Breast Cancer Action is offering a free, one-hour webinar examining the racial and socio-economic factors that influence the health of individuals and communities.

Titled “Inequities in Breast Cancer: Race and Place Matter,” the webinar will take place Tuesday, May 15, at 2 p.m. PDT/5 p.m. EST (register here) and again on Wednesday, May 16, at 11 a.m. PDT/2 p.m. EST (register here).

“Inequities in breast cancer risk and outcomes vary among different racial and ethnic communities and are well documented,” writes Sahru Keiser, BCA program associate of education and mobilization. “In our efforts to address and end this disease, health activists, practitioners, and legislators must focus on the social and economic context in which the disease arises.”

Keiser is presenting the webinar with Irene Yen, associate professor of medicine and associate director of the Experiential Learning, Health & Society Pathway at University of California, San Francisco. Among the questions they’ll address:

Why are white women more likely to develop breast cancer, yet African American, Latina and Samoan women are more likely to die from the disease? Why do women of color tend to develop more aggressive breast cancers at earlier ages than white women? Why are we seeing the sharpest rise in breast cancer rates in Japanese women in Los Angeles?

Topics covered will include:

• How where we live, work and play defines our access to good health

• Breast cancer inequities in under-served communities

• How breast cancer research acknowledges race

• Inequities in breast cancer clinical trials

• How you can work for health equity

Learn more at Breast Cancer Action about environmental links to breast cancer and the importance of social justice. And visit BCA’s Think Before You Pink project, which raises awareness about conflicts of interest in pink-ribbon marketing — like KFC’s Buckets for the Cure campaign that promoted fast food restaurants in low-income neighborhoods.

One of the current campaigns takes on Eli Lilly, the only company in the world making and distributing rBGH, an artificial growth hormone found in many dairy products that is linked to increased risk of breast cancer. BCA is working to remove rBGH from the food supply completely. Free Think Before You Pink toolkits featuring resources and information are available here.

by Ellen Bravo

My favorite Mother’s day gifts from my sons were their original stories, songs and poems. But what I needed when they were infants and toddlers was something children can’t deliver: affordable time off when they were born and when they were sick.

So for all those candidates and elected officials interested in the women’s vote and eager to prove their support for motherhood and families, here’s a sampling of what mothers want and need, not just one day a year but every day:

The right to care for a sick child or personal illness without losing our paychecks or our jobs. Moms need leaders to actively support the right for workers to earn paid sick days and champion local, state and federal policies that would guarantee this protection. Make sure no one has to choose between being a good parent and being a good employee — and that no one has to serve you flu with your soup.

The right to coverage under the Family and Medical Leave Act. Half of private sector workforce employees aren’t covered by this law because they work for an employer with fewer than 50 workers, haven’t been on the job for at least 12 months or work less than 25 hours a week. Moms need Members of Congress to work to expand FMLA to cover all employees after 90 days of employment.

The ability to afford leave under the Family and Medical Leave Act. Many who are covered under FMLA can’t afford to take the time without pay. As a result, nearly 3 million eligible workers a year who need leave to care for their health or the health of a loved one don’t take it, according to a 2000 Labor Department survey. And nearly 9 percent of those who do (including 20 percent for low-income families) are forced to rely on public assistance to keep food on the table, according to a 1995 Department of Labor report. Moms need leaders to voice their support for policies to create family leave insurance funds like those that are working in California and New Jersey so that caring for a new or seriously ill child doesn’t trigger financial catastrophe.

The right to care for one’s partner regardless of their gender. Being able to marry who you love — and being able to care for one another in sickness as well as in health — shouldn’t be a gift, it should be a right. Moms are glad to see more of our leaders standing up for the rights of all families by supporting marriage equality legislation and bills to expand FMLA access to same-sex partners.

The right to attend children’s school activities. Far too many children in this country never see their mom at a school play or sporting event because employers won’t let them take off work or rearrange their schedules. Mothers need leaders to support the right to use family leave to do what’s best for raising our children.

A recognition that men are parents, have parents and also need time to care. All the policies listed above are gender-neutral. Moms — and dads — need leaders to end on-the-job punishment of men who want to be good fathers, sons and husbands. That will also boost women’s efforts to get men to share the work at home.

This list flows from deeply held American values: that no one should have to risk a job to be a good family member or put a loved one at risk in order to keep a job. Mothers want basic standards that guarantee these rights to everyone.

And candidates, if you don’t believe me, check the polls. More and more voters — from all political perspectives — say they’re more likely to support candidates who’ll make sure family values don’t end at the workplace door, and who understand that for the economy to recover, we need policies like these to help people stay employed and have money to spend at local businesses.

Doing the politically smart thing for moms is also doing the right thing for families and for our nation.

Ellen Bravo directs Family Values @ Work, a network of state coalitions organizing to win paid sick days and paid family leave. The former director of 9to5, National Association of Working Women, Ellen also teaches Women’s Studies at the University of Wisconsin-Milwaukee. Her most recent book is “Taking on the Big Boys, or Why Feminism is Good for Families, Business and the Nation” (Feminist Press, 2007).

While there has been considerable attention in the United States to political moves intended to reduce access to women’s health services, our neighbors to the north are also experiencing conservative-led cuts that affect women’s health. Six Canadian organizations focused on research and communication in women’s health have been told that their funding will be cut off next spring.

The six organizations forming the Women’s Health Contribution Program focus on issues including: the women’s health implications of the federal government’s regulation of toxic chemicals; the hyper-sexualization of girls; the inter-generational legacy of residential schools on Aboriginal women and their families; the need for trauma-informed counselling for women with addictions; a working guide for conducting sex and gender-based analysis in health research; and a critical analysis of funding for the HPV vaccine. The Program’s work has also focused broadly on how to best deliver prevention and health care programs to women and their children.

A press release from the Canadian Women’s Health Network describes dissatisfaction with and potential impacts of the cuts:

Staff and directors managing the centres and networks add their voices to the growing body of Canadians who are shocked and outraged by the short-sightedness of the federal government cuts to programs, services and the federal civil service. These cuts are in direct contradiction to the pledges regarding gender equality that Canada has made both in international commitments and to Canadians. Women are being hit particularly hard with these cuts, and, because the research being eliminated generated proactive, preventative strategies for health promotion, these cuts will cost everyone in the long term. The end of this work will be most strongly felt by the disadvantaged and the disempowered.

A spokesperson for Canada’s Health Minister has said that the organizations should compete for funding for individual projects via the $33 million budgeted for “gender health research” through the Canadian Institutes for Health Research (CIHR). Critics of the cut have suggested that the move is one more sign that the current administration, led by Conservative Party leader and Canadian Prime Minister Stephen Harper, is not interested in receiving the groups’ policy advice on women’s health (the non-CIHR groups being cut had a mandate to advise the federal government on policy).

An opinion writer in the Vancouver Sun calls the cuts “penny wise and pound foolish,” writing that:

Set adrift will be researchers and staff with specific expertise; lost will be the opportunity for better and more-effective care and prevention programs for two of the poorest and most vulnerable groups in Canada – elderly women and children growing up in poverty.

Federal budget cuts are also directly affecting programs targeting the health of Aboriginal women in Canada. The Native Women’s Association of Canada points out tremendous health disparities faced by Aboriginal women, calls on the government to rethink its decision, and directly addresses how the move further hurts a vulnerable population:

…more is needed to help local communities struggling with health disparities, but cutting the head off the national voice for Aboriginal women’s health shows a lack of commitment to address the issues that affect the most marginalized population in this country — a country that is envied by many other nations across the globe for its ‘great’ health care system and quality of life

Researchers from a number of universities and the National Institute of Environmental Health Sciences recently published an article in the journal Endocrine Reviews that explores how much exposure to certain chemicals is needed to cause harm, and suggests that “fundamental changes in chemical testing and safety determination are needed to protect human health.”

The researchers, led by Laura Vandenberg, looked at endocrine-disrupting chemicals (EDCs) – chemicals like BPA and DES that interfere with the body’s hormone systems. In their review, they explore complex issues around dose – the effects of low doses, how “low dose” is defined, and what happens when effects of a chemical aren’t directly correlated to the dose.

As the authors explain:

For decades, studies of endocrine-disrupting chemicals (EDCs) have challenged traditional concepts in toxicology, in particular the dogma of “the dose makes the poison,” because EDCs can have effects at low doses that are not predicted by effects at higher doses.

As a result, what we know about exposure to a chemical from following people after a one-time large exposure might not predict what happens when people are exposed to very small amounts of a chemical over a longer time.

The implications are that some of our assumptions about harms from low doses, the reliability of current testing methods, and safe thresholds might be incorrect, because harmful effects of chemicals might vary in unexpected ways at different doses, in different people, or at different stages of development. The authors point out several things researchers should do to improve our understanding of these issues, like carefully considering dose ranges and timing to study.

For the general public, the regulatory implications of the review may be most important. As the authors explain:

For decades, regulatory agencies have tested, or approved testing, of chemicals by examining high doses and then extrapolating down [from where observable effects are thought to start] to determine safe levels for humans and/or wildlife. As discussed earlier, these extrapolations use safety factors that acknowledge differences between humans and animals, exposures of vulnerable populations, interspecies variability, and other uncertainty factors. These safety factors are informed guesses, not quantitatively based calculations. Using this traditional way of setting safe doses, the levels declared safe are never in fact tested. Doses in the range of human exposures are therefore also unlikely to be tested.This has generated the current state of science,where many chemicals of concern have never been examined at environmentally relevant low doses.

In other words, for many chemicals,  regulations are based on best guesses about safety, rather than specific safety data. Additionally, the authors suggest that guessing about low doses based on higher doses really doesn’t work for endocrine-disrupting chemicals, and new approaches to assessing their safety should be developed. The authors also call for greater testing at low doses when new chemicals are developed and approved:

We further recommend greatly expanded and generalized safety testing and surveillance to detect potential adverse effects of this broad class of chemicals. Before new chemicals are developed, a wider range of doses, extending into the low-dose range, should be fully tested.

A related editorial from the director of the National Institute of Environmental Health Sciences also calls for “appropriate actions to protect human and wildlife populations from these harmful chemicals and facilitate better regulatory decision making.”

In an opinion piece, lead author Vandenberg writes more about their research and implications of EDCs for women:

We found overwhelming evidence that these hormone-altering chemicals have effects at low levels, and that these effects are often completely different than effects at high levels. For example, a large amount of dioxin would kill you, but a very small dose, similar to what people are exposed to from eating contaminated foods, increases women’s risk of reproductive abnormalities.

The full review is freely available online. There is also coverage over at Moms Rising, and a summary of the research at Environmental Health News.

[Note: this post and the linked materials contain graphic discussion of sexual abuse, rape, and prison genital searches.]

A Michigan women’s prison that was practicing a particularly degrading type of visual body cavity search on prisoners has agreed to stop the searches.

Earlier this month, the ACLU sent a letter to the Michigan Department of Corrections demanding that they end the practice of performing spread-labia vaginal searches at the Women’s Huron Valley Correctional Facility.  During such searches, women were required to sit on a chair or table and spread their own labia for inspection by prison guards. The women were sometimes forced to undergo such inspection in view of other prisoners, and if they objected, could “be forced to submit through physical force or punished with solitary confinement.”

Our Bodies Ourselves signed on to the ACLU’s letter objecting to these practices, along with several other organizations.

Despite the invasiveness of the inspections, no apparent attention was given to hygiene or to the women’s health. From the letter:

In addition, measures to assure sanitation during these invasive searches are often incomplete or ignored entirely, resulting in women being exposed to the menstrual blood or other bodily fluids of other prisoners when they sit on the chair, including those suffering from serious communicable conditions such as HIV and hepatitis. A disposable liner for use on the chair is rarely if ever provided, and women are seldom permitted to sanitize the chair or wash their hands after the search. At least one woman has suffered a vaginal infection which she believes was contracted during a spread-labia vaginal search.

These searches were not just performed on women newly entering the facility or on those suspected of hiding contraband – they occurred every time the women had visitors, even legal representation or religious workers, and after prison work shifts or receipt of medical care. No considerations were apparently made regarding the actual seriousness of the threat if there was suspected contraband, or for individual women’s physical or psychological needs. For example:

On one occasion, four kitchen workers were subjected to spread-labia vaginal searches in full view of one another because a guard believed that some chicken might have been stolen from the kitchen. No exceptions are made for women who are menstruating, pregnant, ill, or have been sexually abused, whether prior to or during their incarceration.

The ACLU received letters from more than 60 prisoners about these searches; some of their stories have been shared online. Here and elsewhere, women have described not wanting to receive any visitors (because of the search afterward); the discomfort of being forced to touch their own genitals in front of others or of having their PTSD triggered; and feeling that they are being raped when subjected to these exams.

The Michigan Department of Corrections said it had ended the practice in December, while the ACLU said it continued to get complaints about it more recently. Last week, the ACLU confirmed that the practice has now been stopped.

Such spread-labia searches are apparently *not* the norm in prisons nationwide. Even a spokesperson for the state prison stated (emphasis added):

“Corrections officers didn’t think it was necessary, prisoners felt it was an irritant, the prison psychiatric staff thought it was a stressor and, in nearly two years, it didn’t find any contraband.”

This type of search will now only be conducted when there is suspected smuggled contraband, although it is not clear how well that standard will be enforced.

An editorial at the Detroit Free Press called the practice “demeaning and unnecessary,” and notes that follow-up is needed to ensure compliance with the halt:

Warden Warren deserves credit for taking the initiative to investigate the policy and end it, at least officially. But given the department’s history of sexual abuse, Corrections must now take additional measures to ensure the new policy is followed, as well as review its polices on strip searches in general to determine if they are necessary and conducted in the least degrading manner possible.

Kudos to the women who wrote letters to the ACLU and to the ACLU for bringing this invasive, unnecessary, and traumatizing practice to light.

The Supreme Court ruled 5-4 on Tuesday that state government workers may not sue their employers for money for violating a part of the federal Family and Medical Leave Act dealing with personal sick leave.

Debra L. Ness, president of the National Partnership for Women and Families, which drafted and fought to pass the FMLA, called the decision “an appalling and dangerous ruling that simply cannot stand.”

The case was brought by Daniel Coleman, a Maryland state court employee who was fired after requesting a 10-day medical leave. The state argued that federal law could not be applied because states, as sovereigns, are generally immune from lawsuits seeking monetary damages.

The Family and Medical Leave Act of 1993 entitles eligible employees 12 weeks of job-secured leave during any 12-month period for: (A) the birth of a child and to care for the newborn child within one year of birth; (B) the adoption or foster care of a child and to care for the newly placed child within one year of placement; (C) care for a spouse, child, or parent with a serious health condition; (D) a serious health condition that makes the employee unable to perform the functions of the position.

The case hinged on whether the sick-leave provision addressed gender bias. Justice Anthony Kennedy, who wrote the majority opinion, said it did not. He was joined by Chief Justice John Roberts and Justices Samuel Alito and Clarence Thomas. Justice Antonin Scalia agreed with the judgment but did not join Kennedy’s opinion, excerpted below:

Without widespread evidence of sex discrimination or sex stereotyping in the administration of sick leave, it is apparent that the congressional purpose in enacting the self-care provision is unrelated to these supposed wrongs. The legislative history of the self-care provision reveals a concern for the economic burdens on the employee and the employee’s family resulting from illness-related job loss and a concern for discrimination on the basis of illness, not sex. [...] It is true the self-care provision offers some women a benefit by allowing them to take leave for pregnancy-related illnesses; but as a remedy, the provision is not congruent and proportional to any identified constitutional violations.

So since they found no evidence of discrimination or sex stereotyping, the majority found no reason to lift the usual protections against suing a state.

Justice Ruth Bader Ginsburg wrote the dissenting opinion and was joined by Justices Stephen G. Breyer, Sonia Sotomayor and Elena Kagan. From the dissent:

The FMLA’s purpose and legislative history reinforce the conclusion that the FMLA, in its entirety, is directed at sex discrimination. Indeed, the FMLA was originally envisioned as a way to guarantee—without singling out women or pregnancy—that pregnant women would not lose their jobs when they gave birth. The self-care provision achieves that aim.

It goes on to provide an interesting history of the development of the FMLA.

“The best way to protect women against losing their jobs because of pregnancy or childbirth, Congress determined, was not to order leaves for women only, for that would deter employers from hiring them,” said Ginsburg, who took the unusual step of summarizing the dissent from the bench, signaling a major disagreement. “Instead, Congress adopted leave polices from which all could benefit.”

Ness, whose organization led a group of 10 civil and workers’ rights organizations in filing a friend-of-the-court brief in the Coleman case, was outspoken in her criticism of the court’s decision:

Justice Ginsburg noted that “[t]he plurality pays scant attention to the overarching aim of the FMLA: to make it feasible for women to work while sustaining family life. Over the course of eight years, Congress considered the problem of workplace discrimination against women, and devised the FMLA to reduce sex-based inequalities in leave programs. The self-care provision is a key part of that endeavor, and in my view, a valid exercise of congressional power….”

Even Justice Kennedy’s opinion acknowledged that “[d]ocumented discrimination against women in the general workplace is a persistent, unfortunate reality, and, we must assume, a still prevalent wrong. An explicit purpose of the Congress in adopting the FMLA was to improve workplace conditions for women.”

Today’s ruling underscores how tenuous the rights of workers are in this country, and the urgent imperative for the Senate to confirm only those justices and judges who have a demonstrated commitment to equal rights under the law and a real understanding of the impact of their rulings on women, workers and others who struggle to make ends meet.

For more information, view the Kevin Russell’s coverage at SCOTUSblog, including Kevin Russell’s recap of the oral arguments.

Plus: Earlier this year, Judith Lichtman, a National Partnership for Women and Families senior advisor, presented seven specific recommendations to the U.S. Equal Employment Opportunity Commission (EEOC) on what federal agencies can do in response to discrimination based on pregnancy and caregiving. View her full testimony (pdf).

Today, the White House released a document addressing recent controversy over one preventive service covered under the Affordable Care Act – birth control. Under the Act, insurance plans are required to provide coverage for contraception without charging a co-pay, co-insurance or a deductible. U.S. Catholic bishops objected to the coverage, claiming it was a violation of their religious beliefs.

The statement indicates:

The policy also ensures that if a woman works for a religious employer with objections to providing contraceptive services as part of its health plan, the religious employer will not be required to provide, pay for or refer for contraception coverage, but her insurance company will be required to directly offer her contraceptive care free of charge.

In other words, Catholic or other religiously affiliated organizations get to say they selected health insurance plans for their employees that do not cover contraception, while those employees can still receive no-cost contraception directly via the insurance providers. Whether these costs will be covered by the insurance companies directly, or perhaps reimbursed to those companies via Medicaid, is not clear, and we’ll need to watch the implementation to make sure this ends up working for women.

The provision already had exemptions for religiously-focused organizations like churches. At issue were the religiously affiliated organizations such as Catholic hospitals and universities, which typically employee people from a variety of (or no) faith traditions. Many such organizations already offer contraception coverage to employees, and a number of states require employer-based plans to provide this coverage.

According to one recent survey, the majority of Catholic Americans (52%) say religiously affiliated colleges and hospitals should have to provide coverage that includes contraception. A 2011 Guttmacher report indicated that, “Among all women who have had sex, 99% have ever used a contraceptive method other than natural family planning. This figure is virtually the same, 98%, among sexually experienced Catholic women.”

Here’s Rachel Maddow talking about the issue on Wednesday, placing it in the context of the current elections:

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

Today, HHS Secretary Kathleen Sebelius issued a statement finalizing the rule that requires insurance plans to provide coverage for contraception without charging a co-pay, co-insurance or a deductibles.

It wasn’t always a sure deal. Back in August, HHS adopted the Institute of Medicine’s recommendation to include family-planning services as one of the preventive health care items for women that must be covered by newly issued health plans, but it was only an interim rule, subject to comments.

In November, there was a lot of worry about whether the decision that contraception should be a covered preventive service under the Affordable Care Act would survive. President Obama met with Roman Catholic bishops, and one of them came away saying, “I left there feeling a bit more at peace about this issue than when I entered.”

Understandably, many people expressed concerns that the administration was going to back away from birth control coverage requirements and broaden the refusal rule to allow Catholic hospitals and universities to refuse to cover family planning services. But the administration rejected calls allowing employers to opt out of covering contraception. The statement by Sebelius reads in part:

After evaluating comments, we have decided to add an additional element to the final rule. Nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan, will be provided an additional year, until August 1, 2013, to comply with the new law. Employers wishing to take advantage of the additional year must certify that they qualify for the delayed implementation. This additional year will allow these organizations more time and flexibility to adapt to this new rule. We intend to require employers that do not offer coverage of contraceptive services to provide notice to employees, which will also state that contraceptive services are available at sites such as community health centers, public clinics, and hospitals with income-based support. We will continue to work closely with religious groups during this transitional period to discuss their concerns.

Scientists have abundant evidence that birth control has significant health benefits for women and their families, it is documented to significantly reduce health costs, and is the most commonly taken drug in America by young and middle-aged women. This rule will provide women with greater access to contraception by requiring coverage and by prohibiting cost sharing.

Every year in the United States alone, more than 12,000 women are diagnosed and more than 4,000 women die of cervical cancer, a preventable disease that disproportionately affects women of color.

January is Cervical Cancer Awareness Month, and the National Latina Institute for Reproductive Health (NLIRH) is launching “¡Acábalo Ya! Working Together to End Cervical Cancer.” The campaign is aimed at educating Latinas about this disease and how to protect their health; raising the profile of cervical cancer prevention as a national reproductive justice and women’s health priority; and advocating for greater access to the tools and care needed to prevent, detect, and eventually end cervical cancer.

The NLIRH is hosting a blog carnival this week on the topic: What will it take to end cervical cancer? Read more on Why Cervical Cancer is a LGBT Issue by Verónica Bayetti-Flores, NLIRH policy research specialist; Cervical Cancer Awareness Month: Trans Men and Genderqueer/Gender Nonconforming People by the National Center for Transgender Equality; Screen More Women for Cervical Cancer – Not the Same Women More Often! by Kate Ryan, program coordinator, National Women’s Health Network; and Thank YOU Affordable Care Act for Helping Cervixes Stay Healthy by Keely Monroe, program coordinator, National Women’s Health Network.

The following text on disparities in access to Pap tests and HPV vaccines has been adapted from the 2011 edition of “Our Bodies, Ourselves.”

* * * * * * *

Most women who die of cervical cancer never had regular Pap tests, had false-negative results, or did not receive proper follow-up.

In the United States, socioeconomic and racial disparities are evident in statistics for cervical cancer. Vietnamese immigrants are five times more likely to be diagnosed with cervical cancer than white women. African-American and Native-American women are twice as likely to die of the disease as are white women. In one study, Hispanic women had about twice the cervical cancer incidence of non-Hispanic women in border counties near Mexico, and Hispanic women are 1.5 times more likely to die from cervical cancer as compared to non-Hispanic white women.

Disparities are due, at least in part, to women of color having less access to Pap screening and regular health care. It is quite possible that those women with the highest rates of cervical cancer will also have less access not only to Pap screening but also to the HPV vaccine. Until our health care system addresses such disparities in access, girls and women likely to benefit the most from this vaccine may well not be able to choose it.

To ensure more equal access to any adolescent vaccine, adequate infrastructure and resources must be made available. Some recommend implementation of school-based adolescent immunization programs similar to those formerly in place for delivery of hepatitis B vaccines. The United Kingdom and Australia have volunteer, nationally supported school-based campaigns that have resulted in high HPV vaccine coverage for about 70 percent of girls.

Currently, school-based health programs and routine preventive care visits for adolescents are limited in the United States, making it highly difficult to provide good access to HPV vaccines, especially the type of access needed to ensure all three required vaccine doses are administered. Available data suggest HPV vaccine coverage in the United States is low (less than 50 percent), and the proportion of girls receiving all three doses of the HPV vaccine is even lower (less than 25 percent).

Pap Tests Essential for Prevention and Treatment

HPV vaccines do not protect against all types of HPV associated with cervical cancer, and it is currently unclear how long they remain effective or whether booster shots will be needed to maintain protection throughout adulthood. Thus, regular Pap tests among sexually active women remain essential for cervical cancer prevention. Resources should not be diverted away from Pap screening programs to pay for the unusually expensive cervical cancer vaccine. Because Merck marketed Gardasil with a campaign that unnecessarily frightened girls, young women, and parents, many people now have a distorted view of this disease, the vaccine, and the continued importance of Pap screening.

There is no question that HPV vaccines represent an important scientific advance in the field of vaccine research, but exaggerating their potential benefit in places such as North America will not serve us well. In countries where there is little or no access to Pap screening, current HPV vaccines might have much more potential for saving lives if their costs were reduced considerably and if adequate infrastructure to prove them responsibly were securely in place.

The District of Columbia and dozens of states — many of which have been lobbied by vaccine makers to expand vaccination requirements — have introduced legislation to require, fund, or educate the public about the HPV vaccine. However, since 30 percent of infections are now caused by virus types for which the HPV vaccines do not provide protection, universal access to Pap tests remains critically important. Unfortunately, many girls in underserved communities (where HPV infection rates are often high) have less access to both the Pap test and the HPV vaccine.

For example, as of September 2009, when the CDC released its first state-level statistics for Gardasil, only 15.8 percent of girls in the relatively poor state of Mississippi had received the vaccine, compared with 54.7 percent of girls in the relatively wealthy state of Rhode Island. Partly because of greater access to Pap testing, the cervical cancer mortality rate in Rhode Island was already 50 percent lower than in Mississippi — which means the girls in Rhode Island are at much lower risk of contracting HPV to start with.

To reduce disparities for Latinas and other under-served women, we will need to make systemic changes in our health care system to increase access to screening and vaccinations for those who need it most.

At an historic Home Birth Consensus Summit in Virginia last month on “The Future of Home Birth in the United States: Addressing Shared Responsibility,” a group of 68 national and international experts developed nine key common ground statements that provide a foundation for continued dialogue and collaboration across sectors in the maternity care field.

The statements were posted this week at homebirthsummit.org, along with comment about the scope and context of the meeting. The site also includes information about why the summit was necessary and the process involved in reaching consensus. Action plans relating to these statements will be posted soon.

As one of the participants in the three-day summit, I was impressed with our collective commitment — despite different perspectives and areas of disagreement about out-of-hospital birth — to a common goal of improving maternal and newborn care for families choosing to give birth at home or in freestanding birth centers.

Mark Sloan, a pediatrician and writer who attended the summit, briefly explains the history of home birth in United States, offering context for why the summit marks a significant moment: “The representatives of all the major midwifery organizations — MANA (Midwives Alliance of North America) and ACNM (American College of Nurse-Midwives) — as well as ACOG (American College of Obstetricians and Gynecologists), FIGO (International Federation of Gynecology and Obstetrics), and the AAP (American Academy of Pediatrics) sat together in the same room to discuss home birth for probably the first time in history.”

One of the agreed-upon statements emphasized our belief that “collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.”

The ninth and last statement reads: “We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.”

Other statements address improving the current liability system, the licensure of maternity care professionals, increased participation by consumers in multi-stakeholder initiatives, and the creation of an equitable maternity care system without disparities in access, delivery of care, or outcomes. See below for the full list.

The remarkable collegiality and constructive dialogue among the stakeholders present enabled the group to develop these nine core principles as well as commit to a variety of future collaborations. This is an important first step towards achieving improved outcomes for childbearing women and their families in this country.

As Saraswathi Vedam, director of the Division of Midwifery at the University of British Columbia and chair of the Home Birth Consensus Summit Steering Committee, noted: “When you have an issue as controversial as home birth, there are always going to be differences of opinion among various types of providers, policy-makers and even among consumers. But all of us recognize that for women who choose home birth, it’s our shared responsibility to work toward policies that will make that choice as safe as possible.”

Summit participants included obstetricians, family physicians and midwives, non-professionals serving in advocacy roles, insurers, attorneys, ethicists, administrators, policy makers, researchers, and others with expertise in epidemiology, public health, midwifery, obstetrics, pediatrics, nursing, sociology, medical anthropology, law, and health policy research.

We invite your comments on the statements below.

STATEMENT 1
We uphold the autonomy of all childbearing women.

All childbearing women, in all maternity care settings, should receive respectful, woman-centered care. This care should include opportunities for a shared decision-making process to help each woman make the choices that are right for her. Shared decision making includes mutual sharing of information about benefits and harms of the range of care options, respect for the woman’s autonomy to make decisions in accordance with her values and preferences, and freedom from coercion or punishment for her choices.

STATEMENT 2
We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.

STATEMENT 3
We are committed to an equitable maternity care system without disparities in access, delivery of care, or outcomes. This system provides culturally appropriate and affordable care in all settings, in a manner that is acceptable to all communities.

We are committed to an equitable educational system without disparities in access to affordable, culturally appropriate, and acceptable maternity care provider education for all communities.

STATEMENT 4
It is our goal that all health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice.

We believe that guidelines should:

allow for independent practice
facilitate communication between providers and across care settings
encourage professional responsibility and accountability, and
include mechanisms for risk assessment.

STATEMENT 5
We believe that increased participation by consumers in multi-stakeholder initiatives is essential to improving maternity care, including the development of high quality home birth services within an integrated maternity care system.

STATEMENT 6
Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings.

To achieve this, we believe that all health professional students and practitioners who are involved in maternity and newborn care must learn about each other’s disciplines, and about maternity and health care in all settings.

STATEMENT 7
We are committed to improving the current medical liability system, which fails to justly serve society, families, and health care providers and contributes to:

inadequate resources to support birth injured children and mothers;
unsustainable healthcare and litigation costs paid by all;
a hostile healthcare work environment;
inadequate access to home birth and birth center birth within an integrated health care system, and;
restricted choices in pregnancy and birth.

STATEMENT 8
We envision a compulsory process for the collection of patient (individual) level data on key process and outcome measures in all birth settings. These data would be linked to other data systems, used to inform quality improvement, and would thus enhance the evidence basis for care.

STATEMENT 9
We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.

Many U.S. users of cosmetics may not realize that they do not require FDA testing or approval and the federal agency is not authorized to require a manufacturer to recall unsafe products from the market. Because cosmetics are not regulated in the same way drugs are, it’s more difficult for consumers to make informed decisions, and the FDA has less power to regulate the cosmetics industry and respond to problems.

The Safe Cosmetics Act of 2011, introduced by Janice Schakowsky (IL-D), is intended to help close some of these gaps in cosmetics regulation.

The Act would give the government the power to recall unsafe cosmetics, require better disclosure of ingredients, establish additional safety standards and require manufacturers to submit data on the safety of their products, mandate reporting of adverse health effects, allow the banning of ingredients found to have reproductive or cancer-causing effects, encourage alternatives to animal testing, address worker safety, along with other measures.

The Campaign for Safe Cosmetics, which promotes the legislation and greater consumer awareness of cosmetic safety concerns, has more information at http://www.safecosmetics.org/section.php?id=74.

More info:

• More information on the FDA’s current role in regulating cosmetics
• Rep. Schakowsky’s press release on the Act
• Additional coverage at Good and Forbes

Guest post by Sarah Morison

It was not until I started working at the Global Justice Center that I learned that due to U.S. policy (not law, policy), it is almost impossible for a victim of war rape who becomes impregnated to have the option of abortion. That is because all humanitarian aid that the United States gives in areas of armed conflict to either governments or humanitarian organizations contains a blanket prohibition on any monies being used to provide abortions — or even information about abortion.

Yet under the Geneva Conventions, to which the United States has been a party for over 60 years, “wounded and sick” civilian victims of armed conflict are absolutely guaranteed the right to “comprehensive and non-discriminatory” medical care. The Global Justice Center is therefore contending that the United States is in violation of the Geneva Conventions by maintaining its current abortion restrictions on humanitarian funds in areas of armed conflict.

Our current initiative is the Geneva Project, whereby we are harnessing the power of the Geneva Conventions to tackle the horrible problem of sexual violence deliberately used as a weapon and strategy during armed conflict in many parts of the world. (For more background information, see the GJC’s legal brief, “The Right to an Abortion for Girls and Women Raped in Armed Conflict” [pdf].)

No doubt you have read about the epidemic of war rape going on in places such as the Democratic Republic of the Congo (DRC) and the Sudan, and that occurred during the genocides in Rwanda, the former Yugoslavia, Sierra Leone, and the intransigent conflicts in Columbia. During the recent uprising in Libya, the military was given Viagra to help them carry out rapes against the women living in areas of armed conflict. Right now, ethnic women are being raped by the military in Burma.

The military strategy of raping women is intended as a way of destroying families, communities and cultures. In Rwanda, girls and women were deliberately infected with HIV. In Yugoslavia, girls and women were gang-raped (typical form of war rape), impregnated, and then deliberately detained so as to force them to give birth to a child of a different ethnic group.

International courts have classified war rape as a war crime, and also as a form of torture. For those girls and women who become impregnated, the torture often continues, both psychologically and physically. Denial of abortions in this context frequently leads to desperate measures such as suicide or dangerous self-induced abortions.

We have learned that women being treated for war rape at internationally funded clinics often beg doctors for abortions but are turned away because these clinics can’t risk losing funding. By the time they reach these clinics, the time is often well past for using emergency contraception, which must be taken within a short period of time after the rape. Sometimes several donor countries give aid to an organization providing services to rape victims, but if U.S. funds are pooled with other countries’ funds, the effect is that all such funds are restricted.

The 62nd anniversary of the Geneva Conventions is Friday, Aug. 12. An international “August 12th Campaign” is underway, and we are asking organizations and individuals from around the world to commit to writing President Obama on Aug. 12 to urge him to lift these restrictions through an executive order (the current restrictions were put in place in the waning hours of the Bush administration). Many organizations — both prominent and small — throughout the world have committed to the campaign, which is heartening.

There is also a way for individuals to endorse our campaign, by signing an online petition to the President. I am asking you to read this petition and, if you agree this policy should be changed, add your name to the list. Consider sending the link to your friends and posting your endorsement on Facebook and Twitter.

Thank you all for reading this and for considering giving your support to this critical campaign.

Sarah Morison is an attorney at the Global Justice Center in New York City. The GJC advocates for the implementation of and compliance with international human rights laws and humanitarian laws (laws relating to war), especially those relating to women.

As previously reported, women with health insurance will soon have access to a host of preventive health care services, including contraception, without having to pay out-of-pocket costs such as co-payments, co-insurance and deductibles.

Not surprisingly, the news rankled some conservatives who refuse to acknowledge the long-term economic or health benefits.

Take, for instance, Sandy Rios, a FOX News contributor and vice president of the Family-PAC Federal, a conservative political action committee, who likened women’s health needs to beauty services: ”We’re $14 trillion in debt and now we’re going to cover birth control, breast pumps, counseling for abuse? Are we going to do pedicures and manicures as well?”

Once again, we turn to Stephen Colbert to explain the outrage. And he does so beautifully, noting, for instance, that “a woman’s health decisions are a private matter between her priest and her husband,” and insurance companies should be in the business of covering only “necessary medical expenses — like boner pills.”

Plus, learn what happens when U.S. women get their hands on birth control pills …

If you have ever wished you had a little black book that answered your questions about sexual health and insurance, your wish has come true.

My Little Black Book for Sexual Health — LittleBlackBookHealth.org – is available online to help you navigate the maze. This resource offers information on various topics, including how to obtain low cost insurance and rules that might govern whether birth control is covered by your insurance.

Described as “a guide for getting the health insurance you need to prevent pregnancy until you’re ready,” My Little Black Book is aimed at young people between the ages of 18 and 26; this group is most likely to be uninsured and faces a high rate of unintended pregnancy.

The interactive website is easy to use (or download the PDF version). You can flip through the virtual pages, blow the text up for easy reading, follow the tabs, or click through the table of contents. I found all sorts of helpful information — who is eligible for a school’s student health plan, how to get prescription drug coverage, and what kinds of sexual and reproductive services are covered. It is very user friendly and easy to understand.

My Little Black Book for Sexual Health was developed as part of the Reproductive Empowerment and Decision Making for Young Adults (REaDY) Initiative, a unique statewide public-private partnership led by NARAL Pro-Choice Massachusetts and Ibis Reproductive Health, to prevent unplanned pregnancy and promote sexual health for young adults in the wake of Massachusetts health care reform. A Spanish language version will be available soon.

Nekose Wills is the OBOS program assistant.

The FDA has begun the extraordinary process to revoke approval of the use of the popular drug Avastin to treat advanced breast cancer.

Avastin had received accelerated approval in 2008, but further studies have not shown that the drug improves either overall survival rate or quality of life.

Andrew Pollack of The New York Times notes that the approval is not without some controvery — as “various breast cancer patients and some patient advocacy groups have urged the F.D.A. to keep the drug approved and not deny patients a chance at what they say could be a life-saving therapy.”

Pollack also notes the financial stake the drugmaker Roche has in the drug: “Avastin is the world’s best-selling cancer drug, with annual sales of about $6 billion. Analysts have estimated that revocation of the breast cancer approval could cost Roche $500 million a year or more in lost sales.”

Some Republicans in Congress, moreover, have tried to portray the potential revocation as “an attempt at cost control, the beginning of rationing under the new health care law,” even though the FDA’s actions are part of the system set up in the 1990s to evaluate drugs that have received accelerated approval.

Breast Cancer Action, whose opinion we trust more than Republicans’ when it comes to advocating for the best interests of women, opposed Avastin’s original approval of the drug and sent a letter to the FDA this past July recommending approval be revoked. As BCA Program Manager Kimberly Irish noted in an e-mail concerning the latest news, the FDA’s decision is a matter of medical justice:

In 2007, BCA was the only breast cancer organization to actively oppose the use of Avastin for metastatic breast cancer patients because of its failure to improve overall survival or quality of life, its side effects and its high price tag. We applaud the FDA for recommending that Roche’s request for full approval of Avastin for advanced breast cancer treatment be denied.

The interests of patients must come before the profits of companies manufacturing the treatments. We need to continue to demand better drugs for people with metastatic disease. We have a long way to go to end this epidemic but the FDA’s decision to put patient needs before drug company profits is at least a step in the right direction.