[Journal article] What the Agency for Healthcare Research and Quality Forgets to Tell Americans about How to Protect Their Sexual and Reproductive Health

What the Agency for Healthcare Research and Quality Forgets to Tell Americans about How to Protect Their Sexual and Reproductive Health 

From the January/February 2015 journal article abstract

If there is one thing that health care experts seem to agree on, it is the importance of preventive care. Anything that can help the American public to do a better job of understanding, accessing, and affording effective preventive care and thereby helping them to avoid potential threats to their health should be indisputably a good thing for individuals, families, and society.

Recommendations for the public about what preventive care services an individual might need at different points in his or her life can be one important tool in this tool box, and that goes double for recommendations that speak with the imprimatur of the U.S. Department of Health and Human Services (DHHS). So, a series of fact sheets on “staying healthy” from the Agency for Healthcare Research and Quality (AHRQ)—a branch of DHHS devoted to evidence-based improvements to the provision of U.S. health care—should be a welcome and valued resource (Agency for Healthcare Research and Quality (AHRQ), 2014a, Agency for Healthcare Research and Quality (AHRQ), 2014b).

In this light, it is disappointing to find the AHRQ fact sheets falling short of the mark in some critical ways related to their recommendations on sexual and reproductive health care. The four fact sheets—for women of all ages, women at age 50 and older, men of all ages, and men at age 50 and older—contain a wealth of good advice about screenings and preventive medicine that a patient might need. However, they leave out many effective sexual and reproductive health-related preventive services—perhaps most notably any mention of contraceptive services and supplies—that have been endorsed by other agencies in the DHHS and by the medical establishment more broadly, and that have been promoted through the Affordable Care Act’s (ACA) requirements for private health plans to cover preventive services without patient out-of-pocket costs (HealthCare.gov, 2014, Sonfield, 2012). The AHRQ fact sheets compound those oversights by seeming to imply that they embody the sum total of DHHS’s preventive care recommendations, when in reality they seem to be based almost exclusively on the recommendations of a single body, the U.S. Preventive Services Task Force.

Full text of the article here

[Repost] The Healthy Woman: A Complete Guide for all Ages

 

The Healthy Woman: A Complete Guide for all Ages | Publications.USA.gov.

Can be downloaded for free!

A comprehensive reference with helpful charts and personal stories. The guide covers major diseases, aging mental health, reproductive health, nutrition and alternative medicine. It also provices advice on common screening tests and immunizations you may need. (Previous item number: 107W)

Source: U.S. Department of Health and Human Services
Released: 2008
Pages: 500

A tale of two colleges: is it really controversial to advise mothers about potential health effects of chemical exposures?

From the 24 October 2013 post at Health & Environment

This month (October 2013), the American College of Obstetricians and Gynecologists (ACOG)published a Committee Opinion about exposure to toxic environmental agents. It describes “reducing exposure to toxic environmental agents” as a “critical area of intervention” for reproductive health care professionals because of “robust” evidence linking exposure to environmental agents to a range of adverse reproductive and development health outcomes. The Opinion goes on to state that while reproductive health professionals should provide in-clinic counselling on reducing chemical exposure, they also have a role to play beyond the clinical setting, in advocate “timely action to identify and reduce exposure to toxic environmental agents”.

A similar paper was published on the same theme in the United Kingdom in June this year, when the UK equivalent of ACOG, the Royal College of Obstetricians and Gynaecologists (RCOG), issued a Scientific Impact Paper titled “Chemical Exposures During Pregnancy”. As did ACOG, the paper recommended a “safety-first approach” for dealing with the problem of being “exposed to a complex mixture of hundreds of chemicals at low levels” for which “methods for assessing the full risk of exposure are not yet developed”. A list of things which women can do to reduce their exposure was given, and it was suggested that this information be conveyed to women by reproductive health professionals.

…

Concluding remarks

The difference in reaction to two similar papers in the US and UK media should be surprising, given that in the US coverage of chemicals issues is now an everyday occurrence, while UK outlets (outside the confines of the famously sensationalist Daily Mail) are much less likely to cover chemicals stories. Yet here we have a minor publication intended for reproductive health professionals having almost unprecedented impact across all the major UK papers.

Some people undoubtedly wanted there to be a controversy. It sells papers, for one thing. But it does not follow that the originating point of the controversy is itself controversial: there is a very real difference between creating a controversy through eliciting and reporting criticism, and reporting on conflicting opinions which are a direct result of intellectual controversy. In the latter case the controversy is a natural event; in the former, it is a manufactured one.

Journalists, talking heads and commentators should all be cognizant of this, and be aware that if one is going to comment on a controversy, it will not advance issues by treating a manufactured debate as if it is a genuine controversy. The fact is, only Sense About Science, a small handful of university professors and a few trade associations originally had anything at all to say about the RCOG report – and these same faces popped up in almost all the UK media coverage.

Nobody else noticed that RCOG had published their “list” for mothers, and they would not have done had this small group of experts and reporters not made such a fuss about it – just as virtually nobody in the US noticed, barring an advocacy group with a conservative reputation and the US chemical industry trade association.

Read the entire article here

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• Exposure to Toxic Environmental Agents (workers-compensation.blogspot.com)
• A Powerful Union: OB-GYNs and Chemical Policy Reform (huffingtonpost.com)
• Environmental Chemicals are a #Pregnancy Risk says the #ACOG Report, by @acogNews (desdaughter.wordpress.com)
• How Environmental Toxins Harm Women’s Reproductive Health (livescience.com)
• Ob-Gyns Join in the Fight for Safer Chemicals, Healthy Families (shaneshirleysmith.com)
• Rising Risks to Latinos from Toxic Chemical Exposure (examiner.com)
• Report urges OB/GYNs to ask pregnant women about exposure to risky environmental chemicals (globalnews.ca)
• Report: Environmental Chemicals a Pregnancy Risk (abcnews.go.com)
• Mothers-to-be warned of risks from chemicals (readingeagle.com)
• Doc’s should warn about chemicals; health expert says (caribbeanmedschoolblog.wordpress.com)

 

Scientists to EPA: Include Women in Reproductive Health Research

Oncofertility Consortium Logo (Photo credit: Wikipedia)

 

From the Northwestern University press release (October 17, 2012)

 

Northwestern scientists to meet with EPA to request important changes in guidelines

October 16, 2012 | by Marla Paul

CHICAGO — A team of Northwestern University scientists will meet with Environmental Protection Agency (EPA) administrators in Washington D.C. Oct. 18 to advocate for important changes in the agency’s guidelines for reproductive health research.

“The problem is current research assessing the risk of toxins on reproductive health is not being uniformly investigated in both sexes and across the lifespan,” said Kate Timmerman, program director of the Oncofertility Consortium of Northwestern University, who will be one of the scientists meeting with the EPA. The reproductive health guidelines have not been updated since 1996 and need to be revised to reflect new research findings.

The Northwestern team will ask the EPA to expand the definition of reproductive health beyond pregnancy to include the lifespan of an individual.

“Reproductive health is important across the entire lifespan because your endocrine system affects your bone health, cardiovascular health and other systems in the body,” Timmerman said. Endocrine disrupters, sometimes triggered by environmental factors, can lead to increased risk for stroke and heart attack as well as osteoporosis.

The Northwestern scientists also will request that all EPA-sponsored research require appropriate testing in both sexes. Currently many toxicity studies are only conducted in male animal models with the assumption that females are affected the same way, but that isn’t necessarily true.

“What happens now is if researchers don’t see an effect in males, they won’t look in females,” Timmerman said. “But we know certain toxins in the environment can have a significant effect on females and not males and vice versa.”

Timmerman and colleagues will present a white paper to the EPA on how to improve and update the guidelines.

In addition to Timmerman, other Northwestern scientists meeting with the EPA

include Kimberly Gray, professor of civil and environmental engineering at Northwestern’s  McCormick School of Engineering and Applied Science; Mary Ellen Pavone, M.D., assistant

professor of obstetrics and gynecology at Northwestern’s Feinberg School of Medicine and a physician at Northwestern Memorial Hospital; and Francesca Duncan, reproductive scientist/research associate in the lab of Teresa Woodruff, chief of fertility preservation at the Feinberg School and director of the Oncofertility Consortium. Woodruff also is a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

 

 

 

Related articles

• Scientists to EPA: Include women in reproductive health research (sciencedaily.com)

 

Contraceptive Use Averts 272,000 Maternal Deaths Worldwide

Map of countries by maternal mortality [2011](Photo credit: Wikipedia)

From the 10 July 2012 article at Science News Daily

Contraceptive use likely prevents more than 272,000 maternal deaths from childbirth each year, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health. Researchers further estimate that satisfying the global unmet need for contraception could reduce maternal deaths an additional 30 percent. Their findings were published July 10 by The Lancet as part of a series of articles on family planning.

“Promotion of contraceptive use is an effective primary prevention strategy for reducing maternal mortality in developing countries. Our findings reinforce the need to accelerate access to contraception in countries with a low prevalence of contraceptive use where gains in maternal mortality prevention could be greatest,” said the study’s lead author, Saifuddin Ahmed, MBBS, PhD, associate professor in the Bloomberg School’s departments of Population, Family and Reproductive Health, and Biostatistics. “Vaccination prevents child mortality; contraception prevents maternal mortality.”

Effective contraception is estimated to avert nearly 230 million unintended births each year. Worldwide, roughly 358,000 women and 3 million newborn babies die each year because of complications related to pregnancy and childbirth. Nearly all of these deaths occur in developing countries, where 10 to 15 percent of pregnancies end in maternal death due to unsafe abortions….

Related articles

Melinda Gates

• Melinda Gates responds to contraception program-controversy (with video interview, CNN 6 July 2012)

 “Part of what I do with the (Gates) Foundation comes from that incredible social justice I had growing up and belief that all lives, all lives are of equal value,” said Gates during a recent interview with CNN chief medical correspondent Dr. Sanjay Gupta.

About the flak over her Catholicism she said: “We’re not going to agree about everything, but that’s OK.”

Gates is promoting an ambitious family planning program — which includes raising billions of dollars to provide contraceptives to 120 million women worldwide — at the London Summit on Family Planning July 11.”New Study Finds Little Progress in Meeting Demand for Contraception in the Developing World (press release from Guttacher Institute,  19 June 2012)

• Where’s the Controversy in Saving Lives?  by Melinda Gates (Health Care Blog, 7 July 2012)
• New Study Finds Little Progress in Meeting Demand for Contraception in the Developing World (Guttmacher Institute press release, 19 June 2012)

A new study by the Guttmacher Institute and UNFPA, the United Nations Population Fund, finds that the number of women in developing countries who want to avoid pregnancy but are not using modern contraception declined only slightly between 2008 and 2012, from 226 to 222 million. However, in the 69 poorest countries—where 73% of all women with unmet need for modern contraceptives reside—the number actually increased, from 153 to 162 million women.The report, Adding It Up: Costs and Benefits of Contraceptive Services—Estimates for 2012, finds that 645 million women of reproductive age (15–49 years) in the developing world are now using modern contraceptive methods, 42 million more than in 2008. ….

[via the Science Daily article above]
Timing Pregnancy an Important Health Concern for Women (Apr. 11, 2012) — A new article highlights the importance of a woman’s ability to time her childbearing. The author asserts that contraception is a means of health promotion and women who work with their health care …  > read more

Deaths from IVF Are Rare but Relevant (Jan. 27, 2011) — Although still rare, maternal deaths related to in vitro fertilization are a key indicator of risks to older women, those with multiple pregnancy and those with underlying disease, warn …  > read more

Alternative Strategies to Reduce Maternal Mortality in India (Apr. 20, 2010) — A new study finds that better family planning, provision of safe abortion, and improved intrapartum and emergency obstetrical care could reduce maternal mortality in India by 75 percent in less than …  > read more

Should The Contraceptive Pill Be Available Without Prescription? (Dec. 23, 2008) — Making the contraceptive pill available without prescription will not reduce unwanted pregnancies, says an expert in an article published on the British Medical Journal …  > read more

Huge Proportion Of Maternal Deaths Worldwide Are Preventable (Feb. 19, 2008) — Women who die during pregnancy and childbirth in sub-Saharan Africa, more may die from treatable infectious diseases than from conditions directly linked to pregnancy. These results indicate that …  > read more

[via WordPress]

• Contraceptive use averts 272,000 maternal deaths worldwide (esciencenews.com)
• 100,000 Women’s Lives Could Be Saved By Expanded Access To Contraception (thinkprogress.org)
• Contraception Can Prevent More Than 272,000 Maternal Deaths (ibtimes.com)
• Contraceptive use averts 272,000 maternal deaths worldwide (eurekalert.org)
• Fulfilling Contraception Needs Could Lower Maternal Mortality Drastically, Study Says (nytimes.com)
• Contraception saves 250,000 lives each year: study (rawstory.com)
• Better contraception could save 100,000 lives (independent.co.uk)
• Using birth control will cut deaths, study finds (smh.com.au)
• Study Says Meeting Contraception Needs Could Cut Maternal Deaths by a Third (thewip.net)
• Too many mothers still dying (cnn.com)
• Osotimehin maternal deaths (edition.cnn.com)

WHO: Urgent action needed to prevent the spread of untreatable gonorrhoea

6 JUNE 2012 | GENEVA – Millions of people with gonorrhoea may be at risk of running out of treatment options unless urgent action is taken, according WHO. Already several countries, including Australia, France, Japan, Norway, Sweden and the United Kingdom are reporting cases of resistance to cephalosporin antibiotics – the last treatment option against gonorrhoea. Every year an estimated 106 million people are infected with gonorrhea, which is transmitted sexually.

Dwindling treatment options

“Gonorrhoea is becoming a major public health challenge, due to the high incidence of infections accompanied by dwindling treatment options,” says Dr Manjula Lusti-Narasimhan, from the Department of Reproductive Health and Research at WHO. “The available data only shows the tip of the iceberg. Without adequate surveillance we won’t know the extent of resistance to gonorrhoea and without research into new antimicrobial agents, there could soon be no effective treatment for patients.”

Correct use of antibiotics needed

In new guidance issued today, WHO is calling for greater vigilance on the correct use of antibiotics and more research into alternative treatment regimens for gonococcal infections. WHO’s Global Action Plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoea also calls for increased monitoring and reporting of resistant strains as well as better prevention, diagnosis and control of gonococcal infections.

Health implications are important

Gonorrhoea makes up one quarter of the four major curable sexually-transmitted infections¹. Since the development of antibiotics, the pathogen has developed resistance to many of the common antibiotics used as treatment, including penicillin, tetracyclines and quinolones.

“We are very concerned about recent reports of treatment failure from the last effective treatment option – the class of cephalosporin antibiotics – as there are no new therapeutic drugs in development,” says Dr Lusti-Narasimhan. “If gonococcal infections become untreatable, the health implications are significant.”

Antimicrobial resistance

Antimicrobial resistance is caused by the unrestricted access to antimicrobials, overuse and poor quality of antibiotics, as well as natural genetic mutations within disease organisms. In addition, gonorrhoea strains tend to retain genetic resistance to previous antibiotics even after their use has been discontinued. The extent of this resistance worldwide is not known due to lack of reliable data for gonorrhoea in many countries and insufficient research.

Gonorrhoea

Untreated gonococcal infection can cause health problems in men, women and newborn babies including:

• infection of the urethra, cervix and rectum;
• infertility in both men and women;
• a significantly increased risk of HIV infection and transmission;
• ectopic pregnancy, spontaneous abortion, stillbirths and premature deliveries; and
• severe eye infections occur in 30-50% of babies born to women with untreated gonorrhoea, which can lead to blindness.

Gonorrhoea can be prevented through safer sexual intercourse. Early detection and prompt treatment, including of sexual partners, is essential to control sexually transmitted infections.

For more information please contact:

Tarik Jasarevic,
Communications Officer
Mobile: +41 793 676 214
Telephone: +41 22 791 5099
E-mail: jasarevict@who.int

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Second-Trimester Abortions Concentrated Among Certain Groups of Women from Full Text Reports…

Go to http://prolife2011.wordpress.com/category/facts/ for larger image

Second-Trimester Abortions Concentrated Among Certain Groups of Women from Full Text Reports….

From the Full Text Reports Web page

December 23, 2011

Second-Trimester Abortions Concentrated Among Certain Groups of Women

Source:  Guttmacher Institute

In the United States, nearly nine in 10 abortions occur in the first trimester, but, until now, little was known about the 10% of women who have abortions at 13 weeks’ gestation or later. According to “Who Has Second-Trimester Abortions in the United States?,” by Rachel K. Jones and Lawrence B. Finer of the Guttmacher Institute, certain groups of women are overrepresented among second-trimester abortion patients. These groups include women with lower educational levels, black women and women who have experienced multiple disruptive events in the last year, such as unemployment or separating from a partner.

This first-ever comprehensive profile of second-trimester abortion patients in the United States relies on data from a nationally representative sample of more than 9,400 women obtaining abortions in 2008. The authors first compared first-trimester abortion patients with those obtaining abortions at 13 weeks or later to see if there were differences in characteristics between the groups; next, among second-trimester abortion patients, they compared early second-trimester abortion patients (13–15 weeks’ gestation) with those having abortions at 16 weeks or later.

Certain groups of women were more likely than others to obtain abortions at 13 weeks or later. For example, teens were more likely than older women to obtain an abortion in the second trimester—accounting for 14% of abortions among teens, compared with 9% among women aged 30 and older. Similarly, the proportion of abortions that occurred in the second trimester was 13% among black women, compared with 9% among non-Hispanic whites; 13% among women who had not graduated from high school, compared with 6% among college graduates; 14% among those using health insurance to pay for the procedure, compared with 8% among those who paid out of pocket; and 15% among those who had experienced three or more disruptive events in the past year, compared with 9% among women experiencing no disruptive events.

+ Full Report (PDF)

Related articles

• Report: Younger, Less Educated Women More Likely To Undergo Second Trimester Abortions (thinkprogress.org)
• Study Reveals Who Gets Late-term Abortions (maboulette.wordpress.com)
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UNFPA Launches New Online Database, Country Profiles to Track Progress in Maternal and Reproductive Health

From the United Nations Population Fund (UNFPA) news item

The United Nations Population Fund (UNFPA) has recently launched MDG 5b+ Info, an online database system designed to track global progress towards achieving the Millennium Development Goals (MDGs) and other related indicators of maternal health at the country level. Adapted from the UN-endorsed DevInfo database system, MDG 5b+ Info compiles the latest relevant household survey data with international data and allows for easy generation of tables, graphs and maps for inclusion in presentations, reports and advocacy materials.

The MDG 5b+ Info database contains data on sexual and reproductive health indicators drawn from national Demographic and Health Surveys and other MDG indicators at the global, national and sub-national levels, where available. The MDG 5b+ Info database is published online by UNFPA at www.devinfo.info/mdg5b,  providing worldwide access to this important dataset. Policy makers and planners are encouraged to access the data to support evidence-based decision making on issues related to maternal and reproductive health.