Transcript Our body, Ourselves - The site, womenshealth.vcu.edu, is

Global Translation/Adaptation Program
The
Transnational
Journey of a
Women’s Health
Classic
Women’s Collective Strength and Knowledge
The first
newsprint
edition
appeared in
1970.
In 1971 the
book was retitled “Our
Bodies,
Ourselves.”
www.ourbodiesourselves.org
In 2005, this
eighth edition
was produced
under the
leadership of
a new
generation
GLOBALLY DISPARITIES CONTINUE TO
BE STARK
 In industrialized  In Africa,
the figure
countries, one
is about
in 7,300 women
one in
die during
twenty-six
pregnancy or
women.
childbirth.
OBOS ADAPTATIONS NOW UNDERWAY
Armenia: Armenian
China: Chinese
India: Bengali (for India and Bangladesh)
Israel: Arabic and Hebrew
Nepal: Nepali
Nigeria: Pidgin English and Yoruba
Russia: Russian
Tanzania: Kiswahili (for East Africa)
Turkey: Turkish
We are also exploring possible adaptations of OBOS in Finnish, Hindi and Kinyarwanda
Article about the
Turkish OBOS,
2007
The coordinating group,
Mavi Kalem, expects to
publish its edition in 2009
and has positioned its
website –
www.bedenimveben.org –
as a key networking and
lobbying tool for Turkish
women’s groups.
Nepal
The coordinating group, Women’s
Rehabilitation Center, is adapting
OBOS into 7 booklets in Nepali.
In 2007, despite ongoing political
turmoil in the country and
persecution by local communities,
the coordinating group and its
partners facilitated the inclusion of
reproductive health and rights in
Nepal’s new interim constitution.
Nigeria
The coordinating group, Women for
Empowerment, Development and
Gender Reform, is adapting OBOS into
Pidgin English and Yoruba, in alternative
formats such as posters.
In 2009, they will reach 1.5 million people
through outreach on the local canoe
transport system, peer health educator
trainings with village hair dressers, and a
motorcycle campaign to bring health
information to neighboring villages.
Israel
Women and Their Bodies, a group of Palestinian and Israeli
women, is developing new Arabic and Hebrew adaptations.
The old versions – depicted below – are out of print.
Hebrew
1982, Israel
Arabic
1991, Egypt
Russia
"Ourselves and
Our Body"
Electronic adaptation only;
available online at
www.womenhealth-spb.org/.
By Women's Health in St
Petersburg
Armenia
Menk ou Mer Marmine (We and Our Body)
Type: Cultural Adaptation
Format: Print Edition
Language: Armenian
Country: Armenia
Coordinating Group: Charitable Foundation
on Population Development
Published: 2001
Second edition forthcoming in 2009
Bulgaria
Nasheto Tyalo, Nie Samite
(Our body, Ourselves)
Type: Cultural Adaptation
Format: Print Edition
Language: Bulgarian
Country: Bulgaria
Coordinating Group: Women's Health
Initiative in Bulgaria
Published: 2001
China
The 1998 Chinese edition –
depicted alongside - is out
of print.
Another group is currently
developing content into
print and digital format for
web downloads and textcapable mobile phones.
This pioneering project will
reach roughly 1.5 million
people in China.
Senegal
Notre Corps, Notre Sante (Our Body, Our Health)
French Edition for French-Speaking Africa
Type: Inspired by Our Bodies,
Ourselves
Format: Print Edition
Language: French
Country: Senegal
Coordinating Group: Groupe de
Recherche sur Les Femmes et Les Lois
au Senegal
Published: 2004; Reprinted in 2007
(Left) Codou Bop, the coordinator of “Notre Corps, Notre Sante” in
Senegal, and (Right) Jane Pincus, an OBOS co-founder and co-author of
“Our Bodies, Ourselves”
Japan
Type: Cultural Adaptation
Format: Print Edition
Language: Japanese
Country: Japan
Coordinating Group: Shokado Women’s
Bookstore
Published: 1988
Korea
Type: Cultural Adaptation
Format: Print and Electronic Editions
Language: Korean
Country: South Korea
Coordinating Group: Alternative Culture
Publishing Co.
Published: 2005
Poland
Nasze ciała, nasze życie
(Our Bodies, Our Lives)
Type: Cultural Adaptation
Format: Print Edition
Language: Polish
Country: Poland
Coordinating Group: Network of East/West
Women - Polska
Published: 2004
Romania
Tu Si Curpul Tau Pentru un Nou Secol
Type: Cultural Adaptation
Format: Print Edition
Language: Romanian
Country: Moldova
Coordinating Group: National Women's
Studies & Information Center
Published: 2002
Serbia
Nasa Tela, Mi
Type: Cultural adaptation
Format: Print Edition
Language: Serbian
Country: Serbia
Coordinating Group: Autonomous Women’s
Center Against Sexual Violence
Published: 2001
Spanish, USA
Nuestros Cuerpos, Nuestras Vidas
(Our Bodies, Our Lives)
Type: Cultural Adaptation
Format: Print Edition
Language: Spanish (for the U.S)
Country: United States of America
Coordinating Group: Our Bodies Ourselves
Published: 2000 (Seven Stories Press, NYC)
India
A Hundred Thousand Questions about Women's
Health
Type: Inspired by Our Bodies, Ourselves
Format: Print Edition
Language: Telegu (an English adaptation of
this edition called Taking Charge of Our
Bodies was published in 2004)
Country: India
Coordinating Group: Hyderabad Women's
Health Group
Published: 1991
India
Healthy Body, Healthy Mind
Type: Inspired by Our Bodies, Ourselves
Format: Print Edition
Language: Tibetan (back-translated into
English)
Country: India
Coordinating Group: Tibetan Nuns Project
Published: 2005
Lobsang Dechen,
coordinator of the
Tibetan project
Editions in Progress
Turkey / Turkish
Israel / Hebrew & Arabic
Nepal / Nepali
India / Bengali
Nigeria / Local Dialects
Tanzania / Kiswahili
Published Foreign Editions of Our Bodies, Ourselves
Books Inspired by Our Bodies, Ourselves
Editions in Progress
What are some key challenges facing
women’s health advocates today?
• Media portrayals of new medical
research are often inaccurate or
incomplete
• The media often endorse or
reinforce our societal tendency
to embrace the “quick fix” or
“pill for every ill” approach
Key Challenges….
• Increasing influence of the
pharmaceutical industry over
physician prescribing practices
as well as the educational and
advertising materials aimed at
the consumer or patient
The failure to utilize best practices largely because of
perverse payment incentives well described in Dr. Atul
Gawande’s June 1, 2009 New Yorker piece entitled
“The Cost Conundrum.”
In women’s health, maternity care is a primary
arena where there are multiple examples
reflecting the failure to utilize best practices.
As a result, we have rising cesarean section
rates, falling VBAC (Vaginal Birth after
Cesarean) rates, rising rates of premature
births, rising rates of unnecessary medical
interventions that are increasingly shown to be
associated with harms, and falling
breastfeeding rates in some regions.
Evidence-Based MaternityCare: What It Is and What It
Can Achieve
Issued by the Milbank Memorial
Fund, the Childbirth
Connection, and the Reforming
States Group (2008)
What is Evidence-Based Maternity Care?
Definition
Uses best available research on the safety and
effectiveness of specific practices to help guide
maternity care decisions and facilitate optimal
outcomes in mothers and newborns
Gives priority to effective care paths and practices
with least harm
What is Evidence-Based Maternity Care?
Corollaries
Avoid practices with no clear benefit and
established or plausible harms
Avoid practices with marginal expected benefit that
is overshadowed by established harm.
FIRST DO NO HARM
Imperative for
Maternity Care
Quality
Improvement
Imperative for Maternity Care Quality Improvement
Scale
United States: over 4.3 million births/year
Childbirth In United States
• the leading reason for hospitalization
• mothers & newborns are 23% of all discharges
• procedure intensive: 6 of 15 most commonly performed hospital
procedures in entire population associated with childbirth
Imperative for Maternity Care Quality Improvement
Costs and Charges
Childbirth especially impacts 2 purchaser groups
• private insurers/employers pay for 51% of hospital stays
• Medicaid/taxpayers pay for 42% of hospital stays
Combined maternal/newborn hospital charges far exceed charges for any
other condition: $79,277,733,843 in 2005
• private insurers/employers: $39,726,164,301
• Medicaid/taxpayers: $34,164,460,561
Addressing Underuse in Maternity Care
Examples of Practices to Use Whenever Possible
and Appropriate
Smoking cessation interventions
Ginger for nausea and vomiting
Preterm birth prevention
External version to turn breech
presentation babies
VBAC
Addressing Underuse in Maternity Care
Examples of Practices to Use Whenever Possible
and Appropriate
Continuous labor support
Non-supine positions for giving birth
Measures to relieve pain, bring comfort, and/or promote labor progress
Early skin-to-skin contact (versus mother-baby separation)
Breastfeeding and interventions to promote its initiation and duration
Context: Lactation support ranks lower than pet insurance
(thanks to Cate Colburn-Smith)
Comparison of employer
benefits
All
companies
Large
companies
Small
companies
(500+ employees)
(<100 employees)
Chiropractic coverage
91%
83%
79%
Well-baby program (post-natal)
77%
79%
77%
Prenatal program
67%
66%
67%
Accupressure/ Accupuncture
31%
33%
31%
Onsite lactation/mother’s room
25%
35%
13%
Postal services
24%
27%
22%
Massage therapy services
14%
19%
9%
Dry cleaning services
13%
18%
9%
Pet insurance
7%
10%
5%
Lactation support services
6%
10%
2%
o Starting in 2008, lactation program/designated area was separated into on-site lactation/
mother’s room and lactation support services
o Other family-friendly benefits included on-site parenting seminars (4%) and on-site
vaccinations for infants/children (3%)
o The number of employees with lactation programs has grown from 16% in 1999
Source: Society of Human Resource Management 2008 Benefits Report
A Statement by Physicians,
Midwives and Women’s
Health Advocates who
Support Safe Choices in
Childbirth
1. That communities preserve the option of
vaginal births after cesarean (so-called
“VBACs”)
2. That options for hospital-based midwifery
care (utilizing Certified Nurse Midwives and
Certified Midwives) be made available in all
communities
3. That Certified Professional Midwives
(CPMs) be licensed and regulated in order
Breast augmentation statistics
from the American Society of
Plastic Surgeons:
212,500
2000
291,350
2005
329,396
2006
55% increase between 2000 and 2006
“Breast augmentation has
always been among the top
five surgical procedures, but
until now has never been
number one….”
ASPS Press Release, March 22, 2007
(ASPS began collecting statistics in 1992)
MORE PUBLIC SCREENINGS OF THE
DOCUMENTARY “ABSOLUTELY
SAFE” ARE NEEDED.
See also the booklet prepared by the US Food
and Drug Administration for photographs and
descriptions of adverse implant outcomes such
as disfigurement, capsular contracture (when the
breast becomes hard and misshapen), and
deflation:
www.fda.gov/cdrh/breastimplants
A survey by the American
Society of Plastic Surgeons
showed that nearly 40 percent
of plastic surgery patients
believe they should have been
more proactive in learning
about potential side effects and
complications before surgery.
Milking Cancer Partners
Eli Lilly is now the sole
manufacturer of rBGH — the
artificial growth hormone given to
dairy cows that increases
people’s risk of cancer. Eli Lilly
also manufactures breast cancer
treatment medications and a pill
that “reduces the risk” of breast
cancer. Eli Lilly is milking cancer.
Tell them to stop making rBGH.
A large coalition of groups:
See www.safecosmetics.org
“Skin Deep” a report of the Environmental Working Group, helps
consumers and workers to better protect themselves from known or
suspected carcinogens and reproductive toxins.
"It is simply no longer possible to
believe much of the clinical research
that is published, or to rely on the
judgment of trusted physicians or
authoritative medical guidelines. I take
no pleasure in this conclusion, which I
reached slowly and reluctantly over
my two decades as an editor of The
New England Journal of Medicine.”
Marcia Angell, MD
Direct-to-Consumer
Advertising of Prescription
Drugs:
Misleading Ads and How
They Hurt Us
The Public Gets Misinformation
Benefits are often overstated, while
risks are understated
FDA warning letters are issued
after the ads run
Corrective ads are rarely required
Withdrawal of an ad is the only
penalty
Ads are geared primarily to
selling more drug product, not
educating the user
The ads work: the most highly
advertised drugs, accompanied
by promotional campaigns
geared to physicians, sell
extremely well
To promote “The Hunt
for the
Pink Viagra”
(Slide Courtesy of
Leonore Tiefer)
For more information about
female sexual problems, see
the website of the Campaign
for a New View of Women’s
Sexual Problems:
www.fsd-alert.org
Removing healthy ovaries
US federal data from the late 1990s:
78% of women 45-64 who have had
a hysterectomy also had healthy
ovaries removed (even though
most were not at particular risk of
developing ovarian cancer).
“Ovarian Conservation at
the Time of Hysterectomy
and Long-Term Health
Outcomes in the Nurses’
Health Study”
by William H. Parker et al.
Obst & Gyn May 2009
“Compared with ovarian
conservation, bilateral
oophorectomy at the time of
hysterectomy for benign disease is
associated with a decreased risk of
breast and ovarian cancer but an
increased risk of all cause mortality,
fatal and nonfatal coronary heart
disease, and lung cancer. "
This reconfirms findings in an
earlier study by Parker et al (Obst &
Gyn Aug 2005):
For 10,000 women 50-54 yrs old
who undergo a hysterectomy with
oophorectomy, there will be 47
fewer cases of ovarian cancer by
the time these women reach 80
when compared with a similar
group who keep their ovaries.
BUT the oophorectomy group will
suffer 838 additional deaths from
coronary heart disease as well as
158 more deaths from hip
fractures. (Numbers reflect women
who do NOT have estrogen therapy
– there is a smaller survival benefit
to keeping the ovaries in women
taking estrogen.)
Media attention to this critical
issue has been minimal, and the
practice of removing healthy
ovaries continues.
300,000 US women have a
“prophylactic” oophorectomy
every year at the time of a
hysterectomy.
“The Marketing of Osteoporosis”
by Maryann Napoli
American Journal of Nursing
April 2009 (V.109),#4, p58-61
http://journals.lww.com/ajnonline/Fulltext/2009/04000/The_Marketing
_of_Osteoporosis.41.aspx
Chronicles how a risk factor
became a disease
Research did not support the DXA
scanning of well women at or near
menopause as a means of predicting
future fractures
4 year trial of alendronate in elderly
women with bone loss but no
vertebral fractures:
Hip fracture rate virtually no
different for the drug-treated
participants than for the placebo
group (1% vs. 1.4%, respectively)
Alendronates:
-Improve bone density but not
effective at reducing hip
fractures
- Longterm harms now emerging
(eg, risk of severe and
sometimes incapacitating
musculoskeletal pain)
See the 2002 guidelines for
osteoporosis screening from the
Agency for Healthcare Research
and Quality: They recommend
that bone-density scanning not
begin until age 65 (or 60 in some
high-risk cases)
Risks to Women’s Health from
Multiple Egg Extraction Procedures
An issue for women considering
egg “donation” whether to help
infertile women or to provide eggs
for research cloning, also known
as “somatic cell nuclear transfer”
(SCNT).