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Women’s Health

ER Goddess: Low-Income Women and Women of Color Will Bear th… : Emergency Medicine News

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figures:

abortion, bias

FU2-7figures

Half of American women seeking abortions live on incomes below the federal poverty level. (N Engl J Med. 2022;386[22]:2061; https://bit.ly/3zYFcRy.) It will be these women—women who are least able to support a pregnancy and a child—who will disproportionately bear the brunt of post-Roe abortion bans.

In anti-abortion states, only women with the financial resources, ability to take time off work, and pay for child care will be able to seek abortions elsewhere. What was formerly a right for all women is now in too many states a privilege for those with money and connections.

My patients generally don’t have money or connections. I work in an urban inner-city ED where the surrounding neighborhood has a lower per capita income, more single-mother households, and a child poverty rate higher than 99.9 percent of the neighborhoods in America. (Neighborhood Scout. http://bit.ly/2Oc37XD.) I recently saw a 12-year-old who is sexually active. Her mother, who had just learned her preteen was having sex, brought her in concerned that she could be pregnant. What will happen to this 12-year-old and other girls and women who come to my ED when they can’t access abortion?

The Turnaway study offers some unsettling insights into what life will be like for women after they are denied an abortion. (Foster, Diana Greene. The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having—or Being Denied—an Abortion. New York: Scribner, 2021; https://bit.ly/3JsHBHz.) The prospective longitudinal study compared the trajectories of women who were turned away by abortion clinics because they were too far along to the trajectories of women who received abortions at the same clinic.

Still stigmatized

The two groups were similar in demographics and socioeconomics; what separated them was who got to the clinic in time and who didn’t. Interviews with the women every six months during the five years following their pregnancies revealed that receiving an abortion did not harm women’s health and well-being. On the contrary, carrying an unwanted pregnancy to term harmed their finances, health, and families.

The Turnaway study showed that women who were denied an abortion were more likely to end up living in poverty, be unemployed, and go through bankruptcy or eviction and less likely to have money for food, gas, or other basic necessities. Women denied an abortion were more likely to be with a partner who abused them and to end up as a single parent. They were less likely to agree with the statement, “I feel happy when my child laughs or smiles” and more likely to say they felt trapped as a mother.

Even teens could be criminalized for pregnancy if we continue on our current path of stripping women of their reproductive health rights. It sounds like a dystopian novel, but women have already been jailed for miscarrying, something that happens naturally in 12 to 15 percent of pregnancies of women in their 20s, a number that rises to about 25 percent by age 40. (Cleveland Clinic. July 19, 2022; https://cle.clinic/3oUNfIV.)

Brittney Poolaw was 19 when she presented to an Oklahoma ED having a miscarriage at about 16 weeks gestational age. She was asked about illicit drug use, and she answered honestly that she had used methamphetamine. The fetus tested positive for methamphetamine at autopsy. No conclusive evidence proved that methamphetamine caused her miscarriage, but she was sentenced to four years in prison for first-degree manslaughter. She was all of 21 by then. The autopsy reported that the miscarriage could have been caused by congenital abnormality or placental abruption, but this was apparently ignored. (BBC. Nov. 12, 2021; https://bbc.in/3Q3lKJ2.)

Brittney, a Native American, faced the same type of prosecution that many low-income women, drug-using women, and women of color will face if the current legal climate surrounding pregnancy and abortion persists. The majority of women with unplanned pregnancies reported to the Turnaway researchers that they had used contraception, but these women are still stigmatized, as if forgoing abstinence is a moral shortcoming and birth control doesn’t have a significant failure rate.

Supporting Women in the ED

Contrary to what lawmakers may assume, decisions to have an abortion are not casual but serious and agonizing, often made in order to take care of family. The Turnaway interviews showed that most women seeking abortion were already mothers, and their children were more likely to hit developmental milestones and less likely to live in poverty in the years after they terminated a pregnancy. Many who had abortions went on to have more children; their subsequent pregnancies were more likely to be planned and those children had better outcomes too.

Women who seek abortion after their state’s gestational age cutoff often don’t even realize they are pregnant until it’s too late, due to factors like irregular menses and lack of morning sickness, the Turnaway study found. Nonetheless, strangers will impose their morality on these women’s private reproductive health decisions.

At best, our low-income, marginalized patients left with no option but to carry an unwanted pregnancy will face the loss of life they had envisioned for themselves. At worst, they will face their own death from complications of pregnancy. None of the women in the Turnaway study who received an abortion died from it, but two women who were turned away died from complications of pregnancy. The risk of dying from childbirth is 50 to 130 times greater than the risk of dying from abortion, according to the Centers for Disease Control and Prevention. (N Engl J Med. 2022;386[22]:2061; https://bit.ly/3zYFcRy.)

Are we willing to sacrifice the people who gestate fetuses on the altar of fetal rights?

No matter our political or religious beliefs, we EPs need to be empathetic to patients who feel frightened and trapped by the disturbing trend of forced birth and criminal sentences for pregnancy outcomes. Our patients may not seek health care during a miscarriage or after an illegal abortion because they are too scared. We need to be ready to support them with whatever resources we can when they end up in our EDs. Sadly, we also need to be ready for more of them to come experiencing the medical emergencies that will inevitably occur when a common health care procedure becomes illegal and inaccessible.

dr Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMDand read her past columns athttp://bit.ly/EMN-ERGoddess.

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Women’s Health

International Relations Degree: Jobs You Can Pursue with It

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Child marriage is very common menace in Pakistan and is deeply ingrained in traditional, societal, and customary norms. Yet it indicates a severe abuse of the human rights of girls. One in three girls in Pakistan get married before becoming 18 years old (Demographic and Health Survey 2012-13).

A girl’s access to a sound and secure childhood, a good education that can lead to better employability, civic and political empowerment are all violated through early marriages. With 1821 child brides in 2020, Pakistan was placed sixth among nations with the highest number of child brides. Girls lose their childhood and future opportunities when they are married as minors. Girls who marry are less likely to complete their education and are more vulnerable to abuse, marital rape, and health problems. Furthermore, child marriage puts girls at risk for unsafe births, ulceration, STDs, and maybe even death. Also, teenage girls are more likely than women in their 20s to pass away due to difficulties during pregnancy. Firstborn children of women who were 16 years old, 17 years old, and 18-19 years old at the time of birth experienced death rates that were, respectively, 2-4 times, and 1.2-1.5 times higher than those of mothers who were 23 to 25 years old. This is an unfortunate truth, that while the humankind has reached the moon and mars, our women are still dying from unsafe births.

This threat has also been documented in a number of previous articles. However, the latest event of the forced marriage of a young girl from Balochistan, who was just five years old, has shaken me from the core. The girl’s father filed a FIR with the Khuzdar Police Station alleging that his daughter was forced into marriage as a result of regional and tribal beliefs. After the FIR was filed, the Federal Shariah Court Chief Justice took suo-motu notice of the situation and stated that the act appeared to be against both the 1973 Constitution of the Islamic Republic of Pakistan and Islam.

Factors behind forced marriages in Pakistan

There are several factors why early age marriages are prevalent in Pakistan. The majority of these causes include: permissive legislation; a failure to enforce existing laws; the treatment of children as slaves; a primitive feudal class fabric; lack of public awareness of the negative effects of child marriages; widespread poverty; Watta Satta (Weddings between the children of siblings or the exchange of girls in marriage between two households.) underlying trafficking; Concept of Vani (Another harmful tradition is the offering of girls, frequently minors, in marriage or enslavement to a family who has wronged them as payment to settle disputes) and a lack of political will on the part of the government. The inadequacy of birth registration system and lack of responsiveness is a major contributor to forced marriages. The age of the child or children at the time of marriage can be falsified because birth registration for minors, especially girls, is hardly given priority here. Moreover, there is no unified, impartial, or robust child rights associations that might keep an eye on violations of children’s rights, specially female teens.

legislation

The Prevention of Anti-Women Practices (Criminal Law Amendment) Act 2011, which has “reinforced protections for women against discrimination and abuse,” was passed in Pakistan in 2012, according to the country’s National UPR report to the HRC. Forced marriages, child marriages, and other social customs that are harmful to women are being made illegal.

The following headings represent how the Committee on the Rights of the Child addressed the problem of child or early marriages in its Final Report and Recommendations (2009): the child’s definition, non-discrimination, respecting the child’s opinions, teenagers’ health, harmful society customs, trafficking and selling

The International Covenant on Civil and Political Rights and the Convention on the Elimination of Discrimination Against Women, whose Article 16 affirms that every woman has the right to get into matrimony “just with her free and unconditional approval,” have both been signed and ratified by Pakistan.

Pakistan has joined the Child Rights Convention, which requires state parties to uphold children’s rights to freedom of thought, conscience, and religion in Article 14.

The Sindh Provisional Assembly unanimously approved the Bill on November 2016 to put an end to forced marriages and conversions. The bill was compellingly prevented by the agitation of the Islamist groups and parties, and was never enacted into law.

recommendations

First, it seems that nobody in Pakistan, including a lot of women, cares about the precarious status of women. In reality, some educated working women are subjected to so much harassment from men, their families, and society at large that they lack the strength to fight back against their critics. Therefore, the small group of women representatives campaigning for the rights of marginalized women in Pakistan deserve special recognition for their bravery in standing up for and promoting women’s rights despite the fact that doing so would subject them to harassment from males and society.

The government should spend on education particularly in marginalized areas of Pakistan where majority girls have no access to even primary education. Instead of just being a consequence of financial adversity, social conservatism may also contribute to the educational disparity between boys and girls. Long-term policy considerations need to be taken. Lack of maternal education would have a detrimental impact on future generations and is, therefore, just as important as boys’ education because it is believed that mothers’ education plays a significant part in children’s overall development and a complete generation.

Forced marriage victims are also denied access to their most basic yet important right, good education. Here, I want to share a story of a 17 year old advocate fighting child marriages from Swat. Given that it was customary in her household for girls to enter into marriage when they are old enough to fetch water, she was getting married to a taxi driver just at tender age of 11. In an interview, she stated:

“I bravely told my family that if they get me married to that person, I will file a case against them in law. Firstly, they and my community didn’t support me, even denigrated me. But now they do. One human being with conviction can bring the change”

Moreover, police need to be given the capacity to look into the culprits and take appropriate action. I definitely do not mean “Freedom From Law” or “No Accountability” when I talk about empowerment. To ensure that the complaints filed get noticed and are addressed, rigorous policies regarding the institution of police must be devised and put into effect along with increase in the severity of punishments for such activities.

All those engaged in a child marriage, including the parents of the bride and groom as well as the person who solemnises the marriage; the NikahKhwan shall face serious punishment.

The legal age for marriage should be the same for both sexes, which is 18 years. However, the system for registering births needs to be improved. Nadra needs to implement a digital birth registration system that is systematic and reliable.

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Women’s Health

What is women’s health and why is it important?

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At the Norwegian Research Center for Women’s Health, we appreciate the public attention on women’s health over the past weeks here in Norway. I suspect that some of the reason for this debate is that we have different perceptions of what women’s health really is.

Menstrual complaints or life-long health care?

On the labor ward as an obstetrician, I get to share incredible moments with a new family, but I also see women struggling with illness and concerns related to pregnancy, birth and maternity. This part of women’s health, reproductive health, is obviously near to my heart.

For me, as a gynecologist and medical doctor, it is also natural to include menopausal complaints, cervical cancer and endometriosis as a part of women’s health. The fact that women react differently to some medications than men, or that research on how women are treated by the healthcare system is a part of women’s health, can be easier to forget.

I have a plea to politicians and the administration for more earmarked research funds for women’s health (…)

Gender differences in health are also women’s health. These are diseases and disorders that only affect women, affect more women than men, affect especially many women, or have different consequences for women than for men.

A few examples of these inequalities are that women have different signs of a heart attack than men and risk not getting the correct diagnosis, that rheumatic diseases affect more women than men and lack research-based knowledge, or that many older women have osteoporosis that is not optimally treated.

What about women’s health outside of Norway?

Health is often understood in terms of a society’s expectations and resources, and although it perhaps shouldn’t be, I think women’s health in Afghanistan has different issues than women’s health in Norway.

Globally, it is a big problem that women die due to pregnancy and childbirth, or that they do not receive the health care they need because of inequality or lack of access to qualified health care.

In the research project I participate in, we investigate severe bleeding after childbirth. This is potentially life-threatening, but fortunately in Norway women rarely die due to bleeding. Nevertheless, it is important to find out more about such serious complications to childbirth in order to ensure safe births for Norwegian women, but also to contribute to increased knowledge of a complication that may affect all women giving birth all over the world.

Research into women’s health in Norway can therefore also be useful to countries that for various reasons cannot conduct themselves. Research papers are mostly published in a way that makes it possible for everyone to read, and at congresses, we can meet doctors and researchers from all over the world to share the results.

What about women’s health in Norway today, and what are the knowledge gaps?

As a woman in Norway in 2022, I actually believe I am quite well off. I am lucky to live in a society with a focus on equality between men and women, and with a public healthcare system available to all.

Nevertheless, I know that certain women’s diseases have a lower priority by both health personnel and in research. The Norwegian Women’s Public Health Association has demonstrated how endometriosis is a disease with a knowledge gap, which is not prioritized enough by health care personnel. Another, and often shameful condition with lack of attention, is chronic genital pain, and these examples are far from alone.

Just before the turn of the millennium, a report on women’s health in Norway came out (NOU 1999:13, regjeringen.no). The report that there was a lack of knowledge, both about specific women’s diseases and about connections between health and living conditions. It also demonstrated that there was already important knowledge about women’s health and living conditions that was not taken into account in health care policy decisions or in the health care system.

Lack of research on girls and older women

In Norway, the time has now come for a new evaluation of women’s health, and a new report will be drawn up by the women‘s Health Committee, a public committee on women’s health and health from a gender perspective.

I hope that the updated collection of knowledge will reach our decision makers, and that the content is taken into account in other ways, so that the committee’s work contributes to change and improvement of women’s health in Norway.

With regard to further research into women’s health, a report was recently published by the Norwegian Institute of Public Health. The report shows that there is a lack of research on girls as children and adolescents, as well as older women.

It also revealed that there is a lack of systematic reviews on certain conditions, for example prolapse of the vaginal wall. We also need more knowledge on how traditional treatments affect women in diseases such as COPD, skin cancer and lipoedema.

What do we research at the Norwegian Research Center for Women’s Health?

I am so proud of all my colleagues that advocate women’s health at the hospital, and in the field of research!

In our shared office is obstetrician and senior researcher Katariina Laine. Among other things, she has researched, and contributed to the reduction of perineal injuries after childbirth.

Also in the office is dermatologist Kristin Skullerud. Her research project is testing medications against the painful vulva disease genital erosive lichen planus. Her supervisor and dermatologist Anne Lise Helgesen has also created the website vulva.no, which contributes to increased knowledge about vulvar complaints, a part of women’s health previously neglected.

I hope you have learned a little more about women’s health, and understand my passion for women’s health care and research.

I have a plea to politicians and the administration for more earmarked research funds for women’s health. And to the same politicians and to the health care facilities, a demand for action to implement the treatment that the research demonstrates is missing.

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The ScienceNorway Researchers’ zone consists of opinions, blogs and popular science pieces written by researchers and scientists from or based in Norway.
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Women’s Health

XOMA Acquires Royalty and Milestone License to Ebopiprant, a Preterm Labor Asset, Being Developed by Organon

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XOMA Corporation

XOMA assumes the rights to ebopiprant from ObsEva, including the Organon License, Patent Estate, and Merck KGaA, Darmstadt, Germany, license, for a $15 million outlay

Potential to earn $475 million in development, regulatory, and sales milestones

Low- to mid-teens royalties upon commercialization

Expands XOMA’s portfolio into new therapeutic segment – women’s health

EMERYVILLE, Calif., Nov. 22, 2022 (GLOBE NEWSWIRE) — XOMA Corporation (NASDAQ: XOMA), a biotech royalty aggregator playing a distinctive role in helping biotech companies achieve their goal of advancing novel therapeutic candidates aimed at improving human health, announced today it has acquired all rights and title to ebopiprant held by ObsEva for $15 million plus certain earn-out payments. XOMA has assumed the ebopiprant intellectual property (IP) estate and all license agreements, including the 2021 exclusive license agreement from ObsEva to Organon related to the development and commercialization of ebopiprant.

“We are very pleased to add ebopiprant to XOMA’s royalty and milestone portfolio. Preterm labor is extremely stressful for expectant parents and their families. The costs to care for premature babies can quickly escalate to hundreds of thousands of dollars, resulting in long-term financial distress for many families,” stated Jim Neal, Chairman and Chief Executive Officer of XOMA. “The economics in the ebopiprant license acquisition have the potential to deliver significant returns to XOMA and our stockholders from the clinical development milestones alone. We wish Organon, a global women’s health company, success in its development activities with ebopiprant.”

Under the terms of the agreement, XOMA has acquired all rights to ebopiprant held by ObsEva, including the Organon/ObsEva license agreement and the IP associated with the asset. XOMA will now be entitled to receive up to $475 million in development, regulatory, and sales-based milestone payments under the ObsEva/Organon license agreement. XOMA will pay to ObsEva a portion of the development and regulatory milestones, as well as certain sales milestones, up to $98 million. Upon commercialization, XOMA will receive royalties that range from low- to mid-teens from Organon and will make a mid-single-digit royalty payment to Merck KGaA, Darmstadt, Germany.

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About Ebopiprant
Ebopiprant (OBE022) was licensed by ObsEva from Merck KGaA, Darmstadt, Germany, in 2015. ObsEva previously announced positive results from PROLONG Part B, a 113-patient Phase 2a proof-of-concept, randomized, double-blind, placebo-controlled Trial in women experiencing spontaneous preterm labor that compared atosiban (ex-US standard of care) plus ebopiprant versus atosiban plus placebo for 7 days. In the study, ebopiprant plus atosiban reduced delivery in singleton pregnancies at 48 hours after the start of dosing by 55% compared to atosiban plus placebo. Overall, 12.5% ​​of women receiving ebopiprant plus atosiban delivered within 48 hours of starting treatment compared to 21.8% receiving atosiban plus placebo (OR 90% CI: 0.52 (0.22, 1.23)). The incidence of maternal, fetal, and neonatal adverse events were comparable between both the ebopiprant and placebo groups.

About XOMA Corporation
XOMA is a biotechnology royalty aggregator playing a distinctive role in helping biotech companies achieve their goal of improving human health. XOMA acquires the potential future economics associated with pre-commercial therapeutic candidates that have been licensed to pharmaceutical or biotechnology companies. When XOMA acquires the future economics, the seller receives non-dilutive, non-recourse funding they can use to advance their internal drug candidate(s) or for general corporate purposes. The Company has an extensive and growing portfolio with more than 70 assets (asset defined as the right to receive potential future economics associated with the advancement of an underlying therapeutic candidate). For more information about the Company and its portfolio, please visit www.xoma.com.

Forward-Looking Statements/Explanatory Notes
Certain statements contained in this press release are forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934, including statements regarding the timing and amount of potential commercial payments to XOMA and other Developments related to ebopiprant, the potential of XOMA’s portfolio of partnered programs and licensed technologies generating substantial milestone and royalty proceeds over time, and XOMA’s cash sufficiency forecast. In some cases, you can identify such forward-looking statements by terminology such as “anticipate,” “intend,” “believe,” “estimate,” “plan,” “seek,” “project,” “expect,” “may ,” “will,” “would,” “could” or “should,” the negative of these terms or similar expressions. These forward-looking statements are not a guarantee of XOMA’s performance, and you should not place undue reliance on such statements. These statements are based on assumptions that may not prove accurate, and actual results could differ materially from those anticipated due to certain risks inherent in the biotechnology industry, including those related to the fact that our product candidates subject to out-license agreements are still being developed, and our licenses may require substantial funds to continue development which may not be available; we do not know whether there will be, or will continue to be, a viable market for the products in which we have an ownership or royalty interest; if the therapeutic product candidates to which we have a royalty interest do not receive regulatory approval, our third-party licenses will not be able to market them; and the impact on the global economy as a result of the COVID-19 pandemic. Other potential risks to XOMA meeting these expectations are described in more detail in XOMA’s most recent filing on Form 10-K and in other filings with the Securities and Exchange Commission. Consider such risks carefully when considering XOMA’s prospects. Any forward-looking statement in this press release represents XOMA’s beliefs and assumptions only as of the date of this press release and should not be relied upon as representing its views as of any subsequent date. XOMA disclaims any obligation to update any forward-looking statement, except as required by applicable law.

EXPLANATORY NOTE: Any references to “portfolio” in this press release refer strictly to milestone and/or royalty rights associated with a basket of drug products in development. Any references to “assets” in this press release refer strictly to milestone and/or royalty rights associated with individual drug products in development.

As of the date of this press release, all assets in XOMA’s milestone and royalty portfolio, except Vabysmo®, are investigational compounds. Efficiency and safety have not been established. There is no guarantee that any of the investigational compounds will become commercially available.

XOMA Investor Contact

XOMA Media Contact

Juliane Snowden

Kathy Vincent

XOMA Corporation

KV Consulting & Management

+1 646-438-9754

+1 310-403-8951

juliane.snowden@xoma.com

kathy@kathyvincent.com

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