September 19, 2013

Association of Reproductive Health Professionals Honors Our Bodies Ourselves Founder Judy Norsigian

We are thrilled to announce that the Association of Reproductive Health Professionals selected Judy Norsigian, Our Bodies Ourselves co-founder and executive director, as the recipient of the 2013 Irvin M. Cushner Lectureship.

The lectureship honors a layperson, public figure, or health care professional who has raised public awareness of and inspired public policy debate about an important issue in health care. The honoree delivers a presentation at the ARHP’s 50th annual conference, which starts today in Denver.

Judy’s lecture is titled “Reproductive Health and Justice: How Our Advocacy Can Best Address Persistent Problems and New Challenges.” It addresses such issues as maternity care and abortion, medical technologies, and the use of legal strategies, public education, and outreach to policy makers and media to preserve and expand access to reproductive health and justice.

The lectureship’s namesake, Dr. Cushner, was a leader in reproductive health. Past Cushner honorees have included Dr. Jocelyn Elders, Patricia Schroeder, Carole Joffe, Henry Waxman, and Cecile Richards.


September 16, 2013

Headlines about the “Pullout Generation” Are Premature: Studies Show Multiple Methods of Contraception Use

A recent article in the journal Obstetrics & Gynecology has led to some catchy headlines calling today’s young, straight women “the pullout generation.”

The researchers looked at data from the 2006-2008 National Survey of Family Growth for 2,220 sexually active female respondents ages 15–24 years and found that almost 1 in 3 of those surveyed reported using withdrawal as a method of contraception during at least one month of the study. (It’s not clear how girls who were not having sex with male partners were included or excluded.)

What the study-inspired headlines don’t explain, though, is that very few of these respondents relied only the “pullout” method to prevent pregnancy – maybe even fewer than in older studies.

So it is really accurate to call today’s young women the “Pullout Generation?” Almost 9 out of 10 withdrawal users also used other methods, either simultaneously or at some other point in the study. And let’s not forget that 69 percent of those surveyed always used other methods, such as condoms and the pill.

Those who used withdrawal at any point were more likely to have unintended pregnancies, and more likely to use emergency contraception. While some coverage of the study has noted that those exclusively using withdrawal were “less likely” to get pregnant than women exclusively using other methods, the small mathematical difference isn’t considered meaningful.

When the CDC reported in 2009 on the sexual and reproductive health of young people ages 10-24 (covering the years 2002-2007), about 13 percent of unmarried, sexually active girls and women said they had used withdrawal the last time they had sex. This included those who had used withdrawal alongside another method. Thus, the reporting should have noted fewer than 13 percent were using *only* withdrawal.

In another report of contraception use by adolescents released in 2010, almost 11 percent of sexually active girls in 9th-12th grades reported using only the withdrawal method the last time they had sex. This study uses some data sources that overlap with the CDC’s report.

It’s not clear, then, that increasing use of withdrawal as a main method of contraception is actually “a thing.”

As Ann Friedman suggests in her column on the “Pullout Generation,” that doesn’t mean there isn’t legitimate interest in better and alternate birth control methods. In fact, Global Female Condom Day is today, which makes it the perfect opportunity to learn more about this woman-oriented, non-hormonal method.

For more information on withdrawal, including failure rates and things to think about, see Scarleteen and Bedsider. For more info on female condoms, read this excerpt from “Our Bodies, Ourselves” or our many blog posts on the topic.


September 11, 2013

New Book on Birth Control Overlooks Evidence

The new book “Sweetening the Pill: or How We Got Hooked on Hormonal Birth Control” by Holly Grigg-Spall has generated a lot of discussion and critical response — with good reason.

Grigg-Spall argues that the birth control pill is actually making us sick, and feminists don’t want you to know this.

As a feminist women’s health organization that puts a premium on evidence-based information, we disagree.

As noted in the most recent edition of “Our Bodies, Ourselves,” modern oral contraceptives, which are among the most intensely researched pills in history, are safe for most users. That’s not to say the pill is for everyone — as with any medication, some people’s bodies don’t react well — but in general the pill is an excellent option for many women.

Women who use oral contraceptives are at increased risk of having a blood clot; however, the overall risk is still very low (about six women in 10,000 over the course of a year). In fact, the risk is much higher for women who are pregnant or who have recently had a baby. In addition, the pill carries a number of long-term health benefits, including lowering the risk of ovarian and endometrial cancers.

Our Bodies Ourselves has consistently monitored the safety aspects of the pill and has been critical when the evidence has called for it. OBOS has, for example, helped to spread awareness about the safety concerns of newer drospirenone-containing contraceptive pills like Yasmin and Yaz, and has questioned the FDA’s review of these drugs, which carry higher risks for blood clots (about 10 women in 10,000 taking contraceptives with drospirenone over the course of a year) than older versions of the pill.

The National Women’s Health Network, which advocates for the FDA to take drospirenone pills off the market, has likewise has been a longtime advocate for cautious approaches to contraceptives. (Its co-founder, Barbara Seaman, literally wrote the book on safety concerns about early — 1960s — higher dose versions of the pill.) OBOS and NWHN share a common value as organizations in favor of evidence-based approaches to the risks of any drugs targeted to women.

Fortunately, numerous reviewers are calling out the problems with “Sweetening the Pill.” Lauren O’Neal writes that Grigg-Spall overlooks real benefits of the pill, while Jill Filipovic raises concerns about “scaring women away from highly effective forms of birth control with inaccurate claims.”

Grigg-Spall’s essentialist argument is also under fire. Over at Slate, Lyndsay Beyerstein asserts that “Sweetening the Pill” “offers an insultingly reductive account of what it means to be female:

“If we shut down the essential biological center of femaleness, the primary sexual characteristics, then can we say that women on the pill are still ‘female’?” Grigg-Spall muses, casting ovulation as the sine qua non of femaleness. If so, postmenopausal women, pregnant women, girls, ovarian cancer survivors, and transwomen aren’t really female.

It’s easy to write off Grigg-Spall’s inaccurate and reductionist account, but it’s worth noting that this perspective threatens to distract from the discussion that needs to be happening: Instead of promoting fear, women should be offered more evidence-based information on the benefits and side effects of all contraceptive methods, along with more comprehensive sex education and improved access to their method of choice.

To learn more about the pill, check out:

To learn more about safety issues related to pills containing drospirenone, see these previous posts:


September 5, 2013

California Governor Was Right to Veto Bill Allowing Researchers to Pay Women for Their Eggs

by Marcy Darnovsky, Ph.D. and Susan Berke Fogel, J.D.


OBOS is publishing a series of posts on egg donors and the ethical, legal, and health aspects of egg donation. Also read: one woman weighs the risks of donating her eggs to a friend, and a new group forms to share the perspectives of egg donors.


Last month, California Gov. Jerry Brown vetoed a bill that would have allowed researchers to pay women for having their eggs harvested and retrieved. His move was warmly welcomed by women’s health and public interest groups including Our Bodies Ourselves, National Women’s Health Network, Pro-Choice Alliance for Responsible Research, Alliance for Humane Biotechnology and Center for Genetics and Society. (Disclosure: see author affiliations.)

Echoing the longstanding concerns of many progressives about the serious risks of egg retrieval, Brown’s brief but eloquent veto message recognized that “in medical procedures of this kind, genuinely informed consent is difficult because the long term risks are not adequately known.” He also acknowledged that low-income women would face disproportionate temptations to discount the risks. “Putting thousands of dollars on the table only compounds the problem,” Brown wrote.

The vetoed bill, AB 926, was sponsored by the fertility industry’s trade organization, the American Society for Reproductive Medicine. It was supported by several mainstream women’s organizations, and breezed through the Democratic-dominated legislature. Ironically, as Brown noted, the law that this bill would have overturned was approved by near-unanimous votes in both houses.

That 2006 measure established protections for women who provide eggs for research and limited payments to reimbursement for expenses connected to the egg retrieval procedure. “After careful review of the materials which both supporters and opponents submitted, I do not find sufficient reason to change course,” Brown wrote.

The governor’s veto appears to have caught the bill’s supporters by surprise, and their response has been strongly negative, to the say the least. California NOW’s Facebook page asked “WTF Jerry Brown?” and went on to claim that Brown’s move was “consistent with his Jesuit Catholic Monk values” and that “he ignores science and women’s health in favor of the Catholic Conference’s beliefs that women getting compensated equally with male donors is high tech prostitution!”

Along similar lines, another supporter penned a rancorous Huffington Post piece with a headline that accused Brown of treating women like “children and the mentally handicapped.”

Oddly, most of the attacks on the governor — and some media accounts of his veto — have been silent about the existence of progressive and pro-choice opposition to AB 926. Some flatly mischaracterize the opposition as being solely religious and anti-choice. Others briefly acknowledge that pro-choice groups and individuals opposed the bill but describe them as part of a strange-bedfellows “coalition.”

There was indeed a coalition but it did not include any anti-choice groups. Rather it brought together diverse organizations including, besides our groups, Alliance for Humane Biotechnology, Black Women’s Health Imperative, Breast Cancer Action, and Friends of the Earth.

In addition to misrepresenting the nature of the opposition to the bill, its supporters largely failed to actually address the arguments against paying women to provide eggs for research. Although the state’s major newspapers published thoughtful op-eds raising questions about the issue (opinion pieces appeared in the Los Angeles TimesSan Francisco Chronicle and Sacramento Bee), proponents of paying women to provide eggs for research tended to repeat their talking points rather than answer the questions that were raised: Do we have sufficient information about the long-term effects of egg retrieval to ensure the health and future fertility of the women providing the eggs? Is there even enough information to permit “informed” consent? Might the payments for eggs be coercive to low-income women? Can researchers get the supply of eggs they need without resorting to financial incentives?

AB 926 supporters argued that paying for eggs for research is a matter of “equity for women,” which seems to mean several different things at once. One is that women should be paid for providing eggs because men are paid for providing sperm. UC Berkeley medical anthropologist Nancy Scheper-Hughes pointed out the fallacy of this analogy: Selling sperm and selling eggs are totally different matters, she wrote: “One is pleasurable and safe, the other is a complicated and invasive procedure.”

AB 926 supporters also argued that providing eggs for research should be compensated because it is analogous to enrolling in clinical trials, for which healthy people are paid. This too is misleading. In clinical trials, scientists study their subjects to determine the effects of a drug or procedure on the people taking the drug. But scientists do not study the effects of egg-harvesting drugs and procedures on the healthy young women whose eggs they want for their experiments. The object of their interest is only the eggs, not the women.

Finally, AB 926 supporters pointed out that people who need young women’s eggs for their own fertility treatments pay for them, and asked why researchers shouldn’t be permitted to do the same. That brings us to the core question: Should we expand the market in human eggs?

Given that many women who have undergone egg retrieval in the fertility context have experienced serious complications, and that the procedure’s risks are still grossly understudied, we believe that adequate safety data must be collected before we can have a sufficient evidence base on which to make that decision. A well-designed, multi-center prospective trial is long overdue.

AB 926 supporters claimed that they occupy the pro-science and pro-research camp, and that anyone who opposes them (including Gov. Brown) is “anti-science.” But they have had nothing to say about the well-documented short-term egg harvesting risk of ovarian hyper stimulation syndrome, which can cause organ damage, ovarian rupture, and in rare instances death. They also ignored evidence that the drugs used in egg retrieval may be associated with higher rates of cancer and infertility, and the lack of follow-up studies to ascertain what the risks really are.

In 2007, a report by the prestigious Institute of Medicine concluded that too little research had been done on egg retrieval. It noted that with “more data it will be possible to quantify the various risks of oocyte (egg) donation much better than can be done today and to put numbers to the risks that a donor may face.”

Not much has changed since then. But those who believe that it’s fine for women to “work” as egg providers seem indifferent to understanding the occupational hazards it entails, and to investigating what might be done to minimize the dangers.

Currently, New York is the only state that explicitly authorizes payments beyond reimbursement for women’s eggs for research. The practice is prohibited in far more countries than allow it.

We at the Center for Genetics and Society and the Pro-Choice Alliance for Responsible Research have been calling for years now for clinical studies that look at the long-term health effects of retrieving eggs, for both fertility and research. The American public assumes that medical procedures and drugs have undergone careful study and that treatments have been proven safe and effective before being widely used.

Let us be clear: To date, we do not have well-designed, prospective studies of the effects of egg retrieval. Let us start collecting that information and until we have it in hand, let’s rein in the market for eggs instead of expanding it. Doing so will benefit not just the young women who might provide researchers with eggs, but also the many women who undergo egg retrieval for their own or other people’s fertility treatments.

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This guest column was originally published at Huffington Post and has been reprinted with permission.

Marcy Darnovsky, Ph.D., is Executive Director at the Center for Genetics and Society, a public affairs organization working to encourage responsible uses and effective societal governance of reproductive and genetic technologies. She speaks and writes widely on human biotechnologies, focusing on their social justice, human rights, health equity, and public-interest implications.

Susan Berke Fogel, J.D. is the co-founder of the Pro-Choice Alliance for Responsible Research (PCARR), working on cutting edge issues at the intersection of human genetic biotechnology and women’s health and rights. She is also the Director, Reproductive Health for the National Health Law Program, where she is a national expert on reproductive health law, low-income health programs and religious restrictions in health care.


Young women are increasingly being recruited to donate eggs for infertility and research purposes, though numerous health questions remain unanswered. Our Bodies Ourselves is calling for the creation of a mandatory health registry to facilitate long-term tracking and studies to better understand the risks of egg extraction. Please support the Petition for Human Egg Extraction Health Registry & for Warnings on Ads and Notices Seeking Egg Donors, started by OBOS, the Alliance for Humane Biotechnology, Pro-Choice Alliance for Responsible Research, and the Center for Genetics and Society, and endorsed by other organizations.


August 30, 2013

Want to Reduce Unintended Pregnancies? Provide Health Education & Support

Almost half of all pregnancies in the United States are unintended. These pregnancies can result in worse health outcomes for both women and their babies, due to potentially poor health prior to pregnancy and delays in obtaining prenatal care and making changes such as quitting smoking.

For a new, small study published in the Journal of Midwifery & Women’s Health, researchers spoke to women in three Michigan neighborhoods characterized as low-income, urban, culturally/ethnically diverse, and medically underserved — basically the type of neighborhood where unintended pregnancy rates are higher than average.

The researchers conducted six focus groups with a total of 41 women, ages 18 to 44 years, who were either pregnant or had been pregnant within the last three years. They sought the women’s input on three important questions:

  1. What could be done to encourage women to recognize their pregnancies early (within six weeks from their last menstrual period)?
  2. What should be the primary action to help women recognize their pregnancy early?
  3. What are the most important things that could help women to be sure of their pregnancies early?

The women identified a few main themes and provided numerous suggestions for addressing these issues, including:

  • Promoting knowledge of reproductive changes in the body: Teach women about their female reproductive system and its cyclic changes, such as timing of ovulation, number of days in a cycle, and how to keep a menstrual calendar.
  • Promoting early testing or confirmation of pregnancy: Assist women to know symptoms of pregnancy and to recognize their pregnancies early through the use of home pregnancy test kits or going to the doctor or clinic to confirm a pregnancy.
  • Providing informational support: Provide a list of locally available pregnancy-related resources, such as clinics, prenatal classes, and educational sessions on women’s health.
  • Providing emotional support: Have a friend to talk with or have nurses, midwives, and other health professionals to go to for guidance during the preconception and prenatal periods.

While small, this type of study — and the prison health study we wrote about earlier in the week — are very much needed, because they ask the people most affected about their needs and experiences.

In this instance, community health workers (residents from each neighborhood employed to promote health and access to health care) were already familiar figures in these neighborhoods, and a participatory research model was employed that was sensitive to the residents’ needs. For example, the researchers provided transportation *and* childcare so the women could participate.

In their “implications for practice” section, the study’s authors urge future research along the themes the women identified. Teaching women about the menstrual cycle, along with the signs and symptoms of ovulation and pregnancy, can help women to take more control over their health and their lives.

As one woman in the study said, “I guess just being taught more in an individual sense of how to recognize things in your own body instead of being lumped, that it would be the standard, like I said earlier, 28-32 days. I mean, if women could really have that sense of, like, knowing how they are, it’s much easier to plan around that, or at least to be aware.”

The researchers also urge systemic approaches to reducing unintended pregnancy and the associated health effects, including comprehensive reproductive education (starting even before adolescence), policies that promote access to pregnancy-related resources and facilities, and access to early pregnancy testing.


August 28, 2013

How Do You Afford Healthcare in Prison on 50 Cents Per Hour?

Women entering prisons often have poor physical health, in part due to poverty and lack of access to treatment for concerns such as addiction, abuse and mental health. An article in the Journal of Health Care for the Poor and Underserved looks at a different aspect of the health of incarcerated women: how healthcare systems in prison create further harm.

For “Factors Contributing to Poor Physical Health in Incarcerated Women,” researchers Holly Harner and Suzanne Riley conducted 12 focus groups and asked 65 women in a U.S. maximum security prison what they thought about factors affecting their their physical health while imprisoned.

The women reported a wide variety of concerns, with one of the major issues being limited and complicated access to care.

While it’s a widespread belief that inmates have all of their medical care paid for, cost was a significant barrier for the women. The women earned 50 cents per hour in their prison-based jobs, and some of that income was diverted for fines and fees related to their incarceration, making even the mandatory $5 co-payments difficult. Once they have accumulated $5 for a visit, the inmates are only allowed to address one health concern per visit.

The women also reported being discouraged from seeking care, as well as fear of disciplinary action if they questioned a health care provider.

One woman reported: “I went to Medical, telling them I had more than just a cold. I got yelled at, called a hypochondriac, and escorted out with the threat of [being written up for] misconduct. Later I had an asthma attack and was diagnosed with asthma.”

Another reported that routine gynecological care such as Pap tests for cervical cancer is discouraged: “They try to make you not want your Pap because there are so many people waiting. They say, ‘You know, you don’t really have to have a Pap, right?’ They make you feel guilty if you want it.”

Poor dental care and eye care were also mentioned, with consequences that go beyond the medical. One woman with poor eyesight described not being able to do her mandatory homework because she could not obtain glasses, and she feared being disciplined for misconduct as a result. When dental care could be accessed, the women were concerned that the dentists would simply pull their teeth instead of providing other treatments.

The women also expressed concerns about the unhealthy diet causing weight gain and limited opportunities for exercise. Exercise classes were often scheduled during the prisoners’ work hours frequently canceled. Women who expressed a desire to quit smoking often could not afford the offered therapy — nicotine patches cost $187.50 for six weeks (375 hours of work at 50 cents per hour).

Women with disabilities face additional problems. Those using wheelchairs were assigned other inmates as “pushers”; these women received only 15 minutes of training on how to maneuver wheelchairs.

Harner and Riley do not offer solutions for the poor health care offered to women in prison, but they do provide characterization of the problems as expressed by the women themselves. The authors conclude with this statement: “Incarcerated women deserve timely, evidence-based, and respectful health care in prison.”

Related: Learn more about women in prison from the Sentencing Project, the ACLU, and Women + Prison, a website and publication created by incarcerated women. Also see “‘She’s Out of Sight’: Women, Healthcare and the Prison System,” an article by Monique Hassel in Manifesta, and “Inside This Place, Not of It: Narratives from Women’s Prisons,” compiled and edited by Robin Levi and Ayelet Waldman. For issues related to childbirth, see the Prison Birth Project, whose founders were among our 2010 Women’s Health Heroes. In July, the Center for Investigative Reporting broke the story that women in California were sterilized without approval. OBOS has also reported on the persistence of shackling incarcerated women during labor and pregnancy.


August 23, 2013

Studies Show How Abortion Restrictions Hurt Women; New Investigative Report Shows Why More Restrictions Are Medically Unnecessary

We recently wrote about the Turnaway Study, a research project that involved following women who were denied an abortion because they were past the provider’s gestational age limit and comparing their outcomes to women who received an abortion (either during the first trimester or at near-limit, when the women were almost out of time). Women were recruited for the study from “last stop” abortion clinics — those where there’s not a provider with a later gestational age limit within 150 miles.

A new paper released in the American Journal of Pubic Health begins to present results from that study, focusing on the reasons for delays in seeking abortion care. The research has been conducted by the Advancing New Standards in Reproductive Health group at UCSF’s Bixby Center for Global Reproductive Health.

One of the findings provides further evidence of important disparities in access to abortion care: the women who received abortions in the first trimester instead of near the limit were more likely to have a college degree and to have a higher income.

For women who were turned away or had near-limit abortions, “money” and “finances” were the most likely reasons for delay. The authors report that reasons for delay among women who were turned away for being over the gestational age limit included travel and procedure costs (58.3 percent of “turnaways” reported this issue), not recognizing the pregnancy (almost half of turnaways), insurance problems, not knowing where to find abortion care (reported by a third of turnaways), and not knowing how to get to a provider.

Interestingly, the near-limit women in this study reported less difficulty deciding to have abortions than the women who had the procedure during the first trimester. This finding runs counter the anti-abortion notion that women who have late-term abortions have simply been irresponsible in waiting so long to make a decision.

The authors also performed some calculations to try to estimate how many women are turned away each year due to gestational age limits. They concluded that 4,143 women in 2008 were forced to carry their unwanted pregnancies to term because of gestational age limits. This does not include additional women who would have been turned away for medical, financial or parental consent reasons. We can only assume this number will increase if the current anti-abortion push for 20-week limits gains ground.

In related news, the National Women’s Law Center has released a new report, “‘Shut That Whole Thing Down:’ A Survey of Abortion Restrictions Even in Cases of Rape.” A year after former Missouri Rep. Todd Akin’s remarks on abortion and rape (Happy Road Trip Anniversary!) NWLC has analyzed state and federal abortion restrictions proposed in the first six months of 2013 for how they would affect victims of rape.

Astonishingly, NWLC found that the vast majority of proposed legislation would create barriers to abortion for rape victims. For example, 27 provisions in the 38 state provisions restricting women’s access to abortion would apply to a woman whose pregnancy resulted from rape. These include provisions such as forced ultrasounds and requiring women to listen to a fetal heartbeat where there were no exceptions for rape victims.

“The GOP could have learned an important lesson: Picking on rape victims, even in the context of abortion, doesn’t play very well with the voting public,” writes Jill Filipovic at Salon. “Instead, the Republican party seems to have internalized the message that marginalizing rape victims is ok, as long as you don’t brag about it.”

And in case you missed it, RH Reality Check published an impressive series of investigative stories this week that proved abortion is already highly regulated and overwhelmingly safe. There’s a huge database of state documents available for review.


August 20, 2013

Breast Cancer, Mastectomy and Breast Implants: A 20-Year History of Images and Attitudes

CBS Sunday Morning this week aired a segment looking at breast cancer and body image, especially women’s choices around reconstructive surgery and implants.

Artist and former fashion model Matuschka, whose self-portrait on The New York Times Magazine cover 20 years ago (Aug. 15, 1993) created a shock because it displayed her mastectomy scar where her right breast had been removed, describes her reasons for creating the image — wanting to start a conversation about breast cancer — and the backlash she received from readers who thought she brought shame to women.

The moment was compared to the reaction to Angelina Jolie’s recent decision to undergo prophylactic mastectomy, and current public attitudes about women’s breasts.

OBOS Executive Director Judy Norsigian notes how moneyed interests guide what is seen as narrow beauty ideals for women, and how that affects women’s choices about reconstruction after breast cancer surgery.

“We live in a culture in which large breasts are almost universally idealized,” said Norsigian. “We’ve had at the same time a huge industry that has burgeoned to promote the idea that women must have implants.”

(It was great to hear veteran reporter Martha Teichner, in her introduction to the segment, call the ninth edition of “Our Bodies, Ourselves” “the now iconic guide on women’s sexual and reproductive matters, and a gauge of social attitudes.” )

The segment also includes a clip of  7-year-old girls who are interviewed in “Absolutely Safe,” a documentary that examines the popularity of breast implants among ongoing controversies about implant safety. It’s disturbing to see how thoroughly these young girls have already received the message that bigger breasts are better and attract more attention.

Another resource mentioned is The Scar Project, a series of photographs displaying the bodies and scars of breast cancer survivors. The project generated some controversy earlier this year when Facebook began removing and banning some of the photos for allegedly violating Facebook’s policies on nudity; more details are provided in these posts at the Scar Project blog.


August 16, 2013

A Guide to Cervical Cancer Screening & HPV Vaccines

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States. According to the Centers for Disease Control and Prevention (CDC), “nearly all sexually-active men and women will get at least one type of HPV at some point in their lives.”

But the virus usually clears on its own, without causing any damage — and often without showing any symptoms.

The HPV vaccine can prevent infection, but it’s not for everyone. We’ll tell you what you need to know about the virus and the vaccine.

What are the risks from HPV?

In both men and women, HPV infection can lead to warts or cancer in the person’s genitals, mouth, or throat. There are more than 150 types of HPV, but two (types 16 and 18) are thought to cause almost two-thirds of all cervical cancer cases, and close to half of all vaginal, vulvar, and penile cancers.

What are the current recommendations for cervical cancer screening?

The U.S. Preventive Services Task Force (USPSTF) recommends that women who have a cervix have a Pap test (which looks for pre-cancerous cells to screen for cervical cancer) every three years between ages 21 – 65.

Every five years, starting at age 30 and until age 65, women are advised to get a Pap test plus HPV DNA testing to screen cells for certain high-risk types of HPV.

The USPSTF does not recommend cervical cancer screening for women under 21 (i.e., neither Pap nor HPV DNA tests), because the tests are unlikely to find any problems. Similarly, the USPSTF does not recommend HPV DNA tests for women under 30, because almost everyone will test positive for the virus at least once. Even though the virus almost always goes away on its own, a positive HPV test increases people’s health care costs and anxieties.

Some clinicians may order a HPV test as follow-up to an abnormal Pap test, but HPV DNA test is not meant for general screening or simply to determine HPV status.

Can HPV be prevented?

There are two vaccines — Cervarix and Gardasil — that prevent infection with the most common types of HPV, thereby reducing the risk of cervical and other cancers that are associated with high-risk strains of HPV.

Cervarix protects against HPV types 16 and 18, the highest-risk strains of HPV, and is approved for girls ages 9 – 26.

Gardasil protects against HPV types 16 and 18, as well as types 6 and 11, which provides additional protection against genital warts and anal cancer; it is approved for both girls and boys ages 9 – 26.

While studies have shown vaccine efficacy over five to six years, longer-term data is not yet available to determine exactly how long the vaccines work to protect people.

How safe are the vaccines? What side effects can they cause?

The CDC notes that the United States “currently has the safest, most effective vaccine supply in history. Years of testing are required by law before a vaccine can be licensed. Once in use, vaccines are continually monitored for safety and efficacy.”

The HPV vaccines are considered to be very safe, although reactions like dizziness, fainting, and soreness around the injection may occur.

More information is available about Gardasil than Cervarix because it was approved first, but on-going safety studies are being done on both vaccines. As with any vaccine, patients should carefully review whether they have allergies to any of the ingredients before getting the vaccine. (The CDC has also published a guide to vaccine safety, written especially for parents.)

When should vaccines occur?

For greatest protection, the CDC recommends vaccination around age 11-12, so it has time to become effective before sexual activity begins. (There is no evidence that having the HPV vaccine encourages a person to become sexually active.)

For people under age 26 who are already sexually active, the HPV vaccine won’t affect any existing HPV infections, but it may prevent infection from a different HPV type if it’s also covered by that vaccine. Likewise, the vaccine doesn’t mean you no longer need cervical cancer screening; if you have a cervix, you should still follow the USPSTF’s screening recommendations.

Can pregnant women get vaccinated?

There have not yet been adequate studies to establish the vaccine’s safety for use by pregnant women, and neither vaccine is recommended for use by pregnant women.

Women who got the vaccine and then find out they were pregnant at the time of vaccination should call the manufacturer’s “HPV in pregnancy registry” to contribute to efforts to learn more about pregnant women’s response to the vaccine (800-986-8999 for Gardasil; 888-452-9622 for Cervarix).

Where can I get the vaccine, and how much does it cost?

The vaccine is available from pediatricians, family doctors, ob/gyns, public health clinics, and family planning clinics. It is given in a three-dose series that may cost more than $500 in total.

Insurance may cover the vaccine’s cost; uninsured children and young adults may be eligible to get it at low cost from public health departments and clinics.

Do I need my parents’ permission to get vaccinated?

The rules vary from state to state. In many states, teens are explicitly allowed to get reproductive health care (like family planning and STI treatment and prevention services) without a parent’s or guardian’s knowledge or consent. These laws are in place to reduce barriers to young people getting sensitive health care services.

If you get the vaccine from your provider using your parent’s insurance, keep in mind that they will get an “Explanation of Benefits” form that describes the services received.

Scarleteen has published an excellent HPV Vaccine FAQ with advice for talking with parents who have concerns about the vaccine.

What does the National Women’s Health Network think about the vaccines?

The NWHN supports cervical cancer screening to identify pre-cancerous conditions and timely access to treatment and care, which will prevent cancer from developing. The NWHN has determined that the vaccines are an important option for filling the gap where regular access to health care — including Pap tests and follow-up ­– is not viable. This is particularly the case where women face barriers to health care due to poverty, ethnicity, language, and/or other factors.

Nonetheless, more research is needed on the vaccines’ safety, long-term effects, and use in sub-groups such as older women.

For more information:

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This post was adapted from an article by Rachel Walden that first appeared in the July/August 2013 edition of NWHN’s The Women’s Health Activist.


August 14, 2013

How Many Abortion Complications Are Caused by Stigma, Secrecy and Silence?

Although close to one-third of all U.S. women will have an abortion by age 45, there is often little discussion of the topic because of the stigma involved.

In a commentary published in the journal Obstetrics & Gynecology, Dr. Lisa H. Harris describes the cases of two women who had access to safe, legal abortion but who completed their abortions in unsafe conditions because “each woman needed her abortion plan to remain a secret.”

In both cases, the women were undergoing cervical dilation prior to planned surgical abortions and failed to complete the procedures at the clinic. The first woman feared loss of housing and a child custody battle if her family found out about the abortion, so pretended to have miscarried. She later ended up in the ICU.

The second woman, after having a complication, could not tell anyone about her situation and had no transportation back to the clinic. She ended up going to the hospital by ambulance.

While abortion is generally very safe in the United States, Harris writes that if political wrangling leads to increased stigma (alongside more restricted access), complications may increase:

This leads me to ask, how many serious abortion complications are caused by stigma, and the secrecy and silence it generates? Because overall rates of serious complications or death from abortion in the United States are extremely low (the abortion mortality rate is 0.7 per 100,000 abortions), abortion stigma may not currently pose an important public health threat. However, abortion is becoming increasingly contested in U.S. politics and discourse, and social scientists note its increasing stigmatization. Insofar as abortion stigma leads to compulsory secrecy for many patients, which in turn may lead to disruptions of care and lapses in treatment, we might expect rates of some serious complications to increase.

The 1 in 3 Campaign is currently working to fight abortion stigma, encouraging people to share their stories of abortion and challenge shaming. The campaign website features activism resources, including a campus toolkit, and other information about abortion rights and policy.

Secular Women is also running the #ShameLESS campaign, and is posting stories on the AbortTheocracy website.

Related: Carol Joffe, a professor at the Bixby Center for Global Reproductive Health, explains how Kansas is taking the stigmatization of abortion providers to a whole new level.


August 8, 2013

Taking the Stigmatization of Abortion Providers to a New Level

by Carole Joffe

No school district, employee or agent thereof, or educational service provider contracting with such school district shall provide abortion services. No school district shall permit any person or entity to offer, sponsor or otherwise furnish in any manner any course materials or instruction relating to human sexuality or sexually transmitted diseases if such person or entity is an abortion services provider, or an employee, agent or volunteer of an abortion services provider.

Carole JoffeThe above provision is contained in a nearly 50-page bill (pdf) that recently went into effect earlier this year in Kansas. (A judge temporarily blocked two other provisions of the law, but allowed this one to remain.)

To be sure, the relentless assault on abortion that we are currently seeing in other state legislatures — Texas, Ohio, and North Carolina, among others — are far more consequential in the short run. Ambulatory surgical center (ASC) and hospital admitting privilege requirements really do have the capacity to shut down clinics; in Texas, the number of Texas abortion facilities could go from 47 to five in that huge state.

Already, due to a similar ASC requirement, earlier rammed through the Pennsylvania legislature as a cynical response to the Gosnell scandal, a number of clinics in Pennsylvania have closed. And the bans on abortions after 20 weeks, adopted by a number of states, will affect a relatively small number of women, but typically those in desperate medical and/or social condition.

But other provisions of abortion legislation, of which the Kansas one cited above is a prime example, do a different kind of damage. They further the stigmatization and marginalization of abortion providers by making clear that these individuals are not welcome in that most central of community institutions: the schools. It is not just participation in sex education from which Kansas providers are barred.

As Stephanie Toti, senior attorney at the Center for Reproductive Rights, which is challenging this law, told me, “This is unprecedented discrimination against abortion providers. … The prohibition on providers serving as ‘agents’ of a school district has the effect of barring them from serving as chaperones on field trips and engaging in most other volunteer activities.”

So abortion providers are at this moment banned from Kansas schools — and supposedly this will promote the safety of adult women getting abortions, as is the typical sanctimonious rationalization of the various laws we are seeing.

I asked several lawyer colleagues if they knew of other instances in which a whole occupational category was banned by law from volunteering in schools. They did not. Indeed, as far as I can tell, only sex offenders as a class are de facto banned from school grounds.

This shocking ban on abortion providers’ involvement in the schools leads me to recollect other instances I have encountered of attempts to isolate this group and keep them from community involvement. I think of a provider I’ve written about who I call Bill Swinton (not his real name), a family medicine doctor in a small town in the Pacific Northwest. He was deeply involved in both his church and his community, and served for three terms on the local school board. But he was defeated for a fourth term in the late 1980s, as the abortion wars intensified; needless to say, his status as a provider was the key factor in his defeat.

I think as well of another doctor I’ve written about named Susan Golden (also not her real name), in a town in the Midwest, who integrated abortion provision into her family medicine practice. When she and her partner planned to take part in a community health fair, presenting on the care of newborns, the entire event was abruptly cancelled by the anti-abortion owner of the facility where the fair had been scheduled to take place.

As disturbing as these incidents were, they did not have the force, or the legitimization, of law. The Kansas provision does — and as such, takes the stigmatization of abortion providers to a new level.

Assuming the Kansas law, including this provision, is not overturned, we can only speculate as to what effects it might have.

Speaking personally, I remember as a child the enormous pride I felt when my father, a cardiologist, came to my elementary school with his microscope and showed the class wondrous things. As a working mother, I recall how much I valued occasional volunteer stints in my daughters’ schools, getting to know both their classmates and other parents.

It is very disturbing to contemplate that providers and their children will be deprived of these experiences. And it is equally disturbing to contemplate the messages that others in the community will receive from such a ban.

This provision truly is stigma on steroids.

Carol Joffe is the author of “Dispatches from the Abortion Wars” and a professor at the Bixby Center for Global Reproductive Health. This article originally appeared at RH Reality Check and is reprinted with permission.


August 6, 2013

Got Health Insurance? New Site Explains Options, Provides Resources for Women

Raising Women's Voices

Raising Women’s Voices (RWV) launched a new website on Monday that aims to help the 19 million uninsured women in the United States learn more about and apply for health coverage available through the new health insurance marketplaces, or “exchanges.”

Enrollment for these exchanges, created as part of the Affordable Care Act, begins Oct. 1.

The RWV site offers detailed information on who’s eligible, how to choose a plan, and how to apply for the new coverage. It also provides useful links to additional information on the marketplace and insurance coverage.

“Women are the primary health care decision-makers for many families and will probably be doing a lot of the shopping for health insurance in the new marketplaces,” Cindy Pearson, co-founder of Raising Women’s Voices, said in a statement. “That’s why it is especially important that women get the help they need in learning how to use the new marketplaces.”

Raising Women's Voices website: no co-payRWV offers resources for advocates involved in outreach to uninsured women, including a fact sheet (pdf) that you can print and post to let uninsured women know about enrollment. The site also includes details on coverage available to LGBT women, women of color, students, and new mothers.

Founded in 2007, Raising Women’s Voices is a national initiative that has been working to ensure women’s voices are heard and women’s concerns are addressed as policymakers put the health care law into action. Participating organizations include the Black Women’s Health Imperative, the National Women’s Health Network and the MergerWatch Project of Community Catalyst

For more information on health insurance, the government website Healthcare.gov provides details on the marketplace and ACA coverage.


August 2, 2013

Racism, Mistrust in Medical System May Affect Black Women’s Use of Genetic Testing for Breast and Ovarian Cancers

Black women in the United States face many health disparities. The CDC recently provided data showing the average life expectancy for black women (at birth in 2010) is 78 — 3.3 years shorter than that for white women.

One of the many diseases for which there are unequal outcomes is breast cancer. Black women are less likely than white women to develop breast cancer, but are much more likely to die of the disease. One hypothesis to explain at least some of the disparity is that black women may be more likely to carry forms of the BRCA1/2 genes that increase their risk for breast and ovarian cancer.

Genetics alone, though, is probably not enough to explain the difference. A recently published study looks at how racism and mistrust in the medical system may also affect black women’s use of genetic testing to inform the monitoring and care they receive.

The authors studied 100 black women at high risk for breast cancer. They looked at whether the women knew how to get, pay for, and what to do with the results of BRCA gene testing, their knowledge of a U.S. law forbidding discrimination based on genetic findings, and their level of mistrust in the medical system, alongside whether the women knew about or had received genetic counseling and testing.

While it’s a small study, the researchers found that the more women knew about how to get and pay for the tests, and the more trust they had in the medical system, the more likely they were to have had BRCA testing.

It should come as no surprise that the more mistrust the women had in the medical system, the less likely they were to undergo genetic testing and counseling. In fact, some of the researchers on this study are affiliated with Johns Hopkins, which back in the 1950s oversaw the (now) widely publicized experiments using the cells of Henrietta Lacks for research.

There’s a long history of abuse — and resulting mistrust — between the medical and scientific establishment and the black community in the United States. Books such as “Bad Blood: The Tuskegee Syphilis Experiment” and “Killing the Black Body” review this history and are crucial to understanding how past injustices may contribute to ongoing disparities.

The study authors acknowledge this likelihood, and comment on how the era of “personalized medicine” may not benefit all patients equally due to this history of racism:

If minority communities have distrust of the medical system and have not benefited from traditional technologies, it is possible that disparities will persist or even widen in the pharmacogenomics era.

Despite being considered high risk, fewer than 1/3 of the women in the study had ever been referred for BRCA genetic testing by their healthcare provider.

Although the researchers didn’t measure it, the women in the study may have been more likely than many black women to have been referred for BRCA testing in general, as they were largely college-educated women and almost all of them had health insurance.

“Black women who are uninsured or those who have lower levels of education may have less genetic testing and counseling awareness and engagement than we found in our sample,” the study’s authors wrote.

The authors also note that women who are underinsured or uninsured may have trouble accessing these tests, which are expensive. Our Bodies Ourselves was a co-plaintiff in the recent lawsuit against Myriad Genetics, opposing the patenting of BRCA1/2 genes. We hope that the recent Supreme Court decision on those patents will lead to more available, affordable gene testing options for all women.

As an action item for potentially reducing disparities, the authors urge physicians and genetic counselors to “improve medical care by ensuring that risk assessment and risk reduction strategies include a clear presentation of the benefits, not just the risks of testing, and by addressing patient trust and concerns about the medical system.”

Read the full study, “Medical Mistrust and Self-efficacy Influence Black Women’s Level of Engagement in BRCA1/2 Genetic Counseling and Testing,” which is available online for free.


July 31, 2013

The Medical (and Political) Problem with 20-Week Abortion Bans

July 15 protest rally in Austin against anti-abortion legislation

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

The recent wave of anti-abortion legislation has caused much confusion and concern over what the future of reproductive healthcare might look like in a few years.

Texas recently enacted a 20-week abortion ban, and 13 states have passed similar bans. In Congress, Republican senators are pushing to bring a 20-week abortion ban up for a vote after the August recess, reports The New York Times.

Let’s first look at the language in these bills, which usually reference “20 weeks post-fertilization.” Aside from the restrictive issues, these post-fertilization bans present a major problem — that’s not how pregnancy is measured.

When a doctor or midwife indicates that someone is “20 weeks pregnant,” what they mean is that it has been 20 weeks since the first day of the last menstrual period (or LMP). This can be a bit confusing, because the first day of the last period is not when ovulation followed by fertilization actually occur.

This LMP method is used because it’s the easiest to measure. While ovulation is often estimated at about two weeks after the start of the last menstrual period, it can occur at different times for different people, making it impossible to know exactly when ovulation — or fertilization or implantation, for that matter — occurred.

LMP, however, is something we can point to on a calendar and is easily knowable. That’s why healthcare providers ask the question.

To recap the terms:

  • 20 weeks “pregnant” = 20 weeks after the first day of the last menstrual period (LMP); used by medical providers to date pregnancies.
  • 20 weeks “gestational age” = usually the same as above, measured since the first day of the last menstrual period; used by medical providers to date pregnancies.
  • 20 weeks “post-fertilization” = may be approximately 22 weeks “pregnant” by the normal method of measuring; used by politicians to promote 20-week abortion bans.

In other words, nobody but politicians uses fertilization as a way of dating a pregnancy. For the record, a pregnancy does not start at fertilization; implantation must occur for the pregnancy to progress.

So why are politicians using “post-fertilization”? For one, politicians may simply have very little understanding of pregnancy. This would not surprise us in the anti-science era of “legitimate rape.” (Though we really wish members of Congress would read their copies of “Our Bodies, Ourselves.”)

More cynically, politicians may be deliberately fostering confusion in order to make it more difficult for women to determine whether they are within their legal right to obtain an abortion.

For example, a woman told she is “22 weeks pregnant” by a healthcare provider may assume she’s past the cutoff and no longer able to obtain an abortion. In reality, she may be just 20 weeks post-fertilization and still eligible for a short period of time.

Anti-abortion advocates justify 20-week post-fertilization limits based on the widely disputed idea that fetuses may feel pain at that point. The so-called “Pain-Capable Unborn Child Protection Act” (HR 1797) that the House passed in June specifically referred to 20 weeks after fertilization as the cutoff for legal abortion, based on the widely disputed idea that fetuses can feel pain at this point.

However, a 2005 systematic review on the topic concluded that “pain perception probably does not function before the third trimester.” Similarly, a 2010 report by the Royal College of Obstetricians and Gynaecologists (UK) concluded: “Interpretation of existing data indicates that cortical processing of pain perception, and therefore the ability of the fetus to feel pain, cannot occur before 24 weeks of gestation.”

For all the supposed concern about pain, it’s almost unheard of for anti-abortion activists to discuss the counterbalancing notion of pain, illness, injury and potential death that a woman may face carrying a pregnancy to term — see Jessica Valenti’s most recent column in The Nation for more from this perspective.

It’s also important to remember, as Paul Waldman points out, that these bills contain provisions that aim to shut down abortion clinics, including onerous Targeted Regulation of Abortion Providers (TRAP) laws that are costly and do nothing to increase safety:

Abortion clinics often require doctors from out of state to travel to the clinic, because of the harassment, threats, and even assassinations that local doctors have been subject to? Then we’ll require that every doctor have admitting privileges at a hospital within a certain number of miles, which out-of-state doctors won’t have. And we’ll throw in some rules on how wide your hallways need to be (not kidding), meaning in order to stay open you’d have to do hundreds of thousands of dollars of remodeling. Failing that, we’ll make sure that women who need abortions will have to suffer as much inconvenience, expense, and humiliation as possible.

Ultimately, the GOP’s concern is not so much about minimizing human suffering, but about advancing strategies for keeping women from exercising their right to safe, legal abortion. Writing at RH Reality Check, Imani Gandy does a  good job explaining the anti-choice litigation strategy, noting in part:

The push for 20-week abortion bans is part of a national strategy implemented by anti-choice advocates to create exactly the sort of legal mess that will force the Supreme Court to reconsider Roe v. Wade and Planned Parenthood v. Casey, and to revisit the viability standard that has served as the constitutional foundation for abortion rights for 40 years.

An analysis by RH Reality Check suggests that the strategy deployed by anti-choicers is deeply subversive. It capitalizes on personal feelings and anti-abortion hostilities by enticing judges and legislatures to abandon empirical science in favor of biased, agenda-driven science or, as it is sometimes called, “junk science.” Proponents of junk science, which has become a cottage industry among anti-abortion advocates, confuse the issue of fetal viability, invent claims about fetuses feeling pain (or masturbating in utero), and call into question established medical standards.

The strategy is a smart one, to be sure. Anti-choicers understand that once junk science has been incorporated into legislation, courts are not inclined to question those scientific findings—no matter how agenda-driven they are—and will simply apply the law to those “facts.” In cases when junk science is presented to a court, a judge (or justice) hostile to abortion rights requires only the flimsiest reasoning to ground their legal opinion in fact, even if those “facts” are anything but factual.

As the American Congress of Obstetricians and Gynecologists wrote when addressing political attempts to limit abortion based on ideas about fetal, pain: “Facts are important.”

Let’s hope the courts think so, too.


July 30, 2013

Egg Donors Create Support Group for Women and Push for More Safety Data

We Are Egg Donors website

by Raquel Cool
co-founder of We Are Egg Donors

I recently decided to retire as an egg donor.

This choice is clearly right for me, and although I speak for myself and note that the views expressed below are my own, I know that there are others who share my concerns.

Months ago, I viewed a slideshow by Dr. Jennifer Schneider in which she said that donors are treated more like vendors than patients [Ed note: Schneider's daughter, a three-time egg donor, died of colon cancer at age 31]. That statement has stayed with me. In my experience, the egg extraction process is streamlined, impersonal and automated.

Each busy specialist has a designated purpose and only stays in the room long enough to get what they need, whether it’s blood drawn, a cervical swab, a snapshot of my ovaries, etc. It can be a very draining process, and egg donors have no one to reach out to in these instances because we’re supposed to be “professional.” Even the psychologist is hired to assess — not counsel — the donor.

With the financial component, the donor’s role is more like a professional vendor. This furthers the likelihood that we won’t want to speak up about medical, psychological or health concerns, because the expectation is that we should defer to medical authorities and keep the process efficient.

I’m also troubled by the fact that most donors do not recognize a serious conflict of interest — relying on the advice of fertility doctors whose primary patients are the individuals seeking assisted reproductive technology (ART) services.


OBOS is publishing a series of posts on egg donors and the egg donation process. Previously, Ryann Summers weighs the pros and risks of donating her eggs to a friend.


Egg donors, when viewed as “instruments” for achieving other people’s fertility goals, may have their own important needs neglected, and the financial incentives now in place for medical professionals don’t require paying close attention to the health and well-being of egg donors. Everything is structured to first benefit the agency/fertility center, and then the patients seeking to have a baby. The considerations of the egg donor are last.

For example, I recently worked with an agency/broker that did not inform me that I had the right to choose my own lawyer — they simply told me that my lawyer (who is also the lawyer for the recipient couple using my eggs) would be contacting me.

That lawyer emailed me a document to sign that would waive the “inherent conflicts of interest” of having one legal group represent both parties. I ended up choosing my own lawyer, although the broker resisted (“Well, you can do that, but none of our egg donors ever have.”).

Ultimately, I ended up canceling the process. I realized that I no longer have it in me to participate in an industry that has resisted researching donor health for decades.

I recently spoke with a two-time egg donor who was diagnosed with an advanced case of endometriosis only six months after her last donation. When she reported her diagnosis to the egg donor agency, they invited her to use their services to treat her infertility. They said that many former egg donors have turned to them, years later, being diagnosed with infertility themselves. This saddens me deeply.

I would be open to donating if the health risks were better understood, and if the industry’s practices were designed to value the health and well-being of the egg donor.

The group I recently co-founded, We Are Egg Donors (WAED), has a mission to provide legal, emotional and advocacy support for women considering or providing eggs for fertility purposes. We offer a neutral space where women can engage in transparent conversations about their experiences — without the presence of a commercial or political agenda “guiding” their personal narratives.

Every donor’s perspective is different; this is mine. WAED doesn’t want to create a one-size-fits-all political voice for all egg donors, but we do share a passion for making sure that women who choose to do it are informed, supported, safe, and connected to agencies who will advocate for them.

We are compiling a digital library of information so women have access to more evidence-based information on the process. We are also promoting awareness of and participation in the only national voluntary registry that is tracking the long-term health of those involved in ART procedures: the Infertility Family Research Registry, based at Dartmouth Hitchcock Medical Center in Hanover, N.H.

We welcome the inclusion of additional resources for our website, and I hope to hear from those who share our mission. Please contact me (raquel AT weareeggdonors.com). To learn more about WAED, visit WeAreEggDonors.com.


Young women are increasingly being recruited to donate eggs for infertility and research purposes, though numerous health questions remain unanswered. Our Bodies Ourselves is calling for the creation of a mandatory health registry to facilitate long-term tracking and studies to better understand the risks of egg extraction.

Please support the Petition for Human Egg Extraction Health Registry & for Warnings on Ads and Notices Seeking Egg Donors, started by OBOS, the Alliance for Humane Biotechnology, Pro Choice Alliance for Responsible Research, and the Center for Genetics and Society, and endorsed by other organizations.