Monday, April 26, 2010

RH Reality Check: Emergency Contraception: Dispelling Media Myths and Misperceptions

By Elizabeth Westley and Anna Glasier
Created Apr 19 2010 - 3:11pm

This article is a collaboration between the World Health Organization (WHO), the International Federation of Obstetrics and Gynecology, the International Planned Parenthood Federation, and the International Consortium for Emergency Contraception and is republished with permisson from the WHO. [1] Please scroll down for a fact sheet on EC's safety at the bottom of the post.

Emergency contraceptive pills (ECPs) are now available in many countries, but have failed to have the desired impact on unwanted pregnancy rates. Why is this? Earlier barriers to access are becoming less and less prevalent. A market for ECPs has been demonstrated and numerous manufacturers and distributors are keen to supply products; in many countries they are starting to be mainstreamed into norms, pre-service training, and services.

Yet knowledge continues to be an important barrier in much of the world. This post-coital contraceptive method is still relatively unknown in many countries, according to DHS data and other country level surveys. A 2007 survey of adolescents in New York City schools revealed that fewer than half of these young people had heard about ECPs, despite extensive public outreach and media publicity surrounding their over-the-counter status in the US.

Even when knowledge of this type of contraceptive is higher, use often remains fairly low, as in the UK, where 91 percent of women had heard of “the morning after pill” but only seven percent had used it in the past year. One reason for low correct use of ECPs is the very poor basic understanding of fertility, contraception, and pregnancy risk that seems widespread in both developed and developing countries. In France, a survey of women seeking abortion indicated that more than half were unaware of their pregnancy risk at the time that they became pregnant or could not identify specific act that led to the pregnancy; only a minority of women used ECPs. In the UK, a study of abortion and pre-natal care clients showed that ECPs were used by only one in ten women who definitely did not wish to become pregnant, and even fewer used the method every time they were at risk of pregnancy.

Unfortunately, the already substantial misinformation that women have about pregnancy risk and ECPs (along with other contraceptive methods) is being compounded by recent media coverage of ECPs. “Besides side effects, like nausea, heavy bleeding, and cramps, regular use of the emergency contraception may cause infertility and in some instances increase the risk of cancer” declared one BBC story on emergency contraceptive pills in Kenya. “EC [emergency contraception] comes with an increased risk for things like blood clots and hormone-related cancers, like many traditional forms of birth control,” stated a mainstream newspaper in the United States. These statements are factually incorrect, but unfortunately are widespread. Such negative and sometimes inflammatory media coverage only alarms women and may keep some from using the method when they most need it.

Indeed, media and public health can be a volatile mix. The potential association between childhood vaccination and autism proposed in one article in the Lancet in 1998 (and officially retracted in 2010) was picked up by media around the world, and led to resistance to vaccination, millions spent on studies and many years of research to refute the claim. The effects have persisted: a 2009 survey found that fully one quarter of American parents agreed that “some vaccines cause autism in healthy children” and more than one in ten had refused a vaccine for their child.

Today, the echo chamber that is the internet can quickly spread and amplify media stories, particularly if they are sensational. An email circulating for several years describes a “true story” of a woman who died of a stroke while on hormonal birth control; recently, this story morphed and now states “the cause of death–continuously taking the morning after pill.” The fear-mongering media coverage around ECPs is likely driven by concerns about “irresponsible” sexuality hiding behind false “scientific” justification for such concerns.

Public health and medical professionals cannot afford to ignore the role of today’s media. Accurate media coverage has played an important role in spreading the news about health risks, healthy behaviors, and new products; sensationalist and frightening coverage can have the opposite effect. In the case of levonorgestrel-alone ECPs, safety has been clearly demonstrated through countless studies and many decades of use: no new research needs to be conducted. The urgent question is how we can explain and disseminate the science in simple terms.

While countering every health-related rumor on the internet and inaccurate story in local newspapers and magazines is surely a fool’s errand, it is increasingly important to be ready with the facts when reporters, community members, and patients voice concerns. A team of experts from around the world has produced a short, simple statement on the safety of levonorgestrel-alone emergency contraceptive pills, responding directly to articles that appeared in mainstream media in 2009 and written for non-scientists.

Fact Sheet on levonorgestrel-alone emergency contraception pills

Published on

Thursday, April 22, 2010

IPPF News: Catholic journal says Plan B does not cause abortions

April 12 2010

If it holds, a finding in a Catholic health journal could be the key to ending a major dilemma for Catholic health facilities across the nation and around the world.

Plan B, the nation’s most widely used emergency contraceptive, works only as a contraceptive and does not cause abortions, according to an article in the January-February issue of Health Progress, the official journal of the Catholic Health Association.

Theologian Lisa Sowle Cahill of Boston College said if Plan B never causes abortions, then Catholic hospitals should have no moral problem providing it as an emergency contraceptive to a rape victim.

Under the U.S. bishops’ “Ethical and Religious Directives for Catholic Health Care Services,” Catholic facilities may administer emergency contraception to a rape victim, but only to prevent ovulation or fertilization. Ethical and Religious Directive 36 says if the procedure causes an already fertilized egg to be destroyed or prevents its implantation in the womb, in Catholic teaching that is no longer contraception but abortion.

The difference between the Catholic definition of abortion (any destruction of a fertilized human egg) and the American Medical Association’s definition (any destruction of an embryo following its implantation -- typically about seven days after fertilization) is a major subtext in the debate over whether Plan B is only contraceptive or also possibly abortifacient in some cases.

Barr Pharmaceuticals, manufacturer of Plan B, follows the medical association’s definition in describing the drug as strictly contraceptive and suggests that one effect could be to prevent implantation of a fertilized egg, a conclusion challenged by several scientific studies.

Dr Sandra E. Reznik, who teaches reproductive endocrinology and reproductive pharmacology at St. John’s University in New York, wrote in Health Progress that Plan B is widely regarded in the scientific community as “the most effective emergency contraceptive agent available.”

Commenting on the thesis of the article, Capuchin Franciscan Fr. Thomas Weinandy, executive director of the U.S. bishops’ Secretariat for Doctrine and Pastoral Practices, said, “If it can be proved, that would make a difference” as to how Catholic hospitals, doctors and pharmacists treat Plan B.

The distinction between preventing fertilization and preventing implantation is a crucial moral point in Catholic teaching on the difference between contraception and abortion, but in the American Medical Association’s definition of contraception, both are treated equally.

In a phone interview, Cahill said Reznik’s conclusions matched those she has seen in other literature on the topic, including an article in the Oct. 11, 2006, issue of The Journal of the American Medical Association, which she had just recently read in preparing to teach a bioethics course.

She said she knew of at least two states -- Massachusetts since 2005 and Connecticut since 2007 -- that have laws requiring hospitals to provide Plan B emergency contraception to rape victims. A number of other states -- California, Illinois, New Jersey, New Mexico, New York and Washington among them -- require hospitals to offer rape victims emergency contraception or at least inform them where to obtain it.

The question of whether Plan B can also prevent implantation of a fertilized egg as well as prevent ovulation and inhibit sperm from reaching the egg led the Catholic bishops and four Catholic hospitals of Connecticut to oppose that state’s 2007 legislation on emergency contraception unless it allowed hospitals to test for pregnancy and ovulation before administering the drug. In its final form, the law permitted hospitals to do a pregnancy test before administering Plan B, but not an ovulation test.

The question of what tests could be performed before emergency contraceptive treatment is important because of the time-sensitive nature of Plan B. As Reznik put it, “The effectiveness of Plan B decreases with every passing hour, because the chance of missing [the pill’s prevention of] ovulation increases as time passes -- and science has demonstrated Plan B doesn’t work after ovulation occurs.”

In a carefully worded statement Sept. 27, 2007, shortly after the Connecticut law was enacted, the state’s bishops and Catholic hospital leaders said they “believe that this law is seriously flawed, but not sufficiently to bar compliance with it at the present time.”

They said they would continue to work to change the law, but they had come to a judgment that “to administer Plan B pills in Catholic hospitals to victims of rape, a pregnancy test to determine that the woman has not conceived is sufficient. An ovulation test will not be required. The administration of Plan B pills in this instance cannot be judged to be the commission of an abortion because of such doubt about how Plan B pills and similar drugs work and because of the current impossibility of knowing from the ovulation test whether a new life is present. To administer the Plan B pills without an ovulation test is not an intrinsically evil act.”

“The teaching authority of the church has not definitively resolved this matter,” they added, and “if it becomes clear that Plan B pills would lead to an early chemical abortion in some instances, this matter would have to be reopened.”

The statement illustrates the delicacy and fine moral distinctions involved in trying to determine what Plan B actually does and the moral evaluations that would follow from a Catholic perspective.

Reznik wrote that since it takes about a week from an egg’s fertilization to its implantation, the scientific evidence that Plan B treatment is completely ineffective after five days is overwhelming: It works only by preventing fertilization, not by preventing implantation.

Otherwise, she said, the drug would also be found effective from five to 12 days after coitus, because that is the time frame between the last chance for a sperm to fertilize an egg and the time a fertilized egg would implant. The declining effectiveness of Plan B between 48 and 120 hours after coitus adds to the argument that preventing a fertilized egg from being implanted is not one of its effects, she said.

Cahill told NCR that if scientific data show conclusively that Plan B is only contraceptive, any pregnancy or ovulation test before its use as an emergency contraceptive after rape “seems to me an unjustified delay that increases the possibility that the raped woman will become pregnant.”

“From the evidence that you were just telling me [from the Health Progress article] and that I read in The Journal of the American Medical Association, it has a limited effectiveness -- you have to use it right away,” she said.

Plan B apparently “does not affect pregnancies that are already established, so what’s really the point in doing a pregnancy test?” she asked. “It doesn’t seem to have a scientific validity to it in the way that Plan B, by all accounts, operates.”

“If the Catholic church wants to put its abortion teaching, its pro-life teaching, in the best light possible, it really has to be accompanied by equally dedicated and aggressive attempts to help women,” she said. “Taking measures to prevent medically appropriate and legally mandated assistance to basics in the name of protecting the unborn -- in ways that are indicated scientifically not protecting the unborn anyway -- that just seems to undermine the pro-life stance of the Catholic church.

Source: National Catholic Reporter, 31 March 2010


Wednesday, April 21, 2010

New York Times: Good News from the Childbirth Front

April 16 2010

One of the great tragedies of the developing world is the number of women who die in pregnancy and childbirth. But what is that number? Several studies had put it at somewhat more than 500,000 a year, while a new and apparently more rigorous study suggests that it has dropped to less than 350,000 a year.

This is an issue that I’ve written about a great deal over the years, and so I was delighted by the good news — and also delighted that the Times treated it as a major story. Indeed, the article about this breakthrough was the lead news story (the article on the top right of the front page is the lead article, because it’s thought that that is where people start reading). I should quickly add that I have nothing to do with such news decisions. We in the opinion world of the Times are completely removed from news decisions. But one of the reasons maternal mortality has never gotten much traction or donor interest is that it has never been treated as very newsworthy. In recent years, there has been a bit of change in that, and my hope is that we in the news business will treat maternal health — and global health issues generally — as important news because of the numbers involved. That will make a real difference in getting these problems addressed.

One caveat is that none of the numbers are reliable. When women die in childbirth in poor countries, nobody keeps track, and so all these figures are very rough estimates. A few years ago, Honduras was considered an example of a country that had managed to cut its maternal mortality rate through hard work, and I and others cited it as a model. Then a new World Health Organization study came out in 2007 and suggested that maternal mortality had actually risen in Honduras over the previous decade. I got on the phone and called around, trying to make sense of this — and what I learned was that no one really has any idea how many women die in childbirth in Honduras. And the same is even more true of Nigeria.

Still the new figures of just under 350,000 deaths per year are based on more data and are probably as good as any. Some activists were alarmed, fearing that if the report was publicized that would discourage donors and make people think that they didn’t need to worry about maternal health. I think that view is mistaken. Indeed, I think this report is good news for those who want to cut maternal deaths — and here’s why.

One of the mistakes humanitarians sometimes make, I believe, is to emphasize all the things that go wrong. The result is that people are sometimes turned off, and that problems seem intractable. If maternal mortality has remained constant for a quarter-century (as we thought), then who wants to take up the cause? My sense is that people want to be part of something hopeful, something that manifestly can be changed and made better. And that’s what the new study confirms: there is hope in reducing deaths in childbirth, and more resources can make the toll drop even more. We know what to do, we just need to do it better.

The basic reason so many women die in childbirth is simply that they don’t matter in their societies. They are the most voiceless, most marginalized people in their societies, and so resources aren’t expended keeping them alive. There’s a strong correlation between societies where women are repressed and those with very high maternal mortality rates (indeed, in Afghanistan some years ago I came across the highest lifetime maternal mortality risk ever — 50 percent, meaning a woman in one particular region had a 50-50 chance of dying in childbirth at some point in her life). Today in Niger, a woman has a 1-in-7 chance of dying in childbirth at some point in her life, partly because if her husband is off working hundreds of miles away, it’s often considered inappropriate to take her to a hospital if she’s in obstructed labor. She’s not supposed to leave the house without her husband’s permission — and so she dies.

It was always clear that we could do better on maternal mortality, and thank God that is now finally happening.

LINK Where did all the angry young women go?

Despite what an older generation of reproductive rights activists says, younger feminists have been here all along

By Rebecca Traister
Tuesday, Apr 20, 2010 04:01 EDT

I was struck hard by a story in the latest issue of Newsweek about the purported apathy of young women toward their reproductive rights. The piece, by Sarah Kliff, included an interview with NARAL Pro-Choice America president Nancy Keenan, who called herself part of a "postmenopausal militia" and wrung her hands at the lack of young people who show up to support abortion rights. Telling Kliff about the experience of walking smack into a rally of anti-choice activists, Keenan said, "I just thought, my gosh, they are so young ... there are so many of them, and they are so young." Keenan sees no equivalent youthful surge within her own movement.

But she doesn't seem to be looking very hard. As Newsweek reported, Gallup polling shows that basic support for legal abortion has remained between 75 and 85 percent for the past 35 years, and that "even among young people ... 61 percent were 'pro-choice,' supporting legal abortion in 'all cases' or 'most cases.'" Yet, based on an "intensity gap" in feelings about abortion rights, Keenan and her peers worry that young people don't consider reproductive freedom central to their politics; the Newsweek piece cited one unnamed young woman who didn't worry that her rights were imperiled because the parking lot at her local clinic was always full.

If Kliff had spoken to young women about their interest in abortion politics for her story about youthful interest in abortion politics, she might have heard more about the perspectives of a generation that grew up in a world in which abortion was legal. Yes, it's true. The fact that young women have been raised without knowledge or experience of back-alley abortion does alter the dynamics of their approach. It makes the issue less personal, less urgent, less terrifying. That is part of the victory of Roe v. Wade. Frankly, that support for legal abortion has remained so high for so long is a testament to the enduring commitment of younger women -- who never experienced the atrocities of illegal abortion or lived without the power to control their own bodies -- to the issues of women's health and freedom.

To not acknowledge the changed landscape of feminism's inheritors is a failure on the part of the old, not on the part of the young. If senior activists could get past their own experiences of illegality and 1970's-style activism long enough to effectively communicate with -- to perhaps listen to -- junior activists describe the world as they live in it, perhaps they wouldn't have such a dismal take on the future. But again and again, I have seen smart, admirable, brave older women who cannot seem to see the young faces right in front of them.

Last year, I attended a NARAL luncheon at which an older actress and activist attempted to translate the foreign and exotic universe of youth to the crowd: "They're like Roe v. What?" this speaker said of young women. "They don't know who Kennedy is!" Sitting beside me was a 22-year-old full-time feminist activist who had been checking people into the event that day, who spends her life talking to college women who care very much about abortion, about women's health and women's rights, who know perfectly well what Roe v. Wade is, and probably know who John Kennedy was despite the fact that they actually don't need to know who he was because he is not their president; Barack Obama is. This young woman looked like she wanted to bang her head against the table, not with the embarrassment she was apparently supposed to feel on behalf of her own wifty generation, but with fury at how invisible she and her peers were to the organization she had given up her day to volunteer for.

Last year, former NOW president Kim Gandy supported 33-year-old Latifa Lyles to replace her as president in the NOW national elections. Lyles lost the election to 56-year-old Terry O’Neill. Fair enough; O'Neill should not have lost because of her age any more than Lyles should have lost because of hers. But leaders must stop claiming that there are no young feminists out there, when in fact there are plenty. And many of them have gotten the message that they are not particularly valued by institutional feminism.

Keenan's surprise at the numbers of youthful anti-choice activists should not have made her shake her head at the passivity of those on her side, but to consider instead that her ideological foes have apparently found a way to respect the next generation and perhaps to harness its power. When older pro-choice groups begin treating young women not as ungrateful, unschooled whippersnappers but as powerful women who were raised with different sets of expectations, with new modes of communication and protest, and who face a different set of obstacles, perhaps then they will begin to really see them. Perhaps when these leaders stop demanding that young women acknowledge their history, their priorities, their forms of resistance, and start instead to acknowledge the new kinds of activism that young people, not their elders, have succeeded in creating online, perhaps they will start to be able to make out these phantom young women.

Because they are there. They are everywhere. As my colleague Judy Berman, 25, recently told me, "When I was in undergrad ... everyone except the very religious believed pretty strongly in reproductive rights -- we organized a LOT of young women (and men!) to go to the March for Women's Lives in '04, where, as far as I remember, college women made up the bulk of the marchers." Berman remembers correctly. I was at that march too, and looked around at a sea of young people who seemed eager to stand alongside their elders. The speakers castigated them for not knowing what a coat hanger was used for.

Many of the young women who formed and populate the feminist blogosphere will tell you that they took to the Internet because they found no welcome in institutional women's organizations and decided not to work within a system designed and run by leaders who did not trust them, take them seriously, or show any interest in their opinions. Instead, they set out to create their own approach to women's rights, to reach their own peers in their own way, rather than wait to be acknowledged by their elders. As a result, some feminist institutions indeed find themselves with an age imbalance, membership listing precariously toward the senescent.

The Newsweek piece reports that Keenan and her peers at Planned Parenthood and NOW "will retire in a decade or so." But perhaps if, instead of holding on to their crowns like Queen Elizabeth, they might consider passing them down to women who are frankly far better equipped to communicate with future generations than they are, there would not be quite such a perceived crisis. "It's not that pro-choice activism doesn't interest young women anymore," Berman told me. "It's that doing it through NOW, NARAL, etc., doesn't seem relevant when we have all these online outlets that take us seriously."

That's not to say that the bloggy form of activism is always preferable, or louder, or more effective than older iterations of protest or commentary. There's lots to criticize about a feminist blogosphere, about armchair activism, about the self-interest of the Internet, and about the age-old struggles within feminism that are being repeated, and not necessarily fixed, by today's young activists. I smile when I think of Debra Dickerson's exhortation a year ago that "today's feminists need to blog less and work more." Her chiding pissed off a lot of those feminists, but in taking them to task, Dickerson was doing a service to young women: She was admitting that she'd paid attention to the ways in which they raised their voices, considering how their forms of expression differed from those of her own generation. Stories like the one in Newsweek don't go that far, and in failing to do so, create a self-fulfilling prophecy. Why should young people announce their investment or their allegiance to organizations that fail even to acknowledge that they exist?

You want young reproductive rights leaders? Look around you. Look to the Internet, look to the junior ranks of your own organizations, to the women checking people in at the door of your events, to the potential of the women whose pictures you put in your brochures, but whose voices you apparently still can't hear. Instead of clinging to your positions of leadership, hand them over. Share some of your power with the women who see the world and its challenges differently than you do, who may feel critical and not always reverential toward the choices of your generation, but who have hope and drive and means to take their experiences and perspectives into the future, instead of muttering defeatedly and getting stuck in the past.


Monday, April 19, 2010

Daily Telegraph: Abortions 'could be offered in GP surgeries across England'

Kate Devlin, Medical Correspondent
16 April 2010

One in six health care trusts in England wants to carry out the terminations in family doctors’ practices, new figures show.

Early terminations can be carried out using drugs and without surgery up until the ninth week of pregnancy.

Following two Government pilots which showed that they were both safe and effective to be given outside hospital they are allowed in GP surgeries.

The new figures show that 15 per cent of Primary Care Trusts in England have either applied for or are considering for an application for a licence to perform then in GP surgeries.

Some have been made in conjunction with the British Pregnancy Advisory Service (BPAS), which already runs services offering medical terminations in GP surgeries in Wolverhampton and Newcastle.

Applications have been lodged by trusts as far apart as Bradford, North Staffordshire and Basingstoke in Hampshire.

The surgery has to be approved by both the Care Quality Commission and the Health Secretary before abortions can be carried out on the premises.

Fiona Loveless, from Marie Stopes International, said: “This type of service is not suitable for every women but some will want to be able to have an early medical abortion close to home."

But Dr Andrew Fergusson, from the Christian Medical Fellowship, warned that the move would “normalise a procedure where one life is intentionally ended.”
The applications were revealed in response to Freedom of Information requests by GP magazine.

They show that six PCTs have asked for licences to perform the procedures in GP surgeries.

Another 11 told the magazine that they were considering applying.

In total the magazine received responses from 114 of England’s 152 PCTs.
PCTs have to apply for an individual licence for each surgery where they wish the medical abortions to be carried out.

Some, including Harrow in London, said that they had applied for one licence and were considering applying for more.

At the moment GPs have to commission the service from independent providers.
However, from 2012, when GPs will become registered with the Care Quality Commission, they will be able to offer the services themselves.

Under the 1967 Abortion Act the Secretary of State for Health has to approve premises where abortions can be carried out.

Hospitals are automatically approved but after successful pilots the Government has agreed that GP surgeries can now also be used.

In 2008 there were 400 medical abortions carried out in GP surgeries run by BPAS.


Irish Independent: Promise to rewrite Constitution will reignite debate on abortion

By Fionnan Sheahan Political Editor
Monday April 19 2010

LABOUR Party leader Eamon Gilmore will re-open the divisive abortion debate through his promise to rewrite the Constitution if he gets into power.

Aside from abortion, Mr Gilmore's constitutional reform plan would also open up a host of contentious issues like the recognition of God, property rights, the definition of the family, gay marriage and the EU.

Any changes to the Constitution would have to be ratified by a referendum.

Following on from Fine Gael leader Enda Kenny's political reform proposals, such as scrapping the Seanad, Mr Gilmore said he also wanted to see institutional changes -- but didn't say what they should be.

In his keynote address to his party conference, he announced his intention to "develop a new constitution" -- eclipsing even former Fine Gael leader Garret Fitzgerald's 'constitutional crusade' in the early 1980s.

"It is time, in my view, for a fundamental review of our Constitution," he said.

"There is much about it that has served us well, but it is a document written in the 1930s for the 1930s," he said.

"A time when one church was considered to have a special position and women were considered to be second-class citizens.

"And if we are to truly learn from the experience of the last 10 years, then we need to look again, in a considered way, at the fundamental rules that bind us together."

Mr Gilmore said the Constitution would be rewritten by a convention, including experts, specialists and ordinary citizens randomly chosen in the same way as juries.

"Let us set ourselves the target to have it ready for the 100th anniversary of the 1916 rising, that seminal moment when our State was conceived," he said.

Labour has a long-standing policy on abortion, dating back to 2003, committed to bringing forward legislation to allow abortions in a number of circumstances.

The party policy is to support abortions where there is a risk to the life or health of the mother, or where there is a foetal abnormality that means the foetus would be stillborn.

This policy follows a vote at the Labour conference in 2001 to support a woman's right to choose on the issue, which was carried against the wishes of the party leadership.

In government, he said his party would set up a dedicated jobs fund, a strategic investment bank and a department for public sector reform.