“Swept Away” — Abuses against Sex Workers in China
Source: Human Rights Watch
This 51-page report documents abuses by the police against female sex workers in Beijing, including torture, beatings, physical assaults, arbitrary detentions, and fines, as well as a failure to investigate crimes against sex workers by clients, bosses, and state agents. The report also documents abuses by public health agencies, such as coercive HIV testing, privacy infringements, and mistreatment by health officials.
FDA approves Plan B One-Step emergency contraceptive without a prescription for women 15 years of age and older
Source: U.S. Food and Drug Administration
The U.S. Food and Drug Administration today announced that it has approved an amended application submitted by Teva Women’s Health, Inc. to market Plan B One-Step (active ingredient levonorgestrel) for use without a prescription by women 15 years of age and older.
After the FDA did not approve Teva’s application to make Plan B One-Step available over-the-counter for all females of reproductive age in December 2011, the company submitted an amended application to make the product available for women 15 years of age and older without a prescription.
The product will now be labeled “not for sale to those under 15 years of age *proof of age required* not for sale where age cannot be verified.” Plan B One-Step will be packaged with a product code prompting a cashier to request and verify the customer’s age. A customer who cannot provide age verification will not be able to purchase the product. In addition, Teva has arranged to have a security tag placed on all product cartons to prevent theft.
In addition, Teva will make the product available in retail outlets with an onsite pharmacy, where it generally, will be available in the family planning or female health aisles. The product will be available for sale during the retailer’s normal operating hours whether the pharmacy is open or not.
Plan B One-Step is an emergency contraceptive intended to reduce the possibility of pregnancy following unprotected sexual intercourse – if another form of birth control (e.g., condom) was not used or failed. Plan B One-Step is a single-dose pill (1.5 mg tablet) that is most effective in decreasing the possibility of unwanted pregnancy if taken immediately or within 3 days after unprotected sexual intercourse.
Plan B One-Step will not stop a pregnancy when a woman is already pregnant, and there is no medical evidence that the product will harm a developing fetus.
Reproduction is a risky affair; a lifespan cost of maintaining reproductive capability, and of reproduction itself, has been demonstrated in a wide range of animal species. However, little is understood about the mechanisms underlying this relationship. Most cost-of-reproduction studies simply ask how reproduction influences age at death, but are blind to the subjects’ actual causes of death. Lifespan is a composite variable of myriad causes of death and it has not been clear whether the consequences of reproduction or of reproductive capability influence all causes of death equally. To address this gap in understanding, we compared causes of death among over 40,000 sterilized and reproductively intact domestic dogs, Canis lupus familiaris. We found that sterilization was strongly associated with an increase in lifespan, and while it decreased risk of death from some causes, such as infectious disease, it actually increased risk of death from others, such as cancer. These findings suggest that to understand how reproduction affects lifespan, a shift in research focus is needed. Beyond the impact of reproduction on when individuals die, we must investigate its impact on why individuals die, and subsequently must identify the mechanisms by which these causes of death are influenced by the physiology associated with reproductive capability. Such an approach may also clarify the effects of reproduction on lifespan in people.
See: Spayed or Neutered Dogs Live Longer (Science Daily)
Source: U.S. District Court, Eastern District of New York
The decisions of the Secretary with respect to Plan B One-Step and that of the FDA with respect to the Citizen Petition, which it had no choice but to deny, were arbitrary, capricious, and unreasonable. I decline to direct a remedy comparable to that which I directed in my 2009 opinion, such as directing that emergency contraception be made available without a prescription but with the current point-of-sale restrictions to women whom studies have demonstrated are capable of understanding the label and using the product appropriately. As I have previously observed, the obstructions in the path of those adolescents in obtaining levonorgestrel-based emergency contraceptives under the current behind-the-counter regime have the practical effect of making the contraceptives unavailable without a doctor’s prescription. Consequently, the decision of the FDA denying the Citizen Petition is reversed, and the case is remanded to the FDA with the instruction to grant the Citizen Petition and make levonorgestrel-based emergency contraceptives available without a prescription and without point-of-sale or age restrictions within thirty days. On remand, the FDA may determine whether any new labeling is reasonably necessary. Moreover, if the FDA actually believes there is any significant difference between the one- and two-pill products, it may limit its over-the-counter approval to the one-pill product.
Source: George Washington University, School of Public Health & Health Services
Community health centers (CHCs) provided primary health care to over 20 million patients in 2011, 60% of whom are women and 25% of whom are women of childbearing age. Health centers play a central role in women’s health, because of their mission to furnish a full range of primary and preventive care services, including family planning and birth control for women of reproductive age. As a result of the Affordable Care Act, which provide for historic insurance expansions, broad first-dollar coverage of family planning services, and direct investment in CHCs, it is projected that health center capacity will virtually double by 2019, and accordingly, the role of health centers in the provision of women’s health care services can be expected to grow significantly. This study examines how health centers fulfill their family planning mission.
Source: RAND Corporation
Awareness of military sexual assault — sexual assault of a servicemember — has been increasing within the Department of Defense (DoD). The DoD is striving to improve this situation, but unique conditions of life in the military may make response to these events more difficult than within the civilian sector. This paper reviews the prevalence of sexual assault among servicemembers, victim responses in the immediate aftermath of a sexual assault, barriers to disclosure, victim needs, and DoD efforts to provide necessary resources to victims. The authors review civilian guidelines for the care of physical injuries, response to STI/HIV and pregnancy risk, forensic services, advocacy and support services, and formal mental health care. They then review DoD directives, forms, and guidelines for sexual assault victim care, revealing that these generally are consistent with civilian guidelines. However, little is known about the fidelity with which these DoD recommendations are implemented. The authors close with recommendations for future research to support the DoD’s commitment to a culture free of sexual assault, including a comprehensive, longitudinal epidemiological study of military sexual assault, a needs assessment of disclosed and undisclosed military victims, an evaluation of the training enterprise, and an evaluation to document the extent to which DoD directives requiring immediate, evidence-based care for military victims are being implemented with fidelity.
CDC Grand Rounds: The Growing Threat of Multidrug-Resistant Gonorrhea
Source: Morbidity and Mortality Weekly Report (CDC)
Although gonorrhea has afflicted humans for centuries, and the causative bacterium, Neisseria gonorrhoeae, was identified more than a century ago, gonorrhea remains a public health problem in the United States. Gonorrhea is the second most commonly reported notifiable infection in the United States; >300,000 cases were reported in 2011 (1). In the United States, health inequities persist; the incidence of reported gonorrhea among blacks is 17 times the rate among whites, likely because of structural socioeconomic factors (1,2).
Infection with N. gonorrhoeae is spread through sexual contact and, depending on the anatomic site of exposure, can cause acute urethritis, cervicitis, proctitis, or pharyngitis. However, most cases of gonorrhea are asymptomatic, particularly cervical, pharyngeal, and rectal infections. Untreated or inadequately treated gonorrhea can facilitate human immunodeficiency virus (HIV) transmission and cause serious reproductive complications in women, such as pelvic inflammatory disease, ectopic pregnancy, and infertility. Other severe complications, including disseminated gonococcal infection and neonatal conjunctivitis and blindness, still occur in resource-limited settings, but are now rare in the United States. Empiric antimicrobial therapy is used for treatment of gonorrhea. Antimicrobial susceptibility testing generally is not routinely available in clinical practice, and early diagnosis and effective antimicrobial treatment of patients and their partners has been the mainstay of gonorrhea control and prevention; thus, gonococcal antimicrobial resistance poses a grave challenge.
Abortion and Family Planning-Related Provisions in U.S. Foreign Assistance Law and Policy (PDF)
Source: Congressional Research Service (via Federation of American Scientists)
This report details legislation and policies that restrict or place requirements on U.S. funding of abortion or family planning activities abroad. The level and extent of federal funding for these activities is an ongoing and controversial issue in U.S. foreign assistance and will likely continue to be a point of contention during the 113th Congress.
These issues have been debated for over four decades in the context of a broader domestic abortion controversy that began with the Supreme Court’s 1973 ruling in Roe v. Wade, which holds that the Constitution protects a woman’s decision to terminate her pregnancy. Since Roe, Congress has enacted foreign assistance legislation placing restrictions or requirements on the federal funding of abortions and on family planning activities abroad. Many of these provisions, often referred to by the name of the lawmakers that introduced them, have been included in foreign aid authorizations, appropriations, or both, and affect different types of foreign assistance. Examples include
• the “Helms amendment,” which prohibits the use of U.S. funds to perform abortions or to coerce individuals to practice abortions;
• the “Biden amendment,” which states that U.S. funds may not be used for biomedical research related to abortion or involuntary sterilization;
• the “Siljander amendment,” which prohibits U.S. funds from being used to lobby for or against abortion;
• the “Kemp-Kasten amendment,” which prohibits funding for any organization or program that, as determined by the President, supports or participates in the management of a program of coercive abortion or involuntary sterilization; and
• the “Tiahrt amendment,” which places requirements on voluntary family planning projects receiving assistance from USAID.
The executive branch has also engaged in the debate over international abortion and family planning. In 1984, President Ronald Reagan issued what has become known as the “Mexico City policy,” which required foreign non-governmental organizations receiving USAID family planning assistance to certify that they would not perform or actively promote abortion as a method of family planning, even if such activities were conducted with non-U.S. funds. The policy was rescinded by President Bill Clinton and reinstituted by President George W. Bush. It was rescinded by President Barack Obama in January 2009 and remains a controversial issue in U.S. foreign assistance.
This report focuses primarily on legislative restrictions and executive branch policies related to international abortion and family planning.
For information on domestic abortion laws and international population assistance, including funding levels and U.S. programs, see
• CRS Report RL33467, Abortion: Judicial History and Legislative Response, by Jon O. Shimabukuro, and
• CRS Report RL33250, International Family Planning Programs: Issues for Congress, by Luisa Blanchfield.
Effects of Developmental Bisphenol A Exposure on Reproductive-Related Behaviors in California Mice (Peromyscus californicus): A Monogamous Animal Model
Source: PLoS ONE
Bisphenol A (BPA), a pervasive, endocrine disrupting compound (EDC), acts as a mixed agonist- antagonist with respect to estrogens and other steroid hormones. We hypothesized that sexually selected traits would be particularly sensitive to EDC. Consistent with this concept, developmental exposure of males from the polygynous deer mouse, Peromyscus maniculatus, to BPA resulted in compromised spatial navigational ability and exploratory behaviors, while there was little effect on females. Here, we have examined a related, monogamous species, the California mouse (Peromyscus californicus), where we predicted that males would be less sensitive to BPA in terms of navigational and exploratory behaviors, while displaying other traits related to interactions with females and territorial marking that might be vulnerable to disruption. As in the deer mouse experiments, females were fed either a phytoestrogen-free CTL diet through pregnancy and lactation or the same diet supplemented with BPA (50 mg/kg feed weight) or ethinyl estradiol (EE) (0.1 part per billion) to provide a “pure” estrogen control. After weaning, pups were maintained on CTL diet until they had reached sexual maturity, at which time behaviors were evaluated. In addition, territorial marking was assessed in BPA-exposed males housed alone and when a control male was visible in the testing arena. In contrast to deer mice, BPA and EE exposure had no effect on spatial navigational skills in either male or female California mice. While CTL females exhibited greater exploratory behavior than CTL males, BPA exposure abolished this sex difference. BPA-exposed males, however, engaged in less territorial marking when CTL males were present. These studies demonstrate that developmental BPA exposure can disrupt adult behaviors in a sex- and species-dependent manner and are consistent with the hypothesis that sexually selected traits are particularly vulnerable to endocrine disruption and should be a consideration in risk assessment studies.
Source: American Congress of Gynecologists and Obstetricians
Reproductive and sexual coercion involves behavior intended to maintain power and control in a relationship related to reproductive health by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent. This behavior includes explicit attempts to impregnate a partner against her will, control outcomes of a pregnancy, coerce a partner to have unprotected sex, and interfere with contraceptive methods. Obstetrician–gynecologists are in a unique position to address reproductive and sexual coercion and provide screening and clinical interventions to improve health outcomes. Because of the known link between reproductive health and violence, health care providers should screen women and adolescent girls for intimate partner violence and reproductive and sexual coercion at periodic intervals such as annual examinations, new patient visits, and during obstetric care (at the first prenatal visit, at least once per trimester, and at the postpartum checkup). Interventions include education on the effect of reproductive and sexual coercion and intimate partner violence on patients’ health and choices, counseling on harm-reduction strategies, and prevention of unintended pregnancies by offering long-acting methods of contraception that are less detectable to partners.
Arrests of and Forced Interventions on Pregnant Women in the United States, 1973-2005: Implications for Women’s Legal Status and Public Health
Source: Journal of Health Politics, Policy and Law
In November 2011, the citizens of Mississippi voted down Proposition 26, a “personhood” measure that sought to establish separate constitutional rights for fertilized eggs, embryos, and fetuses. This proposition raised the question of whether such measures could be used as the basis for depriving pregnant women of their liberty through arrests or forced medical interventions. Over the past four decades, descriptions of selected subsets of arrests and forced interventions on pregnant women have been published. Such cases, however, have never been systematically identified and documented, nor has the basis for their deprivations of liberty been comprehensively examined. In this article we report on 413 cases from 1973 to 2005 in which a woman’s pregnancy was a necessary factor leading to attempted and actual deprivations of a woman’s physical liberty. First, we describe key characteristics of the women and the cases, including socioeconomic status and race. Second, we investigate the legal claims made to justify the arrests, detentions, and forced interventions. Third, we explore the role played by health care providers. We conclude by discussing the implications of our findings and the likely impact of personhood measures on pregnant women’s liberty and on maternal, fetal, and child health.
Source: PLoS ONE
We report the prevalence of penile implants among prisoners and determine the independent predictors for having penile implants. Questions on penile implants were included in the Sexual Health and Attitudes of Australian Prisoners (SHAAP) survey following concerns raised by prison health staff that increasing numbers of prisoners reported having penile implants while in prison.
Computer-Assisted Telephone Interviewing (CATI) of a random sample of prisoners was carried out in 41 prisons in New South Wales and Queensland (Australia). Men were asked, “Have you ever inserted or implanted an object under the skin of your penis?” If they responded Yes: “Have you ever done so while you were in prison?” Univariate logistic regression and logistic regression were used to determine the factors associated with penile implants.
A total of 2,018 male prisoners were surveyed, aged between 18 and 65 years, and 118 (5.8%) reported that they had inserted or implanted an object under the skin of their penis. Of these men, 87 (73%) had this done while they were in prison. In the multivariate analysis, a younger age, birth in an Asian country, and prior incarceration were all significantly associated with penile implants (p<0.001). Men with penile implants were also more likely to report being paid for sex (p<0.001), to have had body piercings (p<0.001) or tattoos in prison (p<0.001), and to have taken non-prescription drugs while in prison (p<0.05).
Penile implants appear to be fairly common among prisoners and are associated with risky sexual and drug use practices. As most of these penile implants are inserted in prison, these men are at risk of blood borne viruses and wound infection. Harm reduction and infection control strategies need to be developed to address this potential risk.
Cervical Cancer Screening Among Women by Hysterectomy Status and Among Women Aged ≥65 Years — United States, 2000–2010
Cervical Cancer Screening Among Women by Hysterectomy Status and Among Women Aged ≥65 Years — United States, 2000–2010
Source: Morbidity and Mortality Weekly Report
Since 2003, major U.S. organizations consistently have recommended against screening most women for cervical cancer after a total hysterectomy for benign disease. Starting in 2003 and becoming consistent across organizations in 2012, guidelines also state that women with a history of adequate screening no longer should be screened after age 65 years. Reports have shown that many of those women continue to receive Papanicolaou (Pap) testing, contrary to recommendations. To measure recent screening behaviors and trends in accordance with evidence-based recommendations, biennial cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) on women aged ≥30 years were analyzed and stratified by hysterectomy status and by age (30–64 years and ≥65 years). The proportion of women reporting having had a hysterectomy who reported a recent (within 3 years) Pap test declined from 73.3% in 2000 to 58.7% in 2010. Declines among women having had a hysterectomy were significant among those aged 30–64 years, from 81.0% in 2000 to 68.5% in 2010, and among those aged ≥65 years, from 62.0% to 45.0%. Among women aged ≥65 years with no history of hysterectomy, recent Pap testing also declined significantly, from 73.5% to 64.5%. Although recommendations have resulted in reductions in screening posthysterectomy and of those aged ≥65 years, many women still are being screened who will not benefit from it.
Cervical Cancer Screening Among Women Aged 18–30 Years — United States, 2000–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Screening women for cervical cancer can save lives. However, among young women, cervical cancer is relatively rare (1,2), and too-frequent screening can lead to high costs and adverse events associated with overtreatment (3). Before 2012, cervical cancer screening guidelines of the American College of Obstetricians and Gynecologists (ACOG), American Cancer Society (ACS), and U.S. Preventive Services Task Force (USPSTF) differed on age to start and how often to get screened for cervical cancer. (4). In 2012, however, all three organizations recommended that 1) screening by Papanicolau (Pap) test should not be used for women aged <21 years, regardless of initiation of sexual activity, and 2) a screening interval of 3 years should be maintained for women aged 21–30 years. ACS and ACOG explicitly recommend against yearly screening (5–7). To assess trends in Pap testing before the new guidelines were introduced, CDC analyzed 2000–2010 data from the Behavioral Risk Factor Surveillance System (BRFSS) for women aged 18–30 years. CDC found that, among women aged 18–21 years, the percentage reporting never having been screened increased from 26.3% in 2000 to 47.5% in 2010, and the proportion reporting having had a Pap test in the past 12 months decreased from 65.0% to 41.5%. Among those aged 22–30 years, the proportion reporting having had a Pap test within the preceding 12 months decreased from 78.1% to 67.0%. These findings showed that Pap testing practices for young women have been moving toward the latest guidelines. However, the data also showed a concerning trend: among women aged 22–30 years, who should be screened every 3 years, the proportion who reported never having had a Pap test increased from 6.6% to 9.0%. More effort is needed to promote acceptance of the latest evidence-based recommendations so that all women receive the maximal benefits of cervical cancer screening.
2012 Saw Second-Highest Number of Abortion Restrictions Ever
Source: Guttmacher Institute
Reproductive health and rights were once again the subject of extensive debate in state capitols in 2012. Over the course of the year, 42 states and the District of Columbia enacted 122 provisions related to reproductive health and rights. One-third of these new provisions, 43 in 19 states, sought to restrict access to abortion services. Although this is a sharp decrease from the record-breaking 92 abortion restrictions enacted in 2011, it is the second highest number of new abortion restrictions passed in a year.