New Research on Abortion Stigma Offers Hope

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“Where is the Magic Johnson, the Arthur Ashe, the Elton John, the Annie Lennox of safe-abortion access or contraceptive use?” asked Jessica Mack from MS Magazine in last month issue.

There is no denying Mack is right. Reproductive Rights Activists, providers and supporters need to take a page from activists of other movements like the Global HIV/AIDS movement. But it is not like we haven’t tried.

Writer Jennifer Baumgardner and filmmaker Gillian Aldrich attempted to kick start just such a movement with the “I Had an Abortion” film and T-Shirt Project in 2005.But it never took hold the way they might have hoped.  What these idealistic activists did not anticipate was the strength of the stigma that still surrounds abortion globally - even in nations where it is legal.

In Ghana, one of the countries with the most permissive abortion laws on that continent the highest cause of death for women is still unsafe abortion. Cultural and religious stigma is so strong women avoid going to safe practitioners either because they do not know safe and legal medical services are available for abortion or for fear of people finding out.

In The United States– a large percentage of women who have commercial insurance still attempt to fund expensive abortion services without using coverage that could save them hundreds and sometimes thousands of dollars.  Stigma – the concern that employers, family members, or health care providers may learn of their abortion – is a main motivation for women to pay out of pocket for their abortion care when they can afford to. Under the Affordable Care Act, allowing children to remain on parental insurance plans until age 26, and with the trend toward abortion bans in both public and private insurance this situation may get worse.

So what can we do to change this situation? A few women, like Pageant contestant Jordan Barnstable, Miss Illinois 2010, have stepped up and taking a public stand fo reproductive rights. But they are few and far between.

Well, according to researchers we need to look at more than just women who have had, or are having abortions. We need to understand how abortion stigma functions in societies and populations around the world.

“We’ve barely scratched the surface of how this effects male partners,” according to Dr Danielle Bessett, assistant professor of sociology, University of Cincinnati, as an example of just one population that needs to be studied as well.

Bessett is one of a group of researchers looking at abortion stigma around the world. They are hoping their new international studies of abortion stigma in different national, cultural and population setting will help spread light no how to combat this problem.

In “Abortion stigma: a reconceptualization of constituents, causes, and consequences,” form the May – June issue of Women’s Health Issues Drs Bessett, Norris, Steingberg, Kavanaugh, De Zordo and Becker introduced their introduced new approaches to this issue.

These studies covering areas of the United States, Zambia, Nigeria, Tanzania, Mexico, Brazil and parts of Europe look at abortion stigma though multiple populations in areas where abortion is legal and illegal.

We need to better understand what we are dealing with if we want to, “Win the battle of Hearts and Minds around the abortion issue,” according to Bessett.
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Possible Unintended Consequences of the 5 year Pap Smear Recommendation

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On March 14, 2012 the U.S. Preventative Service Task Force changed the recommendation for pap smears for women between the ages of 30 and 65 from every three years to every five years.

While this may be alright in terms of the new findings with regard to cervical cancer screenings and limiting unnecessary and possibly painful testing on women – there may be unanticipated consequences.

Getting a cervical cancer screening and continuing or up-dating birth control methods are two of the major reasons women make it to their OBGYN appointments. While no one looks forward to these visits - these important reasons keep us coming back for regular checkups.

While women are often aware of other concerns – like STI testing which needs to be done at least once a year – without the motivation of cervical cancer screenings or the physical discomfort associated with sever infections -  getting into the office often seems like an unnecessary inconvenience.

At a time when symptom fewer infections, like Chlamydia, are on the rise and the rates of testing for these infections have decreased, saying that one only needs a check up every 5 years limits opportunities for doctors to encourage testing and treatment.
It is key that women stay vigilant and make it into their OBGYN’s office at least once a year to maintain good reproductive health.

"It is critical that health care providers are not only aware of the importance of testing sexually active young women every year for Chlamydia infections, but also of retesting anyone who is diagnosed," Dr. Gail Bolan, the CDC's director of STD Prevention, told reporters in a conference call from the National STD Prevention Conference in Minneapolis..
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Religion Trumps Women’s Healthcare in Illinois

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Illinois set an dangerous precedent  Friday September 21, 2012 when an appellate court upheld the ruling of the lower court stating that pharmacists and pharmacies do not have to provide Plan B – the ‘morning after pill” – if they have religious objections.

Plan B – the brand name for the medication which gives and 80% chance of not getting pregnant if taken within 72 hours of unprotected sex – has stirred controversy because some religious groups feel that by blocking implantation if causes an abortion rather than prevents pregnancy.

In 2005 former Governor Rod Blagojevich gave a mandate to all pharmacies and pharmacists that they must provide Plan B.  This kicks up a backlash from anti-abortion groups in the state. In 2011 an Illinois judge entered an injunction against the rule stating that it was designed to target religious objectors.

"This decision is a great victory for religious freedom," said Mark Rienzi, senior counsel for the Becket Fund, quoted in a statement about the decision.
But not everyone agrees.

"We are dismayed that the court expressly refused to consider the interests of women who are seeking lawful prescription medication and essentially held that the religious practice of individuals trumps women's health care," said ACLU spokesman Ed Yohnka. "We think the court could not be more wrong."
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Pelvic Inflammatory Disease: One Cause of Chronic Pelvic Pain?

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One of the major complaints that a lot of women have is chronic pelvic pain – pain lasting several months. There are a lot of causes – some more serious then others.

Pelvic Inflammatory Disease (PID) is one of the more serious reasons that women may experience Chronic Pelvic Pain.
What is PID? According to the Center for Disease Control and Prevention (CDC) around 750, 000 each year experience an acute case of PID. It refers to a serious complication related to bacterial infection that moves from the vagina into the uterus and fallopian tubes. This infection can cause scarring and blockage of the fallopian tubes leading to infertility.
Symptoms of PID: Symptoms of PID include the following:

Pain in your lower abdomen and pelvis
Heavy vaginal discharge with an unpleasant odor
Irregular menstrual bleeding
Pain during intercourse
Low back pain
Fever, fatigue, diarrhea or vomiting
Painful or difficult urination

While these symptoms are readily apparent PID may cause only minor symptoms or none at all. Asymptomatic PID is especially common when the infection is due to Chlamydia. If you are experiencing any of these symptoms, or suspect you have been exposed to a Sexually Transmitted Infection like Chlamydia, you should contact your doctor to be checked immediately.

More urgent symptoms that indicate the need to go to the emergency room which are linked to PID are:

Severe pain low in your abdomen
Vomiting
Signs of shock, such as fainting
Fever, with a temperature higher than 101 F (38.3 C)

Because these symptoms can also be associated with other sever illnesses you want to seek medical attention as soon as possible if you are experiencing a combination of these symptoms.

Diagnosis: Diagnosis of PID is very important in order to avoid complications like infertility, however it can be difficult. There is no specific test for PID because if can be caused by several different types of bacteria and symptoms may be subtle and easy for women and doctors to miss.

If you come to your GYN with symptoms such as lower abdominal pain, your provider may perform a physical examination to determine the nature and location of the pain and check for fever. They will also ask about abnormal vaginal or cervical discharge, and for evidence of gonorrheal or Chlamydial infection. If the findings suggest PID, treatment is necessary.

Your OBGYN may also order a pelvic ultrasound. An ultrasound can allow the sonographer and doctor to see whether the fallopian tubes are enlarged or whether an abscess is present. In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a procedure in which a thin, rigid tube with a lighted end and camera is inserted through a small incision in the abdomen, usually in the belly button. This procedure enables the doctor to view the internal pelvic organs and to take specimens for laboratory studies, if needed.

Treatment: The basic treatment for mild cases of PID is a course of antibiotics. In most cases this will clear up the infection – however it cannot reverse scarring and damage already cause by PID. For this reason it is key that women seek treatment as soon as the suspect there is a problem. Doctors will often prescribe a course of two antibiotics together because it is difficult to determine which bacteria are responsible for the PID. They often will ask patients to come back in with in week for reevaluation to make sure that they infection is responding to treatment. It is also for all sexual partners to be treated as well because they may not have symptoms, but they may still be carrying dangerous bacteria.

According to the CDC Hospitalization to treat PID may be recommended if the woman (1) is severely ill (e.g., nausea, vomiting, and high fever); (2) is pregnant; (3) does not respond to or cannot take oral medication and needs intravenous antibiotics; (4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess); or (5) needs to be monitored to be sure that her symptoms are not due to another condition that would require emergency surgery (e.g., appendicitis). If symptoms continue or if an abscess does not go away, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring are difficult to treat, but sometimes they improve with surgery.
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