Reading List: Anna Clark interviews Michelle Goldberg, author of “The Means of Reproduction: Sex, Power, and the Future of the World,” at Bitch magazine (and happy birthday to Anna’s blog, Isak!).

Kathryn Joyce, author of “Quiverfull: Inside the Christian Patriarchy Movement,”  talks with Religion Dispatches. An excerpt of her book can be read here.

Planting a Future: Melissa Harris Lacewell digs through the meaning of Michelle Obama planting the new White House vegetable garden. More historians, authors and gardeners weigh in at the Washington Post.

Plus: Sharkfu on nutrition, cost and Alice Waters; Mark Bittman on eating healthy, organic or not.

Dealing with the Recession: Over at Writes Like She Talks, Jill Miller Zimon put together a list of articles that provide perspective on the recession, job loss and the economic impact on women. At Women’s eNews, Mimi Abramovitz explains three new rules about jobless benefits in the stimulus package that will help women and correct a major gender bias.

Pregnant? Here’s a Pink Slip: “Last year the number of pregnancy-based discrimination charges filed with the E.E.O.C. was up nearly 50 percent from a decade earlier, to a total of 6,285. That number seems likely to rise even higher this year,” writes Lesley Alerman in The New York Times.

“Some employers are using the economy as a pretense for laying off just one person,” said Elizabeth Grossman, a lawyer for the Equal Employment Opportunity Commission. “And very often that person is pregnant or the oldest employee on staff. The economy may be the legitimate cause — or there may be discrimination.”

Tenn. Senate Passes Abortion Amendment: The Tennessee Senate passed a constitutional amendment that states in part, “nothing in Constitution of Tennessee secures or protects right to abortion or requires the funding of an abortion.”

Rachel writes: “Supporters keep insisting that the bill does not make abortion illegal, while not addressing the fact that if this ultimately succeeds (there are several more steps for this Constitutional amendment), it makes room for the numerous restrictions often supported by anti-choice folks — such as waiting periods, forced ultrasounds, required ‘informed consent’ scripts that are not medically accurate, and so on. It also makes room for an abortion ban in the event that national protections vanish.”

Meanwhile, “Illinois could be on the verge of passing one of the most progressive reproductive health bills, the Reproductive Health and Access Act, any state has seen in a long time,” writes Veronica Arreoloa. Here are the groups supporting  the bill. If you’re a resident of Illinois, contact your legislator and voice your support.

Cost of Domestic Abuse: Women who are abused by their partners spent 42 percent more on healthcare per year than non-abused women, according to a long-term study of more than 3,000 women published online in the journal Health Services Research.  The study, summarized in this press release, also found that the increased costs don’t end when the abuse does. Women who suffered physical abuse five or more years earlier still spent 19 percent more per year on health care than women who were never abused.

Recognition for the Rights of Persons with Disabilities: “We are living in a new era for persons with disabilities,’ writes Myra Kovary at On the Issues Magazine. The story details the Convention on the Rights of Persons with Disabilities, which was adopted by the General Assembly of the United Nations and has been signed by 50 nations so far.  The U.S. has yet to sign it, but President Barack Obama has said he will do so.

Facts of Life: Sarah Seltzer praises “the sex talk” on one of my favorite television shows, “Friday Night Lights,” and compares it to a conversation from over a decade ago on “My So-Called Life.”

More than half of the 48 baby shampoos, bubble baths and baby lotions analyzed in a recent laboratory test were found to contain formaldehyde and/or 1,4-dioxane, chemicals that have been linked to allergies and skin cancer.

The study was sponsored by the Campaign for Safe Cosmetics, a national coalition of nonprofit organizations focused on health and the environment. The full report, “No More Toxic Tub” (pdf), is available online. Among the findings:

• 17 out of 28 products tested – 61 percent – contained both formaldehyde and 1,4-dioxane.
• 23 out of 28 products – 82 percent – contained formaldehyde at levels ranging from 54 to 610 parts per million (ppm).
• 32 out of 48 products – 67 percent – contained 1,4-dioxane at levels ranging from 0.27 to 35 ppm.

Though the levels found were relatively low, the Campaign for Safe Cosmetics notes in this release “that babies may be exposed to several products at bath time, several times a week, in addition to other chemical exposures in the home and environment. Those small exposures add up and may contribute to later-life disease.”

Product labels do not disclose the chemicals because they’re contaminants (byproducts of the manufacturing process), not ingredients, and therefore are exempt from labeling laws.

Many of the products on the study list are  manufactured by Johnson & Johnson. The company released a statement, published in the Washington Post, noting that their “products meet or exceed the regulatory requirements in every country where they are sold.”

The European Union has banned 1,4-dioxane in personal care products, but the U.S. Food & Drug Administration has determined that trace amounts found in personal care products do not pose a threat. Health advocates are pushing for increased FDA regulation.

“The fact that we are bathing our kids in products contaminated with carcinogens shows how woefully out of date our cosmetics laws are and how urgently they need to be updated,” Rep. Jan Schakowsky (D-IL) told the Post. “The science has moved forward; now the FDA needs to catch up and be given the authority to protect the health of Americans.”

Sen. Dianne Feinstein (D-CA) said she will introduce legislation requiring stronger oversight of the cosmetics industry.

In an online discussion about safety limits on commercial products, Stacy Malkan, the study’s co-author and author of ” Not Just a Pretty Face: The Ugly Side of the Beauty Industry,” stressed that the purpose of the study was not to cause alarm but to point out that products advertised as “gentle” and “pure” may still contain contaminants.

Many companies are already reformulating products for markets with stricter regulation outside the United States. Our own safety standards need to be updated, said Malkan.

Current cosmetics laws in the U.S. were created in 1938 — they’re a bit outdated, to say the least! Scientists have learned a lot over the past few decades about the health risks of low dose chemical exposures, and the special vulnerabilities of children. Companies have also learned a lot about how to make high performance products without carcinogenic chemicals. I believe that shifting to cleaner product formulations will benefit the beauty industry in the long run, making them more competitive globally.

To get there, we need a smarter regulatory system that requires companies to remove chemicals that are known or highly suspected of causing cancer, reproductive harm or other health problems, and also requires them to fully disclose the ingredients in their products. In other words, we need a regulatory system that keeps companies honest and rewards the companies that are doing the best job of making the safest products. This will take an act of Congress. FDA currently does not have the authority to properly regulate cosmetics.

Plus: If you want to look up the products you use, the Environmental Working Group maintains a Skin Deep database with toxicity information on more than 42,000 products.

The March issue of the Guttmacher Institute’s journal, Perspectives on Sexual and Reproductive Health, includes a study on access to abortion [PDF] for incarcerated women in the United States, and found considerable variability in women’s access to these services.

The researchers sent surveys to correctional health providers across the country and asked questions about access to abortion, contraceptive counseling, and other women’s health issues, such as vaccine updates, STI screening, and mammography.

They received 286 responses; among the findings:

• 68% of respondents indicated women at their facility were allowed to obtain an elective abortion if they requested one.
• 54% percent of respondents who said yes reported that they also assist women in arranging an appointment for an abortion, and 88% replied that their facility arranges transportation for women seeking an elective abortion.
• 71% of providers counseled women about contraceptive options at some point during their incarceration.

The authors also note, perhaps unsurprisingly, that “By all of the measures we assessed, abortion appears to be more accessible to incarcerated women in states with predominantly Democratic or bipartisan legislatures than in states with Republican-controlled legislatures.”

A commentary [PDF] in the same issue of the journal by Diana Kasden of the ACLU Reproductive Freedom Project, points out that “even among respondents who indicated that their facilities do allow access to abortion, many said that women receive little or no logistical assistance in arranging, paying for and getting to the appointment,” and discusses the findings and related Constitutional issues.

Thanks to RaceWire for pointing to the study; author Michelle Chen comments on the study’s discussion of the obstacles incarcerated women have often faced in obtaining health care in their communities as well:

“Prison should not be a woman’s first opportunity to obtain quality medical care, though neither should it replicate the systemic problems that limited her opportunities on the outside. President Obama recently started redirecting federal family planning resources toward comprehensive clinical services and away from abstinence-only sex education programs. It remains to be seen whether some of the country’s least free women will see brighter prospects for reproductive freedom under the new administration.”

Last year, a measure passed that requires researchers who receive federal funding from the National Institutes of Health to abide by a public access policy and make their research papers available through PubMed Central, a free online archive of life and biomedical science journal literature.

As a result, much more literature medical research is expected to become available to the public (although much of it will become available only after 12 months have passed since publication). Librarians and consumer advocates have been among the champions of this policy because it will increase access to scientific and medical knowledge.

Last week, it was announced that this policy of access no longer needs to be renewed every year, making it more likely to succeed in providing the public with access to medical research funded by their tax dollars. Supporters of the policy, however, are currently fighting a legislative challenge from Rep. John Conyers (D-MI); it has been suggested that his and others’ opposition the public access policy may be related to political donations received from the publishing industry.

In addition to the individual articles to be made available through the public access policy, a number of journals are already available in full online as “open access” journals — journals which are freely available to the public “without financial or other barrier other than access to the internet itself.” In other words, you or your library do not need to pay for a subscription to access these titles.

Currently, BioMed Central seems to be the biggest publisher of open access medical journals. A complete list of BioMed Central journals is available online. A few that might be of particular interest to our readers:

• BMC Pregnancy and Childbirth
• BMC Women’s Health
• Breast Cancer Research
• Conflict and Health
• Globalization and Health
• International Breastfeeding Journal
• Reproductive Health

For more information on open access publishing (which is distinct from the NIH public access policy), check out this introduction and the fairly detailed Wikipedia entry.

Congress Considers Ban on BPA: Senate and House leaders on Friday said they would introduce bills establishing a federal ban on the chemical bisphenol A in all food and beverage containers. Meg Kissinger of the Milwaukee Journal Sentinel writes:

The move comes a day after Sunoco, the gas and chemical company, sent word to investors that it was now refusing to sell bisphenol A, commonly known as BPA, to companies for use in food and water containers for children younger than 3. Sunoco told investors it could not be certain of the compound’s safety. Last week, six baby bottle manufacturers, including Playtex and Gerber, announced that they would stop using BPA.

The bills would immediately outlaw the sale of all food and drink containers made with BPA. Anything on store shelves would have to be removed. It would suspend the manufacture of food packaged in containers that contain the chemical, but items already made could be sold.

For more information, check out the Journal Sentinel’s ongoing BPA investigation “Chemical Fallout,” at www.jsonline.com/chemicalfallout. Great reporting.

Tiller Trial Starts Monday: The L.A. Times previews the trial of Kansas abortion provider Dr. George Tiller, who faces charges stemming from late-term procedures, and the politics surrounding his prosecution.

Pregnant Inmates Denied Abortion Access: Writing at Feministing, Diana Kasdan, staff attorney for the ACLU Reproductive Freedom Project, discusses the limited access pregnant inmates have to abortion.

A new study, “Incarcerated Women and Abortion Provision: A Survey of Correctional Health Providers,” found that only 68 percent of respondents indicated that women in their facilities can obtain “elective” abortions. And a recent investigative piece in the Texas Observer reported, “For pregnant women in immigration detention facilities, it is virtually impossible to obtain an abortion.”

Racial Disparities and Breast Cancer: An article in the International Journal of Cancer points to high blood pressure as a cause for some of the disproportionately higher mortality rates among African American women with breast cancer compared with white women, reports Reuters. Hypertension explained 30.3 percent of racial disparity in “all-cause survival,’ as well as 20 percent of the racial disparity in breast cancer-specific survival. The study abstract is available online.

Dannon Goes rBGH-Free: As we reported earlier, General Mills, which makes Yoplait, agreed to stop using milk treated with artificial growth hormones in its yogurt. Now Dannon has followed suit. The decision makes economic sense: More than 200 hospitals around the country recently pledged to serve rBGH-free products to their patients, staff and visitors.

Writing about the move by both companies, Patty Fisher of the Mercury News notes that Yoplait never acknowledged any concern over rBGH and women’s health, despite promoting breast cancer awareness through yogurt sales. “The ‘rBGH-free’ label will be on the carton because it will sell yogurt. I guess that’s why the pink ribbon is there, too.”

New State Numbers: StateHealthFacts.org recently added new and updated data on Demographics and the Economy, Medicaid & CHIP, Medicare, Managed Care & Health Insurance, Providers & Service Use, Health Status and HIV/AIDS.

A list of all recent updates is available here. Statehealthfacts.org is part of the Henry J. Kaiser Family Foundation.

Plus: Utah, Hawaii and Wyoming top the nation in well-being in an analysis of more than 350,000 interviews conducted in 2008. Southern states West Virginia, Kentucky and Mississippi have the lowest well-being ratings, according to a new Gallup survey.

The Well-Being Index score for the nation and for each state is an average of six sub-indexes: life evaluation, healthy behaviors, work environment, physical health, emotional health and access to basic necessities.

National Women & Girls HIV/AIDS Awareness Day: March 10th was National Women and Girls HIV/AIDS Awareness Day. Here’s a great post by Veronica explaining why women and girls need to be the focus of an education and awareness effort.

Reproductive Health in Africa: North Carolina Public Radio reports on the high maternal mortality rate in Zambia, where the number of women who die during pregnancy or childbirth is 60 to 70 times higher than it is in the United States. As part of the series North Carolina Voices, Global Health Connections, Rose Hoban traveled to the Zambian capitol of Lusaka to spend time with health care workers who work with Ipas, a global nonprofit organization based in Chapel Hill that helps women get access to the full range of reproductive services.

Targeting Craigslist Over Prostitution: Cook County Sheriff Tom Dart filed a federal lawsuit against Craigslist, asking the website to remove its “erotic services” section, calling it a public nuisance that knowingly facilitates prostitution.

“At a news conference, the sheriff said his office has made hundreds of prostitution arrests, many of them based on ads found on Craigslist,” reports the Chicago Tribune. “But the sex-for-sale ads still proliferate on the site five months after Craigslist promised new safeguards to settle a nationwide lawsuit by the top state prosecutors from Illinois and 39 other states.”

Where Are the Female Coaches in Youth Sports?: University of Southern California sociologist Michael Messner has written a new book about the persistent gender divisions in youth sports, especially at the coaching level. He expands on his findings at Moms Team and shares tips from women coaches.

Overlooking Evidence: “When it comes to breast cancer, why is it so hard to get the most influential media to pay attention to the possibility that, in addition to better-understood risks, unnatural substances entering women’s bodies might also be a factor?” That’s the million-dollar question in this Fair! analysis on the surprising dearth of news coverage on environmental hazards and breast cancer. An excellent report by Miranda Spencer.

Skimping on Care: More than a third of people surveyed have skipped medical check-ups or dental visits over the past year due to concern over health care costs, and 27 percent have put off getting needed health care, according to the Kaiser Family Foundation’s first health care tracking poll of 2009.

Supreme Court: No Legal Shield in Drug Labeling: The Supreme Court on Wednesday ruled that people injured by drugs can sue the drug manufacturer in state courts, even if the drugs were approved by the Food and Drug Administration.

“The ruling could have significant implications beyond drug manufacturing,” writes Adam Liptak at The New York Times. “Many companies have sought tighter federal regulation in recent years in part to shield themselves from litigation.”

The case involved a Vermont woman, a musician, whose arm had to be amputated following an injection of the anti-nausea drug Phenergan. Levine sued the drug maker Wyeth because Wyeth had not changed the label indicating that one method of administering the drug had a small risk of error which caused irreversible gangrene. Nina Totenberg did a good report on the ruling. The NPR link also includes excerpts from the oral arguments heard last November.

Sunshine State Keeps Teens in the Dark: The Healthy Teens Campaign of Florida and the Sexuality Information and Education Council of the United States (SIECUS) have released a report on failed abstinence-only sex education programs in Florida’s public schools: “Sex Education in the Sunshine State: How Abstinence-Only-Until-Marriage Programs Are Keeping Florida’s Youth in the Dark” (pdf).

“[O]ur research has exposed both the state’s appalling indicators of poor outcomes for young people and the equally appalling nature of how abstinence-only-until-marriage programs have become pervasive throughout the state,” writes Adrienne Kimmell at RH Reality Check.

Him/Her/They: Elizabeth Landau at CNN reports on the history of the search for gender-neutral pronouns, an issue that has recently been taken up on Twitter. An interesting story.

On the Issues: Good reads in the On the Issues Magazine cafe, including Diana Whitten‘s look at Women on Waves, a Dutch organization that provides on-ship abortions in international waters for women from countries where it is illegal. Women on Waves recently won an important victory in the European Court of Human Rights. And don’t forget to check out the winter issue, which features stories on topics from ratifying CEDAW to Second Life.

Moving Reproductive Services Off-Site (Six Feet Away): From Women’s eNews: For more than a decade, a hospital merger in New York state was held up by abortion politics. Last week, community activists gathered for a ribbon-cutting ceremony marking their hard-fought compromise. Rebecca Harshbarger reports.

Plus: Emily Douglas points to this Albany Times Union op-ed on the implications of a possible merger between two secular hospitals and one religious hospital in Rensselaer County, New York. The merger raises questions about reproductive health care for patients and employee health insurance benefits, since Catholic directives prohibit coverage for contraception.

In Translation: Over at Sociological Images, a blog sponsored by the American Sociological Association, there’s been some debate over the English and Spanish versions of a pamphlet for pregnant women offered by Kaiser Permanente. Kaiser provides a response.

The Economic Future and Women’s Roles: The Chicago Foundation for Women looks at how the stimulus package affects women’s economic security.

Teaching Domestic Violence Victims Safe Use of Technology: Via this press release, I learned about a Washington state program designed to help victims of domestic violence by increasing their knowledge of how to use technology safely.

“Domestic violence is built around control, not anger, and an abusive partner often limits a woman’s access to information and support. Monitoring computer activity is one of many ways to control a spouse,” said Jerry Finn, a University of Washington Tacoma professor of social work who also evaluates the effectiveness of human services programs.

The training covers how to prevent such things as identity theft; concealing browser history; how to be safe in a chat room; how to set up an e-mail account without using a real name; and how to prevent being followed with a GPS device. What a smart idea.

Welcome Particle, Wave, Astarte and …: To apologize for the late Double Dose, I offer some cute overload, via feminist poet and performance artist Diana Tigerlily, who also raises goats.

Meet the newest ones — five in all, if my counting is correct. Makes me think two dogs and two cats may not be enough : )

Publicly Funded Family Planning Programs Make Sense: This new report (pdf) from the Guttmacher Institute on the essential role of family planning shows the pay-off: prevention of nearly 2 million unintended pregnancies and more than 800,000 abortions each year, saving billions of dollars.

“Report co-author Rachel Benson Gold called the family planning program ‘smart government at its best,’ asserting that every dollar spent on it saves taxpayers $4 in costs associated with unintended births to mothers eligible for Medicaid-funded natal care,” reports the AP.

Iran’s Women Are Taking On The Mullahs: “Iranian women, and not just the sporting queens or Nobel prize winners, are standing up to the mullahs. And some of them are experiencing a frightening political backlash,” writes Katherine Butler at The Independent. A strikingly good story, it provides an in-depth look at life in Iran. Grab a cup of coffee and settle in for this one.

Sex-Discrimination Suit at Boston Hospital: Dr. Sagun Tuli, a 39-year-old neurosurgeon, filed a lawsuit against her employer, Brigham and Women’s Hospital, and her boss, Dr. Arthur Day, the chairman of the neurosurgery, alleging a hostile work environment and retaliation against her when she complained.
After a seven-week trial, a jury agreed and awarded Tuli $1.6 million, reports the Boston Globe.

Read more analysis from Vanessa Merton at Feminist Law Professors.

Facts Matter Most: When you need to be reminded that kids today are (generally) all right, check in with Mike Males, a senior researcher for the Center on Juvenile and Criminal Justice in San Francisco who also heads up YouthFacts.org, which aims to debunk media myths, such as all girls are “girls gone wild.”

Star Tribune columnist Gail Rosenblum recently wrote about a lecture Males gave, sponsored by the University of Minnesota’s Konopka Institute for Best Practices in Adolescent Health, that separated fact from fiction.

Plus: Here’s a great response to the media coverage of Chris Brown & Rihanna, penned by Alex Pates, 15, and Ansheera Ace Hilliard, 17, members of the Chicago-based Females United for Action. FUFA is a youth group that works on issues of violence against women and media justice.

Beautiful Cervix Project: It took a headlamp and a lot of mojo, but photos of a cycling cervix are now available. From the author’s introduction: “I am a 25 year old woman who has never given birth.  My intention with this project was to better understand my cycle and the changes in my cervix throughout the month. As a doula and student midwife, I used this project to help me see how a cervix might look different throughout the cycle in the absence of vaginal infections and to understand speculum exams.”

Another Sign of the Financial Crisis: We know advertising standards have loosened over the years, but it took an economic downturn for some media outlets to let alcohol and sex ads go prime time, reports the L.A. Times.

Food/Access Studies: There’s new research out linking the availability of healthy food and the quality of one’s diet with place of residence. The studies, by researchers at the Johns Hopkins Bloomberg School of Public Health, appear in the March 2009 issue of the American Journal of Clinical Nutrition and the December 2008 issue of the American Journal of Preventive Medicine.

“Place of residence plays a larger role in dietary health than previously estimated,” said Manuel Franco, MD, PhD, and lead author of the studies, in this release. “Our findings show that participants who live in neighborhoods with low healthy food availability are at an increased risk of consuming a lower quality diet. We also found that 24 percent of the black participants lived in neighborhoods with a low availability of healthy food compared with 5 percent of white participants.”

Paging Mr. Whipple: A Toilet Paper Crisis: “The national obsession with soft paper has driven the growth of brands like Cottonelle Ultra, Quilted Northern Ultra and Charmin Ultra — which in 2008 alone increased its sales by 40 percent in some markets, according to Information Resources, Inc., a marketing research firm,” writes Leslie Kaufman at The New York Times.

“But fluffiness comes at a price: millions of trees harvested in North America and in Latin American countries, including some percentage of trees from rare old-growth forests in Canada. Although toilet tissue can be made at similar cost from recycled material, it is the fiber taken from standing trees that help give it that plush feel, and most large manufacturers rely on them.”

As Christine mentioned in her most recent Political Diagnosis, the recently passed stimulus bill includes $1.1 billion for comparative effectiveness research, which compares “the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions.”

Comparative effectiveness research is intended to inform medical decision-making. For example, it may ask whether an expensive new drug really works any better than an old, generic treatment, or whether it is enough of an improvement to justify the added cost. It may take the form of new clinical research, or of systematic reviews of the existing evidence. As respected medical blogger Kevin, MD explains regarding the value of this type of research:

Physicians need an authoritative source of unbiased data, untainted by the influence of drug companies and device manufacturers. With treatments and medications announced daily, having an entity definitively compare these newer, and often more expensive, options with established treatment regimens will be particularly useful in everyday practice.

The only way to tackle such a huge project is with money, and indeed, the Obama administration recognizes this fact by including $1.1 billion in comparative effectiveness research in the economic stimulus package.

Kevin also notes the source of some objections to this type of research:

“The pharmaceutical and device industry would like both the public and physicians to continue to assume that ‘newer means better.’ Not asking these questions allows them to continue promoting profit-making brand-name treatments.”

Indeed, a Wall Street Journal piece published prior to the passage of the stimulus bill suggested that drug and medical-device industries were “mobilizing to gut” the provision. Others critics have suggested that the funds will result in the government mandating or withholding medical treatments; the conference report on the stimulus bill, however, specifically states that a Federal Coordinating Council for Comparative Effectiveness Research will be created to coordinate the efforts, and that:

“…nothing shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer. Further, the conference agreement includes language to clarify that none of the reports submitted or recommendations made by the Council shall be construed as mandates or clinical guidelines for payment, coverage, or treatment.”

As the New York Times noted in their coverage of the funding, supporters of the provision include “Consumer groups, labor unions, large employers and pharmacy benefit managers,” who expect the research to “fill gaps in the evidence available to doctors and patients.”

For resources related to evidence-based medicine, systematic reviews, and comparative effectiveness, see:

• The Agency for Healthcare Research and Quality – includes a section specific to women
• The Cochrane Library – their new and updated reviews currently include a number of topics relevant to women’s health, such as those on treatments for lactation suppression and Chinese herbal medicine for PMS.
• The Comparative Effectiveness Resource Center of the ECRI Institute
• The US Cochrane Center’s online tutorial on understanding evidence-based medicine (which we covered last month)
• The Centre for Evidence-Based Medicine

Full disclosure: one project I contribute to in my daily work is funded through the AHRQ, an agency which will receive some of the comparative effectiveness dollars included in the stimulus package.

Searching for Common Ground: Robert Pear of The New York Times reports on an apparent consensus emerging among key players in the health care debate:

Many of the parties, from big insurance companies to lobbyists for consumers, doctors, hospitals and pharmaceutical companies, are embracing the idea that comprehensive health care legislation should include a requirement that every American carry insurance.

While not all industry groups are in complete agreement, there is enough of a consensus, according to people who have attended the meetings, that they have begun to tackle the next steps: how to enforce the requirement for everyone to have health insurance; how to make insurance affordable to the uninsured; and whether to require employers to help buy coverage for their employees.

Health Care “Reform” is Not Enough: “Most current health care reform initiatives, including those of Barack Obama, focus on providing wider access to health insurance. They do little to address the underlying problems with our health care system,” writes Susan Yanow in On The Issues magazine. Yanow identifies the top five problem areas for women with our insurance-driven health system.

Plus: This list of 10 ways to spend less on health care during a recession is well-meaning, but the list assumes a level of privilege that leaves out millions. I keep thinking of this story from last week.

“Is Your Daughter Safe at Work?”: The PBS program NOW has collaborated with the Schuster Institute for Investigative Journalism at Brandeis University on an unprecedented broadcast investigation of teen sexual harassment in the workplace. Check your local PBS station schedule for air dates.

The NOW website has a terrific collection of useful links and resources, as does the Schuster Institute, including an interactive map with links to information about specific teen sexual harassment cases gone to court. Keep in mind the map reflects a tiny proportion of probable cases. Kudos to EJ Graff for kicking off this project with her article, “Is Your Daughter Safe at Work?,” published in Good Housekeeping in June 2007.

The Trouble With Repeat Cesareans: “Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them,” writes Pamela Paul at Time magazine. “More than 9 out of 10 births following a C-section are now surgical deliveries, proving that ‘once a cesarean, always a cesarean’ — an axiom thought to be outmoded in the 1990s — is alive and kicking.” A good look at the VBAC-lash.

North Dakota House Passes Egg-as-Person Bill: “On Tuesday, one body of North Dakota’s state legislature voted, 51-41, not only to ban abortion, but to define life as beginning at conception. Such a measure, considered extreme even by pro-life standards, would have far-reaching consequences on women’s health,” writes Kay Steiger at RH Reality Check.

Understandably, Rachel Has Some Concerns …: About a proposed Tennessee bill that calls for testing some pregnant for alcohol and drugs.

Gone Daddy Gone: I couldn’t agree more with Creativity magazine editor Teressa Lezzi, who writes at AdAge.com:

After this year’s Super Bowl, I just couldn’t do it anymore. As it was, any time I had to log on to Go Daddy I felt some combination of embarrassment and annoyance at the registrar’s approach to women and marketing. But after its execrable ad efforts around this year’s game, I found that I just couldn’t stomach contributing anything to this organization any longer. I’m transferring my domains and my insignificant little piece of business elsewhere.

GoDaddy turned me off years ago because of its super lame ads, though I sometimes have to deal with the company for other clients. If sexist advertising isn’t reason enough to stay away, GoDaddy’s user interface sucks.

Cervical Cancer Vaccine Usage in California: A study by UCLA’s Center for Health Policy Research found that one in four teenage girls in California  — about 378,000 out of 1.5 million — received at least one dose of the Gardasil vaccine in 2007, its first full year of distribution, reports the L.A. Times.

Truth Catches Up: Remember the eye-catching “truth” anti-smoking ads? Researchers at the Johns Hopkins Bloomberg School of Public Health and the American Legacy Foundation estimate that the nations’ largest youth smoking prevention campaign saved $1.9 billion or more in health care costs associated with tobacco use. The findings appear in the Feb. 12 online edition of the American Journal of Preventive Medicine. The American Legacy Foundation, which launched the ads in 2000, spent $324 million to implement and evaluate the truth campaign.

Plus: Cigarette-maker Philip Morris was ordered to pay $8 million in damages to the widow of a smoker who died of lung cancer in a case that could set the standard for 8,000 similar Florida lawsuits, reports NPR.

When it comes to the politics of women’s health, there’s more common ground than might be expected, according to a new national opinion survey sponsored by the National Women’s Law Center and the YWCA USA.

“The survey of 1,000 Republican and Independent voters conducted by Public Strategies, Inc. found that Republicans, and to an even greater degree Independents, support a range of legislative proposals to make contraception more affordable and accessible,” according to the release. Among the findings:

• Nearly three-quarters (72%) of Republicans and Independents favor legislation that would make it easier for people at all income levels to obtain contraception, and 70 percent favor legislation that would help make birth control more affordable. More than 60 percent of fundamentalist/evangelical Protestants favor these proposals.
• Only 2 percent of Republicans and Independents would like to see government restrict access to contraception. A majority (64%) would like to see government provide more information about contraception, and 33 percent would prefer that the government play no role.
• A strong majority of Independents (67%) and nearly half of Republicans (49%) have a favorable opinion of emergency contraception.

View more of the survey concerning attitudes toward sex education, pharmacy refusals and abortion.

I haven’t seen the questions, but I was a bit surprised to read that “only 8 percent of Republicans and Independents think the government should support abstinence-only education.” The percentage of Independents and Republicans who support comprehensive sex education programs was a less enthusiastic 76 percent and 62 percent, respectively, but those numbers are still higher than I would have guessed.

Plus: Abstinence-only education programs were funded to the tune of $175 million per year under the Bush administration. Has its golden age come to end? The Economist ponders the fate of abstinence-only education under a new administration and Congress.

Chemicals in Toyland: The Consumer Product Safety Improvement Act (CPSIA) took effect this week, mandating stricter enforcement of lead and phtalates in children’s products and toys.

“While the ban was hailed as a victory for children’s health, it’s no guarantee that the products are safe,” reports NPR’s “Morning Edition.” “That’s because companies currently aren’t required to publicly disclose the chemicals they use in place of phthalates — and little is known about the health effects of one of the most widely used alternatives.”

Pthalates have been shown to affect the development of the male reproductive system in lab animals. They’re also present in some cosmetics, personal care products, pharmaceuticals, food packaging and cleaning and building materials — making them almost impossible to avoid. Check out NPR’s timeline of phthalate regulation and an interactive look at chemicals in the home.

IVF – New Lab for Studies: “In addition to helping thousands of infertile couples have children, ‘test tube’ babies are offering scientists a novel laboratory for resolving one of the most vexing debates in science: nature vs. nurture,” writes Rob Stein in the Washington Post.

In the first study of its kind, British researchers have studied children conceived through in vitro fertilization (IVF) to examine whether children whose mothers smoked during pregnancy were more likely to develop behavioral problems because of the toxic effects of smoking — as has been suspected — or because their mothers passed on a genetic predisposition to antisocial behavior.

The study, which appears to debunk the notion that smoking’s effects on the brain of a developing fetus result in antisocial tendencies, could be the first in a series of attempts to use the approach to disentangle whether genes or various prenatal exposures are responsible for later behavioral problems.

Friends Don’t Let Friends Get “Booty” Injections: And definitely not from a woman who administers shots without a medical license. Two women are now hospitalized in critical condition in Tampa, Fla. “It almost is bootleg cosmetology here,” said sheriff’s office spokesman JD Callaway.

Plus: The economy is having some effect on cosmetic enhancements, reports The New York Times. Natasha Singer writes that doctors and pharmaceutical executives thought antiwrinkle shots like Botox would be resistant to the downturn, but the latest earnings report from Allergan, the maker of Botox, fell almost 9 percent compared with a year earlier. Allergan’s sales of breast implants were down 12 percent.

“You could forecast that with implants, but the bigger question was, ‘How have injectables been holding up?’” said Gary Nachman, an analyst with Leerink Swann, a health care investment bank. “Now, even the injectables have been impacted significantly.”

Maternal & Child Health in the Obama Administration: “[...] President Obama has lauded and pledged to expand presidential initiatives to fight HIV/AIDS, TB and malaria — recognizing the sizeable effect they have had not only in saving hundreds of thousands of lives, but also in improving U.S. foreign policy. Now is the time for President Obama to elevate the issue of global family health to that high level,” argues Maurice Middleberg, vice president for public policy at the Global Health Council.

Council members, including global maternal health, child health and family planning organizations, are developing a framework for a Global Family Health Action Plan.

On Their Own Terms: “[B]etween the clinic demonstrations, the political discussions and the imprecations from the pulpit, too many American women have come to feel that their pelvis is public property. Slowly, quietly, a new abortion method has become part of the landscape, and it’s no accident that those women who have chosen it often cite reclaiming privacy and control as the reason,” writes Anna Quindlen at Newsweek, describing how RU-486 has allowed women to keep abortion private and personal.

Plus: Glamour magazine recently featured a whole section on abortion, acknowledging that one in three women will have at least one abortion by age 45. Eight women share their personal stories.

Salma Hayek Sparks Breastfeeding Discussions: By now you’ve probably heard about Salma Hayek breastfeeding an infant in Sierra Leone. ABC’s “Nightline” filmed Hayek during a trip to Africa to spotlight efforts to eliminate tetanus through vaccinations. The infant’s mother had no milk, so Hayek did what came naturally. Tracy Clark Flory nicely sums up some of the respectful and sophmoric public reactions.

Hayek, who is still breastfeeding her 1-year-old daughter, said, “I actually think my baby would be very proud to share her milk. And when she grows up I’m going to make sure she continues to be a generous, caring person.” Read more reactions and more about Hayek’s journey. The full “Nightline” episode is quite moving.

Happy Valentine’s Day: Some feminist advice from RH Reality Check. Plus, researchers at the University of Iowa report on what college-age men and women are looking for in a mate and how priorities have changed since the 1930s. While it’s nice to see that “chastity” is no longer an important characteristic, I’m surprised “similar political background” is considered unimportant as well.

And here’s the best act of defiance I’ve seen mentioned for Valentine’s Day — members of the Facebook group “A Consortium of Pub-going, Loose and Forward Women” are encouraged to “Join us on Feb. 14, Valentine’s Day, the day on which Indian women’s virginity and honor will self-destruct unless they marry or tie a rakhi. Walk to the nearest pub and buy a drink. Raise a toast to the Sri Ram Sene.” Swati Prasad explains the rebellion against the right-wing Sri Ram Sene.

When women have an abnormal mammogram and a biopsy is recommended, there are two basic options – a needle biopsy in which a sample is collected via a needle, or an open, surgical biopsy in which an incision is made and part or all of the tissue of interest is removed. Not surprisingly, surgical biopsies generally require a longer recovery time and can result in more complications, such as scar tissue that may interfere with future breast imaging.

In a study published in the January 2009 issue of the Journal of the American College of Surgeons, “Quality Assurance Initiative at One Institution for Minimally Invasive Breast Biopsy as the Initial Diagnostic Technique,” researchers looked at every patient undergoing a surgical biopsy for benign or malignant disease at a single teaching hospital during 7 months in 2007. While some of these biopsies were performed to treat malignancies, the study focused on diagnostic surgical biopsies, performed to determine whether or not the sample tissue was cancerous.

The authors note that their study took place after the American College of Surgeons Consensus Conference and the American Society of Breast Surgeons issued statements supporting diagnosis prior to (instead of through) surgery and encouraging minimally invasive biopsies – i.e. needle biopsies – whenever possible.

Despite these recommendations, the authors found that fully 36% of the surgical biopsies performed in the study were for initial diagnosis.

In a commentary in the same issue of the journal, surgeon Melvin J. Silverstein asks, “Where’s the outrage?” and reminds his colleagues that “the operating room is for treatment, not diagnosis.” Silverstein explains that “open diagnostic biopsies only add unnecessary costs to our already overburdened and compromised health care delivery system and much inconvenience, morbidity, and scarring for the individual patient.”

Maryann Napoli, of the Center for Medical Consumers, conducted an interview with Dr. Silverstein for the February issue of their HealthFacts newsletter. In it, Silverstein suggests that many surgeons may do invasive surgical biopsies because they simply don’t know how to do the less invasive needle biopsies, and offers other insight into the breast biopsy “market.” He also calls the nearly 40% surgical biopsy rate of the study “outrageous” and proclaims, “Once women all over America know about this, that number will drop precipitously.”

The Center for Medical Consumers also interviewed study co-author Susan K. Boolbol, who reinforced the idea that women need to be educated about this issue, and also “need to ask the question: Is there another way to do the biopsy?”

What I Learned From Breast Cancer Memoirs: “Breast cancer memoirs have become such staples — reliably displayed during Let’s Wave Pink Ribbons for Breast Cancer month — that it’s hard to remember a time when women didn’t document their journey from onset through the catalog of treatments to restored health, stabilization, or imminent death. But it wasn’t always thus,” writes S.L. Wisenberg in the Chicago Reader.

She continues:

True, British author Fanny Burney wrote to her family about the agonizing mastectomy she underwent — without anesthetic — in 1811. And Katharine Lee Bates (whose poem “America the Beautiful” became the famous hymn) wrote to friends in 1915 about her partner’s breast cancer and death. But neither of these works was published in the author’s lifetime. It was only after World War II that prominent American women went public with their tumors. Marion Flexner, wife of a well-known doctor, wrote “Cancer — I’ve Had It” for Ladies’ Home Journal in May 1947, breaking a taboo by refusing to euphemize her condition — and even inserting a little slapstick with a passage describing “roving boozies”: prosthetic breasts that escaped the confines of a bra and fell to the floor.

It’s a terrific essay, and it makes this reader eager to read Wisenberg’s own story, “The Adventures of Cancer Bitch,” due out in March from University of Iowa Press. In the meantime, visit her blog.

Healthcare Overhaul: “Mindful of how delays sapped the political will to overhaul healthcare during the Clinton administration, health advocates hoped to get a major bill during the new administration’s first 100 days,” reports the Boston Globe. “Now, it looks like it will take longer, and some observers fear that a historic opportunity could be missed.”

Family Planning Nursing Program Saved in Washington: “A campaign by Planned Parenthood to save a program that provides family-planning services in welfare offices has apparently worked, for now,” reports the Yakima Herald. “The Community Service Office (CSO) Family Planning Nurse program, which houses 70 nurses statewide at 58 Department of Social and Health Services offices, will stay open through June. Previously, DSHS planned to shut down the service Jan. 30.”

Split Over Abortion-Reduction Tactics: “The election of a pro-choice administration and a Democratic Congress has divided the pro-life movement, between those who are preparing for the fight of their lives and those who see an opportunity to redefine what it means to be pro-life,” reports Newsweek.

Plus: Red Sex, Blue Sex: Back in November, The New Yorker looked at another type of divide:

During the campaign, the media has largely respected calls to treat Bristol Palin’s pregnancy as a private matter. But the reactions to it have exposed a cultural rift that mirrors America’s dominant political divide. Social liberals in the country’s “blue states” tend to support sex education and are not particularly troubled by the idea that many teen-agers have sex before marriage, but would regard a teen-age daughter’s pregnancy as devastating news. And the social conservatives in “red states” generally advocate abstinence-only education and denounce sex before marriage, but are relatively unruffled if a teen-ager becomes pregnant, as long as she doesn’t choose to have an abortion. A handful of social scientists and family-law scholars have recently begun looking closely at this split.

What About …: The delivery of octuplets in Los Angeles this week raised many questions, including: Can a woman breastfeed eight children?

Lawsuit Takes on Higher Insurance Rates for Women: “California insurers are discriminating against women, charging them more for individual health insurance than men, the city of San Francisco maintained in a lawsuit filed Tuesday against the state regulators who govern them,” reports the L.A. Times.

Gender rating is health insurance is also the focus of two bills have been introduced in the California state Legislature to address the issue. If either of the bills is signed into law, the suit may be dropped.

Study Says Common Chemicals May Affect Fertility: HealthDay News reports on a study that suggests chemicals known as perfluorinated chemicals, which are pervasive in food packaging, pesticides, clothing, upholstery, carpets and personal care products, may delay pregnancy. The study appears in the Jan. 29 edition of Human Reproduction and is available online.

These chemicals are being phased out in the United States because of their toxic effects, and are expected to be completely gone by 2010. However, they remain in the environment and in the body for decades, and have been linked to developmental problems.

“These widespread chemicals apparently lower the fertility in couples trying to get pregnant,” said lead researcher Dr. Jorn Olsen, chairman of the Department of Epidemiology at UCLA’s School of Public Health.

Danish women in the study who had with high levels of perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) took longer to get pregnant, Olsen said.

It’s no secret that the United States has parental leave policies that are far less generous than most other nations, standing almost alone in offering no paid leave during or after a pregnancy.

Two new studies of maternity leave suggest reduced odds of a c-section and higher rates of breastfeeding when women take leave before and after birth. From the Juggling Work and Life During Pregnancy study of maternity leave and pregnancy outcomes, pregnant adult women from three counties in Southern California were interviewed at some point after delivery about work and family stress, maternity leave, birth outcomes, breastfeeding, and other details.

The first paper, from the Jan/Feb issue of the journal Women’s Health Issues, looks at women from the larger study population who worked full time and were eligible for California’s antenatal leave benefit after 35 weeks of pregnancy. The authors found that only 15% of workers took the paid pre-delivery leave for which they were eligible, and that women who took leave prior to delivery “had almost 4 times lower odds of a primary cesarean delivery as women who continued working.”

The authors note that further investigation is required to explain this different in outcomes. They looked at factors such as adequate sleep, occupation, income, and education, but did not find differences there that would explain their findings.

The second study, in the January issue of Pediatrics, reports on women’s responses to questions about whether they ever breastfed or pumped breast milk and when they stopped, if they had. The authors attempted to determine whether antenatal or postnatal leave was associated with establishing breastfeeding.

Not surprisingly, the authors found that “Mothers who returned to work within 12 weeks after delivery, and especially within 6 weeks, were less likely to establish breastfeeding than those who took longer leaves or who had not returned to work at time of the interview.” They also report that “having a manager position, autonomous position, or flexible work schedule was associated with longer breastfeeding duration.” Given the barriers to breastfeeding that working women face, especially in certain types of jobs, these findings are not terribly unexpected.

The design and statistics of these two studies are a bit complicated and perhaps worthy of additional critique – the authors themselves suggest cautious interpretation and further study. However, they certainly point in an interesting direction with regard to potential benefits – expected and unexpected – of maternity leave.

As the rate of caesarean sections has risen — to more than 31 percent of all births as of 2006, up from 21 percent a decade earlier — researchers have begun to look more closely at what more surgical births means for the health of mothers and infants.

A study we discussed earlier this month found that early, elective caesarean surgeries scheduled before 39 weeks of pregnancy can be harmful to a baby’s health.

And now a new study published in the February issue of Obstetrics & Gynecology paints a worrisome though incomplete picture concerning health complications in mothers who undergo c-sections.

Less than 1 percent of women giving birth experience severe complications, but the rate has increased between 1998, when it was 0.64 percent, and 2005, when it was 0.81 percent. Researchers examined hospital discharges nationwide and discovered an increase in the rates of kidney failure, respiratory distress syndrome, shock and ventilator use associated with childbirth.

While the study was not designed to determine the cause, Dr. Susan Meikle, study co-author and medical officer at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said some complications may be associated with the rising rate of c-sections. Rising maternal age was not found to be a factor.

“We could do a better job at tracking these complications,” Meikle told USA Today. “There may be short-term trade-offs and long-term trade-offs (depending on mode of delivery). We don’t know that yet.”

HealthDay News breaks down the numbers:

The biggest jump occurred in the need for blood transfusions, which went up by 92 percent. The next biggest increase was in pulmonary embolism, which increased 52 percent during the study period.

“Pulmonary embolism is a complication associated with any type of surgery, and it’s a high contributor to maternal mortality,” Meikle said.

The percentage of women in respiratory distress after delivery jumped by 26 percent, and the rate of women who needed mechanical ventilation went up by 21 percent. The rate of women with kidney failure after delivery increased by 21 percent during the study period.

“It was just amazing the consistency .ƒ.. from vaginal delivery, where the rates were lowest, to repeat Caesareans, where we saw an increase, to primary Caesarean delivery, where the increases were the highest,” Meikle told the Chicago Tribune.

Researchers don’t know why the c-sections were performed — including whether they were elective — or if the mothers were sick beforehand. They also lacked data on race and whether the women were overweight.

“This is an interesting study, but the database isn’t complete,” Dr. Robert Welch, chairman of obstetrics and gynecology at Providence Hospital in Southfield, Mich., told HealthDay News, adding that the study highlights that the risks of c-sections “sometimes get downplayed. It’s often taken as just a step above natural childbirth, but it is a major abdominal operation that needs to be respected, and hospitals need to be prepared to deal with severe complications.”

Plus: Citizens for Midwifery points to a BBC article about the rising rates of induction in the UK, particularly in Scotland, and concerns that pregnant women are being induced “unnecessarily.” Researchers looking at a Scottish audit of 17,000 births could not find a medical or other explanation for the procedure in more than one quarter of the cases.