“There is more at stake than just protecting a woman’s choice to give birth.” Former First Lady Michelle Obama spoke of this reality during a Michigan campaign event for Vice President Kamala Harris on October 26th.1 This November marks the first presidential election since the overturning of Roe v. Wade and the revocation of a once-established national right to abortion, an essential healthcare service. The resulting hostile restrictions on abortion and their devastating health impacts have propelled the issue to its current political salience. Restrictions on abortion care are associated with increased maternal morbidity and mortality, with these burdens disproportionately harming Black birthing people.2 Further, a recent JAMA cohort study illustrated the detrimental impact of abortion bans on infant mortality, with researchers identifying an excess of infant deaths in Texas associated with the state’s 2021 abortion ban.3 These restrictions will also exacerbate inequalities and health systems barriers that prevent low-income patients, who are more likely to report an unintended pregnancy, from accessing...
Cervical cancer is the fourth most common cancer in women globally and the most common among women in Eastern and Middle Africa. Tanzania has one of the highest incidence rates of cervical cancer in this region: 34.3 cases per 100,000 women.1 Low-and-middle-income countries such as Tanzania bear a disproportionate burden of cervical cancer incidence and mortality. These regions have not demonstrated the same reductions in cervical cancer rates that high-income countries have achieved with the introduction of the Papanicolaou smear and HPV vaccination campaigns. This disparity is largely fueled by resource limitations in screening programs and financial and social challenges to the acquisition, distribution, and acceptability of the HPV vaccine.2 "Low-and-middle-income countries such as Tanzania bear a disproportionate burden of cervical cancer incidence and mortality." HIV infection imposes complex barriers to cervical cancer screening among women in Tanzania. Tanzanian women living with HIV are more likely to become infected with HPV and develop persistent infection leading to precancerous lesions. Patients living with...
Despite national efforts to extend postpartum Medicaid coverage for new mothers, Arkansas remains the only state that hasn’t expanded coverage to 12 months. Postpartum Medicaid, funded largely by the federal government, ensures that low-income women receive uninterrupted healthcare for 60 days after giving birth. However, Arkansas interrupts this coverage at 42 days, transitioning women to different programs, which often leads to gaps in care. An NPR article covered the experience of Maya Gobara, a new mother in Arkansas who falls into the low-income category. She lost her Medicaid coverage about six weeks after an emergency C-section and was transferred to a new health plan without any warning. This significantly disrupted her care and left her without coverage for her own health issues and her twins’ intensive care bills. When questioned about whether Arkansas has plans to expand postpartum Medicaid, Arkansas Governor Sarah Huckabee Sanders opposed this measure, believing that adding more coverage would not address the state’s maternal health issues. For context,...
Discovering Hands was founded by Dr. Frank Hoffman in Germany after he identified the need to catch early breast cancer cases that doctors may have missed in regular exams. Hoffman trained blind women, as their heightened sense of touch can potentially detect breast cancer more effectively than doctors. Evidentiary support for this method has shown that trained blind women can detect tissue changes 30% more effectively than doctors. Hoffman also ran a 2023 pilot study which further showed that medical tactile examiners (MTEs) are as accurate as doctors in identifying potentially cancerous lumps. In her NPR article, Kamala Thiagarajan focuses on one blind woman in particular, Meenakshi Gupta, who is part of this program. Gupta has worked as an MTE at Medanta Hospital in Gurgaon, India, for over two years. Introduced to India in 2017, this program is now part of major hospitals in several Indian cities. MTEs are especially important in these hospitals because of the limited access to mammograms....
The HIV epidemic has affected millions globally since the 1980s. While it remains a major public health issue, recent clinical trials of lenacapavir, developed by Gilead Sciences, show significant effectiveness in preventing new HIV infections. According to an NPR article, the recent PURPOSE 2 trial found lenacapavir to be 96% effective in preventing HIV infections in over 3,200 participants of different genders. In African countries, PURPOSE 1 trials had 100% efficacy in preventing HIV transmission among cisgender women. Lenacapavir is unique in that it is a twice-a-year injection, as opposed to pre-exposure prophylaxis (PrEP) drugs like Truvada, which need to be taken every day. Despite being shown to be extremely effective in clinical settings, this efficacy has not held up in the real world, primarily due to the social stigma surrounding the oral pill, especially in African countries. Lenacapavir has also been previously used for HIV treatment; however, Gilead Sciences is ensuring that it can be classified as a prevention drug as well....
Vaccine hesitancy has long remained a pervasive and global issue. The unwillingness to receive vaccines despite their availability and accessibility, remains a major global health issue. This phenomenon was especially felt during the COVID-19 pandemic four years ago. Misinformation and limited trust in institutions are main factors that increased vaccine hesitancy during this time. Unfortunately, we are still seeing patterns of vaccine hesitancy today, particularly in pregnant individuals. As winter approaches, 2023 will be the first year that four vaccines are recommended during pregnancy. However, trends already show that fewer pregnant individuals are getting vaccinated. A maternal-fetal medicine specialist at UCLA Health Dr. Neil Silverman, expresses that he has never seen this kind of pushback before the pandemic. Now, he says that all vaccines are lumped together as “bad”. Before COVID-19, the CDC reported that about 17.2% of pregnant people were “very hesistant” about getting a flu shot. Now, that hesitancy has been raised to almost 25%. Luckily, people tend...
In “SRH in Palestine: A Medical Student’s Experience in Health Education,” Duha Shelah, a medical student at An-Najah National University, explains the strengths and weakness in sexual reproductive health care in Palestine. Shelah has worked as a volunteer health educator for the Palestinian medical Relief Society since 2020, working with communities in the Occupied Palestinian Territories. Surprisingly, the majority of Palestinian women receive adequate antenatal care and had a skilled health staff at livebirths. However, a lot of the research on Palestinian reproductive and sexual health is incomplete, especially on menopause, preconception, and psychosocial services. Shelah found that the Israeli involvement in Occupied Palestinian Territories, and the imposition of closures and military checkpoints, restricts access to medical facilities. Therefore, sexual and reproductive health is heavily impacted by times of heightened violence, such as the 2014 bombing of the Gaza strip. Moreover, between 1999 and 2002, home births grew by over 20% due to increased Israeli military presence. Shelah argues that...
Magnetic resonance imaging (MRI) is a sensitive modality for detection of breast cancer; yet, as its use in screening is expanded from high-risk patients to intermediate- and average-risk individuals, positive predictive value deteriorates, leading to unnecessary biopsies and follow-up. To improve the overall accuracy of breast cancer diagnosis and allow for personalization of patient management, Witowski et al., reporting in Science Translational Medicine(1), propose an artificial intelligence-based solution. A system of deep neural networks was trained to output the probability of malignancy given the MRI sequences of a patient’s breast. The deep learning system performed equivalently to board-certified breast radiologists, generalized well to different patient populations in three external test sets, and was unbiased with respect to patient race. Importantly, the model predictions could serve as an aid for downgrading certain breast lesions from BI-RADS 4 to BI-RADS 3, enabling patients with lower risk of malignancy to opt of unnecessary biopsies. The results of the study underscore the value of...
Almost 20% of women aged 15 to 44 years old douche, which is the harmful act of cleaning or washing out the inside of the vagina with a mixture of fluids. Douches are often sold at as prepackaged mixtures containing water with some combination of iodine, vinegar, or baking soda and squirted into the vagina. While it is popularly known to be a sterilizing practice, douching actually changes the balance of vaginal flora (which is the good, natural bacteria inside the vagina) and increases rates of harmful vaginal bacteria. This bacterial increase can lead to yeast infections, bacterial vaginosis (a vaginal infection), or STIs including HIV and pelvic inflammatory disease (an infection in female reproductive organs). Douching can also cause fertility challenges. It can make it more difficult to get pregnant, as women who did not douche had an easier time getting pregnant than women who douched often (at least once a month). Douching can also increase the risk of ectopic...
A recent study from researchers at Washington State University has shown success in keeping semen in its gel form to block sperm movement and possibly prevent pregnancy. The methods used in this study may eventually materialize into a non-hormonal female contraception method that could be available for over-the-counter purchase. Past research on mice found that the use of a non-specific protease inhibitor called AEBSF prevented the degradation of the protein of Semenogelin 1. Semenogelin 1 (SEMG1) is a protein that traps semen and prevents movement; therefore, its degradation is necessary for sperm liquefaction, where semen is transformed from a gel-like consistency to liquid. By inhibiting the degradation of SEMG1, the researchers were able to prevent the female mice from becoming pregnant. To determine the efficacy of these inhibitors in humans for contraception, the study tested the effects of AEBSF on SEMG1 degradation, which prevented degradation and reduced sperm motility. They next tested the results of a neutralizing antibody that directly inhibited...
