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.

The topic of routine screening mammography has become extremely controversial in recent years, especially following publication of a 2009 evidence review and subsequent U.S. Preventive Services Task Force recommendation that mammography be considered on an individual basis for women in their 40s, rather than automatically recommending mammograms for all women in that age group.

A new study published in the New England Journal of Medicine adds to the questioning of routine mammograms, concluding that “whatever the mortality benefit, breast-cancer screening involved a substantial harm of excess detection of additional early-stage cancers that was not matched by a reduction in late-stage cancers.”

The authors looked at data on how many women age 40 or older had screening mammograms and the incidence of early and late stage breast cancers. The assumption is that if widespread mammography is really helping to catch cancers at earlier, presumably more treatable stages, we’ll see fewer of those late stage breast cancers.

What they actually found was a large increase in detection of early cases (122 per 100,000 women), but a much smaller decrease (8 per 100,000 women) in late cases.

If mammograms were simply shifting diagnosis earlier, they should have seen about the same number for the increase in early cases and decrease in later cases. Instead, it resulted in diagnosis of numerous extra early cases that might not have progressed to more serious disease and would be considered over-diagnosis (with the corresponding over-treatment).

The researchers conclude that “the excess detection attributable to mammography in the United States involved more than 1.3 million women in the past 30 years.”

The authors did find that the death rate attributable to breast cancer had decreased over the last three decades, but they suggest that improvements in treatment over the last few decades may be primarily responsible.

As Dr. Diana Petiti, former vice chair of the USPSTF, explained in an email exchange:

Not all breast cancers detected by mammography would have caused a lump. Some breast cancers detected by mammography (we don’t know how many) revert to normal. Some breast cancers detected by mammography (we don’t know how many) don’t grow to the size of a lump. Some breast cancers detected by mammography (we don’t know how many) grow so slowly, they would not cause a lump in the forseeable lifespan of a woman.

Further not all lumps found by a woman (without mammography) would have caused death from breast cancer. Some breast cancers found as lumps (without mammography) are cured by treatment. Some breast cancers found as lumps (without mammography) grow so slowly that they never cause death due to breast cancer (which occurs because the cancer spreads). Some breast cancers found as lumps (with or without mammography) occur so late in life that something else causes death before the breast cancer spreads and causes death.

The newest data suggests that a not-small percentage of the breast cancers detected by mammography (without a lump) would not have killed the woman from breast cancer had it not been found.

While this is a complicated topic, this New York Times op-ed by Dr. H. Gilbert Welch, one of the authors of study published in NEJM, does a reasonable job of explaining it clearly. Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and an author of “Overdiagnosed: Making People Sick in the Pursuit of Health,” includes this call for change:

What should be done? First and foremost, tell the truth: woman really do have a choice. While no one can dismiss the possibility that screening may help a tiny number of women, there’s no doubt that it leads many, many more to be treated for breast cancer unnecessarily. Women have to decide for themselves about the benefit and harms.

But health care providers can also do better. They can look less hard for tiny cancers and precancers and put more effort into differentiating between consequential and inconsequential cancers. We must redesign screening protocols to reduce overdiagnosis or stop population-wide screening completely.

Dr. David Newman, an emergency room physician in New York City and author of the book “Hippocrates Shadow: Secrets from the House of Medicine,” tackles the controversy head-on in a column titled ”Ignoring the Science on Mammograms“:

For years now, doctors like myself have known that screening mammography doesn’t save lives, or else saves so few that the harms far outweigh the benefits. Neither I nor my colleagues have a crystal ball, and we are not smarter than others who have looked at this issue. We simply read the results of the many mammography trials that have been conducted over the years. But the trial results were unpopular and did not fit with a broadly accepted ideology—early detection—which has, ironically, failed (ovarian, prostate cancer) as often as it has succeeded (cervical cancer, perhaps colon cancer).

More bluntly, the trial results threatened a mammogram economy, a marketplace sustained by invasive therapies to vanquish microscopic clumps of questionable threat, and by an endless parade of procedures and pictures to investigate the falsely positive results that more than half of women endure. And inexplicably, since the publication of these trial results challenging the value of screening mammograms, hundreds of millions of public dollars have been dedicated to ensuring mammogram access, and the test has become a war cry for cancer advocacy. Why? Because experience deludes: radiologists diagnose, surgeons cut, pathologists examine, oncologists treat, and women survive.

Newman also notes that mammography is not the only area of medicine ripe for questioning:

It is normally troubling to see an observational study posing questions asked and answered by higher science. But in this case the research may help society to emerge from a fog that has clouded not just the approach to data on screening mammography, but also the approach to health care in the United States. In a system drowning in costs, and at enormous expense, we have systematically ignored virtually identical data challenging the effectiveness of cardiac stents, robot surgeries, prostate cancer screening, back operations, countless prescription medicines, and more.

To further explore this topic, listen to this WBUR Boston (NPR) segment with Dr. Welch, Judy Norsigian, OBOS founder and executive director, and Dr. Otis Brawley, chief medical officer at the American Cancer Society. Norsigian also wrote a column for WBUR’s Cognoscenti section, “Do Screening Mammograms Do More Harm Than Good?“

A sweeping U.S. study published on Nov. 22, 2012 in the New England Journal of Medicine shows that mammograms have done surprisingly little to catch deadly cancers before they spread. At the same time, they have led more than a million women to be treated for growths that never would have threatened their lives. 

Women over 40 are routinely advised to have yearly mammograms, and it’s widely believed that having one is key to protecting a woman’s health.

Although experts agree that diagnostic mammograms are beneficial (cases where there is a breast lump or other symptoms), there is much controversy about screening mammograms, which are performed on women with no signs of cancer. Mammograms detect breast cancer, although many people believe mistakenly that they prevent breast cancer. We now know that the mortality benefits remain quite small.

Eight trials performed in the United States, Canada and Europe have evaluated the ability of screening mammograms to decrease the death rate from breast cancer, as well as overall mortality. Looking at the overall death rate, not just death from breast cancer, is essential, because this approach also evaluates whether the screening test and any subsequent treatment may be causing other harms.

Overall, the early studies showed a 30 percent reduction in the risk of dying from breast cancer in women who were screened by mammography. In 2001, a critical review of all eight trials by the Cochrane Collaboration found that six of them were sufficiently flawed to invalidate their results. The Cochrane Collaboration then pooled the results of the two remaining studies and found no evidence to support the use of screening mammography.

The U.S. Preventive Services Task Force (USPSTF) evaluated the trials also. Although recognizing many of the same flaws, the USPSTF felt only one trial was sufficiently flawed to be invalidated. They pooled the results of the remaining trials and found a 16 percent reduction in the risk of dying of breast cancer in the women in the screened group.

The meta-analysis published in 2006 by the Cochrane Collaboration confirmed that screening does slightly reduce breast cancer mortality, but that it also leads to over-diagnosis and overtreatment of breast cancer. They concluded:

(F)or every 2000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm.

In a recent issue of the New England Journal of Medicine, Dr. Archie Bleyer and Dr. Gilbert Welch summarized the latest analyses as follows:

Despite substantial increases in the number of cases of early-stage breast cancer detected, screening mammography has only marginally reduced the rate at which women present with advanced cancer.

And this is the key to meaningful breast cancer screening — that we reduce the rate at which women have to be treated for late stage cancer.

When the data for women under 40 were studied (these are women who generally don’t get regular mammograms), Dr. Welch and Bleyer wrote:

There was a larger relative reduction in mortality among women who were not exposed to screening mammography than among those who were exposed. We are left to conclude, as others have, that the good news in breast cancer — decreasing mortality — must largely be the result of improved treatment, not screening.

Dr. Susan Love, a long time clinician and researcher, would like to see less emphasis on screening and more focus on cancer prevention and treatment for the most aggressive cancers. (Roughly 15 percent to 20 percent of breast cancers are deadly.)

“There are still 40,000 women dying every year,” Dr. Love notes. “Even with screening, the bad cancers are still bad.”

As Donald Berry, a biostatistician at M.D. Anderson Cancer Center in Houston, has pointed out:

Most breast cancers are not lethal, however found. Screening mammograms preferentially find cancers that are slowly growing, and those are the ones that are seldom deadly. Getting something noxious out of the body as soon as possible leads women to think screening saved their lives. That is most unlikely.

The challenge now is to make more widespread the use of techniques that help clinicians identify biological markers that will distinguish between the lethal and benign types of tumors. This appears to be the next big advance in reducing mortality from breast cancer.

Mammography, like other detection tools, is imperfect (it misses about 20 percent of lumps due to dense breasts and other factors). Some would consider it a very weak detection tool, and given the harms of overtreatment (for example, unnecessary chemotherapy and radiation treatments), it is not surprising that some women will want to forego screening mammography.

Women need to carefully consider these factors and decide for themselves what would be best, although friends, caregivers, and even commercial interests may tell them that having routine mammograms is the only rational choice. What really helps is knowledgeable and supportive counseling.

This article was originally posted at Cognoscenti, WBUR Boston’s ideas and opinions section, and is re-posted with permission.

“All that stuff I was taught about evolution and embryology and the Big Bang Theory … all that is lies straight from the pit of Hell.”

“If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”

Comments like these are what spurred us to create Educate Congress, a campaign to deliver “Our Bodies, Ourselves“ to every member of the U.S. House of Representatives and Senate. Because these comments really were spoken by members of Congress.

And that’s not the only problem. Misinformation is too often used as the basis for crafting bad policy, which is why we’re working to show how Congress can advance evidence-based reproductive health policy, based on science and fact. Reproductive health policy pertains to issues such as birth control, abortion, breast and ovarian cancers, the effects of environmental toxins on women’s health and fetal development, and more.

We’re into our final countdown, with just eight days left to reach our goal of raising $25,000 to deliver books to every member of Congress and key members of the administration and government agencies whose work involves health care policy.

You can select a specific representative or senator to receive the book or donate to the general fund. There are great perks to show our thanks, including stickers, tote bags, signed copies of “Our Bodies, Ourselves” by OBOS founders and Gloria Steinem, and a signed Legitimate Road Trip poster commemorating the drive from Chicago to St. Louis with The Ladydrawers to rush sex-ed materials to Rep. Todd Akin.

Please help us reach our goal — because, really, doesn’t everyone deserve access to comprehensive sex-ed?

Watch American Voices: Our Bodies Ourselves on PBS. See more from Need To Know.

The most recent episode of the PBS news show “Need to Know” featured an excellent yet disturbing segment about state legislatures slashing funding to women’s health clinics.

Mona Iskander looks at the effects this is having on women — particularly low-income women — and their ability to obtain birth control, STI screenings, and other reproductive health care services. Our own Judy Norsigian, OBOS’s founder and executive director, weighs in at the end about women’s health activism.

As part of the show’s online series “American Voices,”  Judy covers the beginnings of the women’s health movement in the United States and the launch of “Our Bodies, Ourselves.” She discusses the long history of denying women access to services as well as information about their bodies, and notes the effects of so many years of misinformation:

Over the years, we saw repeated attacks on good sex education. So much so that we then ended up with federally funded abstinence-only sex education in many of our schools. And the damage done there is still showing, well into the 21st century. I’ve met professors at medical schools who have said incoming medical students have said that using condoms promotes HIV/AIDS. And that comes straight from their abstinence only sex education in high school.

Watch the video above (just 3.5 minutes) for a look at how hard women have worked to ensure access to accurate, evidence-based information, and why it’s more important than ever  that politicians use this information when setting health care policy.

Want to help educate Congress? Send a copy of “Our Bodies, Ourselves” to your favorite representative or senator. It makes a great holiday gift!

As attacks on women’s access to reproductive health care continue, some states are slashing their budgets for family planning clinics.  The PBS news show “Need To Know“ examines the effects of these cuts on women in Texas.

The episode features Our Bodies Ourselves Executive Director Judy Norsigian, who offers an historical perspective of the fight for women’s reproductive freedom.

The episode airs today and tomorrow on various PBS stations. Click here to find your local station and air times. Here’s the full summary:

Need to Know examines how the Texas legislature has slashed funding to family planning programs because conservative lawmakers believe these programs may encourage women to get abortions.

Anchor Scott Simon interviews Pam Belluck, a health and science writer for The New York Times, who looks at what’s happening to these programs in other states.

And from “American Voices,” Judy Norsigian, one of the authors of “Our Bodies, Ourselves,” provides an historical account of women’s health policy debates over the past 40 years.

Though it won’t be as accessible as condoms, health experts are proposing to make the birth control pill available without a prescription. Photo / Jenny Lee Silver

This month, the American College of Obstetricians and Gynecologists released a statement calling for oral contraceptives to be sold over-the-counter, no longer requiring a doctor’s prescription.

ACOG considered a host of issues, including the safety of birth control pills; whether pharmacists could screen for who shouldn’t get them, or if women could self-screen; adherence to taking the pill; whether women would skip other preventive care if they didn’t visit a health care provider for a prescription; and cost.

Notably, ACOG addresses frequent objections to OTC oral contraceptives by concluding that “several studies have shown that women can self-screen for contraindications,” and “cervical cancer screening or sexually transmitted infection (STI) screening is not required for initiating OC use and should not be used as barriers to access.”

As Kevin Drum points out at Mother Jones, most countries outside of North America and Europe do not require a prescription for these drugs.

ACOG notes, though, that making the pill non-prescription might increase the cost for women who have health insurance — especially since under health care reform, contraception can be purchased without a co-pay. Over-the-counter costs might end up being anything from the $4 deals many pharmacies offer to more than $100. Dr. Kent Sepkowitz also explores this concern at The Daily Beast:

Yes, your life is easier because you will be able to get the pill right this second, without calling my office. No, you don’t need to fill out forms and show insurance cards and wrangle over copay. But guess who is paying for the whole shabang? You. Yes, you.

Another concern is that if the pill were dispensed by pharmacists, we might see the more of same kinds of refusals as have happened with emergency contraception.

However, many patients may experience increased access with an OTC model. The National Latina Institute for Reproductive Health issued this response:

The recommendation that birth control be available over-the-counter supports what we know about Latinas and contraception: over-the-counter access will greatly reduce the systemic barriers, like poverty, immigration status and language, that currently prevent Latinas from regularly accessing birth control and results in higher rates of unintended pregnancy.

Pre-Prescribing Emergency Contraception to Teens
Another professional medical organization, the American Academy of Pediatrics, issued a statement recognizing high teen birth rates in the United States and barriers to access to emergency contraception for adolescents 17  and younger. The AAP strongly admonishes pediatricians who refuse to discuss or provide contraception to teens based on their own beliefs, stating:

Pediatricians have a duty to inform their patients about relevant, legally available treatment options to which they object and have a moral obligation to refer patients to other physicians who will provide and educate about those services. Failure to inform/educate about availability and access to emergency-contraception services violates this duty to their adolescent and young adult patients.

The AAP recommends that physicians provide prescriptions to emergency contraception like Plan B in advance, so teens have it ready if and when the need arises. They also urge physicians to provide accurate information to teens on this topic, and, “At the policy level, pediatricians should advocate for increased nonprescription access to emergency contraception for teenagers regardless of age and for insurance coverage of emergency contraception to reduce cost barriers.”

Nice job, AAP!

HHS Urged to Remove Restrictions on Emergency Contraception
Finally, a petition is circulating urging the U.S. Department of Health and Human Services to remove restrictions on emergency contraception and make it available to women of all ages without a prescription. To learn more, see RH Reality Check’s audio news conference and related links and commentary from Kristin Moore. Our previous posts provide background on why EC is not *already* available OTC to all women:

• Evidence Trampled By Politics: HHS Secretary Sebelius Overrides FDA Decision on OTC Emergency Contraception
• Susan Wood Issues Response to Sebelius’s Overruling of Emergency Contraception Access

Each year, the Centers for Disease Control and Prevention (CDC) releases information on the number of abortions in the United States. Newly published data from 2009 shows that rates of abortion overall have decreased 5 percent since 2008 to the lowest levels since 2000. In general, rates of abortion were highest right after legalization, fell steadily in the 1980s and 1990s, and started to level off in the past decade.

It is not clear why rates have fallen. Possible contributors range from the expanded use of contraceptives and better sex education to the declining number of abortion providers and increases in restrictive abortion laws. Unintended pregnancy rates have not changed in decades – about half of all U.S. pregnancies are unintended — so that is not responsible for any decline.

As we know, many myths persist about who gets abortions and why. The following details shed some light on the topic:

• Women in their 20s have the highest rates of abortion (ages 20–24: 27.4 abortions per 1,000 women / ages 25–29: 20.4 abortions per 1,000 women), and account for 57.1 percent of all abortions.

This doesn’t seem terribly surprising given that women in their 20s are more likely to be fertile. In addition, they are more frequently uninsured. The insurance factor likely decreases their use of the most effective birth control methods –IUDs and implants –as those methods require a visit to a health care provider.

• The majority of women (55.3 percent) having abortions have not had a previous abortion. About 25 percent have had one previous abortion, and about 11 percent have had two previous abortions. Only about 8 percent have had three or more abortions, suggesting that the overwhelming majority of women having abortions do not fit the “using it as birth control” myth.
• Six out of every 10 women having abortions have already had one or more children. Women very frequently say that they chose abortion in order to best be able to care for their existing families.
• Abortions are usually performed early in pregnancy, with 64 percent done at less than eight weeks gestation, and about 92 percent done by or before 13 weeks.

There has been a clear shift to earlier abortions, with an almost 50 percent increase in abortions done at less than six weeks’ gestation. The CDC report is not able to address the reasons why; the increase may be caused by the greater availability of medication abortion (medication abortions are performed only up to 9 weeks) or an increased number of abortion laws that make later abortions more difficult to obtain.

Other points of interest:

• Use of medication abortion continues to increase; 16.5 percent of abortions in 2009 were done medically instead of surgically, a 10 percent increase from 2008.
• Abortion ratios (the number of abortions for every 1,000 women) decreased among non-Hispanic white women but not among women in any other racial/ethnic group.

Poor women, young women, and women of color are less likely to have access to reproductive health care services, more likely to have an unintended pregnancy, and more likely to have an abortion.

The CDC concludes its report with public health recommendations, including support for no-cost birth control. The Affordable Care Act comes close by eliminating co-pays for insured women (though employers who oppose reproductive rights are still fighting this provision), making birth control available without a co-pay for an estimated 47 million women. Here’s what the CDC has to say:

Moreover, although use of the most effective forms of reversible contraception (i.e., intrauterine devices and hormonal implants, which are as effective as sterilization at preventing unintended pregnancy ) has increased, use of these methods in the United States remains among the lowest of any developed country, and no additional progress has been made toward reducing unintended pregnancy. Research has shown that providing no-cost contraception increases use of the most effective methods and can reduce abortion rates. Removing cost as one barrier to the use of the most effective contraceptive methods might therefore be an important way to reduce the number of unintended pregnancies and consequently the number of abortions that are performed in the United States.

See our analysis of a recent study on unintended pregnancies in St. Louis for further discussion of how improved access to free birth control reduces abortions. The study is important for its role in dismantling persistent myths about contraception and abortion.

Plus: Though some members of Congress with less-than-accurate ideas about women’s bodies lost re-election, that doesn’t mean Congress is apt to back smarter policy. Let’s remind all members about the importance of access to contraception and reproductive health services. Join the Educate Congress campaign to send “Our Bodies, Ourselves” to every elected senator and representative. You’ll receive an “I Educated Congress” button (and other perks) showing you did your part!

We’ve been amazed by — and grateful for — the comments left by supporters of the Educate Congress campaign about why the site matters to them and what they want Congress to know about reproductive and sexual health.

During the recent election cycle it became all too apparent that there is a *lot* that some members still need to learn. Speaking from my experience, I want Congress to understand more about the science behind conception. Rep. Paul Ryan was a co-sponsor last year of HR 212, the Sanctity of Human Life Act, which states that “human life shall be deemed to begin with fertilization.”

I’m hoping members of Congress will stop proposing “personhood” legislation that would potentially ban some forms of contraception, such as the birth control pill, and threaten the health of women and their families in numerous ways (see this fact sheet from the Oklahoma Coalition for Reproductive Justice, a group that formed to fight personhood legislation in that state).

What do you think Congress should know about women’s bodies and health?

Tell us what you  think Congress should know when you join our campaign to Educate Congress. It can be something based on your health, the health of a family member or friend, or a community need or policy change.

Then make sure to share your message here on the blog, post it on our Facebook page, or tweet it using the hashtag #EducateCongress.

Our Bodies Ourselves has long believed that women’s stories and experiences inform what we know about women’s health. Who better to educate Congress than all of us?

The story of Savita Halappanavar, who died last month as a result of Ireland’s abortion ban, has sparked much debate over Ireland’s abortion laws and, in a broader sense, the issue of access to reproductive health care.

Savita went to a hospital in Ireland while experiencing severe back pain. The medical staff diagnosed her with miscarriage of a fetus with no chance of survival, but refused to perform an abortion because they detected a fetal heartbeat.

Several days passed before the heartbeat ceased and removal was allowed. But by this point, Savita had developed an infection that led to her death.

This is a tragic example, but one that unfortunately is quite predictable when women are unable to obtain legal abortion care. Abortion has been banned in the Republic of Ireland since 1983 by constitutional amendment, but traces back to an 1861 law. According to the Irish Family Planning Association, more than 4,000 women living in Ireland traveled to England and Wales for abortions in 2011, because the service is not legally available in Ireland.

Earlier this year, The Guardian reported that despite apparent declines in this number, more women may simply be disguising their home country, as “The number of women contacting a charity that helps people in Ireland seek abortions in Britain is set to double for the third year in a row.” (For more on the history of abortion law in Ireland, see this timeline, and “Ireland’s abortion ban: a history of obstruction and denial.”)

Here are some of the articles and analysis stemming from Savita’s death:

• Justice for Savita — Jessica Valenti gets to the bottom line for The Nation: “It’s not just our lives and health that are in danger, but our human dignity.”
• Hospital Death in Ireland Renews Fight Over Abortion – Douglas Dalby at The New York Times writes of a state of Irish politics that will not be entirely unfamiliar to U.S. readers: “Given the divisiveness of the abortion issue in Ireland, which has prompted two bitterly fought referendums, successive governments have avoided passing any legislation.”
• Death in Ireland is a Wake Up Call to Fight Bans on Later Abortion Here at Home – Susan Yanow at RH Reality Check contemplates the U.S. implications and concludes: “We have a sobering lesson to learn from Ireland — when doctor’s medical judgement is compromised by restrictive abortion laws, it is women’s health and women’s lives that suffer.”

Several writers have referred to the “X case” in covering this story. This was a controversial 1992 Irish Supreme Court case in which a 14-year-old girl expressed suicidal thoughts after being raped by a neighbor and becoming pregnant as a result. The girl planned to have an abortion elsewhere, but was prevented from doing so. The court eventually ruled that women have the right to seek abortions in life-threatening situations, including possible suicide.

Despite this 20-year-old ruling, Irish legislators have not passed a law to codify this right, leaving women in dangerously uncertain territory.

A Choice Ireland spokesperson explained:

Today, some twenty years after the X case we find ourselves asking the same question again — if a woman is pregnant, her life in jeopardy, can she even establish whether or not she has a right to a termination here in Ireland? There is still a disturbing lack of clarity around this issue, decades after the tragic events surrounding the X case in 1992.

Ireland’s Deputy Prime Minister Eamon Gilmore has said that the government would act “to bring legal clarity to this issue as quickly as possible.”

See also these additional commentaries on the failure to pass relevant laws after the X case to make abortions clearly legal in life-threatening situations.

Emer O’Toole writes at The Guardian about the struggles of pro-choice activists in Ireland, pointing to the culpability of doctors, legislators, journalists, and others in perpetuating the lack of justice in abortion laws. She issues an apology to Savita’s family that is also a call to action to supporters of abortion rights:

To her family, I want to say: I am ashamed, I am culpable, and I am sorry. For every letter to my local politician I didn’t write, for every protest I didn’t join, for keeping quiet about abortion rights in the company of conservative relations and friends, for becoming complacent, for thinking that Ireland was changing, for not working hard enough to secure that change, for failing to create a society in which your wife, your daughter, your sister was able to access the care that she needed: I am sorry. You must think that we are barbarians.

Related: Study Examines How Inability To Obtain Abortion Care Affects Women’s Lives

Do you live in the Boston area? If so, come on out this Sunday to see Our Bodies Ourselves founder and executive director Judy Norsigian at the Ryna Greenbaum JCC Boston Jewish Book Fair happening in Newton, Mass.

Judy will participate in the “Up Close and Personal” discussion session led by Judith Rosenbaum of Jewish Women’s Archive.

Naomi Wolf, author of the new book “Vagina: A Cultural Exploration” (which Jaclyn Friedman and many others have reviewed) will also participate.

The program kicks off at 2:30 p.m. on Sunday, Nov. 18, at the Leventhal-Sidman Jewish Community Center, 333 Nahanton Street, Newton, MA 02459.

The cost of the event is $5 for members of the Jewish Community Center of Greater Boston, and $8 for non-members.

We hope to see you there!

Bisphosphonates, a category of drugs that includes Fosamax and Boniva, are commonly prescribed to treat and prevent osteoporosis. Unfortunately, concerns have been raised about possible adverse effects of these drugs when used for longer than 3 – 5 years.

There are many unanswered questions about the long-term use of bisphosphonates.  A 2012 New England Journal of Medicine perspective piece notes that it is unclear how long most people should take the drugs, whether certain groups of patients are more likely to benefit from longer term use of the drugs, how long benefits of the drugs last after stopping them, and whether there are reliable measures to help make that decision in individual patients.

One of the concerns regarding long-term use is the potentially higher risk of unusual thigh bone fractures (often called “atypical femur fractures”).

A new study published in the The Journal of Clinical Endocrinology & Metabolism attempts to shed more light on the potentially higher risk of these fractures. The researchers collected the stories of 78 women and 3 men who suffered an atypical femur fracture after taking a bisphosophonate for treatment or prevention of osteoporosis. Medical histories were collected to see how long people had been on the drugs, if they experienced another fracture in the other leg, how long they were in pain before the fractures were actually diagnosed, and other factors.

They found that 77% of the patients were in pain before they were initially diagnosed with a fracture, and they were in that pain for an average of about 9 months (ranging from 1 to 24 months). The authors write, “Sixty-one patients had sought treatment for persistent thigh, leg, or hip pain and had multiple studies and procedures that did not discover the problem.” Almost 40% of the patients ended up with another fracture on the other side. About a third of the patients also had metatarsal (foot) fractures, while 2.5% had a pelvic fracture and 3.7% experienced jaw osteonecrosis. Despite the lack of certainty about long-term safety of these drugs, the patients on average had been taking them for more than 9 years.

The authors note that while patient reports may sometimes be inaccurate or incomplete, they hoped the reports would provide more complete information than that found in bits and pieces across medical charts. Although additional rigorous study is still needed, the authors raise important questions about whether we should also be concerned about foot fractures with these drugs, and whether patients receive timely diagnosis when they do experience bad outcomes.

A systematic review on the risk of fracture was reportedly discussed at a recent American College of Rheumatology meeting – we’ll keep an eye out for those findings being published.

Last night, the War on Women suffered a setback — due largely to women voters who used the ballot to re-elect President Barack Obama and to push back against absurd, insulting and just plain offensive comments about rape and women’s bodies.

As Veronica Arreola posted on Facebook:

Two of the biggest losers last night were the gentlemen who claimed that women have magic wombs that stop pregnancy from occurring during legitimate rape and if it does happen, it was a gift from God. The magic was in our votes, ladies. We’ve had it all along.

Erin Gloria Ryan’s post at Jezebel is succinctly titled “Team Rape Lost Big Last Night.” Read it for a complete look at races around the country.

Some highlights …

Missouri Rep. Todd Akin failed to unseat incumbent Sen. Claire McCaskill, causing Twitter to explode with a new round of Akin-related humor, like “Claire McCaskill legitimately wins and shuts that whole Akin thing down!”

John Koster was defeated by Suzan DelBene in Washington state — Koster famously referred to “the rape thing” and confused one woman’s choice with controlling all women’s choices: “I know a woman who was raped and kept the child, gave it up for adoption and doesn’t regret it.”

And in Illinois, Rep. Joe Walsh, who doesn’t believe abortion is ever necessary to save the life or health of a mother, lost to challenger Tammy Duckworth, an Iraq War veteran who lost both legs in combat.

For more analysis, Bryce Covert at The Nation examines the impact of politicians’ misogyny on the election outcomes, and concludes: “Score one for women’s rights, zero for attempts to control their bodies.”

***

Our Bodies, Our Votes …

“Our Bodies, Ourselves” turned up in a number of tweets last night. Anne Elizabeth Moore, who led The Ladydrawers on the road trip to deliver “Our Bodies, Ourselves” to the offices of Akin and McCaskill, posted this upon news of Akin’s defeat:

hey @RepToddAkin, now maybe you’ll finally have time to get crackin at all those books @oboshealth and @TheLadydrawers dropped off!

We heartily second that recommendation.

Following the defeat of Indiana Senate candidate Richard Mourdock — who recently said, “I think even when life begins in that horrible situation of rape, that it is something that God intended to happen” — Jason Lefkowitz tweeted: ”And in Indiana, Mourdock has officially been buried under a massive pile of hardback copies of ‘Our Bodies, Ourselves.’”

Jason Cherkis also took note of the upsets, tweeting: ”GOP furiously buying ‘Our Bodies, Ourselves’ on Amazon.”

No need; with the public’s help, we’ll deliver the book to each and every member of Congress (41 days left to make this happen!).

***

Big gains for women and marriage equality …

We now have a record number of women in Senate, with 20 women Senators elected.

Rep. Tammy Baldwin became the first openly gay senator, and the first woman senator from Wisconsin. Rep. Mazie Hirono became the first woman senator from Hawaii as well as the first Japan-born immigrant to be elected to the Senate and the first Buddhist.

Another big success last night was the passage of ballot measures in Maine and Maryland approving same-sex marriage, the first time it has been made legal through a popular vote. An amendment to ban same-sex marriage was defeated in Minnesota.

We’re still waiting to hear for sure about Washington state, but early returns are promising. Same-sex marriage is now legal in eight states as well as in Washington, D.C.

More good news: Iowa Supreme Court Justice David Wiggins is staying on the bench – he had been targeted for removal because of his role in the legalization of gay marriage in that state.

***

Mixed results on abortion-related measures …

Abortion-related measures were considered in two states. In Florida, voters defeated Amendment 6, which would have prevented state employees from using their healthcare coverage for most abortions, and would have affected privacy rights in a way that could have led to further restrictions.

In Montana, voters approved a parental notification measure requiring girls under age 16 to notify a parent or seek judicial bypass prior to terminating a pregnancy.

 ***

Lessons learned and work to be done …

Akiba Solomon at Colorlines shares “Five Race and Gender Justice Lessons Learned from This Marathon Election Cycle,” including this important point: “The Republican-led war on abortion, Title X-funded reproductive health care and contraceptive access was—and still is—a war on poor women of color and their families.”

And if anyone needs a reminder of the work we still have before us, On the Issues magazine has appropriately titled its fall issue “The Day After.”

From the editor’s note: “On wide-ranging issues — the economy to the environment, reproductive freedom to voting freedom, sexuality to media representation — our writers, artists and thinkers in The Day After remind us to extend our vision beyond the ballot box to where we need to place our energies, build our muscles and put our feet on the ground every day of the year.”

In other words, it’s time to get busy — again.

Health care reform. Access to contraception. Increased protections for women against violence. Equal pay.

A lot hangs on this presidential election.

On the state level, personhood amendments that grant fertilized embryos all the rights of a born human didn’t make it onto any ballot, but two states, Florida and Montana, have put restrictive abortion initiatives before voters.

The National Women’s Law Center has published a voter education section with a number of useful links, including fact sheets on issues affecting women and great images to share — like the one on the left by Jen Sorensen.

For more on the election and the importance of women voters, visit Women’s Vote Watch 2012, a project of the Center for American Women and Politics that tracks and analyzes polling data. Here’s a section on the gender gap and voting.

Finally, if long lines get you down, just think of Galicia Malone of Dolton, Ill., who stopped to vote this morning on her way to give birth.

The clerk’s office said Malone’s water had already broken when she made the stop to vote in her first presidential election.

“If only all voters showed such determination to vote,” [Cook County Clerk David] Orr said. “My hat goes off to Galicia for not letting anything get in the way of voting. What a terrific example she is showing for the next generation, especially her new son or daughter.”

And remember, no matter who wins, we still have to work on educating Congress about women’s health …