Worldwide, Women Still Lacking Access to Contraception

Birth control can be a hot button in political circles, but there is no doubt that family planning cuts billions in healthcare costs and saves lives around the world, says a report from the United Nations Population Fund.

In 1994, the international community got together and agreed that family planning should be accessible to all who want it, regardless of where they live. However, the most recent research shows that there are still millions of women in both developing and developed countries that do not have this access. They either don’t have the information and education that would allow them to decide if they would like to use contraception, or they don’t have physical access to it.

Women who bear many children within a short time have higher risk of staying in poverty. The women have to make limited funds stretch, have limited access to education, which could help their children be healthier in the long run, and the women have limited opportunities to earn money. Poverty often leads to higher mortality rates.

A study published in the International Journal of Gynaecology and Obstetrics in 2005 found that when pregnancies were spaced by three to five years, infant mortality could be reduced as much as 46 percent in the developing world. According to the Population Fund report, “A study from Colombia, for example, illustrates that the local availability of clinics and hospital beds and increased family planning expenditures per capita are associated with lower child mortality as well as lower fertility across women in urban areas. In the Philippines, the presence of a family planning programme had direct effects on children’s health. Improved access to reproductive health, improved spacing of pregnancies, and a reduction in the number of risky pregnancies in Bangladesh all combined to reduce child mortality and improve child survival.”

Financially, billions of dollars could be saved globally if family planning were the norm for those who want it. The report states that a $4.1 million investment in family planning for women in the developing world would eliminate the almost $6 billion spent on maternal and newborn healthcare costs.

Sadly, the plight of women and newborn health isn’t a popular topic. While millions of dollars are put into research and treatment of infectious diseases and others, like cancer, reproductive health is far behind. “Sexual and reproductive health has lost ground to ‘competing’ health issues, such as infectious diseases, because the field has failed to persuade power brokers — such as policymakers and donors — to increase funds,” wrote the report’s authors.

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Model Christy Turlington established Every Mother Counts in 2010. Check out her organization to learn more about maternal health and poverty.

Maternal health ties in with my work with Sepsis Alliance. Women who die in childbirth or not long after often die of sepsis (Sepsis and Pregnancy), as happened just recently in Ireland, to Savita Halappanavar. Women need to be aware of their health and they need to be in control of their health. Please help spread the word.

You Don't Have to Look Sick to Be Sick

Just a quick fly-by post today. An article I wrote on fibromyalgia: "You Don't Have to Look Sick to Be Sick: Understanding Fibromyalgia" is now available online (on page 25) and in print.

I hope this piece will help bring  a bit more understanding to a misunderstood illness.

Meet the Author: The Breast Cancer Checklist

If we haven't been there ourselves, most of us know someone who has - being dropped into the world of cancer as results from tests come back positive - "You have cancer." The word itself is frightening: Cancer.

Research has come far in treating most cancers, including breast cancer. But what hasn't changed is the fear and the uncertainty that you are left with once you hear those words. After absorbing the information, you have to start acting on what needs to be done. And while much of what needs to be done is told to you - in terms of treatment options and when you need to start - there is a lot that is unknown.

Fern Reiss is the author of The Breast Cancer Checklist, a new book that she wrote to help people who have been just diagnosed with breast cancer. But it's more than that. It's also a good book for people with cancer, period. Here is a brief question-and-answer interview I did with Fern, which I hope will help spread the word about what I think is a valuable and much-needed resource for people who are embarking on their cancer-treatment journey.

How much did you know about breast cancer before you were diagnosed?

My mother and sister both had breast cancer (though none of us had the genetic markers) so I knew a little bit--but no matter how many people you know who've experienced it, including close relatives like in my case, you don't ever *really* know something like this until you go through it yourself.


There are many books already published on the topic of breast cancer but you said that you couldn't find what you were looking for. What exactly were you looking for?

When I was diagnosed, almost my first response was to head to the bookstore, to find the perfect book to get me through. Although I found literally hundreds of books on cancer, including dozens on breast cancer, the book I wanted just wasn't there. I wasn't looking for a 400-page tome on all the intricacies and details and possibilities, though there are many excellent books on the market that provide an exhaustive (and exhausting!) look at the subject. I didn't really care about their focus on how cancer spreads (that's too scary) or all the different types of breast cancer (many women only have one type). I didn't even particularly care about all the chapters on breast cancer prevention and the importance of mammograms--I had been getting regular mammograms, but anyway, since I had already been diagnosed with breast cancer, it was too late for me to worry about mammograms.

Instead, I wanted a book that would somehow, despite the scary overtones of a cancer diagnosis, give me a feeling of control, and the ability to structure a high quality of life during my year of dealing with cancer. I wanted a book that was quick, with checklists so that I wouldn't lose track of things. I wanted an all-in-one book that I could bring with me to doctor's appointments, the grocery store, the physical therapist.

I wanted a book that didn't address just my physical condition, but also my mental and emotional condition. I wanted a book that assumed I was a cancer *survivor* not a cancer victim, and one that didn't include the doom-and-gloom scenarios of cancer recurrence, which I wanted to avoid considering. I wanted a book that spoke not just to me, but also to my family, and maybe even my friends and community, so they would know how to support me.

I even hoped for a book that would keep track of all my personal information--medical and insurance details, kids' scheduling, shopping lists--so that I could stay organized and feel empowered.

This is the book I needed. It includes checklists for what to do before, during, and after breast cancer surgery, chemotherapy, and radiation. It covers lumpectomy, mastectomy, reconstruction, chemo, radiation, infusion ports, lymphedema management, prostheses, tamoxifen, herceptin, lupron, and clinical trials, as well as practical things like checklists for managing schedules and doctor appointments and work and family life during treatment. It even includes checklists for organizing clothing and equipment purchases.


Why is this book important?

Breast cancer treatment is difficult enough. At least with this book women can keep the pieces together and stay organized. I've been giving the advance galleys to friends who've been diagnosed, and people are finding it as helpful as I'd hoped, which is very gratifying. (I also just got a pretty incredible review at Scientific American)


Fighting breast cancer, going through treatment, is pretty intense - how were you able to go through the treatment and write at the same time?

I didn't write the book while in treatment, but I did keep notes all through treatment on what I wished I'd known before. It was just so frustrating: There are some medical things that nobody bothered to mention to me -- like, you should get your teeth checked and a flu shot before you start chemo, because your immune system will be compromised. There are some practical things--like, you're discharged from the hospital with drainage tubes dangling from your chest, and if you haven't purchased or figured out a system for keeping them suspended under your shirt comfortably, you can't really go out. There are nutritional tips--like ways to keep from being nauseated during chemotherapy; that becomes *really* important the minute you start chemo.

Then there are things that might affect your risk of recurrence--like, if you time your surgery for the latter half of your menstrual cycle, studies show that you'll have a much better chance than if you have the surgery earlier--but none of the doctors tell you that. And there are all these great freebies, like free restaurant meals, free housecleaning services, free spa vacations and retreats--which are open to breast cancer patients and survivors for free--but how are you supposed to find out about them?!


What were the obstacles you encountered while writing this book?

The lefty alternative people didn't like that the book covers how to deal with treatment such as chemotherapy; they thought I should advise people to treat breast cancer alternatively, and while that may work for some people, I don't think it's responsible advice for everyone. The medical community had exactly the opposite reaction: They didn't really believe that there should be a chapter on nutrition, and how you can try to prevent recurrence nutritionally, even though that part of the book is based on over 500 medical studies.

A lot of the organizations and communities that should have been *delighted* with this book are in bed with the drug companies--which means they have an interest in maintaining the status quo. And a lot of the publications that I had assumed would be ecstatic to run an article on the book--like Family Circle, which had expressed great interest in doing a story on it--instead ended up doing puff pieces on 'pink nailpolishes and lip glosses' you can buy, as if that sort of piece is going to help anyone in the throes of breast cancer treatment. There are a lot of politics in breast cancer, which makes it very hard to successfully promote this book--and very hard to get to a cure for breast cancer, as well.

You are taking a non-traditional route in getting your book out to the public, including using Crowdfunding. Why did you decide to get your book out this way?

Crowdfunding, for those who've never heard the time, is a more egalitarian modern-day form of Renaissance patronage, or a way to fund the arts.

In 'real life' I run PublishingGame.com, where I consult with people who want to publish and promote books. I keep being offered consulting jobs to crowdfund other people's books, because crowdfunding is similar to other kinds of book publicity things that I do, and I wanted to try it out on one of my own books first. Crowdfunding has been wildly successful with things like independent films and technology, and much less successful with book projects. But I suspected that part of that disparity is that authors aren't necessarily as savvy at publicity as independent filmmakers. I wanted to give crowdfunding a try for a book project. So this was a way to both try out crowdfunding to see if it has potential for book publicity, which has become increasingly difficult in recent years, and simultaneously spread the word about this book. (You can see my crowdfunding campaign on the book's website at http://www.BreastCancerChecklist.com)


This looks like a book that is about taking control in a situation where you may feel like you have little control. Is that the purpose - to help women get a bit of that back?
Absolutely. There's so little you can control about the whole breast cancer experience. This is a way to at least take control of what you can control.


If you could get just one message across to women who are thinking of buying your book, what would that be? What would you like to say?

I hope nobody needs this book, ever. But I hope women will share it with everyone they know--because with one in eight women getting breast cancer these days (and the numbers inching up steadily) *someone* you know will need it this year. Please help them find it.

More info at http://www.BreastCancerChecklist.com

Three Issues Interfering with Pain Management

I was invited to give a talk about chronic pain and stress to university students in an elective psychology course. I'm in a unique situation in that I have experience with pain, acute and chronic, from different angles. As a health writer, I have interviewed experts who research pain and those who treat pain, and I've spoken with people who live with it. As a nurse, I've helped and counselled patients on managing acute and chronic pain and, as a patient, I've experienced a good bit of pain as well. So, I accepted the invitation and began to think about what I was going to say.

In my mind, there are three main issues that need to be addressed before anyone can even begin to talk about how to manage pain:

1 - Pain is misunderstood.
2 - Pain is mistreated or undertreated.
3 - Pain is considered to be a weakness.

Pain is misunderstood

This is a big one and a precursor to the following two. There is a lot of research going on in the field of pain. Scientists can tell you about pain pathways and brain reactions, but actual pain is still not understood. We all have our own perceptions of pain and healthcare professionals are no different.

I get migraines. Unfortunately, it was when my children were young that I experienced the most migraines. My migraine pain was a drilling, knifing pain behind my left eye that went unabated as no medications would touch it. So, as a mother of young children, as many parents did, I had to manage and do what I could through the migraines.

One evening, my oldest son had basketball practice and anyone who has ever gone to a basketball practice knows what it is like - between the bouncing balls, the whistles, the shouting and the stampeding feet up and down the gym - it's anything but quiet. I'm not sure why I brought him, but there must have been no other option. I remember, very clearly, sitting on a bench along a wall wishing this would be over very quickly when a dad looked at me and asked if I was ok. No, I replied. I'm not. I told him I had a migraine and I felt awful. He looked at me and said very matter-of-factly, "You can't have a migraine. If you had one, you couldn't be here."

In my haze of pain, I couldn't bring up the energy to argue with him, it took all I had to just be there. But here was the perfect example of how my pain was misunderstood. Because this man may have experienced migraines that incapacitated him or he knew of someone who would be out for the count, he could not fathom how someone else could work through the pain.

And it's not just the everyday person who does this. A medical professional who doesn't feel that you look like you're in enough pain to satisfy his or her perception of how you should be acting may not be willing to give you the benefit of the doubt.

Pain is mistreated or undertreated

Some physicians are reluctant to order narcotics or opioids for pain relief and some nurses are reluctant to give the medications because of an irrational fear that the patients will become addicted to the medications. As a result, pain that would respond to the opioids goes untreated. I've seen situations when I worked in palliative care with patients who were dying of cancer, and their family members specifically said that their loved one was not to be given any opioids because they didn't want them to become addicted.

Research has shown that if a pain is responsive to opioid analgesia (pain killing) and the medication is taken appropriately, the chances of becoming addicted to the medications are remote. The body uses the pain killing properties of the medications and there is nothing to become addicted to.

What may happen is the body may begin to tolerate the medication, requiring a higher dose. This is NOT the same thing as an addiction. The human body becomes used to many types of medications, making it so that higher doses are needed to achieve the same effect. (Fear of Addiction: Confronting a Barrier to Cancer Pain Relief)

Sometimes pain doesn't respond well to the first-choice pain medications that are suggested or prescribed. There are a variety of reasons for this, ranging from how your body metabolizes the medications to the type of pain you have. Some pain will respond much better to an anti-inflammatory type of analgesic than another type. Unfortunately, it can happen that rather than trying different medications or formulations, the dosage or frequency of a medication is just increased, still not solving the pain problem.

Pain is considered to be a weakness

Think about people who are admired. People may be in awe of the athlete who breaks his ankle but still continues to play, the coworker who has dental work without anaesthetic, or the friend who refuses pain medication following surgery. They're tough! They're strong! This, of course, implies that people who take medication, who complain about pain, aren't strong. They're weak.

We have pain for a reason, usually. It's a warning that there is something wrong, that we need to stop doing something or we need to do something to stop what is causing the pain in the first place. The athlete running on the broken ankle? He may be doing permanent damage that can't be fixed and may end up living with chronic pain for the rest of his life. The friend who doesn't take medication following surgery may end up with a much slower recovery, even complications like pneumonia because she can't get up and about as readily as her roommate who is taking regular doses of pain killers.

Pain is not a weakness and needing treatment for the pain is not a sign of being weak.

These three issues can and do make it difficult for many people who have pain to manage it properly. They can't get people to understand that they hurt. They may have trouble finding a healthcare professional to help them and if they try different doctors or clinics, they may be labeled as "doctor shopping" and may have an even more difficult time finding help. And they may not be able to confide in their friends and family, asking for help, lest they be considered weak.