Women’s health fail

For every step forward the United States takes toward improving women's health, the country appears to be taking one back — or more.

The overall picture is so bad that the nation got a big, black "Unsatisfactory" grade on a report card issued recently by the National Women's Law Center, in conjunction with Oregon Health & Science University.Art deco woman

We are doing all right in some areas. Women are smoking less. The percentage of women getting regular mammograms, annual dental checkups and colorectal screenings has held steady since 2007. In only one area, cholesterol screenings, have we actually improved.

On the negative side, more women are binge drinking, and fewer are getting Pap screening tests for cervical cancer. More women are obese, diabetic and hypertensive, too. More are turning up with chlamydia, a sexually transmitted disease.

Not a single state got a "Satisfactory" mark this year; in 2007, three states made the grade. Massachusetts and Vermont have the best scores, a limp S (for satisfactory) -minus.

Many of the goals have to do with things people can conceivably control themselves, like quitting smoking, and drinking only moderately.

However, nearly 20 percent of women ages 18 to 64 have no health insurance. The disparities are troubling: 38 percent of Hispanic women, 32 percent of Native American women, 23 percent of African-American women — but only 14 percent of Caucasian women — lack health coverage.

And only seven states now require comprehensive maternity care — prenatal care, childbirth and postpartum care — be included in all individual and group health plans.

Most of the goals the report card addresses come from the Healthy People 2010 campaign of the U.S. Dept. of Health and Human Services. On its website, Healthy People is already hoping for better results in 2020, its new goal year.

"The Favorite" by Leon-Francois Comerre, courtesy of Wikimedia Commons

Babies, stay put!

November is Premature Birth Awareness Month at the March of Dimes, part of an effort to bring down the appalling rate of premature birth in this country, where every minute a baby is born before its time — one in every eight babies born — for a total of 543,000 every year. That's almost 1,500 premature babies born every day, 13 of whom die from complications.

Premature birth — any one that takes place before 37 completed weeks of pregnancy — is the leading cause of infant mortality throughout the world. Babies even a few weeks premature can have health problems that will stay with them for their lifetimes.

In the United States, the rate of premature birth has risen 30 percent in the past 30 years. However, after peaking in 2006, the rate has begun to come down. The March of Dimes thinks its campaign, begun in 2003, had a hand in the decrease.

Premature babies can cost 10 times more to care for than babies born after 37 weeks — $32,325, compared with  $3,325 for full-term infants. The total cost of preterm birth in the United States is $26 million, according to the March of Dimes.

The organization hopes to bring premature births down with increased education for moms and health-care providers, prenatal care and research through its Prematurity Research Initiative.

On Wednesday, Nov. 17, the 8th Annual Premature Birth Awareness Day, the Empire State Building in New York will shine purple, the color assigned to this effort by the March of Dimes.

An ill wind indeed

The Black Plague, which wiped out perhaps a third of the population of Europe, demanded an explanation, and the medical establishment of the time responded as well as it could.

The most popular conjectures about the pestilence were variations on the miasmic theory of disease, an idea that went back at least to the ancient Greeks — that disease was essentially bad air. ("Miasma" was the Greek word for pollution.)

Hundreds of treatises about the epidemic survive, many of them written in the mid-14th century, when the plague was at its height. One written by members of the faculty at the medical school at the University of Paris, in response to a request from their king, Philip VI, mixed humoral and miasmic theories: The planets had aligned in such a way as to poison the air.

Another theory held that a series of earthquakes in Europe had released corrupt air from the middle of the earth. A third had the plague wafting in on noxious winds from the equator.

The cause of the plague was actually Yersinia pestis, a murderous bacterium spread by the bite of rodent fleas in the primary, "bubonic" phase, characterized by swollen lymph nodes and other symptoms. The plague can also be spread by infected droplets exhaled by its victims in a less common but deadlier "pneumonic" phase.

The plague was a catastrophe for Europe, but it did usher in reforms. It pushed the medical community toward a more professional approach to its practice, an increased emphasis on public health and the establishment of hospitals that would treat the sick, rather than merely warehouse them away from the healthy population, according to The Black Death: Natural and Human Disaster in Medieval Europe, by Robert S. Gottfried.

Frustration with the utter failure of the medical establishment to discern the pandemic's cause, stop its spread or treat it effectively helped create an environment from which the scientific method emerged.

The basics of birth safety

What do women need when birth becomes difficult? The Averting Maternal Death and Disability program has identified a handful of intervention capabilities that should be in place for emergencies wherever babies are born.

These "signal functions" include having personnel on hand who are trained to administer drugs by injection -- antibiotics, anticonvulsants and "oxytocics," which can start or speed labor -- manually remove the placenta and other "products of conception" not leaving the body spontaneously, and perform assisted vaginal delivery -- with forceps, for example.

AMDD, a major initiative of the Mailman School of Public Health at Columbia University in New York City,  has worked with UNICEF and other partners for 20 years to bring down maternal-mortality rates in the developing world.

Its directive, issued in 1997, cites two additional interventions that might be necessary to save lives -- Caesarean section and blood tranfusion. These two go beyond the basics of a birth center -- in some parts of the world they are strictly wish-list items -- but they can often make the difference between life and death, as they did in our case.

AMDD doesn't include anesthesiology in its signal functions, although surgery is difficult without it.

We in the United States might view these interventions as humdrum, or even as irksome or worse if they become part of our own birth story, but behind the development of each one of them are amazing tales.