Earlier this month, an editor-in-chief of the Journal of Psychiatric Research, along with a co-author, published a commentary critical of a 2009 article  in the journal claiming that women who had an abortion were more likely than women who did not have an abortion to experience panic attacks, alcohol and drug abuse, major depression, bipolar disorder, and other negative mental health outcomes.

The author of the 2009 article,  Priscilla Coleman, suggested the results showed that abortion had more impact on mental health problems than did childhood sexual or physical abuse, physical assault in adulthood, or rape. While Coleman does not explicitly state “abortion causes mental health problems,” she uses language like “abortion…made a significant independent contribution to…mental health outcomes” which suggests not only an association between the two, but a direct causal link.

In 2011, Coleman released a correction to the article, stating that the data had been analyzed incorrectly. The new analysis led to the author dropping panic disorder, panic attacks, new mania and bipolar disorder from the list of conditions she associated with abortion.

Other researchers (Steinberg and Finer) published their own reanalysis of the data Coleman used and were unable to replicate the results of any association between abortions and mood, anxiety, or substance use disorders, with the exception of an association between multiple abortions and substance use disorders. Steinberg and Finer also criticized Coleman for including women who may have already had mental health concerns prior to their abortions, because her analysis relied on women’s mental health diagnoses over their lifetimes rather than specifically after abortion.

The new commentary in the Journal of Psychiatric Research addresses both Coleman’s and Steinberg and Finer analyses. The editor notes that Steinberg and Finer are not the final word on the topic, and future research could do a better job of ensuring comparable groups of women and better understand how responses vary between groups of women in very different life circumstances.

About Coleman’s article, though, they write:

Based on our joint review and discussion of the debate, we conclude that the Steinberg-Finer critique has considerable merit and that the Coleman et al. (2009) analysis does not support their assertions that abortions led to psychopathology….

The fact that the evidence for adverse mental health effects of abortion was weaker in the Steinberg-Finer analysis than the Coleman et al. (2009) analysis is consistent with the conclusions of two recent reviews of the literature, both of which found that evidence for adverse effects of abortion on mental disorders is much less pronounced in higher quality than lower quality studies.

The American Psychological Association in 2008 released a report after reviewing the available evidence (through 2007) on abortion and mental health, and concluded that “the most methodologically sound research indicates that among women who have a single, legal, first-trimester abortion of an unplanned pregnancy for nontherapeutic reasons, the relative risks of mental health problems are no greater than the risks among women who deliver an unplanned pregnancy.” The APA also called methodology problems in the literature “pervasive,” and included criticisms of Coleman’s methods in many of her previous studies, such as their inclusion criteria and failure to control for prior mental health issues or other confounding factors.

With regards to past criticisms of her work published in the British Journal of Psychiatry, Coleman claimed [link goes to LifeSiteNews, an anti-choice website]: “The paper is being published in a very prestigious journal, the British Journal of Psychiatry, which is considered one of the top psychiatry journals in the world. This means the paper has been extensively scrutinized by well-respected scientists and the results of studies are trusted by practitioners throughout the world.”

Unfortunately, even “prestigious” journals are not immune to publishing inappropriately conducted studies, as a look at the site Retraction Watch will illustrate. The 2011 article in the BJP by Coleman reviewed 22 studies of abortion and mental health and drew a number of comments including criticisms of Coleman’s methods, and prompted the Royal College of Obstetricians and Gynaecologists to issue a statement that “What this research does not fully examine is if these women had pre-existing mental health complications such as dependency issues and mood disorders before the abortion.”

Coleman has claimed [link goes to National Right to Life page] that criticisms of her research are just media bias, and “efforts to deny” a link between abortion and mental health problems “will become even less effective, because we all likely know at least one person, who has had trouble coming to terms with an abortion experience.” This statement again refuses to acknowledge the many factors (including pre-abortion mental health, and social stigma around abortion) that may contribute to a woman’s feelings after abortion, and confuses the distinction between what happens with some women and what can actually be attributed to abortion itself.

Why does all of this wrangling about details in studies of abortion and mental health matter? Because research like this is rarely used simply to allow women to make the most well-informed choices for their own lives – it is often part of an agenda of restricting choice. It matters if research suggesting a causal link between abortion and mental health problems is well done because that research is going to end up a tool for restricting women’s choices. We have seen many attempts to restrict abortion across the United States over the last couple of years. New laws requiring hospital admitting privileges for providers, requiring additional regulation and reporting by clinics, and “informed consent” laws that require providers to state false information about breast cancer risks are all enacted under the guise of “protecting” women, but the underlying agenda is prevent women from being able to readily choose abortion. That’s why these informed consent laws *never* contain information on how carrying a pregnancy to term and delivering a baby is statistically *more* dangerous for women than early abortions.

Further Reading:
Guttmacher: Abortion and Mental Health – quick facts about studies on this topic
Reuters, Journal disavows study touted by U.S. abortion foes – good overview of the current discussion
National Women’s Health Network, APA Releases New Report: Abortion No Threat to Women’s Mental Health – 2008 piece I wrote for the NWHN newsletter when the APA released their report on this topic

The U.S. Preventive Services Task Force has released a new recommendation statement on when and how often women should get cervical cancer screening.

Changes from the old recommendations include:

• Pap test screening every 3 years among women age 21 to 65 years. Other organizations and previous recommendations have suggested waiting until age 30 to wait longer than a year between screenings, or suggested screening “at least every 3 years.” The evidence indicates that screening more often offers little benefit while creating a large increase in harms related to additional procedures and overtreatment.
• A new recommendation that women younger than 21 not be screened, even if they are sexually active. Based on the available evidence, screening before age 21 does not appear to reduce the rates of cervical cancer or death.
• A recommendation based on new evidence that HPV testing combined with Pap testing is okay for women age 30 to 65 years who want to do testing every 5 years instead of every 3 years.

The agency continues to recommend that these groups do not need screening: 1) women without a cervix and who don’t have a history of serious pre-cancer lesions or cervical cancer; 2) women older than 65 with a good record of previous screening who are not at a high risk for cervical cancer.

The USPSTF also recommends against HPV testing in women younger than age 30, because the potential harms are thought to outweigh the benefits in younger women. Rates of HPV are high in this age group while rates of cervical cancer are low, so younger women may experience false positives and unnecessary invasive interventions, such as colposcopy and cervical biopsy.

These procedures in turn sometimes can result in vaginal bleeding, pain, and infection. Some procedures, including cold-knife conization and loop excision, are associated with outcomes like preterm delivery, which can create additional risks for a newborn. The report recommendation also notes that women who get abnormal results may also experience short-term psychological harms like increased anxiety, and that overdiagnosis of HPV or lesions that may not really affect a woman’s health can create additional stresses.

The recommendations do not apply to women who have an increased risk of cervical cancer because of HIV infection, a compromised immune system, in utero exposure to diethylstilbestrol (DES), or previous treatment for a high-grade precancerous lesion or cervical cancer.

The new recommendations are freely available online. Note that they will often say “cytology” screening – this means Pap tests (or “smears”). The agency has also released a three-page guide to understanding the recommendations.

To understand how the harms of more frequent screening can outweigh the good, see What the New Cervical Cancer Screening Guidelines Mean for Women on the Our Bodies Ourselves website.

Via Susan Love’s Army of Women project, we learned about a breast cancer research study headed by Boston University researchers that is currently recruiting lesbian and bisexual women. The goal of the study is to learn more about quality of life and well-being issues for lesbian and bisexual women who have been diagnosed with breast cancer, and to use that information to inform services and reduce health disparities.

From the email announcement:

It is widely known that a breast cancer diagnosis can have far reaching effects both socially and emotionally. Less well understood are the ways in which a breast cancer diagnosis impacts the well-being and quality of life of women who have historically been underserved by the medical community. Lesbian and bisexual women are one of these underserved populations, and little research has been done to assess their health and well-being as women with breast cancer. Identifying their unique needs by asking some questions in a survey will help researchers to develop culturally appropriate programs for these women.

The researchers are interested in hearing from all lesbian and bisexual women who have had a breast cancer diagnosis. They have a particular interest in women who have metastatic disease, recurrent disease, or an additional invasive cancer diagnosis, or are currently undergoing cancer treatment. If you have ever been diagnosed with breast cancer, please read on to learn more about what’s involved and who can participate.

Women have been diagnosed with breast cancer at some point their lives and identify as lesbian, bisexual, or as a woman who partners with women are eligible to participate. Participants will complete a 45 minute phone survey about their health, medical history, demographics, and sexual orientation.

Visit this page at Army of Women to learn more or sign up online to participate.

The U.S. Food and Drug Administration (FDA) is seeking public comment on a draft guidance intended to define expectations about inclusion of women* in medical device research, including making sure women are represented in clinical trials and that data on women’s outcomes with devices should be collected and reported. Medical devices include products like contact lenses, coronary stents and pacemakers, breast and hip implants, prostheses, and other equipment for diagnosis and therapy.

The FDA is the agency that approves medical devices for use/marketing in the United States, so we would expect them to ask about these issues and data when companies propose that a device be approved.

This is meant to improve how risks and benefits of medical devices can be understood and communicated to women, and to encourage researchers to consider how sex-related differences may affect women’s outcomes when using medical devices.

For example, according to an evaluation of studies used to seek approval for heart-related devices, there was “persistent underrepresentation” of women – only about 1/3 of the study participants were women. Studies of certain existing heart devices have already found increased risks of adverse effects in women for some products, and possible better outcomes for women using some other devices.

Comments are due before midnight (Eastern time) on March 12, 2012. They can be submitted online, or via mail to the Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852. If you write a paper letter, you should include the docket number: FDA-2011-D-0817.

*Note: the language used in the FDA documents defines female sex “according to their reproductive organs and functions assigned by chromosomal complement,” and gender as provided by patient/participant self-report.

You may have seen recent news coverage along the lines of “BRCA variants not tied to worse cancer outcomes.” This story refers to a recently published study about changes in the BRCA1 and BRCA2 genes that affect breast and ovarian cancer. Women with mutated versions of the genes have greater risks of breast and ovarian cancer than women with typical versions of the genes.

In the new study in the Journal of Clinical Oncology, researchers tried to figure out whether women with BRCA1 or BRCA2 mutations who do develop cancer have worse outcomes than women without the mutations. They compared records for women with breast cancer and one of the mutations with those of women with breast cancer who did not have these gene changes.

Overall, they found that women with BRCA1 mutations had similar rates of metastatic (“distant”) cancer recurrence and death as women without it. Women with BRCA2 mutations had higher risks of recurrence and death, although the risk was similar when the women got adjuvant therapy (additional treatment to help prevent recurrences). Other factors like age and stage of the cancer also made a difference.

However, this study should be interpreted with caution. Bigger studies are probably still needed to properly understand any effects of these genes on women’s cancer therapy outcomes. The similarity of outcomes between women with and without the mutations may have to do, in part, with what we have learned about therapies for women with those mutated genes – which therapies don’t work as well for them, and which therapies might be added on for better outcomes. The researchers for the current study do say that women with mutated BRCA1/2 genes were more likely to have received adjuvant therapy, and the authors were unable to look at women’s results by how much chemotherapy they received.

While women who have BRCA1/2 mutations may be advised to have earlier or more frequent cancer screenings than other women, it’s not yet completely clear who should get tested for these mutations or if women should be tested once they’re diagnosed with breast or ovarian cancer.

As we learn more about how our genes affect our cancer risks and therapy outcomes, I expect we’ll see more and more news on these topics, and it may take some time to figure out how to assess risk, guide cancer therapies, and how our outcomes change based on this knowledge. Here are a few helpful resources for this growing area of study:

• Genetics Home Reference – Cancers – information from the National Library of Medicine on genes related to a number of cancers
• General Cancer Genetics Information – information from the National Cancer Institute on genetic (hereditary) risks for cancer, gene testing, a dictionary of genetics terms, and other resources
• My Cancer Genome – information intended to help inform physicians about tumor (not hereditary) genes and their effect on cancer therapy. Disclosure: I work with the team that produces this site.

A Doctor of Psychology candidate at Deakin University in Australia who is working on her thesis about the connection between a woman’s body image and her sense of well-being contacted us with a request to share a link to the online questionnaire where women 18 and older can participate in her research.

The questionnaire will ask you about how you feel about your body, behaviors related to your body, and how you feel about yourself in general. You can complete it online and they estimate that it should take no more than 20-30 minutes to complete.

The survey includes some questions about sexual orientation, height, and weight, as well as your satisfaction with specific parts and areas of your body and how much you think you resemble your “ideal” body. The researchers do mention that “The completion of this study may result in increased self-awareness regarding your attitudes and feelings about your body, yourself, and your life. For some individuals, this self-awareness may produce…discomfort.” Information about how your responses will be kept private is also provided on the website.

A recent article in the journal Human Reproduction has attracted a fair bit of attention because it suggests a possible link between in vitro fertilization (IVF) and later increased risk of ovarian cancer.

Certain factors increase a woman’s risk of getting ovarian cancer, including a family history of reproductive cancers, personal history of cancer, certain gene mutations, increasing age, hormone replacement therapy, and infertility itself.  Right now, it’s still very hard to determine how much fertility treatments – such as the ovarian stimulation used in IVF – may contribute to increased risk.

For the current study, researchers in the Netherlands identified about nineteen thousand women with fertility problems who received in vitro fertilization, and about six thousand women who had fertility problems before IVF was in common use and so did not receive it. The researchers used questionnaires and medical and cancer records to follow the women for fourteen to sixteen years, from the time of their first IVF treatment or first infertility diagnosis.

The authors found a two-fold risk of ovarian cancer in women who had IVF. Most of this increased risk, however, was for “borderline ovarian tumors,” a noninvasive type that may require surgery but typically has a good prognosis. There was no significant difference in rates of invasive ovarian cancer between the two groups. The authors also note that even larger studies are needed to confirm or refute their findings and to examine any possible relationship between the dose of ovarian stimulation treatments and increased ovarian cancer risk.

They also make this important point:

Knowledge about the magnitude of the risks associated with ovarian stimulation is important for women considering starting or continuing IVF treatment, as well as their treating physicians.

A 2006 review of existing literature on the topic also observed “a stronger association…between fertility drug use and borderline tumors of the ovary,” but called the finding “not consistent among the available studies to date.”

See also: The Politics of Women’s Health: Egg Donation for IVF and Stem Cell Research: Time to Weigh the Risks to Women’s Health.

Escrito por Rachel; traducido del orginial en inglés Sept. 20, 2011.

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

Los bisfosfonatos (p.e. Fosamax, Boniva, etc.) son medicamentos para el tratamiento y la prevención de la osteoporosis en mujeres postmenopáusicas, pero hay preocupación por los posibles efectos secundarios causados por el uso de estos medicamentos por periodos largos.  Entre los posibles efectos secundarios se incluyen: fracturas atípicas de fémur (muslo), osteonecrosis (muerte de la mandíbula), y cáncer de esófago.

El otoño pasado, la FDA pidió cambios en las etiquetas de los bisfosfonatos para incluir advertencias sobre riesgos de fracturas, para explicar que no se sabe exactamente el tiempo que se debe consumir el medicamento, y recomendar que pacientes y doctores reevalúen periódicamente el uso del medicamento.

Recientemente, algunos comités de la FDA encargados de los medicamentos para la salud reproductiva y del manejo de la seguridad/riesgo de las medicinas, se reunieron para discutir el consumo extendido (>3-5 años) de bisfosfonatos, y sus posibles complicaciones.

En un documento informativo preparado para la reunión, la FDA revisó evidencias sobre estos relativamente raros pero preocupantes efectos, y concluyó: “La seguridad para el consumo prolongado de  bisfosfonatos aún no es clara, por cuanto los resultados de los estudios sobre la posible relación entre la osteonecrosis de la mandíbula, las fracturas atípicas de fémur, o el cáncer del esófago, y el uso de bisfosfonatos para la prevención y el tratamiento de la osteoporosis son conflictivos.”

La agencia concluyó que la evidencia sugiere un aumento en la incidencia de osteonecrosis de la mandíbula con un uso prolongado, especialmente de 4 años o más, pero que se necesitan estudios más profundos.  También dice, “Las fracturas atípicas….parecen tener una asociación importante con los bisfosfonatos, pero no hay actualmente consenso en cuanto a la manera como el uso acumulado de bisfosfonatos aumenta los riesgos de este tipo de fractura poco común.  Finalmente, no hay evidencia definitiva para apoyar la relación entre el cáncer de esófago y el uso prolongado de bisfosfonatos.”

En cuanto a los posibles beneficios resultantes del uso prolongado de bisfosfonatos para reducir fracturas relacionadas con la osteoporosis, la agencia no encontró beneficios evidentes.  “Los resultados sugieren que no hay ventajas de importancia en continuar usando esta medicina por más de 5 años.”

El New York Times también informa acerca de las recientes reuniones de la FDA, y destaca: “El comité convocó a más estudios para establecer la eficacia del medicamento en la meta deseada de prevenir fracturas.  Así mismo, los asesores recomendaron que la FDA examine la razón por la que el medicamento es recetado como medicina preventiva a mujeres que nunca han tenido osteoporosis.”

Para más información sobre este tema, vea nuestras previas entradas de blog, y la Red Nacional de la Salud de la Mujer (the National Women’s Health Network), la cual también pregunta si este producto debe ser comercializado y recetado como medicina preventiva para mujeres con buena salud.

Women are being sought to complete an online survey about egg donation to help inform the creation of a website to answer women’s question about the egg donation process, including medical and legal concerns.

The survey is being conducted by the organization Generations Ahead and the Health Equity Institute at San Francisco State University. Questions address work, family, and money issues, as well as what you know about egg donation.

From the organizations:

The survey only takes 15-20 minutes and it is completely anonymous. We are looking for women with all kinds of experiences to fill out this survey. They do not need to have been a donor, or even have thought about donating to participate. We would love to hear from any woman who has been even curious about the process or the money involved.

We will use the information we collect here to make sure women’s voices are inserted into this debate and to design a website to give women comprehensive, unbiased information so that they can make the best decision for themselves.

If you have any questions, or want to learn more about, please contact Sujatha Jesudason (sjesudason@generations-ahead.org) or Laura Mamo (lmamo@sfsu.edu). You can also see a description of this project at http://www.generations-ahead.org/projects/egg-donation.

For more discussion of issues related to egg donation and women’s health, see our online companion materials.

The current issue of Obstetrics and Gynecology includes a paper that examines how doctors are making use of HPV tests, including whether they are using them appropriately to assess women’s cervical cancer risk.

HPV tests are sometimes done as part of pelvic exams because of the connection between HPV and cervical cancer. Guidelines generally recommend screening for high-risk forms of HPV be done in women over age 30, and in women with abnormal pap results. HPV screening is not recommended in women 21 years old and younger because younger women are likely to get and fight off the virus without any resulting health problems.

An earlier article in a less high-profile journal, Journal of Pathology Informatics, reported similar concerns after reviewing data on HPV tests ordered from 2003-2009. Those authors found that while tests on younger women had declined, but about one in four tests were inappropriate according to the American Society for Colposcopy and Cervical Pathology guidelines.

For the current study, the authors used CDC survey data on what providers do for cervical cancer screening, including their use of HPV tests. They compared those responses to guidelines from the American Cancer Society, the American College of Obstetricians and Gynecologists, and the American Society for Colposcopy and Cervical Pathology to find out whether the providers were inappropriately testing.

Almost 60 percent of providers reported using HPV tests for “cotesting” in women younger than 30, meaning that the test was done as part of routine screening along with the pap, a use that is not recommended in that age group. For women under 30, “a positive HPV test more likely signifies a transient HPV infection that will resolve spontaneously without needing further intervention.” With a positive test result, however, these women are likely to undergo additional unnecessary testing or treatment.

Survey takers also reported doing HPV tests because women asked for them in order to know their HPV status, and explain that because HPV is so common, such screening should not be done outside of cervical cancer screening. It does not appear that providers were asked whether they talk with the patients in these cases about why an HPV test might not be useful for their care, but are encouraged to do so by the authors.

The authors also found that 31 percent of office-based health care providers and 25 percent of hospital clinics reported testing for low-risk forms of HPV which are not considered relevant to cervical cancer screening. They put it quite bluntly: “There is simply no role for low-risk HPV testing in cervical cancer screening nor any other clinical scenarios to justify its use.” Almost 13 percent of survey takers reported not being aware that there was a difference between the high and low risk tests.

They go on to write:

The continued use of low-risk HPV testing by health care providers in the United States may be driven by a combination of financial gain, test marketing, and health care provider confusion on the difference between the low-risk and high-risk tests. Eliminating the availability of the low-risk HPV test, which has no clinical indications, should be considered…

Both the study and editorial authors mention the need to address payment for the unnecessary tests, such as the additional costs/reimbursement received for adding a low-risk test to the more useful high-risk test.

In an accompanying editorial, Abuses in Human Papillomavirus DNA Testing, Dr. Phillip Castle writes about the negative effects of undergoing unnecessary testing, including anxiety, distress, and a decreased sense of sexual well-being, unnecessary procedures such as colposcopies, and the costs of extra tests and procedures. He asks:

Who is to blame, clinicians, laboratories, or the manufacturer? I suggest that they all share in the blame—the clinicians order it, the laboratories provide it, and the manufacturer makes it (ie, the low-risk HPV test). Unfortunately, it is the patient who has to live with the consequences of payment or copayments and being labeled as HPV-positive.

The Skin Deep Cosmetics Database, a free online database maintained by the Environmental Working Group, provides information on the safety and potential harms of ingredients in make-up, sunscreen, facial cleansers and moisturizers, contact lens solutions, shampoo, nail polish and remover, baby wipes, soaps, and creams, toothpaste, fragrances, and other cosmetic and skin care products.

You can browse by cosmetic category or search for the name of your favorite product to find out about possible hazards in terms of cancer risk, reproductive toxicities, and allergies. Information is also provided on companies’ animal testing policies. The directions and ingredients listed on each product label is listed, and links are provided to other similar product types and products from the same manufacturer. You can also read others comments and leave your own on specific product pages.

Because in some cases there may not be much testing data on particular ingredients, the amount of available data is labeled, such as none, limited, fair, or robust. Information is provided on whether the data come from a single or multiple animal studies (which may be of limited value for humans), or if there is strong evidence of potential harm in humans.

Sources of data used for the assessments and the methods for computing scores are provided at http://www.ewg.org/skindeep/site/about.php. Thus, you can see how the assessments and ratings are derived in a pretty transparent way. For the fellow librarian readers, yes, I sent them a suggestion about the Hazardous Substance Data Bank!

I love the idea of a database like this, because it’s often difficult to know how “safe” any particular product is. I personally don’t have the appropriate background in toxicology to assess how accurately the potential risks of common ingredients are described, so I’d love to hear from readers with that expertise. I’ll also leave it to commenters to talk about why it was necessary for the “men’s” products to be in their own segregated section of the site.

I was recently contacted by Chia-Chun Li, a doctoral candidate in nursing at the University of Texas at Austin, who is working on a study for her dissertation entitled, “Factors Affecting Sexual Function and Sexual Satisfaction among Females with or without Rectal Cancer or Gynecological Cancer.”

She is looking for women to participate in both the study group (those with cancer) and a control group (women without cancer). According to the announcement, you are eligible to participate in the study group if:

You are a female; are 18 years or order; live in U.S.; are in a relationship or married; read English; have experienced rectal cancer or gynecological cancer surgery for longer than three months; do not have a prior history of any other type of cancer; have finished postoperative chemotherapy and radiotherapy; had no postoperative complications, including wound infections, temporary bladder dysfunction, anastomosis leakage, bleeding, and ostomy complications; and are willing and able to provide information about the research questions.

You are eligible to participate in control group if:

You are a female; are 18 years or older; are in a relationship or married; read English; live in U.S.; not have a history of cancer; and are willing and able to provide information about the research questions.

Below is additional information on the study:

This study is not only for females with sexual dysfunction but also for females without any sexual dysfunction. You are encouraged to participate in this study if you feel interested in the study and are willing to provide information about the research questions.

Data will be collected by sending a packet consisting of an informed consent form, the set of questionnaires, and a $5 cash incentive and a tea bag of appreciation to your residence. If you are interested in the study, you can contact me by e-mail (chiachunli820@mail.utexas.edu) or phone (512-529-4527), and please tell me your mail address.

Your participation includes signing the informed consent form, completing the questionnaires, and returning them to me in the postage-paid envelope.

Risks to participants are considered minimal. All information about you will be kept confidential, and your name will not be connected with any information that you provide. Identification numbers associated with mail and e-mail addresses will be kept during the data collection phase for tracking purposes only.

Contact Information:
Chia-Chun Li, RN, MSN, Doctoral Candidate
The University of Texas at Austin, School of Nursing
4210 Red River #121
Austin, Texas 78751
E-mail address: chiachunli820@mail.utexas.edu
Telephone: 512-529-4527

Advisor: Lynn Rew, EdD, RN, AHN-BC, FAAN
The Denton & Louise Cooley and Family Centennial Professor
E-mail address: ellerew@mail.utexas.edu
Telephone: 512-471-7941

Readers at OBOB and on birth issues generally will know that the Wax meta-analysis on home birth generated much controversy and discussion about its methods, conclusions, and presentation, which Nature News summarizes in a recent story.

As a result of the high level of interest and debate, the American Journal of Obstetrics and Gynecology has allocated additional space to discussion of the paper, making letters to the editor, supplemental materials, and its editorial freely available to the general public for review, saying “There were a number of issues raised in the letters, many of which the panel believed were subjective and should be debated openly.”

The journal also convened a review panel to examine the paper, with the following outcomes as reported in the editorial:

…the results the panel found was slightly different from the result in the manuscript, although there was no difference in (1) the direction of the point estimate of the pooled odds ratio or (2) the overall “statistical significance” of the result. The panel made the following recommendations: (1) The Journal should publish online full summary graphs for each outcome that was assessed in the study, which will allow readers to assess the study findings better, and (2) no retraction of the article is necessary.

The editors themselves conclude, “It is clear that we need more rigorous and better designed research on this important safety issue of home birth, given the many confounding factors.”

The editorial page links to several of the letters to the editor, author replies, and supplementary data.

The supplementary materials from Wax et al, posted this February, thankfully include a type of forest plot for many of the outcomes, making it much easier to see and understand what the results were from each included paper for each variable than it was in the original publication.

by Nekose Wills | OBOS program assistant

The challenges girls face today are unlike the challenges many of us faced growing up. I’m 32, and I remember not caring about my Oscar the Grouch eyebrows, who designed my clothes, or how sexy I looked in them. Girls growing up today don’t have such freedom — they’re sexualized everywhere they look.

The SPARK Summit, held Oct. 21 at Hunter College in New York City, was an alarm, waking us up to the role we can play in bucking the status quo and giving us the tools to take on this fight. SPARK stands for Sexualization Protest: Action, Resistance, Knowledge.

The day started with opening remarks from Hunter College President Jennifer Raaband and MTV’s Amber Madison, summit host and author of “Hooking Up: A Girl’s All-Out Guide to Sex And Sexuality,” a book aimed at young women about sexual health, sexuality and relationships.

Feminist media critic Jean Kilbourne, creator of the groundbreaking “Killing Us Softly: Advertising’s Image of Women” film series, also spoke, followed by a keynote address from the actor Geena Davis. Perhaps best known for her role in the film “Thelma and Louise, ” Davis has long advocated for increasing and diversifying the presence of female characters in media aimed at children. Her presence was a welcomed reminder that not everyone in Hollywood accepts business as usual.

The SPARK Summit encouraged young women to find their voices. There were a number of workshops specifically geared toward self-expression, such as Street Theater, FlipCam Journalism, and Blogs Rock. Throughout the day, it was clear that girls are very cognizant about being sold images of who they should be, but they lack resources to actively combat those images.

Media literacy is the first step. Melissa Campbell who works on media literacy in San Francisco and founded the Manfattan Project (“real fashion, large bodies”), led the Hard-Core Media Literacy workshop. In other workshops, girls created radio spots, photography and art, and shared personal stories. They discussed topics such as street harassment and legislation that would fund media literacy and youth empowerment programs (H.R. 4925).

My favorite part of the day was the Numbers Don’t Lie panel, during which researchers presented findings on how media images and messages influence girls. Among them:

• Even in video games where women are strong, central characters, their sexualized appearance negates the effect of the character’s power — “Video Game Vixens: The Sexualization of Women and Girls in Video Games,” Elizabeth Behm-Morawitz (University of Missouri-Columbia)

• Black women are the most sexualized group in music videos. — “Sexualization in Popular Female Artists’ Music Videos: An Analysis of Race and Genre,” Jennifer Stevens Aubrey (University of Missouri-Columbia)

• Black youth consume more media than their white peers, but they are less affected by the body image ideals perpetuated — “A Woman’s Worth: How Media Use Shapes Black and White Teens’ Views of the Feminine Ideal,” L. Monique Ward (University of Michigan)

• When the media sexualizes female athletes, it negatively affects girls’ perceptions of themselves and of female athletes — “‘You Can Score With Me’: What Girls Think of Sexed-Up Media Images of Female Athletes,” Elizabeth Daniels (University of Oregon)

• Low grades can spur girls to participate more in their own sexualization — “High Heels, Low Grades? The Costs Associated With Sexualization,” Rebecca Bigler & Sarah McKenney (University of Texas, Austin)

• The attire of women and girls in G-rated movies is no different than portrayals in higher-rated movies — “General Audience or G-Porn? A Look at the Prevalence and Sexualization of Females in Film and Children’s Television programming,” Stacy Smith (University of Southern California)

I also learned that Barbie is still evil. One study — “‘I can be … Anything?’: Playing with Barbie Reduces Girls’ Career Aspirations,” by Aurora Sherman and Eileen Zurbriggen (Oregon State University and University of California, Santa Cruz) — found that playing with Barbie lessened girls’ perceptions of attainable occupations. It didn’t matter if girls played with Doctor Barbie — they still thought they could not achieve as much as when they played with Mrs. Potato Head.

The panel made me realize the extent to which girls are encouraged to see themselves as sexual objects — even girls as young as 3 can still be the toddler in a tiara.

We are told that if we just buy enough products, go on enough diets, and work hard to emulate airbrushed and Photoshopped images of girls and women, we might achieve perfection — and there’s something inherently wrong with us if we don’t dedicate ourselves to this quest. It’s time to take our sexy back.

There is nothing wrong with sexy as long as it is not forced on girls and as long as women get to define it on their own terms, not through the lens of a voyeuristic, paternalistic society.

My favorite quotes from the conference were “I am whole, not a ho!” “I am a quirky black girl and proud of it!” and, finally, “Freedom is never really won, you have to earn it in every generation.” We are trying to earn freedom for the well-being of today’s girls.

Years ago, I learned to disconnect from the constant onslaught of negative media images by consuming less. When I stopped watching music videos, especially the ones on BET, and stopped buying women’s magazines, I was much happier. There were less false images for me to compare myself with.

Those images were replaced by the women I saw on the train and on the street, who were in my life as three-dimensional people, with non-airbrushed photos and presences, with blemishes on their faces and extra fat rolls on their sides; real women, beautiful as the reality of an honest life.

The SPARK Summit was the reminder I needed that we can be who we are, with no apologies. We can replace the constant drumbeat of fake “perfection” with action, resistance and knowledge. And, most importantly, we need to have this dialogue on a continuing basis.

From the moment we put girls in front of a television, turn on the radio, drive past a billboard, or let them look at a magazine, we need to reinforce what it means to be beautiful, media literate, and critical of the world around us. I have a few young ladies I need to call.

by Karin Ringheim | Population Reference Bureau

A recent NPR story on the biological basis for the sometimes confrontational, erratic and seemingly irrational behavior of adolescents reminded me of my own experiences in raising adolescents (and gratitude that this particular stage of life is now behind me).

As Garrison Keillor recently reminded us, to be a parent is to live a life of constant silent prayer — prayer that everything will turn out all right. We know that adolescents don’t always exercise the best judgment, and now, at least, we have a better sense of why this is the case.

The Teen Brain – A Work In Progress

The physical evidence gathered from Magnetic Resonance Imaging (MRI), according to Harvard researchers Frances Jensen and David Urion, shows that the adolescent brain is only about 80 percent as developed as an adult brain.

In adolescence, the brain’s frontal lobe, responsible for such important functions as reasoning, planning and judgment, is not as well-connected to the rest of the brain by myelin, or “white matter,” as it is in an older individual. Because of the immaturity of their brains, adolescents are less capable than adults of rational thought processes.

White matter grows substantially over the course of adolescence, providing insulation that increasingly enables nerve signals to flow freely from one part of the brain to another. When the frontal lobe is fully connected to the rest of the brain, around age 25, the brain is more capable of “connecting the dots,” processing complex notions — such as that actions have consequences.

Brain development from age 5 to 20 / Source: Paul Thompson, professor of neurology, UCLA School of Medicine

Death and Disability Rates Double During Adolescence

If parents did not already intuit this, the difficulties that adolescents have in controlling their emotions and behaviors lead to a doubling in rates of death and disability during adolescence as compared to rates among younger children.

According to Ronald Dahl, Staunton Professor of Psychiatry and Pediatrics at the University of Pittsburgh Medical Center, increased risk-taking, sensation-seeking and reckless behavior lead adolescents to higher rates of traffic and other accidents, substance abuse, suicide, eating disorders, depression, violence and risky sexual behaviors.

Although Dahl does not promote a mechanistic view of biology as destiny, he does note that the life trajectories established in youth can have a major impact on later life, and it is best to alter these trajectories in a positive direction while one can.

Youth Reproductive Health: A Politically Charged Issue

Adolescents who become unintentionally pregnant or become infected with HIV are certainly in for a life-altering experience, and usually not one that will be advantageous.

For at least 15 years, reproductive health advocates have called for “youth friendly services” to enable youth who are, or intend to become sexually active, to obtain the information and services they need to remain healthy.

The concept of reproductive health services for adolescents has been, and remains politically controversial. In 2004, ideologues charged that the Global Health Conference [pdf], an international gathering of health professionals held annually in Washington D.C., would be a platform that year to advocate for youth reproductive health services, instigating a last-minute withdrawal of federal funding for the conference from the U.S. Department of Health and Human Services, the Centers for Disease Control (CDC) and the U.S. Agency for International Development (USAID).

While the conference proceeded with funding from other donors, the action had a chilling effect on some federal grantees, who swept their websites clean of any potentially damaging information. U.S. programs for youth in developing countries supported under the President’s Emergency Plan for AIDS Relief, PEPFAR, were firmly grounded in the “ABCs” — Abstain, Be faithful, use Condoms, even as domestic research showed that abstinence-only programs had no long-term health benefits.

Meanwhile, in some African countries, one in five young women is HIV positive and as many as one in two has been pregnant. In South Africa, 22 percent of young women attending antenatal care are both pregnant and HIV positive. These astounding statistics have largely been unmoved by the infusion of PEPFAR and other funding for proscriptive youth reproductive health information and services. And politically shaped policies in the United States help maintain pregnancy, birth and abortion rates among adolescents that are the highest in the developed world.

An Evidence-Based Practice

How should societies respond to the knowledge that adolescents may not be capable of obeying our pleas to “just say no,” “abstain until marriage,” or “always use a condom”?

Adolescents are capable of understanding, if not fully controlling, their own immature thought processes. They need realistic, truly “youth-friendly” tools and resources to help them make better decisions and remain healthy and safe.

If, based on brain research, adults come to view adolescence less as a period of self-centered disobedience and more as a period of innate vulnerability, we will do a better job of providing youth with comprehensive, compassionate services and education. We will do whatever we can to help them navigate this vulnerable period without becoming pregnant or HIV-positive, or undergoing an unsafely performed abortion, and if such outcomes occur, we will aim to minimize the harmful life-altering consequences.

Our obligation is to protect as best we can, those who by virtue of their not-fully-realized intellectual capacity, are less able than we previously assumed to look out for themselves.

Karin Ringheim, Ph.D., M.P.H., is a senior policy adviser at the Population Reference Bureau