Archive for the ‘women’s health’ Category

The Teen Mom Trend: Effective Sex Education

March 11, 2018


In 2015, 22.3 of every 100 babies were born to women between the ages of 15-19 in the US. While this rate is gradually decreasing, teen pregnancy is still a serious issue for many reasons. Teen pregnancy and childbirth accounted for an estimated $9.4 billion in excess costs to United States taxpayers due to increased foster care, increased incarceration rates for children born to teen parents, and lost tax revenue due to lower educational achievement and lower income for teen mothers. Additionally, teen mothers have higher high school dropout rates; only 50% of teen mothers receive a high school diploma before the age of 22. This is in contrast to a rate of 90% for women who do not give birth during high school years. Furthermore, the children of teen parents are more likely to have lower educational achievement, have more health problems, be incarcerated, face unemployment, as well as continue the cycle and give birth as a teenager. Not only does this signify a serious economic burden on taxpayer money for healthcare, jails, foster care homes, and welfare, but it is also a serious public health issue.

Preventing teen pregnancy has wide support, as it is one of the CDC’s seven top priorities in public health. However, while agreement that teen pregnancy is a serious, widespread issue in the US, agreement on what to do about it is not. Because the issue of free birth control is complicated and would require years to pass as a bill in the federal government, implementing an educational policy that can be put to use much more quickly is the best option. A successful program would be adopted in all US public schools to increase awareness and promote safe sex practices in hopes that teen pregnancy rates reduce. The program will be made available to private schools, but as most private schools are religious there may be resistance –because concerns have been made that sex education should be the right and responsibility of the parents. Therefore, the public school sex education system will be the main target. School boards that may be hesitant to adopt a federally regulated sex ed curriculum, should be reminded that their main concern should be on lowering teen pregnancy and keeping girls in school. While sex education does exist in some public schools, it is difficult to regulate the curriculum and the education is focused primarily on abstinence. A new program should  be put in place to provide a more well rounded sexual education that is relatable and up to date on current teenage culture. This will help to increase the chances of teenagers receiving and internalizing the message of safe sex practices. Since 1997, the US government has spent billions of taxpayer dollars investing in abstinence only programs which have been “proven ineffective” and “censor or exclude important information” that could only help adolescents make better decisions about their own sexual health. In 2004, a report released by the US House of Representatives Committee on Government Reform showed that 80% of the most popular federally funded abstinence only education programs “use curricula that distort information…misrepresent risks of abortion, blur religion and science… and contain basic scientific errors.” Furthermore, 88% of youth participating in virginity pledges broke the pledge and had sex before marriage. This demonstrates the need to target the government to reform the sex education system in order to address the severe issues associated with the current sex education curriculum. Societal beliefs and practices have changed in regards to sex, especially amongst the younger generations. Abstinence is considered to be an outdated belief that teenagers most likely will not follow. On the other hand, studies on comprehensive sex education reveal significant effectiveness. Sex education programs funded by the National Campaign to End Teen and Unplanned Pregnancy lead to 40% delayed sexual initiation, 60% reduced unprotected sex and much more. Having a comprehensive sex education program that will include abstinence, but emphasize attainable and current safe sex practices is the only option that can be implemented quickly and has seen success amongst the target audience. Thus, a federally funded and regulated comprehensive sex education program would significantly reduce the rates of teen pregnancy, and thus reduce the burden on American taxpayers, as well as better the quality of life for teens and families across the country.  


Abortion reform in Lao PDR. What next?

March 10, 2018

The global burden of unsafe abortion

Globally, 25 million unsafe abortions occur each year. Unsafe abortion accounts for up to 22, 000 maternal deaths world-wide and approximately 6.9 million hospital admissions, at a cost of $US533 million.

Consequences of unsafe abortion in the developing world

Restrictive abortion laws and policies continue to hamper efforts to reduce maternal death and disability. Restrictive abortion laws and policies significantly reduce the proportion of safe abortions, but do not reduce the total number of abortions. Reforming abortion law and policy can be a catalyst for preventing unsafe abortion.


What is happening in Lao PDR?

Significant abortion reform has occurred in Lao PDR over the past two years. Prior to 2016, abortion law and policy was largely unclear, leading to restrictive interpretations and limited access to safe abortion services. In 2016, the Prevention of Unsafe Abortion Guideline was released, which clarified many aspects of abortion management, including eligibility criteria, procedural standards and post-abortion care.

Whilst the release of the Guideline removes many legal and policy barriers to service reform, there is little evidence that such reform is underway. To date, no data has been released about the number of abortions performed or complications. Further, there is an absence of coordinating policy to facilitate effective implementation of services contained within the Guideline.


What next?

Lao PDR is embarking on the next phase of health sector reform, as outlined in the National Strategy and Action Plan for Integrated Services on Reproductive, Maternal, Newborn and Child Health 2016 -2025. This is a key opportunity to ensure that abortion services contained within the Guideline are implemented to their full extent. This should include the development of an Action Plan, with:

  1. Specific, measurable targets for service delivery
  2. Mechanisms for monitoring implementation and regular review of progress
  3. Allocation of appropriate resources, including managerial staff, health workers, medications and equipment
  4. Defined roles and responsibilities for key advocacy groups including the Lao Women’s Union
  5. Defined roles and responsibilities for key development partners including Population Services International


Dr Jeremy Chin was part of a World Health Organization team that supported the development of the Prevention of Unsafe Abortion Guidelines in  Lao PDR in 2016.

Could Biology Explain Racial Health Inequalities?

March 10, 2018

The consistently greater risk for infections and cancer among men of African ancestry compared to all other ethnic groups in the world suggests fundamental biologic causes that supersede social and geographic influences. One of the most popular arguments for the notion that race is a “social construct” is derived from the point made by the geneticist Richard Lewontin, to the effect that intra-racial genetic similarity among individuals classed within any given “race” typically accounts for only about 7% of genetic similarity. Lewontin concluded from this that racial classification is “meaningless.” While his data concerning intra-racial vs. interracial genetic similarity were correct, the inference from this data that racial classification is meaningless is widely referred to by evolutionary biologists today as “Lewontin’s fallacy.” Indeed, 7% of the genetic material consists of several thousand genetic loci, which is quite an impressive amount of genetic material.

Random studies have found higher Testosterone levels in African American men and higher Testosterone and Estrogen levels among African American women together with low Dehydroepiandrosterone levels (DHEA) compared to their racial counterparts, could explain the health inequality. DHEA levels decrease with old age and low levels are said to reduce body’s immunity against diseases increase the risk for infections and cancer; DHEA levels have been found to be particularly low in African Americans, increasing their vulnerability to diseases. This understanding is key to prioritizing health services to this community. We need policies to address early childhood education including health education; access to healthy food and eating right, and performing work and out of work activities according to your biological capabilities. We need to help people understand their biology and how it affects their health and behaviour and they can take advantage of their differences.racial differences

I advocate for health education and services to reach out to African American communities in their homes, work, schools, and churches. Early screening of African American women, for Breast cancer, Endometrial cancer, and Ovarian cancer and earlier screening of Lung cancer Prostate cancer and other common cancers among African American men; after reaching the age 40.

Featured picture by KANGSTAR

Sweet home Alabama? Criminalization of Drug Use During Pregnancy

March 10, 2018

Alabama has some of the toughest criminal drug laws in the country. The conservative state legislature has introduced a myriad of acts targeting drug use in the past decade, including a  “Chemical Endangerment of a Child,” law in 2006. Originally written to reduce children’s exposed to drug addiction, a 2012 case in the Supreme Court of Alabama interpreted the law to include unborn infants, even if the fetus is not viable.

While the law was created with good intentions, the criminalization of drug use during pregnancy has led to several negative consequences. Among them, pregnant women must choose between their health and risking conviction. The fear is compounded by the fact that women in Alabama have been drug tested at medical facilities without their knowledge. Women interviewed by Amnesty international in Alabama expressed fear in seeking care at professional offices, leading to delays in critical antenatal care. One woman stated, “In my town, I was worried about going to the doctor because if you test positive [for drugs], bam, you’re slapped with a ‘chemical endangerment’ charge.”   Once convicted, women face jail time, even while pregnant, and revocation of parental custody. Incarcerated women may have not access to critical drug treatment and antenatal care.

Alabama is an extreme example, but child assault laws for drug use during pregnancy has become more common. Given the bleak outlook of women convicted with the law, several recommendations can be made:

  • Alabama legislature should take steps to decriminalize drug use during pregnancy, as supported by many key stakeholder organizations, including the American Medical Association, American Academy of Pediatrics, and the American Public Health Association.
  • Clear procedures should be made for health providers in states that criminalize drug use during pregnancy. Recommendations can include open discussions with patients on drug use during pregnancy, and full transparency on drug testing procedures. The American College of Obstetrics and Gynecology already provides standards of care and could provide this guidance.
  • Expansion of residential drug treatment programs targeting pregnant women, that accept Medicaid insurance. A pilot study for federal grants to support drug treatment programs is already underway with the Improving Treatment for Pregnant and Postpartum Women Act of 2016, but should be fast-tracked and expanded to include more states

The Mexico City Policy: Misunderstood, Misguided, and Malignant for Maternal and Child Health

August 20, 2017

Imagine a woman seeking medical care in the direst of circumstances and a sole health worker prepared to deliver her these services. Now imagine that although the worker’s organization is committed to provide these safe, legal, quality services, a single policy financially incapacitates the care because a minority of citizens in a country thousands of miles away opposes even discussion of certain topics with the patient. This is wasted human spirit. This can mean life or death. And this is the Mexico City Policy, a U.S. federal restriction recently re-enacted and expanded under President Trump as the Protecting Life in Global Health Assistance (PLGHA) policy.

PLGHA requires foreign NGOs to agree not to “perform or actively promote abortion as a method of family planning” as a condition for receiving U.S. government funds NOT ONLY for family planning assistance, as the previous Mexico City Policy declared, but for ALL health programs, including those for HIV/AIDS, maternal and child health, malaria, and global health security, putting billions of annual U.S. aid dollars and, thus lives, at risk. An increase in abortions has previously been found under this intervention and models predict staggering numbers of unintended pregnancies, abortions, and maternal deaths. Not surprisingly, advocates of women’s health around the world from International Planned Parenthood Federation to the United Nations have outlined the deadly consequences of the PLGHA and not only stated their firm opposition to it but have created movements against it.


The clearest course of action for advocates of women’s health and Global Health in general is to promote passage of the U.S. Global Health, Empowerment, and Rights Act (HER Act), introduced by Senator Jeanne Shaheen and Representative Nita Lowey. The HER act would create a permanent, legislative repeal of PLGHA and the Mexico City Policy, allowing NGOs to continue to operate U.S.-supported health programs without being forced to sacrifice the provision of appropriate care. The HER act fights the financial coercion of the PLGHA and may offer the best chance to restore global faith in the U.S. as the leader of Global Health worldwide.








Teen Pregnancy Prevention Program Defunded in Baltimore…and Beyond

August 20, 2017

The teen pregnancy rate in Baltimore is 2-3 times the national average, with rates reaching upwards of 64 pregnant teens for every 1,000 female adolescents in 2009. According to the Center for Disease Control, teen pregnancy costs taxpayers $10 billion annually in health care and foster care costs. On the personal level, unplanned pregnancies significantly reduce life opportunities for teen moms, with the CDC finding that only 50% of teen moms graduating from high school by age 22. This lack of education causes a ripple effect, and teen moms have more chronic health problems and higher rates of incarceration.

Courtesy of the Baltimore Sun

Courtesy of Baltimore Sun

Teen pregnancy in Baltimore has seen a steady decline over the last decade, joining a national downward trend. This comes in no small part to programs such as the Health and Human Services’s Teen Pregnancy Prevention Program (TPPP). With funding from the TPPP, 80 city health departments have been empowered to create science-based prevention programs for teens to understand contraception and sexuality.

Unfortunately, the TPPP was abruptly defunded last week. The Trump administration offered little explanation, leaving pro-abstinence groups such as The Abstinence and Marriage Education Partnership to justify such cuts with claims that abstinence is correlated to lower rates of teen drug abuse.

Here in Maryland, the Baltimore City Health Department expressed frustration at losing $3.5 million out of the $214 milling being cut. Health Commissioner Leana Wen called the cuts “shocking.” The Health Department has joined the Big Cities Health Coalition, comprised of the 80 beneficiary cities of TPPP funds, in decrying the budget cuts. Even the American Academy of Pediatrics has joined the plea, adding a link to its website for pediatricians to contact their congressmen in protest.

There’s good news. The National Campaign to Prevent Teen and Unplanned Pregnancy found that 83% of adults support teen pregnancy prevention programs. Now is the time to tell Congress that the constituency wants the TPPP funded. Call your congressman today!

Stop restricting access: Prevent the “Rape Insurance” bill from going into law.

August 20, 2017

On August 15, 2017 Texas Governor Greg Abbott signed House Bill 214 (HB 214). HB 214 is a bill by Rep. John Smithee (R-Amarillo) that bars standard coverage of elective abortions by private, state-offered and Affordable Care Act insurance plans. While it has a very narrowly defined exception for medical emergencies, it makes no exception for rape, incest, or fetal abnormalities. To obtain coverage for abortions due to rape, women would have to have previously purchased supplemental coverage which has led critics to dub this the “Rape Insurance” bill.


Mandel NGAN/AFP/Getty Images

The authors of the bill claim this legislation is about not requiring those who philosophically and fundamentally disagree with abortion to have to subsidize the procedure. Governor Abbott states this bill only limits insurance coverage for abortion procedures, not abortions themselves. But he himself cites this bill as part of his pro-life agenda stating “I am grateful to the Texas legislature for getting this bill to my desk, and working to protect innocent life this special session.”  In truth what SB 214 really does is limit a woman’s access to appropriate and timely health and abortion care. This legislation also unfairly and disproportionately targets low-income women. Abortion is concentrated among low income women.  Low-income women also shoulder a higher financial burden in terms of healthcare in general.

Under the bill, insurance companies would not be required to carry this supplemental “rape insurance”. This adds additional burden to women of all income levels. Ultimately, insurance companies may simply stop covering abortion altogether as the profitability of an “abortion-only” add-on would be questionable at best, further limiting access to care. Lastly, rape is an unpredictable life event, as is pregnancy as the result of rape. Under SB 214 women are expected to somehow anticipate the need for abortion care and purchase supplemental coverage, defying the point of insurance.

What’s missing from this photo? The women this law impacts.

What can you do?  SB 214 goes into law on December 1, 2017. Support Texas pro-choice groups in their prevention efforts. Reach out to Governor Abbott and remind him that “Texas Values” are not synonymous with his personal values. Get informed about women’s healthcare law in Texas.


via Trust.Respect.Access

Don’t live in Texas? There are 25 states with restrictions on abortion coverage in plans set up by state exchanges as part of the Affordable Care Act. There are 10 states (now 11) which have laws restricting insurance coverage of abortion in all private insurance plans written in the state. Find out what the laws are in your state. Contact your elected officials and tell them how you feel about laws limiting women’s access to healthcare.

Put Down the Weapon: Helping to Prevent Gun Violence in the Home

August 20, 2017

Source: The Trace

Under House Bill 294, the Maryland state legislature proposed the regulation that those with probation before judgement (PBJ) for second degree assault for domestically-related crimes be prohibited from retaining or possessing a firearm. Touching on the highly politicized issue of gun control, this bill was introduced to the House and successfully passed in May 2017.


Domestic violence is a public health issue often exacerbated by gun violence. Victims of partner violence are five times more likely to die if their partner owns a firearm. Even when homicide is avoided, those who physically assault their partners are more likely to utilize firearms in subsequent situations. Respected organizations such as the Maryland Network Against Domestic Violence and the Johns Hopkins Center for Gun Policy and Research have long acknowledged and advocated to address these dangers through legislative measures.

To obtain a PBJ, an individual assumes guilt but is not convicted of the actual crime, allowing them to be placed under probation with varying supervision. Often those who are first time offenders are allowed this sentence. After 15 years, these individuals can be expunged, in which case they can once again own firearms. This suggests that this law is only a temporary solution to the problem.

Still, as a nurse researcher who works with women experiencing domestic violence, I am in favor of House Bill 294. Through my work, I have found there to be inconsistent gun control policies throughout the United States. Therefore, I feel this bill is an important step forward. I further advocate for Maryland lawmakers to devise legislation that firearms are kept out of potentially violent domestic environments, even in cases of expungement, to ensure a more hopeful future for the survivors of violence.

Opposition takes aim at Rhode Island’s successful HPV mandate

August 18, 2017

In 2015, Rhode Island led the fight against cancer by mandating that all students be vaccinated against Human Papilloma Virus (HPV) prior to the seventh grade. As a result, Rhode Island now has the highest rate of compliance in the country with the Center for Disease Control and Prevention (CDC) recommendation. However, several interest groups have recently mounted legislative opposition to the mandate in an effort to dismantle the policy.

HPV is recognized as the leading cause of cervical cancer, and also contributes to several head and neck cancers. The CDC recommends protecting children early in life by providing two doses of an HPV vaccine at least 6 months apart between ages 11 and 12. Since its introduction, the vaccine has been shown to be safe and highly effective in reducing the rates of HPV by 64% among women aged 14-19.

The 2015 HPV mandate in Rhode Island to provide free HPV vaccines was championed by the Department of Health, under the authority of state statute. The Rhode Island Medical Society, the American Medical Association, the American Academy of Pediatrics and the CDC all strongly supported this decision. Appropriate medical and religious exemptions to the HPV vaccine are granted, but in the interest of child welfare, the process to seek exemptions is rigorous to ensure that no child’s health is neglected.

In April 2017, two opposing bills were introduced into the Rhode Island General Assembly which proposes that guardians be allowed to opt their children out of the HPV vaccine and any other vaccines in which “non-casual contact diseases are transmitted by sexual contact”. A third bill proposes a philosophical exemption to the vaccine, while a fourth bill attempts to revoke the Health Department’s legislative ability to mandate the HPV vaccine entirely. These efforts were led by interest groups including The Gaspee Project and Rhode Islanders Against Mandated HPV.

Children are counting on Governor Gina Raimondo to stand up for their health by continuing to defend the legislative authority of the Department of Health and oppose these bills which attempt to overturn a critical public health policy.

The Global Gag Rule, a harmful human rights violation

March 12, 2017

The Global Gag Rule (GGR) is harmful to women and families and violates human rights. Originally known as the “Mexico City Policy” because it was enacted by Ronald Reagan in 1984 at a conference in Mexico City, the policy is more commonly known as the Global Gag Rule because of how it silences NGOs and health care workers. Specifically, the original policy dictated that no USAID family planning funds could be awarded to organizations that performed or promoted abortion and therefore prohibited them from even speaking about abortion.

The GGR is highly partisan- every Democrat president since Reagan has rescinded the policy and every Republican has reinstated it. The current administration, however, has not only reinstated the GGR but has dramatically expanded the funds that are affected.

Reagan’s version applied to USAID family planning funds; G.W. Bush’s version limited the GGR by exempting USAID HIV/AIDs related work. The latest iteration, however, greatly expands the affected funds to cover all foreign aid arising from any agency or department. The current version restricts up to $9.5 billion in aid, or 16x the amount of funds that would have been affected by previous versions.

Worse yet, beyond being a clear example of religious overreach in US politics and a violation of human rights, evidence suggests that the policy reduces sex education and contraception use while increasing both abortions and the proportion of abortions that result in health complications- maternal, family, and child health all suffer. There is a large coalition of organizations that oppose the GGR. You can take action today by learning more information about the GGR and volunteering or donating to organizations like IPPF, PAI, and the Bill and Melinda Gates Foundation who, together with UN member countries, are attempting to counteract the extreme funding deficit.