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Women’s Health

Opinion | In Texas, When Is Abortion Legal to Save a Woman’s Life?

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If you will, join us in a thought experiment. It is autumn 2022. Dr. H., an obstetrician-gynecologist, is practicing in a red state. By then, a lot has changed in the reproductive rights landscape: in the spring, her state rushed to pass a law similar to the infamous Texan law of 2021, which bans a vast majority of abortions and encourages individuals to sue anyone who helps to perform an abortion. The Supreme Court that year also overturned Roe v Wade in the Dobbs v Jackson Women’s Health Organization case, leaving the issue of abortion regulation to the individual states; A few years earlier, Dr. H. Issued a withdrawal ban that automatically banned the few abortions that were legal in the state when Roe fell. In their state, the law only allows an abortion if the pregnancy threatens the life of a pregnant person.

Dr. H., Ms. R., has a severe cardiovascular disease which puts her at an extremely high risk of maternal mortality or severe morbidity. There is no way to say for sure that she will die; some patients like her survive their pregnancies. But doctors who care for them and others with the condition are encouraged to talk about abortion. If the patient chooses this option, Dr. H. then terminate the pregnancy with Ms. R.?

History shows us how this lack of clarity puts women at risk. While abortion was illegal in America in the pre-Roe era, the states theoretically gave doctors the right to perform abortions if doctors agreed that a pregnant woman’s life was at risk or, in some cases, her health in later years was. But what counts as a threat to a person’s life or health is often subjective, and those who make such judgments have not been immune from political pressure.

Initially, hospital abortion decisions were made rather informally in a small group of doctors. But in the middle of the century, doctors worried that too many hospital abortions were approved. Given the stigma surrounding abortion, they feared that their reputation, the reputation of their hospitals, and even their licenses could be compromised.

In reality, not a single doctor had been charged with hospital abortion in the 1950s. The only charges that took place concerned abortions performed outside of hospitals, whether by doctors or otherwise. (The majority of abortions before Roe took place outside of hospitals.) Even so, many hospitals established therapeutic abortion committees to formalize the abortion approval process.

These committees proved problematic in many cases. There were often strong disagreements among committee members, with their own views on the morality of abortion inevitably influencing their decisions. Some hospitals set quotas and didn’t want their facilities to be known as places where it was too easy to do the procedure. The committees disproportionately favored abortions for the hospital doctors’ private, mostly white, patients over the black patients and poor white patients who came to the hospital as charity cases. The number of approved abortions fell from an estimated 30,000 in the early 1940s to around 8,000 in the mid-1960s, leading more women to seek often unsafe abortions outside of hospital. Growing frustration at the arbitrariness of the committees’ decisions apparently helped the American Medical Association expand justifications for hospital abortions in 1970

In view of the bitter abortion fight that has raged in this country in the almost 50 years since Roe, an even stronger polarization is to be expected among the doctors who are tasked with decision-making in the post-Roe era. Perhaps they will reinvent a version of the therapeutic abortion committees of yesteryear. Hospital administrations that rely on funding from conservative state lawmakers could pressure these committees to approve as few abortions as possible. In fact, we already have evidence that hospitals – which performed only about 4 percent of abortions in America in 2014 – often have stricter requirements than the law makes.

Around 700 women die each year from pregnancy complications (and a disproportionate number of these women are black). We can expect even more pregnancy-related deaths when legal abortion becomes nearly impossible in about half of the states. Even the most restrictive laws, like the recent Texas bill, usually make exceptions for life-threatening physical conditions and sometimes serious risk to a woman’s health if a pregnancy continues. But history shows us that these supposed exceptions often just don’t work.

The best public health response to the current assault on the right to abortion would be for Congress to pass the Women’s Health Protection Act, which would protect the right to abortion in every state. Spokeswoman Nancy Pelosi plans to submit the bill to the House of Representatives when Congress returns from hiatus, and the Senate must follow suit. We also urge physician decision-makers in each state to set aside their personal views and make a commitment to timely ensure that all pregnant patients receive the care that will best ensure their survival and health. Everyone deserves safe, compassionate abortion care without the kind of political interference that has harmed people’s health since the days before Roe.

Carole Joffe and Jody Steinauer are professors in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco. Carole Joffe is the co-author of Obstacle Course: The Everyday Struggle to Get an Abortion in America.

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Women’s Health

Contraception in SA: What you need to know

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Although the majority of South African women of childbearing age use contraception, research shows that access to information about contraceptive methods of their choice is still limited – especially for women in rural communities. This restricted access to information has resulted in an alarming increase in young women looking for emergency options like the morning-after pill.

Health-e News takes a look at the current situation and explores the opportunities for young women.

#AskLwanda

Without much access to information, women turn to social media in hopes of finding answers to their many questions about contraception.

A pharmacist and health advisor from the Eastern Cape, Lwanda, Mkhatshane, used his experience as a retail pharmacist to set up a service where everyone can access health and health information online in real time. The hashtag #AskLwanda was featured on social media platforms such as Facebook, Twitter, Instagram. For those who are not in the mood for social media, calls via Skype and messages via Whatsapp are available.

Its website states: “This pre-existing technology enables you to speak to the customer, confidentially and privately, with the pharmacist. The pharmacist is ready to speak to you and provide information on acute or chronic treatments, drug side effects, contraindications and other information. This convenient service costs only R20 per consultation.

Mkhatshane, known as “pharmacist on call,” said it was shocking how many women are looking for the pill and stressed the importance of people choosing contraception as a choice rather than an emergency option.

He shared some of the most common questions people ask him:

  • Is there any other way to have safe sex without using a condom mara?
  • Is the morning-after pill a contraceptive method?
  • How does the contraceptive ring work?
  • Why is Implanon so expensive?

Here is the thread on contraception.

I focused on the brand 🇿🇦, the price and for whom the method.

1. Enter-use device (IUD)
2. Implant
3rd injection
4. Skin patches
5. vaginal ring
6. Pills

There is no silver bullet. ❌
The choice depends on the patient. pic.twitter.com/DPzG3frVRg

– Online recipes (@AskLwanda) September 5, 2021

Access to SA and contraception

The prevalence rate of contraceptives among all South African women of childbearing age (15–49 years) using modern contraception is 64.6%, according to a study published by BMC in 2019.

Although this percentage is relatively high, it overshadows the problem of quality contraception services, equal access and the ability of women to correctly and consistently use contraceptive methods of their choice. This is especially true for young black women who live in working-class communities and rural areas, according to the study.

The aim of the study was to understand the needs and behaviors of women of childbearing age in South Africa in relation to family planning and contraception. This was achieved through research into women’s biomedical knowledge of the reproductive system and contraception, including the physical and sensory experiences of contraception and how they influence contraception decision-making.

Body mapping explained

In order to examine the physical and sensory experiences of women with contraception methods, body mapping and group discussions were carried out on 57 women of childbearing age during the study.

Body mapping, which can be defined as “the process of creating body maps using drawing, painting, or other art-based techniques to visually represent aspects of people’s lives, their bodies and the world in which they live” – stressed the need to address communication and knowledge gaps related to the female reproductive system.

An example of body mapping and a contraception timeline. (Photo: Reproductive Health Journal)

AYFS – youth and youth-friendly offers

The South African government has developed and implemented various programs through the National Ministry of Health over the years, such as the National Adolescent Friendly Clinic Initiative or NAFCI (2000-2005), the Youth Friendly Services (2006-2011) and the current revised model for youth and youth friendly services (2013-2017).

While there have been remarkable positive results in reducing the prevalence of HIV among young people, this age group continues to face numerous health problems stemming from the lack of widespread systemic change; Lack of in-depth analysis of AYFS programming and implementation; and poor use of health services by adolescents and young people.

As a result, in April 2017, the government and the Ministry of Health, in collaboration with UNICEF and UNFPA, commissioned a Rapid Assessment of Youth and Youth Friendly Services (AYFS) in all nine provinces of the country, with peer educators in some provinces of primary health care facilities in clinics to help young people.

Another BMC research study found the following: The institutions had the essential components for general service delivery, but there were no youth-specific service offers. AYFS is a government priority, but additional facility support is required to meet agreed standards. The fulfillment of these standards could make an important contribution to safeguarding the health of adolescents, in particular to the prevention of unwanted pregnancies and HIV as well as to the improvement of psychosocial management. “

Communication and knowledge gaps

The study concluded that there is an urgent need to address the gaps in communication and knowledge related to female reproductive anatomy, different methods of contraception, and how contraceptives work to prevent pregnancy, thanks to the influence of wider social networks and local language is underlined.

“Overall, women have limited biomedical knowledge of female reproductive anatomy, conception, fertility, and how contraceptives work, which appeared to be exacerbated by a lack of contraceptive advice and support from health care providers. Body map images put existing local perceptions and reproductive health knowledge in the foreground. Most women were where the baby was developing, outside of the womb, in the abdomen, and often relied on the local vernacular when naming the reproductive organs with words like “mouse” and “cake” for the vagina, “so the BMC research.

“Women, including younger women, have identified gaps in their own knowledge of sexual and reproductive health and identified these gaps as important factors that have influenced the acceptance and effective use of contraception. These gaps in knowledge were mainly due to poor or lack of communication and advice from the health services. “

Types of contraception available in SA

There are six different hormonal contraceptive methods available to women in South Africa. All of these forms of contraception are available free of charge in public hospitals, but shortages remain a problem.

Health-e News reported on the contraceptive shortage that hit parts of South Africa, particularly Limpopo, in July. The ongoing COVID-19 pandemic devastated pharmacies and clinics in particular, which were unable to meet the demand for the Depo-Provera contraceptive injection.

Contraception methods available in South Africa:

  • Oral contraceptives
  • Spirals
  • Implants
  • Injections
  • Patch
  • Rings

Oral contraceptives

The pill is a tablet that you take once a day – there are different types of pill. The combined pill contains estrogen and progestin, which prevent the ovaries from releasing eggs. It also thickens the cervical mucus, which prevents the sperm from getting to the egg. The so-called minipill contains only 1 hormone, a progestogen that offers an alternative to those affected by the hormone estrogen.

You should swallow the pill at the same time each day whether you are having sex or not. Ask your doctor whether the combination pill is an appropriate method of contraception for you based on your medical history, and if so, which one is best for you.

Popular options are Yazmin, Levora, Camila, and Jolivette.

Spirals

An intrauterine device, commonly known as an IUD, is a sling device that releases progestin to prevent fertilization for five years. It can be obtained with a prescription and inserted into the uterus by a doctor to help prevent pregnancy. It is an option for women who have never been pregnant and offers immediate protection.

Any hormonal contraception carries a risk of side effects – albeit rare. With IUDs, side effects can include vaginitis (inflammation, discharge), headache, back pain, mood swings, and depression.

Implants and injections

The contraceptive implant is a small rod-shaped plastic object that is placed under the skin on the upper arm. It is available free of charge, accessible in public clinics, and lasts for three years. Mkhatshane said it should be implanted during the first five days of menstruation and it works immediately. Enlarged breasts, weight gain, and an irregular period are some of the side effects that can occur.

Depo-Provera and Nuristerate injections are available in both private and public health settings. Depo affects glucose intolerance and can be associated with grimacing. While Nuristerate is considered the milder of the two injectable contraceptives available. Depo-Provera slowly diffuses over a period of three months after injection. It offers instant protection when injected within the first week of menstruation and can be used by all women, including those with epilepsy and those unable to take estrogen. It can prevent pregnancy for nine to 18 months after a single injection. The side effects are similar to those of the implant.

Mkhatshane noted that women with the nuristerate injection would still get their periods but would not experience spotting or prolonged bleeding. This is the preferred injection for women with diabetes, but Mkhatshane warned that women with hyperpigmentation (chloasma) should avoid the injection as it could make their condition worse.

Patches and Rings

The skin patch releases hormones through the skin and into the blood and works to prevent ovulation, thicken vaginal fluid to prevent sperm survival, and alter the lining of the uterus to make it harder for a fertilized egg to attach. Mkhatshane suggested that women with a history of active breast cancer, liver disease, and diabetes with high blood pressure should avoid this method.

The vaginal ring is a small plastic ring that is inserted into the vagina. It releases a steady dose of hormones into the bloodstream to prevent pregnancy. According to Mkhatshane, the vaginal ring is just as effective as contraceptive pills but should not be used by women who smoke and are older than 35 years. Side effects include nausea, vaginal discharge, and decreased sexual appetite.

What do SA women prefer?

Injectable birth control was by far the most common method, used by 25% of women, according to a 2017 study by the South African Medical Journal (SAMJ). Other methods were less common and only a negligible proportion used an IUD (1.6%), while 8.6% used a birth control pill. – Health-e news

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Women’s Health

Coming second in the game of life – Kate Pickett

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“We don’t want to behead the big poppies,” said Boris Johnson in July. But for Kate Pickett, his “leveling” ambitions will require a flattening of the entire social divide.

The not entirely social winners? – a wedding reception on the Thames (Ian Luck / shutterstock.com)

There was enough athletic competition in the summer to remind us how hard it can be not to be quite the winner. In England there was great excitement when the national soccer team reached the final of the European Championship, only to lose there on penalties to Italy. There was almost immediately a backlash of racism and hatred towards the players who missed those crucial final shots on goal.

At the US Open tennis tournament, the women’s final was played by two talented teenagers who had both done spectacularly to get this far – but the disappointment of runner-up Leylah Fernandez was hard to see. And at the Tokyo Olympics, one competitor after another said to the cameras, ‘I’m not here for second place; I’m not here for silver. ‘

But in life, unlike in sport, is the second one surely good enough? We can’t all be winners, but if we have a good education, a good job, and all of our material needs, is that enough for our health and wellbeing?

In some ways it is true: nobody needs excessive income or wealth to be healthy, and too large an income gap between rich and poor is detrimental to the health of the population and the good functioning of society. But it is also true that, like in sports, being the winner is not that important.

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Social slopes

Almost all major causes of death and illness show social inequalities. They are not only more common among the poor and the lower classes of society, while they are rare among the rest of the population. Instead, there is a steady gradient in the incidence of various diseases and causes of death between each level of the social ladder. So while morbidity and mortality are certainly highest among the worst-off, if you are not entirely at the top of the income bracket, not entirely in the top social class, or not well educated, there is a risk of poor health. Illness and death are still a little higher than those directly above you.

This is an almost ubiquitous pattern around the world. We see it in life expectancy and infant mortality, in health behaviors like smoking and obesity, chronic diseases, heart attacks, infections, and most cancers. There are one or two exceptions, particularly breast and prostate cancer, but otherwise there are social health gaps everywhere.

In the graph below, the bars show life expectancy for men and women in England, with the population divided into ten groups, from those most deprived on the left to those least deprived on the right. When we look at such charts, we usually notice the differences between the top and the bottom – here a life expectancy of 9.5 years between the most deprived and least deprived men and 7.7 years between the most deprived and least deprived Men least disadvantaged women.

Life expectancy at birth by decile and gender, England 2018

social gradient

But with every step from prosperity to misery, from right to left, both men and women, on average, lose a little bit of life expectancy. Men in the least disadvantaged group live an average of about 82 years, about a year and a half less than men in the least disadvantaged group of all. Women in the second best group live just over 85 years, but women in the top group live about a year longer.

These are surprising penalties for being among the least disadvantaged instead of making it into the top 10 percent. No one in the top 20 percent is denied any material necessity, and no one is likely to lack the knowledge to make healthy decisions. Nevertheless, people in the second decile still die younger and suffer from almost all acute or chronic diseases more often than in the first.

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Status matters

What these social gradients tell us is how important the social environment is – it’s status itself that matters. If you have a little less status than the one at the top, you are not doing as well as if you are the highest status. If we are to address health inequalities, we need to level the entire gap, not just try to tackle health problems from the bottom up.

While social gradients are almost ubiquitous in the health sector, the steepness of the gradient varies from place to place. Societies with lower economic inequalities have a widespread tendency to have smaller absolute differences in health. Reducing inequalities in income, wealth, education and social class will help society as a whole – not just the poorest or those in dire need. We would all be winners if the playing field was leveled.

Covid-19 of course also has a social gradient. It was never an “equality disease,” as some claimed early on. It’s too late for the pandemic we are in, but some serious social and economic leveling would help us cope with whatever might come next.

This is a joint publication by Social Europe and IPS-Journal

social gradient

Kate Pickett is Professor of Epidemiology, Associate Director of the Center for Future Health, and Associate Director of the Leverhulme Center for Anthropocene Biodiversity, all at the University of York. She is co-author with Richard Wilkinson on The Spirit Level (2009) and The Inner Level (2018).

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Women’s Health

Mon Health Stonewall Jackson Memorial Hospital physician honored by WVSOM

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WESTON, W.Va. – Mon Health Stonewall Jackson Memorial Hospital Obstetrician / Gynecologist Robert Harris, MD, was born on Friday 17th), in Lewisburg.

The Outstanding Preceptor Awards are given to physicians who show professionalism and demonstrate their service to students, including a commitment to teaching, mentoring, and the educational process. They also serve as positive role models, reflecting their commitment to the osteopathic teachings or the Hippocratic Oath and commitment to patient care. Preceptors support and advise the medical students of the WVSOM in their clinical rotations in the third and fourth years.

Students in each region nominate and vote on the preceptors for the awards. The Central East region encompasses the central portion of WV, including Elkins, Buckhannon, Weston, Bridgeport, and Morgantown.

Dr. Harris earned his bachelor’s degree from Quinnipiac College, Connecticut, before earning his medical degree from St. Georges University in the West Indies. He completed his residency at Staten Island University Hospital in New York. He is certified by the American Board of Obstetrics and Gynecology and a Fellow of the American Congress of Obstetricians and Gynecologists.

“DR. Harris is an excellent teacher. He challenges you as a student to see your potential. He allows us to perform procedures and has very hands-on experience in obstetrics / gynecology. I’m in with little interest in obstetrics / gynecology gone the rotation but after working with Dr. Harris I appreciate the field a lot more, ”wrote one student.

Other nominators wrote: “Dr. Harris goes way beyond that for his students. He’s a great teacher and really helps students prepare for the post-test rotation and boards. ”Others wrote that Dr. Harris was one of the finest teachers they had worked with and that his ability to teach and work with patients was “paramount”.

In an interview a few years ago, Dr. Harris carefully considered why he made women’s health his specialty.

“I chose Women’s Health because I enjoy short-term and long-term care options. For example, an emergency room cannot maintain a long-term relationship with the patient. This field gives me the opportunity to have both surgical and medical treatments, ”he explained. “But perhaps one of the most important aspects of my practice is the opportunity to be present at the birth. Having a baby is a unique and extraordinary experience. It is more moving than any other experience in the medical field. “

Other doctors at Mon Health Stonewall Jackson Memoria Hospital who have received the award in the past include Dr. Robert Snuffer and Dr. Brian Hornsby.

Approximately 50 hospitals, clinics, and medical centers across West Virginia participate in WVSOM’s statewide campus program. Outstanding Primary Care and Specialty Preceptor Awards were given to physicians in each campus region, including the central (split), eastern, northern, southern, central, southeastern, and southwestern regions.

To learn more about Mon Health Obstetrics and Gynecology, visit MonHealth.com/OBGYN or call 304-269-3108 in Weston.

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