Though it won’t be as accessible as condoms, health experts are proposing to make the birth control pill available without a prescription. Photo / Jenny Lee Silver

This month, the American College of Obstetricians and Gynecologists released a statement calling for oral contraceptives to be sold over-the-counter, no longer requiring a doctor’s prescription.

ACOG considered a host of issues, including the safety of birth control pills; whether pharmacists could screen for who shouldn’t get them, or if women could self-screen; adherence to taking the pill; whether women would skip other preventive care if they didn’t visit a health care provider for a prescription; and cost.

Notably, ACOG addresses frequent objections to OTC oral contraceptives by concluding that “several studies have shown that women can self-screen for contraindications,” and “cervical cancer screening or sexually transmitted infection (STI) screening is not required for initiating OC use and should not be used as barriers to access.”

As Kevin Drum points out at Mother Jones, most countries outside of North America and Europe do not require a prescription for these drugs.

ACOG notes, though, that making the pill non-prescription might increase the cost for women who have health insurance — especially since under health care reform, contraception can be purchased without a co-pay. Over-the-counter costs might end up being anything from the $4 deals many pharmacies offer to more than $100. Dr. Kent Sepkowitz also explores this concern at The Daily Beast:

Yes, your life is easier because you will be able to get the pill right this second, without calling my office. No, you don’t need to fill out forms and show insurance cards and wrangle over copay. But guess who is paying for the whole shabang? You. Yes, you.

Another concern is that if the pill were dispensed by pharmacists, we might see the more of same kinds of refusals as have happened with emergency contraception.

However, many patients may experience increased access with an OTC model. The National Latina Institute for Reproductive Health issued this response:

The recommendation that birth control be available over-the-counter supports what we know about Latinas and contraception: over-the-counter access will greatly reduce the systemic barriers, like poverty, immigration status and language, that currently prevent Latinas from regularly accessing birth control and results in higher rates of unintended pregnancy.

Pre-Prescribing Emergency Contraception to Teens
Another professional medical organization, the American Academy of Pediatrics, issued a statement recognizing high teen birth rates in the United States and barriers to access to emergency contraception for adolescents 17  and younger. The AAP strongly admonishes pediatricians who refuse to discuss or provide contraception to teens based on their own beliefs, stating:

Pediatricians have a duty to inform their patients about relevant, legally available treatment options to which they object and have a moral obligation to refer patients to other physicians who will provide and educate about those services. Failure to inform/educate about availability and access to emergency-contraception services violates this duty to their adolescent and young adult patients.

The AAP recommends that physicians provide prescriptions to emergency contraception like Plan B in advance, so teens have it ready if and when the need arises. They also urge physicians to provide accurate information to teens on this topic, and, “At the policy level, pediatricians should advocate for increased nonprescription access to emergency contraception for teenagers regardless of age and for insurance coverage of emergency contraception to reduce cost barriers.”

Nice job, AAP!

HHS Urged to Remove Restrictions on Emergency Contraception
Finally, a petition is circulating urging the U.S. Department of Health and Human Services to remove restrictions on emergency contraception and make it available to women of all ages without a prescription. To learn more, see RH Reality Check’s audio news conference and related links and commentary from Kristin Moore. Our previous posts provide background on why EC is not *already* available OTC to all women:

• Evidence Trampled By Politics: HHS Secretary Sebelius Overrides FDA Decision on OTC Emergency Contraception
• Susan Wood Issues Response to Sebelius’s Overruling of Emergency Contraception Access

Each year, the Centers for Disease Control and Prevention (CDC) releases information on the number of abortions in the United States. Newly published data from 2009 shows that rates of abortion overall have decreased 5 percent since 2008 to the lowest levels since 2000. In general, rates of abortion were highest right after legalization, fell steadily in the 1980s and 1990s, and started to level off in the past decade.

It is not clear why rates have fallen. Possible contributors range from the expanded use of contraceptives and better sex education to the declining number of abortion providers and increases in restrictive abortion laws. Unintended pregnancy rates have not changed in decades – about half of all U.S. pregnancies are unintended — so that is not responsible for any decline.

As we know, many myths persist about who gets abortions and why. The following details shed some light on the topic:

• Women in their 20s have the highest rates of abortion (ages 20–24: 27.4 abortions per 1,000 women / ages 25–29: 20.4 abortions per 1,000 women), and account for 57.1 percent of all abortions.

This doesn’t seem terribly surprising given that women in their 20s are more likely to be fertile. In addition, they are more frequently uninsured. The insurance factor likely decreases their use of the most effective birth control methods –IUDs and implants –as those methods require a visit to a health care provider.

• The majority of women (55.3 percent) having abortions have not had a previous abortion. About 25 percent have had one previous abortion, and about 11 percent have had two previous abortions. Only about 8 percent have had three or more abortions, suggesting that the overwhelming majority of women having abortions do not fit the “using it as birth control” myth.
• Six out of every 10 women having abortions have already had one or more children. Women very frequently say that they chose abortion in order to best be able to care for their existing families.
• Abortions are usually performed early in pregnancy, with 64 percent done at less than eight weeks gestation, and about 92 percent done by or before 13 weeks.

There has been a clear shift to earlier abortions, with an almost 50 percent increase in abortions done at less than six weeks’ gestation. The CDC report is not able to address the reasons why; the increase may be caused by the greater availability of medication abortion (medication abortions are performed only up to 9 weeks) or an increased number of abortion laws that make later abortions more difficult to obtain.

Other points of interest:

• Use of medication abortion continues to increase; 16.5 percent of abortions in 2009 were done medically instead of surgically, a 10 percent increase from 2008.
• Abortion ratios (the number of abortions for every 1,000 women) decreased among non-Hispanic white women but not among women in any other racial/ethnic group.

Poor women, young women, and women of color are less likely to have access to reproductive health care services, more likely to have an unintended pregnancy, and more likely to have an abortion.

The CDC concludes its report with public health recommendations, including support for no-cost birth control. The Affordable Care Act comes close by eliminating co-pays for insured women (though employers who oppose reproductive rights are still fighting this provision), making birth control available without a co-pay for an estimated 47 million women. Here’s what the CDC has to say:

Moreover, although use of the most effective forms of reversible contraception (i.e., intrauterine devices and hormonal implants, which are as effective as sterilization at preventing unintended pregnancy ) has increased, use of these methods in the United States remains among the lowest of any developed country, and no additional progress has been made toward reducing unintended pregnancy. Research has shown that providing no-cost contraception increases use of the most effective methods and can reduce abortion rates. Removing cost as one barrier to the use of the most effective contraceptive methods might therefore be an important way to reduce the number of unintended pregnancies and consequently the number of abortions that are performed in the United States.

See our analysis of a recent study on unintended pregnancies in St. Louis for further discussion of how improved access to free birth control reduces abortions. The study is important for its role in dismantling persistent myths about contraception and abortion.

Plus: Though some members of Congress with less-than-accurate ideas about women’s bodies lost re-election, that doesn’t mean Congress is apt to back smarter policy. Let’s remind all members about the importance of access to contraception and reproductive health services. Join the Educate Congress campaign to send “Our Bodies, Ourselves” to every elected senator and representative. You’ll receive an “I Educated Congress” button (and other perks) showing you did your part!

Last night, the War on Women suffered a setback — due largely to women voters who used the ballot to re-elect President Barack Obama and to push back against absurd, insulting and just plain offensive comments about rape and women’s bodies.

As Veronica Arreola posted on Facebook:

Two of the biggest losers last night were the gentlemen who claimed that women have magic wombs that stop pregnancy from occurring during legitimate rape and if it does happen, it was a gift from God. The magic was in our votes, ladies. We’ve had it all along.

Erin Gloria Ryan’s post at Jezebel is succinctly titled “Team Rape Lost Big Last Night.” Read it for a complete look at races around the country.

Some highlights …

Missouri Rep. Todd Akin failed to unseat incumbent Sen. Claire McCaskill, causing Twitter to explode with a new round of Akin-related humor, like “Claire McCaskill legitimately wins and shuts that whole Akin thing down!”

John Koster was defeated by Suzan DelBene in Washington state — Koster famously referred to “the rape thing” and confused one woman’s choice with controlling all women’s choices: “I know a woman who was raped and kept the child, gave it up for adoption and doesn’t regret it.”

And in Illinois, Rep. Joe Walsh, who doesn’t believe abortion is ever necessary to save the life or health of a mother, lost to challenger Tammy Duckworth, an Iraq War veteran who lost both legs in combat.

For more analysis, Bryce Covert at The Nation examines the impact of politicians’ misogyny on the election outcomes, and concludes: “Score one for women’s rights, zero for attempts to control their bodies.”

***

Our Bodies, Our Votes …

“Our Bodies, Ourselves” turned up in a number of tweets last night. Anne Elizabeth Moore, who led The Ladydrawers on the road trip to deliver “Our Bodies, Ourselves” to the offices of Akin and McCaskill, posted this upon news of Akin’s defeat:

hey @RepToddAkin, now maybe you’ll finally have time to get crackin at all those books @oboshealth and @TheLadydrawers dropped off!

We heartily second that recommendation.

Following the defeat of Indiana Senate candidate Richard Mourdock — who recently said, “I think even when life begins in that horrible situation of rape, that it is something that God intended to happen” — Jason Lefkowitz tweeted: ”And in Indiana, Mourdock has officially been buried under a massive pile of hardback copies of ‘Our Bodies, Ourselves.’”

Jason Cherkis also took note of the upsets, tweeting: ”GOP furiously buying ‘Our Bodies, Ourselves’ on Amazon.”

No need; with the public’s help, we’ll deliver the book to each and every member of Congress (41 days left to make this happen!).

***

Big gains for women and marriage equality …

We now have a record number of women in Senate, with 20 women Senators elected.

Rep. Tammy Baldwin became the first openly gay senator, and the first woman senator from Wisconsin. Rep. Mazie Hirono became the first woman senator from Hawaii as well as the first Japan-born immigrant to be elected to the Senate and the first Buddhist.

Another big success last night was the passage of ballot measures in Maine and Maryland approving same-sex marriage, the first time it has been made legal through a popular vote. An amendment to ban same-sex marriage was defeated in Minnesota.

We’re still waiting to hear for sure about Washington state, but early returns are promising. Same-sex marriage is now legal in eight states as well as in Washington, D.C.

More good news: Iowa Supreme Court Justice David Wiggins is staying on the bench – he had been targeted for removal because of his role in the legalization of gay marriage in that state.

***

Mixed results on abortion-related measures …

Abortion-related measures were considered in two states. In Florida, voters defeated Amendment 6, which would have prevented state employees from using their healthcare coverage for most abortions, and would have affected privacy rights in a way that could have led to further restrictions.

In Montana, voters approved a parental notification measure requiring girls under age 16 to notify a parent or seek judicial bypass prior to terminating a pregnancy.

 ***

Lessons learned and work to be done …

Akiba Solomon at Colorlines shares “Five Race and Gender Justice Lessons Learned from This Marathon Election Cycle,” including this important point: “The Republican-led war on abortion, Title X-funded reproductive health care and contraceptive access was—and still is—a war on poor women of color and their families.”

And if anyone needs a reminder of the work we still have before us, On the Issues magazine has appropriately titled its fall issue “The Day After.”

From the editor’s note: “On wide-ranging issues — the economy to the environment, reproductive freedom to voting freedom, sexuality to media representation — our writers, artists and thinkers in The Day After remind us to extend our vision beyond the ballot box to where we need to place our energies, build our muscles and put our feet on the ground every day of the year.”

In other words, it’s time to get busy — again.

Health care reform. Access to contraception. Increased protections for women against violence. Equal pay.

A lot hangs on this presidential election.

On the state level, personhood amendments that grant fertilized embryos all the rights of a born human didn’t make it onto any ballot, but two states, Florida and Montana, have put restrictive abortion initiatives before voters.

The National Women’s Law Center has published a voter education section with a number of useful links, including fact sheets on issues affecting women and great images to share — like the one on the left by Jen Sorensen.

For more on the election and the importance of women voters, visit Women’s Vote Watch 2012, a project of the Center for American Women and Politics that tracks and analyzes polling data. Here’s a section on the gender gap and voting.

Finally, if long lines get you down, just think of Galicia Malone of Dolton, Ill., who stopped to vote this morning on her way to give birth.

The clerk’s office said Malone’s water had already broken when she made the stop to vote in her first presidential election.

“If only all voters showed such determination to vote,” [Cook County Clerk David] Orr said. “My hat goes off to Galicia for not letting anything get in the way of voting. What a terrific example she is showing for the next generation, especially her new son or daughter.”

And remember, no matter who wins, we still have to work on educating Congress about women’s health …

by Rachel Walden & Christine Cupaiuolo

This Halloween, ask yourself: Which is scarier — Furry creatures that scamper in the night? Or a Congress ignorant of how reproduction and women’s bodies work?

Unsure? Take a quick quiz to find out which frightens you more!

1. (A) Possessed Vampire Kitty

OR

(B) Legislators claiming that pregnancy from “legitimate rape” is really rare because women’s bodies can just “shut that whole thing down,” and suggesting that pregnancies resulting from rape are “something that God intended to happen.”

2. (A) Golden-Eyed Vampire Kitty

OR

(B) A member of Congress believing that thanks to ”modern technology and science, you can’t find one instance” of abortion being necessary to protect the health or save the life of the mother.

3. (A) Fork-Tongued Vampire Kitty

OR

(B) Forcing women to undergo unnecessary and medically unwarranted procedures,  such as a transvaginal ultrasound, in order to obtain an abortion [HR 3805]. (If you’re in Pennsylvania and you don’t want to view the images, just close your eyes!)

4. (A) Lord Cattula

OR

(B) Holding a Congressional hearing on contraception with no women present?

If you consistently selected “B,” then you’re more scared of misinformed policy and inaccurate statements about how women’s bodies work!

What can you do to change the conversation and protect yourself from misinformation? Join the Educate Congress campaign!

We’re delivering copies of “Our Bodies, Ourselves” to every senator and representative so they have access to accurate, evidence-based information about reproductive health — and you can be part of this important effort.

Because nothing is more scary than legislators drafting policy that harms women — not even Meow Mix …

Credit: Cat photos
1. Possessed Vampire Kitty / Opacity on Flickr
2. Golden-Eyed Vampire Kitty / Digidave on Flickr
3. Fork-Tongued Vampire Kitty / mohd fahmi on Flickr
4. Lord Cattula / sgatto on Flickr

Today in “Yeah, no kidding!”: A new article in the journal Obstetrics & Gynecology reports on a study that found when women are provided with free birth control, women choose more effective long-term methods, and unintended pregnancies and abortion rates drop.

Here are the essential details from the study’s abstract (emphasis below is mine):

OBJECTIVE: To promote the use of long-acting reversible contraceptive (LARC) methods (intrauterine devices [IUDs] and implants) and provide contraception at no cost to a large cohort of participants in an effort to reduce unintended pregnancies in our region.

METHODS: We enrolled 9,256 adolescents and women at risk for unintended pregnancy into the Contraceptive CHOICE Project, a prospective cohort study of adolescents and women desiring reversible contraceptive methods. Participants were recruited from the two abortion facilities in the St. Louis region and through provider referral, advertisements, and word of mouth. Contraceptive counseling included all reversible methods but emphasized the superior effectiveness of LARC methods (IUDs and implants). All participants received the reversible contraceptive method of their choice at no cost. We analyzed abortion rates, the percentage of abortions that were repeat abortions, and teenage births.

RESULTS: We observed a significant reduction in the percentage of abortions that were repeat abortions in the St. Louis region compared with Kansas City and nonmetropolitan Missouri (P<.001). Abortion rates in the CHOICE cohort were less than half the regional and national rates (P<.001). The rate of teenage birth within the CHOICE cohort was 6.3 per 1,000, compared with the U.S. rate of 34.3 per 1,000.

CONCLUSION: We noted a clinically and statistically significant reduction in abortion rates, repeat abortions, and teenage birth rates. Unintended pregnancies may be reduced by providing no-cost contraception and promoting the most effective contraceptive methods.

The study’s researchers have set up an excellent website, The Contraceptive Choice Project, along with a YouTube video (see above) on what would happen if women had access to birth control methods that worked best for them, and the project is on Facebook. You can also read more about the findings at Women’s Health Policy Report.

While the study seems pretty intuitive — removing a major obstacle to birth control use (cost) means that more women use it and the rate of unintended pregnancies goes down — strangely enough, this argument rarely seems to convince abortion foes to support contraception.

Why is that? For starters, some conservatives are unwilling to concede that contraception lowers the rate of unintended pregnancies. As Amanda Marcotte smartly explains, their real opposition is to sex, not to reducing the number of abortions.

Anti-abortion groups have also promoted a specious argument attempting to redefine how contraception works. One provision of the Affordable Care Act requires coverage of women’s preventive services, including contraception, without cost sharing in new health plans. This provision has been decried by those who have religious objections to birth control in general, and by a segment of the anti-reproductive rights crowd that believes contraception is equivalent to abortion.

The conservative group Focus on the Family, for example, sent an alert to its supporters claiming that “the federal government is requiring both religious and secular employers to fund possible abortion-inducing drugs.” The email was sent in response to a federal judge in Missouri’s recent dismissal of a lawsuit challenging the contraception mandate of the federal health care law.

It would take you about two seconds of Googling to find many, many other examples of anti-abortion groups and individuals claiming that contraception is a form of abortion, especially if there is even the remotest possibility that the method may interfere with the implantation of a fertilized egg, which they have insisted is the case with emergency contraception.

But as The New York Times recently reported, emergency contraception (also known as the morning-after pill and marketed under the brand names of Plan B and Ella) doesn’t prevent fertilized eggs from implanting in the womb:

Rather, the pills delay ovulation, the release of eggs from ovaries that occurs before eggs are fertilized, and some pills also thicken cervical mucus so sperm have trouble swimming.

It turns out that the politically charged debate over morning-after pills and abortion, a divisive issue in this election year, is probably rooted in outdated or incorrect scientific guesses about how the pills work. Because they block creation of fertilized eggs, they would not meet abortion opponents’ definition of abortion-inducing drugs.

Medically, women aren’t considered pregnant until a fertilized egg implants, and it’s not possible to carry a pregnancy to term without successful implantation. Despite these medical definitions and standards, the belief that contraception equals abortion persists.

So, where does that leave us? Certainly findings like the St. Louis study provide important evidence of what works to reduce abortion rates, and the study bolsters our arguments for contraception access. What’s less clear, though, is what works to counter the notion that birth control = abortion.

If opponents sincerely believe this, how well do fact-based arguments work to change their minds? Have we seen any evidence of other fact-based appeals resulting in shifts in opinion? Share your thoughts in the comments.

Rep. Todd Akin, the Republican candidate in Missouri for U.S. Senate, made news again last week for his comments on the ladies — this time for asserting that his opponent, Democratic Sen. Claire McCaskill, acted “much more ladylike” during the 2006 campaign, and for suggesting that it’s fine for businesses to pay women less than men.

Well, then.

We do have Akin to thank, however, for sparking an upcoming Congressional Pop Quiz on gender, sex and reproductive health designed by The Ladydrawers. But first they need you to share what you think Congress needs to know about sexual and reproductive health. Here’s info from the call for participation:

The latest Truthout strip asks readers to submit questions for a Congressional Pop Quiz on the workings of your body. We’d like you—the cartoonists, the ladydrawers, the gender-aware media makers—to submit illustrated questions. You can use the questions from the Truthout comments section, generate queries among your own communities, or just straight-up ask Akin to identify the different between your vag and, say, a praying mantis. Which, actually, is pretty damn good at shutting “that whole thing down.”

We’d like questions on sex and reproductive health, of course, but questions about gender seem appropriate too. Marriage, partner benefits—it seems a little bit endless, what we must ensure Congress knows before further legislation is enacted. Anything. Be creative. Be funny. Be accurate. Use evidence-based resources, and cite them, so interested parties (R, D) can read more.

Most important: submit them to us here at TheLadydrawers@gmail.com or on our Tumblr by October 15. We’ll publish everything we receive here and on our Tumblr that fits the above guidelines (so include your website in your submission for proper credit), and choose the very best ones to print or publish in a quiz we’ll send directly to congress. (We might even have a way to pay you.) Line art only, please!

Can’t draw? Submit your text question on Truthout’s comment section, work with a friend who does like to draw, or do it anyway. You’re the expert: on your body, and on what you want to say about how it should be legislated.

The deadline is Oct. 15, so get going!

Having road tripped with The Ladydrawers in August to deliver “Our Bodies, Ourselves” and sex-ed books and comics to Akin’s office, I can pretty much guarantee that they’re the most awesome rabble rousers this side of the Mississippi (view more photos and drawings from that adventure).

The trip’s urgency was set off by Akin’s unfortunate comments about “legitimate rape” and pregnancy. Since we were in the neighborhood, we also stopped by McCaskill’s office and a training for sex-ed educators, dropping knowledge and spreading the word that everyone deserves access to accurate, evidence-based information on reproductive health. In fact, we’re about to launch a larger-scale delivery effort; more on that soon!

In the October issue of the journal Obstetrics and Gynecology, a medical student writes of his discomfort with a practice many people may be surprised to learn still occurs — medical students practicing pelvic exams, without explicit consent, on women who are under anesthesia for surgery.

The student, Shawn Barnes, writes that the practice left him “ashamed.”

“For 3 weeks, four to five times a day, I was asked to, and did, perform pelvic examinations on anesthetized women, without specific consent, solely for the purpose of my education,” writes Barnes. “To my shame, I obeyed.”

He continues:

As a medical student, I am all too aware of the hierarchy that exists during training. My medical education experience has reinforced the notion that the medical student should not question the practices of those above him or her. I was very conflicted about performing an act that I felt was unethical, but owing to both the culture of medicine and my own lack of courage, I did not immediately speak out against what I was asked to do by residents and attendings.

His commentary, titled “Practicing Pelvic Examinations by Medical Students on Women Under Anesthesia: Why Not Ask First?,” is available only by subscription/purchase, or through a library, as is a related editorial in the same issue, “Pelvic Examinations Under Anesthesia: A Teachable Moment.”

Carey M.York-Best and Jeffrey L. Ecker, authors of the editorial, remark that no one knows how often these exams occur, and they point out that teaching hospitals, which are expected to train students, do ask patients for general consent for students to be involved in their care. However, they rightly note that blanket consent is inadequate when it comes to pelvic exams:

After all, consent forms at many teaching hospitals include a statement outlining the involvement of students in patient care. Yet we believe that, even if such phrases may meet the letter of recommended conduct, they often are overlooked and a few words on an already too-long form do not represent true informed consent.

Barnes also calls these forms inadequate, and he also doesn’t buy the argument that women should expect such things when they go to a teaching hospital:

We first must remember that patients tend to seek care at facilities that are geographically nearby, where their regular physician has privileges, or where their insurance is accepted. Consent forms at teaching hospitals tend to use language stating that medical students and residents may be involved in that case. That involvement is not specified.

Practicing pelvic exams on women under anesthesia purely for teaching purposes — not for the women’s medical benefit — is not a new practice. However, many may have assumed it had largely stopped, particularly after a 2003 study (which I discussed several years ago) drew a lot of attention to the issue, causing many medical schools to clarify their policies and/or seek women’s explicit consent. Several professional medical organizations have also denounced the practice.

The study was based on a 1995 survey of students at five U.S. medical schools. The researchers found that only about a third of the students thought it was “very important” to get consent prior to doing a pelvic exam. Students who had actually done an ob/gyn clerkship were even less likely to think consent was important. Almost 10 percent of those students actually responded that explicit consent was “very unimportant.” The overwhelming majority (90 percent) of the ob/gyn clerkship students had performed pelvic exams on women under anesthesia.

Back to 2012 — Barnes informs readers that as a result of a bill signed into law this past June, Hawaii (where he studies) will join California, Illinois, and Virginia in making “unconsented” pelvic examinations against the law. For those interested in learning more, his testimony is included among these documents supporting the Hawaii bill.

This may be an opportunity for advocacy in other states, where it may be possible to get similar laws passed.

Earlier this month, the U.S. Preventive Services Task Force reaffirmed its previous recommendation that most women don’t need routine ovarian cancer screening.

The agency looked at recent evidence to see if anything new has been published that might alter its 2004 recommendation and concluded, once again, that annual screening is likely to do more harm than good in women who do not have any symptoms, genetic markers, or other increased ovarian cancer risk factors.

The reason? Studies have shown that the current methods for regular screening — transvaginal ultrasonography or serum CA-125 testing — are not effective in reducing ovarian cancer deaths in women without increased risk.

For many women, these tests will produce incorrect results suggesting cancer, causing women to undergo unnecessary surgery in order to get confirmation. Surgery can include the removal of a healthy ovary and associated harms such as infections or blood clots.

The recommendation does not apply to women with known genetic mutations that increase their risk for ovarian cancer. The Taskforce has also produced this fact sheet that explains the rationale for the recommendation and includes information to help you decide if you should be screened.

Groups Agree with Recommendation, But Screening Still Common

The Taskforce is not alone in its findings. The American Congress of Obstetricians and Gynecologists does not recommend screening for ovarian cancer in asymptomatic women. And the American Cancer Society has stated that there is no screening test proven to be effective and accurate in early detection.

Despite the USPSTF’s 2004 recommendation against routine screening, many physicians still provide it, likely misunderstanding its utility. According to the The New York Times, based on a 2008 survey:

But some doctors continue to recommend screening anyway, and patients request it, clinging to the mistaken belief that the tests can somehow find the disease early enough to save lives. A report published in February in Annals of Internal Medicine, based on a survey of 1,088 doctors, said that about a third of them believed the screening was effective and that many routinely offered it to patients.

Research on Screening Continues

In addition to finding no new evidence supporting annual screening, and additional evidence on harms, the Task Force also notes that research continues on specific methods of screening and screening in general.

“The main gap in our knowledge,” write Taskforce members, “remains the uncertain ability to offer effective treatment of cancer at an early stage to improve the ultimate outcome.”

The recommendation, then, might change in the future if better evidence is found that screening can reduce deaths or if forms of screening are devised that can be shown to affect survival rates.

Cara Tenenbaum of the Ovarian Cancer National Alliance emphasizes that more research is needed to find better methods of screening: “The task force’s recommendation underscores how badly we need an effective screening test for ovarian cancer. Ovarian cancer is the deadliest gynecologic cancer because it often isn’t detected until the disease is in an advanced state.”

CDC Campaign Advises Women to Pay Attention to Physical Changes

The most common symptoms of ovarian cancer include bloating, pelvic or abdominal pain, trouble eating or feeling full quickly, and urinary symptoms, such as frequent or urgent urination. These symptoms could apply to a range of health issues — most of the time, they’re caused by other, less serious health issues.

The Centers for Disease Control  has created an Inside Knowledge campaign to raise awareness about gynecologic cancers. The campaigns includes fact sheets and posters in Spanish and English, and radio and television public service ads featuring women discussing the symptoms that led them to visit their health care provider. The ad below features writer and performer Jenny Allen.

 Plus: For more links to news stories and analysis, read the Women’s Health Policy Report.

While we’ve been busily tweeting away with reports on the #akinroadtrip to deliver the most recent “Our Bodies, Ourselves” to Rep. Todd Akin, the story has kept up steam in the media. Here’s some coverage of the overall issue and big picture problem of the GOP’s abortion platform that we liked:

• Pretty much everything from the Rachel Maddow Show – she’s been doing a fantastic job covering this all week long, and all the videos are online.
• Akin is Not an Outlier – Republicans on Rape, Abortion, and Women’s Rights – A little something I wrote up at Women’s Health News.
• Opinion Pieces Weigh Impact of Rep. Akin’s Controversial Remarks – a nice round-up of commentary in the Women’s Health Policy Report
• Also in the Policy Report – Significance of Rep. Akin’s Remarks Extends Beyond Current Controversy, Opinion Pieces Argue
• Akin’s comments highlight the extreme GOP platform plank on abortion – Editorial in the Boston Globe
• Paul Ryan Goddam! – Melissa Harris-Perry for The Nation (the title is a take on Nina Simone’s “Mississippi Goddam”)

And much-appreciated coverage of the road trip:

• Jane Henderson, our inspiration, at the St. Louis Post-Dispatch’s Book Blog – Sex ed books on way to Akin in St. Louis
• Jezebel – Todd Akin’s Very Own Copy of Our Bodies, Ourselves Is Being Rush-Delivered to Him Right Now

En Español

Women who choose to breastfeed need better support — on that point, there is no doubt.

Even when a woman wants to breastfeed, she may be forced to contend with numerous barriers, including: lack of family/community support; lack of workplace supports such as breaks and privacy; absence of paid maternity leave; expense of lactation support and pumping equipment (costs which are lessened, finally, thanks to the Affordable Care Act); limited education about breastfeeding among medical professionals; and limited breastfeeding education and hospital support that is culturally and linguistically appropriate. Any one of these can reduce the chances for successful and sustained breastfeeding.

Recently, New York City Mayor Michael Bloomberg provoked a fair bit of outrage with the launch of Latch on NYC, a voluntary hospital program that aims to promote breastfeeding. New York City hospitals that join the initiative agree to not distribute free formula or display formula-related advertising materials. These hospitals will also restrict staff access to formula, ensuring that it is provided only if a mother chooses to feed her baby formula or if supplementation with formula is medically indicated. In other words, staff will no longer provide formula as the default.

The idea of eliminating formula freebies and advertising in hospitals, and reducing non-necessary formula supplementation, is not particularly new or controversial in public health and breastfeeding support circles. The Baby Friendly Hospital Initiative (see detailed guidelines and evaluation criteria for hospitals seeking this designation), the 2011 Surgeon General’s Call to Action on Breastfeeding, and the World Health Organization’s International Code of Marketing of Breast-milk Substitutes all encourage hospitals to adopt similar measures.

What raises people’s ire, it seems, is the perception that the NYC program limits a mother’s choice, for whatever reason, to use formula. As Gayle Tzemach Lemmon wrote for The Atlantic, “it infantilizes women by telling them they are no longer adult enough to decide for themselves what is best for their families and themselves.”

New York City is trying to address such concerns and has published a document to make the provisions more clear. Here’s an excerpt:

Myth: The city is requiring hospitals to put formula under lock and key.
Fact: Hospitals are not being required to keep formula under lock and key under the City’s voluntary initiative. Formula will be fully available to any mother who chooses to feed her baby with formula. What the program does is encourage hospitals to end what had long been common practice: putting promotional formula in a mother’s room, or in a baby’s bassinet or in a go-bag – even for breastfeeding mothers who had not requested it.

That last phrase (emphasis mine) is a key point. As it turns out, giving formula to mothers who have indicated they want to breastfeed is all too common in hospitals. Offering a bottle when a mother needs help getting the baby to latch on or if she isn’t sure if she’s producing enough milk is simply easier and less costly than providing an on-call lactation counselor or developing a program with volunteer peer counselors who can offer support.

WBEZ in Chicago did a report on hospital breastfeeding rates that showed the difference a hospital initiative in support of breastfeeding can make. Not surprisingly, many hospitals lacking lactation consultants are in low-income neighborhoods, so those mothers are more likely to be steered toward formula even when their hospital chart indicates a preference for breastfeeding. Following the report, a Chicago hospital on the Southwest Side with the lowest newborn breastfeeding rate in the area — only 7 percent of newborns breastfed there — took steps to improve the statistics.

More from Latch On NYC:

Myth: Mothers who want formula will have to convince a nurse to sign it out by giving a medical reason.
Fact: Mothers can and always will be able to simply ask for formula and receive it free of charge in the hospital – no medical necessity required, no written consent required.

Myth: Mothers requesting formula will be subject to a lecture from the nurse.
Fact: The City’s new initiative does not set a requirement that mothers asking for formula receive a lecture or mandated talk. For the last three years, New York State Law under the Breastfeeding Bill of Rights, has required that mothers simply be provided accurate information on the benefits of breastfeeding. This requirement has not changed under the City’s new initiative.

Myth: Latch on NYC is taking away and/or jeopardizing a woman’s right to choose how to feed her baby.
Fact: The initiative is designed to support mothers who decide to breastfeed. For those women, the program asks hospital staff to respect the mother’s wishes and refrain from supplementing her baby with formula (unless it becomes medically necessary or the mother changes her mind). It does not restrict the mother’s nursing options in any way – nor does it restrict access to formula for those who want it.

If you accept the city’s clarifications, it’s more clear that the goal is to change hospital practices, not individual preferences. But as noted above, there are many other barriers to breastfeeding that such initiatives do not address. Over at RH Reality Check, Marianne Møllmann writes about the lack of paid parental leave and other real societal supports for breastfeeding.

Regardless of your personal choices around breastfeeding, it’s clear that women overall need better supports for making that choice. To further explore this topic, here’s a presentation OBOS Executive Director Judy Norsigian delivered at the third annual Breastfeeding and Feminism Symposium on the cultural, social and economic issues that prevent women who want to breastfeed from doing so. Also see our previous blog posts on breastfeeding.

End of English post.

El Alcalde Bloomberg y el Debate (y la Verdad) sobre la Lactancia y la Fórmula

Las mujeres que eligen amamantar sus bebes necesitan mejor apoyo — sobre este no hay duda.

Aún cuando una mujer desea amamantar, tiene que enfrentarse a varias barreras, incluyendo: falta de apoyo familiar y de la comunidad; falta de apoyos en en trabajo como pausas y privacidad; falta de baja de maternidad con beneficios; el costo del apoyo de lactancia y los sacaleches (costos que, finalmente, resultan más bajos gracias la Nueva Ley de Asistencia Asequible); limitación de educación sobre la lactancia entre profesionales médicos; limitación de educación y apoyo de lactancia en los hospitales que sean culturalmente y lingüísticamente apropiados. Cada cual puede reducir la oportunidad de seguir el amamantamiento.

Recientemente, el alcalde de Nueva York Michael Bloomber provocó un poco de indignación con el lanzar de Latch on NYC, un programa voluntario nuevo para hospitales que intenta promover el amamantamiento. Hospitales en Nueva York que se juntan a la iniciativa aceptan no distribuir fórmula gratis o exponer publicidades relacionadas a la fórmula. Estos hospitales también aceptan limitar el acceso de sus empleados a la fórmula, asegurando que solamente se provee cuando una madre lo elige, o si el suplemento con fórmula sea médicamente indicado. En otras palabras, la fórmula ya no será provista automáticamente.

Eliminar la fórmula gratis y sus publicidades en los hospitales, y reducir el suplemento no necesario, no es una idea nueva o controversial in el círculos de salud pública y apoyo de lactación. La iniciativa Baby Friendly Hospital Initiative (ver las directrices y los criterios de evaluación para hospitales buscando esta designación), la Llamada para Acción sobre la Lactancia del Director general de Salud Pública, y el Código Internacional de Publicidad de Sucedáneos de la Leche Materna de la Organización de Salud Mundial promueven que los hospitales tomen medidas similares.

Lo que molesta a la gente, me parece, es la percepción que el programa da NYC limita a la decisión las madres, por cualquier razón, de usar la fórmula. Como escribió Gayle Tzemach Lemmon en The Atlantic, “infantaliza a las mujeres, diciéndoles que ya no son tan adultas para decidir para ellas mismas lo que es mejor para ellas y sus familias.”

La ciudad de Nueva York está dirigiéndose a tales preocupaciones y ha publicado un documento para aclarar las provisiones. Vea un pasaje:

Mito: La ciudad está obligando que hospitales pongan la fórmula bajo llave
Verdad: Bajo la iniciativa voluntaria de la ciudad, los hospitales no tienen que poner la fórmula bajo llave. La fórmula seria completamente disponible a todas las madres que eligen alimentar a sus niños con fórmula. Lo que intenta el programa es acabar con algo que ha sido practica común: poner fórmula promocional en el cuarto de la madre, o en la cuna del bebe, o en una bolsa para llevar– aun para las madres que estaban amamantando y que no la pidieron.

Esa ultima frase (con mi propio énfasis) es un asunto clave. Resulta demasiado común que los hospitales le dan fórmula a madres que ya han indicado que quieren amamantar. Ofrecer una botella cuando una madre necesita ayuda con pegar su niño al pecho, o si está insegura de la cantidad de leche que está produciendo es más fácil y menos costoso que proveer un asesor de lactancia o desarrollar programas de consejeras coetáneas voluntarias que pueden dar apoyo.

WBEZ en Chicago hizo un reportaje sobre la prevalencia de amamantamiento en los hospitales que demostró la diferencia que puede hacer una iniciativa de apoyo de lactancia. Muchos de los hospitales sin asesores de lactancia se encuentran en comunidades de bajos ingresos, y estas madres probablemente serán dirigidas hacia la fórmula, aun cuando su historial medico indica que prefieren amamantar. Después del reportaje, un hospital en el lado sudoeste de Chicago con la prevalencia de lactancia de recién nacido más bajo en el área — solamente 7% de los recién nacidos se amamantan allí– tomó medidas para mejorar sus estadísticas.

Más de Latch On NYC:

Mito: Madres que desean la fórmula tendrán que convencer una enfermara a firmarles un consentimiento con alguna razón medica.
Verdad: Las madres que desean la fórmula pueden y siempre van a poder simplemente pedir la fórmula y recibirla gratis en el hospital– sin ninguna necesidad medica, sin ningún consentimiento firmado.

Mito: Madres que piden la fórmula serian regañadas por la enfermera.
Verdad: La iniciativa nueva de la Ciudad no tiene ningún requerimiento que las madres que piden la fórmula deben recibir un sermón o alguna conferencia obligada. Para los últimos tres años, la ley de Nueva York bajo la Declaración de Derechos de la Lactancia solamente requiere que las madres sean provistas con información correcta sobre los beneficios del amamantar. Este requerimiento no ha cambiado bajo la nueva iniciativa.

Mito: Latch on NYC está quitando y/o poniendo en peligro el derecho de la madre de elegir como alimentar a su bebe.
Verdad: La iniciativa esta hecha para apoyar a las madres que eligen la lactancia. Para esas madres, el programa le pide a los hospitales que respeten los deseos de la madre y que no alimenten a su niño con fórmula ( a menos que resulta médicamente necesario o si la madre cambia de opinión). No limita sus opciones de lactancia en ninguna manera– ni tampoco limita el acceso a fórmula para todas las mujeres que la desean.

Si aceptamos las clarificaciones de la ciudad, vemos que la meta es cambiar las practicas en los hospitales, no las preferencias individuales. Pero como ya se notó más arriba, hay muchas más barreras contra la lactancia que tales iniciativas no enfrentan. En el blog RH Reality Check, Marianne Møllmann escribe sobre la falta de baja por maternidad con beneficios y otros apoyos sociales verdaderos de la lactancia.

A pesar de nuestras decisiones personales sobre amamantar, es claro que las mujeres en general necesitan mejores apoyos para elegir la lactancia. Para explorar este tema, aquí está una presentación dada por Judy Norsigian de OBOS en el tercer Simposio anual sobre las razones culturales, sociales, y económicas que previenen la lactancia en mujeres que desean hacerlo.

Countdown to Coverage is a campaign to help women understand the concrete ways that the Affordable Care Act can improve our health. This blog entry is the first in a series designed to answer the question, What’s in it for women?

by Leana S. Wen, MD

As an emergency physician, I tend to work on the other side of preventive care services. I see what happens when women don’t know about safer sex and birth control, and end up with complications from sexually transmitted infections. I see what happens when women do not get routine screening for cervical cancer and struggle with life-threatening cancer. I see what happens with out-of-control hypertension and diabetes, and the heart attacks and strokes that are detected far too late.

These experiences have shown me that prevention is the best medicine. That’s one big reason why the Affordable Care Act provision requiring new insurance plans to cover women’s preventive care without any extra charges or co-pays is a real victory for women. These requirements, which go into effect Aug. 1, will be phased into existing insurance plans over time.

Because of this change, women will be able to obtain complete contraceptive care, screening for sexually transmitted infections, and screening and counseling for intimate partner violence. This builds upon earlier requirements that insurance companies cover — at no additional cost to women — mammograms and screenings for cervical cancer. It’s clear to me that these mandates will significantly improve women’s health and lives and ultimately lead to a reduction in health care costs.

The Well-Woman Visit
One of the easiest ways to obtain preventive services is through a well-woman visit. These visits, which will soon be covered with no co-pay, give you the opportunity to ask key questions about birth control, sexually transmitted infections, and other reproductive issues, along with questions about diet and exercise and any health concerns you may have. You can also discuss changes in your family’s medical history that are important for your health care provider to consider. For example, when my mother was diagnosed with breast cancer, my doctor recommended that I get earlier screenings.

Along these same lines, your health care provider may have questions or issues to discuss with you. Smoking, drinking and recreational drug use can create and contribute to health problems, and often need to be discussed and addressed multiple times before change happens. Well-women visits also give your health care provider a chance to screen for potential high blood pressure, diabetes, depression, domestic violence, and more.

The well-woman visit is important for another reason: It gives you and your health care provider a chance to get to know each other. Most people go to their provider or to a clinic only when there’s a problem, but the best time to get to know your provider isn’t when you’re in distress from a painful or troublesome condition. Studies have shown that health care providers make more accurate diagnoses when they know their patients and can put the symptoms in the context of your life. A well-woman visit is a precious opportunity to build this trusted relationship.

As an emergency physician, I am excited about the new provisions taking effect Aug. 1, which include annual well-women visits for those who want them. I would much rather women regularly visit their health care providers than come to the E.R. later suffering from preventable problems. So please take this opportunity and make an appointment with your provider. The importance of investing in your health is too crucial to ignore.

Plus: Want to learn more about the Affordable Care Act? These resources from Countdown to Coverage provide detailed information about coverage for women, including specific information for LGBT people, women of color, young women, older women, moms and families, and more. 

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Leana S. Wen, M.D., is an emergency physician at Brigham & Women’s Hospital and Massachusetts General Hospital and a clinical fellow at Harvard Medical School. She is the author of a forthcoming book on patient advocacy, “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.” For more information, visit her blog When Doctors Don’t Listen or her website. You can also follow her on Twitter @DrLeanaWen.

Our Bodies Ourselves has partnered with The Big Push for Midwives in support of this important legislation. Please take a moment to learn how you can help improve the health of mothers and infants in Massachusetts. Thank you! – Judy Norsigian, OBOS Executive Director

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If you care about mothers and babies, the Commonwealth needs your help TODAY to PASS HB 4253, An Act Relative to Certified Professional Midwives.

We have just a few days left to pass this important legislation that will regulate Certified Professional Midwives.

Currently, there is no state oversight, which means ANYONE — even an 18-year-old car mechanic — can hang out a shingle and practice as a midwife. Hairdressers must be licensed to practice in Massachusetts, but midwives do not.

Should a “cut and color” be regulated and have professional practice requirements while MA midwives currently have none?

How to Help

• CALL your own STATE REPRESENTATIVE
  You can find contact information for your representative here: http://wheredoivotema.com/bal/myelectioninfo.php
• GIVE them an update on the bill, HB 4253 — An Act Relative to Certified Professional Midwives — and let them know the bill is now with the House Ways and Means committee.
• ASK them to contact Chairman Dempsey’s office (617-722-2990) (representing Haverill and Chair, House Ways & Means Committee) to REQUEST that HB 4253 BE RELEASED TO THE HOUSE FLOOR FOR A VOTE ASAP.
• ASK them to then support the bill when it reaches the House Floor.
• URGE them to tell their colleagues to support the bill on the House Floor.
  The calls will take TWO minutes or less. Please pass this on to friends, family, neighbors and anyone else to also make calls. We need to flood the State House!

Want to do even more?
PLEASE reach out to Massachusetts HOUSE LEADERSHIP (see listing at the end of this message), letting them know:

• This bill is important to you
• That this bill is being supported by House leaders

Also, we will be at the State House on Wednesday and Thursday afternoons this week (7/25 and 7/26). Please join us! Drop a quick email to Ann Sweeney at ann AT annsweeney.com, and we’ll let you know where to rendezvous with us.

Please help us in spreading the word and passing this legislation into law! Keep the calls coming! We need EVERYONE to call to get this done! Make a difference! Make it count!

Thank you for your support!
- Ann Sweeney (Mass Friends of Midwives)
ann AT annsweeney.com
- Miriam Khalsaak (Mass Midwives Alliance)
akmidwife AT gmail.com

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To help out even more:
CALL more Massachusetts House Leadership

Other Important Representatives in House Leadership to call:
Rep. Haddad—very supportive—617-722-2600
Speaker DeLeo—he is aware of the bill—seems to understand need for it—617-722-2500
Rep. Reinstein—very supportive and a co sponsor—617-722-2180
Rep. Moran (Boston and Brookline)—supportive and a co-sponsor— 617-722-2006
Rep. Story (Amherst)—very supportive—617-722-2012
Rep. Donato—seems supportive—617-722-2040
Rep. Mariano—has always supported licensure bills—617-722-2300
Rep. Jones—aide seems supportive—617-722-2100
Rep. Rushing—617-722-2783
Rep. Bradley—617-722-2520

Last Thursday, the Supreme Court ruled to largely uphold the Patient Protection and Affordable Care Act, or health care reform. The Act should help women access a number of preventive services and help them access healthcare more easily.

The National Latina Institute for Reproductive Health issued a press release, Supreme Court decision means health care access for Latinas, calling the decision “a significant victory for Latinas, who are more likely than other groups to face structural barriers that prevent them from accessing health care and preventive services.” They also note, however, that works remains to be done and many immigrants still lack access to essential care.

Physicians for Reproductive Choice and Health’s board chair Douglas Laube released a statement for the organization, writing:

Thanks to today’s ruling, we can move closer to the day when our patients won’t go without basic medical care because they can’t pay for it. The Affordable Care Act has already begun to change health insurance in the United States for the better, doing away with pre-existing conditions, gender-rating (making insurance more expensive for women than men), and other practices that have hurt women’s health.

The Planned Parenthood Federation of America calls the decision a victory, and lists several benefits for women:

• More than 45 million women have already received coverage for preventive health screenings at no cost since August 2010 thanks to the Affordable Care Act – including mammograms and Pap tests – and millions more will be able to get free screenings in the coming years.
• 3.1 million young adults have already been able to stay on their parents’ insurance because of the Affordable Care Act. In the next year, millions more who would have otherwise lost coverage will continue to be insured under their parents’ plan.
• Women are guaranteed direct access to ob/gyn providers without a referral, as a result of the Affordable Care Act.
• Starting in August, birth control will be treated like any other preventive prescription under the Affordable Care Act, and will be available without co-pays or deductibles.

The National Women’s Health Network called the decision “historic and thrilling,” and is currently running a “Countdown to Coverage” campaign to highlight ways the Act will benefit women’s health.

At RH Reality Check, Jodi Jacobson writes of some women’s group’s reactions to the Supreme Court Decision. Amanda Marcotte, also at RH Reality Check, has some questions for opponents of the Affordable Care Act. Also there, an author from MADRE writes about the international and human rights context for the decision.

Raising Women’s Voices has a ton of coverage and links, including information on what women can expect out of health care reform.

The Centers for Disease Control and Prevention has released a draft of its National Public Health Action Plan for the Detection, Prevention, and Management of Infertility, and will be soliciting public comments until June 15, 2012.

The CDC describes the purpose of the plan as follows:

Addressing both male and female infertility, the plan outlines and summarizes actions needed to promote, preserve, and restore the ability of women in the United States to conceive, carry a pregnancy to term, and deliver a healthy infant. This goal extends beyond simply addressing the inability to conceive but also focuses on reducing the burden of impaired fecundity by promoting behaviors that maintain fertility; by promoting prevention, early detection, and treatment of medical conditions; and by reducing environmental and occupational threats to fertility. Given the public health focus of this action plan, promoting healthy pregnancy outcomes associated with treating and managing infertility is also important, as is improving the efficacy and safety of infertility treatment.

OBOS hopes to comment on the draft plan and will share any useful comments that colleagues will be making. In the meantime you can read the draft and submit your comments to the agency.

To comment, first go to regulations.gov and do a search for CDC-2012-0004. The first result should be the Plan – just click on Submit Comment and complete the form. Note that you do not have to enter your name with your comment, and if you do it will appear on the site.