7 Disruptive Ways to Celebrate Mothers’ Day

It’s about time that we looked at Mothers Day expansively and rocked the boat. Lots of positive vibes could be set in motion. Some of my thoughts:

1.     Press for action and donate to organizations devoted to preventing unnecessary maternal deaths around the world and in the United States.

 Every Mother Counts is worthy of your donation, as are numerous other organizations, including Samahope, WeActx, the International Planned Parenthood Foundation, Partners in Health, and undoubtedly many more. India and Nigeria account for more than one-third of the world’s reported maternal deaths, but maternal deaths are far too high in many countries and are rising in the United States.

Expedited training of skilled birth attendants, access to emergency obstetrical care, ultrasound, promotion of prenatal care, and access to safe abortion are urgently needed. According to the World Health Organizations, the major complications that account for 80% of all maternal deaths are:severe bleeding (mostly bleeding after childbirth); infections (usually after childbirth); high blood pressure during pregnancy (pre-eclampsia and eclampsia); and unsafe abortion.

In the United States, maternal death rates are rising. Efforts to lower maternal deaths need to be comprehensive and target risk factors and environmental barriers to care. State differences, shown here, are striking. Disparities by race and class are also important. In the United States, since 2011, the Maternal Health Accountability Act of 2011 has been floating around Washington. It would establish accountability, fight maternal health disparities, and combat severe maternal complications. Ask your representative to co-sponsor the bill and get it through.

2.     Buy a copy of Trans Bodies, Trans Selves for your mom or a friend’s mom.

This book, compared to the landmark Our Bodies, Ourselves, looks like it could radically inform and transform views on transgender people. I have seen excerpts and I am very impressed. The Washington Post review is extremely positive. Let’s not let transgender equality lag behind. Think outside of the box: don’t forget that trans moms are out there.

3. Press your elected officials for a national long-term care policy for our moms and dads.

Please, don’t turn the page here. The safety net is failing our aging moms—and dads for that matter—and yes the population is getting older. Think about it: are you going to be able to support your parents? Will they be able to support themselves? (I won’t bore you with the obvious here.) We need a comprehensive, national long term care policy.

Older Women’s League National Mothers Day Report 2014, released Friday, points out:

“The American public still lacks understanding about long-term care; where it occurs, how to plan for it, and why comprehensive, thoughtful, and rational long-term care policy is of importance to all Americans.” 

The Report can help you get up to speed on how we could create and sustain a long-term care system that permits Americans to remain financially solvent, independent, and with a decent quality of life.

4.     Move beyond thinking about mother’s day with a narrow compass. Single moms, lesbian, gay, and transgender moms, and moms with HIV, are just some of the groups overlooked in traditional mother’s day celebrations. Shake up the usual mother’s day celebrations by including them.

 5.     Donate or volunteer to stop restrictions to abortion access in the United States and around the world. Every pregnant woman cannot go through a pregnancy.

A recent article by @irincarmon addressed the end of abortion access in the South. Of course, we know that this is far from the only restriction out there. Consider donating to abortion access projects. Here are some ideas: the National Network of Abortion Funds  A few others that you might want to consider are listed here: Texas , North Carolina, and in Kansas, the SouthWinds Women’s Center, where George Tiller worked.

Globally, access to safe abortion –all too often– does not exist. I addressed the outrageous roadblocks that Beatriz faced in El Salvador last year in getting access to abortion. Her story is emblematic of countries that have been firmly opposed to abortion as a basic human right. Donate to the groups linked to above, which can save women’s lives.

6.     Keep the pressure up to #bringbackour girls every day.

Take the pressure to your elected officials, to twitter, to Facebook. Stay informed. I wish I had a solution that would bring these girls back. If you have ideas, please put them in the comments.

7.     Make a yearlong commitment to the fight for equity and women’s health by volunteering in campaigns or donating what you can afford. Many organizations are happy to get donations as small as $5 a month.


Hope that you take time to comment below!

 …and now for a moment of shameless self promotion! There’s been a hiatus on PatientPOV. Writing about ways to disrupt healthcare, end inequality, and build social change is my first love, but I cannot afford to do work like this without $ support. Contact me @lauranewmanny for paid writing opportunities or support this blog with a Paypal donation above.


Making Gender Justice, Birth Control,
And Abortion Access Health Priorities

Women’s health and life are under fire in the United States and around the world. Here are  issues that health policymakers need to incorporate into health quality. It’s time to stop marginalizing them.

Last week, women’s groups coordinated by the Women’s Media Center and Everyday Sexism, successfully organized a campaign against Facebook rape #fbrape to get advertisers to pull ads off the site unless it pledged to monitor and remove content condoning violence against women. It was successful: the campaign led to an editorial in the New York Times,  and papers and social media nationally and internationally. The campaign’s success suggests organizing other campaigns around gender justice and reproductive rights may pick up steam and make the world friendlier to women.

Delaying “Beatriz” Access to Abortion Unconscionable

Broad international outrage over the forced continuation of one woman’s pregnancy with an anencephalic fetus, i.e. a fetus missing most higher brain structures, in El Salvador, led to an international court ruling that a woman’s pregnancy must be terminated.

Another issue in this case concerns detection of an anencephalic fetus. A routine fetal ultrasound will clearly show a fetus lacking parts of the brain. Because anencephalic fetuses have never lived more than a few hours after they are born, women who learn that their fetus lacks higher brain structures, choose to have an abortion as soon as it is detected. This option was not open to “Beatriz” because abortion for any reason is illegal in El Salvador. In states that block women from speedy abortion access, women will also have to prolong a useless pregnancy like this.

“Beatriz” also had her own health risks, namely lupus and kidney failure, which made her continued pregnancy hazardous. But that carried no weight in El Salvador, nor does it carry much weight with far too many legislators in the United States and elsewhere. That’s worrisome.

“Beatriz” had a cesarean section under general anesthesia at 26 weeks of gestation. The fetus died shortly after the procedure. Broad consensus exists in the ob/gyn and public health community that cesarean section abortions (hysterotomies) are hazardous and that an induced abortion would have been far safer. In fact, in the United States, these procedures are rarely done.

Frances Kissling, President of the Center for Health, Ethics and Social Policy, and past-president of Catholics for a Free Choice, had this to say: “ I totally agree that an early abortion should have been performed and the case is an example of extremist anti-abortion medicine…We have every right to condemn the delay, the decision to incur greater risk by performing a hysterotomy rather than use the best technique for abortion in her case. We also should reject the noting of trying to save both woman and fetus, especially when the fetus has no chance of more than minutes of survival. This way of constructing cause and effect is hooey, which results in women’s death and/or suffering.”

The Vast Scope of Reproductive Control Practices

El Salvador and several other countries in Central and Latin America have some of the most regressive policies internationally on abortion. A Foreign Policy post this week points this out. As shown repeatedly, in countries that block access to abortion and contraception, maternal and child health outcomes suffer.

You don’t have to look very far to see that access to birth control and abortion are getting blocked. Legislation on the books and proposed, puts discriminatory hurdles up to women getting contraceptives and abortion. Sadly, federal programs and religious organizations are controlling access. Unscientific, biased regulations, including waiting periods, mandatory fetal ultrasounds that pregnant women must view, and onerous abortion facility construction requirements are just some of the barriers. Efforts to pressure women to continue unplanned pregnancies must be stopped.

The so-called “pro-life” fanatics will stop at nothing to state their case. Just like edited ACORN tapes by James O’Keefe and Hannah Giles on Andrew Breitbart’s website that went viral at first uncritically,  Live Action anti-abortion fanatics have gone to abortion clinics using secret microphones and cameras, photoshopping and editing alarmist videos for their cause. As Carol Joffee, MD, notes in this article: “I fear that a possible consequence of these Live Action videos may be a chilling effect on the free and open conversation between clinic staff and patients that is such an important part of abortion care.”

Honoring and Organizing for Quality Women’s Health

In the past week, we remembered the four-year assassination anniversary of George Tiller, abortion provider who was murdered by anti-abortion fanatics, as well as the death of Henry Morgentaler, Canadian doctor who helped spearhead legalized abortion. Conscientious providers who provide quality reproductive care merit thanks from us too.

We must continue to organize to protect access to contraception and reproductive care. As Robin Marty and Jessica Mason Pieklo note in their new book, Crow After Roe: How Separate But Equal Has Become the New Standard in Women’s Health and How We Can Change That, a separate, discriminatory standard of health care for pregnant women is expanding rapidly across the United States. Our elected officials must be held accountable.

Patient POV Update: Immigration and Abortion News

I regret not posting here recently. It’s been a very busy time for me and I am following several issues that will make their way to this blog soon. I can’t give you a rank order of what’s most important, but I think there is a heck of a lot going on out there that warrants an in-depth look.

Immigrants with Mental Illness Need Rights to Counsel

US Homeland Security citizenship and immigrationImmigration is becoming a big issue (no surprise) since the Boston bombings.

The US Department of Homeland Security handles deportations. If you can,  grab a copy of this week’s New Yorker, I highly recommend reading: “The Deportation Machine.” It’s a horrifying story about what happens when a mentally ill person gets trapped by the Department of Homeland Security. In this case, the person was U.S. born! Authorities had good information and bad information, but whenever they uncovered good information, they wrote it off as being wrong.

On a related note, in California, a class action suit is underway that raises the issue that mentally ill immigrants should have access to counsel before they are hurdled into deportation. It’s a right that has been denied unfairly until now. The case may come to closure in the coming weeks.

Separating the Gosnell Case from Safe, Legal Abortions

Kermit A. Gosnell is a 72-year-old black doctor who performed abortions at  Women’s Medical Services, an abortion clinic in Philadelphia. Many women treated there were poor and black. Abortions were done late, many beyond the legal limit of 24 weeks for abortion in Pennsylvania.

It’s the one and only case that I’ve ever heard of since abortion became legalized in 1973 rife with charges of a doctor operating outside the law,  aborting viable infants long past legal gestational age for abortions in Pennsylvania, stockpiling infant parts in jars, filthy conditions, using unlicensed staff to do abortions, and practicing outside of the law. I am appalled by the conditions presented related to this case. However, it is noteworthy that the Judge cleared Gosnell of several charges earlier this week, as reported in the New York Times last night.

The case has been on my mind quite a bit. I was active in the movement to legalize abortion. and writing about this case requires attention to detail. The lurid details of the case revolt people, no matter what side of the abortion spectrum they are on.

Concerns I have about this case include the following:

  • that Gosnell is brought to justice;
  • that the media makes clear that Gosnell is a renegade, who based all accounts, operated outside the law, with no regard for safety.
  • that Gosnell does not resemble licensed abortion providers;
  • Legal abortions are extremely safe, far safer than childbirth;
  • Restrictive abortion laws do not serve the public’s health, but that make it unacceptably onerous for women to get timely abortions and clinics to operate economically.

I hope that the public and lawmakers put this case into proper perspective because it could unjustly continue policies that already have negatively affected access to timely abortions in many states.

I have serious concerns about the media handling of this story. My points are actually quite different from what you might have read. Expect to hear more from me on this in the coming weeks.

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We Need to Recognize Conscience
In Provision of Reproductive Services

The Obama Administration made a concession to Catholic leaders yesterday, bowing to conscience-based refusals to subsidize contraception coverage. At the same time, a compromise was struck enabling women who work for Catholic nonprofit institutions to use separate insurance plans independent from the church to obtain coverage for contraception at no out-of-pocket cost. The National Health Law Program stated: “Today’s announcement is largely a victory for women who have been fighting alongside health advocates for the past two years while employers threatened to deny women coverage for birth control in the courts and as lawmakers attacked and resisted implementation. No employer should be able to make personal decisions for their employees, including whether or when a woman is able to access birth control.”

However, the conscience-based contraception and abortion refusers are unlikely to let rulings like this stick. They promise to keep pressing for exemptions to providing reproductive services based on conscience.

But the Catholic Church does not have a monopoly on conscience. I neglected to cover an important New England Journal of Medicine Perspectives piece last fall, also overlooked by the mainstream press by Lisa H. Harris, MD, PhD.  Harris drew attention to recognizing conscience in abortion provision.

Harris pointed to “an ongoing false dichotomization of abortion and conscience, making it appear that all abortion opponents support legal protections of conscience and all supporters of abortion rights oppose such protections, with little nuance in either position.” What perpetuating this falsehood has done is permitted laws that fail to protect caregivers who are compelled by conscience to offer care, rather than refuse it, Harris argues.

Like many readers, I cannot believe that we are back to trying preserve the legalization of abortion and access to contraceptive care services. Day after day, roadblocks to reproductive care services are introduced, many claiming moral superiority, we need to underscore, as Harris and many others before her have done, that before the legalization of abortion, providers performed abortions “for reasons of conscience.”

Harris points out that before abortion was legal, many providers rallied to provide safe abortions to prevent women from dying from self-induced abortions and abortions provided by unskilled providers. This was a matter of conscience. Today, Harris explains, “abortion providers working within the law continue to describe their work in moral terms as “right and good and important” and articulate that the failure to offer abortion care generates a crisis of conscience.” It’s a moral imperative that underlies belief in “women’s reproductive autonomy as the linchpin of full personhood and self determination.”

On one hand, I am glad that the compromise yesterday ensures that women who work for religious organizations will be able to gain the same access to contraception as other women. However, I think we must continue to press for equitable access to contraception for all women. If we must work around conscience-based refusals, it is high time that we recognized conscience-based provision of reproductive care services.

Are Dense-Breast, Right-to-Know Laws Helpful?

Doctor reviews a digital mammogram of a dense breast and points to a potential cancer. Credit: National Cancer Institute.

In a victory for the dense-breast patient movement, Governor Jerry Brown (D-CA) signed legislation last week requiring that doctors who discover that women have dense breasts on mammography must inform women that:

  • dense breasts are a risk factor for breast cancer;
  • mammography sees cancer less well in dense breasts than in normal breasts; and
  • women may benefit from additional breast cancer screening.

The California law goes into effect on April 1, 2013. It follows four states (Connecticut, Texas, Virginia, and New York) with similar statutes. All have enjoyed solid bipartisan support. Rarely do naysayers or skeptics speak up.

Young women who are leading the charge often bring lawmakers the story of a young constituent, diagnosed with a very aggressive, lethal cancer that was not shown on film-screen mammography. The Are You Dense? patient advocacy group engages patients on Facebook, where women share their experiences with breast cancer, organize events, and lobby for legislation. Individual radiologists work with the advocacy groups, but many radiology groups and breast surgeons do not endorse these laws.

A Closer Look at Breast Cancer Data

Living in an age when information is viewed as an entitlement, knowledge, and power, many physicians find it hard to argue against a patient’s right to know. Can sharing information be a mistake? Some epidemiologists think so. Otis W. Brawley, MD, FACP, Chief Medical & Scientific Officer, American Cancer Society, says: “I really worry when we legislate things that no one understands. People can get harmed.” Numerous issues have to be worked out, according to Brawley. For one, he explains: “There is no standard way to define density.” Additionally, “even though studies suggest that density increases the risk of cancer, these cancers tend to be the less serious kind, but even that is open to question,” Brawley says. “We in medicine do not know what to do for women who have increased density.”

A study of more than 9,000 women in the Journal of the National Cancer Institute revealed that women with very dense breasts were no more likely to die than similar patients whose breasts were not as dense. “When tumors are found later in more dense breasts, they are no more aggressive or difficult to treat,” says Karla Kerlikowske, MD, study coauthor, and professor of medicine and epidemiologist at the University of California San Francisco. In fact, an increased risk of death was only found in women with the least dense breasts.

The trouble is what is known about dense breasts is murky. Asked whether he backs advising women that dense breasts are a risk factor for breast cancer, Anthony B. Miller, MD, Co-Chair of the Cancer Risk Management Initiative and a member of the Action Council, Canadian Partnership Against Cancer, and lead investigator of the Canadian National Breast Cancer Screening Study, says: “I would be very cautious. The trouble is people want certainty and chances are whatever we find, all we can do is explain.”

Women in their forties, who are most likely to have dense breasts (density declines with age) may want to seek out digital mammography. In studies comparing digital mammography to film-screen mammography in the same women, digital mammography has been shown to improve breast cancer detection in women with dense breasts. Findings from the Digital Mammographic Imaging Screening Study, showed better breast cancer detection with digital mammography. But digital mammography is not available in many areas.  Moreover, Miller explains: “We do not know if this will benefit women at all.  It is very probable that removal of the additional small lesions will simply increase anxiety and health costs, including the overdiagnosis of breast cancer, and have no impact upon mortality from breast cancer.”

Additional imaging studies sound attractive to people convinced that there is something clinically significant to find. But as I pointed out in my last post, many radiologists and breast physicians contend that there is no evidence that magnetic resonance imaging or any other imaging study aids breast cancer screening in women with dense breasts. Brawley notes: “These laws will certainly lead to more referral for MRI and ultrasound without clear evidence that women will benefit (lives will be saved.) It’s clear that radiologists will make more money offering more tests.” Miller adds: “A number of doctors are trying to capitalize on this and some of them should know a lot better.”

Many Advocates Question More Tests, Statutes

Even though the “Are You Dense?” campaign has been instrumental in getting legislation on the books across the county, other advocacy groups and patient advocates want research, enhanced patient literacy about risks and benefits of procedures. Many recall mistakes made that led women down the path of aggressive procedures. In that group is the radical Halsted mastectomy, used widely before systematic study, but once studied,  found no better than breast-conserving surgery for many cancers, and bone marrow transplants, also found to be ineffective, wearing, and costly.

Jody Schoger, a breast cancer social media activist at @jodyms who engages women weekly on twitter at #bcsm, had this to say on my blog about the onslaught of additional screening tests:

“What is needed is not another expensive modality… but concentrated focus for a biomarker to indicate the women who WILL benefit from additional screening. Because what’s happening now is an avalanche of screening, and its subsequent emotional and financial costs, that is often far out of proportion to both the relative and absolute risk for invasive cancer. I simply don’t think more “external” technology is the answer but one that evolves from the biology of cancer.”

Eve Harris @harriseve, a proponent of patient navigation and patient literacy, challenged Peter Ubel, MD, professor of business administration and medicine, at Duke University, on his view of the value of patient empowerment on the breast density issue. In a post on Forbes, replicated in Psychology Today, Ubel argued that in cases where the pros and cons of a patient’s alternatives are well known, for example, considering mastectomy or lumpectomy, patient empowerment play an important role. “But we are mistaken to turn to patient empowerment to solve dilemmas about how best to screen for cancer in women with dense breasts,” he writes.

Harris disagrees, making a compelling case for patient engagement:

“I think that we can agree that legislative interference with medical practice is not warranted when it cannot provide true consumer protection. But the context is the biggest culprit in this situation. American women’s fear of breast cancer is out of proportion with its incidence and its mortality rate. Truly empowering people—patients would mean improving health literacy and understanding of risk…”

But evidence and literacy take time, don’t make for snappy reading or headlines, and don’t shore up political points. Can we stop the train towards right-to-inform laws and make real headway in women’s health? Can we reallocate healthcare dollars towards effective treatments that serve patients and engage them in their care? You have to wonder.


On Mother’s Day, Invest in Maternal Health

Mother’s Day is usually a time for celebration in the United States, but celebrating it in a culture that devalues women, women’s health, and sets back the clock on Roe v. Wade are reasons to take stock, take a stand– not to smile and sit quietly.

Earlier this week, I attended a premiere of Christie Turlington’s movie, No Woman No Cry, which shows the hard public health work to improve maternal health globally.  See it. It will be on this weekend on Oprah Winfrey Network on Saturday,May 7th,  9:30 PM EST.

Ninety-nine percent of maternal deaths occur in the developing world.

Statistics on maternal death and access to care among poor and minority women in the United States are staggering. The maternal death rate for black women in New York City is especially astounding. 2008 statistics reveal:

  • a maternal death rate for black women of 79 per 100,000 live births for black women, compared to 10 white maternal deaths per 100,000 live births.

These numbers ought to be embarrassing for a city like New York.

If Mayor Michael Bloomberg wants to leave office with a decent record in public health, he should make improving maternal health a priority and invest dollars in restoring nurse midwifery programs in the City’s public hospitals. Sure you can tell a woman not to eat salt or drink sugary beverages. Obesity and diabetes make for trouble in pregnancy and labor. Prenatal care is paramount. These programs are valuable, but alone, they will not resolve these statistics. Resources are desperately needed at the time of labor and delivery.

Guidance for Quality Care

Cesarean section rates are abysmal in the United States, and cesarean sections have been associated with maternal deaths. Without concerted efforts to change practice patterns, these statistics won’t change. Other startling statistics, buried in federal reports, but extracted in a Childbirth Connection fact sheet are as follows:

  • The 2009 cesarean section rate of 32.9 percent set a record nationally. It marks the 13th consecutive year of increase, and a record level national rate;
  • Variation in practice patterns across the United States is pronounced, with New Mexico having the lowest cesarean section rate of 22.8 percent, Louisiana a high of 39.6 percent, and 48 percent in Puerto Rico;
  • Vaginal births after cesarean (VBAC) are declining, not improving. In 1997, vaginal births after cesarean sections accounted for 35.3 percent; in 2006, the VBAC rate was 9.7 percent.

Maternal death review boards may help inform quality care, if they are not used to punish overworked workers. Texas is considering a bill. If you know how Boards have helped or hindered, say so in the comments here.

Back High-Quality Care

Childbirth Connection, formerly the Maternity Center Association in New York City, has a wealth of information and expertise on evidence-based, quality maternity care. Maternal health advocates are working hard in the developing world, where travel for care, nutrition, and access to quality maternal programs in a safe setting are especially daunting.

Honor the fine public health work of groups, such as Partners in Health and Save the Children, as well as your local workers, striving to improve these statistics with limited resources.

Happy Mother’s Day, everyone!