According to the CDC, in 2009, 98.9 percent of all U.S. births were in hospitals, while only 1.1 percent took place elsewhere.

Many women, however, wish to give birth in an environment that is more homelike, or want to reduce their likelihood of experiencing many of the interventions that have become very common in hospitals, such as continuous electronic fetal monitoring, induction of labor, and cesarean section.

Of the non-hospital births documented in 2009, 27.6 percent (just over 12,000 births) took place in freestanding birth centers – an option for women interested in giving birth with trained professionals outside of hospital obstetrics units. At birth centers, midwives generally provided prenatal, birth and postpartum care.

Now, there’s a large new study showing that birth centers are a safe option for both mothers and babies, reaffirming safety findings from previous research.

The study, published in the Journal of Midwifery & Women’s Health, looked at data from U.S. birth centers to assess outcomes for women and babies, including the need for a hospital transfer, mode of birth, complications, and deaths from 2007 through 2010.

The study is referred to as the National Birth Study II (NBSII); the research is an update of the National Birth Center Study conducted by Judith Rooks and colleagues and published in 1989.

The study gathered data from member organizations of the American Association of Birth Centers; 79 birth centers took part, with 59 of those sending data for the complete study period. The analysis included 15,574 women who planned and were eligible for a birth center birth at the onset of labor.

What does “eligible” mean in this context? Pregnancies considered medically low-risk: single-baby deliveries; pregnancies that went to full-term; and no breeches or medical/obstetric risk factors that required cesarean, continuous electronic fetal monitory, or labor induction.

Among the findings:

• Of the women admitted to the birth center in labor, 87.6 percent did give birth there. The rest (12.4 percent) were transferred to the hospital. Most of the transfers were considered non-emergencies and occurred because of prolonged labor or arrest of labor. Just 1.9 percent of women or newborns required emergency transfer. Women who had never given birth before accounted for most (81.6 percent) of the transfers.
• A few women (4.5 percent) planned to give birth at a center but were not able to, for issues such as breech, premature membrane rupture, or the woman’s choice.
• Most of the births (92.3 percent) for all women who planned a birth center birth were head-first, spontaneous vaginal births. The mode of birth data includes women who transferred to a hospital as well — 1.2 percent ended up with an assisted vacuum or forceps birth, and 6.1 percent ended up having a cesarean birth.
• There were no maternal deaths.
• Women can mostly expect care from Certified Nurse-Midwives at AABC birth centers. Most of the care providers in the study were CNMs (80 percent, in 63 of the birth centers); Certified Professional Midwives or Licensed Midwives provided care in 11 of the centers (14 percent). In five of the centers, care was delivered by mixed teams of these providers.

There are some things the study can’t tell us, such as the outcomes at non-AABC birth centers and at AABC centers that don’t report their data to the AABC registry, and outcomes for women attempting vaginal birth after a prior cesarean (because most birth centers do not support it).

The NBSII study found a rate of 6.1 percent for cesareans. The authors looked at the cost savings related to reducing cesareans, and conclude, “Had this same group of 15,574 low-risk women been cared for in a hospital, an additional 2,934 cesarean births could be expected.”

They base this comparison on national rates of cesareans in low-risk women, currently reported at 26.5 percent (derived from data reported on birth certificates).

“Given the increased payments for facility services for cesarean birth compared with vaginal birth in the hospital,” the researchers wrote, “the lower cesarean birth rate potentially saved an additional $4,487,524. In total, one could expect a potential savings in costs for facility services of more than $30 million for these 15,574 births.”

I had some questions about whether the 26.5 percent figure was the best comparison group (versus older data with a lower rate), so I emailed the study authors, who responded: “It is not a perfect comparison, because this pool of low-risk women from birth certificate data may not be as stringently selected as women screened for birth center eligibility. But it is the best estimate we have for low-risk women being cared for in hospitals.” [We can discuss this issue in more detail in the comments if anyone is interested.]

Without a perfect comparison, we can still safely assume that the rate of cesarean is pretty low for women who qualify for AABC birth center births. It’s also fair to assume that very few women at AABC birth centers require emergency transfer to a hospital, and that the vast majority (almost 80 percent) of women who qualify for birth center care do end up giving birth there and being discharged to home.

There were no maternal deaths recorded in the study, and low fetal/neonatal death rates — the researchers found an intrapartum fetal mortality rate for women who were admitted to the birth center in labor of 0.47/1,000, and a neonatal mortality rate excluding lethal anomalies of 0.40/1,000. From this, we can conclude that AABC birth centers are a reasonably safe choice for low-risk women.

On Feb. 13, the American Association of Birth Centers and the American College of Nurse-Midwives are holding a Congressional briefing focused on the role of midwives and birth centers in potentially affecting health care costs and outcomes (such as cesarean rates). More information and registration are available here.

For more information, here a Q&A about the study. Visit Science & Sensibility for an interview with one of the study’s authors.

Plus: “It took more than two decades of labor,” writes Julie Deardorff in the Chicago Tribune, “but Illinois is finally poised to permit its first free-standing birth center, an alternative model of care for low-risk pregnant women who want to deliver in a homey environment with a reduced chance of medical interventions.”

Read about the pilot program and steps supporters took, along with the Illinois Department of Public Health, to negotiate with hospitals and doctors.

Taleen K. Moughamian, a women’s health nurse practitioner in Philadelphia, traveled to Armenia in the fall of 2012. Working with the Children of Armenia Fund, she conducted  health exams, including breast and cervical cancer screenings, and provided contraceptive counseling. The following account is based on her work and conversations with Armenian women.

by Taleen K. Moughamian

The differences between Armenia’s capital, Yerevan, and the rest of the country are vast. While Yerevan has most of the modern-day conveniences you could ask for, the villages I visited in the Armavir region have populations between 300 and 1,000, mostly comprised of women.

Their husbands have gone –- off to neighboring countries, especially Russia, to find work. They usually stay away for 10 months out of the year. Some men have even started new families in their work countries.

It was not uncommon to meet women who needed to be treated for sexually transmitted infections (STIs) because their husbands are having extra marital affairs while abroad. They are upfront about this, though it surprised me how openly they talked about it.

I heard so many of them say, “They are men. They have needs. What can we do?”

This has created a huge problem and is one of the reasons why STIs, including HIV, are on the rise in Armenia.

There is limited access to effective contraception, so the rate of abortion, which is legal up to 12 weeks, is high. Most of the women who seek an abortion are married, already have two or three children, and do not feel they can provide for a larger family.

Sex-Selective Abortions
For some women, this means having three or four or even 15 abortions over the course of their lives as they struggle to create a family they can support. The median number of abortions for women over 40 is eight, according to a 1995 study conducted at a Yerevan abortion clinic.

Sex-selection has also become a huge issue. Since women leave their homes and join their husband’s family after marriage, a son provides a source of security for his parents. I met so many women who have had multiple abortions because the sex of the child was not what they had wished; for more data, see this UNFPA report on sex selection in Armenia and this story in The Armenian Weekly.

If you look at recent family planning data, it appears the number of abortions is going down, but from what I observed, that is not necessarily the case. Rather, more abortions are going unreported.

Rise in Unsupervised Abortions
Women are using an over-the-counter medication called Cytotec (the brand name for misoprostol) to induce abortions at home without the supervision of a trained medical professional. Cytotec’s indication is to treat ulcers, but it also acts as an abortifacient. Fifty cents worth of Cytotec can induce an abortion, whereas a surgical abortion usually costs about $35-$50.

When used properly, Cytotec is very safe, even without clinical supervision. But it is most effective when used in combination with a second drug, mifepristone (see more on this below).

Women in the villages I visited were not familiar with the World Health Organization guidelines now used by women all over the world. (Note: Women on Waves offers guidance, based on the WHO research, on how to do an abortion with pills.)

Many Armenian women are therefore in a dangerous situation, as they are using Cytotec without the relevant information about its efficacy or side effects, which can range from an incomplete abortion to bleeding to death.

Barriers to Contraception
As part of my work with the Children of Armenia Fund (COAF), I counseled women on birth control options. This has been quite a challenge, as there are so many myths surrounding birth control, and it’s expensive for rural women. One pack of birth control pills costs about $15-20 a month in Armenia. For a village family barely making $100 a month, it is completely unaffordable.

Besides the cost and access issues, social factors also influence a woman’s reproductive health. Although many husbands are supportive, others do not allow their wives to use birth control.

Sometimes the mother-in-law gets involved, too. When a woman in Armenia gets married, she moves in with her husband and his mother. The mother-in-law is usually the matriarch of the family, so she has a lot of pull in decision-making, even when it comes to her daughter-in-law’s reproductive health.

Changing Patterns, Changing Lives
During my last week in Armenia, I met a woman who had come to her village clinic for an abortion. She had two children and this was going to be her fourth abortion. She told me that her husband wants to have another child, but that he’s an alcoholic -– has been since the day they got married –- and he beats her.

She doesn’t think it’s right to bring a child into this world when her life at home is so unstable, and yet she is completely dependent on him for financial security. Living in the village, there are very few resources for either of them to get any help.

Stories like this are difficult to hear; you quickly realize how vital organizations like COAF are to these women. COAF provides free screenings for breast and cervical cancer and free treatment for STIs. With the help of the UNFPA, I inserted intrauterine devices (IUDs) for free to eligible women. This provides them with one of the most effective forms of birth control for up to 10 years.

On my final day working with COAF, one of the women was so thankful that as soon as the IUD procedure was complete, she jumped up and gave me a big kiss. She had had six surgical abortions, and she could not remember how many times she had taken Cytotec to end her other pregnancies.

It amazed me how much the women opened up to me. They are yearning for accurate information and resources, and they are deeply grateful not only for the health care that is provided but for the conversations about their bodies and their health.

Some women may not change their minds about birth control right away, but I know they at least have the information they need to consider it, and sometimes that is enough to start changing attitudes.

Despite all the economic and cultural barriers, I believe things are changing for women in Armenia -– slowly, of course, but moving in the right direction. There is no reason why Armenian women should have to keep relying on abortions for family planning, or why they should be misinformed about their reproductive health.

My hope is that educating women about their health and family planning options will empower them to take control of future. At the very least, they know where and when to seek care if they need it.

Related: Learn more about OBOS’s partner in Armenia, “For Family and Health” Pan Armenian Association (PAFHA), and efforts to adapt and distribute women’s health information based on “Our Bodies, Ourselves.” The preface to the Armenian edition is available in English.
——

Ed. note about mifepristone and misoprostol:
Mifepristone and misoprostol are now frequently used together to produce what is called “medication abortion” for women who are less than eight weeks pregnant. The drugs are not identical and perform different actions. Mifepristone, often known by its manufacturing name RU-486, is almost always used for abortion or to end missed miscarriages. Misoprostol has wider applications and may be used in place of prostaglandins to create cervix softening prior to birth. It can also help prevent stomach ulcers that are caused when people take non-steroidal anti-inflammatory drugs (NSAIDS).

Under the supervision of a health care provider, women choosing a medication abortion typically use an oral dose of mifepristone first, followed by either an oral or vaginal suppository dose of misoprostol several hours later. In slightly more than 90 percent of women, this induces abortion within two days, provided it is used in early pregnancy. Misoprostol becomes increasingly less effective in more advanced pregnancies, and other, more effective drugs may be chosen for pregnancies that are more than eight weeks along.

The different actions of mifepristone and misoprostol explain their effectiveness in inducing abortion. Mifepristone works to separate the placenta from the uterine lining, and it causes uterine contractions. Additionally, the drug has some effect on the cervix and may cause it to soften.

by Jenelle Marie

When you hear the term STD (sexually transmitted disease) or STI (sexually transmitted infection), what do you think of first?

Grotesque pictures of maimed genitalia displayed on a projector during yesteryear’s sex-ed class geared toward frightening you into abstinence? That scene from ” The Hangover” where Sid says, “What happens in Vegas stays in Vegas … except for herpes. That shit will come back with you”?

Whatever first comes to your mind is not likely to include your neighbor, professor, or best friend living with an STI, having an incredible sex life, and otherwise prospering. That is, of course, unless you’re also living with an STI and you know better.

I am your neighbor, a professor at a community college, and am enjoying a wonderfully healthy sex life with a man who thinks the world of me and nothing of my STI. I’ve been living with genital herpes for over 14 years now; I’ve also contracted HPV, scabies, and vaginitis throughout the years. And yet not once did an STI hinder my relationships or happiness once I stopped allowing it to dictate my self worth.

Embracing Stigma

At 16, when our family doctor peered at me with a lazy eye, through thick glasses, and accompanied by a partially missing ear to tell me my genital herpes outbreak was the worst case he’d ever seen, I was devastated. Embarrassment coursed through me as he handed me a prescription and sent my mother and me on our way – sans brochures, additional information, and references to resources, support groups or even a mention of the vast number of people living with an STI everywhere. I was a pariah – a leper – even the doctor was disgusted by my condition.

For years, I accepted my fate and considered myself as being punished for having been sexually active before marriage. As a high-schooler, I was called a slut or a whore and “friends” of mine forewarned men who took interest in me that I would merely infect them, hurt them, and they should steer clear entirely. I actually maintained some of those friendships for a period of time, not knowing otherwise about STIs and those who contract them, thinking myself deserving of such treatment.

A Long Overdue Paradigm Shift

It wasn’t until a few years ago I began to see myself for who I truly was: a beautiful, intelligent, thoughtful, and valuable individual who just happened to contract a long-term infection. In fact, my infection had not stopped me from obtaining two honors degrees, getting married, conquering my fear of heights by going skydiving – not once, but three times – or pursuing my dreams by auditioning for “American Idol.”

While I’m not the next American Idol, I learned an invaluable lesson throughout that period of self-discovery: I am not deserving of poor treatment, cruel friendships, or snide remarks; the stigma placed upon those living with an STI is inaccurate, ignorant, and illogical. And I have the power to change that. We all do.

In order to change the status quo, though, one has to first understand where the misunderstandings and wrongful judgments originate. Rather than be angry at my doctor for leaving me with nothing more than a crass diagnosis or at my childhood friends for mistreating our relationship, I am choosing to delve into why those perceptions persist.

Part of the problem came from within. I didn’t challenge what little I knew about STIs, and I embraced the negative opinions for years before I was able to distinguish between the laymen’s view of STIs and the reality behind the array of people who contract them. STIs do not define one’s character; they’re merely a reflection of an experience – an experience that is as individually unique as are the people who contract the STIs themselves.

Consequently, I’m not angry or frustrated by the amount of time it took for me to finally find solace in my infection. Rather, I have a holistic appreciation for the process one undergoes when being diagnosed with any type of taboo condition (infection or otherwise). Not only have I taken great pains to find myself in a place of self-love and self-respect, I want very much for others to have an opportunity to feel the same fortitude after their diagnosis as I do now and over a far shorter time table.

Becoming an Advocate

Hence, I have become an advocate.

Due to the immense stigma behind contracting an STI, most people don’t speak openly about their experiences. However, as people, we learn best through community. Naturally, we are pack animals – we nurture our young for years beyond most other mammals and we develop complex (and hopefully, healthy) relationships with others outside of our family nucleus. It makes sense then we need others to help overcome obstacles and boundaries – in this case, contracting an STI and/or living with an STI.

So, I’m willing to tell you how horrible my experience has been at times, and how I’ve found incredible happiness, love, success, and rewarding relationships despite living with an STD all in hopes you can move through the process with much more clarity, community, and understanding than I once endured.

Join me, and I welcome you.

Jenelle Marie is the founder and administrator of The STD Project, a website geared toward eradicating the sigma associated with having a sexually transmitted infection. This entry was originally posted at BlogHer and is reposted with permission.

If you spend any time reading about evidence-based medicine, eventually you are going to hear someone mention a “Cochrane” review. These reviews take a systematic look at the research on a health topic, and try to provide answers to questions about best practices.

The Cochrane Collaboration is the international non-profit organization that produces these reviews and works to spread the findings to health care providers and patients. There’s a helpful newcomers’ guide to introduce people to Cochrane, and the video below provides some history and context for the organization.

The United States Cochrane Center, one of 14 centers around the world, is based at Johns Hopkins Bloomberg School of Public Health in Maryland. In addition to performing evidence reviews, the USCC also runs Consumers United for Evidence-based Health Care (CUE), a coalition of advocacy groups working to provide consumers with access to evidence-based information about health. Our Bodies Ourselves is a member organization.

CUE offers an online course on understanding evidence-based healthcare topics, such as research design, statistics, and other topics.

The video below offers more explanation, and features Zobeida Bonilla, who works on OBOS’s Latina Health Initiative.

Related: 
Meeting Dispatch: Resources from the CUE/Cochrane/Campbell Colloquium - Links to sources of evidence-based information, critiques of health journalism, info on pharmaceutical company payments to doctors, and more, collected from the 2010 joint meeting of CUE and the Cochrane and Campbell Collaborations.

Although we celebrated the 40th anniversary of Roe last week, access to abortion is not only difficult for many women, but legislators are working to make it even more difficult.

On Saturday, Melissa Harris-Perry opened a discussion on her show with these remarks:

Before 1973′s Roe v. Wade, complications from abortion was the leading cause of death among women of childbearing age. This was especially true for women of color. As access to abortion once again narrows, it puts women’s lives in danger. So while much of the debate about reproductive rights is focused on the legal interpretation and the Constitution and the bodily rights of women, we can’t forget the basic issue of access. [...] Access is the frontier on which we need to be fighting. 

It was a great conversation (watch above if you missed it!), and we were thrilled to see Steph Herold, a New York Abortion Access Fund board member and a contributor to the new edition of “Our Bodies, Ourselves” (which we’re aiming to send to all members of Congress; learn more here), and Feministing editor Chloe Angyal taking part in the round table, along with The Nation editor/publisher Katrina vanden Heuvel and Demos senior fellow Bob Herbert.

Herold talked about the implications of the Hyde Amendment, which since 1976 has banned Medicaid coverage of abortion, and how that limits access for low-income women.

“We really believe that however people feel about abortion, politicians shouldn’t be be able to deny women health care coverage just because they’re poor,” said Herold.

As legislatures reconvene for the new year, we’re keeping an eye on proposed bills that further restrict access to abortion.

In the states:
Proposed bills in Arkansas would prohibit all abortions after 20 weeks, ban the practice of remotely prescribing medication for abortions (otherwise known as telemedicine), and ban abortion coverage in health insurance exchanges.

A bill has been introduced in Florida to ban all abortions except in medical emergencies and to sentence abortion providers (or those who assist or own/run clinics) with up to life to prison. The bill has failed in previous years.

The previously defeated personhood bill is back in Oklahoma.

You may have seen news of a New Mexico bill from Republican state Rep. Cathrynn Brown, which would make it a felony for a woman to have an abortion if the pregnancy resulted from rape or incest. The bill frames such abortions as “evidence tampering.”

Brown claims the bill is being misunderstood; at the very least, it’s poorly written, as it very clearly prohibits not only “compelling or coercing another to obtain an abortion” but also “procuring or facilitating an abortion.” The bill is reportedly being re-written; advocates should keep an eye out for clarification of the language.

Here’s another summary on more abortion restrictions being proposed around the country.

At the federal level:
Multiple bills have been proposed by Tennessee lawmakers to prohibit Planned Parenthood from receiving Title X family planning funding (here’s my personal take as a Tennessean).

A bill has been introduced to define “life” as starting at fertilization.

Other bills would require hospital admitting privileges nationwide for abortion providers (a medically unnecessary move intended to restrict access), and would criminalize people who take a minor across state lines to access abortion, including a sister or aunt as well as other relatives and friends.

Lizz Winstead, Daily Show co-creator and producer, has a message for what’s at stake on the 40th anniversary of Roe v. Wade.

On the 40th anniversary of the Supreme Court’s Roe v. Wade decision, we celebrate four decades of legal abortion — which has undoubtedly changed and saved many women’s live. Yet we recognize there is still much work to be done.

To help change policy and to ensure that all legislators understand the basics about women’s bodies and reproduction, OBOS has re-opened the campaign to send copies of “Our Bodies, Ourselves” to every member of Congress.

Let your friends and colleagues know there’s still time to join the campaign — we’ll be delivering the books to D.C. starting in late February.

OBOS is also taking part in Trust Women Week to urge policy makers to support reproductive justice and access to contraception and abortion. You can add your name to a petition that will be sent to legislators. If you’re in San Francisco, there’s an event this Saturday starting at 10 a.m. at Justin Herman Plaza.

Many organizations and individuals are covering the anniversary today from a variety of personal and political perspectives. Below are some interesting commentaries and reminders of what has been accomplished and how we can work to ensure access for all women. Please leave your favorite links in the comments.

At reddit, two abortion clinic workers have answered a wide variety of questions from readers.

Kimberly Inez McGuire of the National Latina Institute for Reproductive Health spoke at a Center for American Progress panel on Roe 2.0: Strategies for the Next Generation of Reproductive Rights Activism. Also, check out the group’s new Yo Te Apoyo (I Support You) campaign and Roe v. Wade 40 years later: Latinas weigh in on abortion.

NARAL Pro-Choice America is holding their annual Blog for Choice day; expect links to many posts on the topic of personal stories and abortion.

Planned Parenthood has a 40th anniversary video.

The author at Deana’s blog, a professor of sociology, talks about the new study documenting attacks on pregnant women’s autonomy (see our recent post on this issue).

The National Women’s Law Center encourages us all to write our legislators to support abortion access and stand against restrictions.

Physicians for Reproductive Choice and Health have made available online the documentary “Voices of Choice: Physicians Who Provided Abortions Before Roe v. Wade.” The film includes interviews with Bylle Avery, founder of the National Black Women’s Health Project, and Dr. George Tiller, an abortion provider who was murdered.

The 1 in 3 campaign, a project of Advocates for Youth, provides stories from individuals who’ve had an abortion. The organization has also released a book of stories and resources for college campuses.

Shanelle Matthews has a powerful story and insightful commentary at The Crunk Feminist Collective: The story that’s taken ten years to tell: On abortion, race and the power of story. Here’s an excerpt:

The narrative that abortion gives women and transpeople an opportunity to live the rest of our lives, to become a doctor or a lawyer or whatever isn’t true for everyone. For some of us, abortion just provides one more day. One more day to live our lives exactly the way we want to. For some of us the decision isn’t political, it’s essential. It is essential to taking care of the children we already have, to circumventing difficult medical experiences or to just not be pregnant. There is nothing heroic about having an abortion. It is an essential part of reproductive health care.

Bridgette Dunlap at RH Reality Check describes an unusual argument for the legality of abortion, resting not in the right to privacy but in the 13th Amendment forbidding slavery and involuntary servitude. This argument suggests the government may not outlaw abortion, because “to do so would be to require physical service from a woman for the benefit of a fetus.”

Flyover Feminism is hosting a week-long series on reproductive rights.

In Mississippi, the state’s only abortion clinic may close. Coverage includes “Inside Mississippi’s Last Abortion Clinic,” from Mother Jones, and “In Jackson, Mississippi, Southern Hospitality and Food for Thought on Access to Abortion“ at RH Reality Check.

Monica Raye Simpson, Executive Director of SisterSong issued a statement celebrating Roe but highlighting the bigger picture: “We need to discuss how issues such as economics, immigration reform, interpersonal violence, rape and lack of comprehensive sexual education are all a part of the equation needed for reproductive justice to be achieved.”

Jill Filipovic in “Roe v Wade at 40: what American women owe to abortion rights” writes about the ongoing struggle to make reproductive rights accessible to all women:

The primary victims of the pro-life strategy are poor women. The pro-life movement has stepped up its legislative game in the past two years, introducing and passing record-breaking numbers of anti-choice laws in 2011 and keeping the victories coming in 2012. They’ve made it not only hard to get an abortion, but to get birth control, sex ed and health care generally.

The result is that Roe’s promise of abortion rights isn’t available to large swaths of the American population.

The National Women’s Law Center explains that the health care reform allows states to pass laws banning private insurance coverage of abortion in state exchange plans, meaning that “in twenty states, a woman will not be allowed to purchase an exchange-based health plan that covers abortion services, and also may not be able to purchase a plan that provides insurance coverage for abortion at all.”

As we were saying, there’s plenty of work left to do.

by Carol Sakala, Director of Programs, Childbirth Connection

One of most commonly cited barriers to improving maternity care is the risk of providers and hospitals being held liable for bad outcomes. Whether it is reining in overuse of tests and procedures, honoring women’s preferences, or increasing interdisciplinary collaboration, good ideas often cannot move forward once the issue of liability is raised.

If we cannot make progress toward more evidence-based, woman-centered care because of liability concerns, then the liability system is functioning poorly. But what are the aims of a high-functioning liability system? Is it just to avoid lawsuits and hold liability insurance premiums down?

In our new report, Maternity Care and Liability, we hold 25 possible liability reforms up to a framework that addresses the needs and interests of all of the system stakeholders: those who deliver care, those who pay for care, and most importantly, the women and newborns who receive care.

We developed this framework based on maternity care and liability studies and with the input of clinicians, legal scholars, consumer advocates, policy makers, and others. For each possible reform, we asked whether it does or would likely:

• promote safe, high-quality maternity care that is consistent with best evidence and minimizes avoidable harm
• minimize maternity professionals’ liability-associated fear and unhappiness
• avoid incentives for defensive maternity practice
• foster access to high-value liability insurance policies for all maternity caregivers without restriction or surcharge for care supported by best evidence
• implement effective measures to address immediate concerns when women and newborns sustain injury, and provide rapid, fair, efficient compensation
• assist families with responsibility for costly care of infants or women with long-term disabilities in a timely manner and with minimal legal expense
• minimize the costs associated with the liability system

The proposed framework has the potential to move discourse and policy forward. When options for reform are held up to criteria in the framework, many that have been widely implemented do not appear to meet any of the criteria. Most notably, the best available evidence shows that tort reforms fare poorly against these aims, despite the fact that they are the most widely advocated and enacted liability reforms.

On the other hand, various reforms have the potential to be win-win-win solutions for women and newborns, providers, and payers. Strategies are needed both to prevent harm and ensure that it is rare and to respond appropriately to harm or claims of harm when they occur. For preventing negligent injury and related lawsuits, these reforms include rigorous quality improvement programs and shared decision making initiatives.

A series of recent reports clarifies the “business case” for quality improvement initiatives: successful programs with strong leadership are achieving better care, better health outcomes, and rapid substantial declines in liability claims, payouts, and premiums. Among redress approaches, disclosure and apology programs were the most promising, but have not yet been evaluated in maternity care.

The report includes summary tables with the full list of more promising and less promising strategies assessed and their demonstrated or plausible impact on the various areas addressed in the framework.

To achieve the high-performing maternity care system that stakeholders need, we cannot allow longstanding liability concerns to continue to rankle. By seeking guidance from the best available evidence about the nature of liability problems in maternity care and the effectiveness of possible solutions, we can move constructively beyond belief and entrenched positions.

It is time to pilot and evaluate the most promising strategies and scale up those that are effective, beginning with routine maternity care quality improvement initiatives. They have the potential to transform the quality and value of maternity care, and to ensure that maternity care work offers the joy and honor that draws talented, passionate individuals to the profession and keeps them caring for women, babies, and families.

For the full report, a set of 10 fact sheets, links to three related open-access Women’s Health Issues articles and an invited commentary from legal scholars Sara Rosenbaum and William Sage, and other resources, please visit http://transform.childbirthconnection.org/reports/liability.

This entry was originally posted at Transforming Maternity Care and is republished with permission.

Carol Sakala, director of programs at Childbirth Connection, is a long-time contributor to “Our Bodies, Ourselves.” She has worked on maternity care issues as an advocate, educator, researcher, author, and policy analyst for more than 25 years, with a continuous focus on meeting the needs of childbearing women and their families.

Although this January marks the 40th anniversary of the landmark Supreme Court decision legalizing abortion, we know that there is still much work to be done to ensure reproductive justice for all women.

The Guttmacher Institute reports that 2012 saw the second highest number of abortion restrictions enacted in a single year; the Center for Reproductive Justice addresses each state in this report.

Among the provisions ultimately defeated were “fetal personhood” bills in Mississippi and Oklahoma. But the notion that fetuses should be protected from the women carrying them has resulted in the restriction and punishment of women across America.

Lynn Paltrow, executive director of National Advocates for Pregnant Women, and Jeanne Flavin, a professor of sociology at Fordham University and chair of NAPW’s board, have put together an extremely interesting and important study: “Arrests of and Forced Interventions on Pregnant Women in the United States, 1973–2005: Implications for Women’s Legal Status and Public Health.”

Paltrow and Flavin (who is also the author of the 2008 book “Our Bodies, Our Crimes: The Policing of Women’s Reproduction in America“) tried to identify and examine U.S. cases from 1973, the year of Roe v. Wade, through 2005, in which a medical or government authority tried or succeeded in stripping a woman’s autonomy because of pregnancy. The study appears in the Journal of Health Politics, Policy and Law.

These cases could have involved threat of or actual arrest, incarceration, or increased prison/jail time; detention in a hospital, treatment program, or mental institution; or forced medical intervention. Descriptive detail of several cases is provided, along with summary statistics on the findings.

Looking at legal, medical and other sources, Paltrow and Flavin analyzed 413 cases, which they speculate are “a substantial undercount,” because cases were difficult to identify and some sources referred to additional cases.

The data reveals substantial racial, income and geographic disparities. While almost every state had multiple cases, the regions with the most were the south (56 percent) and midwest (22 percent). These cases disproportionately targeted black women (52 percent of cases overall, and 72 percent of cases in the south), and 71 percent involved low-income women (enough so that they qualified for indigent defense).

Most women who faced criminal charges were charged with felonies; a greater percentage of black women (85 percent) were charged with felonies than white women (71 percent).

The authors explore how these disparities are interlinked with disparities in drug laws, disproportionate application of criminal laws, and outdated stereotypes about cocaine use (such as the “crack baby” myth).

The vast majority of the cases — 84 percent — involved allegations of illegal drug use. In the remaining cases, “women were deprived of their liberty based on claims that they had not obtained prenatal care, had mental illness, or had gestational diabetes, or because they had suffered a pregnancy loss.”

Although concern for the health of the fetus/infant is typically offered as a reason for increased scrutiny or detainment of pregnant women, in 64 percent of the cases there was no reported health issue cited in the allegation.

Chillingly, most cases were reported by people in so-called “helping professions”: health care providers (41 percent), social workers (12 percent), and hospital, child protective services, or police personnel (17 percent). Health care providers reported black women at a higher rate (48 percent) than white women (27 percent).

As the authors point out:

Due in part, no doubt, to the strong public health opposition to such measures, no state legislature has ever passed a law making it a crime for a woman to go to term in spite of a drug problem, nor has any state passed a law that would make women liable for the outcome of their pregnancies. Similarly, no state legislature has amended its criminal laws to make its child abuse laws applicable to pregnant women in relationship to the eggs, embryos, or fetuses that women carry, nurture, and sustain. No state has rewritten its drug delivery or distribution laws to apply to the transfer of drugs through the umbilical cord. To date no state has adopted a personhood measure, and no law exists at the state or federal level that generally exempts pregnant women from the full protection afforded by federal and state constitutions.

In other words, nothing about existing law should make women subject to such persecution. They also note that public health groups have observed that targeting pregnant women may lead to women avoiding medical care or having unwanted abortions to avoid increased and punitive scrutiny.

Paltrow and Flavin also highlight these cases in the context of proposed personhood laws, which would give fetuses individual rights and potentially could lead to increased prosecutions of women. They authors note that they have identified “more than two hundred cases initiated against pregnant women since 2005 that also overwhelmingly rest on the claim of separate rights for fertilized eggs, embryos, and fetuses.”

Opponents to personhood laws have cautioned that such measures could lead to forced medical interventions on pregnant women along with possible punishment for miscarriages and stillbirths. While personhood proponents often dismiss these warnings as scare tactics, the research shows there is good reason to be concerned.

Paltrow and Flavin conclude with a call for change:

In light of these continued efforts and our findings, we challenge health care providers, law enforcement and child welfare officials, social workers, judges, and policy makers to examine the role they play in the arrests and detentions of and forced interventions on pregnant women. We call on these same people to develop and support only those policies that are grounded in empirical evidence, that in practice will actually advance the health, rights, and dignity of pregnant women and their children, and that will not perpetuate or exacerbate America’s long and continuing history of institutionalized racism.

Finally, our study provides compelling reasons for people who value pregnant women, whether they support or oppose abortion, to work together against personhood and related measures so women can be assured that on becoming pregnant they will retain their civil and human rights.

The whole article is well worth a read if you can get a copy. The abstract is freely available online.

In light of Congress’s recent failure to reauthorize the Violence Against Women Act, it’s heartening to hear about the ongoing efforts of White Ribbon, a movement of men and boys working to end violence against women and girls.

Here in Boston, the Men’s Initiative Project of Jane Doe Inc., a coalition of community-based sexual assault and domestic violence groups, is gearing up for the sixth annual Massachusetts White Ribbon Day. The event will take place at the State House in Boston on March 7.

The event, which is open to all, aims to change societal attitudes and beliefs that perpetuate and make excuses for violence against women, promote safety and respect in all relationships and situations, and promote the safety, liberty and dignity of survivors.

Men can sign up online to be an Ambassador for the campaign and to participate in other ways.

OBOS Board member and MA White Ribbon Day co-chair Jarrett Barrios spoke about the campaign recently in an interview with New England Cable News’s BroadSide program. Jarrett talks about the negative media imagery about women that young boys receive, and the need for parents and others to take responsibility for actively countering those messages and work to address rather than excuse them.

Jarrett calls for people to wear the white ribbon, to talk to their sons about treating women with respect, and to not “let go” of or overlook the language that is used against women that is part of a culture of violence.

The 112th Congress ended without reauthorizing the Violence Against Women Act (VAWA), threatening the funding of programs and services that prevent and respond to domestic violence, rape, stalking, and other forms of violence against women. It’s the first time Congress has failed to reauthorize VAWA since it was signed into law in 1994.

The failure is due to objections by House Republicans over new provisions adding protections for LGBTQ individuals, Native American women on tribal lands, and undocumented immigrants — protections that are considered “controversial,” according to Florida Republican Rep. Sandy Adams.

Those provisions are included in the Senate version, which passed with bipartisan support in April. The House passed its own version, stripping those provisions and making other changes that the administration has refused to approve.

The National Task Force to End Sexual and Domestic Violence Against Women addresses objections to the LGBTQ and Tribal provisions with a smart analysis of myth vs. fact. The organization also provides a good outline of many of the problems with the House version and its possible effects on vulnerable communities, and it asks the 113th Congress to reauthorize VAWA immediately.

Please encourage your senators and representatives to pass an inclusive version of VAWA. You can also contact House Speaker John Boehner’s office (202-225-0600 or 202-225-6205) and House Majority Leader Eric Cantor’s office (202-225-2815 or 202-225-4000).

Here’s further commentary and analysis, on both the bills and the failed reauthorization. Feel free to suggest other commentary or news items in the comments.

• We live in a culture of violence, and it needs to stop. — Adrienne K., Native Appropriations
• Congress Fails to Reauthorize Violence Against Women Act — National Center for Lesbian Rights
• House bill takes VAWA name, leaves Latinas behind – National Latina Institute for Reproductive Health
• Blocking VAWA, The GOP Keeps Up the War on Women — Erika Eichelberger, The Nation
• GOP House’s inaction on VAWA shows bigotry — Ilyse Hogue, CNN
• Racism and Sexism Go Hand in Hand in Opposition to VAWA Reauthorization — Scot, Changelab
• No real answers on ‘death’ of Violence Against Women Act — Jamil Smith, Melissa Harris-Perry show; Jamil also had a great analysis back in December, Why does the Violence Against Women Act remain stalled?
• House GOP lets the Violence Against Women Act expire for first time since 1994 – Zerlina, Feministing
• In Last Salvo on War On Women for 2012 Legislative Session, Congress Refuses to Renew VAWA – Robin Marty, RH Reality Check
• Everything You Need to Know About The GOP’s Opposition To Protecting Native American Women From Abuse — Erik Stegman, ThinkProgress
• Violence Against Women Act Debacle: Why Congress Should Be More Diverse – Tara Culp-Ressler, The Atlantic
• Why the Violence Against Women Act is a LGBT issue – Suzy Khimm, Wonkblog

This January 22 marks the 40th anniversary of Roe v. Wade, the landmark U.S. Supreme Court decision that made abortion legal.

Many local and national pro-choice and reproductive justice organizations will be holding events to mark this anniversary. Here are a couple we know about, including one we’re excited to co-sponsor with many great organizations in our home state. Know of others or want to share your own? Please tell us in the comments!

In Massachussetts, we’re co-sponsoring the Roe v. Wade 40th Anniversary Legislative Breakfast and Lobby Day at the State House on January 14. You can sign up to attend the breakfast, with keynote speaker Paula Johnson, MD, MPH, Executive Director of the Connors Center for Women’s Health and Gender Biology, and/or the lobby events, a chance for you to meet with elected officials after a brief advocacy training. Please sign up online to participate.

In Manhattan on Jan 14, Physicians for Reproductive Choice and Health is hosting “Roe Revealed: Doctors Tell Their Stories on the 40th Anniversary of Legalized Abortion,” with Dr. Willie Parker, Dr. Linda Prine, and a special guest. The event with these abortion providers is $20; additional tickets are required for the reception.

NARAL Pro-Choice America is holding its annual Blog for Choice Day on Jan 22. This year, they’re asking participants to share their own stories of why they’re pro-choice. As usual, you can sign up online to join in.

While there’s plenty of reason to celebrate 40 years of Roe, legislative attacks on reproductive and sexual health and choice continue around the country. In 2011 alone, U.S. lawmakers enacted 92 abortion-restricting provisions in bills designed to curtail women’s rights to health services. According to the Guttmacher Institute, that number shattered the previous single-year record of 34 such provisions enacted in 2005. Such laws make it more difficult, and painful, for women to exercise their legal right to terminate a pregnancy.

What will you do this year to ensure reproductive justice for all? For starters, check out Our Bodies, Our Votes, our resource for fighting back against attacks on women’s health and rights. While you’re there, order a sticker and submit your picture to our awesome Click It, Stick It, Share It tumblr.

Related:
History of Abortion in the U.S. – an “Our Bodies, Ourselves” excerpt
The 40th Anniversary of Roe v. Wade: A Teachable Moment, by Linda K. Kerber

If you’re a filmmaker with an interest in spreading the word about female condoms, check out this contest from PATH, a global health organization:

Why does the world need female condoms? How can female condoms enhance your life? Submit a short film (1:00–5:00 minutes) that tells a story about what Female Condoms Are to you and your community. The deadline to enter is March 1, 2013.

First prize receives $5,000. Winning entries will also be screened at the 2013 Women Deliver conference. Full details and rules are on the contest website.

To learn more about female condoms, see our previous posts and this excerpt from the most recent edition of “Our Bodies, Ourselves.”

by Alice Dreger

Dr. Mark Sloan, a pediatrician based in northern California, has written a very helpful overview of a controversial fetal engineering intervention: prenatal dexamethasone for pregnant women considered at risk of giving birth to a daughter with congenital adrenal hyperplasia (CAH). The article has been posted on the Our Bodies Ourselves website .

Although CAH is relatively rare, the use of this prenatal intervention should interest and concern all women’s health advocates for two reasons:

• This fetal intervention has been pushed through the use of highly problematic sexist and heterosexist stereotypes.
• The unscientific and unethical ways in which the intervention has been deployed send up all sorts of red flags with regard to patient safety and patients’ rights to informed consent.

CAH is a serious inborn endocrine disease; newborns are screened for it, and people who have it usually require lifelong hormonal management. One “side effect” of CAH is atypical (different from average) sex development in some females.

In an effort to prevent that atypical sex development, some doctors have offered prenatal dexamethasone, a synthetic steroid, to pregnant women identified through genetic analysis as being at risk of having a child with CAH. Giving a pregnant woman dexamethasone cannot prevent CAH or cure her offspring of CAH. The intervention is offered only in an attempt to ensure typical sex development in the offspring who are genetic females.

A genetic female fetus with CAH may develop differently from average females because CAH can result in high levels of masculinizing hormones. The process is called virilization, because it leaves a female skewed more toward the middle or even the male end of the genital development spectrum. (For an animated primer on genital development, click here.)

A female with CAH may be born with a large clitoris, even one that looks something like a penis; her labia may be joined like a scrotum; and her vagina and urethra in some cases will form joined together, which can put her at increased risk for infection and, at sexual maturity, difficulties with intercourse and giving birth.

Although in theory ensuring typical genital development may sound reasonable, in practice, this off-label use of dexamethasone has been a high-risk game. For the drug to work, doctors must give it starting by about week 7 of fetal life, before the genitals sexually differentiate. At this early stage, doctors cannot know if the woman is carrying a male or female fetus or whether the fetus even has CAH.

Only about 10 percent of the fetuses exposed will actually turn out to be females with CAH, meaning about 90 percent of those exposed will bear all the risk of fetal biochemical engineering with no chance to benefit.

As Dr. Sloan explains, the CAH-affected population of girls and women also shows signs of having their brains “virilized” during development. They are more likely than non-CAH girls to be tomboyish, and more likely to grow up to be lesbian, bisexual, or to identify as male in terms of their gender. (This population contributes to the idea that gender identity and sexual orientation have a biological component.)

I find it disturbing that the chief clinical-researcher proponent of the intervention has indicated that she’s interested in seeing if the intervention can “successfully” prevent this “behavioral masculinization” — in other words, she’s interested in seeing whether the fetal intervention can lower the rates of tomboyism, lesbianism, and bisexuality in this population.

As University of Michigan pediatric psychologist David Sandberg told Time magazine, “Maybe this gives clinicians the idea that the treatment goal is normalizing behavior. To say you want a girl to be less masculine is not a reasonable goal of clinical care.” (I agree.)

Most troublingly, as Dr. Sloan notes in his article, there has been shockingly little study of what this intervention does to the exposed children’s health.

After nearly 30 years of use, we have stunningly little data on efficacy and safety on this off-label use. It appears that, in many cases, women have been offered this drug without the protections of being enrolled in formal studies, after being lured into the intervention with claims that it “has been found safe for mother and child.”

Dr. Sloan discusses a paper I recently authored on this matter with my colleagues Ellen Feder, PhD, of American University, and Anne Tamar-Mattis, JD, of Advocates for Informed Choice. I encourage you to read Dr. Sloan’s article, and then, if you want to learn more about how this history unfolded, read our article, which is available for free download.

I also encourage you to read the “Dex Diaries” series I have mounted at fetaldex.org. There you’ll find a series of short essays unpacking this story from a personal point of view.

Kiira Triea (who recently died of cancer) wrote there about her own experience of having been changed in the womb; Fran Howell has relayed about how hard it is to watch this after herself being exposed to DES in the womb; Ellen Feder has expressed sympathy for the poorly informed mothers; Aron Sousa has analyzed the game that has apparently been played here with regard to federal funding; and Anne Tamar-Mattis has reported on the real silent majority of doctors who are troubled by how this population has historically been treated.

Finally, I encourage you to watch the videos at The Interface Project, where real people born with uncommon forms of sex development explain why no body is shameful.

Alice Dreger is Professor of Clinical Medical Humanities and Bioethics at Northwestern University’s Feinberg School of Medicine. Her personal website is alicedreger.com, and you can follow her on Twitter @AliceDreger.

Women in Udaipur, eastern Nepal with WOREC founder Dr. Renu Rajbhandari (far left) and the OBOS Nepali booklets to which they contributed. Photo / Judy Norsigian

In early October, I had the honor of co-leading a workshop in Kathmandu on the growing popularity of cross-border surrogacy arrangements with two colleagues from the New Delhi-based Sama Resource Group for Women and Health and Dr. Renu Rajbhandari, founder of the Women’s Rehabilitation Centre (WOREC).

Already a booming business in India, where estimates suggest that 25,000 couples a year travel to arrange surrogacy contracts and there are about 1,000 surrogacy centers, this practice is soon expected to extend to Nepal, where poor women with limited economic opportunities will likely be attracted by the prospect of earning money by bearing children for others.

In some parts of India, women are now offered fees ranging from $5,000 to $7,000, amounts that represent up to 10 years of earnings for people in rural areas.

The workshop, hosted by WOREC, OBOS’s global partner in Nepal, brought together women’s right activists from across the country to better understand the growing market in cross-border reproductive health care, its implications for Nepal, and the most effective strategies to educate and empower women.

Surrogacy Legislation in India
Participants included two nurses from the Kathmandu-based IUI (intrauterine insemination) clinic, several health counselors, a psychosocial counselor for women with fistulas, a family planning coordinator, the editor of a quarterly women’s magazine, several members of Women’s Human Rights Defenders, a nursing professor, an advocate with Save the Children, and a staff person from a rural women’s radio station in eastern Nepal. Languages used during the workshop were primarily Hindi and Nepali, with English translation offered as needed.

Sarojini and Preeti, our colleagues at Sama, provided an excellent overview of surrogacy in India, including a description of assisted reproductive technology (ART) legislation now being hotly debated in Parliament. One provision in the controversial bill would require that a woman entering into a contract surrogacy agreement undergo an embryo transfer rather than be inseminated with the intended father’s sperm.

Since insemination would be much safer, many workshop participants felt that a choice should be offered. An embryo transfer places the woman at greater risk by exposing her to powerful hormones that prepare her body for the pregnancy and to surgical procedures required to physically transplant the embryo into her uterus.

The proposed law assumes that a woman using her own eggs will be more likely to change her mind at birth and decide she wants to keep the baby than a woman who becomes pregnant with an embryo created with another woman’s eggs. There is poor evidence to support this assumption.

Participants at the Kathmandu workshop on cross-border surrogacy arrangements.

Preparation in Nepal
By their very nature, commercial surrogacy arrangements are created by contracting couples and agencies whose primary interests typically do not reflect the needs and concerns of women recruited as gestational mothers.

This is why groups like Sama and WOREC are advocating for public policies that will protect gestational mothers and ensure they receive evidence-based information about risks and benefits in a manner they fully understand. Policies must also ensure follow-up care and effective recourse if things go wrong.

The women at the workshop want to be better prepared in case a similar bill is introduced in Nepal. Sarojini, Preeti and I shared practical information about the various ART techniques involved in surrogacy and explored, with our Nepali colleagues, ways to preserve the health and rights of women agreeing to be surrogates. Most participants were quite unfamiliar with the whole topic of ARTs and asked many questions about the medical, social and economic impacts.

Why Language Matters
We also screened two documentary films about surrogacy – Made in India, by New York City-based filmmakers Vaishali Sinha and Rebecca Haimowitz, and Would Like to See Baby Bump Please, a new film just released in India by Sama — and discussed the importance of using language sensitive to all the parties involved in a surrogacy arrangement.

For example, the term “reproductive tourism” carries the image of couples vacationing in their pursuit of parenthood. In most cases, these trips are stressful and a far cry from the typical tourist experience. Using alternative language such as “cross-border commercial surrogacy” is one way to avoid such innuendo.

Similarly, referring to a gestational mother as a “surrogate mother” or “gestational carrier” can belittle and objectify her central role as the woman carrying a pregnancy for nine months and then giving birth. Many at the workshop preferred the descriptive, less diminishing term “gestational mother.”

At the end of the workshop, we developed a number of recommendations for moving forward.

Meeting Local Activists
After the workshop, I traveled with Renu to Udaipur in eastern Nepal, where she introduced me to many younger women at the WOREC center, including some who contributed to WOREC’s set of six Nepali health booklets, recently adapted from Our Bodies, Ourselves.

I also visited a group of young women who are the sole staff for a radio station in Udaipur, where egg cartons provide the sound proofing in their recording studio. They frequently address women’s health topics in their programming and invite community conversations about sexuality, domestic violence and the environment.

Although I had met Renu briefly when she traveled to Boston for OBOS’s 40th anniversary symposium in 2011, the many hours of chatting while we drove over mountainous terrain cemented a special friendship I now treasure. I have a new appreciation of her remarkable leadership over the past several decades and was deeply impressed by her efforts to pass the torch to a younger generation.

A trip to a fairly remote mountain village was particularly inspiring. The women had successfully lobbied for village development council funds to create a small multipurpose women’s center. Though a bit run-down, it was getting a lot of use and clearly a sign of how effective some women’s groups have been over the past decade.

The provisional constitution for the country still has not passed, but its contents – including funding for legal abortion – offer great hope for the future of women’s reproductive rights and justice in Nepal.

This article was originally published in the winter 2012/2013 Our Bodies Ourselves newsletter. View the full newsletter.

By Eyitemi Mogbeyiteren

In 2011, three members of our outreach team were kidnapped in the Delta State of Nigeria. We were held captive for several weeks, during which we were repeatedly raped, and only released after a ransom was paid to the kidnappers. Soon after, we learned that all three of us had tested positive for HIV.

My name is Eyitemi Mogbeyiteren, and I work with Women for Empowerment, Development and Gender Reform. Our goal is to ensure that poor grassroots women in the South-West region of rural Nigeria have information on their bodies and health, adapted from the trusted book Our Bodies, Ourselves, so they make choices that protect their reproductive and sexual needs and dignity.

HIV is rarely talked about in our community, and people living with the virus are inevitably discriminated against and cast out by their friends and family. Over the years, our organization has worked hard to unravel myths about the virus — its transmission, prevention and treatment — and fight the terrible stigma and isolation faced by those infected.

But as more people become ill, we continue to see families despair and grieve as their loved ones die without medicines, care and support. Drugs cost approximately $15,000 per person in my community — an amount that is beyond the grasp of many people!

After being diagnosed, I experienced a lot of the same discrimination and isolation. I was shunned in my community and my family stopped speaking to me for a long time. With my own health failing, there were many moments when I felt I could not live, could not stand people saying things about me.

It felt like the end of the road, until I decided to raise my voice and change the fear and shame into something positive.

We are now expanding our HIV/AIDS outreach to include palliative care — care that relieves not only the physical but also the emotional, spiritual and socially generated suffering faced by a person infected with the virus. It is one of the most valuable services that can be offered to someone with terminal illness and their family. Unfortunately, it’s availability in my community is zero!

Using Our Bodies, Ourselves as our tool yet again, our plan is to train ourselves on this holistic and critical model of care, and bring our services to our women via support groups and home visits. We will also develop a training manual for other caregivers, including family and community health workers, so they can comfort their loved ones and clients.

And, to get word out, we will organize an “itinerant exposition” on board a bus. This vehicle — our Anti-Rape, Anti-Kidnap and HIV/AIDS Bus — will carry 12 activists around the country for 18 months, unleashing our materials, our knowledge and our passion. It will allow us to serve women beyond our community, to empower them with information on HIV/AIDS and self-defense skills to protect them from rape and kidnap.

And if we are able to raise the funds, we will distribute the drugs needed to prolong life — drugs that are the right of every human being to access, drugs that are impossible to find in my community.

OBOS is assisting Eyitemi and her colleagues at WEDGR with strategies, promotion and in-kind donations, and by generating funds for this critical work. If you would like to help with this effort, contact Ayesha Chatterjee at ayesha AT bwhbc.org.

This article was originally published in the winter 2012/2013 Our Bodies Ourselves newsletter. View the full newsletter.