When Will Black Women’s Health Matter?

When will Black women’s health matter? That’s a question I’ve asked myself more than once during the recent Congressional effort to repeal health care reform that would deny countless women of color access to affordable and quality reproductive health care services.

I asked myself that question again when I heard the story of a desperate Black woman in Sacramento who had saved to pay for her abortion but did not have enough money to pay for a babysitter for her two children (and barely enough gas money to drive the 60 miles to her appointment). She arrived at the clinic with her children in tow.

But it wasn’t until a group called The Radiance Foundation started putting up billboards saying abortion is Black genocide that the subject of Black women’s role in this debate made headline news. More controversy was stirred up recently when a group distributed flyers on Princeton University’s campus declaring, “In the new Klan, lynching is for amateurs,” and pointing to a website called klanparentood.com. I suppose I should be grateful for all this attention. However, given the willful deception and bizarre claims being spread by these campaigns (and lampooned on The Daily Show), I can’t say that I am.

The billboards had been appearing in Black communities coast to coast for more than a year, and the campaign was reported on months ago by the Times and other major news outlets. But when a huge ad went on display in lower Manhattan in late February, a real furor erupted, resulting in headlines across the U.S and even overseas.

The billboard, depicting a sweet, worried-looking young Black girl, declared: “The Most Dangerous Place for an African American Is in the Womb.” An accompanying Web site, toomanyaborted.com, informed visitors that abortion is part of a racist scheme “to stealthily target blacks for extermination.” Late last month, the same group unveiled billboards in Chicago with President Obama’s image and the tag line, “Every 21 minutes, our next possible leader is aborted.”

The new “Klan” website advertised on Princeton’s campus, obviously targeted to young people, is no doubt eager to stir similar outrage with its cartoon character of a doctor in a Klan hood wielding a knife, and its faux-hipster declaration, “We are the hood in parenthood.”
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Creating a perfect storm of race, class, and gender-baiting in the midst of the abortion and health care debate, these ads imply that Black women are either ignorant dupes of racist, profiteering abortion providers, or uncaring enemies of their people, willing to make Black children an “endangered species” to further their own selfish goals. By that same logic, the groups behind the billboards and web campaigns ought to take out ads against education, since studies demonstrate that well-educated Black women have fewer children.

So who are these groups that purport to care so much about the survival of the Black “species?” According to news reports, funding for the Radiance Foundation ads comes from Georgia Right to Life and the Georgia Republican Party, two largely white, male, conservative groups not previously known for their commitment to women or people of color. These are the same Republicans, after all, who recently passed a bill that would take away women’s access to critical services including prenatal health care, nutritional programs for infants, and child care assistance. Given all these cutbacks in services for one of the most under-served groups in America, a more accurate billboard would have said that the most dangerous place for an African American child is outside the womb.

But accuracy is not the point of these ads. Take for instance the claim that abortion is making black children an endangered species. While it is true that abortion rates for black women are higher in some states (including Georgia, where this campaign was hatched), it is also true that the fertility rate — or births per 1,000 women of childbearing age — among Black women remains higher than the national average and has inched up in recent years, according to data from the Centers for Disease Control. To the extent that Black women are having abortions in greater numbers, the Guttmacher Institute has determined that this is due to their greater incidence of unintended pregnancies, resulting from economic inequality and poor access to contraception and education.

All of which leads me back to my question: When will Black women’s health matter? In a country where Black women are likely to have less access to health care, have higher incidence of chronic illness and injury, and in which at least 17 percent are uninsured, it is little wonder that some are driven to abortion out of desperation. They are trying to keep body and soul together and save the children they already have. For women like that single mother of two in Sacramento, this is not a “choice” issue so much as a life circumstance — or a decision borne of desperate circumstances.

Perhaps Black women’s health care will begin to matter when politicians realize that protecting their health, improving their life circumstances and safeguarding personal decision making – not blaming them for genocide — is the route to making abortion less necessary. Billboards, lurid websites and punitive legislation will never accomplish this urgent goal, if indeed they were ever really meant to.

Making sense of scary news about calcium supplements

If you take a calcium supplement, you might be wondering what to make of a new finding from the British Medical Journal suggesting that calcium supplements increase a woman’s risk of heart attack and stroke by about 20 percent. Should you keep taking your supplement, and how do the benefits compare against the risks?

That’s a tricky question, and one that you might assume researchers have figured out by now — given that Americans with thinning bones have been advised to take the bone-protecting supplement for decades. Turns out, though, that calcium might be yet another nutrient that’s been oversold as a supplement — at least according to some experts.

“I think all people taking calcium supplements should reassess whether these are doing them any good,” says study co-author Dr. Ian Reid, a professor of medicine and epidemiology at the University of Auckland in New Zealand via email. “Our paper shows that for every three fractures that are prevented by calcium, six heart attacks or strokes are caused. Thus, the balance of risks and benefits is negative.”

That finding, though, only applies to healthy postmenopausal women who were randomly assigned to take calcium along with vitamin D; more than half the women participating in the clinical trial — the landmark Women’s Health Initiative — were already taking calcium supplements on their own to, say, combat thinning bones. Oddly, those who were randomly assigned to take even more calcium had no increased heart or stroke risks compared to those who were assigned to take a placebo.

In fact, the supplement takers who were given more calcium had about a 16 percent lower risk of dying compared to their counterparts who took placebos.

Confused yet? So are experts who aren’t sure what to make of the findings and whether they mean that some benefit from calcium supplements more than others. Also, men weren’t included in the study, which means they could have a different risk-benefit profile.

“It is not possible to provide reassurance that calcium supplements given with vitamin D do not cause adverse cardiovascular events or to link them with certainty to increased cardiovascular risk,” write the European authors of an editorial that accompanied the study. “Clearly further studies are needed.”

Until then, experts say we need to exercise some common sense when it comes to calcium. “I think it’s generally a good idea to get as much calcium as you can from food rather than supplements,” says Dr. Frank Hu, a calcium researcher and professor of nutrition at Harvard School of Public Health.

Women aged 51 and over and men aged 71 and over need 1,200 milligrams a day of calcium. Younger adults need 1,000 mg a day. Eight ounces of yogurt, an eight-ounce glass of milk, and a 1.5-ounce serving of cheddar cheese provide 1,000 mg of calcium. Adding a cup of fortified orange juice can get you up to 1,200 mg.

Experts generally agree that there’s no benefit to exceeding the government’s daily recommended allowance and that we should aim to get no more than 800 mg of daily calcium from a supplement. Research indicates that calcium overdose has become more common in recent years leading to an increased risk of high blood pressure and even kidney failure.

If you do have thinning bones, talk to your doctor about the pro’s and con’s of calcium supplements. They only have a modest effect on fracture prevention, says Hu, and need to be taken along with vitamin D.

Protect women’s health-care access

The question of Planned Parenthood’s government funding is so divisive that it almost shut down the federal government this month before a last-minute compromise. Now, the issue is splitting Hoosiers after the legislature moved closer to making Indiana the first state to ban the agency from receiving Medicaid funds.

The state Senate voted on Tuesday to cut off all tax dollars going to Planned Parenthood of Indiana, a proposal that had died earlier in the House.

Opponents of defunding argue that Planned Parenthood, barred from using tax money for abortions, puts the funds into family-planning and other health services that aren’t widely available elsewhere, especially for the poor and uninsured. They also say these services can reduce abortions, that simply removing government funding won’t decrease the number of abortions, and that Indiana will ring up a $68 million Medicaid bill for unintended pregnancies if the measure passes.

Still, as a private organization, Planned Parenthood doesn’t have a special right to public funding. The fact that it performed 5,500 abortions in Indiana last year can’t be ignored.

The key question is whether all women in Indiana would have access to health care such as cancer screenings, protection against sexually transmitted disease and birth control if Planned Parenthood is denied tax dollars.

The answer, for now, is uncertain. In some areas of the state, particularly in Southern Indiana, women have few alternatives to Planned Parenthood for reproductive health services unrelated to abortion.

It’s true that some clinics that don’t perform abortions hope to expand. A clinic called Open Door Health Services, for example, plans to double its patient capacity within three years.

But what will women do in the interim if Planned Parenthood cuts its services or closes clinics because of the loss of public dollars? And what happens if alternative clinics, despite their best intentions, aren’t able to raise the money needed to greatly expand their capacity?

Abortion opponents shouldn’t let their disdain for Planned Parenthood lead them to make decisions that ultimately could hurt women, including many who have no intention of having an abortion.

In an ideal world, all women, regardless of where they live in the state, would have sound alternatives to Planned Parenthood. But, as abortion opponents know all too well, the world, as it now exists, is far from ideal.

Mercer Islander is leader of women’s health studies

Islander and epidemiologist, Dr. Andrea LaCroix is again at the center of the decades-long discussion about the efficacy and risks of hormone replacement therapy for menopausal women. The results of the recent phase of the studies she has lead indicates some significant benefits for women who took estrogen alone beginning in their 50s after hysterectomies.

From the paper in the Journal of the American Medical Association to lengthy stories in the New York Times and the McNeil Leher Report, LaCroix has been questioned and quoted about what these new results mean. The findings will most certainly add to discussions between women and their doctors about other risks of medication to ease the symptoms that can occur with menopause.

LaCroix is a professor of epidemiology at the University of Washington, where she works at Fred Hutchinson Cancer Research Center. She is the lead investigator tracking the health of thousands of women who were participants in an unprecedented study of hormone use begun in 1991. The studies, which looked at the effects and risk of hormone medication on menopausal women, were conducted through the Women’s Heath Initiative (WHI) study funded by the National Institutes of Health (NIH). Millions of women contemplate taking hormones each year.

Data from the U.S. Census suggests that women between the ages of 45 and 55, represent the single largest segment of the U.S. population.

The Reporter first wrote about LaCroix and her work on the WHI studies in 2002.

LaCroix is the lead author of the findings published in the April 6, 2011, issue of the Journal of the American Medical Association. The news headlined national media outlets and was reported and parsed by journalists, readers and doctors everywhere.

The findings of the study represent a reversal of sorts from the news of 2002 and 2004, when the NIH sounded a cautionary alarm about what they perceived was an unacceptable risk to participants of hormone replacement therapy. NIH stopped the study on the combination of hormones in 2002, and the estrogen-alone study in 2004.

But researchers continued to follow the women to find out what effect the hormone use — taken even for just a short period of time — might have on the health of the participants in the long term. Their health was followed and compared to those who did not take the drug.

The study yielded a surprising result. The hormone-taking women who had hysterectomies, who used estrogen alone, showed a 23 percent lower risk of invasive breast cancer than their counterparts who were taking no hormones at all.

“The data seemed to ‘speak clearly,’” LaCroix said for benefits lasting well after the drug had been stopped.

“In their 50s, women can be very reassured that, if they decide to take hormone therapy for relief of menopause symptoms or for other reasons, that they’re not going to have an increased risk of breast cancer; they’re not going to have more heart attacks. In fact, their risks of those outcomes might be lower.”

LaCroix said there are other important findings.

Risks and benefits of hormone therapy differ importantly by age for several types of chronic disease: heart attacks, colorectal cancer, death. Overall, chronic diseases are lower among women taking the single hormone therapy in their 50s compared to placebo, but among women in their 70s, they actually had higher rates of all these conditions if they were taking estrogen alone vs. placebo.

There are some caveats, to be sure. Every patient is different. The study was not designed to measure the effect of when or how long to take the drug.

Despite these encouraging results for this particular set of women, LaCroix emphasizes that the results — both positive and negative — are useful for all.

These studies are about health and about informing women, she said. “It is not clear what each individual should do,” she said.

LaCroix holds a master of science in public health nursing and a Ph.D. in epidemiology, the study of the causes of disease, from the University of North Carolina in Chapel Hill, N.C., in 1984. She spent many years in Washington, D.C., where she earned her first nursing degree at Georgetown University. She later returned there to post doctoral studies at Johns Hopkins University and the National Institutes of Health.

Islanders since 1989, LaCroix and her husband, Fred LaCroix, have two seniors at Mercer Island High School. The twins are in the high school marching band that performed in the New Year’s Day parade in London in January.

“Each arrived in the city via different flights,” their mother said, noting that she and her husband got up in the middle of the night to watch them march on television. They are heading off to college next fall. She said it is going to be very different with both gone at the same time.

Of the media attention, LaCroix said that it has been “a privilege to interact with the media,” noting “they are bright and informed.”

“I am here to help people to understand what all of this means,” she explained. “I have had all sorts of good conversations. Hopefully, it will help encourage more introspection about how we view these types of therapies.”

Learn more

For more information on the results of this and other WHI studies and resources, go to www.whi.org.

LaCroix is also part of a study called ‘MsFlash’ sponsored by Group Health Research Institute. Seattle is one of five locations in the United States conducting the study. Islanders received a flyer about the study in the mail earlier this month.

The study needs participants, ages 40 to 62, to study how yoga, exercise or taking Omega-3 fatty acids might ease hot flashes. The 16-week study will involve either yoga classes or exercise, the supplement or placebo.