Meals, Snacks, and Obamacare

Hello everyone. I know, I've been a very irregular blogger of late. In the 5 years since I started this blog, a lifetime in internet time, blogging has become old school. It's too long-form. Facebook, Twitter, Tumblr, Pinterest - they're what's happening. The fewer words, the better. The blog still has its readers, of course. But the FB page is where the action is. Do I think this march toward brevity heralds the decline of literacy and civilization itself? Why yes, I do. Am I guilty of it as well? Absolutely. I post on FB far more often than I post here. Usually just a link with a sentence or two. Blogs are meals. And most people are snackers.

Get your Facebook snack on.

Meanwhile, for you gourmands, here's something more substantial:

The Affordable Health Care Act (aka "Obamacare") is slowly coming to fruition, with many benefits already in effect and others not yet realized. It's a very detailed Act and few people go beyond the sound bites to actually learn what's in it. Today, August 1, 2012, a raft of benefits for women and children came into effect. Two organizations have been doing a good job of getting the word out about specific benefits for women. 

-We Are Ultraviolet has created a lovely graphic (below) which hits the highlights. It's too large to read properly in this space, so click on this link to see the whole thing. Or, you can view it (and share it) on Facebook. Sigh.

-And the wonderful folks over at the National Women's Health Network have created a 

site (actually, a blog!) which has been providing detailed coverage with analysis called Countdown to Coverage, with one post per day in the week leading up to today's rollout. Their name for the Affordable Care Act is Mamacare :)

Do the new regulations provide for free Fertility Awareness instruction? No. The Act only provides  free contraception in the case of FDA approved devices. Now, if you're among the fraction of people who receive FA or NFP education in a medical setting, your healthcare provider can code your visit in such a way that it's covered. That's been the case for years. And as more women gain health insurance through the Affordable Care Act, more women will be able to take advantage of that coverage. But the majority of women who practice Fertility Awareness to avoid pregnancy will continue to gain their instruction privately. (Or, frighteningly, practice without benefit of instruction.) 

The Affordable Care Act will thus probably not result in much greater numbers of women practicing Fertility Awareness. But with mandatory coverage and the elimination of co-pays for things like Pap smears, gestational diabetes screening, breastfeeding equipment and lactation support, and screening for domestic violence as well as counseling, the Affordable Care Act reaches far beyond "free birth control," and will result in vast health benefits for women and their children, especially those who currently face financial barriers to service. And that's something we should all be able to get behind.

 

Couple of Item re Herpes

Herpes has been in the news recently, as a new CDC study was published in March that caused a bit of a media stir. Two main findings emerged from this study:

-One is that approximately 1 in 6 Americans is "infected" with HSV2. "Infection" simply means that someone has been exposed to the virus. Many people with antibodies to either herpes virus (HSV1 or HSV2) do not have outbreaks and don't know that they are infected, although they can still transmit the virus to others.

-The second finding is that there is a major discrepancy in prevalence when one looks at gender and race. Women are twice as likely to be infected as men, and black women are three times as likely to be infected as white women.

As is so often the case, I wonder where the other races are in these findings.

Other things to note:
-This CDC study did not address HSV1 at all. HSV1 is the type of herpes that prefers to reside in the area of the mouth. It causes what we call cold sores. It is also very happy taking up residence around the genital area, although outbreaks in that area tend to be less severe, less frequent, and the virus is less likely to be shed from that area.
-These findings are largely the same as those from the last such study, from approximately 5 years ago.

Here is the original press release from the CDC:
CDC Study Re Herpes (HSV2)

The discrepancy in prevalence based on race was of course the part that caused some controversy, especially in the African-American press. Here is a piece in The Root which questions the statistical sampling, as well as the meaning of the findings:
Reply in the Root to CDC Study

In related news, the New York Times "Consults" blog has been running a series about herpes in recent months. Here is a link to the post about transmission, with links to related posts below the main piece:
"Giving Your Partner Herpes" in the NY Times

And here is the NY Times main guide to herpes:
Times Guide to Herpes

Herpes is as prevalent as it is because (a) it's a quiet virus - many carriers don't know they have it and (b) people don't know much about it, or how it's spread. Much of the ignorance is due to the stigma that is attached to herpes. This is stupid. With up to half of some American populations, and approximately 16% of the general population, infected with HSV2, it's beyond time to grow up and treat this virus as we do any other virus. The more you know about herpes, the better your chance of avoiding it, or of giving it to someone else.

US Has Waaaaaay Too Many Caesarian Births

One in three births in the US is currently a caesarian section (C-section).   The World Health Organization suggests that the normal percentage of C-sections should be about half what we currently have, i.e. about 15%. (I should note that other countries have even higher rates. In Puerto Rico and China, nearly 50% of all births are by caesarian.) Here is an article from the New York Times about the US C-section rate and its implications:
US C-Section Rate Hits All Time High

Some C-sections are for primary deliveries (first birth), while others are C-sections following an earlier C-section. Fewer than 10% of women who have had a C-section in the US will go on to have a subsequent vaginal birth, or VBAC. VBAC, is considered risky, but so is a caesarian. The National Institute of Health recently held a conference devoted specifically to VBAC. You can read about the NIH conference here (with links to lots of data, reports, etc):
NIH VBAC Conference

The issues of primary caesarian and VBAC are separate, but of course related. They reflect an overall state of extremely poor maternal health care in the US. Amnesty International recently released a report with some shocking statistics about birth in the US:

"The USA spends more than any other country on health care, and more on maternal health than any other type of hospital care. Despite this, women in the USA have a higher risk of dying of pregnancy-related complications than those in 40 other countries. For example, the likelihood of a woman dying in childbirth in the USA is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain. African-American women are nearly four times more likely to die of pregnancy-related complications than white women. These rates and disparities have not improved in more than 20 years."

Here is a link to Amnesty International's report, along with suggestions for action you can take:
Amnesty Campaign for Maternal Health


Interestingly, although Native Americans generally lag behind other Americans in nearly every aspect of prosperity and health care, in terms of labor and delivery, their very lack of access to what is considered state-of-the-art medical care may be working in their favor. A recent NY Times article looked at births in Tuba City, Arizona, where most patients are Native Americans, and most births are attended by midwives. A number of factors contribute to the low C-section rate here (about 13.5%) and the high VBAC rate (about 32%). One is just patience; vaginal births take a lot longer, on average, than C-sections. Midwives don't mind waiting. Another is compensation: "Doctors and midwives here earn salaries and are not paid by the procedure, so they have no financial incentive to perform surgery." Native American cultural traditions also play a part. Make sure to check out the beautiful narrated slide show that accompanies this article:
Lessons at Tuba City Hospital, Run by Navajos, About Births

Black Women Breastfeeding: A Multi-Generational Story

As in most measures of American healthcare, black women lag behind white women in breastfeeding. The reasons are of course complex, but are rooted in socio-economic disparity, lack of education, and lack of equal access to healthcare. This video explores the issue of breastfeeding in several generations of an African-American family (ok so it's a celebrity family - Carol Jenkins was a long-time TV news anchor and correspondent and her daughter is a writer). The video isn't edited particularly tightly and has the feel of a home movie, but perhaps it will inspire other women to have a conversation with their mothers, or daughters. And dig that chubby little baby!