Photo by Stacy Lynn Baum and used under a CC BY-NC-ND 2.0 licence.

While debate has been raging about women’s access to birth control and employers’ coverage of contraception, I’ve mostly been unable to write about it. Strange, I know. But every time I heard some ridiculous thing out of woman-hating Rick Santorum or Rush Limbaugh, I was really just too full of sputtering rage to coherently post. After several quick arguments with other folks online, though, below are responses to some common arguments I’ve heard. For more in-depth discussion, I highly recommend any recent clips from The Rachel Maddow Show, where it has been very well handled.

But you can live without birth control.
There are many items of covered medical care people can “survive” without having – orthopedic surgeries for painful injuries or disabilities, vasectomies, prenatal care. People can “survive” without many types of preventive medicine (including birth control) and even cancer treatment – for a while. What is appropriate for insurers to cover has never been based on “what you can’t live without,” and it’s a pretty poor standard to have.

Women who don’t want to get pregnant should just not have sex.
This is extremely hostile to women, and to the male partners of heterosexually-partnered women. It assumes that the sole purpose of sex is procreation, any time is the right time for a child, and as many children as possible are welcome. There may be some religious sects who technically support this belief, but we know that even among Catholic women, rates of birth control use are very high. For most people, it’s unreasonable to suggest that they never have sex if they’re not willing to be pregnant all the time or at any time. This perspective also puts women in the constant, stereotypical position of being the ones to fend off sexual advances, rather than supporting the idea that a man and a woman can be equal partners who both desire sex and make responsible choices about preventing unintended consequences. It denies women the agency of having their own desire, and puts them squarely in “aspirin between the knees” territory. Let’s be clear. Humans have sex, women can seek and enjoy sex, and women have purposes other than making babies.

Women who don’t want to get pregnant could just have a hysterectomy – those are probably covered.
Hysterectomies of course are not an equivalent to contraception, as they permanently prevent pregnancy, rather than allowing a woman to best time pregnancy to her own economic and health situation. It also ignores the non-contraceptive medical uses of birth control drugs, as well as historical inequities that inform which women get to choose hysterectomy and which women have had hysterectomy forced upon them.

Pregnancy is not a disease. So it’s not medical care to prevent it.
No, pregnancy itself is not “a disease” – neither is birth. But pregnancy can and does injure and even kill women. Pregnant women can require frequent medical care, and may encounter any number of complications over the course of pregnancy, from morning sickness so severe it requires hospitalization to eclampsia. So while pregnancy itself is not a “disease,” it is a medically vulnerable state for women that can necessitate frequent medical attention and can indeed result in disease and death.

Churches shouldn’t have to cover birth control.
Churches were not going to have to cover birth control. Period. Religiously affiliated institutions like Catholic churches and hospitals were going to have to cover it, but were given a generous out in which employees would be covered but the employers would not have to be the ones providing that coverage. These are institutions which in many states are already required to provide birth control coverage, and many individual institutions across the country do so in the absence of any requirement. Why? Because these employers need to attract talent, and they can’t or won’t get that talent purely from the pool of professionals who adhere to their own institutional religious affiliations (and even most Catholic women in the U.S. use birth control anyway). Catholic hospitals for example may hire doctors and nurses from any or no faith, because they need qualified people to provide the services that make them money and keep the doors open. They also recognize that providing employees with easy, cheap access to contraception is much cheaper than paying to cover pregnancies and a lifetime of medical coverage for numerous children and their mothers.

No employer should have to provide coverage for things they’re morally opposed to.
I have the slightest bit of sympathy for this perspective, but suspect it’s an extremely slippery slope. With absolutely no requirements for coverage, employers could stop covering lots of different things for economic reasons and claim moral objections. Employees would also be at the mercy of mergers and acquisitions. Imagine finding your company bought by another that would no longer cover blood transfusions, health care for LGBT individuals, any care related to any outcome of premarital sex, psychiatric drugs, or other common therapies. Of course, if employers started gutting already reduced service/higher cost insurance coverage based on their “moral objections,” we might actually start to see more widespread public support for movement away from employer-based coverage to a federal/universal model, so just chew on that.

Women who want to use birth control are just wanting to be irresponsible.
In a country in which half of all pregnancies are unintended, the active choice to prevent pregnancy until it is medically and financially viable is an extremely responsible choice. It actually represents a woman assessing her current situation and thinking explicitly about whether it is appropriate for her to be pregnant and potentially become a parent at this time. Unintended pregnancies also are associated with worse outcomes such as from delays in accessing prenatal care, quitting smoking, or resolving other health issues, the possibility of upsetting women’s ability to earn an income to support their existing families, and other economic, health, and social adverse effects. Many women have health conditions which make it very important to prevent or time pregnancy, and access to birth control makes it possible for them to be the most responsible for their own bodies and the bodies of potential offspring.

Also, the tip off that what we’re really talking about is controlling women’s abilities to make their own choices and to have sex without pregnancy, it’s extremely rare to hear an argument that grocery and drug stores should stop selling condoms, or that men should not have such easy access to condoms, because it just enables them to be irresponsible. Rush Limbaugh is not going to come out saying that men just want easy access to condoms because they’re sluts, I guarantee it – because he and his ilk don’t think *men* should just not have sex if they don’t want to get someone pregnant.

Nobody has a right to birth control.
Well, sure, if you don’t think healthcare is a human necessity and right (a point on which I disagree). What we’ve really been arguing about over the last few weeks, though, is not so much about whether healthcare is a fundamental right, or whether all the specific pieces of usually un/covered healthcare is a right, but about birth control specifically. The politicians and pundits have not been arguing over healthcare as a right generally, but specifically about women’s ability to time and prevent pregnancies, and their ability to have sex without high risk of having a pregnancy *just because some groups of men think women should not be able to have sex without risking pregnancy.* Note that we have not been arguing over whether gestational diabetes screening, HIV testing, domestic violence screening, or lactation support are “rights” – and these are all other services the Institute of Medicine said should be covered as preventive care for women under healthcare reform. Why’s that? Because this debate was never about what care people have a “right” to – it was always about who gets to have a say over women’s control over their own bodies and reproduction.

Filed under: Access, Rights, & Choice, Contraception, Drugs, Government, Women’s Health

[Originally posted at Our Bodies Our Blog. Speaking of, did you know the OBOS 40th anniversary edition book is one of Library Journal's Best Books for 2011 in the consumer health category?]

This week, Health and Human Services head Kathleen Sebelius interfered with the FDA’s decision that emergency contraception could safely be made available over the counter (OTC) without a prescription to women and girls of all ages.

The drug is already available without a prescription for women 17 and older, after years of political wrangling. Advocates have worked to ensure OTC access because emergency contraception is most effective when used as soon as possible, and time, distance, money, and privacy can be serious barriers to getting a prescription and obtaining the drug in time to prevent pregnancy.

The FDA’s Center for Drug Evaluation and Research (CDER) had completed a review of the issue and concluded that Plan B One-Step emergency contraception should be available OTC to younger women, which Commissioner Margaret Hamburg explains:

Based on the information submitted to the agency, CDER determined that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted diseases. Additionally, the data supported a finding that adolescent females could use Plan B One-Step properly without the intervention of a healthcare provider…CDER experts, including obstetrician/gynecologists and pediatricians, reviewed the totality of the data and agreed that it met the regulatory standard for a nonprescription drug and that Plan B One-Step should be approved for all females of child-bearing potential.

That’s when Sebelius stepped in and blocked the findings of CDER from taking effect. In her letter [PDF] overruling the FDA’s findings, Sebelius objected that “The label comprehension and actual use studies submitted to the FDA do not include data on all ages for which the drug would be approved and available over-the-counter.”

That data is not available for the vast majority of over-the-counter drugs on sale to all age groups without a prescription. Many OTC drugs (like acetominophen and aspirin) can have serious, even fatal, effects if taken inappropriately because of deliberate misuse or misunderstanding the label and instructions. You will not find data on safety and label comprehension for every possible age group for these medicines, yet they are readily available OTC in adult doses to consumers of any age.

Former FDA official Susan Wood – who resigned after a previous round of political interference in emergency contraception – agrees:

“They don’t do this for pain medication, headache medication, cold medication,” she said. “That’s not part of how we assess products. Are we going to go and now do this with all products, or are contraceptives once again being singled out for this special treatment and this extra standard when we’re talking about a very safe and very effective product that can really help women?”

Change.org has a petition up urging Sebelius not to let politics trump science, and objecting to the HHS leader’s focus on very young girls who may access the drug:

The fact that the HHS and the Secretary are focusing on this extremely young age group is bizarre. Less than 1% of 11 year olds are sexually active, where over half of adolescents have had sex before their 17th birthday.

This decision is illogical and unfounded. Physicians around the country agree that Plan B is incredibly safe and effective for all ages, helping to decrease the number of unintended pregnancies.

Further reading:
This NPR coverage provides a succinct timeline and political explanation of the controversy over accessibility of emergency contraception.

Statement from Physicians for Reproductive Choice and Health stating that the Obama administration’s “put[ting] politics before science and responsible health policy…is appalling.”

Heather Corinna at Scarleteen urges young people to speak up in protest of this action.

Jodi Jacobson at RH Reality Check, who reminds us that the previous administration wasn’t the only one playing political games with reproductive rights:

…no amount of proof it seems can make up for the fact that, despite all the evidence, even President Obama and Secretary Sebelius appear to think young women are too stupid to make their own decisions or that they are just chum to be thrown to the religious right in an election year. As the saying goes, with friends like these, who needs the far right?

Added: Email the White House directly.

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Filed under: Access, Rights, & Choice, Adolescent Health, Contraception, Drugs, Ethics, Government, Women’s Health

For the clinical folks among you, I wanted to pass along that the new, 40th anniversary edition of Our Bodies, Ourselves is available at a 70% discount to clinics and other groups providing health counseling services.

As detailed on the clinic discounts page, “The discounted price is currently $7.80 per copy plus plus applicable tax and shipping. Orders must be for 12 or more copies.”

There are some additional details online about how you can pay, and what documentation is needed to get the clinic or non-profit discount. There are also discounts on some of the other books, including OBOS: Pregnancy and Birth and OBOS: Menopause.

Note: I contributed to some pieces of the book and am a blogger for OBOS but do not receive any direct payment from sales of the book.

Filed under: Abortion, Adolescent Health, Body Image & Eating Disorders, Contraception, HIV/AIDS, HPV, Menstruation, Mental Health, Pregnancy, Sex & Sex Education, Vaginas & Vulvas, Women’s Health

Recently, Our Bodies Ourselves was featured on the NBC Nightly News, and there are some great clips – like Susan Love saying, “Our Bodies, Ourselves really set the stage for my whole career.”

Wow. I’ve been meaning to write a summary post of my time in Boston/Cambridge for the OBOS 40th anniversary, and how inspiring it was for me to be around so many fantastic women with so many strong things to say. I left inspired and reenergized. Susan’s commentary reminds me all over again, as does that from some of the other prominent women interviewed for the piece, including OBOS’s own Judy Norsigian. Hearing Brian Williams call it “a groundbreaker, a game changer” makes me pretty proud to be associated with OBOS in my own little way, too. I’ll have to forgive him the “plumbing” intro.

Posts from Christine with embedded video and commentary:

• The Legacy of “Our Bodies, Ourselves”: Sex, Plumbing and Menopause – The main video

• Judy Norsigian on “Our Bodies, Ourselves,” Past, Present and Future – Judy! Judy! Judy! Judy is a tireless advocate for OBOS, and why it matters into the 21st century and beyond as more than just a book, but a tool for knowledge and change.
• Susan Love on the Impact of “Our Bodies, Ourselves” and Why Breast Cancer Should Focus on Breasts – Susan (of Army of Women) reminds us how women’s bodies were viewed and taught when *she* was in medical school, and how OBOS played a role in transforming that mindset of women as “small men who have babies.”

There was also a nice review from Ms. Magazine recently. I love the end of the review, which again reminds us that OBOS is more than a book:

OBOS is a complete resource–or the closest to one that I can imagine–for women’s health and activism. Not only does the reader find clear, trustworthy information about her body, but also a thorough introduction to the politics of having that body. When you read OBOS, you join a community, one that is growing and changing (as each editions’ increasing thickness testifies to) and that provides the resources to start and keep talking.

OBOS certainly did that for me when I first encountered it, so I’m pretty excited that the new edition may provide that experience for a whole new set of women and girls.

Note: the NBC/MSNBC sites are really iffy about which videos they provide transcripts for. I didn’t see them on the OBOS videos.

Filed under: Access, Rights, & Choice, Women’s Health

In Memphis, TN, Title X family planning funds have been awarded to Christ Community Health Services, a religious health provider which has indicated that it may refuse to provide information, referrals, and some kinds of health care to Shelby County’s women.

Title X funds have historically gone to Planned Parenthood in Memphis; the move to give the funds to an anti-choice organization is part of nationwide efforts to defund Planned Parenthood because PP provides abortions. Existing laws already clearly prohibit Title X or other federal funds from being used for abortion services – the money goes to provide necessary services like contraception and cancer screenings.

Reports indicate that Christ Community has no intention of providing referrals to women who choose to have abortions, whether that is for personal or medical reasons. From a report by a Memphis newspaper (emphasis added):

[Christ Community CEO] Waller initially said the clinic refers patients to abortion providers if they request it, but he and Dr. Rick Donlon, a founding physician at the clinic, later called the newspaper to change that statement.

“We really try to provide women with other options and make sure they have those possibilities. And if they at the end still want a pregnancy termination, we know they know where to go,” Donlon said.

“They know where to go.” That doesn’t exactly sound like a professional provider of medical services to me. The clinic leaders obviously made a point of contacting the newspaper to make sure it was clear that they would *not* provide referrals, demonstrating a clear intent to put religious belief ahead of the medical care of women who may consider or require abortions.

Christ Community has also said it will not provide emergency contraception, only doing so through a third party. No details are available about how this will happen in practice, and how much additional time, travel and cost women may be subjected to in order to access this legal, previously available, and non-abortifacent medical care. This change clearly creates an additional burden for women seeking emergency contraception, and the women of Memphis currently have no guarantees that the third party provision will happen in a timely way, while timely administration of emergency contraception drugs is absolutely crucial for them to work.

I have not seen this discussed elsewhere, but it is also not readily apparent to me whether Christ Community would or could ever decide that any other forms of birth control are off-limits because of purely theoretical possibilities of preventing fertilized egg implantation. If we’re already providing the Title X money to a provider who can pick and choose services because of religious beliefs, I don’t see that refusing other forms of contraception is completely out of the question.

The organization also is reportedly working to install “crisis pregnancy centers” at its locations; these centers are well known for providing false and misleading information about abortion and exist to convince women not to choose abortion. Title X rules require “nondirective” counseling about abortion, and Planned Parenthood and other reputable providers who do provide abortions (using other, non-federal money) have processes and counselors in place to check whether women are certain of their decisions without pushing them in either direction.

Given the interest in installing deliberately biased in-house counseling and the stated intention to refuse to refer women out to other providers for abortion, it seems unlikely that Christ Community will be able to or has any intention of meeting the rules requiring factual, nondirective counseling. Women who cannot afford to access family planning care elsewhere will be subjected to a provider who clearly wishes to influence women’s choices, rather than providers who are committed to medical accuracy and offer women a full range of choices, supporting their right to individual decision-making about their bodies.

One woman reports that “Christ Community provides high-quality medical services, but that they sometimes come with a ‘sermon.’” She says she was told by a Christ Community provider, “If only my relationships with people and God were right, I would have fewer health problems.”

You have got to be f***ing kidding me.

In addition to these concerns, there may be other issues with Christ Community’s administration of the Title X funds. I’m not personally familiar with CCHS’s existing health clinics and services on the ground. A Memphis local informed me Christ Community does not take appointments – patients must show up first thing in the morning and wait to be seen, and may even have to come back the next day if too many people show up. This is obviously not a good model for providing family planning services, especially when emergency contraception or other urgent services are needed or when women must take time off from jobs, school, or childcare in order to wait around for care. Although the organization’s website does have an “appointment line,” it indicates that this is to find out which clinics provide which services; I’d like to hear from others about whether this matches their experience at Christ Community clinics.

Another serious concern is that Christ Community’s proposal to provide these services clearly indicated that they would provide less care to fewer women than would Planned Parenthood. Steve Ross, of Memphis and blogging at Vibinc, has an excellent series chronicling the whole debacle, from the Tennessee state government pressuring the Memphis health department to take the funds despite their lack of capacity for family planning through to the current funding of Christ Community (parts 1, 2, 3, and 4). In part 2, he lays out the numbers and apparent relative deficiencies of the Christ Community proposal, including their lower numbers for proposed services and inconsistencies in how the proposals from Christ Community and Planned Parenthood were scored by local officials.

In Part 3, Steve points to the questions asked by the potential providers – Christ Community, Planned Parenthood, and a third non-religious applicant. Although they are unattributed, we can only assume that the following questions were asked by Christ Community, the only applicant with an explicit religious mission and on the record about refusing services because of beliefs. I think these are very telling about the intentions of the leadership of the organization that asked these questions, and how they plan to approach women’s health:

In providing information about pregnancy termination, is it sufficient to have the referral information in writing? [My interpretation: In other words, do we even have to bother to actually have a conversation with women about this?]

If the information about pregnancy termination is provided, is the contractor allowed to indicate in wiriting (NOT coerce) – on a referral sheet or in the office that it does not provide that service because of its beliefs.

If a contraceptive method is not provided on site by a provider because of the provider’s ethical beliefs, can the provider refer the client to another Title X provider who offers this method? If so, does the referring provider have to pay for the service?

The answers to these questions explicitly state that emergency contraception must be provided, the organization cannot choose not to provide forms of contraception because of its beliefs, and they are not allowed to talk about refusing abortion and referrals because of beliefs. Yet everything we’ve heard – as mentioned above – indicates that Christ Community plans to do exactly that.

As Steve writes:

To be honest, these three questions left me flabbergasted. Certainly individuals and associations of people are allowed to hold their own beliefs. Certainly, different physicians and networks of physicians have different preferred treatment plans. There’s plenty of room for this diversity out there in the private sector. However, when you choose to enter the public sector by seeking a contract for public dollars, you are bound by the requirements those public dollars place on you. If those requirements are unpalatable to you, then perhaps you shouldn’t seek them.

Honestly, I’m sure this whole thing will end in lawsuits, and I wouldn’t be unhappy if HHS would intervene. In the meantime, poor women suffer.

I will leave you with this excellent rant from Sig at DowntownMemphisBlog:

Public policy needs to be based on reason and fact, not feelings and faith. Abortion is a legal medical procedure. Any organization that aspires to hold a government contract in the area of family planning needs to present all options and perform all medical procedures, not just the ones it agrees with or likes. Not just the ones that make them feel warm and fuzzy inside. Not just the ones that fit into the narrow world view defined by their archaic religious beliefs.

See also: Aunt B

Filed under: Access, Rights, & Choice, Contraception, Ethics, Government, Women’s Health

This Saturday, Our Bodies Ourselves will celebrate the 40th anniversary of the publication of the original book on women’s bodies and health, editions of which have informed and inspired women ever since.

To mark this milestone, the organization is holding a free public symposium this Saturday at Boston University, with speakers including Loretta Ross of SisterSong, Jacyln Friedman of Women, Action, & the Media, Bylle Avery of the Black Women’s Health Imperative, and OBOS’s own Judy Norsigian. There will also be panels on OBOS’s global initiatives, activism, and change, and partners from 12 countries there to “share their extraordinary journeys transforming ‘Our Bodies, Ourselves’ for their own countries.” Last but not least, the 40th anniversary edition of the landmark book will be released on the day of the event.

I’m super-excited.

Realizing that everybody who might be interested in these sessions – which include a great deal of representation of OBOS’s global partners – might not be able to attend, the event will be live-streamed online starting at 9am on Saturday.

If you’re following along at home and want to tweet about it, the hashtag we’re using is #obos40. There will be a post-event round-up at Our Bodies Our Blog.

Filed under: Events & Observances, Global Issues, Women’s Health

This week, the National Latina Institute for Reproductive Health and other organizations have been observing the second annual Latina Week of Action for Reproductive Justice:

This year’s theme is Caminamos: Justice for Immigrant Women. We’re inviting everyone to join us in moving toward a brighter future for immigrant women and their families. Mean-spirited enforcement, workplace exploitation, and the criminalization of basic rights like education and health care are just a few of the challenges that have forced immigrant women into the shadows and ignored the crucial, positive role we play in our communities.

Action items for the week include calling for a review of the 287(g) program and online discussion on the theme, “what’s the real problem behind the targeting of immigrant women?” – including a blog carnival with lots of great posts worth reading, and NLIRH’s posts at their blog Nuestra Vida, Nuestra Voz.

I haven’t read all of the posts yet myself, but one I particularly liked is at Abortion Gang, where the writer talks about appropriate reproductive health care requiring more than just Spanish-language services:

…if we want to provide “culturally competent” health care services (and I’m not just talking about abortion care), we need to be constantly learning from and with our patients. We have to be more than “culturally competent.” We need to be culturally fluent…a lack of understanding of the diverse Latina/o cultures keeps immigrant women from getting the care they need. Lack of cultural understanding breeds intolerance and scapegoating. We need to speak more than Spanish; we need to comprehend the language of experience.

Another good one is What’s the Real Problem? Some families are valued while others are demonized at the NLIRH, blog, which criticizes devaluing of families of color generally and my least favorite libertarian Ron Paul specifically, for his views on protecting fetuses and denying citizenship to American-born children of immigrants via the 14th amendment:

The two different approaches to the Fourteenth Amendment reveal a subtext of whose children are wanted and valued. The fetuses of white women are offered constitutional protection, while the lives of immigrant women of color are dismissed and demonized. In the United States, immigrants are denied benefits while being blamed for environmental degradation, the recession, and lack of jobs. They are also portrayed as coming to the United States solely for the purpose of having children who are then raised to be terrorists. Anti-immigrant advocates are the same people who spout pro-life rhetoric and claim to be protecting family values.

Go check out the blog carnival for more.

While not reproductive justice-focused, Aunt B points to and remarks on this 287(g)-related story out of Nashville, in which a teenage girl just about to graduate from high school was taken to jail and spent almost 3 days there for driving without a license (which I don’t believe she could have obtained under state law). The 18 year-old, who was brought to the U.S. by her parents as a child 9 years ago and has hopes of attending college and med school, may be deported. The local implementation of 287(g) has been criticized for being heavy-handed in targeting Latino/a immigrants for deportation for such non-violent crimes as driving without a license.

Filed under: Abortion, Access, Rights, & Choice, Ethics, Laws, Legislation, & Courts, Women’s Health

Not the Governor who pushed for the move, apparently.

Earlier this month, I wrote about how Republican-led efforts to defund Planned Parenthood in Tennessee will affect women in Nashville – one of two TN cities where the state usually gives federal family planning and cancer prevention money to Planned Parenthood. In Nashville, that money will now go to the local health department, which explicitly said that it doesn’t expect to serve the same number of women for the money.

Planned Parenthood made up the gap between the federal funds and what it takes to actually serve Nashville’s women by raising funds from donations. The health department does not expect any additional funds to make the shortfall, and would need local tax increases to make up the difference.

As at least one Twitter friend observed, the irony of Republicans causing health care to be shifted *to* the government – and needing to raise taxes if the same level of service is to be provided – is just too bitter to appreciate.

Jeff Woods has additional follow-up on this story for the Nashville City Paper, where he writes, “Told that health officials fear thousands of women might lose services once Planned Parenthood is denied federal money…the governor wouldn’t acknowledge the problem.”

“It’s news to me if that’s true,” he said. “Nobody’s told me that.

Oh, really?

As I pointed out in the previous post, the letter from the Metro Public Health director accepting the money was pretty damn explicit that the same number of women would not be served.

Perhaps Governor Haslam never saw that letter. Perhaps State Health Commissioner Susan Cooper, who reportedly pressed Metro to accept the funds at Haslam’s urging, didn’t tell her boss that this political “win” came with a downside for women seeking health care. Perhaps nobody on the Governor’s staff reads the news and not a single person involved in the political pressure to move the funds either thought of or worried about the implications and was willing to say so. I’ll pause here so we can all ponder whether that seems likely, and what it means if it is.

Notice that the quote Woods got from the Governor doesn’t say, “That’s news to me, and we’ll make sure the same level of preventive care and family planning services is provided, because the health of Tennessee’s women, including vulnerable low-income women, is important to me.” There is no “we’ll check on that” addendum, at least in Woods’s reporting. What this suggests is that the Governor Haslam may not have known – which is problematic on its own – but doesn’t especially care. “Nobody’s told me that” is a brush-off, one that doesn’t commit Haslam to any future worrying about or follow-up on this issue.

I also wrote in my previous post that I am troubled by public health officials accepting this money knowing that doing so, in addition to playing a part in a ridiculous political agenda, would mean fewer women getting the same services for the same money. In Woods’s piece, Metro Health Director Bill Paul weakly defends this move with the excuse that he thought the state legislature might kill the funding altogether if he didn’t. “I honestly was quite concerned that the money would go away completely,” he said.

I’d like to know how Paul thinks that would have worked out given that the funds are federal, and would have put Tennessee in basically the same position as Indiana. The state trying such a move might actually have worked out better for Nashville’s women, because the federal funding agency might have stepped in at that point as they have in Indiana – which was already happening when Paul accepted the funds in Nashville.

Paul reportedly told Woods he hopes nonprofit family planning providers will fill the unmet need caused by Metro taking the funds. Uh, again, nonprofit family planning providers LIKE PLANNED PARENTHOOD? Paul played a role in solidifying that gap in services by accepting funds that would have been supplemented by private donations if they had one to Planned Parenthood. And now he hopes some unnamed non-profit family planning provider – presumably through private donations – can make up the gap? Who does he think is likely to do that? Is this really just a way of saying, “We took the money because of political pressure, but we really hope Planned Parenthood can keep providing those services, because we know and have acknowledged that we don’t have the capacity?” Maybe Paul’s secretly a great guy in a tough position, but I’m pretty sure being complicit in this situation was not the best way to protect or promote the public’s health.

Filed under: Access, Rights, & Choice, Adolescent Health, Cancer, Contraception, Ethics, Government, Health, Sex & Sex Education, Vaginas & Vulvas, Women’s Health

I posted on Friday about Nashville’s Department of Health deciding to accept the funds that would normally go to Planned Parenthood for family planning services, and stating when they did so they were taking the money on the condition that they did not have to serve the same number of people. A commenter here – who appears to be close to the issue – pointed out that the county would probably need more local tax dollars to provide the same amount of service that Planned Parenthood provided with a combination of those federal funds and private donations.

I saw a few news items today that don’t make a coherent whole, but that I felt were related to the issue.

1. State Health Commissioner Susan Cooper reportedly sent a letter to the Metro Public Health Department urging them to take the federal funds that would normally go to Planned Parenthood. According to the Tennessean, her letter urged the department to “‘think creatively and consider working with community partners’ to deliver family planning services.”

Um, there’s already a community organization that is well-equipped with appropriate expertise for delivering family planning services. It’s called Planned Parenthood.

2. I have never really thought of Susan Cooper as a bowing-to-political-pressure, in-line-with-social-conservatives-instead-of-public-health sort of health commissioner. But we have a new Republican governor, and a newly more Republican state legislature. And then I ran across this news piece from January stating that she’s still in the position on an “interim” basis under said new Governor.

So I just assume that “interim” means “as long as the folks in charge are accomplishing political goals.” Which apparently include providing less care to fewer women, at least in the undefined short term.

3. That new Governor, Bill Haslam (R), was summed up just a week or so ago as proclaiming that “‘Unless Tennesseans make an effort to improve personal health, they could see more budget cuts in their children’s education as health-care costs continue to drain the state budget,’ Gov. Bill Haslam said Thursday.”

So, um, your kids might get even worse educations if we don’t all get healthier in Tennessee. But maybe “we” don’t seem to include women who need birth control, cancer screenings, or other family planning and reproductive health services, and especially not those women who struggle to afford such care. Those people can just pay more, somewhere else, as long as it serves the social conservative agenda.

4. I’ll just be over here banging my head against the wall.

Filed under: Access, Rights, & Choice, Government, Women’s Health

Today marked the release of the 2011 Tennessee Women’s Health Report Card, a publication which provides a snapshot of the health status of women in our state, and the disparities they experience. It’s a handy resource for anyone interested in making a case – or understanding the need – for improved health services and community programs, and includes statistics that clearly illustrate some of the challenges we face.

Among them:

• 18.4% of us – or almost 1 in 5 – smoked while we were pregnant. The rate is highest (21.4%) among white women, and lower among African American (10.3%) and Hispanic (2.4%) women.
• African American women experience tremendous disparities in their infant mortality rate, with 16 infant deaths per 1,000 live births, compared to 6 for white women and 6.6 for Hispanic women.
• About a third of us have high blood pressure, high cholesterol, are obese, and do not “engage in leisure time activity,” or exercise.
• 16.9% of us live below the poverty line, with disparities here as well – 13.9% of white women, 28.2% of African American women, and 42.1% of Hispanic women meet this depressing criteria.

I would encourage to take a look at the full report [PDF], especially if you are interested in working to improve the health of women and Tennesseans. Just browsing the statistics on reproductive health, sexually transmitted infections, causes of death, risky behaviors, preventive health practices (like cancer screening), and barriers to health care is sure to give you ideas for possible actions to take in your family, neighborhood, county, and state.

This year, I had the privilege of attending the release event for the report at the downtown branch of the Nashville Public Library, and so got to hear some really smart and engaged folks speak about the report and its implications for our communities. Action, or what we do in response to this report, was a major theme.

First up, Dr. Katherine Hartmann of Vanderbilt made a clear call to action, stating that this must be the year we look at this report and say, this is not just public health data, it’s us and our families, and represents many challenges that we must address.

Next, Dr. Jeffrey Balser of Vanderbilt, noted the responsibility of large employers in contributing to the health of their employees and, by extension, the community. He challenged people in places of authority to do active and visible things to improve the health of those around them.

Third up, Dr. Charles Mouton of Meharry Medical College observed that some of his peers have grown weary of hearing about health diaparities and how we have failed to fully addreas them. He then challenged us all to work to eliminate them, calling it our duty to the women this report card represents to eliminate those disparities. He asked the audience to look at the report card as a roadmap for where we have not done well, and where we can and should work to improve health care and access to care for all Tennesseans.

Next, Dr. Stephaine Hale Walker of Vanderbilt began with a review of the good and bad grades on the report card, noting the good news that deaths from diabetes continue to decline, more than 80% of women over 50 had a mammogram in the last two years, and deaths from colorectal cancer are at a low. She also noted that stroke and heart disease rates are very slowly showing trends toward improvement.

The bad news, as we’ve touched on, is that disparities continue for many health issues, such as our African American women being at a much higher risk of having a very low birthweight infant, having an infant die before its first birthday, dying from cervical or breast cancer, or having a sexually transmitted infection. Likewise, social barriers such as poverty, unemployment, and lack of healthcare coverage continue to challenge us.

From there, Dr. Hale Walker moved to an inspiring discussion of the need to ask ourselves “now what?” We can’t just talk about these problems, she said, we need to ask what we can do to be part of the solution, form collaborations, and act to make change.

As an example of her own committment to acting for change, Dr. Hale Walker spoke about the Full Circle organization which works to connect people with the great organizations in Nashville offering free and sliding scale healthcare resources. She also is married to Bishop Joseph Walker of prominent Mount Zion Baptist Church, where the church has implemented the ChurchFit program to provide access to fitness classes to the member community, and health education programs on a variety of topics, partially inspired by the statistics in the 2009 edition of the report card. I had the opportunity to speak to one of Mount Zion’s congregants at the reception after the report release, and found her attitude, story, and words inspiring and motivating as well. Stories shared by other women in conjunction with the report are available on this page.

Finally, Commisioner Susan Cooper of the Tennessee Department of Health spoke, calling for us to be smarter about how we spend our resources, and to focus them in areas of highest risk. She reminded us that significant improvements are not going to happen overnight or on their own, and require time and dedicated action. She highlighted state programs acting to make a difference, like the tobacco Quit Line, and Get Fit Tennessee, the website of which includes a free healthy cookbook I need to check out.

Cooper asked us to think about small personal changes we can make, but to also think about policy. Her vision of policy extends beyond whatever the legislature is or isn’t doing – we are asked to think about how university, urban design, and other policies affect the health of our community, and to ask for these policies to be formed in ways that promote our health.

All of this is a very long-winded way of saying – I left today’s report card launch inspired, and hope seeing the disparities and room for major improvement of the full report inspires you, too.

*Disclosure: Vanderbilt is my larger place of work, and people I’ve worked with worked on this report.

Filed under: Birth, Cancer, Events & Observances, Heart Health, Infectious Diseases, Mental Health, Pregnancy, Women’s Health

This post is late because I was busy taking the bus to get here.*

I wrote several times in 2008 about the case of Juana Villegas, an immigrant in Nashville who was arrested as the result of a traffic stop and ultimately ended up shackled to a hospital bed during labor, separated from her newborn for two days without seeing him, and denied a breast pump or cream for lactating women. This past week, a federal judge ruled in her favor that the shackling during labor and after delivery violated her civil rights. I have a full post up at Our Bodies Our Blog on this topic.

I also have a full post up at the OBOS blog on the Skin Deep database, which provides info on the safety and ingredients of skin care and cosmetic products.

I spent the last few days at the IHA Health Literacy conference. I intend to post on this separately later, including a list of a lot of good resources I learned about, but Siobhan has a few things up at her place. One thing I need to think about is the level at which this blog is written, and whether it is useful and helpful to make some adjustments so posts are more readable for a wider audience, and whether there would be interest in that.

The National Resource Center on LGBT Aging, which I think I also found out about from Siobhan, has information and guidance for providers, patients, and organizations on a number of topics, including ageism, HIV and aging, housing, legal support, Medicare, homelessness, and more.

Jodi Jacobson at RH Reality Check (which has a new look) asks, “What does it mean to be pro-choice?“

NPR, on Morning Edition and Talk of the Nation, aired several pieces on the local Magdalene/Thistle Farms, a residential program in Nashville, TN for women who have experienced violence, sex work, and addiction, and a bath and body products enterprise through which the women work and earn money. You can buy from them online at http://store.thistlefarms.org/.

A question at Good: Why isn’t birth control getting better?

Relatedly, I talked briefly with a representative of the California Family Health Council at the health literacy conference, and was told that they are trying to promote some longer term methods of birth control. This is among their other work, which includes the development of patient education materials on contraception, violence, cancer prevention, pregnancy, STIs, and other sexual and reproductive health topics. I always kind of get the willies when people talk about “promoting” long term contraception, because of the problematic history of how it has been used to assert control over the reproduction of women of color and poor women – regardless of what may be good methods, ethics and intent from whoever is talking about it. I’ll have to contact them and find out what the motivation for this is and how they are approaching it, because I didn’t have time to follow up at the event. In the meantime, anybody familiar with this group?

In the comments at Aunt B’s place, the topic of “gender parties” comes up. I have an appeal to saucy bakers to incorporate the message, “Now you know the sex, not the gender” into the design of these ill-conceived “gender party” cakes.

Here in Tennessee, Stacey Campfield has been pushing his “don’t say ‘gay’” bill, which – despite an intro that talks generally about home being the appropriate place for discussions of sexuality – provides specifically that “no public elementary or middle school shall provide any instruction or material that discusses sexual orientation *other than heterosexuality*” – which is not at all the same as “teachers shouldn’t be discussing sexuality in schools at all.

I picked up a weekly paper in Orange County this week and noticed that Dan Savage mentioned the bill in his 5/4 column, pointing readers to wesaygay.com, a site ostensibly set up by a couple of teenagers opposing the bill and gathering petition signatures in opposition – it’s nice to see students being active in this way.

The bill passed the House committee and is scheduled for a full Senate vote on May 9, although it has been reported that the state Senate will not take it up this year.

The wonderful Rev. Chris Buice of Knoxville argues in a commentary on the bill that prohibiting teachers from discussing homosexuality in school hinders them in acting against bullying and prevents them from having many educational discussions related to current events and legislation.

Apparently this coming week is National Women’s Health Week.

From the FDA:

The U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) today announced a joint effort to remove products from the market that make unproven claims to treat, cure, and prevent sexually transmitted diseases (STDs). Among the products targeted in today’s action are Medavir, Herpaflor, Viruxo, C-Cure, and Never An Outbreak.

The Harper Collins controversy has escaped the boundaries of libraryland. tigtog at Hoyden notes it, and Andy’s change.org petition got sent out on a huge scale. Short version of the controversy – Harper Collins wants to make libraries buy new copies of ebooks after they’ve been read 26 times. You know, because libraries are rolling in money and typically discard books after 26 reads. *eyeroll* There’s a ton of writing on this in the library blogosphere, just google it with some combination of Harper Collins, libraries, 26, ebooks.

The Abortioneers are talking about the stigma of multiple abortion, and there is some really good discussion in the comments, including from those gently pushing back against the OP for certain attitudes expressed in the post.

The Utah AIDS Drug Assistance Program is closing to new applicants due to a funding shortfall; supporters of the program are encouraged to contact their state and federal legislators.

This week’s title: I was in a car accident a couple of weeks ago, car three in a five-car wreck. I’m fine, although I was a little rattled and had a seatbelt bruise for about a week. The car, which is older and was in a previous accident, is totaled. The spouse and I are planning to go without a car, at least for the next few months. Tips and strategies for doing so are welcome. Depending on my mood, the situation gets framed as “car free” or “carless.”

Filed under: Abortion, Abuse, Rape, & Safety, Access, Rights, & Choice, Adolescent Health, Birth, Contraception, Drugs, Ethics, Government, HIV/AIDS, Infectious Diseases, Laws, Legislation, & Courts, Libraryland, Miscellaneous, News Round-Ups, Pregnancy, Sex & Sex Education, Women’s Health

This post is late because I was busy taking the bus to get here.*

I wrote several times in 2008 about the case of Juana Villegas, an immigrant in Nashville who was arrested as the result of a traffic stop and ultimately ended up shackled to a hospital bed during labor, separated from her newborn for two days without seeing him, and denied a breast pump or cream for lactating women. This past week, a federal judge ruled in her favor that the shackling during labor and after delivery violated her civil rights. I have a full post up at Our Bodies Our Blog on this topic.

I also have a full post up at the OBOS blog on the Skin Deep database, which provides info on the safety and ingredients of skin care and cosmetic products.

I spent the last few days at the IHA Health Literacy conference. I intend to post on this separately later, including a list of a lot of good resources I learned about, but Siobhan has a few things up at her place. One thing I need to think about is the level at which this blog is written, and whether it is useful and helpful to make some adjustments so posts are more readable for a wider audience, and whether there would be interest in that.

The National Resource Center on LGBT Aging, which I think I also found out about from Siobhan, has information and guidance for providers, patients, and organizations on a number of topics, including ageism, HIV and aging, housing, legal support, Medicare, homelessness, and more.

Jodi Jacobson at RH Reality Check (which has a new look) asks, “What does it mean to be pro-choice?“

NPR, on Morning Edition and Talk of the Nation, aired several pieces on the local Magdalene/Thistle Farms, a residential program in Nashville, TN for women who have experienced violence, sex work, and addiction, and a bath and body products enterprise through which the women work and earn money. You can buy from them online at http://store.thistlefarms.org/.

A question at Good: Why isn’t birth control getting better?

Relatedly, I talked briefly with a representative of the California Family Health Council at the health literacy conference, and was told that they are trying to promote some longer term methods of birth control. This is among their other work, which includes the development of patient education materials on contraception, violence, cancer prevention, pregnancy, STIs, and other sexual and reproductive health topics. I always kind of get the willies when people talk about “promoting” long term contraception, because of the problematic history of how it has been used to assert control over the reproduction of women of color and poor women – regardless of what may be good methods, ethics and intent from whoever is talking about it. I’ll have to contact them and find out what the motivation for this is and how they are approaching it, because I didn’t have time to follow up at the event. In the meantime, anybody familiar with this group?

In the comments at Aunt B’s place, the topic of “gender parties” comes up. I have an appeal to saucy bakers to incorporate the message, “Now you know the sex, not the gender” into the design of these ill-conceived “gender party” cakes.

Here in Tennessee, Stacey Campfield has been pushing his “don’t say ‘gay’” bill, which – despite an intro that talks generally about home being the appropriate place for discussions of sexuality – provides specifically that “no public elementary or middle school shall provide any instruction or material that discusses sexual orientation *other than heterosexuality*” – which is not at all the same as “teachers shouldn’t be discussing sexuality in schools at all.

I picked up a weekly paper in Orange County this week and noticed that Dan Savage mentioned the bill in his 5/4 column, pointing readers to wesaygay.com, a site ostensibly set up by a couple of teenagers opposing the bill and gathering petition signatures in opposition – it’s nice to see students being active in this way.

The bill passed the House committee and is scheduled for a full Senate vote on May 9, although it has been reported that the state Senate will not take it up this year.

The wonderful Rev. Chris Buice of Knoxville argues in a commentary on the bill that prohibiting teachers from discussing homosexuality in school hinders them in acting against bullying and prevents them from having many educational discussions related to current events and legislation.

Apparently this coming week is National Women’s Health Week.

From the FDA:

The U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) today announced a joint effort to remove products from the market that make unproven claims to treat, cure, and prevent sexually transmitted diseases (STDs). Among the products targeted in today’s action are Medavir, Herpaflor, Viruxo, C-Cure, and Never An Outbreak.

The Harper Collins controversy has escaped the boundaries of libraryland. tigtog at Hoyden notes it, and Andy’s change.org petition got sent out on a huge scale. Short version of the controversy – Harper Collins wants to make libraries buy new copies of ebooks after they’ve been read 26 times. You know, because libraries are rolling in money and typically discard books after 26 reads. *eyeroll* There’s a ton of writing on this in the library blogosphere, just google it with some combination of Harper Collins, libraries, 26, ebooks.

The Abortioneers are talking about the stigma of multiple abortion, and there is some really good discussion in the comments, including from those gently pushing back against the OP for certain attitudes expressed in the post.

The Utah AIDS Drug Assistance Program is closing to new applicants due to a funding shortfall; supporters of the program are encouraged to contact their state and federal legislators.

This week’s title: I was in a car accident a couple of weeks ago, car three in a five-car wreck. I’m fine, although I was a little rattled and had a seatbelt bruise for about a week. The car, which is older and was in a previous accident, is totaled. The spouse and I are planning to go without a car, at least for the next few months. Tips and strategies for doing so are welcome. Depending on my mood, the situation gets framed as “car free” or “carless.”

Filed under: Abortion, Abuse, Rape, & Safety, Access, Rights, & Choice, Adolescent Health, Birth, Contraception, Drugs, Ethics, Government, HIV/AIDS, Infectious Diseases, Laws, Legislation, & Courts, Libraryland, Miscellaneous, News Round-Ups, Pregnancy, Sex & Sex Education, Women’s Health

Actually, the round-up is not a joke – but I have been cracking up at Stephen Colbert’s response (and the resulting tweets) to Republican John Kyl’s way, way off statement on the Senate floor that >90% of what Planned Parenthood does is abortion (it’s more like 3%), and his spokesperson’s response, when Kyl was called on the error, that it “was not intended to be a factual statement.” [more via Know Your Meme]

At Our Bodies Our Blog, some discussion of “opiate babies” as the new “crack babies,” with all of the problematic media coverage and decentering of women’s stories and experiences that implies.

Also, OBOS is looking for individuals who might want to be on the cover of the 40th anniversary edition of the book, which will use images of real readers/fans rather than generic pseudo-diverse stock imagery (yay!). Get details here.

The National Partnership for Women and Families has discussion of a study on medication abortion and whether ultrasound is needed. I haven’t read the paper it reviews yet, but thought I’d share.

The Maddow blog has some discussion of how efforts to restrict abortion rights really go beyond abortion, including anti-contraception perspectives that seek to limit women’s ability to prevent pregnancy.

Relatedly, social conservatives may be barking up the wrong tree if they think religious folks will support measures to reduce contraceptive/family planning services – per new results out from Guttmacher, which surprised nobody – “Among all women who have had sex, 99% have ever used a contraceptive method other than natural family planning. This figure is virtually the same among Catholic women (98%).” Although, almost 15% of women getting abortions apparently describe themselves as born-again or evangelical Christians, so possibly the believe vs. do connection is not so strong after all.

A Maine bill that would have interfered with the ability of transgender people to choose the appropriate restroom for themselves and have legal resource if they were prevented from doing so was defeated (that’s a good thing, for safety for and decency to trans people).

Trans Respect vs. Transphobia tallies up an awful number of murders of trans people around the globe.

If I haven’t pointed to it before, Retraction Watch is a pretty cool resource on retractions of papers from medical journals and the ethics (or lack thereof) and bad scientific practices involved.

Kevin MD has a guest post on data overload and genomic medicine.

Honestly, I think the idea of a flash mob at Walgreens is an ineffective and unfortunate action in response to the Fox claim that we don’t need Planned Parenthood because you can get pap smears (and other services) at Walgreens. Nobody at Walgreens made that claim, and you don’t need a flash mob to document that – you need one person getting a statement from one Walgreens official. What a waste of effort.

Via Siobhan at BHIC, the CDC’s new health literacy site.

Random note: the most frequently found posts here have to do with “lost” tampons; as a librarian, I’m absolutely fascinated by all the ways people find to search the web for this topic.

Filed under: Abortion, Abuse, Rape, & Safety, Access, Rights, & Choice, Contraception, Government, Miscellaneous, News Round-Ups, Pregnancy, Women’s Health

Assorted items of interest collected over the last week or so; as usual, the Sunday round-up is more socially than medically oriented, this week with several items on transgender women and related rights, issues, and prejudices as I’ve been trying to read more about these topics.

Scientific American has an excerpt from a new book, Demand Better! Revive Our Broken Health Care System. It’s a pretty clear explanation of how little doctors apply the best, most current evidence to medical treatment, and might be pretty shocking for folks who are not involved in evidence-based medicine issues. For example:

Even though clinical guidelines exist…physicians get it right about 55 percent of the time across all medical conditions. In other words, patients receive recommended care only about 55 percent of the time, on average…. How well physicians did for any particular condition varied substantially, ranging from about 79 percent of recommended care delivered for early-stage cataracts to about 11 percent of recommended care for alcohol dependence. Physicians prescribe the recommended medication about 69 percent of the time, follow appropriate lab-testing recommendations about 62 percent of the time and follow appropriate surgical guidelines 57 percent of the time. Physicians adhere to recommended care guidelines 23 percent of the time for hip fracture, 25 percent of the time for atrial fibrillation, 39 percent for community-acquired pneumonia, 41 percent for urinary-tract infection and 45 percent for diabetes mellitus.

Friends and family members who I encourage to question your physicians, to find out more, to not accept decisions based on simple authority? See above.

Renee at Womanist Musings calls out Bitch magazine for their focus on middle class white women in an article on “mommy bloggers” and their inclusion of women of color only as (literal) footnotes in the piece. She points out that in general women of color are not thought of when people thing of “mommy bloggers” and “mommies,” and that white women who blog on these topics are much more likely to receive recognition, book deals and other rewards – and it’s not because they’re just inherently better writers or more experienced moms.

Apparently some obstetricians in Tennessee are upset about a plan to have the state’s Medicaid program reimburse cesareans at the same rate as vaginal deliveries, in part to influence physicians to do fewer cesareans that are not medically indicated.

One physician interviewed tries to make a claim that physicians have to do more cesareans now because physicians are doing more cesareans…making a distinction between elective procedures and elective procedures done so physicians can avoid risks without working patients into that equation:

“It is very true that the rate of cesarean deliveries is increasing, but it is not increasing just because of convenience. It is increasing because of the repeat cesarean deliveries that occur…Many doctors now don’t want to face the liability of doing a vaginal birth after a cesarean section.”

Some repeat cesareans are obviously going to be medically indicated, but repeat after me: physician’s desire to avoid potential legal liability /= medical indication.

Becoming Johanna — A Trans Youth’s Story (VIDEO) – video focuses on an adolescent transgender Latina kid Johanna whose mother committed her to a mental hospital in order to prevent her from transitioning. A trailer is available; they’re part of a larger project.

Guest Post: Transmisogyny is Misogyny Against All Women at Transarchism. Includes discussion of what a woman’s body “should” have in order to be considered “woman” by other people:

What the hell does a woman’s body possess that makes it a woman’s body? What does it NEED to have to be female. Did you immediately think of breasts, ovaries, vaginas? Gross. Think about that for more than two minutes and you’ll see why it’s gross. Still don’t get it? Well then go down to the nearest breast cancer walk and tell every single woman with a double mastectomy she’s not a woman. When you’re done with that, go down to your local hospital, ask the nurse where the OR is, and wait outside until you can find a woman fresh out of her hysterectomy surgery, and tell her the news. Yeah, that sounds evil, doesn’t it? Well it’s basically what you’re doing when you’re policing trans women’s bodies. You’re telling all women what they have to have on/in their bodies to be a woman. Which, obviously, is totally gross.

Monica at TransGriot notes that while white feminists called out George Lopez for his body size-related remarks on Kirstie Alley, they were silent about transphobic comments directed at woman of color Wendy Williams. You don’t have to be a fan of any of those three to note the difference in handling.

The blogger at Lollygagging and Lassitude reacts to the reaction to the misogynistic, ableist, and ageist nonsense of Scott Adams of Dilbert by talking to feminists about picking targets – “But do not forget there are women who will die for reasons that have nothing to do with Scott Adams’ words” – including trans women. I have noted my dislike of “shouldn’t you be focused on more important things?” arguments in the past, and they are often cited as a derailing tactic when employed by external parties. In this case, though, it’s worth talking amongst ourselves about whether there are systemic privileges that focus what we talk about as feminists – nobody’s saying we shouldn’t talk about Scott Adams, I think the author is saying that we can talk about Scott Adams but we need to also remember not to use all of our fighting energy on people like him.

Audacia Ray explains that “You” probably couldn’t be arrested in New York City under provisions that allow condoms to be counted as evidence of sex work, that “Policies like this one exist solely to uphold the ability of police to harass people of color, poor people, and often trans women who are profiled as being sex workers or nabbed for ‘walking while trans.’”

Queerty has a bit on challenging the New York City requirement that trans men and women have genital surgery in order to change their birth certificate.

TransTalk points to the “Two Spirits” documentary to be aired by Independent Lens (PBS) in June. The website for the film is at http://twospirits.org/.

Rep. Henry Waxman demands answers from Ther-Rx about Makena – There’s a drug meant to help prevent preterm birth that was approved by the FDA as an “orphan drug” at which point the company that got the approval hiked the price from about $10-$20 a dose to $1500/dose. There is also commentary on the March of Dimes’s response, and a call to boycott Makena in favor cheaper compounded preparations.

AARP has a piece on inaccuracies in translated drug labels, citing a study (I haven’t read yet) that “Fifty percent of all prescription labels translated from English to Spanish are wrong or incomplete.”

The FDA may start regulating mobile medical software/apps.

Women’s eNews has a bit on maternal deaths in New York City.

Ron Paul introduced the Sanctity of Life Act for 2011 (HR 1096), which would define human life and personhood “from the moment of conception.” I hardly need to get into the fetus>woman, miscarriage, detectability of non-implanted fertilized eggs, and gross misogyny issues, right?

Some things from libraryland:
We need to work together to save the Statistical Abstract of the United States.

And the Nashville Public Library is compiling a digital history of our May flood.

For emergency responders, WISER has been updated – it’s “a system designed to assist first responders in hazardous material incidents” from the National Library of Medicine.

Filed under: Abortion, Abuse, Rape, & Safety, Access, Rights, & Choice, Birth, Drugs, Ethics, Government, Libraryland, Miscellaneous, News Round-Ups, Pregnancy, Women’s Health

The Now@NEJM blog posted a new item in its Clinical Practice series, Streptococcal Pharyngitis. This seemed particularly relevant after a worker fixing a light on Friday – after about 20 minutes in my office – told me all about how his current case of strep throat. The NEJM piece doesn’t seem to address people like me, though – I have a penicillin allergy!

Acquaintance Ilissa has a diary up at Daily Kos on her first morning as an abortion clinic escort. I particularly liked one of the comments: “There is not room in one skin for two people with full rights.”

At the New York Times, Study of Breast Biopsies Finds Surgery Used Too Extensively. This would be the kind of harm people were talking about when they talked about what happens when we do too many mammograms on low-risk women.

Ema at the Well-Timed Period says it clearly with regards to the South Dakota bill that could have made it legal to murder abortion providers, and how any changes they make to the bill now don’t make up for it:

Bottom line: Just because Rep. Phil Jensen and his cohorts were caught in the act of trying to legalize domestic terrorism and, when called on it, made some changes to the bill doesn’t mean they are absolved of responsibility.

Relatedly, over at Our Bodies Our Blog today I have The State-Level War on Choice: Updates from South Dakota. Note: I’m no longer even considering the possibility that Republicans “didn’t mean it that way” when they propose egregious legislation.

Over at The Unnecesarean, emajaybee writes about a 1940s experiment at the larger workplace in which pregnant women were given radioactive iron as part of an experiment. As I mentioned there, I first learned of this a few years ago when helping some students look for materials for a project on these studies. Over the weekend, I went to use the Nashville Banner (local newspaper) archives at the Nashville Public Library and pulled a news item on the experiments, if anyone would like to see it.

In the midst of the House vote to defund Title X (which funds family planning health services, including those non-abortion services provided by Planned Parenthood), I’ve picked up on some comments on Twitter stating that Planned Parenthood is anti-trans. While I support Planned Parenthood’s provision of low cost health services and tireless support of choice, those are serious allegations that deserve attention. I’m in the process of trying to learn more, but haven’t found much online – I’ve run into comments like this one and this one, but would like to find out more about how much this involves individual screw-ups vs. organizational policy, and if PP staff are held accountable by their employers for anti-trans statements and practices. If anyone has insights into how/whether PP folks are trained to provide services to trans women and men, or how PP is failing trans women individually or systemically, I would like to hear about that. There need to be clear consequences for PP staff members who discriminate against *any* women.

That said, I do believe PP provides crucial access to abortion services and other family planning and health services for so many women, and defunding Title X further disadvantages poor women who rely on their services.

Relatedly, in my searching, I found this post: Promoting and Protecting the Sexual and Reproductive Rights and Health of Transgender People: What We Can Do, which outlines actions to be taken by the public, donor agencies, and states.

Not really health related, but some bills have been introduced in Tennessee that are similar to the union-busting bills in Wisconsin. The Tennessee Education Association is having a rally in Nashville on March 5th.

Filed under: Access, Rights, & Choice, Government, News Round-Ups, Pregnancy, Women’s Health

Three things this week that I think are important to focus on for advocates of reproductive rights and justice: HR3, HR358, and proposed cuts to Title X family planning funding and other women’s health services. I wrote about HR3 and HR358 at Our Bodies Our Blog this week. There, I note that I particularly appreciated the succinct explanations provided by Jennifer Steinhauer in the New York Times, excerpted below.

1) On HR3:

One bill, the “No Taxpayer Funding for Abortion Act,” would eliminate tax breaks for private employers who provide health coverage if their plans offer abortion services, and would forbid women who use a flexible spending plan to use pre-tax dollars for abortions. Those restrictions would go well beyond current law prohibiting the use of federal money for abortion services.

The Hyde Act already forbids taxpayer funding for abortion except for in limited circumstances (often rape or incest; this is the bill that had/has the “forcible” rape language). This law would make that permanent, and would perpetuate the injustices of Hyde, which specifically makes it harder for poor women and women of color to exercise this right.

As so clearly expressed alongside a recent report on the issue:

As long as these unjust provisions remain a part of our laws, the rights of women in this country will continue to be treated according to two different standards whether you can afford to pay for your rights or not. That is not equality.

Hyde currently has to be renewed on a regular basis. HR3 would make these inequalities permanent, in addition to potentially affecting issues such as whether employers who provide abortion coverage through their health insurance plans would be financially penalized through the loss of tax breaks.

Related Posts:
Meet the HR3 Ten – RHRC is calling attention to Democrats who cosponsored HR3
Kudos to Senators Gillibrand, Boxer, Franken, Murray, Lautenberg, Blumenthal speak out against HR3 (silver ribbon blog)
House Committees Press On with “Stupak on Steroids” Attacks on Women’s Health (Blog for Choice)
The “Stupak on Steroids” Agenda: A Multi-Pronged Attack (Blog for Choice)
Hr3/Smith Bill Toolkit for Action (National Latina Institute for Reproductive Health)

2) On HR 358:

Another bill, sponsored by Mr. Pitts, addresses the health care overhaul head-on by prohibiting Americans who receive insurance through state exchanges from purchasing abortion coverage, even with their own money. The bill is essentially a resurrection of a provision in the House version of the health care law but was not in the Senate version.

The bill would also permit hospitals to refuse abortions to women, even in emergency situations, if such care would offend the conscience of the health care providers.

The thinking about this bill is that it would effectively override EMTALA provisions that require emergency departments to treat patients regardless of ability to pay. Existing rules already protect the right of individual providers to choose not to perform abortions, but EMTALA requires that if the patient can’t be safely stabilized and transferred (in other words, if the patient might die if the procedure is not performed), an emergency department *must* provide that care.

Related Posts:
Waxman and Pallone Ask “Where’s the Constitutional Authority” on H.R. 358? (RHRC)
After ‘forcible rape,’ another abortion restriction (PostPartisan)
Anti-Choice Politicians Propose Eliminating Funding for Birth Control and Cancer Screenings (Blog for Choice)
PRCH Board Chair Submits Testimony on Pitts and Smith Bills (Physicians for Reproductive Choice and Health, on both bills)

3) A third item of concern is the Continuing Resolution from the House Appropriations Committee for funding throughout the fiscal year which proposes to completely eliminate the funding the President has requested for family planning services. The CR proposes a number of reductions, including the following decreases in women’s and reproductive health:

• WIC -$758M
• Community Health Centers -$1.3B
• Maternal and Child Health Block Grants -$210M
• Family Planning -$327M

That $327 million reduction proposed for family planning is the *entire requested family planning budget* from the President, who requested:

$327,356,000 shall be for the program under title X of the PHS Act to provide for voluntary family planning projects: Provided further, That amounts provided to said projects under such title shall not be expended for abortions, that all pregnancy counseling shall be nondirective…

This move is intended in part to achieve the Republican wet dream of “defunding Planned Parenthood.” So not only are they attempting to block women from accessing necessary and legal abortion procedures through HR 3 and HR 358, they are attempting to block women’s access to the kind of medical care and contraception that would help them prevent pregnancy and achieve healthy pregnancies. Awesome.

Related Posts:
House GOP Declares War on Planned Parenthood (Mother Jones)
GOP Spending Plan: X-ing Out Title X Family Planning Funds (Wall Street Journal blog)
Congress’s Latest Fiscal Strategy: Cutting Programs that Save Money and Protect Women’s Health (National Women’s Law Center)

Filed under: Abortion, Access, Rights, & Choice, Ethics, Government, Laws, Legislation, & Courts, News Round-Ups, Women’s Health

Dr. Kermit Gosnell was a Philadelphia abortion provider, and has been charged with several counts of murder after one patient died and several infants born alive were allegedly murdered. The grand jury documents [PDF] related to this case describe horrors encountered by patients who were ostensibly in the care of Dr. Gosnell. Let me be perfectly clear: it is an abomination when women cannot receive safe, legal abortion services. What happened at Kermit Gosnell’s “clinic” is unacceptable at any time, in any place.

I also believe that this horrific story is not a case study in why abortion should be further restricted.

The situations described in news reports are a violation of the women who trusted Dr. Gosnell and his staff to provide safe, good quality, abortion procedures. It will unfortunately give ammunition to those who attempt to pass regulations to further regulate abortion clinics. Some of the inevitable proposed rules may not be necessary, and may be intended primarily to make abortion providers go out of business rather than to actually make abortion safer for women, but they’re sure as hell going to be easier to sell to legislatures and the public by whispering “Gosnell.”

In that sense, actions and conditions such as those alleged about Dr. Gosnell’s clinic harm all women who seek safe, legal abortions (estimated as about 1/3 of us over our lifetimes), and all people who support the rights of women to make this personal choice in a safe environment with properly trained medical professionals. The harms inflicted on the women who received “care” at the clinic are of course worst of all.

There have been a number of pro-choice posts written on how this situation highlights the need for access to safe, legal abortion, and I will list some of those at the bottom of the post for further reading. I want to highlight two things:

1) I believe the atrocious conditions at Kermit Gosnell’s clinic would not have been allowed to continue if more privileged women had been affected by them.
The grand jury document describes more appalling conditions than can be easily imagined: dirty and damaged equipment, failure to dispose of medical waste and fetal remains, fraud in which untrained personnel acted as “doctors,” appalling misuse of anesthesia, neglect of patients, poor performance of the procedures, failure to appropriately respond to complications, allowing cats to roam the clinic and defecate freely throughout it, and possible infant murder.

Each of these things is appalling on its own, as is the failure of public health authorities to follow up on complaints about the clinic.

Adding insult and injustice to (literal) injury, the grand jury documents describe explicit differences in the treatment of women depending on their race, with women of color singled out for worse treatment. The following passage describes testimony about Gosnell’s allowing untrained personnel to administer anesthesia without supervision or talking to the patient:

Like if a girl – the black population was – African population was big here. So he didn’t mind you medicating your African American girls, your Indian girl, but if you had a white girl from the suburbs, oh, you better not medicate her. You better wait until he go in and talk to her first.

The same individual who made these statements “also testified that white patients often did not have to wait in the same dirty rooms as black and Asian clients. Instead, Gosnell would escort them up the back steps to the only clean office – Dr. O’Neill’s – and he would turn on the TV for them.”

That is not okay. It is never okay. This explicit singling out of women of color for poorer treatment is an abomination. Many of the women were receiving late term abortions which could perhaps have been unnecessary if the women had economic access to a quality clinic earlier in their pregnancies when most abortions take place. Some of them may have had concerns about their immigration status, the stigma of abortion, limited knowledge of the healthcare and legal systems, or other issues which may have legitimately prevented them from reporting their treatment. Kermit Gosnell likely knew that these women had few alternatives, and – I can only imagine – therefore assumed that these disenfranchised women did not have access to the kind of privilege and resources it takes to go elsewhere or to raise a fuss about how they were treated at his clinic.

Some women *did* make complaints, though, as did a physician who performed follow-up care for some of Gosnell’s patients and noticed that several of them were coming in infected with “trichomoniasis, a sexually transmitted parasite, that they did not have before the abortions.” Even after complaints such as these, no inspection was performed and nobody at the state level bothered to intervene.

I believe that if such abuses were going on in an abortion clinic frequented primarily by privileged white or higher income women, the state would not have neglected to perform inspections or intervene for so long. The grand jury report expressed a similar sentiment:

Bureaucratic inertia is not exactly news. We understand that. But we think this was something more. We think the reason no one acted is because the women in question were poor and of color, because the victims were infants without identities, and because the subject was the political football of abortion.

The case highlights an injustice that deserves much more attention, especially as we anticipate political maneuvers to roll back both health coverage and abortion access. While Gosnell’s actions are deplorable, attention must be paid to systemic inequalities and racism that allow and perpetuate such abuses. As an author at the grio writes:

We can’t allow the sensationalistic images from Gosnell’s case to distract us from the underlying issues that might otherwise be highlighted by this case; namely, the realities of women’s and children’s health care in poor, urban, and minority-populated areas of the United States, and basic things we can do as a community to improve these realities…That we live in an environment in which such an obviously shady practice could thrive for so long is simply unacceptable.

2) As I read through the descriptions, I can’t help thinking: this is what an underground, illegal abortion clinic looks like.

I am fortunate enough to have been born in the post-Roe era in which abortions, while not always accessible, are legal. I’ve never personally experienced the fear and danger of the so-called “back alley” abortion provider, and have only heard stories of the fear and tragedy of those times. Reading the Grand Jury report on Kermit Gosnell’s clinic reminds me of everything I’ve ever heard or read about pre-Roe America, when women with few options were forced to choose substandard abortion providers and were expected to silently suffer the consequences of their maltreatment.

From the grand jury report:

One woman, for example, was left lying in place for hours after Gosnell tore her cervix and colon while trying, unsuccessfully, to extract the fetus. Relatives who came to pick her up were refused entry into the building; they had to threaten to call the police. They eventually found her inside, bleeding and incoherent, and transported her to the hospital, where doctors had to remove almost half a foot of her intestines. On another occasion, Gosnell simply sent a patient home, after keeping her mother waiting for hours, without telling either of them that she still had fetal parts inside her. Gosnell insisted she was fine, even after signs of serious infection set in over the next several days. By the time her mother got her to the emergency room, she was unconscious and near death.
A nineteen-year-old girl was held for several hours after Gosnell punctured her
uterus. As a result of the delay, she fell into shock from blood loss, and had to undergo a hysterectomy.

These stories, of neglect, infection, poorly performed procedures and lack of follow up. They’re appalling, and they sound just like what I’ve always heard from older women about the pre-Roe era. While we celebrate the anniversary of Roe tomorrow, we must remember that Roe didn’t make abortion safe and accessible for everyone, even in America.

Women – all women, all the time, every where – deserve better.

Further reading, will be updated as I find things to pass along:

• Victims say abortion doctor scarred them for life
• Doctor Who Performed Illegal Abortions Indicted for Murder – Amie Newman at RHRC
• Why the Pa. Abortion Doc’s Case Is About Poverty, Not Roe v. Wade – Belinda Luscombe at Time Healthland
• Roundup: Everyone Deserves Safe Medical Care – Rachel Larris at RHRC
• What Makes Abortion Dangerous – Pema Levy at the American Prospect blog, Tapped

Filed under: Abortion, Abuse, Rape, & Safety, Access, Rights, & Choice, Women’s Health

Some of my recent posts at Our Bodies Our Blog are highlighted below. Don’t forget the upcoming 40th anniversary of the landmark book; a new edition will come out next year to celebrate the milestone! In the meantime, catch up with health news and commentary over at http://www.ourbodiesourblog.org

Election-Related Repro Rights Round-Up – a collection of commentary from reproductive rights advocates on what the recent election may mean for women.

NPR Takes on Pink Ribbon Fatigue: Views from Komen, Breast Cancer Action – NPR talked to a representative of Breast Cancer Action, which has criticized pink ribbon campaigns for breast cancer, and a representative of Komen, which kind of thrives on them.

Meeting Dispatch: Resources from the CUE/Cochrane/Campbell Colloquium – Includes links to plenary session videos from speakers including Susan Love and former Rep. Patricia Schroeder, as well as online resources for health information.

Letters Respond to Lancet Home Birth Editorial With Feminist Perspective – snippets from letters responding to an editorial that proclaimed that “Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.” Oh hell yeah we do. Ahem.

And also, from our fearless leader Judy Norsigian: Share Your Story: What Have You Learned About Your Body from a Women’s Health Nurse-Practitioner Or Other OB-GYN Clinician? – a call for clinicians to share their stories of educating women about their bodies, and for women who have benefited from clinicians who really take the time to explain what’s going on with their bodies to tell those stories as well. See the post for further details.

Filed under: Access, Rights, & Choice, Boobs, Cancer, Events & Observances, Government, Miscellaneous, Web Resources, Women’s Health

[cross-posted from Our Bodies Our Blog]

At the recent Consumers United for Evidence-based Healthcare Advocacy Summit and joint colloquium of the Cochrane and Campbell Collaborations (#ccckeystone), I met many interesting people with fond memories of their first experiences with the “Our Bodies, Ourselves” book. I loved hearing these stories, about how a small group of friends used the book to perform self-exams, how it motivated women to advocate for themselves or become active in women’s health and rights, and the many other ways in which the landmark book has inspired so many people.

Believe it or not, 2011 is the 40th anniversary of the first edition of the book. As part of the celebration, OBOS is releasing a new edition of the book and hosting a symposium that will bring together women who are culturally adapting and transforming “Our Bodies, Ourselves” into different formats for use in their own countries.

We’ll be writing more about these events over the course of the next year, but for now, we invite you to share your own stories. If you have an OBOS story – however brief, or however “small” it may seem to you – please share it with us. We love to hear them, and plan to use the stories in conjunction with our 40th anniversary celebration and book release next year.

For more information on the upcoming anniversary and book, including how to support the new edition, check out our anniversary page. Also check out our history section for lots of cool and interesting information about how the book came to be and the impact it has had over the years.

Filed under: Events & Observances, Miscellaneous, Women’s Health

There has been a lot of recent discussion about empowered patients, e-patients, and participatory medicine – all shorthand for patients being actively involved in their own medical care and decision-making rather than simply accepting the authority of medical providers who issue recommendations and orders that patients then follow.

The recent stories of two of my close relatives perfectly illustrate the problem of provider-patient relationships in which the patient is expected to simply accept the advice they’re given, and the hazards of doing so.

First, a menopausal female who went to a doctor for a pelvic exam. She checked “frequent urination” on the intake form, and her provider – without asking any questions or exploring the patient’s feelings about how much of an issue this was – said, approximately, “Oh, you have overactive bladder, I’ll write you a prescription for that.”

A 2009 systematic review on treatment of overactive bladder in women concluded that a woman might save 1-2 trips to the bathroom per day with drug treatment of OAB, and that “treatment effects are modest.” In other words, women typically don’t get major relief from OAB drugs (maybe one bathroom trip saved over placebo), while they contend with both the drug prices and any unpleasant side effects. This leaves aside the fact that the doctor suggested this without even asking the patient about the extent of symptoms or affect on quality of life.

The same patient is menopausal; the doctor said he would prescribe estrogen for heart protection, which the patient refused. The doctor never mentioned the findings of the Women’s Health Initiative estrogen-alone study:

The study was stopped ahead of schedule in February 2004 by the National Institutes of Health because of increased stroke risk. During 7.1 years of follow up, estrogen provided no overall protection against heart attack or coronary death in generally healthy postmenopausal women most of whom were more than 10 years past menopause when they entered the study. In women 50-59 years of age at study entry, there was a suggestion of lower rates of heart attacks or procedures to re-open clogged arteries; these findings could be due to chance. There was no suggestion of benefit in women who were 60 years or older.

The patient is in that 50-59 age range where the evidence is kind of iffy, but these issues and the weighing of potential risks and benefits were not raised at all by the physician. The patient told him in no uncertain terms that she was managing her symptoms without drugs, was concerned about her family history of stroke and blood clots, and therefore would not take an estrogen. What did she find when she next went to the pharmacy? The doctor had called in the prescription anyway, despite her refusals.

The second patient went to a doctor who attributed a persistent sore throat to TMJ and tonsil debris, and recommended an allergy test that insurance wouldn’t pay for. This diagnosis didn’t “feel” right to the patient, who thankfully sought a second opinion. That second physician was attentive and thorough enough to diagnose the throat cancer.

Thankfully, the patient didn’t simply accept the word of the first doctor (who wasn’t felt to be very thorough or interested in the problem), or let the considerable barriers get in the way of getting a second opinion from a doctor who seemed to be paying attention. Not everyone has the resources to overcome those barriers.

Of course, second opinions have long been recommended for patients experiencing difficult or complicated conditions. Seeking those second opinions, however, requires initiative, financial and logistical means, and an important first step – the willingness to believe that an expert might be wrong, and to seek additional expertise. In both of the examples above, the patient felt that the doctor was not attentive, thorough, or particularly engaged in the matter at hand. Neither physician suggested to either patient that a second opinion might be warranted. Neither addressed the other possibilities for diagnosis or treatment. Each simply proclaimed the nature of the problem, and expected the patient to go along. Problem solved.

Many people would have simply accepted the prescriptions, or the diagnoses, and done what the doctor ordered. This may be particularly true in rural small towns like the one where these two incidents occurred, where doctors are part of the town’s high society, many people may be uncomfortable questioning a physician’s authority, and education about medical evidence is sparse among the patients. While there are many up-to-date, empathetic, thorough providers out there, those that these two patients encountered were not. Yes, all providers are human, and therefore they make mistakes – however hard to accept that is when one mistakes cancer for TMJ. Hearing these two stories so close together, however, provided a great example of why questioning authority and becoming an active partner in one’s medical care is absolutely necessary to receive evidence-based, high-quality healthcare. It might even save your life.

Filed under: Cancer, Health, Heart Health, Miscellaneous, Women’s Health