Wednesday, February 28, 2007

FDA Response to Budget Cuts for Office of Women's Health

I received the following response from an FDA representative regarding questions about possible budget freezes within the FDA's Office of Women's Health (message from FDA spokeswoman Julie Zawisza, published with permission):

Rachel,

Thanks for your message. I think there may have been some misunderstanding of how FDA proceeds during the 2OO7 Continuing Resolution process by which FDA develops a spending plan that is approved by Congress. We do not have final budget numbers yet for any of our operating components so it is premature to discuss what the final budget may look like.

Recent press reports discussed preliminary results of an internal numbers exercise, leading to inaccurate and premature reporting. We are still finalizing the 2007 spending plan and intend to apply the same approach to the Office of Women's Health as to other components of the Office of the Commissioner, specifically that the 2007 plan is intended to allow our operating components to spend at least at their 2006 level. This will continue to support our strong commitment to the Office of Women's Health and its role.


I have not yet identified the 2006 spending level figures.

The Washington Post reported in its piece, Women's Health Office Funds Cut, that "The administration had requested -- and Congress had budgeted -- $4 million for the office in fiscal 2007, just as they have for several years running. Last week, however, word came down that the FDA intends to withhold $1.2 million of that, apparently for use elsewhere in the agency. Because the remaining $2.8 million has already been spent or allocated for salaries and started projects, the office must effectively halt further operations for the rest of the year, according to a high-level agency official with knowledge of the budget plan, who spoke on the condition of anonymity because the official is not authorized to speak publicly." The story also mentions concerns that any budget cuts might be retribution for the OWH's support of science-based decision-making on over-the-counter status for Plan B emergency contraception.

The Kaiser Network has an update

Tuesday, February 27, 2007

HPV Vaccine Discussion on the NewsHour

The NewsHour on PBS aired a segment tonight, "New Study Stirs Debate over Mandatory Cervical Cancer Vaccination." The NewsHour health correspondent, Susan Dentzer addresses a new study of HPV infection rates, the HPV vaccine, and debate over making the vaccine mandatory. A transcript is available, as are audio versions via RealAudio and mp3 download.

The study mentioned above, released today in the Journal of the American Medical Association, reports that 1/3 of American women are infected with HPV by the age of 24, according to this article in the Washington Post. JAMA is providing the full-text of the article, "Prevalence of HPV Infection Among Females in the United States," for free on its website. According to the report, prevalence of HPV infection among women ages 14-19 was 24.5%. Interestingly, the two most frequently detected types of HPV were not those the Gardasil vaccine protects against, but were considered low-risk forms of the virus. There were no statistically significant differences in rates of each type of HPV found except for the greater frequency of those two low-risk forms. According to the study, "Overall, HPV types 6, 11, 16, or 18 were detected in 3.4% of the study participants, corresponding with 3.1 million females with prevalent infection with HPV types included in the quadrivalent HPV vaccine. Few participants (0.10%) had both HPV types 16 and 18 and none had all 4 HPV vaccine types. At least 1 of these 4 HPV types was detected in 6.2% (95% CI, 3.8%-10.3%) of females aged 14 to 19 years."

Sunday, February 25, 2007

More Emergency Contraception Research

The current issue of the journal Contraception has two articles on emergency contraception availability and awareness, and the journal Women's Health Issues has an article on California women's knowledge of emergency contraception.

1) Schwarz EB, Reeves MF, Gerbert B, Gonzales R. Knowledge of and perceived access to emergency contraception at two urgent care clinics in California. Contraception. 2007 Mar;75(3):209-13.

For this study, the researchers recruited adult (18-45) English-speaking women from two urgent care clinics in San Francisco from Mar-Jul 2005. They excluded women who were currently pregnant, had had a hysterectomy or tubal ligation, had an IUD in place or a partner who had had a vasectomy, were over 45, or who planned to relocate or did not have a telephone. Women completed a computerized survey while they waited for their appointments. The 10-question survey asked about their knowledge of emergency contraception (EC), which was made available without a prescription in California in 2002. 446 women completed surveys that were analyzed. Younger women (<30) and women who had had a prior abortion were more likely to know that EC is currently available in California. Overall, women scored poorly, averaging only 4 correct answers out of 10.

  • Only 39% knew that emergency contraception is effective in the 3-5 days after intercourse.
  • Only 27% knew that EC is very or extremely safe, and only 39% knew it is very or extremely effective at preventing pregnancy.
  • 50% knew that EC poses no risk to future fertility, but only 19% knew it does not cause birth defects or miscarriage.
  • 84% knew that EC offers no protection from sexually transmitted infections.
  • Only 19% reported a personal or religious objection ot abortion, and only 7% reported a personal or religious objection to EC.

    Despite the low levels of knowledge of EC found by this survey, the authors note that their design may have actually overestimated knowledge of EC, as it excluded women who did not speak English, 47% of participants had college degrees, and women with less knowledge of EV may have elected not to complete the survey more frequently than those with some knowledge.

    ****************************

    2) Shacter HE, Gee RE, Long JA. Variation in availability of emergency contraception in pharmacies. Contraception. 2007 Mar;75(3):214-7.

    The researchers conducted telelphone surveys of EC availability in Boston, MA, Philadelphia, PA, and Atlanta, GA. At the time of the study, state policy required MA pharmacists to fill all valid prescriptions, GA law allws pharmacists to legally refuse to fill the prescriptions, and PA had no policy regarding pharmacist refusals. A prescription was required for emergency contraception in all three states at the time the calls were made. 1085 pharmacies were included in the analysis: 268 in Boston; 427 in Philadelphia; 390 in Atlanta.

  • 23% of pharmacies could not dispense EC within 24 hours, including 4% in Boston, 23% in Philadelphia, and 35% in Atlanta. 18% of these reporting being willing to but unable to dispense within 24 hours due to not carrying the drug.
  • Atlanta had the highest rate of refusal to dispense, at 9% (34) of pharmacies.
  • Large chains (20 or more stores in the city) were least likely to be unable to dispense EC within 24 hours (27%), followed by small chains (4 or fewer stores in the city, 32%), and medium chains (5-20 stores in the city, 46%).
  • No refusals occurred in Boston, where pharmacists are required to fill valid prescriptions.

    ****************************

    3) Foster DG, Ralph LJ, Arons A, Brindis CD, Harper CC. Trends in knowledge of emergency contraception among women in California, 1999–2004. Womens Health Issues. 2007 Jan-Feb;17(1):22-8.

    The authors took 6 years of data from the California Women's Health Survey, an annual telephone survey of ~4,000 rnadomly selected adult women in California. Two questions about emergency contraception were added to the survey in 1999 and were asked of women who had ever had sexual intercourse but had not had a hysterectomy.

  • In 1999, 48% of women knew there was something they could do in the 3 days after unprotected intercourse to prevent pregnancy; by 2004, 65% of women knew this.
  • Women who answered "yes" to the first question (about whether something could be done to prevent pregnancy in the 3 days after intercourse) were asked what could be done. 3% in 1999 and 4% in 2004 explicitly named emergency contraception in response. 66% in 1999 and 65% in 2004 referred to the "morning after pill" (indicating that they were aware of EC) or some other correct response such as having an IUD inserted or taking a modified dose of birth control pills.
  • Incorrect responses included RU-486, abortion, douche, injection, and herbal remedies.
  • Younger women (<25) and college-educated women were more likely to know about EC in both 1999 and 2004.
  • Racial/ethnic disparities were found, with Hispanic and South/Southeast Asian women having the lease knowledge of EC, and significant differences in EC knowledge between native and foreign-born Hispanic women.
  • Foreign-born Hispanic women, women with incomes below the poverty level, and women who did not complete high school had the lowest levels of EC knowledge in 2004.
  • Sunday News Roundup - 2/25/07

    Saturday, February 24, 2007

    Online Gallery of AIDS Posters

    The UCLA Lousie M. Darling Biomedical Library History and Special Collections Division has launched its AIDS Posters collection online, which consists of images of and information about posters that were issued by a variety of institutions in numerous countries (including the United States) to educate people about HIV/AIDS. Users may search this digital library by keyword, perform an advanced search for keyword, title, description, creator, country, and/or subject, or browse by country, subject, creator, or title. Users may also register with the site in order to create a virtual collection of saved poster images for later reference. Each image is accompanied by a record with details on the above-listed search fields, as well as the current location of the poster, dimensions, date, subjects, notes, and inscription. Copyright status is also provided to inform how a poster image may be used. The only addition I'd like to see is an option to search/browse by year and decade, which might be useful for examining how this type of material has changed over time.

    (found via Our Bodies, Our Blog)

    Tennessee Pregnant Women Support Act

    Warning: lengthy post follows.

    A bill has been introduced in Tennessee entitled the "Pregnant Women Support Act" [SB2161, HB2146] The bill is essentially a state version of the Pregnant Women Support Act introduced in the federal legislature last year and currently winding its way through committees and such. The national bill was introduced by another Tennessean, Representative Lincoln Davis. The national bill began as an effort to reduce abortion, and the state bill will likely be touted in the same terms.

    As Sean Brainsted points out, it's difficult for advocates of reproductive rights to find much in this bill to be strictly against, and it's certainly a more reasonable approach to abortion than Stacey Campfield's monstrosity. However, criticism of the bill is likely to address what it does not include. As has been pointed out with regards to the national bill (posts 1 and 2), this bill does nothing to actually reduce unwanted pregnancy in the first place. Some of the language provides for informing women about how to prevent future pregnancies, which is great, but a bill attempting to reduce abortions might at least pay lip service to well-woman care (when reproductive health education can occur), comprehensive sex education, and access to contraceptives.

    The bill in full:
    AN ACT to amend Tennessee Code Annotated, Title 49; Title 56; Title 63; Title 68 and Title 71, and to enact the “Tennessee Pregnant Women Support Act”.
    BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
    SECTION 1. Tennessee Code Annotated, Title 68, is amended by inserting Sections 2 through 6 below as a new chapter thereto to be designated as Chapter 59.

    SECTION 2. This act shall be known and may be cited as, the “Tennessee Pregnant Women Support Act”.

    SECTION 3. The department of health is authorized to and shall apply for any available federal grant providing for the collection of data regarding the number of abortions performed in this state, the characteristics of those seeking abortions, the reasons why women choose abortion, or any other information applicable to supporting pregnant women in this state who may be seeking an abortion.

    While the number of abortions performed in the state is already collected by the Department of Health, this portion encourages the Department to seek funds to research why women have abortions. It seems reasonable to collect this type of data in order to plan any future prevention programs. This section specifically corresponds to the section of the national bill that would have the Institute of Medicine conduct a study on why women have abortions, to release a report by 1/2010.

    SECTION 4. The department of health shall develop a comprehensive informational pamphlet for distribution upon request to Tennessee licensed physicians. Every licensed physician in this state shall provide such pamphlet to any woman to whom the physician provides an abortion or provides information concerning a possible abortion. The pamphlet shall contain: a list of public and private health care services available to women during pregnancy and after the birth of a child, whether the women wish to keep their children or place them for adoption; public and private adoption resources available in the state, including but not limited to the surrender of an infant without criminal liability pursuant to § 68-11-255; and public and private services available, pursuant to Title X of the federal Public Health Service Act, to assist women in preventing future pregnancies. The pamphlet shall contain the name, address and telephone number of public and private organizations, health care facilities, or other persons providing these services; provided, that the commissioner of health may promulgate such rules in the commissioner’s discretion as are necessary for any public or private organization, health care facility, or other person to qualify for inclusion in the pamphlet. The department shall make the pamphlet available to physicians by no later than January 1, 2008.

    This is a slightly problematic section. I am supportive of women having all possible information on all of their possible options in times of crisis, such as an unplanned pregnancy. The section provides for informational pamphlets on non-abortion-related services to women who ask their healthcare providers about abortion. It might be more appropriate if the pamphlets contained information on all related services and options, including abortion. It might be argued that the pamphlet simply provides an alternative to the information the physician is providing, but physicians frequently provide patients with pamphlets on conditions they have just discussed in the office. If all information were presented, the pamphlet would simply be an information resource for the woman as she weighs her options. As-is, it is specifically positioned to counter the option of abortion, and becomes a persuasive tool rather than a strictly informational one.

    Additionally, the Department would provide pamphlets on request, rather than automatically distributing them to the licensed physicians and nurses who are registered with the State. However, the section also requires provision of a pamphlet to any woman asking about a possible abortion. Therefore, if time a woman visited her family physician and received an unexpected pregnancy result, that physician would technically need to have the pamphlets on hand in order to legally have a conversation with the patient about abortion. I hope that logistical concerns such as these will not, in real practice, get between a woman and her physician talking about her health.


    SECTION 5. The department of health shall develop a toll-free telephone hotline for pregnant women or other interested parties to obtain information about: public and private health care services available to women during pregnancy and after the birth of a child, whether the women wish to keep their children or place them for adoption; public and private adoption
    resources available in the state, including but not limited to the surrender of an infant without criminal liability pursuant to § 68-11-255; and public and private services available, pursuant to Title X of the federal Public Health Service Act, to assist women in preventing future pregnancies. The department shall operate the toll-free telephone hotline no fewer than eight (8) hours per day for no fewer than five (5) days per week, during normal business hours, and shall publicize the hotline through the use of media which may include radio, television, newspaper, billboard or other advertisements. The commissioner of health may promulgate such rules, in the commissioner’s discretion, as are necessary for any public or private organization, health care facility, or other person to qualify for inclusion in the information distributed pursuant to the hotline. The department shall make the hotline available by no later than January 1, 2008.

    I'm a librarian, I'm all for the dissemination of information, so a hotline suits me just fine. Numerous voluntary health organizations run hotlines to provide information for consumers on their health information needs. I'd like to see a website with directory accompany the hotline - even if it couldn't be accessed by all w omen, it would be accessible to healthcare providers, librarians, and others who may serve in a role that exposes them to health and community service information requests.

    SECTION 6.
    (a) There is hereby created in the general fund an account to be known as the "Tennessee pregnant women support fund", hereinafter known as "the fund", as a special nonreverting fund. Funds appropriated from the Tennessee pregnant women support fund shall be administered by the department of health to support women and families who are facing unplanned pregnancy.
    (b) The department is authorized to solicit gifts, donations, bequests and grants on behalf of the fund from any source and to deposit all moneys received in the fund. The commissioner shall submit to the governor an annual report of all gifts, donations, grants and bequests accepted; the names of the donors; and the respective amounts contributed by each donor.
    (c) All moneys received from any source pursuant to subsection (b) shall be credited to the fund. Interest earned on moneys in the fund shall remain in the fund and be credited to it. Any moneys remaining in the fund, including interest thereon, at the end of each fiscal year shall not revert to the general fund but shall remain in the fund. Moneys in the fund shall be used solely for the purposes of carrying out the activities enumerated below:

    The question I still have after reading this section is how much money will be allocated to the program from the State budget, and where that money will come from. I don't see anything in this proposal that says, "The State will provide X dollars to establish the fund and support the activities required by this legislation." It does allow the Department of Health to solicit grants and donations to support the programs, but doesn't seem to provide for how to administer the law if there is not enough grant/gift money to carry out the directives.

    (1) Purchasing or upgrading ultrasound equipment for the benefit of any public health program or private health provider in this state;

    The emphasis on ultrasound equipment is interesting. Healthcare providers who see pregnant women (and women of reproductive age in general) need equipment other than ultrasound machines on a daily basis. Ultrasound equipment is expensive, and if this section benefits legitimate, unbiased clinics who provide services to women, that is a good thing. However, ultrasound machines are also a point of controversy in the reproductive rights movement, as so-called "crisis pregnancy centers" like to add ultrasound services, believing that they can help coerce women into rejecting abortion as an option. See my previous post on "Option Ultrasound," just such an initiative by anti-choice Focus on the Family. Not every woman will want to have an abortion, but to try to convince women to "choose life" based on emotional manipulation is unseemly. The warm-and-fuzzy a woman gets from viewing an ultrasound is in no way going to make the emotional, physical, and financial resources needed for childbearing magically appear. This provision corresponds to a section in the national bill that would allow grants to be made for the purchase of ultrasound equipment.

    (2) Creating a separate program within the department to address domestic violence, dating violence, sexual assault and stalking screening against pregnant women and new mothers;

    This is important and worthwhile if well-executed, because the statistics on women abused during pregnancy are staggering. Part 2 corresponds to the national bill section providing for states to "obtain funding for a separate program for domsetic violence, dating violence, sexual assault, and stalking screening and treatments for pregnant women and new mothers. This would include training health professionals to identify and respond to patients experiencing abuse, and ensuring that services are provided in a "linguistically and culturally relevant manner." $4,000,000 would be authorized for appropriation for each of the fiscal years 2007-2011."" Note that the national bill does something the State bill does not, which is to specifically address the training of providers, a monetary value, and linguistic and cultural appropriateness.

    (3) Conducting the campaign outlined in this chapter to increase public awareness of public and private resources available to pregnant women in this state;

    Again, regarding Part 3, information is a good thing. This is directly taken from the national bill.

    (4) Providing support services for students of institutions of higher education in this state who are pregnant;

    (5) Providing funds to allow early childhood education programs to work with pregnant or parenting teens to complete high school and provide job training education; or

    Part 4 also corresponds with measures in the national bill, which included disbursement of grants (not to exceed $25K) to public higher education institutions to assist pregnant students who intent to carry their pregnancies to term through on-campus facilities. More specific information is needed in the state bill to address what type of support will be offered and how it will be funded. Part 5 also replicates the national bill. Supporting women's pursuit of primary and higher education is a good goal, as it wasn't so long ago that pregnant women were automatically expelled from schools.

    (6) Providing education on the health needs of infants to teenage or first time mothers through free home visits by registered nurses.

    Part 6 is a laudable objective, and there are already agencies in Tennessee providing this kind of service, who I hope would benefit from funding under this section. This provision appears in the national bill, although the national bill also provided for breastfeeding education through WIC.

    (d) The department shall establish an application process and related procedures for community health centers, migrant health centers, homeless health centers, public-housing centers, or any other public or private entity seeking grants from the fund. A grant may be made only if an application for the grant is submitted to the department in such manner as specified by the department pursuant to rule.

    This is just administrative, so just needs to be done well. The process needs to be done in a way that is not so burdensome to the already stretched resources of public agencies and healthcare providers that it becomes a barrier to funding and implementing services.

    SECTION 7. Tennessee Code Annotated, Title 56, Chapter 7, Part 23, is amended by adding the following language as a new, appropriately designated section:
    (a) Notwithstanding any other provision of law to the contrary, any individual, franchise, blanket, or group health insurance policy, medical service plan contract, hospital service corporation contract, hospital and medical service corporation contract,
    fraternal benefit society, health maintenance organization, preferred provider organization, or managed care organization which provides hospital, surgical, or medical expense insurance shall not deny coverage under any such policy, contract, or plan for obstetrical services to a pregnant woman insured on the basis that the pregnancy was a pre-existing condition if such plan otherwise provides coverage for obstetrical services for insureds who become pregnant after enrollment in such policy, contract or plan.
    (b) The provisions of this section are applicable to all health benefit policies, programs, or contracts which are offered by commercial insurance companies, nonprofit insurance companies, health maintenance organizations, preferred provider organizations, and managed care organizations, and which are entered into, delivered, issued for delivery, amended, or renewed after January 1, 2008.
    (c) Reimbursement for obstetrical services for insureds who are pregnant at the time of their enrollment shall be determined according to the same formula by which charges are developed for obstetrical services for other insureds. Such coverage shall have durational limits, dollar limits, deductibles, copayments, and coinsurance factors that are no less favorable than for other types of obstetrical services generally.
    (d) Nothing in this section shall be construed to prohibit any insurer from providing medical benefits greater than or more favorable to the insured than the benefits established pursuant to this section.
    (e) The provisions of this section shall not apply to short term travel policies, short term nonrenewable policies of not more than six (6) months’ duration, accident only policies, limited or specific disease policies, contracts designed for issuance to
    persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under state or governmental plans, including the TennCare and Medicaid programs.

    I'm not seeing a corresponding portion in the national legislation, but I seem to recall another federal bill that addressed this topic (I'm unsure of the status). It would essentially prevent insurors from denying care to pregnant women, which is a good thing.

    SECTION 8. Tennessee Code Annotated, Title 68, Chapter 5, Part 5, is amended by inserting the following as a new, appropriately designated section thereto: Any person who offers or provides to a pregnant woman a testing or screening service to detect genetic disorders in that woman’s fetus shall inform the woman in a medically and statistically accurate manner of the likelihood that a positive result of such test or screen might be a false positive. For a person who is a licensed physician or osteopathic physician in this state, a violation of this section may be considered a violation of the practice act governing that person pursuant to title 63, chapter 6 or title 63, chapter 9, respectively. In addition, a violation of this section may be considered a violation of the licensure requirements governing any facility licensed by the department pursuant to this title where the testing or screening service was provided.

    This is similar to but more limited than the national bill, which would also provide for peer-support programs, a phone hotline and website for patients, a registry of families willing to adopt newborns with genetic disorders, a clearinghouse of information on these conditions, and education programs for healthcare providers. Information on the false positive rates of these tests, as is information on false negatives, which should seemingly also be included.

    SECTION 9. Tennessee Code Annotated, Section 68-11-255, is amended by deleting subsection (a)(1) thereof and by substituting instead the following: (1) “Facility” means any hospital as defined by § 68-11-201, birthing center as defined by § 68-11-201, community health clinic, outpatient “walk-in” clinic, local department of health clinic, local office of the department of human services, or local fire department or police station.

    SECTION 10. The commissioner of health is authorized to promulgate rules and regulations to effectuate the purposes of this act. All such rules and regulations shall be promulgated in accordance with the provisions of Tennessee Code Annotated, Title 4, Chapter 5.

    SECTION 11. This act shall take effect July 1, 2007, the public welfare requiring it.

    As stated in my previous post on the national legislation, I do think this bill does some very worthwhile things, and at least partially addresses the old argument that if you want to reduce abortions, you have to make it easier for women to have children and support them after birth. On the other hand, the folks involved with tthe national bill have proposed it as a means to reduce abortion, and I don't see a single thing in it about comprehensive sex education (big surprise) or contraceptives. There is nothing in here that addresses preventing pregnancy in the first place, except when a woman has already experienced an unplanned pregnancy. Also, I think it's good if more women are referred to appropriate community agencies, but I don't see a specific increase in funding for existing providers. If they suddenly become swamped with women, will they be able to afford it, and will women receive good service? I also don't see much that truly makes it easier for women to afford to have a baby, because there isn't a lot of substantial funding increase for prenatal care, the actual birth, or all the expenses that come with children (especially after the first year covered by the home visits, which are educational rather than medical). Finally, this legislation could be read as an attempt to push women into carrying a pregnancy to term and giving up the child for adoption, while it does not in any way address the psychological consequences or provide post-surrender counseling for these women. It will be interesting to see how this plays out.

    NARAL Urges Action on Campfield Bill

    Stacey Campfield's proposed legislation to issue death certificates for abortion has come to the attention of NARAL Pro-Choice America, which has an online form set up for Tennessans to send a letter to their Representative and State Senator. The text of the letter is as follows, although you can personalize it as desired:
    As your constituent, I'm writing to ask you to oppose HB 982, which would require a death certificate be filed for every abortion in Tennessee.

    Women who live in Tennessee already face an uphill battle when it comes to their reproductive rights. Anti-choice legislators in recent years have passed biased counseling and mandatory delay requirements, mandatory parental consent rules, targeted regulations against abortion providers, and an unconstitutional ban on abortion as early as 12 weeks in pregnancy.

    This bill is not only unnecessary, it is an assault on women's dignity and privacy. Tennessee's Office of Vital Records already keeps track of the number of abortions in the state, but these records keep the women's identities private.

    If passed, death certificates would include personal and identifying information - including full name and mailing address - that would become public record.

    Women in Tennessee deserve their constitutionally protected right to privacy when they make their personal reproductive decisions. Please help defeat this dangerous bill by voting "no" on HB 982.


    Visit the action center and send your letter.

    Campfield, who previously released a set of irrelevant questions in an attempt to deflect criticism of the bill, but claims he doesn't have time to respond to all of the questions he's being asked, has time to leave at least 10 comments like this on another right-wing Tennessee blog. He's harrassing a local reporter to get the facts (if they exist) related to a different, non-legislative story:

    Well WKRN it sounds like you have been called out. It is put up or shut up time. Terry has said she will release to MSM (I would say you qualify) But I would think the exchange would be a story on the TV news possibly with credit given where it is due. It has been said a good reporter will dig for the story. I don’t think for this story much digging will be needed. Will you still present the facts on the news if it hurts your agenda or will you cop out?

    Will you step up or will we get more snarky comments? I would say it is news worthy if it is true. Are you scared she might be right and have the facts? Why not make the deal and see. In poker if you think the other person is bluffing you put you money on the table and call. People turn over the cards and one person is right. I don’t see the money…..

    Make up your mind. Stick with one dodge. You will look less foolish


    Given that Campfield is either lying about what his bill would do or simply doesn't understand the implications, and has repeatedly ignored attempts to present factual arguments and ask legitimate questions about the bill, his comments would be laughably ironic if they didn't demonstrate that Campfield is only interested in the free flow of information when it suits his agenda.

    Friday, February 23, 2007

    In the Hopper

    There are a few posts in the works, but it has been a crazy week and I want to take time to do the topics justice. Coming this weekend:

    -Two new studies on emergency contraception availability and knowledge
    -The Tennessee Pregnant Women Support Act
    -The APA and sexualization of girls (maybe)
    -Any truth to a breast cancer myth?
    -Rhythm method as effective as the pill? - a new study
    -Women + fish + babies + mercury
    -Your Saturday news roundup

    Wednesday, February 21, 2007

    If I'm In a Carnival, Do I Get a Costume?

    The 32nd Carnival of Feminists is up at Bumblebee Sweet Potato, and the post about Rep. Stacey Campfield's proposed legislation to issue death certificates for abortion got a nod. Check it out for links to discussion of the Edwards blogger flap, policy issues, and other topics.

    Merck to Stop Lobbying for Mandatory HPV Vaccines

    In today's New York Times, "Merck to Halt Lobbying for Vaccine for Girls." The company has been criticized for its efforts to push state legislation that would make the HPV vaccine mandatory for schoolgirls. According to the piece, "The company said it made the decision after realizing that its lobbying campaign had fueled objections across the country that could undermine adoption of the vaccine." The company declined to provide information on how much money it has already spent lobbying for mandatory HPV vaccination.

    Read more

    Adventures in Blood Donation

    This post is not for the squeamish. *evil grin* I'm sure my buddy Ceeelcee will love it.

    I went for a blood donation this morning. I do this as often as possible/I remember, and this week the workplace is competing with another Big University in Tennessee to collect the most blood. I had an appointment, I quickly scanned the information sheet, signed in, and waited my turn for processing. I was taken back in less than 2 minutes, and checked in by a nice woman who actually told me my BP, pulse rate, temperature, and iron level as she measured them. So far, so good, and a big improvement over previous experiences.

    Next it was time to wait in the glorified lawn chair to start the donation. I waited, and waited a little more, but took the time to read the latest issue of MLA News. There was a little wiggling involved with getting the giant needle properly placed, but this is not terribly uncommon. Then we just tick down the 4-5 minutes it takes to fill the bag, and wait for the attendant to come over to collect the tubes of blood for testing and disconnect everything. No fuss, no muss.

    When the Red Cross worker attempted to set up for collecting the tubes of blood, we had an, um, equipment failure. The tip snapped and blood spurted everywhere, like a low-budget horror flick. "Blood fountain" would not be an inappropriate description. I, of course, could not look away. Neither could the lady in the next chair, who I think was a little disturbed. My first reaction was to giggle (sick, I know), and my first thought was, "I wish I had my camera so I could blog this." Ultimately, blood had to be cleaned from my arm, the floor, the attendant, and the arm tray, and the attendant had to change into a clean lab coat. Multiple sets of gloves were gone through. Meanwhile, I had to lift and move my arm so the pools of my blood could be cleaned up, causing stress on the needle (still connected to the tubing and bag), which wiggled around.

    So, what of collecting the tubes of blood? Did you know there are 5-6 of these? I had never noticed, because they're usually below the chair and out of site. A supervisor came over to consult, and determined that the only way to collect them would be a "second VP." At first I heard "second BP," which made no sense. No, second VP, for venipuncture. I had to be stuck in the other arm in order to collect the tubes.

    I want to say that the Red Cross folks were nothing but professional, and this was more equipment failure than human error. I'll still donate in the future, I just wanted to share my morning of gore with you nice people. I hope we kick Other Big University's behind.

    Photo by Yogi and used under a Creative Commons Attribution-Sharealike license.

    Tuesday, February 20, 2007

    New Guidelines for Women's Heart Health

    The American Heart Association has released an updated 2007 version of its Evidence-Based Guidelines for Cardiovascular Disease in Women Prevention emphasizing a more lifetime-oriented approach to heart disease prevention. According to an AHA press release, major highlights are:

    [Note: "CVD" refers to cardiovascular, or heart, disease]
  • Recommended lifestyle changes to help manage blood pressure include weight control, increased physical activity, alcohol moderation, sodium restriction, and an emphasis on eating fresh fruits, vegetables and low-fat dairy products.
  • Besides advising women to quit smoking, the 2007 guidelines recommend counseling, nicotine replacement or other forms of smoking cessation therapy.
  • Physical activity recommendations for women who need to lose weight or sustain weight loss have been added – minimum of 60–-90 minutes of moderate-intensity activity (e.g., brisk walking) on most, and preferably all, days of the week.
  • The guidelines now encourage all women to reduce saturated fats intake to less than 7 percent of calories if possible.
  • Specific guidance on omega-3 fatty acid intake and supplementation recommends eating oily fish at least twice a week, and consider taking a capsule supplement of 850–1000 mg of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) in women with heart disease, two to four grams for women with high triglycerides.
  • Hormone replacement therapy and selective estrogen receptor modulators (SERMs) are not recommended to prevent heart disease in women.
  • Antioxidant supplements (such as vitamin E, C and beta-carotene) should not be used for primary or secondary prevention of CVD.
  • Folic acid should not be used to prevent CVD – a change from the 2004 guidelines that did recommend it be considered for use in certain high-risk women.
  • Routine low dose aspirin therapy may be considered in women age 65 or older regardless of CVD risk status, if benefits are likely to outweigh other risks. (Previous guidelines did not recommend aspirin in lower risk or healthy women.)
  • The upper dosage of aspirin for high-risk women increases to 325 mg per day rather than 162 mg. This brings the women’s guidelines up to date with other recently published guidelines.

    The complete guideline will be published in the journal Circulation.
  • PG-13 Players Needs Actors

    Planned Parenthood of Middle & East Tennessee is looking for teen actors to join its Teen Theatre Troupe and Peer Education Group, the PG-13 Players, a peer education theatre troupe that develops and performs skits on various teen issues such as teen pregnancy, depression, dating violence, etc. Participants must be entering 9th-12th grades in the 2007/08 school year. Auditions are by appointment only on the evenings of March 13th, 14th, and 20th. Contact Kayce Matthews at 345-0952 ext. 218.

    From the PPMET website:
    The PG-13 Players program combines peer education with theatre to help young people deal with teen issues. Cast members, about 15 per year, are high school teens from throughout the Nashville area.

    Each summer, the PG-13 Players receive intensive training in both dramatic skills and teen-related issues. They hear from community experts on more than 15 topics, including HIV/STDs, refusal skills, communication, dating violence, eating disorders, and healthy relationships. The peer educators use this information to develop skits which bring teen issues to life.

    The goal of the PG-13 Players is not to give out easy answers, but to enable teens to struggle with the realities of teen life, rehearsing the skills they need to cope with difficult situations.

    The Players perform throughout the school year at schools, religious organizations, and youth-serving agencies. During the performance, the situations presented are left unresolved, leaving characters facing tough decisions. After each skit, the actors remain in character for discussion with the audience. Audience members talk to the characters as they struggle with their dilemmas. These conversations with the characters enable young audience members to rehearse decision-making and communication skills, thereby taking the education to a deeper, more personalized level.

    The PG-13 Players is supported through private contributions, and grants from:

    * The National Council of Jewish Women, Nashville Section
    * United Way of Metropolitan Nashville
    * Tennessee Department of Health

    Each PG-13 Players performance lasts from 45 to 90 minutes according to your group's needs.

    Performances are available in the Nashville area only.

    Monday, February 19, 2007

    Get Up, Stand Up

    This post is simply to give thanks to the blogger at Sitting Still for standing up for a vulnerable pregnant woman during a genetic counseling session. A snippet:

    "She's crying. He's yelling at her to stop crying. She's saying she doesn't want testing, doesn't want to know for sure. He's saying that she *will* have the test because he doesn't want a retarded baby."

    Visit Nicole's blog to find out how she mustered up her courage and intervened on behalf of the woman.

    Saturday, February 17, 2007

    Saturday News Roundup - 2/17/07

  • Welcome new readers who came over from Feministing and AlterNet.

  • Representative Stacey Campfield, in response to discussion of his bill proposing death certificates for abortion at Nashville is Talking, had this to say: ";-)" The wait for a mature, truthful response to questions about the bill continues.

  • Women's Health News was among the blogs featured in Friday's on-air blog roundup on Nashville's ABC news affiliate, WKRN. [Video on YouTube]

  • Lindsey at theology&geometry has a post on how she became a feminist, and it's related to hearing the tale of a surviving "comfort woman."

  • Who wants to take up a collection to help out our sisters in Alabama, where a ban on selling sex toys has been upheld? I'm thinking an "adopt an Alabamian" program would do it - they never said mailing a sex toy as a gift was illegal! Surely there's a web 2.0 application that could be developed for a sex toy version of "Need a penny? Take a penny. - Have a penny? Leave a penny."
    (Tidbit: Alabama's state insect is the monarch butterfly. Too bad the state animal isn't a rabbit.)

  • The CDC has released a report on state-specific data on people living with heart disease, and finds that "Residents of Alabama, Arizona, Florida, Kentucky, Louisiana, Missouri, Oklahoma, Tennessee, Texas, and West Virginia had the highest prevalence of these heart diseases."

  • Doctors in China are pushing for more c-sections, resulting in a c-section rate over 60% at some hospitals. The fees the physicians receive for c-sections are 3-4 times higher than those for vaginal birth, so pushing this abdominal surgery brings in more money for the docs.

  • From the New York Times, "Furor on Rush to Require Cervical Cancer Vaccine." According to the piece, "at least 20 states are considering mandatory inoculation of young girls against the sexually transmitted virus that causes cervical cancer."

  • "Scientists Determine How HIV Infects Vagina"

  • Feministing on Camel's new cigarettes targeted to women. This is not the long way we wanted to come, baby.

  • Obama targeted for history of pro-reproductive rights votes.

  • The Guttmacher Institute releases "Laws Affecting Reproductive Health and Rights: Trends in the States 2006," with a state-by-state roundup of laws affecting reproductive rights enacted in 2006 [PDF].

  • Via Our Bodies, Our Blog, an article in Glamour magazine on father-daughter purity balls.

  • NARAL Pro-Choice America is running a campaign asking Wal-Mart to fill Plan B prescriptions, mentioning a recent refusal in Springfield. Allegedly, Tashina Byrd visited a Wal-mart pharmacy for Plan B after a condom broke, and the pharmacist shook his head and laughed. Tashina and her boyfriend were told that the pharmacy had the drug in stock, but that nobody would give it to them. Note to pharmacists - if you're going to refuse legal medications to women, you could at least not be mocking a-holes about it.

  • Catholic leaders oppose New York's condom distribution plan.

  • Japan's Minister of Health says of women, ""Because the number of birth-giving machines and devices is fixed, all we can ask for is for them to do their best per head." [hat tip to David]
  • Friday, February 16, 2007

    Washington, DC - Coming Together with Free Condoms

    Washington, D.C. is getting in on city-branded condom distribution, much like the New York City program mentioned previously. According to the Washington Post, the District plans to give away 250,000 free condoms today, with "Coming Together to Stop HIV in DC" branding; officials say the double entendre of the slogan was unintentional. Similar to the NYC program, the condoms are expected to be placed in government buildings such as health departments, as well as bars, convenience stores, barber shops, and other locations. Organizations can request condoms for distribution through this online form.

    The Department of Health has a page on their site describing the initiative to give away 1 million free condoms, with information on how to use male condoms, female condoms, female condoms for anal sex, and dental dams. The site is not quite as useful as its NYC equivalent, as it doesn't yet have information on all of the sites where condoms will be or promotional materials; perhaps it will be updated when the program is further along.

    PS - Who wants to send me some? I really want a collection of city-branded condoms.

    More on Death Certificates for Abortion

    Representative Stacey Campfield is obviously getting a lot of questions on his proposed legislation to issue death certificates for abortion. Rather than answering the questions posted to his blog on the issue, the Rep says, in what I think is a stunningly childish commentary, "You all look to be doing quite well with out me so I think I will let you all continue on without much input on my bill from me for now. A few questions I would love your input on though," and proposes his own list of questions, essentially ignoring the commentary of his contituents and other concerned Tennesseans. In a later post, he says, "I have responded to other legislators who are getting asked questions as well as Tennessee Right to Life." Again, no response for the people who are pointing out how the bill does absolutely nothing the Rep says it would do.

    Now, to respond to the Rep's questions, which are truly nothing but his attempt at distraction:

    1. If it is not a life, then why do you care if it gets a death certificate or not?
    It has been clearly pointed out on numerous blogs that creating public records containing the names of women receiving a controversial legal medical procedure is a serious privacy issue for the women having abortions. Additionally, asking your constituents, "Why do you care?" is not the level of adult discourse we expect from politicians. You proposed the certificates, Rep, so the burden is on you to convince us what this legislation does (because what you say it does is already being done, or it does not in fact do) and why it matters.

    2. Is this bill about paper work more controversial then the fact that abortions don't have to be performed by licensed doctors in Tennessee?
    State law requires that "The administrator of such facility shall be: (a) A licensed physician, licensed practical nurse, registered nurse, or have a college degree from a four-year accredited institution and experience in a health-related field; and (b) Of good moral character." You're correct that some abortion providers in the hands-on setting may not be "licensed doctors;" however, you make no argument for why this is necessary, nor do you include provisions to change this in your legislation. Yet another red herring.

    3.If you think I am wasting my time on this, Do you also think all of congress is wasting its time on a NON BINDING RESOLUTION that will have no effect on the direction of the war from a political point of view.
    Completely irrelevant to criticisms of your proposed legislation. This is simply an attempt at distraction, and you should be ashamed of yourself.

    4. If you do, have you told your congress person? Will you hold it against them for doing any thing but condemning it as a waste of time?
    See above; in addition, nothing about being opposed to your bill prohibits an individual from having an opinion or contacting their legislators about Iraq. If you want to make a "if you're not doing everything, you should do nothing" argument, perhaps you should consider why you don't have provisions to reduce unwanted pregnancies in your bill.

    5. If you work for the state and spend a large chunk of your day surfing the web and complaining about how bad a piece of legislation is, Do you think I should trust you to be non biased when doing an assessment of said legislation? Do you think this is an ethical lapse? Do you think I should trust you when you say you are over worked but seem to have plenty of time to surf the web and author long posts and comments on blogs during time you are getting paid to work? Do you think you would get away with it on a real job?
    This is obviously directed at the blogger, an employee of the Department of Health, who commented on the fiscal waste associated with stunt legislation. Again, one person's response to the bill has nothing at all to do with whether the bill is a good one, whether it does what you say it will do, or whether you are either completely misinfored or flat-out lying about your own bill. Especially if you're not really doing your job, as you're only responding to other legislators and an anti-choice group. Distraction.

    6.Is a death certificate worse then the fact that partial birth abortion is legal in Tennessee? If you had a choice to end one or the other, what would you put your effort behind stopping? Have you?
    This is another mistruth; "partial birth abortion" is a Class C Felony in the state of Tennessee. See Tennessee Code : Title 39 Criminal Offenses : Chapter 15 Offenses Against the Family : Part 2 —Abortion : 39-15-209. Partial birth abortions. —
    "(b) No person shall knowingly perform a partial-birth abortion.
    (c) Subsection (b) shall not apply to a partial-birth abortion that is necessary to save the life of the mother whose life is endangered by a physical disorder, illness or injury."
    Again, you're setting up a false choice between two issues - it's not necessary to choose to "end one or the other," so your premise is false. We'll leave along the fact that "partial birth abortion" is not a medical term, but is a "fighting word" created by anti-choice activists.

    7. If you know in your heart you did "the right thing" and had an abortion why would you care if people found out? Shouldn't you be proud of it?
    Legal medical care is private, and is protected by privacy laws, which you are trying to make an end run around. How the woman feels about obtaining legal medical care is none of your business. Do you think that all medical records should be open to the public? Will you release yours? However, should the names of women obtaining abortions become part of the public record, those women could be subjected to how *other* people feel about their obtaining legal medical care. Surely you remember the "abortion doctor hit list" that was posted on the Internet - some of us who are concerned about life are concerned about the ramifcations for the lives of women and their families if they become targets of zealots in this manner.

    8. If you found out that taco bell has more regulation on it then an abortion clinic would that make you feel safe in your "choice"? What if you found out abortion clinics have no regulation whatsoever, no cleanliness, licensing or any thing? If you found out your legislator voted to keep it that way would you vote for them again? Did you vote Democrat this last year?
    This depends on whether Taco Bell needs more regulation than an abortion clinic. Are you arguing that it does or does not? Do you have any evidence one way or the other? Whether a person voted for a Democrat last year is irrelevant to your proposed bill. It's not correct that abortion clinics have "no regulation whatsoever." Examine TN Code:
  • Title 68 Health, Safety and Environmental Protection : Health : Chapter 11 Health Facilities and Resources : Part 2 —Regulation of Health and Related Facilities : 68-11-201. Definitions. —
  • Title 39 Criminal Offenses : Chapter 15 Offenses Against the Family : Part 2 —Abortion
    These are just a couple of the major sections that compose abortion regulation in Tennessee. To turn your own technique around on you, what are you doing to correct this, if it's a problem? And what does that have to do with criticism of your bill?

    Honestly, these questions don't truly deserve a response, but to point out the childishness, dodging and deception Campfield is engaging in. Don't expect the Rep to actually address the serious questions associated with this bill. Thanks to Nashville is Talking for pointing out Campfield's new post, and Brittney for noting the hypocrisy of Campfield claiming to not have time to respond to valid criticism, but having had the time to set up the above list of irrelevant, distracting nonsense.
  • Thursday, February 15, 2007

    NYC Condoms - Get Some

    As mentioned in a previous post, New York City gave out 150,000 free condoms in the subways for Valentine's Day. The free condom extravaganza doesn't end there - the city has established the NYC Condom website, which provides info on the numerous locations in the city where free city-branded condoms can be obtained, including bars, hair salons, health departments, and even a dry cleaner. Organizations can order online to receive condoms for distribution. The New York Times has an article on the initiative, and you can also read the Health Department's press release. I'd love to see more cities take such a proactive approach to condom distribution.

    Warning: This site mucks up the operation of Firefox for me, so I have to close the window to get back to other tabs. Your mileage may vary.

    PS - Who wants to send me some? :)

    Wednesday, February 14, 2007

    Breastfeeding Welcome

    Mothering Magazine had a contest to design a symbol that would serve as "an international symbol for breastfeeding is to increase public awareness of breastfeeding, to provide an alternative to the use of a baby bottle image to designate baby friendly areas in public, and to mark breastfeeding friendly facilities." The symbol (shown at left) has been donated to the public domain, and can be posted anywhere to indicate a breastfeeding-friendly environment.

    Meanwhile, New York City is spending $2 million+ in city hospitals to encourage breastfeeding.

    Thanks to Belly Tales for pointing out both stories.

    Technorati Tags:
    MeSH Tags: Breast Feeding

    Tennessee Representative Proposes Death Certificates for Abortion

    Tennessee State Representative Stacey Campfield has proposed legislation that would require "A death certificate for each induced termination of pregnancy which occurs in this state shall be filed with the office of vital records within ten (10) days after the procedure by the person in charge of the institution in which the induced termination of pregnancy was performed."

    In his blog post on the proposed legislation, Campfield states his purpose as "This bill will give information to the state that is not available now on how many abortions are given each year as well as information on race, age, weight. It will also give consistency to when and what is a life based on factors that are already used and consistent. When we make the definition of life a little more consistent we can begin to treat it with the respect it deserves and not base it on whims of fancy." In truth, information on how many abortions are performed is already required to be reported to the State. In an interview, the Rep said, "All these people who say they are pro-life — at least we would see how many lives are being ended out there by abortions." The bill also does nothing to define "what is a life," and does not require death certificates for all miscarriages - State law does issue some certificates for miscarriage, depending on weight/age (500 grams or 22 weeks), but not for all, and not in the first trimester, when most abortions occur (the CDC estimates that 1.4% of abortions occur after 21 weeks). So at the same stage we would be issuing death certificates for most abortions, the State would not issue one for a miscarriage, because it wasn't far enough along. How's that for clearing up "what is life?" Thus far, we have a bill that does nothing that the Rep says it would do.

    The pressing question, as mentioned by several folks in the roundup below, is privacy, as the effect would be that the State would essentially be creating a set of records identifying women who had abortions. Vital Records are publically available documents, and death certificates include parental information. It is not currently clear whether and how the State would handle requests for this information, or whether HIPAA laws would apply. HIPAA does not usually cover death certificates, but providing the certificates with parental details in this case would essentially be providing a living woman's medical record/history details to the requestor (rather than cause of death for a deceased person). I'm concerned that, if made available, these records could be used to intimidate/harass/target women who have had abortions. If so, that could put women and entire families in jeopardy.

    It's not entirely surprising that this bill would do nothing in terms of using the information to target preventive services, provide reproductive healthcare to vulnerable populations, or otherwise take actual measures to reduce abortion. What it would do is create a climate of fear and privacy invasion for women and an additional reporting burden for providers (who currently have to report on abortions, but in a confidential manner and not within 10 days - nobody really needs that information within 10 days.)

    So, Campfield, are you simply misinformed about the existing data collection requirements, or is this really an attempt to make an end run around state laws/medical privacy?

    See Update, 2/16/07

    A Roundup of Tennessee Bloggers:
  • The Rep Himself - Is it a Life?
  • Tiny Cat Pants - Stacey Campfield Wants in Your Medical Records; I Appeal to You Anti-Abortion Folks; Stace, Shall I Send My Used Tampons to You or to the Medical Examiner?
  • Tennessee Guerilla Women - TN Lawmaker Wants State to Call a Fetus a Person
  • Thoughts of an Average Woman - Death Certificates for Fetuses Would Identify Women
  • No Silence Here - More GOP Big Government
  • Cup of Joe Powell - Campfield Targets Women?
  • Volunteer Voters - More Talk of Certificates for Clumpy - "This bill accomplishes only one goal: getting Stacey Campfield's name in the paper. That's all this does. Campfield, by introducing this bill has done nothing for the unborn or the cause of Life. He is an embarrassment and impediment to it." - AC, we finally agree on something!
  • Salem's Lots - Here’s one for all you folks who want to cut out waste in government - Interesting fiscal perspective from a Dept. of Health Employee

    In the News:
  • Knoxville News-Sentinel - Abortions: Lawmaker touts death certificates
  • Safer Sex Wednesday

    From the New York Times:

    Free Condoms on the Subway? And Who Says New Yorkers Aren’t Friendly?

    Greatest Generation Learns About Great Safe Sex - "By the time Ms. Binford got around to describing a safe sexual act involving Saran Wrap, a woman shouted, 'Enough, already!' and the room erupted in laughter."

    Happy National Condom Week

    Did you know that Valentine's Day kicks off National Condom Week? Neither did I, and I have Tyler at RHReality Check to thank for pointing it out.

  • Press release and condom info from the American Social Health Association
  • Silly slogans - "If you think she's spunky, cover your monkey"
  • Guttmacher Institute press release
  • National Condom Week of Action from FeministCampus (part of the Feminist Majority Foundation), with everything you need to know about condoms and an e-card (scroll down until you see a shamrock)
  • The Condom - info from Planned Parenthood
  • Talking to your partner about condoms
  • Birth Control - Condom - KidsHealth
  • Condoms: Effective birth control and protection from sexually transmitted diseases - MayoClinic.com
  • How Effective Are Latex Condoms in Preventing HIV? - CDC

    While you're reading about condoms, don't forget that the Great American Condom Campaign needs your support.
  • Maternity Scrubs

    Someone arrived at this blog from a search for "scrubs for pregnant women." Admittedly, I never thought of this as a need, because scrubs are so stretchy in the first place. However, I did some searching and turned up a few companies offering maternity scrubs. Please note that I have no experience or ties with these companies and can't vouch for the quality or fit, and that this list is not exhaustive.

  • ScrubMed - maternity tunic and maternity pants
  • Accent Uniforms - maternity tops and pants
  • GOTOSCRUBS - maternity pants by Landau, print maternity tunics by Karesan
  • Scrubies - maternity pants and tunics
  • Sassy Scrubs - tops, pants, and jackets
  • AllHeart - maternity scrubs from various companies
  • Tuesday, February 13, 2007

    Responding to the Clinicians and Conscience Study

    The New York Times has published an editorial in response to the study summarized here last week that found some physicians would withhold treatment, referrals, and information from patients when they had personal objections to certain legal procedures. In part, the editorial states:

    "Although the close-mouthed doctors claim a right to follow their consciences, they are grievously failing their patients and seem to have forgotten the age-old admonition to “do no harm"...The researchers put the burden on patients to question their doctors upfront to learn where they stand before a crisis develops. But that lets doctors off the hook. Physicians have a right to shun practices they judge immoral, but they have no right to withhold important information from their patients. Any doctors who cannot talk to patients about legally permitted care because it conflicts with their values should give up the practice of medicine."

    Reminder: Motherland Afghanistan Airs Tonight

    Motherland Afghanistan, on the state of women's healthcare in Afghanistan and one man's attempt to help in the crisis, airs tonight on your PBS station.

    Update: After watching the film, you may wish to take a moment to contact your Senators/Representative to ask them to support the Afghan Women Empowerment Act of 2007, which would include the authorization of $30,000,000 (each fiscal year 2008-2010) "for grants to Afghan women-led nonprofit organizations to support activities including the construction, establishment, and operation of schools for married girls and girls' orphanages, vocational training and human rights education for women and girls, health care clinics for women and children, programs to strengthen Afghan women-led organizations and women's leadership, and to provide monthly financial assistance to widows, orphans, and women head of households." The legislation also includes monetary support for the Afghan Ministry of Women's Affairs and the Afghan Independent Human Rights Commission.

    The Feminist Majority Foundation has a letter of support all set up for you, which will automatically identify your Congressional representatives.

    The Great American Condom Campaign Needs Your Help

    The Great American Condom Campaign needs your help to continue to the important work of ensuring that all people have access to condoms and appropriate disease prevention and contraceptive information. To learn more, visit the links at the bottom of this post. Your donation will help support this work, including providing 100 condoms a month to registered SafeSites for distribution to the community. From an email, republished with permission:

    Just wanted to check in and ask that you give a few bucks to The Great American Condom Campaign. We are in a very challenging financial situation. As you might know, our flagship project, "Safesites" - a national grass-roots condom distribution program - has expanded FAR faster than any of us had predicted: Reaching ten times more people per month than we thought we could hit in a year. This is a GREAT problem to have, to be sure, but the added cost of creating a logistical system to support the 90,000 people we are hitting every month has been hard on us. Especially considering we are a volunteer organization. None of us are paid. No salaries. No benefits. Nothing. In fact, the whole Campaign has been self-financed for the past year and a half. The only problem is that we've run out of things to sell, houses to mortgage, and loans to get to pay for this very important next phase.

    It is hard to ask for money, but I can not think of a more worthwhile cause to ask for your support on. I'm not asking you for $10,000 (but if you gave it, I would be hard-pressed to say no ;) but I am asking you to consider giving as much as you can. Twenty bucks from you, in the context of two thousand other people giving $20, makes a huge difference.

    Every little bit counts, Rachel. Get your friends to donate, your office, your neighbors -- your contribution will make a difference, I guarantee that. Please donate right now, just visit our homepage and click on the blonde in the lower left corner. It takes less than a minute.

    Please also feel free to contact me directly whenever you like at stephen@condomcampaign.org or 202.341.0656.

    Be Great,
    Stephen

    Stephen B. Sobhani, MPP
    The Great American Condom Campaign
    www.condomcampaign.org

    Great American Condom Campaign
    PO Box 3769
    Washington, DC 20027

    Related Info:
    Why a Condom Campaign?
    SafeSites Sign Up
    How To Use A Condom
    STIs 101 - info on a range of sexually transmitted infections

    Sunday, February 11, 2007

    One to Watch: Motherland Afghanistan

    In Motherland Afghanistan, filmaker Sedika Mojadidi follows her OB/GYN father to Afghanistan to witness his work in a Kabul maternity ward (once the Rabia Balkhi maternity women's hospital, renamed the Laura Bush Maternity Ward). Dr. Mojadidi was asked by the U.S. Government to help rehabilitate post-Taliban Rabi Balkhi in 2003, and the film documents the doctor's frustration and lack of support (including the U.S. Department of Health and Human Service's failure to supply the promise basic medical supplies and equipment), and the resulting difficulties in providing medical care for Afghanistan's women. As the piece reports, Afghanistan has the second highest maternal mortality rate in the world, with a 2000 survey finding 1,600 maternal deaths for every 100,000 live births. In the same year, only 10% of Afghanistan's clinics were equipped to perform c-sections, and 2/3rds could not provide basic reproductive health services. According to World Health Organization statistics from 2000, only Sierra Leone experiences more maternal deaths (2,000 per 100,000 live births). By comparison, the United States experienced only 16 deaths per 100,000 live births. While some estimates disagree on the exact numbers, the rate of maternal mortality in Afghanistan is nonetheless extremely high.

    Motherland Afghanistan makes real the problems of a broken healthcare system that cannot provide enough trained doctors, infrastructure, or knowledge to properly care of the nation's pregnant women. Alongside images of the Afghanistan landscape and insight into the culture and social climate, the documentary presents startling images of broken, overflowing sinks, filthy toilets, patients bringing their own medical supplies, and other scenes from a hospital on the edge of ruin. It also presents up-close encounters with the women affected by this lack of care. Yet when Dr. Mojadidi complains to the HHS that they have not fulfilled their promises to send money and supplies, he receives in return only a letter congratulating him on his good works. The doctor eventually leaves the country in frustration.

    Two years later, in 2005, the filmmaker once again follows her father to Afghanistan, this time to an NGO-sponsored medical facility. While conditions are better there, the doctors, patients, and families still face extraordinary hurdles in providing even the most basic care. One baby is born prematurely at 7 months; in the U.S. the baby might survive, but in this facility with no incubators, where the baby is fed milk via a spoon, the chances of a good outcome are strikingly lower. The film also highlights the problem of fistula, an injury that can occur when emergency care is not available to laboring women, resulting in a hole between the bladder and vagina or rectum and vagina. One woman has seemingly suffered from this problem, with urine leaking from her bladder into her vagina and down her legs, for 8 months before receiving care.

    The features shown on Independent Lens are typically informative and moving, and this documentary is no exception. Motherland Afghanistan is an eye-opening and worthwhile look at the state of reproductive health care in Afghanistan. Visit the website and see these selected resources to further explore this topic.

    Motherland Afghanistan can be seen this week on Tuesday, February 13th as the Independent Lens broadcast on your local public television station. [search for showtimes]

    Thanks to itvs for provision of a screener copy of the film.

    Friday, February 09, 2007

    Pennsylvania Pushing to Oust Direct-Entry Midwives

    From the Philadelphia Inquirer, "A Push to Stop Midwives."

    According to the piece, "In Pennsylvania, only midwives who have nursing degrees can be licensed. The state argues that the practice of lay midwifery - usually defined as midwives trained through apprenticeship - is illegal, and many doctors say it is dangerous. However, the Pennsylvania statute does not explicitly prohibit the practice of lay midwifery." One midwife (Diane Goslin) without a nursing degree, who has practiced for more than 25 years and delivered more than 5,000 babies, came to the State's attention after an Amish baby she delivered died a day after work. The coroner reported that the death was "likely from pneumonia caused by bacteria transferred in utero." The State Board of Medicine is now accusing Goslin of practicing medicine and nurse-midwifery without a license, with each charge carrying a maximum fine of $10,000. If the court orders that Goslin must stop catching babies and she refuses, she could be subject to criminal charges.

    Some are concerned about the Amish population in Pennsylvania, which oftens depends on "lay" midwives for birth. From the article - "Home-birth advocates say safe home births would be nearly impossible without lay midwives, who attended nearly half the 3,481 out-of-hospital births in Pennsylvania in 2004, the last year for which the state has statistics."

    Direct-Entry Midwifery State-by-State Legal Status-Last Updated 4-17-2006

    Thursday, February 08, 2007

    Clinicians, Conscience, and Information

    The paper, Religion, Conscience, and Controversial Clinical Practices, published in the current issue of the New England Journal of Medicine, examines U.S. physicians' attitudes about disclosing information to patients concerning "legal but morally controversial medical procedures." Essentially, the doctors were surveyed about whether they would withhold information, treatment, or referrals from patients if they personally objected to the procedure in question. A summary:

    Who Was Included: Practicing U.S. physicians who were 65 years old or younger chosen randomly from a database of all U.S. docs. A modest incentive ($20) was offerred for participation in the survey.

    What Was Done: A 12-page questionnaire [PDF] was mailed to physicians for them to complete and return. Participants were informed that the survey was intended to assess physicians' perspectives on religion and spirituality in medicine, and were asked questions about their own religiosity and opinions on refusing treatment and withholding information based on their beliefs.

    What Was Asked:
    Physicians were asked a number of questions to assess their own religiousity, how often religious discussions occur with patients, and how, their level of objection to controversial procedures (abortion, birth control for adolescents without parental consent, and physician-assisted suicide/"terminal sedation"), the physician's obligation to the patient when the procedure is legal but the physician objects on religious or moral grounds, and general patient, workplace, and individual demographics.

    Findings: 1114 surveys were returned to the researchers. Among the results:
  • 83% have no objection to "terminal sedation," 48% do not object to abortion, and 58% do not object to prescription of birth control to adolescents without parental consent.
  • 37% reported low,27% reported moderate, and 36% reported high religiosity, while 46% reported attending religious services twice a month or more.
    When the doctor objects to a legal medical procedure requested by a patient:
  • 63% thought it would be ethical to explain in detail to the patient why he or she objects to the procedure.
  • Only 86% thought they had an obligation to present all possible options to the patient (including about the procedure objected to); 6% were undecided, and 8% believed they had no such obligation.
  • Only 71% believed they were obligated to refer the patient to another doctor who does not object to the procedure, while 11% were undecided, and 18% believed they were not obligated to refer the patient to another provider.
  • "Catholics and Protestants were more likely to report that physicians may describe their religious or moral objections and less likely to report that physicians are obligated to refer patients to someone who does not object to the requested procedure." (Jewish, None, and Other were the remaining categories)
  • "Physicians who objected to the three controversial medical practices were less likely to report that doctors must present all options and refer patients to other providers. The associations for religious characteristics and objections to controversial clinical practices persisted after controlling for age, sex, ethnic group, region, and specialty."
  • "Physicians who objected to abortion for failed contraception and prescription of birth control for adolescents without parental consent were more likely than those who did not oppose these practices to report that doctors may describe their objections to patients." The researchers did not find a connnection between objection to terminal sedation and believing it was appropriate to discuss these objections with patients.
  • Male physicians were more likely than their female colleagues to both believe it is appropriate to present personal religious/moral objections to patients and to be willing to withhold information/referral from the patient.

    Notes:
    The survey was conducted in 2003 - I think the debate over pharmacist refusals to women has heated up since the time of the survey, but I don't know how/if that would affect a suvery conducted now. Doctors were not asked how often they actually had refused information or referral to a patient or told patients about their religious/moral objections. Rather, they were asked if they believed those refusals are appropriate. The authors also point out that because they surveyed physicians from a number of medical specialties, many of the responding physicians may not be in the position to provide or be asked to provide the "legal but morally controversial" procedures, thus making their opinions about what is appropriate perhaps not representative of what happens in real practice. For example, a set of OB/GYNs asked about birth control and abortion might respond differently overall than a set of cardiologists asked the same thing, but the issue would almost never come up in the cardiologists' medical practice, whereas the OB/GYN's opinions may affect real patients.

    Don't you really want to believe that 100% of the time, if you ask your physician about something, you'll be provided with all of the relevant information about your options, and referred somewhere else if your physician believes he or she cannot care for you?

    Citation: Curlin FA, Lawrence FE, Chin MH, Lantos JD. Religion, conscience, and controversial clinical practices. N Engl J Med. 2007 Feb 8;356(6):593-600. Free full-text.
  • The Hoohaa Monologues

    Some Atlantic Beach, FL woman was offended by seeing the word "Vagina" on the marquis of a theater running a production of "The Vagina Monologues," and having to explain to her niece what "vagina" means. You know, the play that is supposed to help take away the stigma about talking about the vagina? The theater changed the marquis to read "The Hoohaa Monologues." More/images from BoingBoing and WJXT.

    Wednesday, February 07, 2007

    In Support of Amanda & Melissa

    It's stand up for bloggers day in the wake of the Edwards campaign blogging "scandal." My contribution.

    Dear John Edwards,

    If you did your homework before hiring your bloggers, and approved of their work, you should stand by them. If you are cowed into firing them because the Catholic League says you should, you don't have what it takes to be President.

    If didn't do your homework before hiring your bloggers, and had not even the slightest notion that they might be criticized at the speed of electrons all across the tubes, you also don't have what it takes to be President.

    As you "weigh their fate," consider what it suggests about what your own should be. I'm looking forward to seeing just what kind of stuff you're made of.

    Yours,
    Rachel


    [Background info here]

    Update: Two (almost) official thumbs down to Edwards, who has allegedly fired the bloggers.
    Update 2: Amanda and Melissa are not fired. Or they're unfired. Or something.

    National Black HIV/AIDS Awareness Day

    Today is National Black HIV/AIDS Awareness Day. According to the CDC, "The primary goal of NBHAAD is to motivate African Americans to get tested and know their HIV status; get educated about HIV/AIDS; get involved in their local community; and get treated if they are currently living with HIV or are newly diagnosed."

    Resources:
  • HIV/AIDS and African Americans - CDC
  • Fact Sheet: HIV/AIDS among African Americans - CDC
  • What African Americans Can Do - CDC, prevention information
  • National HIV Testing Resources - searchable database of testing sites in the U.S.
  • National Black HIV/AIDS Awareness Day - campaign site, includes information on "Blacks and HIV/AIDS" and getting tested, registration and supplies for local events, and the NBHAAD blog.
  • African American HIV/AIDS Program - American Red Cross. According to the website, "The African American HIV Education and Prevention Instructor Course" addresses public health concerns for African American communities in the area of HIV prevention. It is designed by African Americans for African Americans. The course trains instructors to deliver culturally sensitive and culturally specific HIV education and prevention. Instructors learn how to facilitate community sessions using a series of activities including role plays, brainstorming, practice and demonstrations. The sessions help participants build critical skills towards preventing the spread of HIV. These skills include decision-making, problem solving, negotiation and refusal."
  • The Balm in Gilead - " For 18 years, The Balm In Gilead has mobilized The Black Church Week of Prayer for the Healing of AIDS, which engages Black churches to become centers for education, compassion and care in the fight against HIV/AIDS."
  • BlackAIDS.org
  • Events Recognize National Black HIV/AIDS Awareness Day - Kaiser Network, with list of events, statements, and opinion/editorial pieces on the day
  • National Black HIV/AIDS Awareness and Information Day: February 7 - Office of Minority Health
  • National Black Leadership Commission on AIDS
  • National Minority AIDS Council
  • Racial/Ethnic Disparities in Diagnoses of HIV/AIDS --- 33 States, 2001--2004 - CDC, Morbidity and Mortality Weekly Report
  • Mobilizing against the HIV/AIDS crisis among African Americans
  • Living with HIV/AIDS - CDC, tips for patients
  • AIDSInfo - lots of patient-friendly information, a glossary of terms, etc. Also has special page set up on National Black HIV/AIDS Awareness Day 2007
  • HIV: Coping with the Diagnosis - familydoctor.org
  • YOUR RIGHTS AS A PERSON WITH HIV INFECTION OR AIDS - U.S. Department of Health and Human Services, Office for Civil Rights