Global Translation/Adaptation Program The Transnational Journey of a Women’s Health Classic Women’s Collective Strength and Knowledge
The first newsprint edition appeared in 1970. In 1971 the book was retitled “Our Bodies, Ourselves. ”
www. ourbodiesourselves. org In 2005, this eighth edition was produced under the leadership of a new generation
GLOBALLY DISPARITIES CONTINUE TO BE STARK § In industrialized countries, one in 7, 300 women die during pregnancy or childbirth. § In Africa, the figure is about one in twenty-six women.
OBOS ADAPTATIONS NOW UNDERWAY Armenia: Armenian China: Chinese India: Bengali (for India and Bangladesh) Israel: Arabic and Hebrew Nepal: Nepali Nigeria: Pidgin English and Yoruba Russia: Russian Tanzania: Kiswahili (for East Africa) Turkey: Turkish We are also exploring possible adaptations of OBOS in Finnish, Hindi and Kinyarwanda
Article about the Turkish OBOS, 2007 The coordinating group, Mavi Kalem, expects to publish its edition in 2009 and has positioned its website – www. bedenimveben. org – as a key networking and lobbying tool for Turkish women’s groups.
Nepal The coordinating group, Women’s Rehabilitation Center, is adapting OBOS into 7 booklets in Nepali. In 2007, despite ongoing political turmoil in the country and persecution by local communities, the coordinating group and its partners facilitated the inclusion of reproductive health and rights in Nepal’s new interim constitution.
Nigeria The coordinating group, Women for Empowerment, Development and Gender Reform, is adapting OBOS into Pidgin English and Yoruba, in alternative formats such as posters. In 2009, they will reach 1. 5 million people through outreach on the local canoe transport system, peer health educator trainings with village hair dressers, and a motorcycle campaign to bring health information to neighboring villages.
Israel Women and Their Bodies, a group of Palestinian and Israeli women, is developing new Arabic and Hebrew adaptations. The old versions – depicted below – are out of print. Hebrew 1982, Israel Arabic 1991, Egypt
Russia "Ourselves and Our Body" Electronic adaptation only; available online at www. womenhealth-spb. org. By Women's Health in St Petersburg
Armenia Menk ou Mer Marmine (We and Our Body) Type: Cultural Adaptation Format: Print Edition Language: Armenian Country: Armenia Coordinating Group: Charitable Foundation on Population Development Published: 2001 Second edition forthcoming in 2009
Bulgaria Nasheto Tyalo, Nie Samite (Our body, Ourselves) Type: Cultural Adaptation Format: Print Edition Language: Bulgarian Country: Bulgaria Coordinating Group: Women's Health Initiative in Bulgaria Published: 2001
China The 1998 Chinese edition – depicted alongside - is out of print. Another group is currently developing content into print and digital format for web downloads and textcapable mobile phones. This pioneering project will reach roughly 1. 5 million people in China.
Senegal Notre Corps, Notre Sante (Our Body, Our Health) French Edition for French-Speaking Africa Type: Inspired by Our Bodies, Ourselves Format: Print Edition Language: French Country: Senegal Coordinating Group: Groupe de Recherche sur Les Femmes et Les Lois au Senegal Published: 2004; Reprinted in 2007
(Left) Codou Bop, the coordinator of “Notre Corps, Notre Sante” in Senegal, and (Right) Jane Pincus, an OBOS co-founder and co-author of “Our Bodies, Ourselves”
Japan Type: Cultural Adaptation Format: Print Edition Language: Japanese Country: Japan Coordinating Group: Shokado Women’s Bookstore Published: 1988
Korea Type: Cultural Adaptation Format: Print and Electronic Editions Language: Korean Country: South Korea Coordinating Group: Alternative Culture Publishing Co. Published: 2005
Poland Nasze ciała, nasze życie (Our Bodies, Our Lives) Type: Cultural Adaptation Format: Print Edition Language: Polish Country: Poland Coordinating Group: Network of East/West Women - Polska Published: 2004
Romania Tu Si Curpul Tau Pentru un Nou Secol Type: Cultural Adaptation Format: Print Edition Language: Romanian Country: Moldova Coordinating Group: National Women's Studies & Information Center Published: 2002
Serbia Nasa Tela, Mi Type: Cultural adaptation Format: Print Edition Language: Serbian Country: Serbia Coordinating Group: Autonomous Women’s Center Against Sexual Violence Published: 2001
Spanish, USA Nuestros Cuerpos, Nuestras Vidas (Our Bodies, Our Lives) Type: Cultural Adaptation Format: Print Edition Language: Spanish (for the U. S) Country: United States of America Coordinating Group: Our Bodies Ourselves Published: 2000 (Seven Stories Press, NYC)
India A Hundred Thousand Questions about Women's Health Type: Inspired by Our Bodies, Ourselves Format: Print Edition Language: Telegu (an English adaptation of this edition called Taking Charge of Our Bodies was published in 2004) Country: India Coordinating Group: Hyderabad Women's Health Group Published: 1991
India Healthy Body, Healthy Mind Type: Inspired by Our Bodies, Ourselves Format: Print Edition Language: Tibetan (back-translated into English) Country: India Coordinating Group: Tibetan Nuns Project Published: 2005
Lobsang Dechen, coordinator of the Tibetan project
Editions in Progress Turkey / Turkish Israel / Hebrew & Arabic Nepal / Nepali India / Bengali Nigeria / Local Dialects Tanzania / Kiswahili Published Foreign Editions of Our Bodies, Ourselves Books Inspired by Our Bodies, Ourselves Editions in Progress
What are some key challenges facing women’s health advocates today? • Media portrayals of new medical research are often inaccurate or incomplete • The media often endorse or reinforce our societal tendency to embrace the “quick fix” or “pill for every ill” approach
Key Challenges…. • Increasing influence of the pharmaceutical industry over physician prescribing practices as well as the educational and advertising materials aimed at the consumer or patient
The failure to utilize best practices largely because of perverse payment incentives well described in Dr. Atul Gawande’s June 1, 2009 New Yorker piece entitled “The Cost Conundrum. ” In women’s health, maternity care is a primary arena where there are multiple examples reflecting the failure to utilize best practices. As a result, we have rising cesarean section rates, falling VBAC (Vaginal Birth after Cesarean) rates, rising rates of premature births, rising rates of unnecessary medical interventions that are increasingly shown to be associated with harms, and falling breastfeeding rates in some regions.
Evidence-Based Maternity. Care: What It Is and What It Can Achieve Issued by the Milbank Memorial Fund, the Childbirth Connection, and the Reforming States Group (2008)
What is Evidence-Based Maternity Care? Definition Uses best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and facilitate optimal outcomes in mothers and newborns Gives priority to effective care paths and practices with least harm
What is Evidence-Based Maternity Care? Corollaries Avoid practices with no clear benefit and established or plausible harms Avoid practices with marginal expected benefit that is overshadowed by established harm. FIRST DO NO HARM
Imperative for Maternity Care Quality Improvement
Imperative for Maternity Care Quality Improvement Scale United States: over 4. 3 million births/year Childbirth In United States the leading reason for hospitalization mothers & newborns are 23% of all discharges procedure intensive: 6 of 15 most commonly performed hospital procedures in entire population associated with childbirth
Imperative for Maternity Care Quality Improvement Costs and Charges Childbirth especially impacts 2 purchaser groups private insurers/employers pay for 51% of hospital stays Medicaid/taxpayers pay for 42% of hospital stays Combined maternal/newborn hospital charges far exceed charges for any other condition: $79, 277, 733, 843 in 2005 private insurers/employers: $39, 726, 164, 301 Medicaid/taxpayers: $34, 164, 460, 561
Addressing Underuse in Maternity Care Examples of Practices to Use Whenever Possible and Appropriate Smoking cessation interventions Ginger for nausea and vomiting Preterm birth prevention External version to turn breech presentation babies VBAC
Addressing Underuse in Maternity Care Examples of Practices to Use Whenever Possible and Appropriate Continuous labor support Non-supine positions for giving birth Measures to relieve pain, bring comfort, and/or promote labor progress Early skin-to-skin contact (versus mother-baby separation) Breastfeeding and interventions to promote its initiation and duration
Context: Lactation support ranks lower than pet insurance (thanks to Cate Colburn-Smith) Comparison of employer benefits All companies Large companies Small companies (500+ employees) (<100 employees) Chiropractic coverage 91% 83% 79% Well-baby program (post-natal) 77% 79% 77% Prenatal program 67% 66% 67% Accupressure/ Accupuncture 31% 33% 31% Onsite lactation/mother’s room 25% 35% 13% Postal services 24% 27% 22% Massage therapy services 14% 19% 9% Dry cleaning services 13% 18% 9% Pet insurance 7% 10% 5% Lactation support services 6% 10% 2% o Starting in 2008, lactation program/designated area was separated into on-site lactation/ mother’s room and lactation support services o Other family-friendly benefits included on-site parenting seminars (4%) and on-site vaccinations for infants/children (3%) o The number of employees with lactation programs has grown from 16% in 1999 Source: Society of Human Resource Management 2008 Benefits Report
A Statement by Physicians, Midwives and Women’s Health Advocates who Support Safe Choices in Childbirth 1. That communities preserve the option of vaginal births after cesarean (so-called “VBACs”) 2. That options for hospital-based midwifery care (utilizing Certified Nurse Midwives and Certified Midwives) be made available in all communities 3. That Certified Professional Midwives (CPMs) be licensed and regulated in order to make
Breast augmentation statistics from the American Society of Plastic Surgeons: 212, 500 2000 291, 350 2005 329, 396 2006 55% increase between 2000 and 2006
“Breast augmentation has always been among the top five surgical procedures, but until now has never been number one…. ” ASPS Press Release, March 22, 2007 (ASPS began collecting statistics in 1992)
MORE PUBLIC SCREENINGS OF THE DOCUMENTARY “ABSOLUTELY SAFE” ARE NEEDED. See also the booklet prepared by the US Food and Drug Administration for photographs and descriptions of adverse implant outcomes such as disfigurement, capsular contracture (when the breast becomes hard and misshapen), and deflation: www. fda. gov/cdrh/breastimplants
A survey by the American Society of Plastic Surgeons showed that nearly 40 percent of plastic surgery patients believe they should have been more proactive in learning about potential side effects and complications before surgery.
Eli Lilly is now the sole manufacturer of r. BGH — the artificial growth hormone given to dairy cows that increases people’s risk of cancer. Eli Lilly also manufactures breast cancer treatment medications and a pill that “reduces the risk” of breast cancer. Eli Lilly is milking cancer. Tell them to stop making r. BGH.
A large coalition of groups: See www. safecosmetics. org “Skin Deep” a report of the Environmental Working Group, helps consumers and workers to better protect themselves from known or suspected carcinogens and reproductive toxins.
"It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine. ” Marcia Angell, MD
Direct-to-Consumer Advertising of Prescription Drugs: Misleading Ads and How They Hurt Us
The Public Gets Misinformation Benefits are often overstated, while risks are understated FDA warning letters are issued after the ads run Corrective ads are rarely required Withdrawal of an ad is the only penalty
Ads are geared primarily to selling more drug product, not educating the user The ads work: the most highly advertised drugs, accompanied by promotional campaigns geared to physicians, sell extremely well
To promote “The Hunt for the Pink Viagra” (Slide Courtesy of Leonore Tiefer)
For more information about female sexual problems, see the website of the Campaign for a New View of Women’s Sexual Problems: www. fsd-alert. org
Removing healthy ovaries US federal data from the late 1990 s: 78% of women 45 -64 who have had a hysterectomy also had healthy ovaries removed (even though most were not at particular risk of developing ovarian cancer).
“Ovarian Conservation at the Time of Hysterectomy and Long-Term Health Outcomes in the Nurses’ Health Study” by William H. Parker et al. Obst & Gyn May 2009
“Compared with ovarian conservation, bilateral oophorectomy at the time of hysterectomy for benign disease is associated with a decreased risk of breast and ovarian cancer but an increased risk of all cause mortality, fatal and nonfatal coronary heart disease, and lung cancer. "
This reconfirms findings in an earlier study by Parker et al (Obst & Gyn Aug 2005): For 10, 000 women 50 -54 yrs old who undergo a hysterectomy with oophorectomy, there will be 47 fewer cases of ovarian cancer by the time these women reach 80 when compared with a similar group who keep their ovaries.
BUT the oophorectomy group will suffer 838 additional deaths from coronary heart disease as well as 158 more deaths from hip fractures. (Numbers reflect women who do NOT have estrogen therapy – there is a smaller survival benefit to keeping the ovaries in women taking estrogen. )
Media attention to this critical issue has been minimal, and the practice of removing healthy ovaries continues. 300, 000 US women have a “prophylactic” oophorectomy every year at the time of a hysterectomy.
“The Marketing of Osteoporosis” by Maryann Napoli American Journal of Nursing April 2009 (V. 109), #4, p 58 -61 http: //journals. lww. com/ajnonline/Fulltext/2009/04000/The_Marketing_o f_Osteoporosis. 41. aspx Chronicles how a risk factor became a disease
Research did not support the DXA scanning of well women at or near menopause as a means of predicting future fractures
4 year trial of alendronate in elderly women with bone loss but no vertebral fractures: Hip fracture rate virtually no different for the drug-treated participants than for the placebo group (1% vs. 1. 4%, respectively)
Alendronates: -Improve bone density but not effective at reducing hip fractures - Longterm harms now emerging (eg, risk of severe and sometimes incapacitating musculoskeletal pain)
See the 2002 guidelines for osteoporosis screening from the Agency for Healthcare Research and Quality: They recommend that bone-density scanning not begin until age 65 (or 60 in some high-risk cases)
Risks to Women’s Health from Multiple Egg Extraction Procedures An issue for women considering egg “donation” whether to help infertile women or to provide eggs for research cloning, also known as “somatic cell nuclear transfer” (SCNT).
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