White House Defines Contraception as Abortion: You know you’re counting down the remaining hours of the Bush presidency when you read that the administration “wants to require all recipients of aid under federal health programs to certify that they will not refuse to hire nurses and other providers who object to abortion and even certain types of birth control,” as reported in The New York Times.

Under the draft of a proposed rule, hospitals, clinics, researchers and medical schools would have to sign “written certifications” as a prerequisite to getting money under any program run by the Department of Health and Human Services. Such certification would also be required of state and local governments, forbidden to discriminate, in areas like grant-making, against hospitals and other institutions that have policies against providing abortion.

And the kicker:

The proposal defines abortion as follows: “any of the various procedures — including the prescription, dispensing and administration of any drug or the performance of any procedure or any other action — that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation.”

Check out the full memo (PDF). Reuters has reaction from family planning groups. NARAL created a letter you can send to members of Congress.

For more reading, see Allison Stevens; Susan Wood; and Christina Page, who notes:

Up until now, the federal government followed the definition of pregnancy accepted by the American Medical Association and our nation’s pregnancy experts, the American College of Obstetricians and Gynecologists, which is: pregnancy begins at implantation. With this proposal, however, HHS is dismissing medical experts and opting instead to accept a definition of pregnancy based on polling data. It now claims that pregnancy begins at some biologically unknowable moment (there’s no test to determine if a woman’s egg has been fertilized). Under these new standards there would be no way for a woman to prove she’s not pregnant. Thus, any woman could be denied contraception under HHS’ new science.

Senate Passes PEPFAR: Scott Swenson of RH Reality Check has the live blog on the 80-16 vote to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR), a five-year, $50 billion global initiative to combat HIV/AIDS, tuberculosis and malaria.

SEICUS, International Women’s Health Coalition, and other groups issued a response to the vote, noting in part that “policymakers failed to address critical shortfalls in the bill that would have ensured effective use of scarce public funds and a sustainable response to the pandemic.” It continues:

One key change that should have been made in the PEPFAR bill was the abolishment of arbitrary funding guidelines that determine how money can be distributed on the ground. The Senate bill calls for spending at least fifty percent of prevention funds designed to halt the sexual transmission of HIV, in countries with generalized epidemics, only on abstinence and faithfulness programs. PEPFAR recipients that do not meet this requirement must justify their programmatic decisions through an onerous reporting requirement to Congress, potentially facing defunding. [...]

The PEPFAR bill passed by the Senate also failed to fully increase protection for women and young people, two groups increasingly vulnerable to new infections in nearly every region of the world. Women and young people are most likely to use family planning and other reproductive health services, and would benefit greatly from a strategy that integrated HIV prevention and treatment with family planning. Recent studies suggest that upwards of 90 percent of HIV-positive pregnant women in countries such as Uganda and South Africa have unmet need for integrated family planning and HIV services. However, the bill passed by the Senate fails to call for, or even acknowledge, the need to strengthen critical linkages between family planning and reproductive health services and HIV prevention efforts.

Regional “Hypersegregation” May Contribute to Racial Disparity in Preterm Births: Where a mother lives may account for some of the striking racial disparities in preterm birth, according to a new study described in this release and published in the American Journal of Epidemiology.

Written by Northeastern University professor Theresa Osypuk, the study found that regional hypersegregation (residential racial segregation across four or more dimensions*) may contribute to the higher rate of preterm births among black women. Prior research has shown that infants born to Black women in the U.S. are 50% more likely to be preterm than infants born to White women, although the causes remain poorly understood. [...]

“The complexity of residential segregation and its impact on preterm births and related health outcomes has been overlooked by health literature,” said Dr. Osypuk, Assistant Professor in Northeastern’s Bouve College of Health Sciences. “We believe that the association between residential segregation and higher risk of preterm birth is related to the neighborhood environments in which black women live, including neighborhoods characterized by high levels of poverty, violent crime, and worse housing stock.”

Are Breast Self-Exams Worth It?: Kate Harding breaks down a new study by the Cochrane Collaboration.

Blogging While Brown (and Female): “People consider me the 411 on what goes wrong with black women in America,” Gina McCauley, founder of www.whataboutourdaughters.blogspot.com,” tells Kristal Brent Zook in this article on how women bloggers of color are getting their messages out without having to first get approval through a male power structure.

Plus: The first ever “Blogging While Brown” conference takes place July 25-27 in Atlanta.

Return of the C-Word for Departing Trib Editor: From Romenesko: “In 2004, Ann Marie Lipinski had her Chicago Tribune staff manually pull 600,000 copies of the WomenNews section out of preprinted packages because of the headline, “You c_nt say that.” (The story explored usage of the vulgar term for a woman’s anatomy.) On Thursday, the departing editor showed the newsroom a reader’s e-mail that said, “You C_nt Leave.”

Dissecting the Diets: I caught a frustratingly superficial TV news segment on a long-term Atkins Foundation-funded study (published in the New England Journal of Medicine) that concluded participants on the Atkins Diet lost more weight compared to people on low-fat or Mediterranean diets. Tara Parker-Pope notes, however, that none of the diets resulted in much weight loss (though there were other health benefits), and she takes a closer look at what eating low-carb meant for the purpose of this study — while some commenters discuss whether the low-fat diet was low enough to be effective. Parker-Pope’s most concise critique of the study may be found here.

AIDS Conference Coverage: Kaisernetwork.org will provide daily coverage of AIDS 2008 from Mexico City, Aug. 3-8. Coverage will include live and tape-delayed webcasts and transcripts of each day’s sessions, including the opening and closing sessions, all plenary sessions, and selected other sessions and press conferences; English- and Spanish-language audio podcasts of select sessions; slide presentations from select conference sessions; a daily update email with links to the latest coverage; and more.

Plus: Here’s information on how you can syndicate Kaiser’s coverage on your own website.

Hot Flash Fan Heats Up Exhibit: Lucinda Marshall points to an exhibit at the Huff Gallery at Spalding University in Louisville: “The Hot Flash Fan, Then and Now: Celebrating 160 Years of Feminism.” The Hot Flash Fan, an 8’ x 16’ wall hanging, was created by Ann Stewart Anderson in collaboration with more than 50 women artists. From the exhibit website:

The Hot Flash Fan was created in 1985 and facilitated by renowned feminist artist, Judy Chicago. The Hot Flash Fan, an immense wall hanging, encompasses various media and materials including: elaborate knotting, roping, beading and stitching. In addition, the piece is swathed in vibrant colors, which enhances the viewer’s image of the realities and experiences of menopause.

This specific piece has particular historical significance because it was one of the first artworks to ever visualize the subject of menopause. Through its vivid colors and intricate detailing the Hot Flash Fan depicts the various myths, stereotypes, as well as lived experiences of women transitioning through the multiple phases of menopause. Though historically, representations of menopause have largely focused on the decaying of women’s bodies, as the piece indicates, there are also many reasons to celebrate menopause as one of the important phases in women’s lives.

Check it out:

Planned Parenthood Expands its Reach: “Flush with cash, Planned Parenthood affiliates nationwide are aggressively expanding their reach, seeking to woo more affluent patients with a network of suburban clinics and huge new health centers that project a decidedly upscale image,” reports the Wall Street Journal.

Unfortunately the full story is available to subscribers only, but the WSJ health blog has a summary that includes these remarks:

Despite some critiques to the contrary, Planned Parenthood insists it’s not compromising is long-held focus on serving the poor with birth control, sexual-health care and abortions. Officials there say they take a loss of nearly $1 on each packet of birth-control pills distributed to poor women under a federal program that funds reproductive care. But they make a profit of nearly $22 on each month of pills sold to an adult who can afford to pay full price. That money helps subsidize other operations, including care for the poor as well as pursuing Planned Parenthood’s political agenda.

“It is high time we follow the population,” said Sarah Stoesz, who heads Planned Parenthood operations in three Midwest states. She recently opened three express centers in wealthy Minnesota suburbs, “in shopping centers and malls, places where women are already doing their grocery shopping, picking up their Starbucks, living their daily lives,” she said.

Pregnant in Gloucester: Concerning the 18 high school students pregnant in Gloucester, Mass, that have received national news coverage for supposedly choosing to get pregnant and raise their children together, Kelly McBride, who covers media ethics for Poynter Institute, has an excellent piece on pack journalism in search of a “pact..” Meanwhile, the high school principal who first said their was evidence of a pact defends his comments and his memory.

Plus: Courtney Macavinta of Respect RX discusses her own sex “pact” at age 15 and the cycle of disrespect that leads girls who don’t value themselves to make choices “in which the fine print (that life is about to get even harder) is written in invisible ink.”

Teen Pregnancies at 30-Year Low: Writing in the Chicago Tribune, Lisa Anderson reports on the latest pregnancy statistics released by the Guttmacher Institute.

Pregnancies — whether they end in birth, miscarriage or abortion — among women age 15 to 19 dropped to 72.2 per 1,000 women in 2004, down from a peak of 117 per 1,000 women in 1990 [...]

While some 700,000 women age 15 to 19 become pregnant every year, the rate has declined 36 percent since it peaked in 1990. The rate of abortions among teens also plummeted, to 19.8 per 1,000 women in 2004 from a high of 43.5 per 1,000 in 1988.

But researchers are keeping a close eye on the numbers, as there are some signs that the drop may be reversing:

Despite decades of improvement and for reasons yet unknown, there is statistical evidence that the drop in pregnancy rates, the age of first sexual activity and contraceptive use among teens stalled after 2001.

The exception may be in the teen birthrate. After a 14-year decline, the birthrate, meaning the number of live births, among women age 15 to 19 rose 3 percent in 2006 to 41.9 per 1,000 women from 40.5 per 1,000 women in 2005, according to the U.S. Centers for Disease Control and Prevention. Until more data are compiled, it is unclear whether the 2006 uptick in births was an isolated blip or the harbinger of a more significant and negative change on the teen reproductive landscape, according to David Landry, a senior research associate at the Guttmacher Institute.

Mandating Insurance Coverage for Psychiatric Ailments: Illinois will become the 17th state to mandate insurance coverage for treatment of anorexia and bulimia, assuming the governor signs a bill recently approved by the state Legislature.

Bonnie Miller Rubin and Ashley Wiehle of the Chicago Tribune write:

The measure is part of a larger national debate about addressing inequities in insurance coverage between psychiatric and physical ailments.

More than 12 million Americans, mostly young women, have eating disorders in their lifetime, according to the National Association of Anorexia Nervosa and Associated Disorders. The organization ranked risk of death as higher with anorexia than with any other mental illness. Among patients with anorexia, almost half of all deaths are suicides, according to ANAD. Yet many insurers balk at covering the tab, which can run as high as $2,500 a day.

“I’ve met so many parents who have had to refinance their homes,” said Rep. Fred Crespo (D-Hoffman Estates), one of the bill’s sponsors.

But others cite the financial cost of such a law. Richard Cauchi, health program director for the National Conference of State Legislatures, said Illinois has taken “an unusual action” for 2008, when the trend is to move away from mandates on business and governments.

“There’s more pressure now to repeal and restrict mandates than to enact new ones,” he said..

“Neglected Infections of Poverty”: “Despite plummeting mortality rates for most infectious diseases over the last century, a group of largely overlooked bacterial, viral and parasitic infections is still plaguing the nation’s poor, according to a report released this week,” writes Wendy Hansen in the L.A. Times.

“Many of the diseases are typically associated with tropical developing countries but are surprisingly common in poor regions of the United States, according to the analysis, published in the Public Library of Science journal PLoS Neglected Tropical Diseases.”

The study’s author, Dr. Peter Hotez, chairman of George Washington University’s department of microbiology, immunology and tropical disease, says there are 24 diseases affecting at least 300,000 Americans, and possibly millions. Poverty-stricken regions, including Appalachia, inner cities, the Mississippi Delta and the border with Mexico, are the areas most severely affected.

Will Women Give Hormone Maker a Second Chance?: “Can Wyeth win back the 40 million Premarin and Prempro users it’s lost since 2002 — along with $1 billion a year in profits — with a new menopause drug? Or will the once-bitten women who have filed more than 5,000 lawsuits claiming the hormones gave them cancer feel fooled twice?” asks Martha Rosenberg at AlterNet.org, in this look at Wyeth’s hope of marketing Pristiq as the first nonhormonal treatment for menopause symptoms.

Don’t Ask, Don’t Tell Affects Women More: “The Army and Air Force discharged a disproportionate number of women in 2007 under the “don’t ask, don’t tell” policy that prohibits openly gay people from serving in the military, according to Pentagon statistics gathered by an advocacy group,” reports The New York Times.

While women make up 14 percent of Army personnel, 46 percent of those discharged under the policy last year were women. And while 20 percent of Air Force personnel are women, 49 percent of its discharges under the policy last year were women. By comparison for 2006, about 35 percent of the Army’s discharges and 36 percent of the Air Force’s were women, according to the statistics.

The information was gathered under a Freedom of Information Act request by the Servicemembers Legal Defense Network, a policy advocacy organization.

Gardasil Not Approved for Older Women: “U.S. regulators have told Merck & Co they cannot yet approve Merck’s application to expand marketing of its cervical cancer vaccine Gardasil to an older group of women, the drugmaker said on Wednesday,” reports Reuters.

“Merck had applied for the use of Gardasil in women ages 27 through 45. The U.S. Food and Drug Administration said in a letter regarding the application that it has completed its review and there are ‘issues’ that preclude approval within the expected review time frame, Merck said.”

Exercise as a Tonic for Aging: The New York Times reports on an updated series of physical activity recommendations for older adults from the American Heart Association and the American College of Sports Medicine, which are expected to match new federal activity guidelines due in October from the United States Health and Human Services Department.

“Contrary to what many active adults seem to believe, physical fitness does not end with aerobics,” writes Jane Brody. “Strength training has long been advocated by the National Institute on Aging, and the heart association has finally recognized the added value of muscle strength to reduce stress on joints, bones and soft tissues; enhance stability and reduce the risk of falls; and increase the ability to meet the demands of daily life, like rising from a chair, climbing stairs and opening jars.”

Best Headline: “Abstinence-only funding is like an evil Energizer Bunny,” courtesy of Vannesa at Feministing. Why the evil? The House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies voted to continue funding the Community-Based Abstinence Education (CBAE) program, an abstinence-only education funding stream, despite all the research that’s it’s a waste of money and resources. Scott Swenson of RH Reality Check has a good wrap-up here.

Share This: Via Brownfemipower, I found an online petition — Statement of Black Men Against the Exploitation of Black Women — written in the wake of R. Kelly’s acquittal. The petition and related useful books, films and organizations are also listed on Mark Anthony Neal’s blog, which itself is a terrific resource on issues on issues of race and masculinity.

UN Addresses Rape as a War Crime: “In Sudan, girls as young as four are raped by rebel forces and government-backed militias. In Democratic Republic of Congo, women are sexually mutilated by roving gangs. In Burma, they are systematically raped as part of a military offensive,” writes Olivia Ward in the Toronto Sun. “[Thursday], the United Nations Security Council agreed that sexual violence against women and girls in war zones is a threat to international stability, opening the way for action against countries that condone or promote atrocities.”

Here’s more from the BBC, and the full text of UN Resolution 1820, which states that “rape and other forms of sexual violence can constitute war crimes, crimes against humanity or a constitutive act with respect to genocide.” The 15-member Security Council also demanded the “immediate and complete cessation by all parties to armed conflict of all acts of sexual violence against civilians.”

In Europe, Debate Over Islam and Virginity: From The New York Times:

As Europe’s Muslim population grows, many young Muslim women are caught between the freedoms that European society affords and the deep-rooted traditions of their parents’ and grandparents’ generations.

Gynecologists say that in the past few years, more Muslim women are seeking certificates of virginity to provide proof to others. That in turn has created a demand among cosmetic surgeons for hymen replacements, which, if done properly, they say, will not be detected and will produce tell-tale vaginal bleeding on the wedding night. The service is widely advertised on the Internet; medical tourism packages are available to countries like Tunisia where it is less expensive.

“If you’re a Muslim woman growing up in more open societies in Europe, you can easily end up having sex before marriage,” said Dr. Hicham Mouallem, who is based in London and performs the operation. “So if you’re looking to marry a Muslim and don’t want to have problems, you’ll try to recapture your virginity.”

A 23-year-old French student of Moroccan descent who paid $2,900 for the procedure, said: “In my culture, not to be a virgin is to be dirt … Right now, virginity is more important to me than life.”

Plus: Read Judith Warner’s column, which links hymen surgery, father-daughter purity balls and other news stories related to patriarchy and female chastity.

World Refugee Day: In recognition of the 8th Annual UN World Refugee Day on June 20, Worldview looked at the plight of Iraqi refugees.

Cervical Cancer Screenings Lacking in Developing Countries: “A study published in the open-access journal PLoS Medicine has found that women in the developing world are not getting the cervical cancer screenings that they need,” according to Medical News Today. “Researcher Emmanuela Gakidou (University of Washington) and colleagues report that although women in the developing world have the highest risk of developing cervical cancer, few are effectively screened. Additionally, there exist severe inequalities between and within countries concerning the access to cervical cancer screening.”

Plus: A survey of 38,000 Canadian women found that obese women are significantly less likely (30 to 40 percent, depending on the degree of obesity) to be tested for cervical cancer than women of average body weight, according to CBC News. Breast and colon cancer screening are unaffected by a woman’s body mass.

Shopping for Breast Cancer: The Center for Media & Democracy’s PRWatch recently posted an article about “Pinkwashing” — which is what happens when corporations try to boost sales by associating their products with the fight against breast cancer. “The worst pinkwashers exploit the intense emotions associated with breast cancer while selling products that actually contribute to breast cancer,” writes Ann Landman, who goes on to offer some key examples, including a Ford 2008 V-6 Mustang with Warriors in Pink Package, which proclaims to “add more muscle to the fight.”

Landman also links to Breast Cancer Action’s excellent Think Before You Pink campaign.

Study Finds Drop in Use of HRT: “Fewer older women in Canada are using hormone-replacement therapies to treat the symptoms of menopause, turning instead to natural remedies, says a study released Thursday,” reports The Vancouver Sun.

“The Canadian Institute for Health Information has found only five per cent of women in five provinces who are 65 years and older use hormone-replacement therapies — a drop from 14 per cent six years ago, when a report found the risks of using the menopause therapies outweigh the benefits.”

The Number of Underinsured Grows: Via the L.A. Times - A new study published in Health Affairs journal found that 25 million people ages 19 to 64 were underinsured in 2007, up from 16 million in 2003.

Nearly 50 million additional people have no health insurance at all. In all, “You end up with about 75 million adults who were either underinsured or uninsured at some time during the year,” says study co-author Sara Collins, an assistant vice president of the Commonwealth Fund, a foundation that supports independent healthcare research.

Those who had inadequate insurance coverage were almost as likely as those with no insurance to avoid getting needed care or to suffer medically related financial problems. Some 53% of the underinsured went without needed care, compared with 68% of the uninsured. And 45% of underinsured people had trouble paying medical bills, compared with 51% of uninsured people. “You can have health insurance and still go bankrupt if you get sick,” the authors note.

ACLU Symposium on LGBTQ Rights: Melissa points to a number of pieces posted at the symposium, including her piece on gay marriage written as a LGBTQ ally. I loved what Rachel Maddow had to say in an interview with the ACLU:

So far the state where I grew up (California) and the state where I live (Massachusetts) and the state where I work most of the time (New York) have legalized, legalized, and agreed-to-recognize-other-states’ same-sex-marriages, respectively. I am accepting applications now from other states that want me to relocate, since apparently I am to second-class gay citizenship what Saint Patrick was to snakes.

Court Denies Bid to Sterilize Mentally Disabled Woman: “Disability rights advocates and medical ethicists praised a precedent-setting ruling Friday by the Illinois Appellate Court denying a bid to sterilize a mentally disabled woman against her will,” reports the Chicago Tribune.

The woman’s guardian had sought a tubal ligation, but a three-judge panel ruled unanimously that the guardian did not prove sterilization was in the woman’s best interest. There are “less intrusive and less psychologically harmful [birth-control] alternatives,” read the opinion.

“It’s extraordinarily significant” because it guarantees the disabled a court hearing, said Katie Watson, a Northwestern University professor who wrote a friend-of-the-court brief in the case on behalf of about two dozen medical ethicists.

“In the past, this was a decision that could be made between a guardian and a doctor,” she said. “The decision must be moved into the light.”

Choosy Mothers Choose … Well, Not This C-Section Story: Time magazine’s “Choosy Mothers Choose Caesareans” is problematic on multiple levels — but mainly for overplaying the role of women requesting elective c-sections as the reason being the skyrocketing caesarean rate, and downplaying the risks involved. Lucinda Marshall rocks with a great response.

Plus: For more information, read “Maternal Request for Cesarean Delivery: Myth or Reality?” — a summary of the latest research and articles compiled by Our Bodies Ourselves.

Fundamentalism Comes Under Public Health Scrutiny: From Women’s eNews: “Amid the growing influence of fundamentalism around the world, Asian researchers say women in almost any affected religion — Christian, Muslim or Hindu — pay the price in eroded health and safety.” Read the story by Swapna Majumdar, a journalist based in New Delhi.

Take Two on Time Off: “This year marks the 15th anniversary of the landmark Family and Medical Leave Act, which made it possible for many workers to take unpaid job-protected time off to care for their newborn children or sick relatives,” writes Nancy Trejos at the Washington Post. “But instead of celebrating, workers’ rights advocates and the Bush administration are battling over what would be the most sweeping revisions ever to the law.”

Trejos notes that a “fierce debate” has been sparked by some proposed changes, which have yielded more than 4,000 public comments:

Under proposals being considered by the Labor Department, workers would have to tell their bosses in advance when they take nonemergency leave, instead of being able to wait until two days after they left. They would have to undergo “fitness-for-duty” evaluations if they took intermittent leave for medical reasons and wanted to return to physically demanding jobs. To prove that they had a “serious health condition,” they would have to visit a health-care provider at least twice within a month of falling ill. What’s more, employers would have the right to contact health-care providers who authorized leave.

Botox and Disrespect of Aging: “The 2,775,176 Botox treatments in 2007, at a cost of more than $1 billion dollars neatly expresses the desperation some people feel about physical signs of aging,” writes Ronni Bennett, before going on to discuss recent studies on the potential dangers of Botox and the FDA’s make-your-own-personal-judgment advice to consumers.

Coming of Age on Antidepressants: Writing in The New York Times, Richard A. Friedman, MD, reflects on the remarks of a 31-year-old patient who has been treated for depression since she was a teen: “I’ve grown up on medication,” she said. “I don’t have a sense of who I really am without it.”

The patient credited the medication with saving her life, “but now she was raising an equally fundamental question: how the drugs might have affected her psychological development and core identity.” Friedman continues:

Her experience is far from unique. Since their emergence in the late 1980s, serotonin reuptake inhibitors like Prozac and Zoloft have become some of the most widely prescribed drugs in the world, for depressed teenagers as well as adults. Because depression is often a chronic, recurring illness, there are certain to be many young people, like Julie, who are coming of age on these newer antidepressants.

We know a lot about the course of untreated depression, probably more than we do about very long-term antidepressant use in this population.

Plus: Friedman and Norman Rosenthal, MD, were both guests on NPR’s “Talk of the Nation” on Thursday, discussing the physical and psychological effects of taking antidepressants long-term.

Ireland Releases Study on Menopause: Ireland’s Minister for Health, Mary Harney, published “Menopause and Me,” hailed as the largest ever study in Ireland on awareness, attitudes and experiences of menopause, according to The Irish Times. Ireland’s Women’s Health Council carried out the study, which is available online here.

Performance Artist Killed on Peace Trip: An Italian performance artist, Pippa Bacca, 33, was raped and killed by a driver who offered her a ride just three weeks into a hitchhiking trip from Italy to the Balkans to the Middle East. Bacca and her friend, Silvia Moro, 37, both wore wedding dresses as part of their “Brides on Tour” project, created to send a message of peace and “marriage between different peoples and nations.” Elisabetta Povoledo writes in The New York Times:

The performance piece, a trip through nearly a dozen countries in the Balkans and the Middle East, many of them ravaged by war recently, was meant to underscore that “by overcoming differences and lowering the level of conflict,” individuals and cultures could come together, Ms. Moro said in a telephone interview. “Meeting people was the key.”

Accepting rides with strangers was crucial to the art performance’s success, Ms. Moro said. The artists’ statement at their Web site, bridesontour.fotoup.net, says, “Hitchhiking is choosing to have faith in other human beings, and man, like a small god, rewards those who have faith in him.”

Ms. Moro explained: “It’s a poor way of traveling, and we wanted to underscore that you can’t foster love between people if you’re holed up in business class. You can’t go to, say, Mauritius, and eat pasta. You won’t understand people until you break bread with them, because it’s in the small diversities that you find similarities.”

A report published in The Journal of Advanced Nursing found that women living in rural areas may have extra pressures in coping with menopause, including “geographical isolation, lack of confidentiality and anonymity, stress from multiple roles (including caring for aging relatives), poverty and limited health care and support services”

The study was only of 25 women, but the findings make sense. Limited access to doctors, support groups and factual information can make any condition or disease more stressful. Sheri L. Price, a nurse researcher who specializes in women’s health at the IWK Health Centre in Halifax, suggests some very practical solutions to scarce health care resources:

“One solution may be for advanced practice nurses or nurse practitioners - who have received additional training in women’s health - to offer holistic care and comprehensive support to rural women going through the menopause,” says Sheri Price. “This would enhance the women’s well-being as they go through menopause and enable them to optimise their health as they age.

“Another option may be to train female community leaders to deliver local information sessions and help to set up support groups. Community leaders with personal menopausal experiences would also be able to offer further validation and support to women.”

Such low-cost solutions aren’t groundbreaking, either, but they reinforce the need for grassroots community involvement in any comprehensive health care program.

For more on addressing menopause, check out the information on midlife and menopause from Our Bodies Ourselves.

Score One for the Patient: A breast cancer patient whose medical coverage was canceled by her insurer was awarded more than $9 million from her for-profit insurer, Health Net Inc., reports the L.A. Times. “The award issued by an arbitration judge was the first of its kind and prompted Health Net to announce it was scrapping its cancellation practices that are under fire from state regulators, patients and the Los Angeles city attorney.”

BCA Blasts Approval of Avastin: In a surprise move, the FDA approved the use of Avastin as a treatment for breast cancer. “The big question was whether it was enough for a drug temporarily to stop cancer from worsening — as Avastin had done in a clinical trial — or was it necessary for a drug to enable patients to live longer, which Avastin had failed to do. Oncologists and patient advocates were divided, in part because of the drug’s sometimes severe side effects,” writes Andrew Pollack.

“In the end, the agency found a compromise of sorts. It gave Avastin ‘accelerated’ approval, which allows drugs for life-threatening diseases to reach the market on the basis of less than ideal data, subject to further study.”

Breast Cancer Action blasted the decision. “The FDA has lowered the bar on the approval of breast cancer therapies. At a time when many questions are being raised about how the FDA approves drugs for market, today’s decision is a victory for drug companies, but not for patients,” BCA Executive Director Barbara A. Brenner said a statement posted at Prescription Access Legislation.

Short Maternity Leaves, Long Deployments: The Washington Post reports on the difficulty women in the military face if they want to have children and keep their jobs. Ann Scott Tyson writes:

The wars in Iraq and Afghanistan have placed severe strains on the Army, including longer deployments in which soldiers serve 15 months in the war zone, followed by 12 months at home. Under that system, a woman who wishes to have a child and remain with her unit must conceive soon after returning home so she can give birth, recover and prepare for her next overseas tour.

Female soldiers interviewed over the past year say the tight schedule cuts short precious time for mother and infant to bond and breast-feed, forcing women to choose between their loyalty to their comrades — as well as their careers — and nurturing their families.

Vaccinating Boys for Girls’ Sake?: The New York Times looks at efforts to convince parents to vaccinate boys to prevent the spread of human papillomavirus, or HPV, which can lead to cervical cancer. HPV also causes anal and penile cancers, but these are much more rare. (Read our previous coverage of the HPV vaccine Gardasil here.)

One woman tells the NYT, “You don’t want to say it’s just the girls’ problem … But my sons won’t contract cervical cancer. And genital warts are treatable. I’m very skeptical. What risks will I expose them to?”

Another woman comments, “If there was a vaccine I could take that would get rid of prostate cancer, why wouldn’t I? … If there was a vaccine that sons could get that would get rid of breast cancer, most parents wouldn’t hesitate. But cervical cancer is the ’sex cancer.’”

Do Cellphones Affect Male Fertility?: Some studies suggest as much, but the data is limited, writes Tara Parker-Pope, adding, “There are some global concerns about declining male fertility in industrialized countries, but issues like pollutants, exposure to chemicals and smoking are likely far more worrisome culprits than cellphones.”

The Studies Surrounding DHEA: The L.A. Times “Healthy Skeptic” column looks at the anti-aging claims of DHEA and finds it’s no fountain of youth.

More on Migraines (and Music): I’ve mentioned the group blog on migraines at The New York Times — be sure to check out Paula Kamen’s latest post on leaving the rabbit hole. Kamen, who suffers from chronic daily headaches, also appeared last week on WBUR’s “The Point”.

Jeff Tweedy hasn’t weighed in yet, but I did see Wilco Tuesday and Wednesday (braving cold and limited views) during the band’s five-night run in Chicago. Yeah, OK, that had nothing to do with women’s health, but I had to boast somewhere.

Debating “Juno”: Will “Juno” win best picture? Stay tuned. In the meantime, young birth mothers discuss what they liked and didn’t like about the film’s portrayal of adoption.

The Washington Post last week reported on an ad campaign protesting the FDA’s crackdown on pharmacies that manufacture and market biodentical hormones to treat symptoms of menopause. Sandra J. Boodman writes:

Last week the HOME (Hands Off My Estrogens!) Coalition, a group based in tiny Edinburg, Va., placed a full-page ad in five newspapers, including USA Today and the Wall Street Journal, accusing regulators of being hostile to “natural” hormonal medicines made according to a doctor’s prescription by a compounding pharmacy.

The ads urge women and their physicians to e-mail the White House and members of Congress asking them to protect patients’ access to medications they claim are “bio-identical” to those found in the body.

Hold the outrage. There is no scientific evidence that bioidentical hormones are safer than conventional hormone therapy drugs — and marketing claims that such drugs can restore youth and prevent or treat serious conditions such as cancer have long irked many in the medical community. As the Post story notes, “A key ingredient in these made-to-order drugs is estriol, a form of estrogen that the coalition claims is safe and protects against breast cancer — but that the FDA says is unapproved.”

Last month, the FDA sent letters to seven pharmacy operations that compound biodentical hormones, warning them that their claims about the safety and effectiveness of bioidentical hormone replacement therapy “are unsupported by medical evidence, and are considered false and misleading.”

While this upset the HOME Coalition, the National Women’s Health Network, along with physician groups such as the Endocrine Society, applauded the enforcement. The NWHN has long been concerned about the oversight of natural hormones — here’s a handy fact sheet on the subject — and two years ago the NWHN petitioned the FDA to stop companies from marketing estrogen-and-testosterone combination pills.

Marian Sadler of the NWHN critiques the Home ad over at Prescription Access Legislation. Sadler writes that the ad attempts to “make you feel that the HOME Coalition is looking out for women’s health and women’s rights, defending natural care from hostile attacks by drug companies and the FDA, and ’speaking the truth,’” but it’s basically just a sales pitch for natural hormones. She continues:

Like hormones that are synthesized in a lab and sold by drug companies, natural hormones are powerful chemicals that affect many parts of the body. It is very important to understand that products are not necessarily safe just because they’re natural. The same questions we ask about drugs need to be answered for alternative therapies too.

Just as pharmaceutical companies promote drugs, there is a large industry that produces and sells alternative health care products. Whether they are recommended by a doctor, a nurse practitioner, a naturopath or the cashier at the health food store, women should be skeptical of products that claim they will extend life, reverse aging, restore youth or prevent disease without causing any adverse effects.

Plus: The “Our Bodies Ourselves: Menopause” features a section specifically on “Natural Products: Phytoestrogens and Bioidentical Hormones.”

A Modest Proposal: “Pregnant students in a Denver high school are asking for at least four weeks of maternity leave so they can heal, bond with their newborns and not be penalized with unexcused absences,” reports the Denver Post, which notes that Denver Public Schools has no districtwide policy, meaning it’s left up to schools to “to work out plans for students to continue their education.”

What that means is some schools have set a policy whereby girls who don’t show up for school the day after they give birth are charged with unexcused absences. Many of the comments on this story argue against “special treatment.”

Florida Considers Proposal to Teach “Abstinence Plus”: “The bill would still require that schools teach abstinence as ‘the only certain way to avoid pregnancy or sexually transmitted diseases,’” reports the AP. “But, the measure would require that starting in the 6th grade, sex education classes provide information about the health benefits and side effects of contraceptives.”

Iowa Gets Funding to Reduce Unintended Pregnancies: Former Iowa first lady Christie Vilsack launched a statewide project called “Iowa Initiative to Reduce Unintended Pregnancies” that will focus on women ages 18 to 30. “As a woman, as a teacher, as a mother, I believe we have a responsibility to give all women in our state the knowledge and the means to prevent unintended pregnancies,” she said. From the Des Moines Register:

Half of all pregnancies in Iowa in 2006 were unintended, Vilsack said, citing state Department of Public Health statistics. Of those, 14 percent ended in terminations, she said, citing Iowa Barriers to Prenatal Care Project statistics.

Iowa ranks 48th in the nation in making family planning services available and 39th in its public funding for those efforts. More than half of Iowa’s counties do not have family planning centers, Vilsack said.

C-Section Statistics Under Review: “In 2006, 31.1% of U.S. births were by C-section, a 50% increase over the previous decade,” notes USA Today in a story that examines the debate over safety of elective c-sections.

For more information, check out this earlier post on c-sections and the rise of maternal mortality, as well as Rachel’s post on c-section rates by hospital.

FDA Takes Action on Biodentical Hormones: “The Food and Drug Administration is cracking down on pharmacies that sell customized hormone mixtures as antidotes for menopause symptoms such as hot flashes, saying they are being promoted with false claims about their benefits and contain an ingredient the agency hadn’t approved,” reports the Wall St. Journal.

Here’s more from Well, where an interesting discussion follows, and the FDA press release.

Do You Google Your Health?: Rahul K. Parikh, M.D. doesn’t mind if you do and suggests websites that provide accurate, up-to-date medical information. Don’t forget Rachel’s great post on online health research — it includes questions to ask when evaluating the reliability of websites.

Medicare and Health Insurance Coverage: The Kaiser Family Foundation this week released a new issue brief providing an overview of Medicare’s financing and the fiscal challenges the program faces in the coming decades.

KFF also released two updated fact sheets that provide the most current information and data on health insurance coverage for women ages 18-64. The first, Women’s Health Insurance Coverage, provides new statistics on health coverage, describes the major sources of health insurance, summarizes the major policy challenges facing women in obtaining health coverage, and provides data on the more than 17 million women who are uninsured.

The second fact sheet, Health Insurance Coverage of Women by State, provides state-by-state data on the uninsured rate, as well as rates of private insurance and Medicaid coverage.

Our Bodies Ourselves Executive Director Judy Norsigian and Managing Editor Heather Stephenson recently wrote about the potential side effects associated with some medications for post-menopausal osteoporosis, and they offered smart tips to help navigate the pharmaceutical hype.

Writing in the Washington Post, Nancy J. Nelson personalizes the challenge of determining one’s risk for bone fractures and making informed decisions about treatment options:

I share an anxiety with several women friends in their 50s and 60s. We’ve all been told that because our bone mineral density is low — though not low enough to meet the definition of the brittle-bone disease osteoporosis — we need to take medication to reduce our chance of fractures. This means primarily hormones or Fosamax, the top-selling osteoporosis drug, for which doctors wrote more than 20 million prescriptions last year, nearly $2 billion worth. Knowing the associated risks — heart disease, stroke and breast cancer for hormones; ulcers of the esophagus and stomach, and jaw decay for Fosamax — none of us is eager to follow our doctors’ orders. [...]

I also suspect my friends and I are a lot less at risk than someone in my parents’ generation. My mom and three of her pals have all fallen and had fractures; no one I know in my generation has done either.

My search of the scientific literature suggests we are right to be wary of over-medication.

Low bone density is only one of several well-established risk factors for bone fractures. Age and fracture history are just as important, according to Michael R. McClung, director of the Oregon Osteoporosis Center and a member of the council of scientific advisers for the International Osteoporosis Foundation. None of these factors alone is very good at predicting fracture risk. But some doctors don’t appear to have gotten the message.

“Many younger women whose bone density is borderline low are getting treated, although their risk of fracture in the next five to 10 years is fairly low,” said Nelson B. Watts, director of the University of Cincinnati Bone Health and Osteoporosis Center and chairman of the Food and Drug Administration’s Advisory Committee for Endocrine and Metabolic Drugs. “And many patients who have had fractures are not being evaluated or treated, even though their risk of a second fracture in the next five to 10 years is fairly high.”

Nelson reports on a new fracture-risk tool that may be published later this year by the World Health Organization. The tool, which will combine bone density with other risk factors, could end up altering osteoporosis treatment guidelines.

And it’s still important to remember the basics when it comes to good bone health: quitting smoking, limiting alcohol consumption to two drinks per day, exercising (particularly weight-bearing exercises like running or tennis) and making sure you get enough calcium and vitamin D.

Plus: It’s never too early to start educating girls about good bone health, note Newsweek columnists Barbara Kantrowitz and Pat Wingert:

Getting that message across is the focus of a new public service educational campaign sponsored by the American Academy of Orthopedic Surgeons (AAOS) and the National Institute for Child Health and Human Development (NICHD). The campaign ads feature a young girl with the headline “Almost Past Her Prime.” “This is a prevention campaign,” says Dr. James H. Beaty, AAOS president and a pediatric orthopedic surgeon at the Campbell Clinic in Memphis. “We’re trying to prevent future problems rather than treat them when the kids become adults.”

Breast Cancer Drop Linked to HRT: Rates of the most common form of breast cancer dropped15 percent from August 2002 to December 2003, while rates for all breast cancer dropped by 7 percent, according to researchers. “The reason, they believe, may be because during that time, millions of women abandoned hormone treatment for the symptoms of menopause after a large national study concluded that the hormones slightly increased breast cancer risk,” reports The New York Times.

See also: the National Cancer Institute website about menopausal hormone use and the Women’s Health Initiative study, which included nearly 17,000 women. It was halted prematurely when slight increases in breast cancer, heart attacks, blood clots and strokes were discovered.

Replacing One Male-Dominated Culture With Another: “The United States military has long prided itself on molding raw recruits into hardened soldiers. Perhaps none have undergone a transformation quite like that of Ms. Hamdan,” writes Andrea Elliott in The New York Times. Fadwa Hamdan’s story is nothing short of remarkable:

Forbidden by her husband to work, she raised five children behind the drawn curtains of their home in Saudi Arabia. She was not allowed to drive. On the rare occasions when she set foot outside, she wore a full-face veil.

Then her world unraveled. Separated from her husband, who had taken a second wife, and torn from her children, she moved to Queens to start over. Struggling to survive on her own, she answered a recruiting advertisement for the Army and enlisted in May.

Ms. Hamdan’s passage through the military is a remarkable act of reinvention. It required courage and sacrifice. She had to remove her hijab, a sacred symbol of the faith she holds deeply. She had to embrace, at the age of 39, an arduous and unfamiliar life.

Continue reading the story here.

Military Opens Women’s Health Clinic: The U.S. military has opened a new women’s health clinic on a military site in Germany, and it’s the first of its kind, reports Stars & Stripes.

“Although women’s health clinics are fairly common at civilian hospitals, the concept is relatively new in the military,” writes Scott Schonauer. “The new building will have nine exam rooms decorated with the type of color and style not often seen at most drab hospital wards. Exam tables will an extra feature: They’ll be heated. The center also will include a sex-assault suite that will offer 24-hour care for victims. The room will be stocked with testing kits and provide a more comfortable alternative to going to the emergency room.”

Still, U.S. law prohibits military facilities from performing abortions, even when privately funded to avoid using taxpayer funds. Such regulations put the health of women serving overseas at risk every day.

Hospitals in Violation: “Some Massachusetts facilities violate the year-old state law requiring hospitals to offer emergency contraception to rape victims by imposing “serious restrictions” on the treatment, according to a survey by NARAL Pro-Choice Massachusetts,” reports the Boston Globe. According to the survey, “officials at 7 percent of the hospitals with emergency rooms contend the provision for emergency contraception may be left to the doctor’s discretion. Another 7 percent indicated that such provisions were contingent upon the woman undergoing a rape exam.”

Male Circumcision Cuts HIV Transmission: News that men who are circumcised are about 50 percent less likely to contract HIV, based on studies in Uganda and Kenya, sparked this response from Broadsheet’s Tracy Clark-Flory, who looks at arguments for and against circumcision. See also Carol Lloyd’s post on female infanticide in India.

The Skinny on Thin: Jessica Clark of In These Times on “Thin,” a documentary by Lauren Greenfield about patients at a residential center for eating disorders. “[The recovery] process can be circuitous and frustrating, with many false starts,” writes Clark. “Anorexia is the most deadly mental disorder; up to 20 percent of sufferers die from related complications. Some even court it: ‘I just want to be thin,’ says Alisa ‘If it takes dying to get there, so be it.’”

Suspected Prostitutes Paraded Through City Streets in China: “For people who saw the event on television earlier this month, the scene was like a chilling blast from a past that is 30 years distant: social outcasts and supposed criminals — in this case 100 or so prostitutes and a few pimps — paraded in front of a jeering crowd, their names revealed, and then driven away to jail without trial,” reports The New York Times. But the public effect wasn’t what officials hoped for, and an “angry nationwide backlash” has ensued.

Healthiest Places for Women: What do Honolulu, Portland, Maine; Nassau-Suffolk counties in New York; Orange County, Calif.; and Burlington, Vt. have in common? They’re the healthiest cities for women, according to Self magazine. Honolulu came in at no. 1. (Having lived in Burlington, I’m up for a site-test challenge.)

If you’re procrastinating working by blog surfing, stay an extra minute and test your menopause knowledge … Answers follow below, but no cheating!