Silicone Gel Implants May Lose Approval: From our enlightened neighbor to the north ... "Health Canada may have to reverse its controversial 2006 decision to allow women to get silicone gel-filled breast implants if it proceeds with a plan to declare key chemicals found in them to be toxic, experts say," reports The Ottawa Citizen. (via Beauty and the Breast)

South Carolina Supreme Court Overturns Conviction: "A South Carolina woman convicted of homicide by child abuse after her stillborn baby tested positive for cocaine should get a new trial because of several mistakes her attorneys made, the state Supreme Court ruled Monday," reports the Associated Press. "Attorneys for Regina McKnight did not introduce the baby's autopsy report into evidence and failed to rebut the prosecution's medical expert, the court said in the unanimous decision."

Prosecutors have 15 days to decide whether to appeal. From the Myrtle Beach Online:

Attorneys for the National Advocates for Pregnant Women and the S.C. Civil Liberties Union became involved in McKnight's case when she asked for post-conviction relief.

"The groups got involved because there is complete consensus that prosecuting pregnant women is bad for mothers and babies," said Lynn Paltrow, with the National Advocates for Pregnant Women. "Regina McKnight was convicted on junk science and was not fairly represented at trial."

A Place to Pump: "Washington area women have hooked up electric or manual versions in parked cars, restrooms, a telephone booth and the basement storage room of the National Zoo visitors center, where a box of panda costumes doubled this spring as a table on which one woman set her pump, bottles and other equipment," writes Rebecca Adams at the Washington Post.

"Not perhaps what the D.C. Council had in mind when it passed a law in December requiring employers to provide female workers a private, clean space, outside a restroom, to express milk. The Child's Right to Nurse Act also gives a woman the right to breast-feed, covered or not, in any place, public or private, where she has a right to be."

Maternal Exposure to Persistent Organic Pollutants Linked to Urologic Conditions in Boys: This release from the American Urological Association summarizes studies that confirm existing hypotheses that maternal exposure to endocrine-disrupting chemicals – including total polychlorinated biphenyls (PCBs, such as Arochlor) and organochlorinated pesticides (such as dichlorodiphenyl-trichloroethane, or DDT) may contribute to an increased incidences of congenital anomalies.

Mammograms Coupled with Ultrasounds: Deborah Katz of U.S. News & World Report looks at new research on combining mammography and ultrasounds, which may be better for finding cancers in some women, but it also greatly increases the rate of false-positive results. Plus: Check out our analysis on routine mammograms for premenopausal women.

The Business of Bacteria: The L.A. Times reports on the popularity of probioitics, live "friendly" bacteria that is showing up in more foods, like Dannon's Activia yogurt. "Companies claim that the daily consumption of probiotics can provide consumers with benefits such as a boost to the immune system and relief from intestinal distress -- and researchers think that certain probiotic strains hold promise in a number of areas," writes Brendan Borrell. "But how significant these benefits are is a matter of debate. And it can be tough to decipher which products offer verifiable health claims and which are piggybacking on the hype of the booming industry.

Doctors Start to Say "I'm Sorry" Long Before "See You in Court": The New York Times reports on a change in hospital policy: full disclosure when a doctor makes a mistake. Kevin Sack writes:

For decades, malpractice lawyers and insurers have counseled doctors and hospitals to "deny and defend." Many still warn clients that any admission of fault, or even expression of regret, is likely to invite litigation and imperil careers.

But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach.

By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.

Malpractice lawyers say that what often transforms a reasonable patient into an indignant plaintiff is less an error than its concealment, and the victim’s concern that it will happen again.

Culture Affects How Teen Girls See Harassment: "Teenage girls of all ethnic and socioeconomic backgrounds still experience sexism and sexual harassment – but cultural factors may control whether they perceive sexism as an environmental problem or as evidence of their own shortcomings," according to this release from the University of Kentucky summarizing a study of 600 girls, ages 12 to 18, in California and Georgia.

Ninety percent of the girls reported experiencing at least one incident of sexual harassment, the researchers from University of Kentucky and University of California Santa Cruz found.

Specifically, 67 percent of girls reported receiving unwanted romantic attention, 62 percent were exposed to demeaning gender-related comments, 58 percent were teased because of their appearance, 52 percent received unwanted physical contact and 25 percent were bullied or threatened with harm by a male. 52 percent of girls also reported receiving discouraging gender-based comments on the math, science and computer abilities, usually from male peers, and 76 percent of girls reported sexist comments on their athletic abilities, again predominantly from male peers.

The researchers found that girls have different levels of understanding of sexism and sexual harassment, which may affect reporting data. Older girls and those from a lower socioeconomic background reported more sexism than did their peers. Latin and Asian American girls reported less sexual harassment than did girls of other ethnic groups. Girls who had been exposed to feminist ideas, either through the media or an adult such as a mother or teacher, were more likely to identify and report sexist behavior than were girls who had no information about feminism. Girls who reported feeling pressure from their parents to conform to gender stereotypes were also more likely to perceive sexism. Girls who felt atypical for their gender and/or were unhappy with stereotypical gender roles were most likely to report sexism and harassment.

The study appears in the May/June issue of Child Development.

When a woman turns 40, her doctor will likely suggest she schedule a screening mammogram, with a repeat screening every year or two. Mainstream organizations such as the American Cancer Society, and government institutions like the National Cancer Institute, recommend beginning routine mammograms at this age (women younger than 40 who have a higher than average risk of breast cancer are urged to discuss with their doctors whether they should get screened sooner).

Yet despite these recommendations, the value of routine mammograms for premenopausal women age 40 and over is hotly debated, with some women's health organizations and researchers raising questions about the risks.

Why the break with conventional wisdom? For starters, mammograms are an imperfect cancer detection method, and some studies show that routine mammography may do more harm than good -- especially for premenopausal women, who statistically have a lower risk of breast cancer.

These concerns, however, are routinely drowned out by public health campaigns that maintain mammograms are the best available tool for early detection. It's been up to breast cancer activists to address the limitations of current screening practices and call attention to the risks of unnecessary biopsies and treatments.

To be clear, the safety controversy focuses on the value of screening mammograms, not diagnostic mammograms, which are given to women who have a breast lump or other symptoms that require further investigation.

After analyzing a number of studies in the 1990s, the National Breast Cancer Coalition in 2002 changed its policy and no longer advises annual mammograms for healthy women, even those over age 50. The NBCC says here that based on scientific reviews, "the benefits of screening mammography in reducing mortality are modest and there are harms associated with screening."

Last year, in a newsletter to members, Cynthia Pearson, executive director of the National Women's Health Network, explained the history behind bringing the mammography controversy to light:

What we discovered in the 1990s was disheartening. In the aftermath of mammography screening's first trial, several other trials were undertaken, without impressive results. Screening's life-saving benefit was not found in all trials. It certainly wasn't found in the one trial designed to show the benefit of beginning mammography at age 40. NWHN went public with this information, and in 1993, issued a position paper recommending against screening mammography for pre-menopausal women -- a very controversial position. The breast cancer advocacy movement was just getting started back then, and many organizations had a hard time accepting the idea that screening mammography might not really be very effective.

We also found that many people were shocked at the very idea that screening could, in fact, be harmful. Here's why: screening leads to diagnosis, which leads to treatment. There is no treatment without risks. Treatment is often worth the risk when a condition is causing symptoms or is dangerous. But early cancer found through screening, when no symptoms are present, doesn't always progress to life-threatening, advanced cancer. We wanted to be sure that treating everyone found to have early cancer would actually help save women's lives. It was these considerations that led NWHN to tell women we believe that breast cancer screening should not be recommended for pre-menopausal women until it's been well-proven to do more good than harm.

"Times have changed but, unfortunately, the complicated nature of mammography screening hasn't," Pearson adds.

The main risks most often cited include the high incidence of both false-negative and false-positive results (and the problems that result from each), along with the potential risk of radiation.

About half of all premenopausal women, and one-third of postmenopausal women, have dense breasts, which makes their mammograms more difficult to read. In fact, women under age 50 have a false-positive rate 12 times higher than women age 50 and older. When a positive reading occurs, women are likely to experience psychological stress while waiting for a biopsy and the results (here's a recent study).

Biopsies are also problematic -- though the surgery is relatively simple, they can cause distress, scarring and, more rarely, medical complications. The NBCC notes that in the United States, it has been estimated that a woman's cumulative risk for a false-positive result after 10 mammograms is almost 50 percent, while the risk for undergoing an unnecessary biopsy is almost 20 percent.

Barbara Brenner, executive director of Breast Cancer Action, said research indicates that having more biopsies increases the risk of breast cancer, though the reason is unclear.

Another problem is that women are constantly being told "early detection saves lives," yet we know some breast cancers, by the time they're found, cannot be treated. Other cancers will never be life-threatening, and some will respond to currently available treatments. Unfortunately, the type of cancer cannot be determined at the time of diagnosis, which means the treatment can end up causing more harm than the cancer.

"Sometimes the side effects are deadly," said Brenner. "Some of the chemotherapy treatments increase the risk of heart disease or other cancers. Radiation treatment also increases the risk of other cancers."

So what's the bottom-line advice for a woman who just turned 40? According to Brenner, she should talk to her doctor to determine her individual risks and benefits.

"If screening mammography is less effective for a premenopausal woman, she'll need to decide with her doctor whether the risk posed by additional exposure to radiation is worth it," said Brenner. "This is a highly individual decision that requires knowing all the options -- including clinical breast exams and breast self exams, which are appropriate for women at all ages."

Plus: For further reading ...
* Our Bodies Ourselves provides an overview of the mammography screening controversy, along with links for further reading and interviews with researchers.

* Breast Cancer Action has more analysis of the benefits and shortcomings of breast cancer screenings and information on new breast cancer screening technologies.

* Maryann Napoli, associate director of the Center for Medical Consumers, argues in this article that women are not receiving honest information about mammography's harms.

* And the Oct. 15, 2003 issue of the Journal of the National Cancer Institute includes point and counterpoint articles on whether women have enough information to give true informed consent for mammograms.

Next month -- minus any national awareness campaign -- we'll look at related health care disparities concerning screening costs and access to the best and safest technologies.

Counselors the reporters spoke to for the article noted that it's good for women to reach out after an assault, but that posting too much personal information on sites such as YouTube and MySpace may make them vulnerable to retribution from the perpetrator. The piece also includes the statement, "a rape survivor must consider how they would feel if that information were dredged up in the future."

Although it is important to be careful online (as in "real" life), I wonder if this is terribly realistic advice given the large proportion of rapes that are committed by people the victims know. In Crystal's case, she had known her alleged rapist for some time. Does this simply reflect old offline attitudes that women who report rape will be judged and should avoid coming forward to avoid embarrassment or other retribution? Is asking rape survivors to consider the far-off potential future consequences over their current need to speak out and connect just another instance of victim-shaming?

I was able to locate the video in question, and was appalled by many of the comments. Several people don't seem to believe that statutory rape is a valid concern, others accuse the poster of lying to get attention, and some suggest that if an ongoing sexual relationship is present, rape is not possible. One commenter began by calling the piece "fake" and "bad acting," then went on to offer the discordant, "if it's true then sorry." Unfortunately, these kinds of comments increase the suffering of real victims and feed the notion that victims should simply keep quiet or risk having the worst assumed about their motives and truthfulness.

The article also reveals that RAINN's new secure online sexual assault hotline has served 10,000 people since it was launched in April of this year. I think this is a great new service (especially with declining public/pay phone availability), but I was floored that so many people had needed it in such a short time.

Note: If you're curious about Crystal's video, I do not recommend searching YouTube for the keyword "raped."

From The New York Times:

The court’s 4-to-3 decision striking down state laws that had limited marriages to unions between a man and a woman makes California only the second state, after Massachusetts, to allow same-sex marriages. The decision, which becomes effective in 30 days, is certain to play a role in the presidential campaign.

“In view of the substance and significance of the fundamental constitutional right to form a family relationship,” Chief Justice Ronald M. George wrote of marriage for the majority, “the California Constitution properly must be interpreted to guarantee this basic civil right to all Californians, whether gay or heterosexual, and to same-sex couples as well as to opposite-sex couples.”

Of course, it's not all smooth sailing from here, as the L.A. Times notes:

The state high court's 4-3 ruling was unlikely to end the debate over gay matrimony in California. A group has circulated petitions for a November ballot initiative that would amend the state Constitution to block same-sex marriage, while the Legislature has twice passed bills to authorize gay marriage. Gov. Arnold Schwarzenegger vetoed both.

Here's a PDF of the court ruling and reactions in California. Our reaction: w00t!

One commenter posted a response from her anesthesiologist friend, who discussed his concerns about the safety of nitrous oxide for both the laboring woman and other people in the room exposed to the gas. After reading the anesthesiologist’s concerns, Judith Rooks, a nurse-midwife, epidemiologist, and Our Bodies, Ourselves contributor, felt compelled to respond. She sent us a long, detailed email breaking down his concerns one by one, and addressing what she believes is misinformation about what is known about nitrous oxide and the risks of epidurals. We’ve decided to post the entire email here (with permission). The original comments are posted in bold, with Judith's response immediately following.

"Nitrous oxide in trace amounts is considered a biological hazard. It must be scavenged, which is difficult to impossible for someone who has just been taught to self-administer while in labor."

Yes, nitrous oxide (N2O) is a biological hazard, but not all biological hazards are equal. Nitrous oxide is produced by trees, among other sources, so some of it is a natural part of our environment. I mention this just so that no one thinks it is like Sarin, e.g., which is a very deadly gas even in minute quantities. N2O has been used as a component of anesthesia for more than a hundred years, and as an analgesic for women during labor for nearly a hundred years. It is the most widely used labor analgesic in the UK, Sweden, Finland, and many other countries. It is also widely used for analgesia during dentistry in this and other countries. American dentists find it particularly useful for children, and it is often used by pediatricians during necessary procedures on children.

"There is a tremendous abuse potential for N20, and perhaps other countries do not seek to control access, but the US does. Dentists often abuse N2O, resulting in neuropathy. N2O cylinders sitting around would be likely to be abused."

There is potential for abuse of N2O in hospitals, just as there is potential (and actual) abuse of almost all drugs that are used for pain abatement. But N2O canisters are not just sitting around in those hospitals in which it is used. (FYI, it is used not only in surgery and labor, but in many emergency rooms, and in many women's health care centers, where it is used during procedures.) Hospitals have to control many substances, including blood, bacterial contamination, radio-active substances, and all pain medication, among others. No US hospital would just let any of those materials "sit around" without control. Nitrous oxide is not, however, the substance which provides the biggest risk of abuse in the US, and to the extent that N2O is abused, there are many sources easier to access than a hospital. Canisters of it have traditionally been thrown from floats during Mardi Gras parades, and somehow or other, teenagers seem to be able to get it for getting happy (it's called "laughing gas", after all) during rock concerts. It is also sold in every can of fake whipped cream; push the button and the fake cream gets fluffed up by N2O. Some tattoo parlors also use it. The possibility of abuse is not an acceptable reason to fail to provide a service or product that is needed for serious purposes.

"Nitrous can be administered in a "safe" 50% mixture with O2, but the results can be highly variable and are unpredictable. Some patients get little relief, while the same inhaled concentration could render others unconscious."

Dr. Rosen described it as “safe for parturient women, their newborns, and health-care workers in attendance during its administration.” He has provided it to women during labor for more than 30 years and has never seen either a woman or a baby be harmed as a result. It is true, however, that the effectiveness of nitrous oxide analgesia is unpredictable. Although about two-thirds of women find it to be effective “enough” and are satisfied, a few women report that it was not helpful. A consumer oriented book co-authored by Dr. William R. Camann, Director of Obstetric Anesthesia at Brigham and Women's Hospital in Boston and a past president of the Society for Obstetric Anesthesia and Perinatology (Easy Labor: Every Woman's Guide to Choosing Less Pain and More Joy during Childbirth. New York: Ballantine Books; 2007) noted that "The gas can cause nausea and vomiting in some women" and that "Very rarely, if too much gas is inhaled, it can result in a loss of consciousness." But that does not happen if the rule of self-administration is followed, as it would be in any setting that provides careful care to women during labor. As Dr. Camann noted, "The mask will not be attached to you while you inhale the gas. This is intentional and will prevent you from inhaling too much gas at once. If you become too drowsy as a result of the gas, you will no longer be able to hold the mask or mouthpiece to your face." He also noted that there are no known clinical side effects to impact the newborn.

Dr. Camann described the effectiveness as "a kind of strange sensation of feeling the pain while at the same time feeling a sense of bliss. So, the pain may still exist for some women, but the gas may create a feeling of: "Painful contraction? Who cares?!"

The graphics are a bit surreal to look at in print, but it makes more sense online, where each body part is an interactive link to a related story (don't say you weren't warned that the shoulders and knees lead to nowhere). Online additions include links to exercises, test-your-knowledge quizzes and health risk calculators.

Update: The knee now connects, as you might expect, to a story on knee surgery.

The interview covers the rate of cesarean sections in the United States; how other countries compare when it comes to care during pregnancy and delivery; what OBOS is up to these days; and lots more. Here's an excerpt:

You’ve been doing this kind of work for so many decades. How do you keep your spirit and your energy up? Seeing the effects of our work is tremendously rewarding and energizing. Also, working with younger women who are now assuming leadership roles in the women’s health movement is inspiring. I love to learn in an inter-generational setting.

Is their a presidential candidate you feel has a strong handle on the health care needs of the U.S., especially women's health, and why?
Both Clinton and Obama have pretty good understandings of women’s health care issues, but I am disappointed that neither is so far willing to challenge the pharmaceutical or insurance industries in ways that I believe to be essential. Hopefully, that will change.

Read the rest here. Thanks, Feministing!

The story is notable not only for Connors' reach in describing how her life (and by extension her husband and children) was affected by the rape, but she also sets out to learn more about her rapist -- and in doing so peels back the layers on a family trapped in a cycle of violence and abuse toward women. While exploring the related race and class issues, Connors raises many questions as she sets about trying to answer them.

All the sections to the series are available here, along with an introduction by the paper's editor and resources for victims of rape.

Plus: Editor & Publisher looks at responses to Joanna Connors' story.

Are Doctors Shilling for Drug Companies on Public Radio?: Check this out -- as Shannon Brownlee and Jeanne Lenzer write at Slate:

A few weeks ago, devoted listeners of public radio* were treated to an episode of the award-winning radio series The Infinite Mind called "Prozac Nation: Revisited." The segment featured four prestigious medical experts discussing the controversial link between antidepressants and suicide. In their considered opinions, all four said that worries about the drugs have been overblown.

The radio show, which was broadcast nationwide and paid for in part by the John D. and Catherine T. MacArthur Foundation, had the air of quiet, authoritative credibility. Host Dr. Fred Goodwin, a former director of the National Institute of Mental Health, interviewed three prominent guests, and any radio producer would be hard-pressed to find a more seemingly credible quartet. Credible, that is, except for a crucial detail that was never revealed to listeners: All four of the experts on the show, including Goodwin, have financial ties to the makers of antidepressants. Also unmentioned were the "unrestricted grants" that The Infinite Mind has received from drug makers, including Eli Lilly, the manufacturer of the antidepressant Prozac.

Continue reading ....

For Prospective Moms, Biology and Culture Clash: Just before Mother's Day, NPR's "Morning Edition" looks at the rising age of first-time mothers and the "clash" between culture and biology.

The average age of first-time mothers in the United States has been rising steadily over the past four decades -- up from 21.4 in 1970 to a little over 25 in 2005, the National Center for Health Statistics reports. [...]

"Women are no longer marrying the boy they met in high school," [Rutgers anthropologist Helen] Fisher says. "They're concerned with getting a career before they marry. This takes time."

But this is time on the biological clock that cannot be recaptured. ...

I appreciate that the story includes a couple sharing household duties while both work, and Fisher notes that businesses are recognizing women want to keep their careers, but there's still a tone of women should know better -- and should get on with making babies.

A story on, say, the glacial speed of government and business to provide adequate paternity and maternity leave and to accommodate breastfeeding moms returning to work -- along with the lack of access to quality childcare and the advocacy work of groups like Moms Rising -- would be a more welcome and appreciated "Mother's Day" story.

Plus: This Wall Street Journal's Heath Matters column focuses on unplanned pregnancies later in life. Close to 40 percent of pregnancies among women over 40 are unplanned, according to a 2001 survey by the National Center for Health Statistics in Atlanta, the most recent data available.

Public Citizen Calls on FDA To Withdraw Ortho Evra Patch From Market: Public Citizen's Health Research Group called on the FDA this week to withdraw the birth control patch Ortho Evra from the market, citing studies that found an increased risk of dangerous blood clots, reports Reuters.

"The considerable safety concern of high-dose, variable estrogen exposure tips the balance of risks and benefits against the availability of Ortho-Evra as a contraceptive," wrote Sidney Wolfe, head of the research group.

A Better Method for Handling Rape Kit Evidence: Jessica Voorhees Norris, a Ph.D. candidate in forensic chemistry at University of Virginia, has created a method for handling rape kit evidence that reduces part of the DNA analysis time from 24 hours to as little as 30 to 45 minutes and improves the sperm cell recovery rate by 100 percent, according to this university release.

If her method was to be adopted by forensic labs -- and the results accepted by courts -- the backlog could potentially be reduced within months.

"There is an overwhelming demand for DNA analysis of sexual assault evidence, but laboratories have neither the funding nor the manpower to handle the caseload in a timely manner," Norris said. "Juries have come to expect DNA evidence in sexual assault cases, but forensic labs are not able to perform in a timely and efficient manner due to limitations in the currently used technologies."

"Homosexuality," "Sexually Explicit" Most Common Reasons for Challenging Books: For the second year in a row, "And Tango makes Three," a children's story by Justin Richardson and Peter Parnell about two male penguins caring for an orphaned egg, was the most "challenged" book in U.S. public schools and libraries, according to the American Library Association.

Other books in the top 10 cited as "sexually explicit" include "The Color Purple" by Alice Walker; "It's Perfectly Normal," by Robie Harris; and "The Chocolate War," by Robert Cormier.

"Overall, the number of reported library challenges dropped from 546 in 2006 to 420 last year, well below the mid-1990s, when complaints topped 750," reports the Associated Press. "For every challenge listed, about four to five go unreported, the library association estimates."

National Women's Health Week: We here at OBOS like to think of every week as Women's Health Week, but next week it's official: National Women's Health Week runs May 11 - May 17, and the push this year is to encourage women to make their health a top priority and take simple steps for a longer, healthier and happier life.

Consider that in many rural areas a hospital can be hours or even days away, and the urgency of medical attention becomes clear. Given this dire situation, some health researchers are working on promoting the adoption of less-invasive, evidenced-based medical practices to prevent excess bleeding from occurring during childbirth and simple innovations that can help stem the blood flow when there is a problem.

One low-tech device that can be used to help women who are hemorrhaging and who don't have immediate access to maternity care interventions is the LifeWrap. Also known as a non-pneumatic anti shock garment (NASG), the LifeWrap -- which resembles a partial wet suit -- is made of neoprene and Velcro, and it literally wraps around the lower body, using pressure to treat shock, resuscitate, stabilize and prevent further bleeding in women with obstetric hemorrhage.

Check out a video here to see how it works.

Dr. Suellen Miller, director of Safe Motherhood Programs at the UCSF BIxby Programs for Global Reproductive Health, is currently conducting foundation-funded studies of the LifeWrap to treat maternal hemorrhage in Nigeria, Mexico, Egypt, Zambia and Zimbabwe. She is also working with Pathfinder International on a postpartum hemorrhage project in India.

What has the research shown so far?

In 2004, Suellen Miller, Dr. Paul Hensleigh, and their Egyptian colleagues, conducted a pilot study at four large hospitals in Egypt. Study participants who suffered severe obstetrical hemorrhage and shock were treated according to standard management or standard management AND the LifeWrap.

There was a 50% decrease in bleeding for the women treated with standard care AND the LifeWrap. 75% fewer women in the LifeWrap died or had severe maternal morbidity.

That's super impressive, but as the LifeWrap website points out, larger studies are needed, especially for funding.

These studies would provide the scientific, clinical and statistical evidence required by donor and advisory agencies (World Health Organization, UNICEF, UNFPA, USAID) before they will contribute the funds necessary to distribute the LifeWrap globally.

With Mother's Day around the corner, now's a great time to make a donation to LifeWrap to help speed up distribution -- $160 buys one LifeWrap, which can be used up to 50 times.

In other news this week, a University of North Carolina at Chapel Hill School of Public Health study that was published in the New England Journal of Medicine found that relatively inexpensive interventions helped health care providers in Latin America improve the way they treat mothers during labor and delivery, especially when it came to reducing blood loss.

The teaching techniques focused on behavioral change strategies aimed at modifying practices. According to the study, researchers were able to reduce the number and severity of episiotomies at public hospitals in Argentina and Uruguay and increase the use of the hormone oxytocin – which is given to mothers to make their uterus shrink and bleed less during the third stage of labor.

"Both of these changes greatly reduced the amount of blood mothers lost during childbirth, with mothers in the intervention hospitals losing 44 percent less blood," said Marci Campbell, a professor in the UNC School of Public Health whose research focuses on health interventions.

"This randomized trial showed that knowledge alone does not change behavior," Campbell said. "It takes the combination of opinion leaders, personal visits, reminders, and support to change behavior. This change is especially important for developing countries where maternal hemorrhage is a major health threat. However, the intervention also could be beneficial in developed countries, including many parts of the United States, where rates of routine episiotomy are still above optimal."

The study by the U.S. National Cancer Institute appears in the April 30 online edition of the journal Breast Cancer Research.

Researchers found that aspirin (but not other painkillers) reduced the risk of estrogen receptor-positive breast cancer, which accounts for some 75 percent of all breast cancers.

Barbara Brenner, executive director of Breast Cancer Action, noted that the theory behind aspirin use has been around for many years (see, for instance, this BCA 2004 newsletter article).

"If this works, it is a very exciting development for a lot of people who are thinking about how we can control not only cancer, but the price of cancer drugs," said Brenner.

She stressed that aspirin would not be "a cure-all, it's only reducing the risk of estrogen positive-breast cancer."

Other pluses include the fact that aspirin is inexpensive and relatively non-toxic for most people, though the American Cancer Society does not recommend using aspirin because of its link to gastrointestinal bleeding.

"There are risks with aspirin, and there are people for whom aspirin is not indicated," Brenner said. "But they might want to talk to their doctors about this study and whether aspirin is appropriate for them."

It's important to remember, however, that aspirin is not a breast cancer preventative.

Plus: Also check out BCA's policy on pills for prevention.

The bill calls for a long-term study of the health of women serving in Iraq, an assessment of barriers for women seeking care at Dept. of Veterans Affairs facilities and of the VA's provision of health services to women, training of VA staff on treating women veterans who have experienced sexual trauma or PTSD. Although reliable estimates of military sexual assault and PTSD among women veterans are difficult to obtain, some authors have suggested that rate of sexual assault is 30% or higher. It also includes measures that would assist with child care while women are being seen by VA providers, and a requirement for VA medical centers to have a full-time women veterans program manager.

The bill has been referred to the Senate Committee on Veterans' Affairs, although it is not clear when the committee will consider the legislation. A companion bill (HR 4107) was introduced in the House last November and was referred to the Subcommittee on Military Personnel.

"I think it would help mostly because it would send a message that fat people are equal citizens. It's not in the litigation rates, but the rights consciousness that comes after legislation," said Anna Kirkland, an assistant professor of women's studies and political science at the University of Michigan who is author of the new book, "Fat Rights: Dilemmas of Difference and Personhood," which examines the question of whether weight should be a protected category.

The story goes on to discuss a law to ban discrimination against weight and height pending in Massachusetts. Here's the text of House bill 1844 (PDF), sponsored by Rep. Byron Rushing.

Rushing has offered similar bills six times in the last 12 years. He told the Trib that last month's public hearing on the bill showed "there is a growing number of people who think this should happen and an even larger number of people who think we should at least be talking about it."

Similar anti-discrimination legislation is already in place in Michigan and the District of Columbia, and cities such as San Francisco, Santa Cruz and Madison.

"It's not really about litigation, but about taking a stand," said Marilyn Wann, a fat-rights activist who testified at the Boston hearing and helped get San Francisco's law passed in 2000. "I do think when a government says it's not OK to dismiss someone as a person because of weight, that's helpful."

Plus: Read Fat People: Please Stop Existing at Big Fat Blog.

There isn't a tremendous amount of research on nitrous oxide during birth, but a 2002 systematic review highlights some basic information about this technique. The authors note that the gas does not appear to affect the fetus or newborn or depress uterine contractions, although women may experience some lightheadedness and may have a slight delay in pain relief as the gas takes ~50 seconds to achieve its full analgesic effect. They also note that the gas can be both administered and stopped quickly.

Most interesting, perhaps, is this assessment of how widely use of nitrous oxide varies from country to country - "By the 1980s, use of nitrous oxide had almost disappeared in the United States. In the United Kingdom, it has been estimated that nitrous oxide is used by approximately 50% to 75% of women and in Finland by approximately 60%. Nitrous oxide is used and widely considered to be safe in many parts of the world including Canada, Australia, and New Zealand, supervised by physicians, nurses, or midwives."

It is not entirely clear why this option isn't more readily available in the United States. I'd be interested in hearing from readers as to whether nitrous oxide was available to you in labor - let us know in the comments! If you're in the UK or elsewhere with common use of this option, please share your thoughts as well.

Citations for further reading:

• Rooks JP. Nitrous oxide for pain in labor--why not in the United States? Birth. 2007 Mar;34(1):3-5.
  
• Rosen MA. Nitrous oxide for relief of labor pain: a systematic review. Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S110-26.

Richard Wiles, executive director of the Environmental Working Group, called the EPA process a "bureaucratic quagmire," adding, "With these rules in place, it's now official: The Bush White House is where all good public health protections go to die."

Death in Childbirth a Health Scourge for Afghanistan: Reuters takes a close look at the staggering maternal death rate in Afghanistan, where about 1,600 Afghan women die in childbirth out of every 100,000 live births.

"In some of the most remote areas, the death rate is as high as 6,500. In comparison, the average rate in developing countries is 450 and in developed countries it is 9," writes Tan Ee Lyn. "Virtually everyone in Afghanistan can recount a story about a relative dying in childbirth, often from minor complications that can be easily treated with proper medical care."

Plus: Read our previous posts on Afghanistan and maternal health -- and how the United States has mismanaged funding and programs intended to improve hospital conditions.

The Disney Hyprocrisy: From Slate: Forget Miley Cyrus. Check out Disney's Chinese underwear ad. Just go.

Plus: There's a new book out on the sexualization of 'tween girls: "The Lolita Effect," by Gigi Durham, a University of Iowa journalism professor.

"I'm criticizing the unhealthy and damaging representations of girls' sexuality, and how the media present girls' sexuality in a way that's tied to their profit motives," said Durham in this release. "The body ideals presented in the media are virtually impossible to attain, but girls don't always realize that, and they'll buy an awful lot of products to try to achieve those bodies. There's endless consumerism built around that."

Divorce Leads to Job Loss: So imagine you're a professor and you're going through a divorce. Your college requires that you talk with a staff member to see whether the grounds for divorce meet Biblical standards. If you don't, you'll lose your job. Yep, that's what happened to a popular English professor who has taught at Wheaton College in Illinois for 20 years. From the Chicago Tribune:

Many theological conservatives say the New Testament permits divorce only in cases of adultery or desertion. Wheaton requires faculty and staff to sign a faith statement and adhere to standards of conduct in areas including marriage, said Provost Stan Jones.

Still, every year, the college has dealt with several cases in which it must evaluate the divorce of a job applicant or a staff or faculty member and consider whether it matches the exceptions laid out in Matthew 19 and the writings of the Apostle Paul.

I admit I'm not up on Bible readings, but what about, say, domestic abuse -- along with a host of other very good reasons?

Genetic Link to Osteoporosis: "Researchers have identified two common genetic mutations that increase the risk of osteoporosis and related bone fractures, according to a study released Tuesday," reports Reuters.

U.S. Federal Funding for HIV/AIDS: The Kaiser Family Foundation has released a new fact sheet on federal funding for HIV/AIDS in the President’s Fiscal Year 2009 budget request, and comparisons over time, with key funding highlights for domestic and global HIV/AIDS programs. It also includes additional information on federal funding for global TB, malaria and other global health efforts.

Can I Get A May Day for Immigrant Women's Health?: "May Day, May 1st, has come to hold the promise of rallies for immigrant rights staged across the United States. And this year is no different. But with McCain's more-of-the-same health care plan having just been released, it's a perfect time to focus on why women's reproductive health care must be a crucial part of any discussion about immigration reform," begins Amie Newman's essay at RH Reality Check.

Rescue Us From Our Bodies: Here's a nice round-up of responses to Midol's new "Reverse the Curse" campaign.

Stop the Mommy Madness: Salon talks with feminist activist Amy Richards, whose new book is titled "Opting In: Having a Child Without Losing Yourself."

Plus: Rachel Fudge reviews "Opting In" for Mother Jones.

More Mothers Breast-Feed, in First Months at Least: "About 77 percent of new mothers breast-feed their infants at least briefly, the highest rate seen in the United States in more than a decade, according to a government survey released on Wednesday," reports The New York Times. Enthusiasm, however, was tempered.

Breast-feeding experts said that they were cheered by the report's numbers but noted that rates of breast-feeding at 6 months of age have remained unchanged and are significantly lower than goals set by government agencies. The most recent C.D.C. survey did not report breast-feeding rates at 6 months because of a lack of data. [...]

In the most recent survey, breast-feeding rates increased among non-Hispanic black women to 65 percent from 36 percent in 1993 and 1994. Eighty percent of Mexican-American infants and 79 percent of non-Hispanic white infants had been breast-fed.

The age and income of mothers played important roles. Just 57 percent of poor mothers and only 43 percent of mothers under 20 breast-fed their infants, the survey found.

Dr. Barbara L. Philipp, associate professor of pediatrics at Boston University, said the C.D.C. survey had not asked mothers whether they breast-fed exclusively. "One sip was positive, so they set the bar very low," Dr. Philipp said.

by Pauli Ojea

In the late 1980s, a group of women in a breast cancer support group decided it was time for change. These women, who met regularly to share information and to support each other through their experiences, felt there was more they could do, more they needed to do. Frustrated by the lack of reliable information about the disease and the lack of support most women with breast cancer received, they wanted to change the situation for all women facing breast cancer.

So, in a San Francisco living room in 1990, the women set out to do something about it: They formed Breast Cancer Action (BCA).

Their goal was to move breast cancer from an individual woman's private medical crisis to a public health emergency. The founders put their political know-how, passion and courage to work in order to bring national attention to what was then a rarely mentioned issue.

Fast-forward to 2008. BCA is now a national education and advocacy organization with 19,000 members, a 10-person staff, and hundreds of activists and volunteers in the United States and abroad.

Although breast cancer has received a lot of attention, the problem has not been fixed. And BCA is still here to help change things. Sadly, all but one of the original founders have passed away, but the vision set for the organization almost 20 years ago lives on.

BCA continues to work for change on the political and social issues that have a significant impact on this disease. One of BCA's biggest priorities is advocating for more effective, less toxic treatments for breast cancer patients. Central to this work is the role of the FDA -- the agency that can help, or hinder, the adoption of these treatments.

There's been a lot of press coverage lately about the FDA's failure to do its job. In addition to concern that the agency is overstretched and under-funded, there are also concerns about the overwhelming influence of the pharmaceutical industry. The impact of this influence can be felt in many ways. For example, drug companies are currently trying to convince the FDA to loosen regulations on off-label marketing of drugs.

Off-label means that the drug is being prescribed for a condition for which it has not yet been approved. Although it's legal for a doctor to prescribe drugs off-label, current FDA rules don't allow drugs to be marketed this way, since approval is based on clinical trials for specific uses. But the drug companies now want the right to market drugs to doctors for unapproved uses.

Why does this matter? Drug company reps would be able to visit your doctor (perhaps over an expense-account lunch), talk about other problems their drug could be used for (other than those for which it's been approved), and leave behind medical journal articles depicting the drug's benefits in unapproved settings.

While such information may seem beneficial, remember that drug companies are often involved in the studies the journals are covering -- sometimes disclosing their involvement; sometimes not. Besides, if there were enough research to clearly demonstrate the safety and efficacy, the drug would be approved for this use. But drug companies are not as comfortable advertising this point.

Of course, it's in the drug industry's best interest to see their drugs used for more diseases: More use translates into bigger profits.

The example above is just one of the many ways the pharmaceutical industry attempts to get its way at the FDA. BCA has urged the FDA to make the right choice for public health by not loosening regulations on off-label marketing. The FDA will make its decision soon.

We need less pharmaceutical company influence in health care decisions, not more. For the FDA to do its job well, and to effectively protect the public's health, the balance of power at the agency needs to shift away from the drug companies and toward the interests of patients.

Pauli Ojea is the community organizer at Breast Cancer Action, where she mobilizes people to do something besides worry. To learn how you can join BCA in speaking up for public health over private profit, click here.