November 20, 2013

Is There a Connection Between Endometriosis and Environmental Pollutants?

Endometriosis is a painful and puzzling condition in which the tissue that lines the inside of the uterus — the endometrium — grows outside the uterus, often on the ovaries and fallopian tubes. In addition to causing pain, endometriosis can result in heavy bleeding and infertility. One in 10 women of reproductive age is thought to be affected.

One of the most frustrating aspects of endometriosis is that the cause is unknown. A couple of new studies have focused on environmental triggers, with mixed results. Both studies appear in an upcoming issue of the journal Environmental Health Perspectives.

The first study used data from the large Nurses’ Health Study II, involving more than 84,000 female nurses. The researchers identified those who lived near roadways, exposing them to more particulate matter in the air as adults. (Particulate matter is a type of pollution that can come from vehicle exhaust and other sources, such as coal-burning power plants.) The authors report that they did not find any significant association between exposure and the incidence rate of endometriosis, but also note this is the first human study to assess the relationship between particulate matter exposure and endometriosis.

Future research is likely needed to confirm the result, and other factors may need to be considered, such as the amount of exposure to particulate matter where women grew up or where they work. 

The second study did find a link between another type of pollution and endometriosis. Researchers used data from the Women’s Risk of Endometriosis study conducted in Washington state, analyzing blood samples of women with and without endometriosis to gauge their levels of organochlorine pesticides (OCPs). The researchers found associations between levels of two pesticides — β-hexachlorocyclohexane (HCH) and mirex — and a greater chance of having endometriosis.

Organochlorine pesticides, such as DDT, were commonly used in agriculture and for mosquito control during the 20th century. While their use has been greatly restricted in the United States, these pesticides accumulate in bodies and are still often detected in blood studies. The researchers note that most U.S. exposures are now from consumption of fatty foods, fish, and dairy products where the toxins have built up. Global use of OCPs is also a concern, as the contamination may spread.

These pesticides are known to be potential endocrine disruptors, but the exact nature of any link with endometriosis is unclear. The researchers involved in the study also found that the link was stronger when they looked just at ovarian endometriosis, although they don’t speculate on why that may be, except that ovarian cases may differ in some way from other cases of endometriosis.

All of this points to the need for more research.

For more information, visit the Endometriosis Association, which offers free informational packets and other resources. You can also read excerpts from “Our Bodies, Ourselves,” and learn more about both endometriosis and pesticides via the National Library of Medicine.

November 13, 2013

Researchers Explain How Anti-Abortion Legislation Threatens Women’s Health

Protest rally against Texas HB2 and SB1 on July 15

July 15 protest rally in Austin against anti-abortion legislation / Photo by Mirsasha

There have been a number of recent articles and campaigns detailing, often from a personal perspective, how legislation restricting access to abortion will harm women’s health.

A new article that will be published in the journal Contraception goes a step further — it draws on research to address the specific hardships women face and urges healthcare providers to push back against such restrictive measures.

The authors — researchers from university medical centers and health policy organizations such as Ibis Reproductive Health who have collaborated together before on matters of abortion and women’s health — open with a sharply worded question: “What happens when abortion access is severely restricted for 26 million Americans? Texas is about to find out.”

Texas, as you might recall, passed a law in July — the subject of State Sen. Wendy Davis’s epic filibuster – that mandates hospital admitting privileges for abortion providers; requires abortion facilities to meet the same standards as ambulatory surgical centers; bans most abortions after 20 weeks post-fertilization (22 weeks “pregnant”); and restricts use of medication for abortion to an outdated regimen. A lawsuit was filed to try to overturn some of these restrictions.

The admitting privileges requirement was temporarily blocked this month, then reinstated, causing up to a third of abortion clinics to suddenly close and forcing women to scramble for alternatives. The issue may end up in front of the Supreme Court. (More wrangling took place this week; view the latest coverage at RH Reality Check).

Despite claims that the new restrictions are for women’s “safety,” the authors report that the evidence suggests something different: “Evidence from other countries indicates that severely restricting abortion does not reduce its incidence — it simply makes unsafe abortion more common.”

Among the public health concerns raised in this article is the potential increase in the number women attempting to induce their own abortions:

In 2012, we conducted a survey with 318 women seeking abortion in six cities across the state to assess the impact of the 2011 restrictions. We found that 7% of women reported taking something on their own in order to try to end their current pregnancy before coming to the abortion clinic. This proportion was even higher — about 12% –among women at clinics near the Mexican border. Misoprostol and herbs were the methods women more commonly mentioned. By comparison, a nationally representative survey of abortion patients in 2008 found that 2.6% reported ever taking something to attempt to self-induce an abortion. The confluence of extremely limited access to abortion in the context of poverty, access to misoprostol from Mexico, as well as familiarity with the practice of self-induction in Latin America, makes it particularly likely that self-induction will become more commonplace in Texas.

Early medical abortion with misoprostol is a safe and effective regimen and is  recommended by the World Health Organization in settings without access to mifepristone. But if women do not have accurate information, they may use ineffective dosages and may not realize the abortion failed until much later in pregnancy, forcing them to seek a second-trimester abortion or continue the pregnancy and have a child they do not want or feel they cannot care for. Using misoprostol in the second trimester also increases the risk of hemorrhage that might require surgical intervention or transfusion, as well as the risk of uterine rupture if inappropriately high dosages are used, especially with a history of prior cesarean delivery. And while misoprostol is unquestionably a safe method to self-induce abortion, women may use a variety of less effective and more dangerous methods to end a pregnancy on their own, including taking herbs or self-inflicting abdominal trauma.

The authors also explain that a reduction in the number of clinics, due to the provision requiring clinics to meet the standards of ambulatory surgical centers (ASCs), is likely to cause delays for women seeking care, resulting in later, more costly abortions. They describe the following scenario involving delays and travel burdens:

In 2011, 2,634 women living in the Valley obtained an abortion. Neither of the two existing abortion clinics in the Valley is an ASC, and one of the clinics has already announced its planned closure. The nearest ASC is in San Antonio, about 250 miles away, adding about eight hours of travel time to the process of obtaining an abortion. If a woman chooses a medical abortion, state law requires her to make this long journey at least three times. These barriers are likely to be too great for many women.

The three visits rule is due to a provision in Texas law requiring doctors to follow an outdated regimen for medical abortion. Most U.S. providers, they note, use a newer protocol, which has been found safe and effective — and requires only two visits instead of three. They write:

Texas is only one of several states attempting to regulate abortion out of existence — a trend that should be deeply troubling to the medical community. First, it represents a stunning incursion into the physician’s exam room, allowing state representatives to dictate how doctors should practice medicine. Second, it is in blatant contradiction to evidence-based medicine.

And they call on physicians to be more involved in protesting this type of legislation:

As the fight for abortion rights in Texas moves from the legislature to the courts, it is critical that reproductive health specialists — both clinicians and researchers — add their voices to this outcry, highlighting the negative impact of these restrictions and demanding that all women have the right to comprehensive health care services.

The article, “The Public Health Threat of Anti-Abortion Legislation,” will appear in an upcoming issue of Contraception.

November 8, 2013

Here’s What ABC World News Did, and Did Not, Get Right in Report on Egg Donors

by Diane Tober / Associate Executive Director, Center for Genetics & Society

ABC World News joined other media this week in addressing the astonishing 74 percent rise over the past 10 years in young women providing their eggs so that other women can create families.

Correspondent Cynthia McFadden interviews egg “donors” and fertility practitioners to explore the risks of egg retrieval, and chats with anchor Diane Sawyer about the story. While the segment lets several misleading statements stand, it gets some important things right.

First, the report is clear about the point that young women, primarily college students, are recruited to become egg providers with offers of thousands of dollars (yet use of the term “egg donor” for what is a commercial transaction is misleading). Women who are considered better-looking are typically paid more, as are white and Asian women, and those who have higher SAT scores and/or athletic skills. More money also goes to “proven donors” — women whose eggs have been used by “intended parents” to achieve a successful pregnancy.

The story also correctly reports — and expresses appropriate surprise about — the lack of short- or long-term tracking of egg providers’ health and the fact that there is no national database for egg providers. As Dr. Jennifer Schneider points out in the segment, egg providers are “not considered patients — they’re considered more like vendors.” They essentially disappear as soon as the procedure is done.

Now let’s turn to the inaccuracies in the ABC World News story.

McFadden interviews Dr. Joel Batzofin, a reproductive endocrinologist, who states that although “nothing is risk free,” egg extraction is “essentially risk free.” He describes the short-term complication known as ovarian hyperstimulation syndrome or OHSS as “extremely rare” and says it occurs in less than 1 percent of cases.

Unfortunately, his claim remains unchallenged in the segment, despite emerging evidence that OHSS occurs much more frequently than that. One prospective study analyzed OHSS rates in 339 women who produced more than 20 ovarian follicles. 49 (14 percent) were hospitalized due to OHSS, 13 (3.8 percent) needed intravenous fluids, and 9 (2.7 percent) needed to have fluid drained from their abdomens.

Egg providers are commonly stimulated to produce more than 20 follicles, and therefore appear to be at much higher risk for OHSS than is currently being reported. A recent study in the Journal of the American Medical Association found that more than 21 eggs were retrieved in 40.3 percent of the retrieval cycles performed on “oocyte donors.”

Furthermore, preliminary collaborative research on egg provider experiences by CGS and We Are Egg Donors has found numerous cases of women experiencing OHSS to the point where they are bedridden for a week or more. Even though doctors and clinicians assure egg providers that OHSS is “rare,” no one is surprised when it occurs.

When donors are in pain and bloated to the point where they look six months pregnant — after their eggs have been retrieved — they are told that this is “normal,” and to rest and drink plenty of fluids. These cases are not even diagnosed as OHSS, let alone reported or tracked, so there is no data to substantiate that it only occurs in 1 percent of cases.

The ABC World News segment is equivocal in its discussion of links between egg retrieval and cancer. McFadden reports that “there are no known long-term medical issues for donors,” but goes on immediately to say that this is “a world of difference from saying [that there are] no long-term issues.”

In fact, some data does suggest that the synthetic hormones used in egg retrieval may increase risk of colon, ovarian, uterine and breast cancers, though it is difficult to prove the connection due to the delayed onset of cancers in former egg providers and infertility patients.

One Dutch study published in Human Reproduction by Dr. Flora van Leeuwen followed over 19,000 women for 15 years and found that those who had undergone at least one IVF cycle were approximately twice as likely to suffer ovarian malignancies as women who had not undergone IVF treatment.

So how does the ABC World News report rate overall? We recognize that it is not possible in a three-minute segment to cover the entire gamut of egg retrieval risks and experiences but would have liked to hear a mention of the side effects of Lupron (which is used off-label and has been known to cause strokes and a variety of dangerous side effects) and Clomid (which has been linked to increased cancer risk in women who don’t go on to become pregnant).

We would also have liked to see correspondent McFadden question the claims made by Dr. Batzofin, and point out that he and others in the infertility industry stand to profit from taking eggs from young women.

At the same time, we applaud ABC World News for its clear and explicit call for follow-up studies of egg providers and for a national database to track their short- and long-term health.

This post was originally published on Biopolitical Times, the blog of the Center for Genetics & Society.

Plus: Raquel Cool, co-founder of We Are Egg Donors, explains the need for a group that supports women considering or who have provided eggs for fertility purposes. Also check out this petition (started by OBOS, the Center for Genetics and Society, and other organizations), which calls for a human egg extraction health registry and for warnings on ads and notices seeking egg donors. And read one young woman’s experience as she contemplates donating her eggs.

November 7, 2013

Guides to Breastfeeding and Working

The American College of Nurse-Midwives recently published a free guide to breastfeeding and working, which carries tips for preparing to go back to work full-time, what to look for in a breast pump, how often to pump, and how to store milk.

The suggestions are very practical, although some — such as working part-time or working from home for a while — are not realistic for many women, especially in non-office or hourly jobs.

Newer legal protections for breastfeeding workers, however, should make some aspects of breastfeeding and work a little easier to manage. One rarely mentioned benefit of the Affordable Care Act (aka Obamacare) is that the act amended the Fair Labor Standards Act to require employers to provide breaks for nursing mothers to express breast milk for a year after the child’s birth.

Workplaces with 50 or more employees are required to provide “a reasonable amount” of break time for expressing milk as often as needed, as well as a functional space for pumping that is *not* a bathroom.

The employers are not required to pay for the time of these breaks. Employers with fewer than 50 employees might be exempt if they claim it creates a “hardship,” so it’s important to check on if you work for a small business. The Department of Labor provides more resources on this topic for workers and employers.

Some states also have laws that protect breastfeeding women in the workplace. Where the state law does a better job of protecting workplace breastfeeding/pumping, the state law is what applies.

See also: Previous posts and excerpts from “Our Bodies, Ourselves” on breastfeeding.

November 4, 2013

The Ultimate Guide to the Legal Battle Over OTC Access to Emergency Contraception

In the October issue of the journal Contraception, authors from Harvard Law School and Brown University’s medical school trace the legal and political battles over non-prescription access to emergency contraception.

The authors date the legal dispute back to Jan. 21, 2005, when a coalition of organizations in favor of emergency contraception filed a lawsuit accusing the FDA of ignoring the science and safety and applying different standards to Plan B, a type of EC under review at that time, than the FDA applied to other drugs.

Of course, concern about access and the FDA’s process actually goes back further. Organizations had filed a Citizen Petition four years earlier asking the FDA to approve over-the-counter access. The FDA’s failure to respond to that petition, and rejection of the drug company’s application for OTC status, are what ultimately led to the 2005 lawsuit.

The article in Contraception covers the legal battles and notes the various ways the U.S. government interfered in the FDA’s decision-making. You might recall that politically motivated delays under the Bush administration led Susan Wood, a former assistant FDA commissioner for women’s health and director of the Office of Women’s Health, to resign in 2005.

“I can no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended for approval by the professional staff here, has been overruled,” she said at the time of her decision.

After President Obama took office, and amid hopes that sound policy would prevail over politics, HHS Secretary Kathleen Sebelius overruled the agency’s 2011 decision that Plan B could be made available without a prescription or age restrictions. Noting this and subsequent political interference, the authors comment:

The final resolution of this controversy offers an ideal vantage point to examine the vulnerability of the FDA to political influence. While the FDA has “consistently been named or identified as one of the most popular and well-respected agencies in government”, the ability of the FDA to resist political influence is more precarious than its apparent reputation might suggest. After all, the FDA is not an independent agency. Indeed, the FDA Commissioner serves at the pleasure of the President. What is more, the idealized notion that the science-driven decision-making process of the FDA is insulated from and resistant to the political discourse is incommensurate with precedent.

Yes, that’s lawyer speak, but what it translates to is this: The Plan B drama has shown us that the FDA cannot be relied upon to make purely evidence-based decisions. At any time, a presidential appointee (like Sebelius) might step in to overrule evidence-based decisions. And as we’ve seen with Plan B, the resulting legal battle and limited access to a needed drug can stretch on for years.

Without a doubt, as the authors note, “there can be little questioning the foot dragging and active role played by two successive presidential administrations in shaping the emergency contraception debate.”

Plus: For more on the history of the fight for OTC emergency contraception, view a timeline from the Center for Reproductive Rights, and the original Citizen’s Petition, and check out coverage at Our Bodies, Our Blog. Important posts for context include this item on  Sebelius overriding the FDA’s decision, Susan Wood’s response at the time, and more history of the battle for increased access to EC.

October 31, 2013

What Percentage of Older Women Are Satisfied with Their Body Image? Survey Says …

Body image is often thought of as a concern for teen girls and younger women, and the abundance of resources on this topic are skewed toward those age groups.

But a new study published in the Journal of Women and Aging illustrates how few of us are happy with how our bodies look, even as we get older: Only 12 percent of women reported being satisfied with their body size.

While the number is pathetically low, it’s not surprising considering how many of us are self-critical about our appearance. Even if we are not actively dieting, our culture — and sometimes our own families and friends — make it impossible to tune out messages that we should be younger, thinner and prettier.

Researchers from UNC Chapel Hill conducted an internet-based survey of 1,789 U.S. women age 50 and older to find out more about their perspectives. Participants were overwhelmingly white (92.3 percent), and the average age was 59. Close to half (42 percent) had a body mass index (BMI) that put them within “normal” weight ranges for their height.

For the study, participants were shown silhouettes of nine bodies of various sizes and asked which silhouette most resembled their own body, and which body size they preferred. Women who preferred the shape closest to their own were considered to be satisfied with their bodies. Women who preferred a different body shape were categorized as dissatisfied.

In discussing their findings, the authors point out that women who are generally satisfied “appear to exert considerable effort to achieve and maintain this satisfaction, and they are not impervious to experiencing dissatisfaction with other aspects of their appearance, particularly those aspects affected by aging.”

For instance, many of the women who fell into the “satisfied” group were unhappy with specific body parts, including their stomach (56.2 percent), face (53.8 percent), and skin (78.8 percent) — although they reported dissatisfaction at lower rates than the women who were dissatisfied overall with their bodies.

And while the majority (88 percent) of women who were satisfied were considered “normal” weight, 40.6 percent said they would be moderately or extremely upset if they gained just 5 pounds.

Satisfaction with one’s body shape/size also does not grant immunity to negative thinking:

- A third (34.1 percent) reported thinking about their weight “daily” or “always.”
- Half (50.7 percent) expressed envy of younger women’s appearance.
- More than three-quarters (77.1 percent) reported that their shape played a primary role in their self-evaluation — about the same percentage of women who were unsatisfied with their appearance.

The women were also asked about their weight, height, ethnicity, symptoms of eating disorders, diet, and weight-control behaviors (like dieting and frequent weighing), concerns about their weight and shape, and quality of life. There was no difference between the satisfied and unsatisfied groups when it came to skipping meals or extreme/disordered weight control measures.

Satisfied women reported somewhat more exercise (average of 5.1 hours vs. 3.8 hours), and the authors note that “exercise may directly (and indirectly) enhance body esteem in women.”

Women who were unsatisfied with their bodies were significantly more likely to report that a physical or medical condition affected their weight or appetite (30.3 percent vs. 9.2 percent). The were also more likely to do frequent body checking, attempt weight loss, spend more than half their time dieting, and report having tried low-calorie diets or diet plans.

The authors were not able to determine whether these activities led to dissatisfaction, or whether body dissatisfaction more often led to these activities. The study also doesn’t address the effect that negative messages and stigma may have on satisfaction rates.

The authors recommend that health-care providers discuss weight, shape, and aging-related concerns with all mature women, and “maintain sensitivity when talking about weight management.”

For a more personal take on these survey results, read Rachel Zimmerman’s post at WBUR’s Common Health. Zimmerman reflects on how she spends an “inordinate, and frankly embarrassing amount of time thinking about food, planning meals and strategizing about how to control [her] weight.”

And for more information, check out Our Bodies Ourselves resources on body image. For help related to eating disorders, see the National Eating Disorders Association.

October 24, 2013

Medical Groups Call on Health Care Providers to Advocate for Reduced Exposure to Environmental Pollutants

Two major medical societies and an important research group have released a joint statement calling on health care providers to advocate for reduced exposure to toxic chemicals and pollutants that can can cause reproductive health problems, harm to pregnancies, and long-term health complications.

The organizations involved — American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women, American Society for Reproductive Medicine Practice Committee, and UCSF Program on Reproductive Health and the Environment – state that although hundreds of new chemicals are introduced in the United States each year, safety data and regulation are lacking:

Because of deficiencies in the current regulatory structure, unlike pharmaceuticals, most environmental chemicals have entered the marketplace without comprehensive and standardized information regarding their reproductive or other long-term toxic effects.

Among the recommendations for health care providers (the target audience for the statement): learn about patients’ exposures before pregnancy and during prenatal visits; encourage pregnant and breastfeeding women to carefully wash produce and avoid fish with high levels of mercury; include information about environmental hazards in childbirth classes; and promote healthy food systems and policy changes that reduce exposure.

It’s great to see the medical establishment recognizing the need for better study and regulation of toxic chemicals — and acknowledging both the impact on reproductive health and the disparities in exposure to pollution and toxins. This new committee opinion, intended as an informative guide for professionals, may bring much-needed attention to these issues among obstetricians, gynecologists, and other reproductive medicine practitioners.

The committee opinion acknowledges that certain recommended actions — like eating fresh, unprocessed foods, selecting organic produce, and avoiding canned food that might expose consumers to bisphenol A — are not realistic strategies for many low-income women and vulnerable populations. The authors rightly note:

In the United States, minority populations are more likely to live in the counties with the highest levels of outdoor air pollution and to be exposed to a variety of indoor pollutants, including lead, allergens, and pesticides than white populations. In turn, the effects of exposure to environmental chemicals can be exacerbated by injustice, poverty, neighborhood quality, housing quality, psychosocial stress, and nutritional status.

The organizations add that “individuals alone can do little about exposure to toxic environmental agents, such as from air and water pollution, and exposure perpetuated by poverty,” and they therefore urge healthcare professionals to help advance policies that reduce exposure to toxins.

Relatedly, Breast Cancer Action is currently seeking signatures on a petition to Congress to increase chemical safety testing. And ACOG has released a brief guide to toxic chemicals and their effects for more information. Also, check out “Our Bodies, Ourselves” and related content on environmental and occupational health.

October 18, 2013

New Study on Youth and Sexual Violence Considers Spectrum of Rape Scenarios

In a new study published in JAMA Pediatrics, nearly 1 in 10 youths in the United States reported committing an act of sexual violence.

As part of a larger Growing Up With Media study on media consumption and exposure, the researchers surveyed 1,058 girls and boys ages 14 to 21 about their experience as perpetrators of sexual violence and their exposure to violent sexual media.

Rather than ask participants if they had ever raped or sexually assaulted anyone, the researchers asked more nuanced questions, including if they had tried to make someone have sex with them when they knew the other person didn’t want to, and if they had succeeded at doing so.

The participants were also asked if they had kissed, touched, or done anything sexual with an unwilling partner. Among the findings:

  • 9 percent of youths surveyed reported some type of sexual violence perpetration in their lifetime;
  • 8 percent kissed, touched, or made someone else do something sexual when they knew the other person did not want to (ie, forced sexual contact);
  • 3 percent got someone to give into sex when he or she knew the other person did not want to have sex (hereafter referred to as coercive sex);
  • 3 percent attempted – but were not able – to force someone to have sex (ie, attempted rape);
  • 2 percent forced someone to have sex with him or her (ie, completed rape).
  • About 3 in 4 victims were a romantic partner.

There was a good amount of overlap: 12 percent reported two different behaviors, 11 percent reported three, and 9 percent reported all four types.

When asked about the most recent time they tried to force or were able to force someone to have sex, tactics were mostly coercive. Arguing or pressuring the person (32 percent) or getting angry or making the person feel guilty (63 percent), were more commonly used than threats (5 percent) or physical force (8 percent). Alcohol was a factor in 15 percent of these situations.

It’s important to keep in mind that survey research like this — even when conducted via the internet — may underestimate true rates of actions like sexual assault, because perpetrators are motivated to avoid reporting their own crimes.

The authors note this as a limitation, adding, “Nonetheless, rates are much higher than the lifetime rate of 0.15% yielded in a national study of adults that was conducted face to face.”

Perpetrators & Victims
Women were much more likely to be the victim of an attempted or completed rape; perpetrators reported that about 80 percent of victims were female. The researchers also found that about 5 percent of victims were transgender.

White youths were more likely than nonwhite youths to report perpetrating coercive sex, and youths living in higher-income households were more likely to report attempted rape.

Perpetrators of any type of sexual violence were significantly more likely to have consumed any type of X-rated material, especially violent materials.

The authors note that while media consumption and violence could not be causally linked by their study, “it seems appropriate to suggest that frequent consumption of sexual and violent material and especially sexually violent material should be a marker for concern for adolescent health care professionals.”

Looking at the gender of assailants, researchers found that boys and young men accounted for almost all rapes and attempted rapes committed before age 18. The study notes that 98 percent of perpetrators whose first act occurred at ages 8 to 15 were male, as were 90 percent of perpetrators involved in an assault at ages 16-17.

Among 18- and 19-year-olds, women accounted for slightly more than half (52 percent) of attempted/completed rape perpetrators (seven women out of 13 total). The authors note that their broad definitions may result in finding an unexpectedly high amount of female perpetrators. They add, however, that it’s important to challenge the widespread notion that women cannot coerce men.

Some may argue that the definitions of rape and sexual assault in our investigation are too broad. Indeed, this may be why the perpetration rate among females is higher than might be posited. Rape includes acts beyond those in which the victim is physically overpowered, however. Restrictive definitions have potentially led to undercounting of sexual assault experiences.

For example, in the National Violence Against Women Survey, respondents were asked whether anyone had ever made them engage in a sexual activity “by using force or threat of force.” Psychological coercion was not clearly specified even though there are multiple coercive strategies other than physical force that can be used in a rape. To ensure that comprehensive rates of sexual assault and rape are identified as well as to begin building the research base on female perpetrators, research needs to include a fuller spectrum of rape scenarios.

Few Criminal Consequences
The findings on attitudes and punishment are chilling.

“Sixty-six percent of perpetrators reported that no one found out about the perpetration. Contact with the justice system was uncommon: 1% of perpetrators reported police contact and 1% an arrest,” note the authors.

They also found that half of perpetrators said that the victim was completely responsible for the incident. Only 1 in 3 said that they, the perpetrator, were completely responsible for the incident.

The authors recommend that more effort should be made on education that avoids victim blaming and emphasizes perpetrators taking responsibility for their own actions. They also suggest further research on factors related to taking responsibility, such as motivations behind the sexual violence and feelings of remorse or regret.

Incidents like this recent one in Maryville, Mo., in which a family moved due to harassment after the daughter was sexually assaulted, highlight the cruelty of victim-blaming and the need for prevention programs that put responsibility on the assailant.

The authors also commend bystander intervention programs, but note that most of that research has been done at the college level, and more work is needed at the high school level.

Plus: To learn more about consent, including essential rules, ways to talk about it, and examples of the enthusiastic consent model, check out Scarleteen’s Driver’s Ed for the Sexual Superhighway: Navigating Consent.

October 10, 2013

All Pinked Out in October? There’s a Cure for That! Join the Think Before You Pink Campaign

by Annie Sartor
Policy and Campaigns Coordinator, Breast Cancer Action

Why is the breast cancer epidemic still raging after 30 years of “awareness” and pink ribbon products?

Each year, corporations pack the shelves with pink ribbon products, surrounding us with “breast cancer awareness” messages. These products help to raise billions of dollars in the name of breast cancer, and yet more than 40,000 women in the United States still die of the disease every year.

And many corporations sell pink ribbon products in the name of breast cancer that actually contain chemicals linked to an increased risk of the disease. At Breast Cancer Action, we call this blatant hypocrisy “pinkwashing.”

For 12 years, Breast Cancer Action’s Think Before You Pink campaign has held corporations accountable for their toxic pink ribbon products. This year, it’s time to say we’ve had enough. Instead of targeting pinkwashers one at a time, it’s time to go straight to the source — the chemicals in these products that are making us sick in the first place.

Do you have any idea how many toxic chemicals are in the average pink ribbon product? Nope? Neither do we. Nor does anyone!

Toxic Time is UpAll anyone knows for certain is that only a small handful — about 200 of the over 80,000 chemicals in use in the United States — have been tested for human safety. And that’s a serious problem for all of us.

These chemicals are found in everyday consumer products such as plastics, paint, clothing, and cleaning supplies, including an unknown number of pink ribbon products being sold in the name of breast cancer.

Evidence of the links between environmental toxins and cancer continues to mount. In 2010, the President’s Cancer Panel reported that “the true burden of environmentally induced cancer has been grossly underestimated [and] … the American people — even before they are born — are bombarded continually with myriad combinations of these dangerous exposures.”

And just this week, yet another study came out showing an even stronger link between BPA and breast cancer than we’d previously thought.

Why is pinkwashing so prevalent, and even possible in the first place? Our current chemical policy, the Toxic Substances Control Act, is extremely outdated and woefully inadequate to protect public health from hazardous chemicals in our daily lives.

Thanks to a large coalition of health activists, environmentalists, scientists, and thousands of others, pressure has continued to mount for reform of this outdated and toothless law. If strong TSCA reform legislation moves forward this fall, we will have a real opportunity to enact a bill that could make history and be the biggest win for cancer prevention we’ve ever seen.

We refuse to waste another October watching corporations make money off pink ribbon products that contain toxins linked to breast cancer.

Please join us in taking a stand to protect all of us from toxic chemicals that are making us sick, because the manufacturers of pink ribbon products certainly won’t. Sign our petition to end pinkwashing once and for all via strong chemical regulations. It’s time to turn our outrage over pinkwashing into action and ban the toxins that make us sick in the first place.

October 9, 2013

Studies Look at Access to Family Planning Services Provided at Federally Qualified Health Centers

A pair of newly published studies in the journal Contraception look at the types and access to family planning services provided at community health clinics that are considered a popular primary care option for low-income women of reproductive age.

The studies, produced by researchers at the George Washington University School of Public Health, examine the services at Federally Qualified Health Centers (FQHCs). These health clinics provide primary and preventive care on a sliding scale, primarily to low-income and uninsured patients. It’s also worth noting that when states attempt to defund Planned Parenthood clinics, these are clinics to which many women may get directed for care.

The authors anticipate that these health centers will become an even more important part of care as the Affordable Care Act is fully implemented and Medicaid is expanded. One of the co-authors is Dr. Susan Wood, who resigned her post as director of the FDA’s Office of Women’s Health in 2005 in protest over delays in approving over-the-counter access to emergency contraception.

In the first study, “Scope of Family Planning Services Available in Federally Qualified Health Centers,” researchers surveyed several hundred FQHCs about on-site care, including approaches to pregnancy prevention and STI/HIV testing and treatment, as well as referrals of patients to other sites, staffing issues, and other aspects of care. While they found that almost all of the FQHCs provided at least one contraceptive method, the type and accessibility of those methods varied.

Slightly more than half of the centers were able to dispense oral contraceptives on site rather than sending patients elsewhere with a prescription. Slightly more than a third (36 percent) offered both oral contraception and longer acting IUDs and/or implants on-site. If a woman has to go to another location, there may be consequences such as incurring lost work time that may make it harder to follow through.

Also, only about a third of the surveyed centers received Title X family planning funding (it’s not clear whether some clinics had not applied, or did apply and were rejected). The researchers found that while pretty much all of the centers provided access to oral contraception, the Title X-funded clinics were more likely to provide the full range of contraceptive options.

A companion paper, “Accessibility of Long Acting Reversible Contraceptives (LARC) in Federally-Qualified Health Centers (FQHCs),” looks specifically at the survey results on long-acting contraceptive options, including intrauterine devices (IUDs) and implants. The study found that slightly more than half of the FQHCs offered IUDs on-site, while about a third offered contraceptive implants on site. For the rest of them, patients would have to be referred elsewhere to receive the devices.

The authors again found that clinics receiving Title X funds were more likely to provide these options.

October 4, 2013

Wendy Davis is Running for Governor in Texas, and That’s a Big Deal

Democratic State Sens. Sylvia Garcia (obscured), Royce West, Wendy Davis and Kirk Watson after the Senate passed the abortion bill on July 13, 2013. Photo by Callie Richmond / Texas Tribune (Creative Commons)

Wendy Davis, the Texas state senator who held off a vote restricting abortion rights by staging an 11-hour filibuster in June, announced on Thursday that she will run for governor.

Davis’s filibuster was an attempt to block legislation intended to reduce abortion access, including a 20-week ban on the procedure, imposition of surgical center standards for abortion clinics, and a requirement for providers to have admitting privileges at a nearby hospital — which would force the majority of Texas’s 42 abortion clinics to close.

The legislation was later enacted; a lawsuit is underway to block the admitting privileges and medication abortion provisions of the law from taking effect.

The state senator’s actions inspired women’s health advocates around the country (and a whole bunch of memes). Her actions capped off a difficult six months, as states enacted 43 provisions aimed at restricting access to abortion — the second highest number on record at the mid-year point, and as many as were enacted in all of 2012, according to Guttmacher Institute. These states are, not surprisingly, mostly led by Republican male politicians.

If Davis is successful in her run (a very big “if” considering Texas hasn’t had a Democratic governor since 1995, when the formidable Ann Richards, mother of Planned Parenthood President Cecile Richards, was in charge), she would join a very small group of female governors throughout the country. At present, there are only five.

But as Danny Hayes, a political science professor at George Washington University, writes in the Washington Post, getting more women to run for office is a very big deal: “[B]ecause the main barrier to electing more women in the United States is getting them to run in the first place, Davis’s emergence — the result of her 11-hour filibuster against an abortion bill in the state Senate in June — may be critical for encouraging other female candidates to throw their hats into the ring.”

While Davis’s views on abortion are clear, female representation is, of course, no guarantee of more sensible approaches to women’s reproductive health. Arizona Gov. Jan Brewer (R) signed a 20-week ban in that state last year.

October 2, 2013

How the Government Shutdown Affects Women’s Health

The federal government shutdown is expected to have wide-ranging consequences on the health of women and their families.

Before we get to the bad news, an important reminder: Enrollment for health coverage under the Affordable Care Act is *not* being blocked by the shutdown.

Go to to learn more about your options and to enroll. If you need additional information, Raising Women’s Voices and the National Latina Institute for Reproductive Health both have resources that explain more about healthcare benefits for women under the Affordable Care Act/Obamacare (yes, as Jimmy Kimmel demonstrated, they’re one and the same).

Now, here are the negative consequences:

- The WIC program that provides nutrition for women, infants, and children will not be able to take on new people and may run out of money to provide food assistance.

- Likewise, the Administration for Community Living will not be able to fund programs in Senior Nutrition, Native American Nutrition and Supportive Services, Prevention of Elder Abuse and Neglect, and Protection and Advocacy for persons with developmental disabilities.

- Federal websites that provide health information to consumers, like and MedlinePlus, are not being updated during the shutdown. The longer the shutdown continues, the more likely it is that these sites will have information that is no longer current.

- Researchers trying to answer questions about women’s health are also affected, meaning important research databases on medical topics may not be fully updated or updated at all.

- Clinical trials from the National Institutes of Health will not be able to accept new patients, possibly delaying important new discoveries in health.

- The FDA will be unable to support the majority of its food safety, nutrition, and cosmetics reviews. While the agency is expected to continue managing emergencies and high-risk situations, it will not have the resources to deal with some inspections and less urgent product alerts.

- In addition, those who may have delays in their paychecks and benefits – and other services – are hit directly, potentially making it harder for them to attend to their own health and that of their families.

Republicans tried to make restrictions on women’s preventive health care– including contraception coverage – a condition of not shutting down the government. As Cecile Richards writes, “The country wants Congress to focus on jobs and the economy, not on pushing an extreme agenda against women’s access to health care.”

And we really don’t want to bargain away our health.

September 27, 2013

Concerned About the New “Hookup Culture?” It’s No So New, or Worrisome, After All

It seems like every so often, the media and others can’t resist a story about how college students — especially girls — are going wild with lots of meaningless sex. The implication is usually that these young women are destroying both themselves and society.

For example, a 2009 ABC news piece actually uses the word “sluts” in the headline. Almost 15 years ago, Tom Wolfe’s novel “I am Charlotte Simmons” raised some of the same criticism, often focusing specifically on the behavior of young women.

The topic was recently in the news again, thanks to a New York Times article “Sex on Campus: She Can Play That Game, Too.” Like those before it, the article largely looks at “hooking up” as something new, even though that may not be the case.

Following the trend of focusing on the “problem” of women having sex, there’s been a lot of questioning as to whether female college students are missing out on prime husband-finding time — or simply making their own choices during a period when relationships are not high on their to-do lists. Disturbingly, The New York Times story takes a detour to explore drinking and campus rape, as though non-consensual activity is somehow linked to what women enthusiastically consent to.

Given all the hand-wringing, you’d think today’s college women just discovered sex outside of long-term relationships. Yet according to research results released at a recent American Sociological Association meeting, 18- to 25-year-olds are probably not having any more sex or sexual partners than women their age 15 to 25 years ago.

The main researcher commented, “College students overestimate the degree to which their peers are hooking up. It feels like something new, but they might be surprised to know the actual frequency of sex, the number of sexual partners, etc. don’t appear to have increased from their parents’ generation.”

It may also be helpful for students to know that when Guttmacher researchers looked at rates of “premarital” sex in 2002, the percentages of women and men who had sex by age age 20 (74 percent of women, 77 percent of men) was extremely similar to the overall rates for 20-year-olds in the 1970s (72 percent), 1980s (76 percent), and 1990s (74 percent).

As Kate Harding puts it in this column on “hook-up culture’s bad rap,” none of the drama over hook-up culture — which is often based on misogyny and what people want from girls instead of for girls — is really that helpful:

If we encouraged girls and women to place real value on their own desires, then instead of hand-waving about kids these days, we could trust them to seek out what they want and need, and to end relationships, casual or serious, that are unsatisfying or damaging to them, regardless of whether they’d work for anyone else.

She later adds:

[I]f we teach all kids that there’s a wide range of potentially healthy sexual and emotional relationships, and the only real trick (granted, it’s a doozy) is finding partners who are enthusiastic about the same things you want, then there’s room for a lot more people to pursue something personally satisfying at no one else’s expense.

And that’s a fact.

Also see:
Let’s Talk About Casual Sex, Baby” by Jaclyn Friedman
Breaking News: Casual Sex Won’t Ruin Your Life!” by Jessica Wakeman
Thoughts on the ‘Hook-Up Culture,’ or What I Learned From My High School Diary” by Nona Willis Aronowitz

September 25, 2013

“After Tiller” Focuses on Real Life Stories of Abortion Doctors and Their Patients

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After Tiller” is an important new documentary that explores the controversies around third-trimester abortions in the wake of the assassination of Dr. George Tiller.

Only four doctors in the United States now offer the procedures; the filmmakers explore how these providers “risk their lives every day in the name of their unwavering commitment toward their patients.”

Reviewing it for The New York Times review, film critic A.O. Scott, referencing a scene in which a young, pro-life woman’s request for abortion is discussed, calls it “one of the most illuminating discussions I have seen about the complicated reality of abortion.”

He concludes:

Documentaries can rarely be judged as works of dispassionate, neutral reporting since few of them aspire to uphold those journalistic criteria. Rather, a documentary should be assessed as a representation of the world as it is, from a perspective that is itself part of that world. “After Tiller” is impressive because it honestly presents the views of supporters of legal abortion, and is thus a valuable contribution to a public argument that is unlikely to end anytime soon.

New York Times editorial page editor Dorothy Samuels praises the film for taking “a complicated subject beyond the familiar muck of abstract and often ill-informed talking points to deliver a frank portrayal of the real life situations of the physicians and their desperate patients.”

Similarly, Jason Bailey, writing in The Atlantic, calls it “a rare consideration of the abortion debate that moves past labels and abstracts and takes a long look at the people involved. It is a showcase for empathy, a quality lacking in many conversations on the subject.”

The film premiered at this year’s Sundance Film Festival and is starting to open around the country. Scheduled screenings are listed online. Not playing near you? You can request a screening to bring “After Tiller” to your town. You can also follow @AfterTiller on Twitter, and like the documentary’s page on Facebook.

Want to learn more? Head over to PBS, where Tom Roston talks with “After Tiller” filmmakers Martha Shane and Lana Wilson on the Doc Soup blog.

September 24, 2013

How Can You Be Sure You’re Getting An Insurance Policy That Covers Maternity Care?

Michelle Andrews of Kaiser Health News answers an important question about maternity care coverage. Read more from the KHN series Insuring Your Health.

Q. My wife and I are newlyweds. We are looking into family insurance plans and are curious about maternity coverage, rates and any limitations. I’m seeing a lot of companies don’t cover maternity benefits or impose six-month restrictions. It seems really complicated and not helpful, to say the least. Any information you can provide will help.

A. This is one of the problems that the health law was designed to address.

The Pregnancy Discrimination Act requires companies with 15 or more workers that offer health insurance to provide maternity coverage for workers and their spouses. But the law doesn’t apply to plans sold on the individual market.

Only 12 percent of those individual plans provide maternity coverage, according to an analysis published last year by the National Women’s Law Center. Plans that do cover maternity services may have a separate deductible of up to $10,000 and impose a waiting period of up to a year before members can use the services, the study found.

All that will change next year. Starting in January, the Affordable Care Act requires all new individual and small group health plans to cover 10 “essential health benefits,” and maternity and newborn care is one of them.

Insurers can’t impose waiting periods for maternity coverage nor charge women higher rates than men, as typically occurs now.

If you buy a plan on the individual market now, chances are you’ll pay extra for maternity coverage, if you can find it at all. But even if you buy a plan now, there’s nothing to stop you from shopping for a plan that meets the new maternity coverage requirements when your state’s health insurance marketplace launches in October. Your new coverage could begin in January, says Carrie McLean, director of customer care at online vendor

If you and your wife do become pregnant before year’s end, you may benefit from another provision of the Affordable Care Act. Under current law, insurers on the individual market typically consider pregnancy to be a pre-existing medical condition and refuse to issue policies to people who are pregnant.

Starting in January, “Nobody can ask them if they’re pregnant and then deny them coverage,” says Judy Waxman, NWLC’s vice president for health and reproductive rights.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.