Acupuncture has been used in Eastern countries to address women's health issues but is not readily adopted in the U.S. especially by the medical establishment. A new study reports preliminary data indicating that acupuncture may improve menstrual health and overcome delays in becoming pregnant. There are experimental data indicating that acupuncture can influence female reproductive functioning, although the actual mechanisms involved are not yet clarified. Acupuncture is a complex intervention yet the evaluation of acupuncture research designs and outcome measures expect a level of commensurability difficult to achieve in complex interventions. A focus on effectiveness rather than efficacy may be a solution. Further research is needed that includes the rich traditions of acupuncture practice and the rigorous methods of evidence-based research.
A recent report in Fertility & Sterility has indicated that among women between the ages of 18 and 40, there is a significant amount of misconception regarding fertility and becoming pregnant. Dr. Illuzzi, an OB/GYN at Yale University School of Medicine, led a study in which 1,000 women of various ages and backgrounds completed a survey about their knowledge of reproductive health. The results showed a lack of knowledge across the board, with higher educated women knowing only slightly more than less educated women.
Over one-third of the women surveyed believed that specific positions during intercourse, such as elevating the pelvis, increase the odds of conception, although there is no scientific evidence to back this up. Additionally, only 10 percent of women know when the best time of the month to conceive is. The majority of women thought that sex must take place after ovulation to become pregnant, while in reality, pregnancy is most optimal when intercourse occurs 1 to 2 days prior to ovulation.
Other notable findings in the study include women’s thoughts on what can decrease fertility and prevent conception. Around 25% of surveyed women were unaware that factors such as obesity, smoking, and a history of sexually transmitted disease can cause infertility. In fact, the number one factor women cited as causing infertility was stress. Stress can have many negative side-effects, but according to Dr. Illuzzi, research does not currently support that it leads to infertility. While most of the women surveyed were aware that conception becomes more difficult with age, many did not know that later pregnancies are also more likely to result in miscarriage and chromosomal defects.
If you are concerned about fertility, or have questions about becoming pregnant, it is best to talk to your doctor, but you can get more information on websites such as the American College of Obstetricians and Gynecologists.
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.
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.
The Patient Protection and Affordable Care Act has cleared two major hurdles in the recent past: the Supreme Court ruling on constitutionality and the reelection of President Obama. However, there is a very good chance that the Supreme Court has not seen the last of the health care reform law. Despite the bill's legal successes in the past, there are (at publication) more than 35 different cases on file against the contraception mandate in the bill filed by individual companies and religious organizations.
Thanks to the health care law, insurance plans are required to cover birth control and other women's preventive health services with no co-payments or deductibles at the start of their next plan year. For proponents of the bill, this means more health plans come under the law's reach, and that more women will be able to keep their wallets closed when they pick up their birth control.
Proponents further assert that gender equality means women having complete control over their reproductive lives. However, some organizations do not believe funding such services align with their organizational missions. Most filing amicus briefs are using the Religious Freedom Restoration Act, and it’s unanimous support by the Supreme Court, to say that the mandate violates religious organizations right to not pay for contraception.
The Religious Freedom Restoration Act requires that the federal “government may substantially burden a person’s exercise of religion only if it demonstrates that application of the burden to the person 1. Is in furtherance of a compelling governmental interest and 2. Is the least restrictive means of furthering that compelling governmental interest.”
Those in support of the mandate, like the American Civil Liberties Union (ACLU), believe that the mandate will be upheld. The ACLU specifically states in their amicus brief that the plaintiffs are trying to “discriminate against women and deny them benefits because of [the employer’s] religious beliefs.”
No matter where a woman falls in her beliefs about what the health reform bill should and should not require, it is clear that the Affordable Care Act still has many hurdles before full implementation. For more information about the impact of these state-level decisions on your contraception and access to reproductive health care, contact your local Congressional leaders and employer mission statements.
Yesterday morning we awoke to a political landscape that seems jarred by the process of democracy, but ready to move forward as a nation. Three issues defined the outcome: the percent of women who chose democratic principles; the resounding losses by candidates who are antiquated in their thinking about pregnancy, in particular; and, the need to hold all of us accountable as citizens in the care of each other starting at the research bench to the bedside. I’m a reproductive scientist and direct the Women’s Health Research Institute at Northwestern University, so these issues are my issues and it is now time to look forward and identify actionable steps that moves our field forward.
I’ll start with the women. I believe the 55% to 43% differential in the women’s vote for Obama was not just a vote for a person, but for a platform. It is a vote that recognizes that sexuality is not something that can be regulated by the state. It is a vote that states emphatically that the fact of rape is never legitimate. It says that the consequences of forced intercourse are never ‘god’s will’. Women ‘got’ the vote in 1920 and today their votes say that the politicians must begin to understand that women’s concerns are important and legitimate.
How we move forward to ensure that women’s bodies and their health are not political footballs or pincushions (depending on your gender-identified metaphor) is critical. Here are some suggestions:
- We can no longer allow basic research and new drug development be done solely in male models (cell, animal or human) —this practice loses the ‘bang for our buck’ when we discover sex differences further down the research pipeline.
- We must report sex differences (or no difference) in study findings and include them in our scientific publications.
- We must redistribute more federal dollars to fund important reproductive health studies that include the ovary, uterus, testis, egg, and sperm that impact the next generation of Americans. (The Reproductive Science Branch of the National Institute of Child Health allocates only .022% of $30 billion to address reproductive health issues)
- And we must invest in tomorrow’s generation of innovators who might now be high school students or graduate students by funding innovative education programs and traditional training grants today that include a respect for sex and gender differences in all aspects of health and well-being.
I’ve gone from the very broadest issue of our day – the election and women’s issues and women’s votes – to the very granular issues of funding the next generation of research. Bill O’Reilly, speaking on Fox News election night said that 50% of the population voted for Obama because they want ‘stuff’. I think the ‘stuff’ we want is the right to speak our mind and be heard on issues that concern our health and the health of our families. We want our bodies to be respected by politicians, scientists, and everyone in between. The ‘stuff’ we want is assurances that the biomedical community is including male and female animals and patients in all of the scientific studies that we, women, fund through our taxes. The ‘stuff’ we want is to make sure that there is a way forward for research in an area that without question, touches each and every one of us. Our vote suggests that that ‘stuff’ is important and on this ‘morning after’ we are looking forward to the next four years.
Author: Teresa K. Woodruff, PhD, Thomas J. Watkins Professor of Obstetrics and Gynecology
A team of Northwestern University scientists including a member of our Institute team met October 18, with Environmental Protection Agency (EPA)in Washington, D.C., to advocate for important changes in the agency’s guidelines for reproductive health research.
“The problem is current research assessing the risk of toxins on reproductive health is not being uniformly investigated in both sexes and across the lifespan,” said Kate Timmerman, program director of the Oncofertility Consortium at Northwestern University. The reproductive health guidelines have not been updated since 1996 and need to be revised to reflect new research findings.
The Northwestern team asked the EPA to expand the definition of reproductive health beyond pregnancy to include the lifespan of an individual.
“Reproductive health is important across the entire lifespan because your endocrine system affects your bone health, cardiovascular health, and other systems in the body,” Timmerman said. Endocrine disrupters, sometimes triggered by environmental factors, can lead to increased risk for stroke and heart attack as well as osteoporosis.
The Northwestern scientists also requested that all EPA-sponsored research require appropriate testing in both sexes. Currently many toxicity studies are only conducted in male animal models with the assumption that females are affected the same way, but that isn’t necessarily true.
“What happens now is if researchers don’t see an effect in males, they won’t look in females,” Timmerman said. “But we know certain toxins in the environment can have a significant effect on females and not males and vice versa.”
Timmerman and colleagues presented a white paper to the EPA on how to improve and update the guidelines. See our previous blog for more details.
In addition to Timmerman, other Northwestern scientists meeting with the EPA include Kimberly Gray, professor of civil and environmental engineering at Northwestern's McCormick School of Engineering and Applied Science; Mary Ellen Pavone, MD, assistant professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital; and Francesca Duncan, reproductive scientist/research associate in the lab of Teresa Woodruff, PhD, chief of fertility preservation at Feinberg and director of the Oncofertility Consortium. Woodruff is also the founder and director of the Women's Health Research Institute at Northwestern who host this blog site.
Author: Marla Paul , Northwestern NewsCenter
Our success as researchers is measured by our ability to translate our findings, according to the often-used phrase, from bench to bedside. In other words, if we can apply our basic science findings to clinical care, we have the ability to impact countless lives. This pipeline is a national priority, and in fact, many Academic Medical Centers have established programs to facilitate rapid clinical translation. However, equally as important, and perhaps less appreciated is the need to translate basic science findings into relevant policies that protect and influence the general public.
Reproductive science and medicine are greatly impacted by the environment. Trends in reproductive health demonstrate that reproductive function has declined since the mid-20th century in certain populations and locations . Coincident with this decline in reproductive function is the large and ever-increasing number of natural and synthetic chemicals to which humans are exposed [2, 3]. Basic, clinical, and epidemiological research has demonstrated that exposure to certain compounds and contaminants, such as Endocrine Disrupting Chemicals (EDC), can have negative impacts on reproductive health. These compounds interfere with the production, transport, activity, and metabolism of natural hormones in the body. As we, as basic scientists and clinical researchers, understand the mechanisms by which these environmental exposures to such compounds affect developmental, reproductive, and neuroendocrine functions, we must also be able to inform and educate the implications of these specific reproductive health findings to the decision makers in Washington, DC. The question is: How?
In 2010, the Program on Reproductive Health and the Environment at the University of California, San Francisco developed the Reach the Decision Makers Fellowship with the exact intent of providing interested individuals and teams with the resources to advance science-based policy solutions. Specifically the Reach Program serves to provide individuals with a distinct interest in reproductive health and the environment, with mechanisms to interact with the United States Environmental Protection Agency (US-EPA). Over the past two years, the Reach program directed by Tracey Woodruff, PhD, MPH, an esteemed leader in the field, has trained over 75 individuals nationwide based on the principles of participatory democracy, social justice, and taking action to prevent harm (for more recent news about the Reach Program, check out the following blog written for the Physicians for Social Responsibility).
Table 1. Our interdisciplinary team
To take advantage of this unique program, we assembled an interdisciplinary team of six individuals committed to reproductive health and the environment (Table 1). Our team is comprised of professionals from academia, health care, government, and the community, and collectively we have experience in research, policy, advocacy, teaching, and communication (Table 2). Prior to joining the Reach Program, our team has worked together at Northwestern University and Northwestern Memorial Hospital in various settings including the Women’s Health Research Institute, the laboratory of Teresa K. Woodruff, PhD, the Oncofertility Consortium, the National Physicians Cooperative, the Oncofertility Saturday Academy, and the proposed Northwestern University Superfund Research Center in Reproductive Health Hazards. We joined the Reach Program with the goal of ensuring that the manner in which the US-EPA evaluates reproductive health and toxicity is in line with the current state of scientific knowledge.
Table 2. Team backgrounds
As Reach Program fellows, we have participated in a rigorous training program to define a reasonable “ask” in relation to our goal, to perform research on the topic, and to learn how to identify the key decision makers within the US-EPA who will listen to our request and affect change. Over the past six months, we have engaged in a first trip to Washington, DC where we attended presentations from policy experts regarding the US-EPA hazard evaluation procedures and how scientists can inform the agency on emerging research regarding the effects of environmental toxins on reproductive health. Meetings at the US-EPA gave the team a greater understanding of the overall institution and current initiatives of the agency. We have also participated in nine webinars covering topics spanning from the effects of environmental toxins on reproductive health to identifying policies and policy makers at the US-EPA.
We also developed our policy project by systematically gaining an understanding of the US-EPA as an agency and the documents and guidelines that inform its staff. Members of the US-EPA helped us identify a principle document in reproductive health and the environment, the Guidelines for Reproductive Toxicity Risk Assessment. This document was written in 1996 and has not been revised since that time so our group decided to focus on some of the significant opportunities to improve upon the guidelines. Since 1996, the state of reproductive research has advanced and we identified three specific areas of research that could be prioritized during the updating of the Guidelines for Reproductive Toxicity Risk Assessment, as follows:
- While the Guidelines acknowledged the importance of non-reproductive consequences of an impaired reproductive system, such as osteoporosis and increased risk of stroke, they did not include these outcomes as endpoint measures for further research study.
- Model organisms are necessary for advancing research in reproductive and environmental health. In the Guidelines, the authors state that effects seen in one organism may be assumed to occur in another. While this is meant to be protective for unstudied species, it is also true that certain species are ideal to investigate different aspects of science and health. Thus, we encourage the study of multiple model organisms in reproductive health and the environment.
- Research advances over the past decade have shown that significant sex differences are seen in the way males and females respond to different drugs and environmental toxins. This warrants the need to include both sexes in reproductive research, a consideration that could strengthen the updated Guidelines.
Our team developed these ideas into a position statement to inform US-EPA staff and interested parties of the need to advance reproductive health and the environment. This project culminates tomorrow, Thursday, October 18, 2012 when the team will fly to Washington, D.C. to meet with Nica Louie (Environmental Health Scientist at the National Center for Environmental Research), Brenda Foos (Director, Regulatory Support and Science Policy Division, Office of Children's Health Protection), and Daniel Axelrad (Environmental Scientist, Office of Policy) at the US-EPA. We hope to gain a greater understanding of the procedures of the agency at these meetings and advocate for the need to update Guidelines for Reproductive Toxicity Risk Assessment.
Virginia Neale, the Associate Director of Government Relations for Northwestern University, will also join the team and bring her expertise in bridging academia and the government to the project. Neale also facilitated a meeting between team members and legislative assistants to the House of Representatives congresswoman Jan Schakowsky (D-IL), who resides over Northwestern University’s Evanston campus. As congressional requests to the US-EPA are often needed to gather teams of experts and update guidelines, we will ask Schakowsky’s office to make such a request to gather the National Academy of Sciences and revise the Guidelines for Reproductive Toxicity Risk Assessment.
The work done this week, and over the past six months, by this interdisciplinary group, will build the foundation for the team to continue communicating evidence-based reproductive health findings to the policy makers in Washington D.C. who have the ability to affect change on a federal level. The relationships we develop this week will be fostered in the coming months and years to ensure that reproductive health is promoted at the highest level within the EPA and advocate that US-EPA guidelines are updated to include the most recent advances in reproductive research
This blog was Contributed by Francesca Elizabeth Duncan, PhD and Kate Waimey Timmerman, PhD Read more about the team here in a Northwestern University press release.
1. Woodruff, T.J., J. Schwartz, and L.C. Giudice, Research agenda for environmental reproductive health in the 21st century. Journal of epidemiology and community health, 2010. 64(4): p. 307-10.
2. Sutton, P., L.C. Giudice, and T.J. Woodruff, Reproductive environmental health. Current opinion in obstetrics & gynecology, 2010. 22(6): p. 517-24.
3. Woodruff, T.J., et al., Proceedings of the Summit on Environmental Challenges to Reproductive Health and Fertility: executive summary. Fertility and sterility, 2008. 89(2 Suppl): p. e1-e20.
The 2012 election cycle has seen unprecedented coverage (and often misinformation) on women’s reproductive health care due to the Affordable Care Act’s immediate impact and nonstop campaign gaffes related to women’s health.
Last Thursday, the National Women’s Law Center (NWLC) launched a new campaign to improve access to women’s health information called This Is Personal. The mission of the campaign is to target, engage and inform younger women about reproductive rights and help disseminate information related to women’s health topics ranging from contraception, maternity care, and what Congress is presently voting on.
It is therefore vitally important that women get involved in the decision-making process to ensure that the women impacted by these deeply personal issues have real world input. “Decisions about women’s reproductive health are personal. Period.” said NWLC Co-President Marcia Greenberger. “These decisions should be a woman’s to make with the important people in her life. The personal beliefs of lawmakers should not trump a woman’s ability to take care of her health.” Despite the private nature of decisions impacting reproductive health care, they are often made at the federal, state or local levels instead of the individual level.
The This Is Personal campaign hopes that through social media, celebrity involvement in videos and satire, young women (and men) will become increasingly active and interactive about reproductive rights. For example, through the new website’s interactive action tabs women can gather more information about state and federal health care decisions, sign petitions and contact legislators.
Decisions about women’s reproductive health care are greatly personal and deserve intimate involvement from women themselves. This Is Personal has a Facebook, Twitter and website with data and satirical videos which should be used as an educational tool and a place for women to educate themselves for the upcoming election. It is also a place where women can actively use their beliefs and knowledge to have their voices heard by decision makers. Sharing of ideas and knowledge is the only way to put decision making into the hands of the women who will be affected by the policies of the 113th Congress.
With women’s reproductive health reemerging as a heated issue this year in policy debates and news reports, this month’s Kaiser Health Tracking Poll assesses women’s perceptions and reactions to that attention and its potential impact on the upcoming presidential election.
Three in ten women (31 percent) overall believe that there is currently a “wide-scale effort to limit women’s reproductive health choices and services, such as abortion, family planning, and contraception” in the U.S. A larger share (45 percent) say there are some groups that would like to limit women’s reproductive health choices and services but it is not a wide-scale effort, while others volunteer that no such effort exists (7 percent) or decline to offer an opinion (17 percent). Women who say they are liberals (49%) are far more likely than women who say they are conservatives (18%) to perceive a wide-scale effort to limit services.
For many women, women’s reproductive health issues resonate on a personal level, with 42 percent reporting that they took some action in the past six months in reaction to something they’ve seen, heard or read. This includes attempting to influence a friend or family member’s opinion (23 percent), donating money to a non-profit working on reproductive health issues (15 percent), and contacting an elected official (14 percent). Fewer say they’ve changed their mind about who to vote for, donated to a political candidate or group, or contacted a media outlet.
For now, female voters (like male voters) continue to focus on the economy above all else as an election issue, with several other issues (including health care generally) rising above women’s reproductive health. Six in ten women voters name the economy and/or jobs as the issue they’d most like to hear about from candidates, compared to just 5 percent who name women’s health or other women’s issues (including abortion). To the extent this becomes a voting issue, female registered voters give President Barack Obama a clear advantage over presumptive Republican nominee Mitt Romney: more than half say they trust the president more to “look out for the best interests of women” and to make decisions about women’s reproductive health in particular, while closer to a quarter pick Governor Romney.
Other findings from the poll include:
- The share of the public with a favorable view of the Affordable Care Act (ACA) dropped 5 percentage points this month, with unfavorable views now outnumbering favorable ones by a small margin (44 percent versus 37 percent).
- The idea of defunding the law, as discussed by some members of Congress, is as unpopular now as it was a year ago, with roughly six in ten (58 percent) saying they disapprove of cutting off funding as a way to stop some or all of the law from being put into place, and about a third (32 percent) saying they approve of this strategy.
The poll was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted May 8-14, 2012, among a nationally representative random digit dial telephone sample of 1,218 adults living in the United States.
The Kaiser Family Foundation, a leader in health policy analysis, health journalism and communication, is dedicated to filling the need for trusted, independent information on the major health issues facing our nation and its people.