to less than 15 percent,” said lead study author Kanaka Shetty, M.D.

The swine flu news of recent days has sparked calls from advocacy organizations for attention to issues that a pandemic may exacerbate, such as the lack of paid sick leave and the lack of  of availability of licensed midwives to attend home births.

MomsRising, a campaign to bring “important motherhood and family issues to the forefront of the country’s awareness,” includes paid sick leave among the concerns it addresses. They note that advice from officials has been to stay home if sick, in order to avoid further transmission of the virus, but that:

This is easier said than done. In the U.S. today, nearly half of workers aren’t allowed to earn paid sick days (i.e. they don’t have a single paid sick day to take when illness strikes in order to keep our communities healthy and not spread illness). And more than half of the workforce does not have or cannot use paid sick days to care for sick children.

The group has further discussion here, including a link to a petition in support of paid sick leave.

Additionally, The Big Push for Midwives campaign issued a release (PDF) yesterday calling on policy makers to support and legalize Certified Professional Midwives (CPMs) for the provision of out-of-hospital birth in the scenario that hospitals are an undesirable place for otherwise healthy pregnant women. CPMs currently are “legally authorized to practice in just over half the states and are eligible for Medicaid reimbursement in fewer than a dozen states.”

Colette Bernhard, Vice President of Illinois Families for Midwifery, explained:

Hospitals filled to capacity with flu patients are unsafe and inaccessible places for healthy women to deliver their babies….legal and reimbursement barriers at the state and federal level prevent far too many Certified Professional Midwives, who already have the necessary training and equipment, to utilize their services to the fullest. Given the very real possibility of a flu pandemic, the need to fully incorporate CPMs into our health care system could not be more urgent.

Russ Fawcett of The National Birth Policy Coalition called for states “to get on board and license CPMs to practice legally” and argued that “it is every bit as critical that our federal policy makers require Homeland Security to include CPMs—who function as mobile primary care facilities for pregnant women—in disaster planning at local, regional, and national levels and as eligible providers for the National Health Service Corps.”

Relatedly, the CDC has issued “Interim Guidance—Pregnant Women and Swine Influenza: Considerations for Clinicians” – guidance addresses the presentation of the disease in pregnant women, prevention, treatment, and breastfeeding considerations.

For more information on swine flu generally, see the CDC website (with news and resources for both the general public and clinicians), CDCemergency on Twitter (you don’t need an account to follow the updates), and this consumer health page from MedlinePlus.

Secretary of State Hillary Clinton on Wednesday, during her first congressional testimony since her confirmation hearing, broke “the political sound barrier,” writes Jodi Jacobson at RH Reality Check.

The moment came during questioning by Rep. Chris Smith (R-NJ). When Smith asked whether the Obama administration would seek to “overturn pro-life laws” in Africa and Latin America, Clinton replied:

We have a very fundamental disagreement and it is my strongly held view that you are entitled to advocate and everyone who agrees with you should be free to do so anywhere in the world, and so are we.

We [the Obama Administration] happen[s] to think that family planning is an important part of women’s health and reproductive health includes access to abortion, that I believe should be safe, legal and rare.

Here’s Clinton on the U.S. government’s role in supporting global access to safe abortion, contraception, maternal health care and education:

Ipas, an international women’s health organization, has just released a new documentary, “Not Yet Rain.” The 23-minute film by Lisa Russell explores abortion in Ethiopia through the voices of four women who have faced the challenge of finding safe care. Nearly 67,000 women die each year from unsafe abortions; more than half of these deaths occur in Africa.

One of the women, Asnaketch, 32, was repeatedly attacked and raped. At the time, abortion was illegal, so she turned to traditional practices and herbs to end the unintended pregnancies — a common practice. Abortion is now permitted under more liberal guidelines, but access is still a major concern. Two of the other women interviewed must travel to regional hospitals for safe abortions.

Below is the trailer, but you can now watch the full film at NotYetRain.org. The website also includes a number of excellent resources; look in the About the Issue section for fact sheets, including this one on abortion and reproductive health and information specific to Ethiopia.

By Jane Pincus
Our Bodies Ourselves co-founder

How many readers know about the dramatic reach of the Our Bodies Ourselves Global Translation/Adaptation Program?

As one of the founders of the Boston Women’s Health Book Collective, and a writer and editor of “Our Bodies, Ourselves” for the past four decades, I am excited to discuss the reach of this amazing program.

Over and over again, it brings to life our original goal of women speaking directly with one another about their own experiences, and using this shared knowledge and wisdom to inform themselves, their families, and communities. It also reflects our goal of improving cultural attitudes toward women and initiating woman-centered national health policies.

Let’s start with what is happening in Nepal. The Women’s Rehabilitation Center (WOREC) has published the first three of seven health booklets based on “Our Bodies, Ourselves” and adapted to the needs of Nepalese women and girls. The group has tested the information in many settings across the country — with women in the community, the barefoot gynecologists who manage women-centered health clinics, activists and Women Human Rights Defenders, and health ministry officials.

From grassroots to government, their project has had positive results. During a health fair in December 2007 organized by the gynecologists, 1,500 of the 4,000 women who attended volunteered to undergo self-examinations. WOREC was responsible for the inclusion of reproductive health in Nepal’s new interim constitution and helped develop a national health strategy focused on women.

A WOREC health counselor sharing information from the Nepali OBOS booklets with women at the health fair / Photo by Jwala Kwolakshyapati, WOREC

This is just one example of how our Global Translation/Adaptation Program continues to realize OBOS’ original goals. The organization has facilitated adaptations of “Our Bodies, Ourselves” in 23 languages around the world. Projects are currently underway in seven countries, including Turkey and Israel, where a group of Jewish and Palestinian women are working together on two editions of “Our Bodies, Ourselves” — one in Hebrew and one in Arabic. (Find out below how you can help fund a specific translation/adaptation, or support a women’s group seeking start-up funds.)

Sally Whelan and Ayesha Chatterjee are the women at the heart of the program. Just as they remain in constant communication with WOREC’s project coordinator, Dr. Renu Rajbhandari, and offer their continuous support to WOREC in all of its efforts, they are in contact with dozens of women’s groups choosing to adapt “Our Bodies, Ourselves” as a national or regional project.

Once a group approaches OBOS, Sally and Ayesha listen to its needs and help plan the unique form their project will take — from start-up and adaptation to publishing, distribution and outreach.

They also encourage groups in each country to focus on building networks for their project, creating a “circle of friends” that includes laywomen, community groups, translators, reviewers, media contacts and policy makers. These networks can extend further geographically, as Sally and Ayesha put project coordinators from different countries in touch with one another to share strategies and experiences.

How do women incorporate this information and learn about their bodies? In all sorts of innovative ways relevant to their lives: books, booklets, magazines, posters, leaflets, workshops, websites, text messages and training sessions abound. Women gather in libraries, community centers, district councils, marketplaces and village hairdressers’ shops to share information. Outreach on motorcycles and other forms of local transport, such as canoes in Nigeria, bring simple health content to rural areas.

To support these efforts, the Global T/A Program counts on donations so it can continue to connect women throughout the world in the most lively, useful way, and build a global women’s movement despite tremendous odds.

In Nepal, WOREC often works under adverse conditions. More than 40 percent of the Nepalese population is under 25, which makes connecting with that age group essential to their vision. The team fights against the many forms of violence that women and girls face, including early marriage and sexual trafficking. Dedicated to promoting women’s health rights in a culture that is conservative and patriarchal, they are resilient in the face of humiliation, harassment and sometimes terrifying threats to their safety.

Nepal’s minister of Health and Population receiving a gift basket of appreciation at an event to launch WOREC’s booklets / Photo courtesy of WOREC

When WOREC launched the health booklets, government officials, health professionals and health and human rights activists spoke at a moving event about the needs of Nepalese women and families. The team also presented a gift basket of appreciation, filled with medicinal herbs, fruits and flowers, to the minister of Health and Population.

The best part of their work, says WOREC staff, will be when they actually begin using the booklets in the field. They plan to work with OBOS to strategize on publicity and expanded distribution for their materials.

I was lucky enough to attend the first conference of OBOS translators and adaptors in Utrecht, The Netherlands, in 2001. It was incredibly moving to sit around a large, oval table with women from Japan, Armenia, Poland, Tibet, Senegal, Mexico, Cuba, The Netherlands, Bulgaria and Serbia, and listen to their stories.

They shared what motivated them to write their own books, and how they had created, or were about to create, health materials appropriate to their own cultures. They described problems with language and discussions about which topics to include or leave out. Many national efforts encountered difficulties, ranging from repressive religious attitudes in Poland to an earthquake in Armenia.

They were also interested in the story of how “Our Bodies, Ourselves” began and has changed over the years, and were astonished to hear that it had been censored in the United States in a number of places.

The stories of our publications continue. What an adventure! In the coming months, we’ll share more tales and include the voices of women using “Our Bodies, Ourselves” around the world. We’ve also posted a video about the program on our new YouTube channel. Please take a look and let us know what you think.

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Want to support a translation or adaptation of “Our Bodies, Ourselves”? Here’s a list of women’s groups seeking start-up funds. You can support these groups, or any of the projects underway, by making a donation to OBOS. Please contact Ayesha Chatterjee or Sally Whelan for more information.

I was away last week, so no Political Diagnosis, but it’ll be back to business on Monday …

Court Strikes Down Iowa Law Banning Same-Sex Marriage: The unanimous state Supreme Court decision means same-sex couples will be allowed to marry in Iowa by the end of the month — and the doors will be open to couples from other states. The decision seems pretty solid for now. Unlike California, voters in Iowa cannot directly initiate constitutional amendments. Instead, an amendment would have to be taken up by the state Legislature, and Democrats, who control both chambers, show no interest in making it a priority.

Here’s the Supreme Court summary and the full decision (both pdf).

Mammogram Benefits Under Debate: “The conventional wisdom about breast cancer screening is coming under sharp attack in Britain, and health officials there are taking notice,” writes Roni Caryn Rabin in The New York Times. “They have promised to rewrite informational fliers about mammography after advocates and experts complained in a letter to The Times of London that none of the handouts ‘comes close to telling the truth’ — overstating the benefits of screening and leaving out critical information about the harms.”

Do People Who Support “Traditional Values” Value Pregnant Women?: Lynn Paltrow writes at Huffington Post –  “I have to thank Andrea Lafferty, of the Traditional Values Coalition for her response to a piece I wrote opposing Personhood USA’s efforts to give full constitutional rights to the unborn from the moment of fertilization. In her commentary she hopes to discredit my organization, National Advocates for Pregnant Women (NAPW) by exposing our commitment to all pregnant women, including those who love their children but are unable to overcome a drug problem in the short term of pregnancy …”

The Search for a Donor: Frances Kissling, the former president of Catholics for a Free Choice and a visiting scholar at the Center for Bioethics at the University of Pennsylvania, will soon need a kidney. This is her story about learning how to ask.

Birth Centers Advocacy Update: As we previously mentioned, American Association of Birth Centers was looking for 100 physicians to sign a letter in support of legislation to mandate the facility fee in Medicaid. There are 102 signatures so far and counting …

Women Pay Higher Price For Health Insurance: NPR reporter Sarah Varney writes about a past experience seeking health insurance (a completely frustrating process) and the higher insurance rates women pay in some states. The piece concludes with some important news for workers laid off after Sept. 1, 2008:

If you had employer-sponsored health insurance and qualified for COBRA coverage, under the new stimulus bill, the federal government will pay 65 percent of your premium for up to nine months.

And that even includes laid-off workers who initially turned down COBRA coverage because they thought it was too expensive. They now have a second chance to sign up.

Plus: Also from NPR — the hidden costs of cancer treatment, even with insurance. And The New York Times offers tips for people with pre-existing conditions, whether you’re currently covered or shopping for insurance.

Congress Approves Budget: The House and Senate approved budget blueprints on Thursday that include funding for expansion of health care coverage; now the hard work begins in conference committee.

America Going Quiet on HIV/AIDS: A new Kaiser Family Foundation survey found that the percentage of people in the United States who say that they have seen, heard or read a lot about HIV/AIDS in the United States has fallen from 34 percent five years ago to just 14 percent today. The percentage of African Americans reporting this has fallen from 62 percent to 33 percent.

Global Women & Health Salon: President Obama this year has signed executive orders eliminating the “Global Gag Rule” and restoring U.S. funding for the United Nations Population Fund. “Now that [these two goals] have been met what else should the Obama administration do to promote the health and welfare of women worldwide?” asks Mark Goldberg, in the kick-off post for the After the Gag Rule Salon sponsored by RH Reality Check and UN Dispatch.

Afghan Law Criticized: UN and Western aid agencies are urging Afghan President to repeal a law he signed last month that reverses freedoms won by Afghan women, reports BBC News. Human rights activists say the law legalizes rape within marriage, and women will need permission from their husbands to leave their homes.