global translation/adaptation program womens collective strength and knowledge the transnational...
TRANSCRIPT
Global Translation/Adaptation Program
Women’s Collective Strength and Knowledge
The Transnational Journey of a
Women’s Health Classic
The first newsprint
edition appeared in
1970.
In 1971 the book was re-
titled “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: ArmenianChina: Chinese
India: Bengali (for India and Bangladesh)Israel: Arabic and Hebrew
Nepal: NepaliNigeria: Pidgin English and Yoruba
Russia: RussianTanzania: 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.
NepalThe 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 forEmpowerment, Development andGender 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.
Arabic 1991, Egypt
Hebrew1982, Israel
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
BulgariaNasheto 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 text-capable mobile phones. This pioneering project will reach roughly 1.5 million people in China.
SenegalNotre 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
PolandNasze 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, USANuestros 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)
IndiaA 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
Published Foreign Editions of Our Bodies, Ourselves Books Inspired by Our Bodies, Ourselves Editions in Progress
Israel / Hebrew & Arabic
India / Bengali
Nepal / Nepali
Nigeria / Local Dialects
Tanzania / Kiswahili
Turkey / Turkish
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 HARMFIRST 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)
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 1999Source: Society of Human Resource Management 2008 Benefits Report
Comparison of employer benefits
All companies
Large companies
(500+ employees)
Small companies
(<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%
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 the option of homebirth as safe as possible.
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 rBGH — 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 rBGH.
Milking Cancer Partners
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 1990s: 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, p58-61
http://journals.lww.com/ajnonline/Fulltext/2009/04000/The_Marketing_of_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).
