Archive for March, 2010

A Blow for Women’s Health – Legal Abortion

One of the greatest advancements in women’s health was not the discovery of a new pill or the invention of a revolutionary surgical device.   It was the legalization of abortion.

In 1973, the U.S. Supreme Court took abortion from the back-alleys and in one felled swoop struck a blow for the health of millions of women.   Still, decades later, many women (and men) do not understand how they are performed.  Let’s talk about that today.

Approximately 1.3 million abortions are performed every year in the United States.  It is one of the safest medical procedures performed on women and they are generally performed in private clinics that are staffed by medical personnel including, of course, the physician. 

There are surgical abortions and non-surgical abortions (otherwise known as “the abortion pill”).   Approximately 90% of abortions are performed in the first trimester.  The most common surgical method is vacuum aspiration (the suction method). It can be performed with a local anesthetic, mild sedation or general anesthesia.  During vacuum aspiration, the cervix (opening of the uterus) is gently widened about a quarter-inch, a narrow tube is inserted through the vagina and cervix to the uterus, and then the contents are vacuumed out. The procedure takes only a couple minutes and the woman can usually return home later in the day.

Abortions are rare in the second trimester, which begins in the 13th week of pregnancy. During this type of abortion, a medication called prostaglandin is given in a clinic. This results in uterine contractions, which can last several hours, and is usually accompanied by some anesthesia.  Some second trimester abortions may take more than one day. 

The “abortion pill” is generally only offered in the first 7 weeks of pregnancy. Most facilities give two different medications to complete this method. The first one is given in the office and stops the pregnancy from growing. The second medication is taken a few hours to days later. This is the one that causes the uterus to contract and expel the pregnancy. Symptoms can be similar to a woman who’s having a miscarriage. Bleeding, cramping and nausea are expected parts of the process. However, if you take your temperature and find a fever or have bleeding that soaks more than 2 pads in an hour for 2 hours, this is not normal. You should contact your provider or possibly go to the nearest emergency room. Otherwise, expect to return to your provider’s office in the next week or two so that they can verify that the pregnancy has ended.

Studies show that both methods are about 99% successful when done properly; and neither have been shown to alter a women’s chances of getting pregnant or carrying a baby in the future.

Of course, if you are considering abortion you need to talk extensively to the clinic about the procedure as they vary from office to office.


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Protect Young Women from Tanning Beds

Okay, girls, fess up…

The captain of the football team just asked you out and you decide you want to look “extra special.”  So, you make an appointment at your local health club to use the tanning bed.  Sound familiar?     

Well, if it does, then the next time you think about enhancing that tan, think again. 

Last year, the World Health Organization declared that tanning beds cause skin cancer, finding that people who used them in their early years had a 75% increase in the risk of melanoma, the deadliest form of skin cancer.  And, the vast majority of people who get cancer from tanning beds are women.  As a result, the WHO moved ultraviolet tanning beds to its highest cancer risk category, along with arsenic and cigarettes.

In response to this growing problem, an advisory panel for the Food and Drug Administration recently recommended imposing tougher controls on tanning beds.  Some are suggesting an outright ban of the devices for teens under the age of 18.  Heck, even the Congress has recognized the potential danger and recently imposed a 10 percent tax on indoor tanning salons as part of the healthcare bill. 

These devices, unlike natural sunlight, focus ultraviolet radiation directly to your skin.  So, contrary to the popular notion that you are getting a “healthy tan,” the skin is actually getting damaged.  UV exposure is cumulative over a lifetime; so the greater one’s exposure, the greater the risk for developing a skin cancer.

Although the FDA does not have to follow the advice of their advisory panel, it traditionally does. They will take the next few months to go over the recommendations before making a final decision. 

From my perspective, I say we should prohibit teenagers from using these machines.  I realize there is a lot of pressure on a young girl to get that “movie star” look and a 17 year old generally doesn’t consider the long term consequences of his or her acts. They are certainly not thinking of cancer at that age or about how excessive tanning leads to premature aging (leathery appearance and wrinkling) that is decidedly NOT healthy in appearance.

Still, there is no upside to tanning beds. 

Young girls in particular need protection.  Let’s hope the FDA does the right thing.

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Now that the Congress has passed the Healthcare Reform bill, I’d like to take a moment to talk about how that legislation will affect women’s health, in particular their access to affordable health insurance.

The bottom line is that women are going to benefit from this legislation.  Yes, I know that opponents of abortion successfully prohibited federal dollars from being used for abortion but, aside from that loss, there are some positive developments for women. 

At the current moment, in most states health insurance companies are allowed to consider gender when they set their rates for individual health plans.  What that means is that women are often charged more than men for the same coverage.  Indeed, a recent study found that at age 25, women are charged between 6-45% more than men for the identical insurance coverage.  At age 40, women’s monthly premiums are between 4-48% higher than men’s monthly premiums.   

In addition, when it comes to group health insurance plans (that are used by businesses), insurance companies can take into account the percentage of women in that company when they set the company’s overall premium.  So, companies that employ more women often pay more for coverage.

When this bill is signed into law in a few hours by President Obama, the use of “gender rating” will be severely curtailed as it related to both individual and group health insurance plans. 

From a more generic point of view, 45% of women (39% of men) were uninsured or underinsured in 2007 versus 39% of men.  Under the new law, up to 4.5 million uninsured women will now be eligible for insurance under the Medicaid program.  Also, new insurance plans would be required to cover preventive care, including mammograms, without cost sharing.  And one relatively unnoticed provision recently caught my eye:   employers with over 50 employees will now be required to provide a break and a location for nursing mothers to breast feed their infants!

The new law is by no means perfect.   But it’s a great start, especially for women!

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