Christine has a post at Our Bodies Our Blog about the passage of the health reform legislation last night. She notes

As I watched Democrats congratulate themselves, it was difficult to feel celebratory. Passage of the Stupak amendment — which bars a government-run insurance plan from offering abortion *and* prohibits women who receive government insurance subsidies from purchasing private plans that include abortion coverage — sucked a lot of the energy out of the room.

She has a number of posts on health care reform and especially the Stupak amendment from yesterday, with links to a number of additional resources and roll call vote results, so I won’t try to duplicate all of that info here – I’m still trying to catch up on and absorb all of the intricacies. See Our Bodies Our Blog.

Also, here’s what Physicians for Reproductive Choice and Health had to say, and an NY Times article on the abortion aspect. RHReality Check has a bit on the mixed reactions from women’s groups.

Assorted other:

Kudos to Vanderbilt’s Nurse-Midwifery practice.

ACNM’s Midwife Connection blog on a woman planning to broadcast her labor and birth on the internet.

Gender Across Borders is exploring the topic of female genital cutting.

The FDA issued a warning about “sexual enhancement” supplements. Many of these have been found to include undeclared ingredients or ingredients similar to prescription drugs that may pose serious safety concerns.

A presentation on MyNCBI and changes to PubMed en español. If you’re having any trouble with the revised PubMed interface, let me know, I’ll try to help.

The National Institute for Occupational Safety and Health is solciting suggestions from tattooists and piercers on their health concerns about their work environments via their Science Blog. The agency also has some informational pages for these body art workers on vaccination, preventing needle-stick injuries and cross-contamination, and related topics.

The National Institutes of Health provides this bioethics resource online.

There are a bunch of great new posts at FWD/Forward. I just finished reading this one on taking responsibility for accessibility, and this one on “hipster ableism” and Glee.

At Your Cervix has a series of posts related to L&D and hospital visitation restrictions related to H1N1 flu including the new policy at her hospital, the postin of their official policy, and day one and day two with the more restrictive visiting rules in place. There is a bit of good discussion in the day two post about what exactly a woman should have done when her doctor told her to go to the hospital, she had the care of her two minor children (assume no child care is available), but the hospital subsequently sent her away because they are no longer allowing minor visitors under the more restrictive policy.

Judy Norsigian, executive director and co-founder of Our Bodies Ourselves, will be in Nashville later this month. During her visit, there will be a fundraising house party for OBOS graciously hosted in the home a couple of Nashville folks at 4 pm on Sunday, November 15. Attendees are asked to RSVP by phone; if you’re interested in attending, contact me and I’ll get you the details.

As the invite states:

Through their programs and publications, Our Bodies Ourselves provides accurate, accessible information on health, sexuality, and reproduction. Join us to learn how the book has grown into a global health movement, and find out how you can support the organization’s exciting work. Please bring your questions, ideas, and friends.

I look forward to seeing you there!

In the past year or so, I’ve seen a lot of effort toward convincing pharmacy/retail chain CVS to “unlock the condoms.” The argument is that, when these stores lock up the condoms in a special case, it creates barriers to access and gets in the way of people acting responsibly. Yes, ideally we’re all comfortable asking for help with access to condoms and store staff are professional and helpful and don’t tell our mamas in our small towns about it, but we don’t live in an ideal world.

Cure CVS and Amplify have examples of the campaigns directed at CVS, which Feministing and others have also written about.

Well, it’s definitely not just CVS. I had occasion recently to notice that my Kroger (grocery store) pharmacy was closed, and they keep all the condoms and such in a cabinet in front of the pharmacy. Yep, it was locked. I did a quick search and haven’t found a coordinated campaign to convince Kroger to change this policy, but I did find at least one other blogger who encountered the problem.

Have you run into this at your local Kroger? Other stores? Let me know in the comments. Now to send Kroger a letter…

Yesterday I went for my pelvic exam, which I often talk a little bit about here just because a) it’s obviously theme-related, and b) I figure the more open discussion, the better. I saw my provider in the workplace’s fancy new off-campus clinic, and had the chance to use the self check-in kiosk (where I updated my info and paid my co-pay) and to get one of the restaurant-style buzzers that would let me know when they were ready for me. Some people may find that impersonal, but idea behind the buzzers is that the clinic is located in a shopping area, so with this piece of technology people can wander away from the waiting area and shop.

I was more excited that it allowed me to wander off to the restroom without worrying that they would call me during that time and I wouldn’t know it. Yes, these are the things I worry about in waiting rooms, and in airports, and in lectures and movies – missing something because I’m peeing.

Anyway, my provider is a women’s health nurse practitioner I’ve used for several years, so while the setting was unfamiliar, the provider was familiar…but then she asked if it was okay if her med student participated. And I said yes, because it’s an academic medical center, and these kids have to learn…

and…

Oh, damn, it’s a dude.

With the exception of my very first pelvic exam years and years ago, I’ve deliberately chosen women providers. I’ve heard the arguments that it shouldn’t make a difference, but that has been my choice. After being initially taken aback (I just wasn’t thinking about the high probability of any given med student being a man), I decided it was okay. I had a number of things to talk frankly with my provider about, so the poor guy got an earful – he’ll probably specialize in dermatology after this.

She (my NP) did the breast exam, but the student did the pelvic/Pap. There was an “ow” moment of slightly too much pressure, and the provider took a look to see what was going on, righted the course so to speak, and turned it back over to the student. He actually apologized that he was not well-practiced in the exam, but she and I both told him, “That’s okay, this is how you learn!”

Of course, your provider should always ask first and you always have the right to refuse, but if you are comfortable letting a medical student participate in your care you might consider allowing them to observe/participate – they might not be perfect at it yet, but you may help them get better.

For at least part of the past weekend, I was busy attending the Southern Chapter of the Medical Library Association’s annual conference in Memphis, TN, so the round-up is a bit delayed. A few things that caught my eye over the past week:

Meharry Medical College in Nashville got a big grant to fund research in women’s health, eliminating cancer disparities and HIV/AIDS.

A new edition of the Carnival Against Sexual Violence has been posted.

Mom’s Tinfoil Hat is talking about conscience clauses and their responsible application.

The National Women’s Law Center is doing a “Women’s Day of Action for Health Care Reform” blog-a-thon on Wednesday, Nov 4, and is asking women to sign up to “to blog, tweet or post for fair, affordable and comprehensive health care coverage.”

Newsweek had a piece on the future of abstinence-only sex ed now that it hasn’t been proven to be effective and government dollars for the programs are being cut off.

Not sure if I’ve pointed to this before: The Society for Menstrual Research’s blog. Some good recent posts there.

Via Siobhan at BHIC, this report: The Current State of Health Care for People with Disabilities.

The Nation has a piece on health reform and birth control and gynecological care.

The Unnecesarean has a post on Joint Commission (JCAHO) measures related to elective induction and c-section.

Science and Sensibility has some business about whether WHO actually retracted the 15% c-section rate cut-off. For reference, here’s the cached Medical News Today piece, and the later retraction. The retracted piece was based on a release, apparently, from The Coalition for Childbirth Autonomy (coalitionforchildbirthautonomy.org), which includes the electivecesarean.com people.

If you have subscription access, the journal Women’s Health Issues has a piece in the November-December 2009 issue on welfare family caps and social justice.

From HHS, Initial Results Show Pregnant Women Mount Strong Immune Response to One Dose of 2009 H1N1 Flu Vaccine. The agency also announced that it is publishing a rule lifting the ban on travel to the U.S. for people living with HIV.

And don’t forgot Our Bodies Our Blog! I have something there today on women’s reports of side effects when stopping Depo-Provera shots – if you have a story on the same, leave it in the comments there.

Yesterday I was able to attend another presentation as part of Vanderbilt’s Women’s Health Week, featuring Dr. Valerie Montgomery Rice and Dr. Gloria Richard-David of Meharry Medical College and Dr. Katherine Harmann of Vanderbilt who conducted a panel discussion on the state of women’s health in Tennessee. They centered the discussion around their collaborative work on the 2009 Tennessee Women’s Health Report Card, which I’ve posted about previously. Briefly, the report characterizes the health status of women in the state on measures such as cause of death, STIs, and reproductive health, comparing 2002 and 2007 data and grading our status for improvement/worsening and comparison to Healthy People 2010 goals.

When asked about what might have surprised them when working with the data for the report, Dr. Hartmann reported that unfortunately Tennessee women’s health status was as generally bad as they might have expected, which while not surprising is certainly not a positive situation. There was also discussion of how screening rates – such as for mammography- are pretty high, and yet rates for breast cancer deaths aren’t as good.

This led into a discussion of “going beyond access,” or figuring out to improve care and quality beyond those initial screening exams. The panelists talked about making sure appropriate follow-up care happens, of making sure people are treated in equal and appropriate ways, and examining why – if we achieve equal access to screening and follow-up care – outcomes might be different from individual to individual.

A piece in the New England Journal of Medicine on this topic, “Denial,” was referenced. Rather than being about denial of care or coverage, the article presents the case of a patient who fell through the cracks, who did not receive appropriate and needed breast cancer treatment simply because she did not receive a follow-up call and assumed the doctors were done with her care. It explains:

This patient’s journey began unremarkably: she presented promptly, complied with her workup, underwent grueling chemotherapy, and attended every scheduled appointment. Then, the theoretically seamless transition between the medical oncologist and the breast surgeon failed. When the patient’s call to the outpatient department was not returned, she took the silence and past encouraging assessments as signals that she was out of danger. To her thinking, no news was good news — not an uncommon belief among chronically ill patients who long for normality. The diligent breast care nurses inexplicably lost track of her. Her primary care physician assumed that her follow-up was taking place at the hospital and did not worry about not having seen her. Over the next several months, the patient continued to feel well and work full-time. She had little family, and her workmates probably thought it inappropriate to ask an apparently fit colleague about her illness. Thus, multiple individually plausible assumptions collectively compromised this patient’s outcome.

In that case, then, it wasn’t a problem of getting the patient in the door and access to screening – it was a problem of losing the patient in the often complex follow-up process.

There was also discussion of our very high infant mortality rate, the racial disparities in that rate, and the associated challenge of reducing preterm birth. The panelists indicated that enrolling women in early prenatal care has not made a dramatic difference in those preterm birth rates, and it’s a tremendous research challenge to figure out what else is going on and how those rates can be affected. The high rate of STIs was also discussed, with commentary that many have reacted that the rates are appalling, but that there is no reason to be appalled, there is simply reason to do better with sex education and prevention.

Thanks to the organizers for another great session! Check out their blog at http://vanderbiltwhw.blogspot.com/.

At Our Bodies Our Blog, I have recent posts on ePatients and participatory medicine, and on revisiting breast cancer screening guidelines. C also has something on U.S. healthcare myths and facts and health reform.

So often in topics of women’s health and reproductive rights the things I’m compelled to write about are the negatives, the bad news, the absolute outrages. Today I want to take a moment to give kudos to some individuals who are taking actions to make a difference. I mentioned in the previous post that it’s Women’s Health Week at Vanderbilt (my larger workplace). I learned, at the event I attended, that the week will cap off with a day of service at the Shade Tree Clinic in Nashville, and think this effort from Vanderbilt medical students and their supporters deserves recognition. Note that they are still looking for additional Vanderbilt ob/gyn residents and attendings to volunteer, so if you’re able and qualified, see the contact information at the end of the post.

I received the following description of the project from the organizers:

On Saturday, October 31st from 12 noon – 4pm, we’ll be holding our Annual Women’s Health Week Service Day at the Shade Tree Clinic (http://www.shadetreeclinic.org/). We are busing women in from local homeless and domestic violence shelters. They will receive Pap smears, STD testing, HIV testing, contraceptive counseling, and colposcopies. Social workers, childcare and Spanish interpretation will also be available.

Typically when a woman comes to her ob/gyn for her annual pelvic exam, she woman receives a Pap smear, the smear is read within a few days. If any abnormal cells are found on the smear, she comes back to her physician for a colposcopy. A colposcopy uses various dyes and an endoscope to examine the cervix for cancerous and precancerous cells. If the colposcopy finds anything abnormal or that appears potentially cancerous, the cervix is biopsied.

Our population of patients is at a higher risk for being infected HPV and for developing cervical cancer, because they have higher rates of smoking, higher rates of infections with other STDs, usually have a poor diet, and are living in poverty (see: http://www.cancer.org/docroot/cri/content/cri_2_4_2x_what_are_the_risk_factors_for_cervical_cancer_8.asp). Our patients also have limited access to transportation and healthcare, so we wanted to reduce the number of follow up visits needed. We are going to combine the first two steps, and provide both Pap smears and colposcopies for them on Saturday.

This element of the project was inspired by a group at the University of California, Irvine. This group screened a population of high risk Hispanic immigrants and had their Pap smears read the same day. They then performed colposcopies and biopsies for the women who had abnormal cells.

We are incredibly excited to have a group of medical students and ob/gyn physicians and nurse practitioners to help us out with this project. We are also looking for more Vanderbilt ob/gyn residents and attendings to help us out, so they should feel free to email me at jacqueline.a.clauss@vanderbilt.edu if they would like to volunteer.

For more information on the week’s events in general, check out the Women’s Health Week blog at http://vanderbiltwhw.blogspot.com/.

Can you tell I’ve been impressed with these folks and the week they’ve organized?

October 25-31 is Women’s Health Week at Vanderbilt University in Nashville, and a series of lectures have been planned to raise awareness on a variety of women’s health topics.

Today I had the pleasure of attending the lecture by Diana Whitten, filmmaker, whose current project is a film called “Vessel” which documents the work of the Women on Waves project. I was passingly familiar with Women on Waves before today, a project in which a ship chartered in The Netherlands (where abortion is legal) travels to countries where abortion is illegal and takes women out into international waters to receive medication abortions. In this way, the restrictive laws of those countries are circumvented to provide abortion access, as the law of the ship’s charter nation takes effect.

What I didn’t know, though, was about the educational work Women on Waves does in the course of those visits, the spreading of information – such as the number for a hotline for women to get information on and access to medical abortion. The video snippets Whitten shared made clear that there is also a bit of a rabble-rousing advocacy component that I can’t help appreciating.

Whitten made some compelling points about this kind of legal maneuvering, posing other possibilities for activists to think about such as whether abortion access can be provided via embassies or on Reservations, and how intracontinental waterways might be utilized to provide access from one state to another.

Some footage from “Vessel” is available online – I got a huge kick out of this video of the ship’s arrival in Valencia, Spain. Donations are needed to complete the film, so if you’re able, you can find information on how to do that here. Finally, there’s a blog for the project at http://vesselthefilm.wordpress.com/.

Via Whitten’s presentation, I also learned about women on web, which helps women in countries where there are no safe abortion services gain access to medical abortion.

There is a blog set up for the events at http://vanderbiltwhw.blogspot.com/. Unfortunately, I’m going to have to miss tomorrow’s talk from Dr. Stephanie Bailey, Chief of Public Health Practice for the CDC, speaking on the state of women’s health in the United States. Wednesday will feature Meharry and Vanderbilt physicians speaking on the 2009 Tennessee Women’s Health Report Card, and Thursday will have Beth Huff speaking on reducing cervical cancer deaths in Tennessee. Reservations are needed via email; details are available at http://calendar.vanderbilt.edu/calendar/2009/10/26/womens-health-week.94450.

I’m biased, of course, but there’s lots of good stuff at Our Bodies Our Blog (as usual!), including a guest piece from OBOS intern Meg Young on sex education and the UU program on the topic, Our Whole Lives.

Order your free 2010 women’s health calendar (in English or Spanish) from the National Women’s Health Information Center.

Amie at RH Reality Check has a piece on preexisting condition exclusions women sometimes face from health insurance companies.

Arts4Choice uses photographs and sound “to show Canadians that women who have had abortions are their mothers, sisters, neighbours and friends.” The online exhibit reminds us that these women don’t look like the monsters they’re sometimes portrayed as.

MedlinePlus has added some Pet Health information.

Wired ran a good piece on the anti-vaccine movement.

Renee at Womanist Musings has some links to interesting pieces in her weekly round-up.

National Advocates for Pregnant Women announced the winners of their writing contest for law students on pregnant women’s civil and human rights, and you can read a couple of the pieces from links on the announcement.

I Heart Guts has a “Menstrual Flow Chart” – an illustrated explanation of the menstrual cycle. On one hand, it’s kind of cute and lighthearted, what with the cartoony uterus and whatnot. On the other, that’s a whole lot of pink, and when the creator explains its purpose as “so I can justify to my poor husband exactly why I am feeling totally insane,” I cringe more than a little about the implications there about women and also want to refer to this post from FWD/Forward on inclusionary language. [Via Jezebel]

Arwyn at Raising My Boychick has an interesting post on how women who choose to give birth without pain meds are discouraged by others and told the pain isn’t worth it, while most people would not make the same arguments to athletes enduring pain.

HHS released a report, Health Insurance Reform and Breast Cancer: Making the Health Care System Work for Women. The agency also announced a plan “to establish the nation’s first national resource center to assist communities across the country in their efforts to provide services and supports for older lesbian, gay, bisexual and transgender (LGBT) individuals.”

The American College of Obstetricians and Gynecologists has a page of information up on H1N1 influenza for pregnant women and their healthcare providers. Tragically, they selected Comic Sans as the font for said page of information.