President Bush has decided for the seventh year to withhold funds allocated to the United Nations Population Fund (UNFPA), which conducts global work on issues such as reducing obstetric fistula, increasing access to contraception and family planning, HIV prevention, and improving obstetric care.

The administration has withheld funds allocated by Congress to UNFPA since 2002, citing concerns that UNFPA work in China was supporting forced or coerced abortions. However, a report delivered to the President in that same year resulting from a fact-finding mission to China stated that “We find no evidence that UNFPA has knowingly supported or participated in the management of a program of coercive abortion or involuntary sterilization in the PRC.” At that time, it was recommended that all of the allocated funds be released to the UNFPA for its global work, while withholding funds specifically from programs in China.

As last week’s Department of State release indicates, “We are prepared to consider funding UNFPA in the future if its program in China is ended or restructured in a way consistent with U.S. law, or if China ends its program of coercive abortion and involuntary sterilization.” They also cite the Kemp-Kasten Amendment, which provides that no international assistance funds “may be used to pay for the performance of abortions as a method of family planning or to motivate or coerce any person to practice abortions.”

Aside from the report on UNFPA’s work in China contradicting the stated rationale for withholding funds, why withhold all of the money from the organization because of the policies of one nation where it works, reducing its ability to work on reproductive health issues worldwide? Nicholas Kristof notes this problem in a commentary for the New York Times, arguing that it “would be ridiculous to withhold funds for UNFPA activities against maternal mortality in Africa because of its work in China.” Kristof also asks:

UNFPA convinced China in 1992 to switch to a more effective but more expensive IUD, averting half a million abortions each year, 5 million abortions a decade. Does any anti-abortion group have that good a record?

The administration, however, may be looking to extend this leap in logic. Craig Lasher of Population Action International writes for RH Reality Check that:

“The Bush administration has threatened to dramatically expand the interpretation of the Kemp-Kasten amendment, which prohibits U.S. funding to organizations that support coerced abortion or involuntary sterilization. Until now, Kemp-Kasten has only been used to withhold funding from UNFPA. Now there’s a threat to cut off funding to other organizations solely because they operate health programs in China.”

See his post for further discussion of this issue, and this PAI fact sheet for information on how UNFPA has worked to improve family planning options in China.

Related Links:

• The Bush Administration Disappoints the World’s Women and Withholds Funds from UNFPA for the Seventh Time - UNFPA
• UN Foundation Women and Population Executive Director Tamara Kreinin Remarks on Withholding of UNFPA Funding - United Nations Foundation
• PAI Condemns Bush Administration Threat to Dramatically Expand Ban on Funding Organizations Working to Reform Chinese Population Program - Population Action International
• No U.S. Funding for Reproductive Health…Again” - UN Dispatch

Planned Parenthood Expands its Reach: “Flush with cash, Planned Parenthood affiliates nationwide are aggressively expanding their reach, seeking to woo more affluent patients with a network of suburban clinics and huge new health centers that project a decidedly upscale image,” reports the Wall Street Journal.

Unfortunately the full story is available to subscribers only, but the WSJ health blog has a summary that includes these remarks:

Despite some critiques to the contrary, Planned Parenthood insists it’s not compromising is long-held focus on serving the poor with birth control, sexual-health care and abortions. Officials there say they take a loss of nearly $1 on each packet of birth-control pills distributed to poor women under a federal program that funds reproductive care. But they make a profit of nearly $22 on each month of pills sold to an adult who can afford to pay full price. That money helps subsidize other operations, including care for the poor as well as pursuing Planned Parenthood’s political agenda.

“It is high time we follow the population,” said Sarah Stoesz, who heads Planned Parenthood operations in three Midwest states. She recently opened three express centers in wealthy Minnesota suburbs, “in shopping centers and malls, places where women are already doing their grocery shopping, picking up their Starbucks, living their daily lives,” she said.

Pregnant in Gloucester: Concerning the 18 high school students pregnant in Gloucester, Mass, that have received national news coverage for supposedly choosing to get pregnant and raise their children together, Kelly McBride, who covers media ethics for Poynter Institute, has an excellent piece on pack journalism in search of a “pact..” Meanwhile, the high school principal who first said their was evidence of a pact defends his comments and his memory.

Plus: Courtney Macavinta of Respect RX discusses her own sex “pact” at age 15 and the cycle of disrespect that leads girls who don’t value themselves to make choices “in which the fine print (that life is about to get even harder) is written in invisible ink.”

Teen Pregnancies at 30-Year Low: Writing in the Chicago Tribune, Lisa Anderson reports on the latest pregnancy statistics released by the Guttmacher Institute.

Pregnancies — whether they end in birth, miscarriage or abortion — among women age 15 to 19 dropped to 72.2 per 1,000 women in 2004, down from a peak of 117 per 1,000 women in 1990 [...]

While some 700,000 women age 15 to 19 become pregnant every year, the rate has declined 36 percent since it peaked in 1990. The rate of abortions among teens also plummeted, to 19.8 per 1,000 women in 2004 from a high of 43.5 per 1,000 in 1988.

But researchers are keeping a close eye on the numbers, as there are some signs that the drop may be reversing:

Despite decades of improvement and for reasons yet unknown, there is statistical evidence that the drop in pregnancy rates, the age of first sexual activity and contraceptive use among teens stalled after 2001.

The exception may be in the teen birthrate. After a 14-year decline, the birthrate, meaning the number of live births, among women age 15 to 19 rose 3 percent in 2006 to 41.9 per 1,000 women from 40.5 per 1,000 women in 2005, according to the U.S. Centers for Disease Control and Prevention. Until more data are compiled, it is unclear whether the 2006 uptick in births was an isolated blip or the harbinger of a more significant and negative change on the teen reproductive landscape, according to David Landry, a senior research associate at the Guttmacher Institute.

Mandating Insurance Coverage for Psychiatric Ailments: Illinois will become the 17th state to mandate insurance coverage for treatment of anorexia and bulimia, assuming the governor signs a bill recently approved by the state Legislature.

Bonnie Miller Rubin and Ashley Wiehle of the Chicago Tribune write:

The measure is part of a larger national debate about addressing inequities in insurance coverage between psychiatric and physical ailments.

More than 12 million Americans, mostly young women, have eating disorders in their lifetime, according to the National Association of Anorexia Nervosa and Associated Disorders. The organization ranked risk of death as higher with anorexia than with any other mental illness. Among patients with anorexia, almost half of all deaths are suicides, according to ANAD. Yet many insurers balk at covering the tab, which can run as high as $2,500 a day.

“I’ve met so many parents who have had to refinance their homes,” said Rep. Fred Crespo (D-Hoffman Estates), one of the bill’s sponsors.

But others cite the financial cost of such a law. Richard Cauchi, health program director for the National Conference of State Legislatures, said Illinois has taken “an unusual action” for 2008, when the trend is to move away from mandates on business and governments.

“There’s more pressure now to repeal and restrict mandates than to enact new ones,” he said..

“Neglected Infections of Poverty”: “Despite plummeting mortality rates for most infectious diseases over the last century, a group of largely overlooked bacterial, viral and parasitic infections is still plaguing the nation’s poor, according to a report released this week,” writes Wendy Hansen in the L.A. Times.

“Many of the diseases are typically associated with tropical developing countries but are surprisingly common in poor regions of the United States, according to the analysis, published in the Public Library of Science journal PLoS Neglected Tropical Diseases.”

The study’s author, Dr. Peter Hotez, chairman of George Washington University’s department of microbiology, immunology and tropical disease, says there are 24 diseases affecting at least 300,000 Americans, and possibly millions. Poverty-stricken regions, including Appalachia, inner cities, the Mississippi Delta and the border with Mexico, are the areas most severely affected.

Will Women Give Hormone Maker a Second Chance?: “Can Wyeth win back the 40 million Premarin and Prempro users it’s lost since 2002 — along with $1 billion a year in profits — with a new menopause drug? Or will the once-bitten women who have filed more than 5,000 lawsuits claiming the hormones gave them cancer feel fooled twice?” asks Martha Rosenberg at AlterNet.org, in this look at Wyeth’s hope of marketing Pristiq as the first nonhormonal treatment for menopause symptoms.

Don’t Ask, Don’t Tell Affects Women More: “The Army and Air Force discharged a disproportionate number of women in 2007 under the “don’t ask, don’t tell” policy that prohibits openly gay people from serving in the military, according to Pentagon statistics gathered by an advocacy group,” reports The New York Times.

While women make up 14 percent of Army personnel, 46 percent of those discharged under the policy last year were women. And while 20 percent of Air Force personnel are women, 49 percent of its discharges under the policy last year were women. By comparison for 2006, about 35 percent of the Army’s discharges and 36 percent of the Air Force’s were women, according to the statistics.

The information was gathered under a Freedom of Information Act request by the Servicemembers Legal Defense Network, a policy advocacy organization.

Gardasil Not Approved for Older Women: “U.S. regulators have told Merck & Co they cannot yet approve Merck’s application to expand marketing of its cervical cancer vaccine Gardasil to an older group of women, the drugmaker said on Wednesday,” reports Reuters.

“Merck had applied for the use of Gardasil in women ages 27 through 45. The U.S. Food and Drug Administration said in a letter regarding the application that it has completed its review and there are ‘issues’ that preclude approval within the expected review time frame, Merck said.”

Exercise as a Tonic for Aging: The New York Times reports on an updated series of physical activity recommendations for older adults from the American Heart Association and the American College of Sports Medicine, which are expected to match new federal activity guidelines due in October from the United States Health and Human Services Department.

“Contrary to what many active adults seem to believe, physical fitness does not end with aerobics,” writes Jane Brody. “Strength training has long been advocated by the National Institute on Aging, and the heart association has finally recognized the added value of muscle strength to reduce stress on joints, bones and soft tissues; enhance stability and reduce the risk of falls; and increase the ability to meet the demands of daily life, like rising from a chair, climbing stairs and opening jars.”

RH Reality Check has gathered all of its political coverage by D.C. correspondent Dana Goldstein and packaged it in one easy-to-find location: http://www.rhrealitycheck.org/blog/tag/prochoice-vote

Articles include an anti-choice ballot initiative watch; a look at pro-choice candidates fighting for Senate seats; and a discussion of whether the GOP is a mixed-choice party.

More election coverage can be found here.

Yesterday, the Supreme Court of the State of Missouri reversed a lower court ruling in a 5-2 decision and upheld a 2007 law that would allow legal midwifery in the state. The law states that “any person who holds current ministerial or tocological certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services” - this would include both CNM/CMs certified by the American Midwifery Certification Board and CPMs certified by the North American Registry of Midwives.

After the bill, which dealt with numerous health issues as well as including the midwifery provision, was passed and signed into law by the Governor, the Missouri State Medical Association, The Missouri Association of Osteopathic Physicians and Surgeons, Missouri Academy of Family Physicians, and the St. Louis Metropolitan Medical Society filed suit to invalidate the section that would allow legal midwifery practice in the state. The lower court invalidated the statute, but an appeal was filed by the State of Missouri along with Friends of Missouri Midwives, the Missouri Midwives Association, and other parties.

The medical associations seeking to invalidate the law had claimed standing for the challenge by arguing that physicians may be subject to disciplinary actions if they cooperate with midwives, and that they should be allowed to challenge the law on behalf of patients as their representatives. The Court disagreed on both of these matters and indicated that the groups had no standing to challenge the Constitutionality of the law. They therefore reversed the lower court decision, allowing the law legalizing midwifery in Missouri to stand.

Organizations supporting midwifery in Missouri issued a press release in response to the ruling, stating that

“Today’s Missouri Supreme Court decision is a tremendous victory for Missouri families, who have been working for 25 years to gain legal access to professional midwives. The ruling increases access to maternity care in the state and allows women and families more birth options and affirms their ability to exercise their rights to choose how their babies are born.”

This ruling closely follows recent AMA/ACOG statements in which the organizations express intent to support legislation restricting or preventing both home birth and non-CNM midwifery. Susan Jenkins, legal counsel for the National Birth Policy Coalition and a consultant to the Missouri midwives, stated:

“This case confirms the message that’s been reverberating loud and clear in both the mainstream media and the blogosphere ever since the American Medical Association launched its attacks against midwives and home birth last week—physicians do not have the right to speak for patients when it comes to deciding who delivers their babies.”

Our Bodies Ourselves was among those who submitted an amicus curiae (friend of the court) brief in support of reversing an injunction against the law and thereby making midwifery legal in the state. Judy Norsigian, Executive Director of OBOS, also addresses the central choice issue:

Many women’s health advocates working on pregnancy and birth issues are deeply concerned about current trends in childbearing, especially the strange way in which “choice” is selectively used. More obstetricians now promote the acceptability of medically unindicated cesareans (”elective” cesareans), while at the same time fewer obstetricians are working to preserve the option of vaginal birth after cesareans (so-called “VBACs”), which are known to pose (overall) fewer serious risks to the mother than planned repeat cesarean sections. In fact, ACOG (the American College of Obstetricians and Gynecologists) has a position that calls for the 24/7 presence of an anesthesiologist if a hospital is to offer VBACs.

Ironically, organized medicine is now spending considerable energy to oppose the licensure and regulation of Certified Professional Midwives (CPMs, now officially recognized in 24 states), and in mid-June, the American Medical Association passed an anti-homebirth resolution (proposed by ACOG) that many believe is a step towards an attempt to make homebirth ultimately illegal. Despite the absence of evidence that planned homebirth with trained caregivers is any less safe overall than hospital birth, the AMA and ACOG apparently don’t apply the principle of reproductive choice when it comes to this arena of decision-making for a pregnant woman.

Similarly, in our recent post on the AMA/ACOG issue, we included a letter from Dr. Andrew Kotaska, who argued that “Modern ethics does not equivocate: maternal autonomy takes precedence over medical recommendations based on beneficience, whether such recommendations are founded on sound scienctific evidence or the pre-historic musings of dinosaurs.” Another obstetrician, Dr. Lauren Plante, has generously granted permission to publish her recent letter to ACOG on the same topic:

Dear Colleagues,

I was dismayed to read the recent ACOG statement opposing home birth and specifically disallowing any support for individuals that advocate or support home birth. While I understand ACOG’s concern for mothers and babies, any reasonable support for patient autonomy–which the College favors when it comes to cesarean upon maternal request–would have to include autonomy in choosing a birth place. Many of us would not agree that choosing to labor and deliver at home subordinates the goal of a healthy baby to the process. As you know, home birth remains a viable option in several developed nations where birth outcomes for both mother and baby are excellent. Many ACOG members have backed up home birth providers in the past, and a few have attended a home birth. I personally know of several ACOG members who themselves have chosen to deliver at home. The recent ACOG statement further marginalizes both our patients and our members.

Sincerely,
Lauren Plante, MD, MPH, FACOG
Associate Professor, Obstetrics & Gynecology
Thomas Jefferson University
Philadelphia PA

Our sincere appreciation goes to those physicians who are willing to openly share their dissent, and all those working to preserve choice for women.

This is a little off the beaten path, but it is most definitely health-related.

My 5-year-old niece visited for a sleepover this weekend, and despite being told that getting her to eat vegetables was pretty much impossible, I decided we’d make a build-your-own veggie burger.

She selected a black bean patty for the head; I chose a portobella cap. We both added carrot sticks for the arms and the legs, kale for the skirt or shorts, chopped garlic scapes for the eyes and nose, and a yellow tomato slice for the mouth.

Alexandra replaced the tomato with a ketchup smile, but then offered that the tomato would make an excellent hula-hoop. I smiled smugly. This meal thing was easy; all it took was a little creativity.

We took pictures (proof!). Then we started to eat. Or, rather, I ate.

Many parents and caregivers are probably familiar with what came next. Alexandra broke up pieces of the bun and dunked it in ketchup (”But it’s a vegetable, tia Christine!”). The body parts swirled around on the plate until they resembled a cubist painting.

Clearly I had no idea what I was up against.

After Alexandra left the next morning (following whole grain pancakes with blueberries, bananas, carob chips and a real chocolate chip or two — I was a pushover by 8 a.m.), I came across this L.A. Times story on the various methods used to get kids to eat vegetables, including pureeing veggies and hiding them in sweetened foods. Melinda Fulmer writes:

Everyone hopes that their kids will eat their fruits and vegetables so they’ll grow into big, strong adults who will eat the nine daily servings recommended by the U.S. government. But everyone also knows kids rarely put “broccoli” at the top of a list of favorite foods.

So an increasing number of parents are loading the foods their kids will eat with produce they think they should be getting. And food makers are lending a hand, offering a growing array of processed foods that sneak vegetables and fruits into chips, juice and nuggets.

But some nutritionists and public health experts wonder if parents these days are relying too much on the sneak attack. They doubt if kids will ever develop a taste for vegetables in all their leafy glory if they are hidden in smoothies and macaroni and cheese. Some say this well-intentioned sneaking could produce kids less likely — not more — to eat greens.

“Children should learn to make healthy choices,” says Pat Crawford, co-director of the Center for Weight and Health at UC Berkeley. “It really comes down to whether we are feeding our children for nutrients, or for the potential development of healthy patterns that are lifelong.”

Many mothers say they were turned on to hiding vegetables in their kids’ foods by bestselling cookbooks such as Jessica Seinfeld’s “Deceptively Delicious” and Missy Chase Lapine’s “The Sneaky Chef.” Both offer kid-friendly recipes with hidden vegetable and fruit purées in such items as pizza and pasta.

Some of the big food companies that have entered the fray by including helpings of fruits and vegetables in everything from chips to pancake mix are also continuing to include sodium, fat and sugar in amounts that would seem to negate the health benefits. Consider, for instance, that “a 1-ounce, 130-calorie serving of Frito-Lay’s Tangy Tomato Ranch chips offers 210 milligrams of sodium, 3 grams of sugar and 5 grams of fat along with its half-serving of vegetables.”

I also visited a cool blog mentioned in the Times — Fresh Mouth, where a family of five had one mission: to eat only fresh food or processed food with 5 ingredients or less for 30 days. It takes some serious commitment, but Fresh Mouth also makes it seem fun.

So, dear readers, are any of you hiding vegetables in your kids’ meals? What other methods have worked for you?

Women insured by Blue Shield of California recently received a double whammy: Not only is the cost for individual health insurance cost going up, but now under a new two-tier system women will pay more than men for the same coverage. The change goes into effect July 1.

“It’s not about pregnancy,” writes L.A. Times columnist David Lazarus. “No, this is purely a matter of Blue Shield deciding that women, as a general rule, are more expensive to insure than men.”

Perhaps this is partly because women are more likely to seek preventive care, according to the Kaiser Family Foundation. But this should make them better insurance risks. After all, they’re proactively working to stay healthy. And isn’t that exactly what insurers encourage people to do?

“It doesn’t make any sense,” said Alice Wolfson of United Policyholders, a San Francisco-based advocacy group. “The insurers aren’t assessing risk. They’re assessing how much healthcare is used, even when it’s preventive treatment.”

A spokesman for the California Department of Insurance said there were no regulations preventing gender-based pricing for individual policies.

Vehicle insurers also use gender in determining rates. In their case, though, men often pay more for coverage because they’re viewed as the greater risk. Supposedly guys drive more recklessly and get into more accidents.

Yet men are nevertheless viewed as a lesser medical liability than women, who live longer on average because they tend to eat right, exercise more frequently and take better care of themselves.

Lazarus breaks down the difference in cost for Blue Shield’s Balance Plan 1700 — a high-deductible individual policy. Women and men pay the same at age 18 — $98 per month — but by age 20, women pay $119 while men pay $110. At age 45, women are paying $25 more — $271 to $246. The gap persists until age 60. At that point, women pay $548 a month while men’s premiums increase to $589.

Aetna Inc. and Anthem Blue Cross also charge women higher rates. A spokeswoman for Anthem Blue Cross told the L.A. Times that gender was added last year to the mix of factors that can affect an individual’s rates. Other factors include current health status, medical history, age, residence and occupation.

Lazarus also raises questions about how far insurers might go in the future to determine risks and related costs:

If women are more expensive than men to insure, and middle-aged women are significantly more expensive than middle-aged men, what about, say, older women with red hair? After all, they have fairer skin and thus are more susceptible to skin cancer.

How about if, statistically speaking, blacks are more expensive to insure than whites? Or Christians more expensive to cover than kosher-observing Jews?

David Gross, who covers California politics at the California Progress Report, writes that that while risk-analysis may be a standard insurance practice, “I think the public realizes that this is unacceptable social policy to have such discrimination, against women or any other group.”

Plus: This isn’t the first discrepancy in health care coverage we’ve noted this month. See Rachel’s post on women who have had a cesarean section being denied or having to pay more for individual insurance.

As you may have heard by now, the American Medical Association recently met and adopted a resolution similar to ACOG’s position on homebirth, stating

“That our AMA support state legislation that helps ensure safe deliveries and healthy babies by acknowledging of the concept that the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.”

Not all physicians agree with the AMA’s position, however. Dr. Andrew Kotaska, noted Canadian researcher and Clinical Director of Obstetrics and Gynecology at Stanton Territorial Hospital, issued the following response:

I would invite ACOG to join the rest of us in the 21st century.

Modern ethics does not equivocate: maternal autonomy takes precedence over medical recommendations based on beneficience, whether such recommendations are founded on sound scienctific evidence or the pre-historic musings of dinosaurs. In the modern age, the locus of control has, appropriately, shifted to the patient/client in all areas of medicine, it seems, except obstetrics. We do not force patients to have life-saving operations, to receive blood transfusions, or to undergo chemotherapy against their will, even to avoid potential risks a hundred fold higher than any associated with home birth. In obstetrics, however, we routinely coerce women into intervention against their will by not “offering” VBAC, vaginal breech birth, or homebirth. Informed choice is the gold standard in decision making, and it trumps even the largest, cleanest, RCT.

Science supports homebirth as a reasonably safe option. Even if it didn’t, it still would be a woman’s choice. ACOG and the AMA are, by nature, conservative organizations; and they are entitled to their opinion about the safety of birth at home. As scientific evidence supporting its safety mounts, however, (to which BC’s prospective data is a compelling addition) they will be forced to accede or get left behind. The concerning part of this proposed AMA resolution is the “model legislation.”

If ACOG and the AMA are passive-aggressively trying to coerce women into having hospital births by trying to legally prevent the option of homebirth, then their actions are a frontal assault on women’s autonomy and patient-centered care. Hopefully the public and lawmakers realize the primacy of informed choice enough to justify Deborah Simone’s words: “We don’t need to be angry or even react to these overtly hostile actions from the medical community. We just need to keep doing what we do best; the proof is always in the pudding.”

It is sad to see the obstetrical community still trying to earn itself a wooden club as well as the wooden spoon; if the resolution passes, it is sad to see the politico-medical community helping them.

Andrew Kotaska
Yellowknife

Dr. Kotaska centers the discussion around issues of autonomy and choice. Indeed, there has been considerable discussion about what form AMA-supported legislation might take. and what this would mean for women’s autonomy in choosing a birth place and provider. Would the organization support the criminalization of women who give birth at home? Would it support making it illegal for providers to attend home births? In either case, home birth is a choice that women will continue to make, not unlike abortion as described in a recent essay in the New York Times:

“It is important to remember that Roe v. Wade did not mean that abortions could be performed. They have always been done, dating from ancient Greek days. What Roe said was that ending a pregnancy could be carried out by medical personnel, in a medically accepted setting, thus conferring on women, finally, the full rights of first-class citizens — and freeing their doctors to treat them as such.”

Likewise, no state laws can prevent home births from happening. They will, however, determine whether women can make this personal choice without fear of persecution, and whether midwives are free to support this choice. Ultimately, AMA’s resolution, though couched in safety language, may encourage states to further restrict the available choices women have regarding their own bodies.

Finally, the original version of the resolution included the following language specifically attacking Ricki Lake: “Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as ‘Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film.’” Lake (along with Abby Epstein and Jennifer Block) issued a response via the Huffington Post, stating, “if U.S. women are to have real birth choices, everybody needs to be working together to provide them, not waging turf wars at their expense.”

Although the language was pulled from the final version of the resolution, I find it extremely insulting to women, as it reveals an assumption that women will just do whatever a celebrity recommends. It precludes the possibility that women make this personal choice based on their individual preferences and available options in an educated manner. It dismisses those choices as simply “trendy,” rather than asking (rather than assuming) why women might be making the choice to give birth at home in the first place.

A number of other bloggers have been discussing this topic; try this Google blog search to browse among them. You may also wish to visit our page on Choosing Your Health Care Provider and Birth Setting.

As you may have heard by now, the American Medical Association recently met and adopted a resolution similar to ACOG’s position on homebirth, stating

“That our AMA support state legislation that helps ensure safe deliveries and healthy babies by acknowledging of the concept that the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.”

Not all physicians agree with the AMA’s position, however. Dr. Andrew Kotaska, noted Canadian researcher and Clinical Director of Obstetrics and Gynecology at Stanton Territorial Hospital, issued the following response:

I would invite ACOG to join the rest of us in the 21st century.

Modern ethics does not equivocate: maternal autonomy takes precedence over medical recommendations based on beneficience, whether such recommendations are founded on sound scienctific evidence or the pre-historic musings of dinosaurs. In the modern age, the locus of control has, appropriately, shifted to the patient/client in all areas of medicine, it seems, except obstetrics. We do not force patients to have life-saving operations, to receive blood transfusions, or to undergo chemotherapy against their will, even to avoid potential risks a hundred fold higher than any associated with home birth. In obstetrics, however, we routinely coerce women into intervention against their will by not “offering” VBAC, vaginal breech birth, or homebirth. Informed choice is the gold standard in decision making, and it trumps even the largest, cleanest, RCT.

Science supports homebirth as a reasonably safe option. Even if it didn’t, it still would be a woman’s choice. ACOG and the AMA are, by nature, conservative organizations; and they are entitled to their opinion about the safety of birth at home. As scientific evidence supporting its safety mounts, however, (to which BC’s prospective data is a compelling addition) they will be forced to accede or get left behind. The concerning part of this proposed AMA resolution is the “model legislation.”

If ACOG and the AMA are passive-aggressively trying to coerce women into having hospital births by trying to legally prevent the option of homebirth, then their actions are a frontal assault on women’s autonomy and patient-centered care. Hopefully the public and lawmakers realize the primacy of informed choice enough to justify Deborah Simone’s words: “We don’t need to be angry or even react to these overtly hostile actions from the medical community. We just need to keep doing what we do best; the proof is always in the pudding.”

It is sad to see the obstetrical community still trying to earn itself a wooden club as well as the wooden spoon; if the resolution passes, it is sad to see the politico-medical community helping them.

Andrew Kotaska
Yellowknife

Dr. Kotaska centers the discussion around issues of autonomy and choice. Indeed, there has been considerable discussion about what form AMA-supported legislation might take. and what this would mean for women’s autonomy in choosing a birth place and provider. Would the organization support the criminalization of women who give birth at home? Would it support making it illegal for providers to attend home births? In either case, home birth is a choice that women will continue to make, not unlike abortion as described in a recent essay in the New York Times:

“It is important to remember that Roe v. Wade did not mean that abortions could be performed. They have always been done, dating from ancient Greek days. What Roe said was that ending a pregnancy could be carried out by medical personnel, in a medically accepted setting, thus conferring on women, finally, the full rights of first-class citizens — and freeing their doctors to treat them as such.”

Likewise, no state laws can prevent home births from happening. They will, however, determine whether women can make this personal choice without fear of persecution, and whether midwives are free to support this choice. Ultimately, AMA’s resolution, though couched in safety language, may encourage states to further restrict the available choices women have regarding their own bodies.

Finally, the original version of the resolution included the following language specifically attacking Ricki Lake: “Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as ‘Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film.’” Lake (along with Abby Epstein and Jennifer Block) issued a response via the Huffington Post, stating, “if U.S. women are to have real birth choices, everybody needs to be working together to provide them, not waging turf wars at their expense.”

Although the language was pulled from the final version of the resolution, I find it extremely insulting to women, as it reveals an assumption that women will just do whatever a celebrity recommends. It precludes the possibility that women make this personal choice based on their individual preferences and available options in an educated manner. It dismisses those choices as simply “trendy,” rather than asking (rather than assuming) why women might be making the choice to give birth at home in the first place.

A number of other bloggers have been discussing this topic; try this Google blog search to browse among them. You may also wish to visit our page on Choosing Your Health Care Provider and Birth Setting.

Best Headline: “Abstinence-only funding is like an evil Energizer Bunny,” courtesy of Vannesa at Feministing. Why the evil? The House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies voted to continue funding the Community-Based Abstinence Education (CBAE) program, an abstinence-only education funding stream, despite all the research that’s it’s a waste of money and resources. Scott Swenson of RH Reality Check has a good wrap-up here.

Share This: Via Brownfemipower, I found an online petition — Statement of Black Men Against the Exploitation of Black Women — written in the wake of R. Kelly’s acquittal. The petition and related useful books, films and organizations are also listed on Mark Anthony Neal’s blog, which itself is a terrific resource on issues on issues of race and masculinity.

UN Addresses Rape as a War Crime: “In Sudan, girls as young as four are raped by rebel forces and government-backed militias. In Democratic Republic of Congo, women are sexually mutilated by roving gangs. In Burma, they are systematically raped as part of a military offensive,” writes Olivia Ward in the Toronto Sun. “[Thursday], the United Nations Security Council agreed that sexual violence against women and girls in war zones is a threat to international stability, opening the way for action against countries that condone or promote atrocities.”

Here’s more from the BBC, and the full text of UN Resolution 1820, which states that “rape and other forms of sexual violence can constitute war crimes, crimes against humanity or a constitutive act with respect to genocide.” The 15-member Security Council also demanded the “immediate and complete cessation by all parties to armed conflict of all acts of sexual violence against civilians.”

In Europe, Debate Over Islam and Virginity: From The New York Times:

As Europe’s Muslim population grows, many young Muslim women are caught between the freedoms that European society affords and the deep-rooted traditions of their parents’ and grandparents’ generations.

Gynecologists say that in the past few years, more Muslim women are seeking certificates of virginity to provide proof to others. That in turn has created a demand among cosmetic surgeons for hymen replacements, which, if done properly, they say, will not be detected and will produce tell-tale vaginal bleeding on the wedding night. The service is widely advertised on the Internet; medical tourism packages are available to countries like Tunisia where it is less expensive.

“If you’re a Muslim woman growing up in more open societies in Europe, you can easily end up having sex before marriage,” said Dr. Hicham Mouallem, who is based in London and performs the operation. “So if you’re looking to marry a Muslim and don’t want to have problems, you’ll try to recapture your virginity.”

A 23-year-old French student of Moroccan descent who paid $2,900 for the procedure, said: “In my culture, not to be a virgin is to be dirt … Right now, virginity is more important to me than life.”

Plus: Read Judith Warner’s column, which links hymen surgery, father-daughter purity balls and other news stories related to patriarchy and female chastity.

World Refugee Day: In recognition of the 8th Annual UN World Refugee Day on June 20, Worldview looked at the plight of Iraqi refugees.

Cervical Cancer Screenings Lacking in Developing Countries: “A study published in the open-access journal PLoS Medicine has found that women in the developing world are not getting the cervical cancer screenings that they need,” according to Medical News Today. “Researcher Emmanuela Gakidou (University of Washington) and colleagues report that although women in the developing world have the highest risk of developing cervical cancer, few are effectively screened. Additionally, there exist severe inequalities between and within countries concerning the access to cervical cancer screening.”

Plus: A survey of 38,000 Canadian women found that obese women are significantly less likely (30 to 40 percent, depending on the degree of obesity) to be tested for cervical cancer than women of average body weight, according to CBC News. Breast and colon cancer screening are unaffected by a woman’s body mass.

Shopping for Breast Cancer: The Center for Media & Democracy’s PRWatch recently posted an article about “Pinkwashing” — which is what happens when corporations try to boost sales by associating their products with the fight against breast cancer. “The worst pinkwashers exploit the intense emotions associated with breast cancer while selling products that actually contribute to breast cancer,” writes Ann Landman, who goes on to offer some key examples, including a Ford 2008 V-6 Mustang with Warriors in Pink Package, which proclaims to “add more muscle to the fight.”

Landman also links to Breast Cancer Action’s excellent Think Before You Pink campaign.

Study Finds Drop in Use of HRT: “Fewer older women in Canada are using hormone-replacement therapies to treat the symptoms of menopause, turning instead to natural remedies, says a study released Thursday,” reports The Vancouver Sun.

“The Canadian Institute for Health Information has found only five per cent of women in five provinces who are 65 years and older use hormone-replacement therapies — a drop from 14 per cent six years ago, when a report found the risks of using the menopause therapies outweigh the benefits.”

The Number of Underinsured Grows: Via the L.A. Times - A new study published in Health Affairs journal found that 25 million people ages 19 to 64 were underinsured in 2007, up from 16 million in 2003.

Nearly 50 million additional people have no health insurance at all. In all, “You end up with about 75 million adults who were either underinsured or uninsured at some time during the year,” says study co-author Sara Collins, an assistant vice president of the Commonwealth Fund, a foundation that supports independent healthcare research.

Those who had inadequate insurance coverage were almost as likely as those with no insurance to avoid getting needed care or to suffer medically related financial problems. Some 53% of the underinsured went without needed care, compared with 68% of the uninsured. And 45% of underinsured people had trouble paying medical bills, compared with 51% of uninsured people. “You can have health insurance and still go bankrupt if you get sick,” the authors note.

ACLU Symposium on LGBTQ Rights: Melissa points to a number of pieces posted at the symposium, including her piece on gay marriage written as a LGBTQ ally. I loved what Rachel Maddow had to say in an interview with the ACLU:

So far the state where I grew up (California) and the state where I live (Massachusetts) and the state where I work most of the time (New York) have legalized, legalized, and agreed-to-recognize-other-states’ same-sex-marriages, respectively. I am accepting applications now from other states that want me to relocate, since apparently I am to second-class gay citizenship what Saint Patrick was to snakes.

The New York Times health blog Well features this headline: “Mother’s Diet May Affect Daughter’s Puberty,” on top of a story about a new study that concludes what women eat during pregnancy and nursing may affect the age at which their daughters start puberty.

How do researchers know this? Because of rats.

The investigators, from the University of Auckland, fed pregnant rats a high-fat diet throughout pregnancy and lactation. Another group of rats received a regular diet of rat chow. After the baby rats were weaned, they also ate either regular chow or a high-fat diet.

The onset of puberty was much earlier in all the rats whose mothers ate a high-fat diet, regardless of whether the baby rats ate high-fat or regular diets.

The findings are important, writes Tara Parker-Pope, because “a girl’s age at first menstrual period may influence her lifelong health. An early first menstrual period, before the age of 12, is a risk factor for breast cancer, teenage depression, obesity and insulin resistance.”

Those are valid concerns, of course, but the study doesn’t offer enough information to support alarming pregnant women that their diets may be the cause of all these future problems. A number of commenters take issue with the study and its implications. See, for instance, #8:

This whole subject is complicated and there’s so much confounding data and studies - we barely have scratched the surface and hardly anybody really knows anything. It’s way to early to freak and decide to indulge in some mom-guilt. And besides, rats are not people. There’s so much more work to be done here.

Conclusion: moderation in all things. There are plenty of other reasons to eat healthy fats in moderation no matter who you are. There is no reason to curl up in a ball of guilt over what you ate while pregnant with your daughters. Just do the best you can and move on.

Or consider #9, which raises interesting environmental questions:

So what kind of fats were the rats eating? Animal fats sourced from livestock who are shot up with growth hormones? Or fats from animals and plants raised without hormones (and other endocrine disruptors like pesticides)? I think that would be an important distinction to make here.

Other readers express concern that mothers are being blamed — yet again. Parker-Pope responds to several commenters inline, such as here, when she writes, “Where did the issue of fault emerge? And why is everyone being so defensive about maternal health during pregnancy? It’s not about blame. I’ve never met a pregnant woman who wasn’t highly interested in her health and the health of her unborn baby.”

Overall it’s an interesting discussion, not only for the research itself, but also for the debate surrounding the role of the media in covering health studies — particularly when the data is limited and the value of the material shared is unproven — and the effect on women who already feel burdened with pressure and guilt.

Late last year, Parker-Pope took a different perspective. Writing about the “The Fertility Diet,” she expressed concern that “the hype” over the book by Harvard researchers would “end up helping couples or merely add to their emotional burden.”

OBOS Executive Director Judy Norsigian wrote a comment posted at Well in support of the research outlined in the book. Her comment describes the decision-making process during the development of “Our Bodies, Ourselves: Pregnancy and Birth,” and she notes that “there were some chapter reviewers who wanted us to tone down the clear benefits of breastfeeding so as to avoid the likelihood that some women might feel guilty because they could not or happened to choose not to breastfeed. (This could be for medical, social, or workplace-related reasons.) We were very careful about the language we used, but we believed it important to include ALL critically important information about the benefits of breastfeeding.”

Norsigian continues: “Hopefully, we can find better ways to support infertile couples so that guilty reactions will be minimized in the process of reading and utilizing information like that offered by ‘The Fertility Diet.’ Researchers like Willett, Skerrett and Chavarro are certainly not responsible for media distortions of their work, and they did credit earlier research by pioneers such as Rose Frisch. As earlier postings noted, they are offering approaches with minimal health risks and a range of potential health benefits.”

The issue of guilt also came up in conversation with colleagues recently after I mentioned seeing a CNN report suggesting that women who are exposed to high levels of stress during pregnancy have an increased chance of their babies developing allergies or asthma later in life. The scary way the study was presented almost ensured that any pregnant woman not already stressed soon will be.

In this case, the research included 315 expectant mothers and their infants (not rats), and other reports I read online featured more comprehensive information. In this HealthDay News story, one of the study’s authors, Rosalind Wright, M.D., an assistant professor of medicine at Brigham and Women’s Hospital and Harvard Medical School in Boston who focuses on the rise of chronic respiratory disease in both adults and children and the connection to psychosocial stressors, notes that longer-term research is needed:

Mothers filled out a questionnaire designed to assess their levels of stress in many different domains. Financial issues, home issues, community safety, relationship problems and medical issues were the most frequently reported negative events experienced by the mothers.

Dust mite exposure was also assessed using samples obtained from the pregnant women’s bedrooms. When the babies were born, a sample of cord blood was taken. After controlling the data to compensate for maternal age, race, smoking, education, history of allergy and asthma, the child’s gender and the season of birth, the researchers found that the number of negative domains — stressors — reported was associated with an increased risk of elevated IgE in the cord blood.

“A mom who had three or more negative events would have a 12 percent increased chance of having a baby with elevated cord blood IgE,” Peters said.

Wright pointed out that elevated IgE is “suggestive” of an increased risk of developing asthma and allergy later in life, but that the association isn’t clear-cut and likely depends on exposure to other risk factors. The researchers will be following these children until they’re 5 years old to see if they end up developing asthma and allergies later in life.

So there’s a lot of information to digest — and more still to learn — yet that won’t stop some media from reducing complicated research to simplistic headlines that leave women feeling more stressed than ever.

As some of you have experienced, we’ve been having technical trouble posting comments (and blog entries, too), which often results in a delay before comments appear on the site. Our apologies!

The good news is we’ll have a new WordPress platform in place soon, at which point we’ll introduce some new features. And, yes, comments will post immediately. We hope to have it rolling in the next few weeks, so stay tuned!

The Surgeon General’s Conference on the Prevention of Preterm Birth was held on Monday and Tuesday of this week, with goals of increasing awareness of preterm birth, reviewing the evidence on the topic, and creating recommendations for advancing understanding of the causes and risk factors of, and approaches to, preterm labor and delivery.

For background, the CDC estimates that 1 in 8 babies in the United States are born prematurely, and that “being born preterm is the greatest risk factor for infant mortality (death within the first year of life).” The CDC also notes significant racial disparities in preterm birth rates.

The first day of the conference was invitation-only, featuring medical experts who reviewed topics such as factors contributing to preterm birth and the need for additional research. However, video from the first day of the conference is now available for public viewing from the NIH Videocast website. Video from Tuesday will likely be available later.

For further related reading, the conference refers to a 2007 report from the Institute of Medicine, Preterm Birth:Causes, Consequences, and Prevention, which can be read online for free.

A report was expected to be prepared at the end of the conference, but this does not yet seem to be available. I’ll update this post if it becomes available online.

Related: Premature birth has also recently received attention following a study that describes the rising rate of “late preterm” birth, which has occurred primarily among c-section deliveries. The authors note that while some high-risk pregnancies may justify preterm interventions, “obstetric interventions at preterm gestation to reduce risks for the mother and fetus need to be optimally balanced with risks associated with preterm birth.” Further discussion is available via this New York Times article.

Congratulations to Del Martin, 87, and Phyllis Lyon, 84 — longtime gay rights activists who were the first to wed in San Francisco Monday, on the eve of the legalization of same-sex marriage throughout California.

“When we first got together we weren’t thinking about getting married,” said Lyon before cutting a wedding cake, according to The New York Times. “I think it’s a wonderful day.”

It was actually their second wedding — their first took place four years ago, also in San Francisco, when Mayor Gavin Newsom sanctioned same-sex weddings. The California Supreme Court later invalidated those marriages.

From the San Francisco Chronicle:

Martin and Lyon have been at the forefront of the gay-rights movement since they moved in together in 1953. They’ve fought for equality for gays and lesbians in the workplace, housing, the medical establishment, the feminist movement and, most recently, the institution of marriage.

Martin wore a purple pantsuit and stood up from her wheelchair to face Lyon, dressed in a blue pantsuit. During the six-minute ceremony, the two held hands as they recited their vows to love and honor each other, for richer or poorer, in sickness and in health. Their eyes welled with tears.

Lyon was the first to say “I do,” her voice resonating in the room. Martin’s “I do,” which came next, was more muted, audible only to those close by. They exchanged rings - the ones they’ve worn before - hugged, and then kissed each other lightly.

The room erupted in cheers - and tears.

For more coverage, check out the Chronicle’s multimedia section on same-sex marriage, which includes profiles of couples saying, “I do”; multiple photo albums; and Chronicle reporter Jim Doyle discussing the recent history of same-sex marriage.

The L.A. Times, meanwhile, looks at the high number of marriage licenses issued as of 5 p.m. Tuesday in California. Here’s a map that shows how counties are handling same-sex marriages; a report on the tactics of opponents (who are apparently lying low for now); and a reader Q&A that even answers questions like this: “Our friend was ‘ordained’ by the ‘Church of the Latter-Day Dude’ and performed his sister’s ceremony in South Carolina last month. Does he need to do anything else to be able to marry us in California?”

Finally, here’s a look at reaction from other countries. Bruce Wallace writes:

Many parts of Europe have reacted with a collective shrug to the California Supreme Court ruling that found the ban on same-sex marriage to be discriminatory. Same-sex marriage has been legal in the Netherlands since 2001, in Belgium since 2003 and in Spain since 2005. The move by the second U.S. state to join them brought only cursory news coverage.

Elsewhere, Canada has officially recognized same-sex marriage since 2005. South Africa stands out as the exception on a continent where homosexuality is largely taboo. It passed a law in 2006 to recognize homosexual marriages after a Constitutional Court ruling said anything less would treat gays and lesbians as inferior.

And Norway happened to legalize same-sex marriage today.

Edwina Froehlich, who helped found La Leche League to support breast-feeding, died earlier this month at the age of 93.

The organization was founded in the 1950s, when Froehlich and six other women met in Franklin Park, Ill., to share information on how to successfully breastfeed their babies.

“In those days you didn’t mention ‘breast’ in print,” Froehlich once said. “We knew that if we were ever going to get anything in the paper we would have to find a name that wouldn’t actually tell people what our organization was about.”

From The New York Times:

A pioneer on several fronts of motherhood, she worked for Young Christian Workers, a Roman Catholic lay organization, before marrying John Froehlich when she was in her early 30s. She had her first child a couple of years later, making her comparatively old to have a first child at the time, and she made the controversial decision to forgo giving birth in a hospital in favor of a more natural delivery in her Franklin Park, Ill., home, with an obstetrician attending.

At a time when most pediatricians encouraged formula and bottle-feeding and when there were few scientific studies demonstrating the health benefits of breast milk, Mrs. Froehlich chose to breast-feed all of her babies, said another La Leche founder, Mary White.

“We used to tell the mothers the three main obstacles to successful breast-feeding were doctors, hospitals and social pressure,” Mrs. White said.

As Rachel noted yesterday, some hospitals, particularly in the south, are still engaging in practices that are not considered supportive of breastfeeding …

Update: The Dallas Morning News calls Edwina Froehlich a feminist pioneer in today’s editorial, which also describes regional prejudices against breastfeeding:

Local breastfeeding activists say many Texans think of the breast only in sexual terms, hence the anxiety over public breastfeeding. State law grants the right to breastfeed in public, but it has never been tested in court. And the risk of public humiliation is a powerful incentive to stay closeted.

That must change, and will. Even so, countless women are more free, and their babies better off, because a 1950s suburban mom refused to accept that one of the most natural things in the world is shameful or retrograde. Edwina Froehlich was ahead of her time.

The CDC has released a new summary of findings with regards to how well U.S. hospitals and birth centers meet Healthy People 2010 goals for supporting breastfeeding.

First, a little background. Healthy People 2010 is a series of health improvement objectives for the nation, with goals of increasing life expectancy, improving quality of life, and eliminating health disparities. Specific targets to reach by 2010 have been established in areas such as tobacco use, maternal health, nutrition, oral health, overweight, mental health, injury and violence prevention, and the like. The breastfeeding objective is to increase early postpartum breastfeeding from 64% to 75%, breastfeeding at 6 months from 29% to 50%, and the one-year rate from 16% to 25%.

In 2007, a survey was distributed to hospitals and birth centers to assess how well they were addressing these targets. They were asked about practices related to 1) labor and delivery, 2) breastfeeding assistance, 3) mother-newborn contact, 4) newborn feeding practices, 5) breastfeeding support after discharge, 6) nurse/birth attendant breastfeeding training and education, and 7) structural and organizational factors related to breastfeeding.

2,687 facilities (2,546 hospitals and 121 birth centers) from 50 states, Puerto Rico, and D.C. returned the surveys, and were assigned scores from 1 to 100, with 100 being the most supportive of breastfeeding.

Among the findings:

• Regional variation was apparent. Out of context, you’d probably think this was an election map. My southern sisters are being served least well with regards to breastfeeding support.
• 99% of facilities had documented the feeding decisions of the majority of mothers in facility records
• 88% “taught the majority of mothers techniques related to breastfeeding”
• “65% of facilities advised women to limit the duration of suckling at each breastfeeding, and 45% reported giving pacifiers to more than half of all healthy, full-term breastfed infants, practices that are not supportive of breastfeeding” (see report online for references for these statements).
• 70% of facilities reported providing discharge packs containing infant formula samples to breastfeeding mothers (another practice considered “not supportive of breastfeeding”)
• This is something I didn’t expect - “postpartum home visits were reported by 22% of facilities.” However, breastfeeding support after discharge received the lowest mean score of all measures.
• “24% of facilities reported giving supplements (and not breast milk exclusively) as a general practice with more than half of all healthy, full-term breastfeeding newborns”
• “In addition, 17% of facilities reported they gave something other than breast milk as a first feeding to more than half the healthy, full-term, breastfeeding newborns born in uncomplicated cesarean births.”

Findings from birth centers are also included - in general, they scored higher overall than hospitals (mean of 86 vs. 62 for hospitals).

The authors note that participating facilities will receive a benchmarking report in July of this year illustrating how they stack up against other facilities in their state, similarly sized facilities, and the nation.

[Cross-posted at Women's Health News]