Female Genital Mutilation: Analyzing its Culture and Consequences
Posted by on June 21, 2013 - 8:32am

Surfacing research proves the Sub-Saharan African traditions of Female Genital Mutilation and Female Genital Cutting (FGM/FGC) lead to long-term health consequences. Such health problems are found to impact the delivery and health of newborns.  Researchers and anthropologists from the Autonomus University of Barcelona collected data from 588 females in The Gambia.  Data were carefully gathered through questionnaires and physical examinations of the female patients, and analyzed with 95% confidence intervals. The results showed that 75.6% of the women had undergone FGM or FGC, and these women had a significantly higher prevalence of health problems including dysmenorrhea, vulvar or vaginal pain, fibrosis, keloid, synechia, and sexual dysfunction.  Furthermore, research showed these women were four times more likely to experience delivery complications such as perineal tear, obstructed labor, episiotomy, cesarean-necessitated delivery, and stillbirth.

The Foundation for Research on Women’s Health reported that seven of The Gambia’s nine ethnic groups practice FGM or FGC on girls between the ages of 10 and 15.  Female Genital Mutilation and Cutting occurs in four types.  Type I is a partial clitoridectomy, Type II is a full removal of the clitoris, Type III is a partial or full excision of the external genitalia, and Type IV is vaginal sealing.  While FGM and FGC are not common in many parts of the world, The Gambia sees these practices as rooted in customs and traditions dependent upon ethnic, religious, and cultural foundations.  Culturally, these practices are seen as “rites of passage” into womanhood, and guarantee a woman’s sexual purity, as pleasure is removed from the woman’s body.

Alternatively, FGM and FGC have been internationally recognized as violations of women’s rights and cruel discriminations against women.  Furthermore, since these practices are almost always carried out on minors, sometimes without parental consent, issues of children’s rights also come into play.  The World Health Organization characterized these practices as violating “a person’s rights to health, security, and physical integrity” as well as “the right to be free from torture and cruel, inhuman or degrading treatment” especially when these practices frequently lead to death or long-term health problems.

While it is difficult to impose regulations on cultural traditions so foreign to the Western world, it is important to document the surfacing research that points to the long-term hazards that accompany these practices.  The next steps should be educational outreaches informing the women of The Gambia of the dangers involved with FGM and FGC. This way, they may best make decisions to protect their reproductive health while preserving and respecting their cultural identity.

Sources: Dovepress, The UN Refugee Agency, and The World Health Organization

 

In the Debate on Women's Reproductive Rights, Where are the Women?
Posted by on June 19, 2013 - 2:53pm

The pro-life v. pro-choice debate continued on the House floor yesterday as party representatives grappled with sustaining women’s reproductive rights in a surfacing abortion bill.  On Tuesday, the House of Representatives approved a bill banning a woman’s right to pursue an abortion after 22 weeks of pregnancy, subtracting two weeks off the current cut-off of abortions at 24 weeks in utero.  The majority-Republican party passed this bill shaving off the extra two weeks based off the medically disputed theory that a fetus is capable of feeling pain 20 weeks after conception (which is equivalent to 22 weeks of pregnancy).  Democrats in the House and the White House fought against the bill, saying the legislation is an “assault on a woman’s right to choose” and is an attempt to undermine the precedent set in the 1973 Roe v. Wade trial.

The argument quickly split down party lines (only six party members from each side voting against their party) and escalated into a debate on women’s reproductive rights.  In this heated bipartisan debate, representatives from both sides evoked emotional appeals.  Though different in message, consistent across both lines is the lack of the female voice.  While the House attempted to integrate more women in this debate, only 19 of the 222 Republican House members who voted for this bill are women.  In total, the House of Representatives only has 78 women, accounting for a meager 18% voice in the House.  Furthermore, there are no Republican women on the Judiciary Committee panel that has jurisdiction over this particular legislation.

While this bill certainly made headlines, the threat of it obtaining further approval is low.  Sources agree that the bill will not find support in the Democrat-controlled Senate, and President Obama has also already voiced his opposition.  Although no abortion laws are changing today, it is important to keep abreast on the dialogue surrounding this controversial and emotional topic.  Most importantly, government representatives must do a better job of allowing women’s voices and opinions to be heard.  Female reproductive rights issues have been considered taboo for too long, and an open dialogue in the government may help bridge the gap between women and policy.

Sources: ABC News, USA Today, and The New York Times.

 

Policy Changes Save the Lives of Pregnant Women
Posted by on June 18, 2013 - 10:39am

 

Policy changes are necessary to decrease the death rate of pregnant women in developing countries.  Research, according to Dr. Stacie E. Geller, does not end once scientists publish.  The true battle is implementing that research to affect global change.  Dr. Stacie E. Geller, Director of the Center for Research on Women and Gender at the University of Illinois at Chicago College of Medicine, puts research into practice by providing safe, affordable medication to pregnant women in developing countries.  Dr. Geller spoke last week at a forum held at Northwestern University's Feinberg School of Medicine and presented her research on Postpartum Hemorrhaging (PPH) and its dangers to women in developing countries.

In 2008, there were an estimated 358,000 maternal deaths occurring during childbirth, 99% of these deaths occurring in developing countries. Such global disparities are reflected in the limited access to skilled birth attendants, restricted access to medications, rudimentary delivery facilities, and complications surrounding reliable transportation and communication in developing countries.  Postpartum Hemorrhaging (PPH) is the leading cause of maternal mortality worldwide, accounting for 30-50% of all maternal deaths in Africa and Asia alone.  While the drug Oxytocin is used to prevent PPH in developed countries, developing countries do not have the resources to preserve and administer this drug.  Dr. Geller began studying the drug Misoprostol as an alternative to Oxytocin to be used in developing countries due to its low-maintenance storage and cost-effectiveness.

Dr. Geller, along with a team of researchers traveled to communities in India and Ghana to study Misoprostol for prevention of PPH in home-birth settings.  Their research proved that Misoprostol provides a safe and efficacious alternative to Oxytocin in these communities, but Dr. Geller didn’t stop there.  She worked with the Indian Ministry of Health to approve the use of Misoprostol for PPH prevention by Auxillary Nurse Midwives (ANMs). In Ghana, Dr. Geller engaged with health stakeholders at all levels, conducted community sensitization and trainings, monitored the safe use of Misoprostol, and empowered women to take control of their health.  Furthermore Dr. Gellar’s success strengthened the networks of health providers, decreased maternal mortality and morbidity (due to PPH), and established a model for all of Ghana and other developing countries.  Dr. Geller was a primary advocate credited for Misoprostol’s addition to the WHO’s list of essential medications for the prevention of PPH in 2011, an accreditation which has a lasting global impact.

Dr. Geller stresses the importance of political will in enacting policy changes from scientific research.  Government engagement is critical in reducing maternal deaths, and a scientist’s work is not over once research is published.  Advocating for women’s sexual and reproductive rights, their access to equal treatment, and their right to effective medicine should inspire all researchers to utilize their knowledge to facilitate global change.

To read more about Dr. Stacie Geller and her ongoing research, please click here.

 

Post-Trauma Women: Victims of Gender Bias
Posted by on June 11, 2013 - 9:46am

Think men and women receive equal care after traumas? Think again.  A recent study found that women are less likely than men to receive trauma treatment after severe injuries.  Dr. Andrea Hill of the Sunnybrook Health Sciences Centre and the University of Toronto’s research on gender-based inequalities found that, across all age groups, 20-30% fewer women are cared for after traumas.  The study and analysis were conducted by observing 99,000 adult patients throughout Canada.  After controlling for demographic and socioeconomic factors, Hill and her colleagues were shocked at such disproportions between male and female patient care.  Hill affirms that “gender-based disparities in access to health care services in general have been recognized for some time,” and she calls for further research into the underlying factors involved in these gender gaps.

 

To read more about this issue, please view the original article here.

 

New Report Evaluates Progress in Women's Health
Posted by on September 28, 2010 - 1:48pm

A new report by the Institute of Medicine issued on Sept. 23, concludes that there has been some progress in women's health over the past two decades especially in lessening the burden of disease and reduced deaths among women in the areas of cardiovascular disease, breast cancer and cervical cancer, specifically. The effort has yielded less but still significant progress in reducing the effects of depresssion, HIV/AIDS, and osteoporosis in women.   However, the report also identifies several areas that are important to women that have seen little progress, namely, unintended pregnancy, autoimmune disease, alcohol and drug addiction, lung cancer, and dementia.

Overall, few gains have been made on chronic and debilitating conditions that cause significant suffering but have lower death rates, pointing to the need for researchers to give quality of life similar consideration as mortality for research attention.  The report also points out that barriers such as socio-economic and cultural influences still limit the potential reach and impact of research developments, especially among disadvantaged women.

Several observations made by the experts who wrote the report are in areas the Institute for Women's Health Research at Northwestern has raised as ongoing problems.   One of those issues is the the fact that many research projects, even if they include both men and women, rarely report the results by sex.   Furthermore, as pointed out in a recent paper in Nature, written by IWHR director, Teresa Woodruff, PhD, and her graduate students, scientific journals should require authors to include sex data in their publications.

Another challenge discussed in the report is how best to communicate complex research findings to the public and the media.   The IWHR through it blog, website and monthly e-newsletters is striving to meet that challenge.

Over the next month or so, this blog will discuss issues in the IOM report in greater detail but in the meantime click HERE to read the press release,  the entire report on line or to order a copy.

Study Suggests Gender/Sex Differences in Cognition Impairment
Posted by on September 24, 2010 - 2:47pm

Older men may be at risk of developing mild cognitive impairment (MCI), often a precursor to Alzheimer’s disease, earlier in life than older women, according to a study appearing today in Neurology. The study raises the question of whether there may be a gender difference in the development and progression of MCI.

Scientists evaluated the cognitive health of 1,969 dementia-free older people and found 16 percent showed signs of MCI, a condition usually marked by memory problems or other cognitive problems greater than those expected for their age. Prevalence was greater among the older participants, and it was consistently higher in men than women across all age ranges.

Ronald C. Petersen, Ph.D., M.D., and his team at the Mayo Clinic, Rochester, Minn., conducted the research.

"Because evidence indicates that Alzheimer's disease may cause changes in the brain one or two decades before the first symptoms appear, there is intense interest in investigating MCI and the earliest stages of cognitive decline," said National Institute on Aging (NIA)  Director Richard J. Hodes, M.D. "While more research is needed, these findings indicate that we may want to investigate differences in the way men and women develop MCI, similar to the way stroke and cardiovascular disease risk factors and outcomes vary between the sexes."

The researchers conducted in-person evaluations of 1,969 randomly selected people from all 70- to 89-year-olds living in Olmsted County, Minn. Results of the study indicated that:

  • Overall, MCI was more prevalent in men (19 percent) than in women (14 percent), even after adjusting for several demographic variables and clinical factors, such as hypertension and coronary artery disease.
  • Of the 16 percent affected with MCI, over twice as many people had the amnestic form that usually progresses to Alzheimer’s disease and the prevalence rate was higher in men than in women.
  • MCI prevalence was higher among people with the APOE e4 gene, a known risk factor for late-onset Alzheimer's, a form of the disease that usually occurs at age 65 or older.
  • A greater number of years spent in school was significantly associated with decreased MCI prevalence, from 30 percent among participants with less than nine years of education to just 11 percent in those with more than 16 years of education.
  • MCI prevalence was higher in participants who never married, as opposed to those currently or previously married.

The researchers noted that estimates of MCI prevalence vary in studies conducted around the world but generally fall into a range of 11 to 20 percent. The Mayo team's evaluation of participants included detailed in-person assessments that helped to capture the subtle changes in daily function that may mark the onset of MCI, Petersen said. The researchers also noted that the study’s limitations include a relatively low participation rate by Olmstead County residents and the fact that the population is predominantly white. Thus, these findings may not apply to other ethnic groups.

Source:  NIH National Institute on Aging

Men to Benefit More from Healthcare Reform Expanded Coverage
Posted by on September 14, 2010 - 9:15am

Contrary to some commonly held beliefs, men, more than women will likely benefit more from expanded healthcare coverage.   According to the Institute for Women's Policy Research June 2010 Fact Sheet,  men represent a majority of non-elderly US adults who lack health insurance across all age groups but particularly ages 18-34.    Under age 18, boys and girls with health insurance have nearly the same coverage with many insured under public plans.   The jump begins when students leave their parents' plan at either high school or college graduation.  This will definitely improve when the Affordable Care Act of 2010 (ACA) becomes effective on September 23, 2010 and raises the age a young adult can stay on their parents' plans.

One of the reasons young women have better coverage is the fact that they have access to healthcare through Medicaid which has traditionally provided a safety net for family planning and pregnancy coverage for those with low or no income.

As we age, and reach 55 years and older, this difference is less between men and women.   Medicare coverage that generally begins at age 65 is universal and fewer than 2 % of men or women lack health insurance once they reach this age group.

If you are interested in reading more about insurance differences between the sexes, visit the IWPR site

Making a Strong Case for Sex-based Research and Implementation
Posted by on July 8, 2010 - 11:18am

Several Northwestern researchers, including our own Institute director, Teresa K. Woodruff, PhD, have been making a strong case for more sex-based research that is making waves in several prestigious journals including Nature and Women's Health.   Readers interested in reading these articles should click here

We've Come a Long Way, Baby.....NOT!
Posted by on March 30, 2010 - 1:13pm

Yesterday, I started writing a blog explaining why sex and gender research was important.  I got bogged down in historical background, mandates, and the usual boring facts and justifications.   While doing this, my desktop binged and one of several daily notices from federal agencies popped up on my computer.   Since I was having writer's block, I decided to check these new emails....and BINGO....there is was!     A news release from the National Institute on Drug Abuse (NIDA), one the Institutes at the  National Institutes of Health (NIH).   The title of the press release was "Common Mechanisms of Drug Abuse and Obesity".   It summarized a study funded by NIDA  that will appear in a prestigious journal in May.   The study found that some of the same brain mechanisms that fuel drug addictions in humans accompany the emergence of compulsive eating behaviors and the development of obesity in animals.  The investigators found that when they gave rats access to varying levels of high-fat foods, they found unrestricted availability alone can trigger addiction-like responses in the brain, leading to compulsive eating behaviors  and the onset of obesity.  According to one of the study authors, "The results of this study could provide insight into a mechanism for obesity".

This was all very interesting but what popped out at me was a sentence in the fifth paragraph:   Researchers conducted this study in three groups of male rats over a 40-day period. What about female rats!  Do they behave the same?    Will this study translate to a human study before these findings are tested in female rats?   What we do know is that obesity rates are higher in women.   How many women reading this have experienced a change of eating urges during their periods? Do hormones play a role here?

Why am I upset?    It took decades of advocacy from women to create mandates at the NIH, the major funder of health research, that requires the inclusion of women in federally funded research studies.  Recently, there has been a growing debate on whether or not researchers are adequately meeting this mandate.   While there are more women's cancer studies (that may be inflating the % of women who are in studies), diseases like heart disease still do not have equal representations of men and women in clinical trials.    This mandate does not trickle down to animal studies, allowing researchers to continue to do basic science work in male animals that are, after all, "easier" (Translated:   they don't have complicated hormone cycles).   Too many studies have been conducted in males (animal and human) over the last few decades and the results applied to the whole population--sometimes with detrimental effects.  The Adverse Reporting system at the FDA has many more reports of adverse effects of drugs in women than in men......has anyone asked if these drugs have been adequately tested in women???

So, what needs to be done?    The inclusionary mandates for research studies requiring both sexes, need to include animal studies.   After all, isn't it much cheaper to do preliminary studies in animal models BEFORE they are applied to humans?  Researchers also need to report findings by sex....even if the answer is "they are the same".   Is anyone else asking these questions? Have women really come 'a long way'?

The Ultimate Gift: Women and Organ Donation
Posted by on July 21, 2009 - 10:12am

This recent article from the BBC discusses how the practice of stranger kidney donations has been increasing in the United Kingdom since it was made legal in 2006. Just to be clear, this refers to kidney donations while the donor is still alive and wherethe donor and recipient don’t know each other. The entire practice seems kind of fascinating to me. Although I carry my donor card around with me and have registered with the National Bone Marrow Registry, I don’t know if I could ever donate an organ to a stranger while I’m still alive.

IMG_3076

I wondered who exactly these donors were, what might instill that kind of altruism, and if gender dynamics might play a role. It turns out, according to this article published in Medicine, Health Care, and Philosophy that gender plays a pretty big role in living organ donation. Apparently, women are much more likely to be living organ donors, making up 58% of kidney donors compared to men’s 42%. At the same time, women are less likely to receive a kidney. These statistics can’t be explained by the thinking that maybe more men need kidneys, so their wives donate more often, because women are also more likely to donate to strangers and non-relatives and more likely to donate to their children and siblings, even when the recipient’s male relative (father or brother) is also a match.
According to a 2008 German study (can be downloaded here), women are also much more likely to be in favor of the idea of donating organs than men are, even if they don't have an organ donor card (in pretty much all cases, whether they are living or dead at the time of donation and whether the recipient is either a distant relatives or stranger). Interestingly, women are also much more likely to be disapproving of proposals of financial compensation for organs than men, who approve such proposals by a large majority.

So what makes women so much more willing to donate their organs? We’ve all heard the psychological behavioral studies that show that, in general, women are more empathetic and altruistic than men, and many of these studies are referenced in the first paper linked above. It does seem to me that society tells women that to be successful as women, they must excel at being caregivers, to their children, significant others, and their community at large. It seems that this conditioning could be a large part of why women donate more often. On the flipside, maybe men are prevented from donating as often as women. This could be because they are traditional breadwinners of the family, and therefore don’t think the risk or leave from work required for the surgery is worthwhile. There is also the fact that men are more likely to fear that having an organ donor card could mean that they get inadequate medical care (doctors might not fight so hard to save his life if his organs are desperately needed.)1

What do you think? Would you donate an organ while alive? Would the identity of the recipient influence your decision at all? Do you think your identity as a woman affects your feelings on the issue?

  • 1. Thompson T.L.; Robinson J.D.; Kenny R.W. “Gender Differences in Family Communication About Organ                   Donation.” Sex Roles, Volume 49, Numbers 11-12, 200312 , pp. 587-596(10)