Thursday, April 12, 2012
Harsh words, and women's health at risk
I'll open with a confession. Women's health has never really been at the heart of Medical Lessons. Your author has, historically, relegated subjects like normal menstruation, healthy pregnancy and reproduction and natural menopause to her gynecologist friends.
Sure, I learned about the facts of life. I even studied them in med school and answered questions, some correctly, along the way. By now, I've lived through these real life-phases directly. But these topics never drew me. That's changed now.
Women's care--and lives, in effect--are jeopardized on three fronts:
First, on birth control. Last week the Senate narrowly tabled a move to limit insurers' responsibility to cover contraception. The vote on the so-called "conscience amendment" was 51 to 48. What this tells us is that essentially half of that powerful group either agrees with limiting women's access to birth control or sees it as dispensable in the context of political aims.
The very fact that the proposal reached the Senate floor is disturbing. Without access to birth control, women, including teenagers, people with significant medical problems that can be exacerbated by pregnancy, those who can't afford to feed another child, and some who are already troubled or otherwise might not be ready or prepared to have children, are much more likely to become pregnant.
It shouldn't take a doctor to articulate this obvious point, and I can't understand why so many are silent on it, but since so few physicians and the AMA in particular hasn't issued any statement on this, I'll stick my neck out and say it clearly: Lack of contraception puts women and their conceivable future-kids at risk for health problems that could be avoided.
The language surrounding the amendment is problematic, besides. Who are the anti-birth control legislation-writers to imply that "conscience" is involved in withholding contraception, and not the other way around? It's like the "pro-lifers" who've implied that the rest of us aren't.
Second, on access to safe abortions. I respect that some people think it's wrong to terminate a pregnancy. But I also know that plenty of women, especially young women, get pregnant who don't want to be pregnant. Regardless of who's "responsible"--and any reader of this blog knows I'm no sucker for finger-pointing and behavior blame games--the bottom line is that if abortions become out-of-reach, women will suffer hemorrhage, life-threatening infections, permanent infertility and premature deaths.
It's hard to know how many women had ill effects or died from botched abortions before January 1973, when the Supreme Court issued its decision on Roe vs. Wade. Like most women of my generation, I know of those unfortunate outcomes only indirectly.
Still, I can't rid my brain of the scary, unclean place Natalie Wood visits with a wad of cash in the 1963 movie Love with the Proper Stranger, or the tragic outcome when actor Gael Garcia Bernal takes his pregnant love to an abortionist in the film Crime of Padre Amaro, set a decade or so ago in Mexico. But the real scoop comes from older physicians and nurses, here and now. When I was in med school in the 1980s, they told me stories of women and girls showing up in the emergency room bleeding, pale ... dead.
As outlined by editorialists and writers elsewhere, mergers of Catholic hospitals with other medical centers threaten to reduce or eliminate access to abortions in some rural areas. In states like Texas, the physical and emotional rigmarole to which pregnant women are subjected prior to an abortion, including mandatory listening to a description of the fetal organs and a loaded discussion, make what might be a tough decision unbearable, especially if the woman lacks confidence.
Which leads me to the third point of vulnerability, that women should be able to obtain care without intimidation or emotional abuse.
When Rush Limbaugh spoke, he wasn't just talking about one Georgetown Law student. He was speaking to and about millions of young women who are sexually active. He called them sluts and insinuated they are like prostitutes. Adding insult to verbal injury, he said he'd like to watch videos of the sex. You could ask who cares, he's just some right-winged showman blowing off steam and misogyny. But this is a man who speaks to conservative leaders and feeds ideas to many households in America.
It's scary that the Republican front-runners, men who would be President of the United States next year, didn't call Rushbo out. Rather, they let it go. As they might your daughter's health, or access to birth control, or to a safe abortion.
In this new climate of shame, it's easy to imagine a girl in some communities might feel really, really bad about herself simply for being sexually active. Whether she's 17 years in high school, or 21 years in college, or 25 and maybe a department store clerk--and possibly lonely or confused--she may be embarrassed to ask for birth control. The Scarlet C, Robert Walker aptly called it yesterday.
The paradox is that this kind of rough talk, posturing and in some states, puritanical law-making, make it more likely that a sexually active young woman will become pregnant. And if she does become so, now, she may delay seeing a doctor because she fears his or her moral judgment about her behavior. And that leads to less healthy outcomes, and more deaths--fetal and maternal.
This is a serious health issue. I wish more doctors would speak out about it.
This post originally appeared at Medical Lessons, written by Elaine Schattner, ACP Member, a nonpracticing hematologist and oncologist who teaches at Weill Cornell Medical College, where she is a Clinical Associate Professor of Medicine. She shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology and as a patient who's had breast cancer.
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