womens health

Pfizer Inc announced new, longerterm data from the Intergroup Exemestane Study (IES) showing that women who switched to AROMASIN® (exemestane tablets) after taking tamoxifen for two to three years experienced a significant reduction (18%) in the risk of diseasefree survival (DFS) events (HR=0.82; 95% CI 0.730.92; P=0.0009), compared to women who continued on tamoxifen for a full five years of treatment.1 In addition, IES showed that AROMASIN prolonged overall survival (OS) in the ER+/unknown population with a 14% reduction in the risk of dying (HR=0.86; 95% CI 0.750.99; P=0.04).1 These results demonstrate that the benefits of treatment are maintained in long term followup. These results were presented at the joint ECCO 15/ESMO 34 meeting in Berlin, Germany.1

“These new, longterm followup data of the IES demonstrate a significant survival benefit for patients who switched to AROMASIN compared to those who stayed on tamoxifen,” said Charles Coombes, head of the oncology department at Imperial College, London, UK and principal investigator of the IES. “These findings are important to patients and physicians alike as they reaffirm their confidence in switching to AROMASIN after two to three years of tamoxifen.”

IES is a landmark trial with the longest followup of endocrine treatment in the adjuvant switch setting. It is a randomized, doubleblind, multinational trial of postmenopausal women with early breast cancer.2 IES evaluates the clinical benefits of switching 2,352 patients to AROMASIN after two to three years of tamoxifen versus continuing 2,372 patients on tamoxifen for a full five years of therapy. The primary endpoint of the study was DFS in the intenttotreat (ITT)i population. Within the IES, 97% of the study population was oestrogenreceptor positive/unknown.1

In postmenopausal women with early breast cancer at a median followup of 91 months, switching to AROMASIN after two to three years of tamoxifen, for a total of five years of treatment, was shown to result in a

16% reduction in the risk of DFS events, defined as local or distant recurrence of breast cancer, contralateral breast cancer, or death from any cause, compared to staying on tamoxifen for five years (HR=0.84; 95% CI 0.750.94; P=0.002) in the ITTi population.1

For the secondary endpoint of overall survival in the ITT population, there was an 11% relative risk reduction of death. There was a statistically significant 14% reduction in the risk of death noted in the ER+/unknownii population (HR=0.86 95% CI 0.750.99 P=0.04).1

These DFS and OS data are consistent with the previous IES update at 55.7 months. Additionally, AROMASINs safety profile at 91 months was similar to that shown previously. An analysis of events of interest including cardiovascular and musculoskeletal showed no new serious adverse events in comparison to the previous analysis.1

“AROMASIN has proven to be an effective treatment for postmenopausal women with oestrogenreceptor positive early breast cancer after 23 years of tamoxifen treatment,” said Mace Rothenberg, MD, senior vice president, clinical development and medical affairs, Pfizer Oncology. “The extraordinarily longterm follow up of patients enrolled in this study adds to the body of data supporting AROMASINs benefits and further underscores Pfizers commitment to oncology.”

About AROMASIN® (exemestane tablets)3

In Europe, AROMASIN is indicated for the adjuvant treatment of postmenopausal women with oestrogen receptor positive invasive early breast cancer, following two to three years of initial adjuvant tamoxifen therapy. AROMASIN is indicated for the treatment of advanced breast cancer in women with natural or induced postmenopausal status whose disease has progressed following antioestrogen therapy. Efficacy has not been demonstrated in patients with oestrogen receptor negative status.

In the United States, AROMASIN is indicated for the adjuvant treatment of postmenopausal women with oestrogenreceptor positive early breast cancer who have received two to three years of tamoxifen and are switched to AROMASIN for completion of a total of five consecutive years of adjuvant hormonal therapy. AROMASIN is also indicated for the treatment of advanced breast cancer in postmenopausal women whose disease has progressed following tamoxifen therapy.

Important AROMASIN® (exemestane tablets) Safety Information3

AROMASIN should not be used in women who are premenopausal, are nursing or pregnant, have a known hypersensitivity to the drug, or are taking oestrogencontaining agents. Dose modification is recommended for patients who are receiving certain medications, including strong CYP 3A4 inducers such as rifampicin and phenytoin. In patients with early breast cancer, elevations in bilirubin, alkaline phosphatase, and creatinine were more common in those receiving AROMASIN than either tamoxifen or placebo. Reductions in bone mineral density over time are seen with the use of AROMASIN.

About Pfizer Oncology

Pfizer Oncology is committed to the discovery, investigation and development of innovative treatment options for cancer patients worldwide. Our robust pipeline consists of 21 biologics and small molecules in clinical development. Pfizer Oncology has over 200 clinical trials including robust Phase 3 clinical trial programs in renal cell carcinoma, prostate cancer, nonsmall cell lung cancer, metastatic breast cancer, and hepatocellular carcinoma.

By working collaboratively with academic institutions, researchers, governments, and licensing partners, Pfizer Oncology strives to transform treatment by targeting the right drug for the right patient at the right time.

For more information please visit Pfizer.com.

1. Coombes RC, et al. Survival and safety post study treatment completion an updated analysis of the Intergroup Exemestane Study (IES). Results presented at ECCO/ESMO September 22, 2009. Abstract 5.010.

2. Coombes, RC, et al. Survival and safety of exemestane versus tamoxifen after 23 years tamoxifen treatment (Intergroup Exemestane Study) a randomized controlled trial. The Lancet. 2007 369 55970

3. Data on File.

i ITT Intenttotreat population is generally interpreted as including all patients in a study population, regardless of whether they actually satisfied the entry criteria, the treatment actually received, and subsequent withdrawal or deviation from the protocol.

A minimally invasive technique to remove fibroids from womens wombs is being pioneered at a Bristol hospital.

Surgical removal of fibroids, when it is required is commonly carried out through an operation called myomectomy which can involve a large, abdominal cut which can take days for the patient to recover from.

But Valentine Akande, Consultant Surgeon at Spire Bristol Hospital, The Glen, can perform the same procedure but by using minimally invasive keyhole surgical techniques.

“Fibroids are quite common growths found in womens reproductive organs,” he explained. “Although they are noncancerous they can grow quite large, sometimes to the size of a melon, and in extreme cases can cause heavy bleeding, miscarriages and even infertility.”

Mr Akande has been carrying out myomectomies for several years and, as an advanced laparoscopic surgeon, is able to combine the procedures and offer a minimallyinvasive operation.

He said “Women who want to preserve their fertility are advised to have the fibroids removed through myomectomy, but they can be discouraged when they learn the operation is generally carried out by making a large incision through their abdomen.

“Now it is possible to perform the same surgery for suitable patients through laparoscopic techniques, better known as keyhole surgery, using very small incisions to the abdomen, offering quicker recovery times, with most patients going home a day after the surgery, as opposed to several days after the larger open incision.”

It is estimated that between 50 per cent of women will develop fibroids by the age of 50 but only a fifth will experience symptoms and for many, treatment may not be required. For those women who do have surgery it is also estimated that following myomectomy, the chances of pregnancy could be significantly improved.

Mr Akande added “The main message is that women diagnosed with fibroids should not worry too much because it is quite a common condition and, thankfully, is treatable.

“However, no one likes the thought of having a large slice in their stomach, so this minimally invasive technique will, Im sure, come as a welcome to relief to the many women diagnosed with the condition.”

References

Akande VA, Jenkins JM. Surgical versus medical treatment of fibroids. Advances in Obstetrics and Gynaecology (2000) 18, 714.

Pritts EA, Parker WH , Olive DL. Fibroids and infertility an updated systematic review of the evidence. Fertil Steril. 2009 Apr;91(4)121523.

Milestones such as marriage and motherhood or retirement and widowhood can affect the amount of exercise women get, according to a large new study from Australia.

Not surprisingly, decreases in physical activity were associated with marriage and childbirth in young women and declining health in older women. However, the study also found that women who retired or who became widows tended to increase their physical activity level.

Altogether, more than 40,000 women responded to the Australian Longitudinal Study on Womens Health, with participants answering survey items on two occasions three years apart. The researchers looked at three life phases young womanhood, middle age and older age.

About a third of the younger (ages 18 to 23) and middleaged (45 to 50) women and a quarter of the older women (70 to 75) were active at both survey times.

“By recognizing the life events that are associated with decreases in activity, women could be alerted to the risk,” said lead author Wendy Brown, Ph.D., a professor at the University of Queensland. “For example, if you are an older woman with heart disease or diabetes, it is vitally important to stay active, as physical activity can help to manage these conditions.”

The study appears in the latest issue of the Annals of Behavioral Medicine.

For younger women, fitting exercise into expanding family obligations can seem overwhelming.

“Situations like marriage and children change the amount of expendable time during the day,” said Amy Eyler, Ph.D., a professor of community health at St. Louis University. “It may vary culturally, but having children almost always decreases the feeling of selfpriority for women.”

“Being widowed was associated with increasing physical activity in the midage women,” Brown said. “This may reflect the fact that women use physical activity to cope with this event or perhaps that they have more time to be active. However, young women who experienced harassment at work tended to increase their physical activity; it may be it was used as a way of coping with the stress of such events.”

Compared to the Australian study, in which less than 30 percent of women were active, physical activity rates are higher in the United States. “Overall 46.7 percent of women reported regular levels of activity to the Behavioral Risk Factor Surveillance System,” a large U.S. survey, Eyler said. “Figuring out ways to maintain regular physical activity throughout the lifecycle is important. Even a walk around the block with a good friend can do wonders for both mental and physical health.”

The family planning industry in Massachusetts is flourishing during the economic recession, according to state medical experts, the Boston Herald reports. Planned Parenthood has reported a 77% increase in the state for procedures to insert intrauterine devices, and physicians are seeing higher numbers of vasectomy procedures. In addition, condom sales are increasing.

A recent Gallup survey conducted for the American College of Obstetricians and Gynecologists found that 17% of married women said the economy has affected their plans to have children, and 33% of women who are in a relationship but not married said they are now more concerned with unintended pregnancies compared with the previous year.

Jesse Mermell, vice president of external affairs for the Planned Parenthood League of Massachusetts, said that NuvaRing and longterm IUD use has increased by 77% in the past year. Mermell said, “The universal reaction to that spike has been wow.”

According to Nelson Bennett, director of male sexual medicine at the Lahey Clinic, there was a 30% increase in vasectomies in the first quarter of 2009 compared with the same period in 2008. Emanuel Friedman of MetroWest Urology who has performed about 1,500 vasectomies said, “People who wanted four children might now stop at two,” adding, “Last year I was doing four to six surgeries weekly, now Im doing six to 10.”

Davin Wedel, president of Glob Protection, a Bostonbased condom manufacturer, said that condom sales “are up, even in retail, which is rare.” His company has seen a 35% increase in online traffic from its flagship brands Web site. He added that the increase is not only because of couples being more careful. “People are out of work, and sex is a cheap form of entertainment,” he said.

According to the Herald, area hospitals have not yet seen a steep drop in the number of newborns, but representatives say it is still too early to forecast how the economy will affect birthrates. August marks the ninth month since the start of the recession (Jordan, Boston Herald, 8/2).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

The New York Times profiles Pashtoon Azfar, the director of Afghanistans Institute of Health Sciences, who works for a nonprofit group from Johns Hopkins University that focuses on women and childrens health, and “also manages to serve as president of the Afghan Midwives Association.” Azfar was the “star” of a recent Capitol Hill briefing about maternal health in Afghanistan.

Despite Afghanistan having “the worlds secondhighest death rate in women during pregnancy and childbirth,” at the briefing Azfar “ran through statistics showing notable increases recently in the countrys number of midwives, their education and the percentage of women who give birth with the help of a skilled attendant, usually a midwife. The U.S., the World Bank, the European Commission, UNICEF, the Hopkins group (known as Jhpiego) and other donors have all helped Afghanistans Ministry of Public Health to make improvements,” according to the New York Times.

Although there has been some progress, “there is a long way to go,” the New York Times writes, noting that up to 80 percent of women in Afghanistan “still give birth without skilled help, and only a third receive any medical care at all during pregnancy.” The countrys problems “mirror those of many other poor countries,” while “deeper problems are cultural, rooted in the low status of women and the misperception that deaths in childbirth are inevitable,” according to the newspaper.

After leaving Afghanistan for more than a decade, Afzar said when she returned in 2003, the state of midwifery was a mess. “A culture of war was going on,” Azfar said, adding, “If a mother came for delivery they didnt treat her as she deserved or needed to be treated. There was no emotional support.” She “acknowledged that it was hard to change attitudes, but she insisted that it could be done, by making interpersonal skills part of the training and the tests that students must pass to be allowed to practice,” writes the New York Times. The article includes more detail about Azfars life and early training (Grady, 7/27).

This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery at globalhealth.kff.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

Four newspapers recently published editorials responding to last weeks confirmation hearings for Supreme Court nominee Sonia Sotomayor. Summaries appear below.

~ Boston Globe Sotomayor “far surpassed” the “meager standard” of “just [having] to avoid saying anything damaging,” according to a Globe editorial. During the hearings, she “made it clear she believes that Supreme Court justices base their decisions on the Constitution, the law and the relevant precedents,” and her “judicial record offers no reason to think otherwise,” the editorial states. It continues that “the hearings did nothing to undermine and much to underscore the notion that Sotomayor has the right temperament, intellect and credentials for the Supreme Court. She should be confirmed” (Boston Globe, 7/20).

~ New York Times The Senate “has learned more than enough about [Sotomayors] qualifications to give her a seat on the court,” according to a Times editorial. However, “[i]t would also be good if senators and the nation had a deeper sense of her views on some of the most pressing legal questions of our times,” the editorial continues. It adds, “We were disappointed that at her confirmation hearings last week, she continued what is becoming an unbreakable habit of nominees dodging controversy.” For example, “[w]e would have liked to hear her boldly defend the idea of the Constitution as a living document, one that changes with the times,” and “we would have preferred if she had used the hearings to explain to the public that the muchmentioned distinction between judges making and applying the law has little meaning,” the editorial states. Sotomayor “avoided saying much of substance about abortion rights, the scope of presidential power, and other hotbutton issues,” although this is “not entirely her fault,” as the “Senate has shown repeatedly that it will tolerate this sort of evasion.” However, “the public has a right to know where judicial nominees stand on important legal issues that will have a direct impact on their lives,” the editorial states. It concludes, “We hope the Senate confirms her without delay so we can see more clearly what her contribution will be” (New York Times, 7/21).

~ Washington Post During her confirmation hearings, Sotomayor “proved herself wellqualified and worthy of confirmation,” according to a Post editorial. The editorial continues, “She spoke convincingly about her belief in and record of consistently respecting legislative prerogatives an approach that signals a modest style of judging.” Although the hearings focused on Sotomayor defending her previous speeches and comments, her “attempts to explain away and distance herself” from the statement that a wise Latina might make a better decision than a white man “were unconvincing and at times uncomfortably close to disingenuous, especially when she argued that her reason for raising questions about gender or race was to warn against injecting personal biases into the judicial process.” The editorial adds, “Her repeated and lengthy speeches on the matter do not support that interpretation.” According to the Post, “Its too bad that she felt she had to disavow her true intent, because, though a wise Latina wont necessarily judge better than a white man would, diversity on the bench is indeed important” (Washington Post, 7/19).

~ Washington Times During the hearings, Republican senators “failed to ask questions of great relevance to public understanding of the judges record and integrity,” a Times editorial states. The editorial continues, “They owe it to all Americans to get tough enough to force an examination of whether the judge may have perjured herself during her testimony.” According to the editorial, “The questions for which Judge Sotomayors answers are almost impossible to believe involved legal briefs on abortion cases that were filed by the Puerto Rican Legal Defense and Education Fund during the 12 years Judge Sotomayor sat on its board.” Republican senators also “failed to ask sharp followup questions on other important points too numerous to mention,” according to the editorial. It continues, “The public deserves full answers and a full and open debate,” adding, “Senate Republicans ought to demand enough time to review the judges answers to written questions they submitted to her on Friday.” Senate Republicans also “should use their automatic hold in the committee to put off a committee approval vote for at least a week” and “should demand and use every last hour of available debate time on the full Senate floor both before and after the majority files for cloture,” according to the editorial (Washington Times, 7/20).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

New results show that postmenopausal women with breast cancer receiving adjuvant letrozole have better cognitive function than women being treated with tamoxifen. The data, from a recent meeting of the American Society of Clinical Oncology (ASCO), are drawn from a substudy of the Breast International Group (BIG) 198 trial.

The trial, which enrolled postmenopausal women surgically treated for earlystage, hormoneresponsive breast cancer, found that letrozole was more effective at preventing recurrent disease (especially distant metastases) than tamoxifen.

Karen E. Ribi, PhD, with the International Breast Cancer Study Group in Bern, Switzerland, and her colleagues had theorized that because of the estrogen deprivation associated with aromatase inhibitors, patients who have received letrozole will have worse cognitive function than tamoxifentreated patients.

“While cognitive function is recognized as a potential longterm side effect of adjuvant chemotherapy for breast cancer treatment, few studies have looked at the effect of adjuvant endocrine therapy on cognition,” Dr. Ribi noted in her presentation. “Whats more, those studies that have examined the effect of adjuvant endocrine therapy on cognition have produced conflicting results.”

The primary endpoint of the substudy was the composite score calculated from seven cognitive tasks. These included detection, identification, learning, memory, monitoring, shopping list, and shopping list delayed recall.

The analysis included 120 women enrolled in an institution with at least ten patients recruited to the parent protocol. All women had been in the trial for fewer than five years and were still taking their assigned endocrine treatment. None had developed recurrent breast cancer or a second malignancy.

Results showed that that while both groups had scores below agestandardized standardized norms of the CogState tasks, patients taking letrozole during the last three of five years of treatment had better cognitive function than those taking tamoxifen.

Dr. Ribi cautioned that potential study limitations include the lack of a true baseline assessment prior to the start of endocrine therapy and the lack of a longitudinal design to evaluate changes during treatment. Also, the substudys low accrual resulted in a revised analysis plan.

Finally, she said that future trials will evaluate the change in cognitive function from five years on endocrine treatment to one year after the completion of treatment. Plans are also underway to examine the impact of endocrine treatment on cognitive function in premenopausal women from baseline to one year on treatment.

Written by Jill Stein
Jill Stein is a Parisbased freelance medical writer.

Overthecounter remedies for menopause symptoms are growing in popularity among some women who fear potential risks from prescription hormone replacement therapy, the New York Times reports. According to the Times, the market for alternative therapies such as natural supplements and topical creams jumped in 2002 after initial results from the Womens Health Initiative suggested that HRT could increase risk for heart disease, cancer, stroke and blood clots.

Gynecologists estimate that about onethird of menopausal women are treated with conventional prescription hormones, and about onethird are treated with bioidentical hormones plantderived synthetic hormones that mimic the molecular structure of human hormones. The remaining onethird either do not seek therapy for symptoms, are not bothered by symptoms or use overthecounter therapies. There are more than 500 overthecounter products available that claim to alleviate menopause symptoms, the Times reports. The treatments include such products as teas, lowdose progesterone creams, black cohosh capsules and phytoestrogens derived from soy and red clover, according to the Times. According to Nutrition Business Journal, the U.S. dietary supplement market associated with menopause increased from $211 million in 1999 to $337 million in 2007.

Some studies have raised doubts about the safety and effectiveness of the overthecounter remedies. Todd Cooperman director of consumerLab.com, a private nutrition producttesting lab said that his companys study of more than one dozen products found that five failed to gain the labs approval because of problems such as inaccurate labeling or tainted ingredients. The Center for Botanical Dietary Supplements Research this fall is expected to release the results of a study, sponsored by the National Institutes of Health, that aims to determine the efficacy of the ingredients associated with menopause symptom relief. Some studies have questioned the efficacy of progesterone creams, which some experts contend can gather in fat cells and disrupt the production and synthesis of other hormones. Other experts maintain that the products are safe if properly used. Theresa Ramsey, director of the Center for Natural Healing in Arizona, said, “I think over all these products are generally safe, but must be taken in the right circumstances and in conjunction with a mindfully healthy approach to life if they are going to be effective at all” (Sweeney, New York Times, 7/2).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

The following summarizes selected womens healthrelated blog entries.

~ “Just Released Gains and Losses for Women in 200809 Supreme Court Decisions,” National Womens Law Centers “Womenstake” The Supreme Courts 20082009 term, which concluded Monday, included “several crucial decisions that demonstrate the impact of the court on womens lives,” according to the blog post, which summarizes a new analysis from NWLC on the cases. For example, the blog post says that the rulings in Fitzgerald v. Barnstable School Committee and Crawford v. Metropolitan Government of Nashville and Davidson County, Tenn., increased employees protections against discrimination in the workplace. However, the rulings in Ricci v. DeStetano which overturned an appellate courts antidiscrimination ruling and AT&T Corp. v. Hulteen which “permitted AT&T to pay women lower pension benefits for the rest of their lives” were “not as positive,” the blog entry says. NWLC CoPresident Marcia Greenberger said that the Supreme Court “ignored the realities of the workplace and the intent of Congress and ruled against female workers” in AT&T v. Hulteen. Greenberger also said that such cases “underscore why every seat on the Supreme Court is of paramount importance to women,” adding that it is “absolutely critical” that Supreme Court nominees have “a strong commitment to upholding and enforcing womens basic legal rights and protections” (”Womenstake,” National Womens Law Center, 6/29).

~ “Waldman and Saletan Oh What a Fine Bromance!” Jodi Jacobson, RH Reality Check In a recent bloggingheads.tv chat on “common ground” in the abortionrights debate, Slate columnist Will Saletan and Beliefnet EditorinChief Steve Waldman “spent as much time as possible complimenting each others work” and “as little as possible on any real substance regarding reproductive health and choice issues,” Jacobson writes. It is “clear that the Obama administrations stated intention to create a common ground platform” on abortion rights has become “a full employment program for both Waldman and Saletan,” she writes. Jacobson continues, “So perhaps the most striking thing about the conversation was that, in the end, they both effectively concluded that the common ground enterprise was a just for show political strategy,” and that the “real strategies” necessary to reduce the need for abortion “are the very prevention programs least likely to be supported by the far right. (Revelation!).” She adds, “However, they came to this conclusion through the same fauxexpert uninformed arguments that characterize their columns.” During the “WillinterviewsSteve format,” Saletan “revealed once again that there is no core philosophy or framework underlying his evershifting positions on choice and abortion,” according to Jacobson. She adds that “Waldman, for his part, several times underscored what is clear from reading his work” that he “just throws things out there without considered thought” about what “might be good versus bad data, not understanding how to read evidence,” and “oblivious or uncaring about the effects his freeform moralistic misinformation and opinions might actually have on an already polarized debate.” According to Jacobson, “Public policies affecting sexual and reproductive health issues” should be “based first and foremost on public health and on promoting individual rights balanced by individual responsibilities,” but “as anyone living on Planet Earth knows, sex and reproduction have become the front in a war waged by ultraconservative religious and political forces for which Waldman serves as a paid flacky.” She continues, “In fact, Waldman himself stated during the program I have a corporate interest in injecting religion into every debate.” Jacobson states, “Reading and watching this duo is like buying the OK! magazine version of the culture wars at the grocery store; they put whatever sells on the front cover, no matter the truth or consequences.” She concludes, “The info and the standards just keep shifting to sell the blogs” (Jacobson, RH Reality Check, 6/28).

~ “As White House Readies Abortion Plan, Packaging Emerges as Major Issue,” Dan Gilgoff, U.S. News & World Reports “God & Country” As the White House prepares its “common ground” reproductive health proposals, “a major debate has emerged over how to package the plans two major components preventing unintended pregnancies and reducing the need for abortion,” Gilgoff writes. He continues, “Many abortionrights advocates and some Democrats who want to dial down the culture wars want the White House to package the two parts of the plan together, as a single piece of legislation”; however, “more conservative religious groups working with the White House Office of FaithBased and Neighborhood Partnerships say they would be forced to oppose such a plan even though they support the abortion reduction part because they oppose federal dollars for contraception and comprehensive sex education.” Gilgoff adds that although the Obama administration has declined to comment and supporters on both sides say that the White House “has offered no hint about how it will come down on the matter,” the administration is “expected to announce its plan on abortion and related issues this summer.” In the interim, “advocates on both sides are strenuously lobbying for the plan, arguing that it offers the only true hope for common ground on very thorny issues,” he continues. Gilgoff concludes, “For the White House, the decision about which track to take is largely a question of whom it feels more comfortable alienating religious groups like the Catholic bishops, which it has been trying hard to win over, or abortionrights groups, a key part of the Democratic base that it doesnt want to lose” (Gilgoff, “God & Country,” U.S. News & World Report, 6/29).

~ “Advocates Urge White House, Congress To Broaden Teen Pregnancy Prevention Initiative,” Jodi Jacobson, RH Reality Check “After years of funding abstinenceonlyuntil marriage programs, there is virtually unanimous agreement among researchers and advocates about doing far more to address teen sexuality, prevent unintended pregnancy and sexually transmitted infections, and prevent the violence and coercion by intimate partners among youth that contribute to these problems,” Jacobson writes. She discusses an article on RH Reality Check describing work by Elizabeth Miller of the University of CaliforniaDavis that “shows that intimate partner violence plays a critical but largely overlooked role in high rates of adverse sexual and reproductive health outcomes among teens.” Miller recommends that policymakers “stop siloing the issues that affect teen sexual health and relationships,” Jacobson writes. She continues that during the presidential campaign, President Obama “appeared to agree.” Therefore, it “comes as something of a surprise that a coalition of over 175 state and national organizations representing advocates, service providers and researchers concerned with comprehensive sex ed now finds itself pressing the White House and Congress to get rid of these silos and is pushing back against what they see as the limited scope of the Obama administrations new Teen Pregnancy Prevention Initiative.” Under Obamas fiscal year 2010 budget proposal, the initiative would replace Title V abstinenceonly funding and the CommunityBased Abstinence Education Program. Although advocates “applauded the elimination of abstinenceonly programs,” they “were deeply disappointed at the narrow scope of the new initiative, in part, they argued, because the programs eligible for funding would address only one outcome (unintended pregnancy), deny funding to programs addressing a wider range of outcomes, and ignore the needs of gay, lesbian and transgender youth, among other concerns,” Jacobson writes. Furthermore, these advocates argue, “vague direction given by the administration leaves the program vulnerable to changes in the balance of power in Congress,” according to Jacobson. She adds that there also is concern that some HIV and STI prevention programs, which already are underfunded, “will have greater constraints if they are not eligible for funding under the proposed teen initiative” (Jacobson, RH Reality Check, 6/29).

~ “Michigan Lawmakers Seeking To Reduce High Rates of Unintended Pregnancy, STDs,” Todd Heywood, RH Reality Check Michigan state Rep. Rebekah Warren (D) and state Sen. Gilda Jacobs (D) on June 23 introduced a “wideranging set of 15 bills” that cover sex education, dispensing of prescriptions and other issues related to womens health, Heywood writes. The lawmakers noted that one in four teens in Michigan have a sexually transmitted infection and that Michigan has an “unacceptable” rate of unplanned pregnancies. One bill (H.B. 2472) would mandate that crisis pregnancy centers provide medically accurate and objective information on options available to women, including abortion, and that they post notice when failing to hire licensed medical professionals or not providing information about abortion or birth control. Clients would be able to sue such centers for violating these rules. Another bill would mandate that schools, which currently are required to teach an abstinenceonly curriculum, would emphasize abstinence but also offer information on protecting against STIs and unwanted pregnancy. Under another bill (H.B. 822), emergency facilities treating rape survivors would have to make emergency contraception available. Heywood reports that the most contentious bill (H.B. 2358) would mandate that pharmacists dispense prescriptions, regardless of their religious or moral views. A competing bill that would codify increased rights for health care workers to withhold services or information was introduced earlier this year (Heywood, RH Reality Check, 6/29).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

Eric Goosby, U.S. global AIDS coordinator and administrator of the Presidents Emergency Plan for AIDS Relief, said that slowing the spread of HIV among pregnant women is one of his top priorities, the San Francisco Chronicle reports. In an interview with the Chronicle, Goosby said he also plans to focus U.S. global efforts on education and prevention, as well as convincing other nations to increase their involvement in the fight against HIV/AIDS. Although Goosby stressed the importance of indentifying people who could benefit from antiretroviral drugs, he added that “[w]ere not going to be able to treat ourselves out of the epidemic, and prevention efforts will need to be continued and increased.” He continued, “We also need to look for concentration of patients who have a higher probability of HIV infection, such as pregnant women getting them tested, getting them on antiretrovirals, which will prevent transmission to the fetus.” Goosby estimated that only around 35% of pregnant women who are HIV positive and could benefit from antiretrovirals receive the drugs.

Goosby also praised the efforts of PEPFAR, which was established six years ago under former President George W. Bush. However, he said that more work must be done and that the disease is not controlled. SubSaharan Africa, where about 23 million people are living with HIV, “is clearly the epicenter on the planet of this epidemic,” Goosby said. He also noted that HIV/AIDS has begun to spread more rapidly among certain populations in Russia, Ukraine, China and Southeast Asia (Doyle, San Francisco Chronicle, 6/24).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.