Rwanda: the sins of the Church

Pope Benedict pronounces, as he departs for Africa, that condoms actually increase the AIDS problem. HIV and AIDS remains an out-of-control plague across southern Africa and the Pope has again done incalculable damage to AIDS prevention.

By Gerald Caplan.- The Roman Catholic Church is preying on
my mind. There are several immediate reasons, some entirely obvious.
Pope Benedict XVI embraces an excommunicated bishop whom everyone but
he (we are told) knew was a demented Holocaust denier. Pope Benedict
pronounces, as he departs for Africa, that condoms actually increase
the AIDS problem. HIV and AIDS remains an out-of-control plague across
southern Africa and the Pope has again done incalculable damage to AIDS
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Book: The Men Who Killed Me

Fifteen years after the Rwandan genocide, “The Men Who Killed Me”
features testimonials from seventeen survivors. Through their
narratives and portraits, sixteen women and one man bear witness to the
crimes committed against hundreds of thousands of others. Proceeds from
this book will go to Mukomeze, a charitable organization established to
improve the lives of girls and women who survived sexual violence in
the Rwandan genocide.

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During the 100 days of genocide in Rwanda in 1994, not only were an
estimated 1 million Tutsi and moderate Hutu killed, but also an
estimated 250,000 to 500,00 women and girls were brutally raped and
experienced other forms of sexual violence. Survivors of sexual
violence, mostly Tutsi women, continue to face the consequences of the
genocide today. Many of these women live in dire conditions, suffer
from poor health and stigmatisation, and are still traumatized by their
experiences during the genocide. In addition, about 70% of women have
been infected with HIV as a consequence of the sexual violence they
endured during the genocide. Many have died of AIDS because they have
not had access to proper treatment.

From Confusion to Clarity: New Mammogram Guidelines Explained!

Amie Newman

Last week, the federal government released re-adjusted guidelines on breast cancer screenings, including mammograms and self-examination causing frustration, confusion and anger throughout the women's health community. Our Bodies, Our Blog explains. 

Last week, the federal government released re-adjusted guidelines on breast cancer screenings, including mammograms and self-examination.

The new guidelines state that instead of receiving yearly mammograms beginning at age 40, women can now wait until 50 years old to begin the annual screenings. But the new recommendations set off a firestorm of frustration from particular groups like the American Cancer Society and caused confusion as well. There are claims that these new guidelines will put women in greater danger, particularly African-American women, who have the highest rate of death from breast cancer and are more likely to develop breast cancer before age 40. 

The guidelines are clearly controversial with the debate focusing on whether or not breast cancer screenings at an earlier age are statistically helpful, whether the risk of exposure to radiation and the chances of false-positives and misdiagnoses are great enough to warrant this change or why the many women’s lives who have been saved by early detection and early screenings are not reason enough to keep the guidelines status quo.

So, what’s a woman to do?

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Our Bodies, Our Blogs does an excellent job at breaking down the new guidelines: what they mean, why there were re-adjusted and how a woman can evaluate what’s best for her given the new landscape.

In her post, New Mammogram Guidelines Are Causing Confusion, But Here’s Why They Make Sense, Christine Cupaiulo writes:

But a number of women’s health organizations, including Our Bodies Ourselves, the National Women’s Health Network and Breast Cancer Action,
for years have warned that regular mammograms do not necessarily
decrease a women’s risk of death. Premenopausal women in particular are
urged to consider the risks and benefits.

Cupaiulo confirms that far from disempowering women to take care of their health, these new guidelines align with the World Health Organization’s recommendations, and may help women to have a clearer understanding of the health impact of mammograms:

I don’t believe the new guidelines are politically motivated, nor are they “patronizing
to women simply because they call into question the stress related to
biopsies and false positive results. Rather, the guidelines provide a
useful framework for helping each of us to decide when is the best time
to begin screenings and the intervals at which they should be repeated.

The guidelines are in sync with international recommendations; the World Health Organization
recommends starting screening at age 50, and in Europe, mammograms are
given to post-menopausal women every other year and detection rates are
similar to the United States. During an interview on MSNBC
on Tuesday, breast cancer expert Dr. Susan Love said the government’s
guidelines bring us into line with the rest of the world and with
current research. (Read more at her blog.)

In response to the claims that these new guidelines will ultimately affect insurance coverage for mammograms, Cupaiulo quotes a New York Times recent article which, in part, explains:

The guidelines are not expected to have an immediate effect on
insurance coverage but should make health plans less likely to
aggressively prompt women in their 40s to have mammograms and older
women to have the test annually.

But, here’s the thing. Cupaiulo is careful to note that there is no reason why women should not be encouraged to continue to make their own decisions they feel are right and best for their health and lives. 

If you’re reading this and thinking you still want to keep that scheduled mammogram, you should certainly do so.

“No one is saying that women should not be screened in their 40s,” said Petitti, the task force vice chair. [Ed. note: of the advisory group that released the new guidelines] “We’re saying there needs to be a discussion between women and their doctors.”

Dr. Amy Abernethy of the Duke Comprehensive Cancer Center said she agrees with updated recommendations.

Tara Parker Pope, writing at The New York Times blog in Our bodies, Our Breast Exam also quotes Dr. Petiti, 

Dr. Petitti also wanted to clarify that the new recommendations did
not tell women to stop doing breast self-exams, just like they did not
tell women not to have mammograms until age 50. Rather, the advisory
group recommends against routine mammography in younger women.

“Nothing in our recommendations says that a woman who finds a lump shouldn’t go to her physician,” Dr. Petitti said.

For some women for whom the anxiety of false-positives, exposure to radiation over a span of years or opening themselves up to surgery to remove a lump that may never have been harmful in the first place, these recommendations may elicit a sigh of relief. But for many others, the personal experience of losing someone close to  breast cancer or receiving a diagnosis of breast cancer via a mammogram at an early age, these new guidelines don’t feel right. 

Read more at Our Bodies, Our Blog


Failing African American Mothers and Babies

Amie Newman

September is Infant Mortality Awareness Month. It's a good time to explore a woefully under-addressed topic: the shocking disparity between the maternal and infant mortality rates of Blacks and Whites. 

Rachel at Our Bodies, Our Blog called my attention to a fascinating article on a woefully underreported topic, in Womens eNews this month – Black infant and maternal mortality in the United States. It’s a topic that, frankly, deserves much more attention from movements and communities across the spectrum – women’s health, feminism, reproductive rights, the medical establishment, mainstream media news, and alternative news sources all.

September is Infant Mortality Awareness Month. The truth is, however, as Kimberly Seals Allers writes in her article, Black Infant Mortality Points to Moms’ Crying Needs,

"…this country is miserably failing women of color, and black women in particular, in the process of birthing healthy babies."

When an obstetrician-gynecologist doesn’t know that African American women in the United States are nearly three times as likely to die during childbirth as white women are, or that the infant mortality rate in the black community is significantly higher than in other communities, there is a lot of work to be done. As Seals Allers (Womens eNews Editorial Director) writes:

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In the course of interviewing obstetrics-gynecologists I have found
many who aren’t aware that their black patients are at a greater risk
during pregnancy, regardless of their socioeconomic status.

African Americans have an infant mortality rate 2.3 times higher than that for non-Hispanic whites. But this isn’t new information. Why do these racial health disparities then still exist in the United States? And as we consider our current health care reform measures, how do we address these kinds of inequities?

Seals Allers quotes Dr. Camara Jones, research director on social determinants of health and equity at the National Center for Chronic Disease Prevention and Health Promotion:

"In this country, we have for a long time thought of our individual
behaviors as the main determinants of health," said Jones in a recent
speech at the University of Georgia. But encouraging individuals to
adopt healthier habits is not the key to ending health disparities.

"If we are interested in eliminating racial disparities in health,"
said Jones, "we need to examine the fundamental causes of those racial
disparities." That includes an awareness of the systems that make race
an important distinction and acknowledging the existence of racism in
practices and organizations."

And Rachel at OBOS notes that addressing these racial disparities is not only an issue of morality or social justice but it makes sense economically, 

"In addition to the moral or social justice argument for eliminating health disparities, a recent report
on the economic burden of these disparities makes a money-saving
argument for eliminating them, estimating that doing so “would have
reduced direct medical care expenditures by $229.4 billion,” money that
some suggest could be used to pay for health reform."

While we make our best efforts to shine a much needed light on the health of women in the developing world as worthy recipients of our attention, one must ask why the health of women in this country is not being given equally as deserving attention?

Carol Jenkins, writing on Rewire in response to Nicholas Kristoff’s and Sheryl WuDunn’s new book, Half the Sky, about the imperative of focusing on gender equity globally, calls African American women in the United States "invisibles", and an "endangered group right here in our backyard" precisely because of these staggering health inequities:

It is a group we need to keep in mind, because you won’t
see us very much in the media—home bred women of color don’t have the exotic appeal
of grand international rescue missions. But there are many of us who believe
that black women in America are now in full blown crisis, and require a
concerted effort of activists, philanthropists, big thinkers. Black women’s
voices are largely missing from our debate about health care, even as the
disparities in their care are the starkest. 

But where are the studies? The research on the multi-layered reasons for these staggering statistics? And why aren’t health care providers informed enough about these kinds of racial disparities to provide appropriate care?

In fact, infant mortality rates for black babies is rising in many states around the country. Sixteen states, of the 39 with a large enough population of black people to make the analysis reliable, "experienced rising black rates between the 1998-2000 and 2002-2004 period." Clearly, this gap persists and it’s not enough to continue to question. 

Seals Allers also raises these questions but adds that in the face of a serious lack of research and not nearly enough provider awareness, Black women – all women – need to advocate for themselves:

As a black woman, who can’t afford to wait for the government or
medical community to figure out how to save our babies, I have to
search for answers and solutions and ask black women all over the world
to do the same.

And as mothers and women of all races, whose lives are all
interconnected, we have to figure out how. It’s the least we can do.
Newborn lives are at stake.

The Department of Health and Human Services (HHS) did develop the Healthy People 2010 initiative to "provide a vision for achieving improved health for all Americans." The initiative contains two goals  – one of which is to eliminate disparities in health based on a variety of factors including race. But a midway review in 2005 acknowledged that, thus far, "While there
have been widespread improvements in rates for most of the populations
associated with the social and demographic characteristics included in
Goal 2, there is little evidence of systematic reductions in disparity." [emphasis mine]

The report also notes that, "It may
be more difficult or more costly to implement effective disease
prevention and health promotion programs for some populations. However,
unless greater reductions occur for the populations with the highest
rates, disparities will not be eliminated."

The key then is for all of us to agree that the lives of African American women and their babies are worth saving. It’s a question of prioritization. Yes, it is critical that African American women are aware of institionalized racism and racial health disparities so that they may advocate for themselves. But that is not enough, of course. Not nearly enough. 

In order to make real progress, we must see attention paid to this problem by President Obama, Congress, advocacy and grassroots organizations, the medical community, activists and the mainstream and alternative media.

Dr. Jones says it best, quoted in Kimberly Seals Allers’ article,

Racism is not some vague thought or practice, it operates through identifiable and addressable mechanisms, says Jones.

So let’s identify and address.


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