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.”

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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.

There is a striking lack of mainstream news coverage of the health hazards posed by beauty products, such as hair relaxers and skin lighteners, that are commonly used by black women. African-American women spend more on beauty products than white women do, but far too little research has looked at how women use these products.

So when the New York City-based WE ACT for Environmental Justice set out to survey African, African-American, and Latina women this year to find out how they use beauty products and what they know about them, it was an important step toward increasing awareness of a long-standing women’s health issue.

“We noticed that groups conducting surveys around this have focused on middle-class white women,” Ogonnaya Dotson-Newman, campaign director for WE ACT in Harlem, told The Uptowner. “But there is a whole area of hair products that you wouldn’t know about unless you live in certain urban areas.”

Straight hair has often — and unfairly — been an occupational requirement for black women. TV journalism is one of the most problematic fields (see the Maynard Institute’s historical view of “good hair” on the TV news). Reporter Rochelle Ritchie’s 2010 story (right) about going natural with her hair — and doing so publicly — made headlines and is included in the Body Image chapter in the new “Our Bodies, Ourselves.”

Keonte Coleman, an assistant journalism professor at Bennett College, has more on Ritchie’s backstory and decision to cut her hair on TV, and the standards to which black women in professional media positions are often held.

“Maybe there aren’t any guidelines preventing natural hairstyles, but there is a culture in place that fosters the need for black women to look like their white counterparts,” writes Coleman.

The ingredients of hair relaxers, which many black women use to straighten their curls, are anything but relaxing. Almost all of the samples of currently available hair relaxers tested by Environmental Working Group (EWG) were ranked highly toxic, although limited information was available. Allergic reactions, hormone disruption, immune system toxicity and organ toxicity were four of the main risks.

In contrast, hair straighteners, which are more commonly used by white women, have generally been considered to be relatively safer. EWG’s website shows most of these products are medium-risk with the highest concerns being allergic reactions, immune toxicity and hormone disruption. These risks are similar to those of the hair polishers which are used by women of color.

That was the thinking, at least, until 2010, when concern about formaldehyde in Brazilian keratin hair straighteners made headlines after salon workers in Oregon and internationally complained of breathing problems and eye irritation. Formaldehyde is an industrial chemical that can cause a host of health problems, including an increased risk of cancer.

In response, the FDA this year sent a warning letter to the makers of the hair straightening product Brazilian Blowout, which was found to contain formaldehyde even though it was labeled “formaldehyde free.” (The Campaign for Safe Cosmetics provides a timeline and status update since complaints were first lodged.)

It’s interesting that the formaldehyde in Brazilian Blowout drew criticism from the FDA, while the many ingredients in hair relaxers African-American women use have remained under the radar. These relaxers, as well as costly hair extensions, have been on the market for a long time.

Yumna Mohamed, reporting for The Uptowner, summarized some of the research on black women’s hair products:

While hair dyes, bleaches and relaxers have already been linked to skin problems (including rashes, burns, itching and hair loss), a number of national studies are being conducted to determine whether women of color face higher risks of breast and lung cancer from beauty product exposure.

Dr. Mary Beth Terry, a Columbia University epidemiologist, published a study in May in the Journal of Immigration and Minority Health showing that African-American and African-Caribbean women were more likely to be exposed to hormonally-active chemicals in hair products than white women, and used them more often.

“These products are often used daily and over the course of many years,” Terry says. “A number of these commonly-used products contain endocrine disruptors and placenta, and exposure to these could cause women to be more susceptible to hormone-sensitive diseases such as aggressive breast cancer.”

WE ACT expects to release its survey findings in January. It will use the information to lobby the cosmetics industry and advise women about the dangers in hair products.

Kat Friedrich is an environmental journalist whose work focuses on urban communities. She lives in Boston, uses Twitter, and blogs at Science Is Everyone’s Story.

Initiative 26 would define personhood as “every human being from the moment of fertilization, cloning or the functional equivalent thereof.” Colorado voted on a personhood amendment in 2008 and 2010, and both times the amendment failed. But in Mississippi the vote looks much more ominous. According to a survey by Public Policy Polling, 45 percent of voters support the amendment and 44 percent oppose it.

Here’s a closer look at the breakdown:

Men (48-42), whites (54-37), and Republicans (65-28) support the proposal. But women (42-46), African Americans (26-59), Democrats (23-61), and independents (35-51) oppose it. The good news for those opposed to the amendment is that 11% of voters are undecided and their demographics are 58% women, 54% Democratic, and 42% black-those still on the fence disproportionately belong to voter groups that oppose the amendment. That suggests when those folks make up their minds the proposal could be narrowly defeated.

“The groups trying to defeat the proposed Personhood amendment in Mississippi have had momentum on their side over the last few weeks,” said Dean Debnam, President of Public Policy Polling. “There is a very real chance now that the proposal will be defeated.”

Among the myriad ways women and families would be affected: Abortions would be banned, with no exceptions for rape, incest or the life of the mother. Birth control, IVF, stem-cell research, miscarriage … it’s all murky.

The initiative would also restrict the ability of doctors to freely practice medicine and raises questions about various health procedures. As Meghan McCarthy writes in National Journal:

For example, an ectopic pregnancy—when the fertilized egg implants in the fallopian tube—can kill a pregnant woman if the egg is not removed. Whether that procedure would be allowed in Mississippi should the ballot initiative pass is under question.

“You have to offer full array of services. You are held to a standard of ‘appropriate medical care,’ ” if you receive federal funds, Sara Rosenbaum, a law professor and the chairwoman of the Department of Health Policy at George Washington University, said in an interview.

Beyond federal health programs, the personhood initiative could end up affecting everything from tax law, such as whether a pregnant woman can claim her unborn fetus as a dependent, to fertility clinics that have unused fertilized eggs.

Loretta Ross, national director of SisterSong, wrote a fantastic commentary last month explaining why the Mississippi ballot initiative on personhood and Initiative 27 on Voter ID exclusions “may be one of the most important opportunities on the ground for the Pro-Choice and Reproductive Justice Movements to work together.”

SisterSong and the Trust Black Women partnership have been on the ground in Mississippi, building bridges and advocating for united campaign work on both initiatives. “We have to make parallels between race and gender so that people easily understand that we take their human rights seriously,” writes Ross, offering a passionate argument for why these issues are intertwined and why a coordinated effort should have begun sooner.

My fear is that if we win, some folks will fail to acknowledge that the African American voters delivered the victory. If we lose, then some may say it was similar to the California gay marriage ballot that some falsely claim was lost because of the black voters in California. In reality, it is the failure of those who run campaigns based on outdated campaign models to invest sufficient resources in the African American community to swing the pendulum our way among some of the most consistent and committed Democratic voters on human rights issues.

Southern African American activists have been sounding the alarm to invest much-needed dollars at the grassroots level in Mississippi and throughout the South for quite some time, recognizing that the Civil Rights movement is not over, and that the Women’s Rights movement is embryonic in our region. Those fighting against the Voter ID initiative around the country and especially in Mississippi are clearly under-funded and lack the resources to provide their own polling research, campaign offices, phone banks, etc. We have been forced to do “quick-fix” organizing and mobilizing in Mississippi; had the call of African American reproductive justice activists been heeded, we could have been stronger and united as two movements working together to save women’s lives and women’s votes.

If the ballot initiative passes, women’s health organizations are expected to challenge its constitutionality in court. Aside from the legal wrangling, we must, as Ross states, look inward at our own strategies in related battles to come.

NLIRH describes the following findings in their press release:

• Far from the stereotype of Latinas being anti-choice, these Latina community health leaders said that Latina immigrants wanted information and in some cases services related to abortion along with other health issues.
• Some community leaders said that Latina immigrant youth need emotional and practical support in making a decision about an unplanned pregnancy, and some immigrant teens do not have consistent resources for medically accurate, unbiased, culturally relevant pregnancy options counseling.
• Program grant restrictions that prohibit discussing abortion and a lack of resources for pregnancy options counseling make it difficult for Latina grasstops leaders to provide women with the full information and resources they would like to regarding unplanned pregnancy options.

Henrietta Lacks was a poor, Black woman whose cervical cancer cells were taken in the course of her treatment for cervical cancer at Johns Hopkins in the 1950s. Her cells were the first “immortal” cells — cells kept alive in culture – and went on to be widely used in medical research.

Henrietta’s cells were used in the development of the polio vaccine, were sent up in early space missions, and are mentioned in tens of thousands of research papers.

Rebecca Skloot’s book chronicles the history of Henrietta Lacks and her cells (dubbed “HeLa” cells), as well as Skloot’s  journey uncovering the story.

Lacks and her family never knew about the vast body of research that was being conducted using the cells, or even that the cells had been taken and used for research at all.  She and her family never benefited financially from the selling of HeLa cells. While Henrietta is long dead, her children and grandchildren still struggle to get medical care, and do not have health insurance.

In the course of her talk, Skloot read snippets of the book and discussed questions of ethics, race and class raised by the story. She talked about whether the family should be compensated, the kind of medical care Henrietta received in John Hopkins’s “colored” ward,  and the past and current use of cells and tissue from people’s biopsies and other procedures for later medical research (which may make money for biotechnology corporations). It was really interesting, and I highly recommend the book to anyone interested in these issues.

Skloot has established the Henrietta Lacks Foundation to fund scholarships and medical care for members of the Lacks family. She also blogs about her work. The text of an interview earlier this year with Skloot on NPR’s Fresh Air is available here.

As part of the week, the groups are asking supporters to contact their Congressional representatives “to ask the Department of Health and Human Services (HHS) to support comprehensive family planning services that include contraception as a key women’s health service under the Women’s Health Amendment.” As with many online action campaigns, you can put in your zip code to identify your Representative and Senators and send them a letter explaining that “Latinas, immigrants, and women of color will be disproportionately affected if contraception is not made affordable and accessible.”

There is also an online conversation about Latinas and contraception happening all week, with an inaugural blog post, My-So-Called-Sex-Education, up at Nuestra Vida, Nuestra Voz (NLIRH’s blog) on the need for information about and access to contraception. Further discussion will happen on Facebook, via Twitter (#latinaRJwk), and on partnering blogs such as VivirLatino. There are in-person events taking place in a few cities; check out this page for details.

The research institute notes that insurance companies not only would have to “jump through numerous, unprecedented hoops to estimate the cost of abortion coverage and ensure that the abortion payments never mix with other funds,” but “they also are likely to face extensive public scrutiny and protest around their action.”

All told, according to an analysis by George Washington University’s Sara Rosenbaum, “the more logical response” for private insurers marketing plans within the exchanges — and eventually in the broader market as well — “would be not to sell products that cover abortion services.”

Plus: Drawing from its Congressional record, NARAL flags Republicans who have voted against reproductive rights and who also warned HRC would lead to government intrusion on private medical decisions.

Lasting Consequences: Katha Pollitt talks with Carol Joffe, author of “Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us,” about the effect of HRC on women’s reproductive rights and health. Joffe discusses the good, the bad and the ugly — which refers to the marginalization of abortion.

President Obama and Democratic Congresswomen repeatedly said, “This is a health care bill, not an abortion bill.” I understand why they said it. They felt this was the only way to get the bill through and perhaps they were right. But abortion is health care! One out of three women has an abortion during her reproductive years. One of the best ways to reduce the stigma around abortion is to normalize the procedure within mainstream health care settings. The mantra “this is a health care bill, not an abortion bill” reinforces exactly the opposite message.

Plus: In a separate piece written earlier this month, Katha Pollitt offers concrete suggestions on how the Democratic Party and the Obama administration can repay supporters of women’s rights for cooperating on HRC, including taking steps to improve maternal care and outcomes, and full funding for Title X and the Violence Against Women Act. I love the ending:

Speaking of violence against women, Dems, would you look in the effing mirror? New York’s Hiram Monserrate and David Paterson? Scott Lee Cohen in Illinois? That these men and others like them could get as far as they did says the culture of the party is tone-deaf when it comes to abuse and its warning signs. The only way to detoxify politics of tolerance for violence is to have lots more women in office. If India can pass a law requiring Parliament to be one-third women, surely the Democratic Party can figure out how to achieve equal numbers of women here. Pro-choice women. Feminist women.

Start by backing the grassroots campaign of former teacher and county commissioner Connie Saltonstall, who has announced her intention to challenge Bart Stupak in the August primary. “He has a right to his personal, religious views,” says Saltonstall, “but to deprive his constituents of needed healthcare reform because of those views is reprehensible.” Now there’s a woman with gumption and a gift for stating things clearly.

In Other News …

Revisions to On-Air Abortion Language: NPR reporters will no longer use the terms pro-choice and pro-life to describe both sides of the abortion rights debate. Instead, according to an internal memo:

On the air, we should use “abortion rights supporter(s)/advocate(s)” and “abortion rights opponent(s)” or derivations thereof (for example: “advocates of abortion rights”). It is acceptable to use the phrase “anti-abortion”, but do not use the term “pro-abortion rights”.

Digital News will continue to use the AP style book for online content, which mirrors the revised NPR policy.

Do not use “pro-life” and “pro-choice” in copy except when used in the name of a group. Of course, when the terms are used in an actuality they should remain.” [An actuality is a clip of tape of someone talking. So if a source uses those terms, NPR will not edit them out.]

Georgia Senate Passes Abortion Bill: The latest assault on women’s reproductive health in Georgia is SB 529, a Senate bill that makes it possible to bring criminal charges against doctors, boyfriends, pimps and even parents if they encourage a woman to have an abortion. The bill’s supporters frame it as a way to protect women — especially women of color — but women’s health advocates say the true motivation is to criminalize abortion.

“This bill was created under the false assumption that abortion doctors solicit women of color, particularly, black women,” said Democratic State Sen. Donzella James. “This bill calls into question all who make a deeply private and personal medical decision. Every woman, regardless of ethnic background, should have the ability to make personal decisions. Not the people in this room. It is between, she, her family and God.”

Heidi Williamson of Sister Song has more. “Publicly, white Republican men claim to care about pregnant black women who are allegedly being targeted by the abortion industry. Privately, those same men scramble to ‘opt Georgia out’ of national healthcare reform and find the perfect wedge issue for the mid-term elections to build the Republican base in African-American communities,” she writes.

We previously discussed an anti-abortion billboard campaign in Georgia targeting black women  that proclaims black children are an endangered species. Women’s eNews reports that the campaign may soon go national. For more on the difference in abortion rates among women, see this Guttmacher Institute policy report, which notes that black and Hispanic women have higher abortion rates than white women because they have higher rates of unintended pregnancy.

What’s Up With Lilith Fair?: After announcing that it would donate a dollar from every ticket sold to a women’s organization in each of the 36 host cities, Lilith Fair is coming under fire for including organizations that don’t support a full range of reproductive services.

Apparently, the only vetting Lilith did was to look online for women-focused organizations with federal tax ID numbers. Jessica Hopper interviewed Nettwerk CEO and Lilith cofounder Terry McBride about the selection process and received a less-than-informed response.

“The seeding at the start was done with a basic digital search in each market of woman’s charities,” he said. “It’s not perfect. Nor could it be, as we simply don’t have the local expertise even within our own city of Vancouver.”

Really? Lilith couldn’t have contacted local women’s health advocates, or put a few interns on the project? Perhaps the festival should include a booth for organizers on research skills.

There’s always a chance for improvement. Facebook fans will vote on the selected organizations, and the top three vote-getters in each city will be forwarded to Lilith founders — Sarah McLachlan, Terry McBride, Dan Fraser and Marty Diamond — who will hand pick the winners. And organizations not currently featured can self-submit for consideration. Read more at the Chicago Reader.

The Plan was developed following regional meetings in 2007-2009, during which:

Twenty common strategies were defined and organized around five core areas for improvement: awareness, leadership, health and health system experiences, cultural and linguistic competency, and coordination of research/evaluation. The Plan provides a roadmap – a starting point – of the collaborative strategies and collective actions. The information provided should serve as a menu from which specific actions at the neighborhood/area, community, state, tribal, regional, and national levels can be advanced.

Comments can be general or specific, with links provided at the end of each chapter for submission of more specific remarks. Comments are being accepted through February 12, 2010.

The second chapter, The Current Context, may also provide a good reference for anyone looking for data on/descriptions of existing health disparities, including a number of charts presenting rates of disease and health risk factors by race/ethnicity.

[Hat tip to Siobhan at Bringing Health Information to the Community]

Sponsored by the Kaiser Family Foundation, the webcast will examine aspects of the current Senate and House health reform bills that particularly affect women of color, who face additional health and access challenges.

You can join the live webcast here. An archived version, as well as a podcast and transcript, will be available later today.

Today’s panel will also address provisions in the bills that would affect access to and coverage of abortions, and recent findings from the U.S. Preventive Services Task Force.

Cara James, KFF senior policy analyst on race, ethnicity and health care, will moderate the discussion with:

• Alina Salganicoff, Ph.D., vice president, director, Women’s Health Policy, Kaiser Family Foundation
• Judy Waxman, J.D., vice president of Health and Reproductive Rights at the National Women’s Law Center
• Paula Johnson, M.D., M.P.H., executive director of the Mary Horrigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital and associate professor of Medicine, Harvard Medical School

Panelists will take questions before or during the live program. Send questions to ask [at] kff.org.

The webcast is part of KFF’s series examining current issues in health disparities.

The new criteria require that any mandated vaccine must be age-appropriate for the immigrant applicant, and must either protect against a disease that has the potential to cause an outbreak or protect against a disease that has been eliminated or is in the process of being eliminated in the United States. As HPV does not meet these criteria, the vaccine will no longer be required starting next month (30 days after publication in the Federal Register).

We have written several times about the requirement, including the CDC’s initial comment on the matter and various action alerts/campaigns asking the agency to reverse the requirement.

As we and others noted, the requirement was problematic for multiple reasons, such the lack of an opt-out provision (in contrast to requirements for U.S. citizens), the expense of the series, the lack of significant public health risk posed by omitting this vaccine, and the vulnerability of the affected population.

In the revised criteria document, published in Friday’s Federal Register, HPV vaccination is specifically addressed as follows:

CDC has applied the criteria and determined that once these criteria become effective December 14, 2009, the HPV vaccine will not be required for aliens seeking admission as an immigrant or seeking adjustment of status to that of an alien lawfully admitted for permanent residence….Therefore, while HPV may be an age-appropriate vaccine for an immigrant applicant, HPV neither causes outbreaks nor is it associated with outbreaks (per explanation in the background section). Further, HPV has not been eliminated, nor is in the process of elimination, in the United States. Therefore, because HPV does not meet the adopted criteria, it will not be a required vaccine for immigrant and adjustment of status to permanent residence applicants.

Under the new criteria, the zoster (chicken pox) vaccine will also be removed from the requirements. The agency continues to recommend the two vaccines for U.S. citizens, but vaccine recommendations will no longer be automatically translated to mandates for immigration.

The National Latina Institute for Reproductive Health, the National Asian Pacific American Women’s Forum, and California Latinas for Reproductive Justice issued a statement commending the agency for the change and for “recognizing that all women and girls—regardless of their immigration status—must be treated with dignity in the context of any medical procedure, including the HPV vaccine.”