*Spoiler Alert: in order to critique this show, I need to reveal some plot points.

Zombies do not discriminate on the basis of sex, race, ethnicity, socioeconomic status, or ability…people do. This sad truth played out in the short but compelling 6-episode first season of AMC’s new show The Walking Dead. Zombies eat any living thing they come across – scary but not evil creatures because they don’t have a functioning brain which would allow them to be human, to distinguish right from wrong.

 Admittedly, I haven’t read the graphic novels of Robert Kirkman, on which this series is based. So, I’m not 100% sure who to credit for the plot twists that portrayed the violent racism of a white supremacist, the vulnerability of daughter and wife to a physically-abusive man, and the terror of a woman fighting off a former lover who is trying to rape her. When the hospital is invaded by “walkers” (a.k.a. zombies), the living soldiers choose to execute ill and disabled patients rather than try to rescue them. [Mind you, the zombies do not seem to move fast enough to cause problems for someone armed with a semiautomatic weapon, but the choice is still made to sacrifice these lower status people.]

 If a common enemy should unite, then social scripts of bigotry and bias should disappear. As one character notes in the season finale, human beings may have reached their point of extinction. The question is whether the zombies or our own human failings are to blame.

With record ratings, the Wall Street Journal and other sources report that this Sunday night’s finale attracted 6 million viewers.  I may not be the typical fan of this show, so I wonder: will most viewers remain focused on the horror of a gruesome, fictitious zombie epidemic? Or, are there others like me, who despite flinching every time a zombie lunged for a bite of human flesh, left the season finale feeling acutely aware of the very real pandemic that plagues almost all societies: that potent combination of bigotry and selfishness which manifests as one of the many ‘isms. I’ve yet to see a ‘walker’ lurching down a street, but I have encountered far too many living human beings who lack empathy, respect, and compassion for each other and for the diversity of life on this planet.

This month’s guest column* by Christine H. Morton, PhD, a research sociologist at the California Maternal Quality Care Collaborative, draws on her research and publications on women’s reproductive experiences and maternity care advocacy roles, including the doula and childbirth educator. She is the founder of ReproNetwork.org, an online listserv for social scientists studying reproduction.

The ever-evolving history of the childbirth reform movement has new developments, which need to be incorporated into the older story which documents the shift from home to hospital birth; and the paradigm clash of midwifery and medical models of birth reflecting holistic and technocratic values, respectively. We need to incorporate the story of the doula, which I argue, is one of many efforts to bridge the divide – to provide, as Robbie Davis-Floyd has called it, humanistic care in birth, which is what most women desire.

History is happening now. In addition to the emergence of the doula in the past thirty years, more recently, we see efforts underway in maternal health policy (Childbirth Connections’ Transforming Maternity Care), among physician and nursing professionals (most especially around maternal quality measures, and maternity quality improvement) and resurgence among, for lack of a better word, ‘consumers’ or childbearing women, who seek greater access to vaginal birth after cesarean (VBAC). What are the goals of each stakeholder; how do they intersect and overlap, and come into conflict with one another? This is a big story, and we need to tell it!

I take a small slice of this larger historical backdrop to consider the interconnected history of childbirth educators and doulas, which will be the subject of my research presentation at the Lamaze-ICEA Mega Conference in Milwaukee.

To back up a bit, when I embarked on my sociological investigation of the doula role, I was interested in many aspects of this innovative approach to childbirth advocacy and support. What strategies and mechanisms enabled women with no medical training to insert themselves at the site where medical care is delivered to a patient in a hospital, and enact their self-defined role? Why did women become doulas and what did the work mean for those who were able to sustain a regular practice over time? How were doulas utilizing and leveraging the corpus of evidence based research which suggested their impact was as great, if not greater, than that of the physician, the culture of the obstetric unit, or the labor and delivery nurse? Where did doulas come from? What, in the history of childbirth reform, or childbirth education, or labor/delivery nursing, could help me understand how doulas emerged at this point in time in U.S. history?

Later, after learning that there were limited histories of childbirth education (by non-childbirth educators), and little research on the history of obstetric nursing, I had to take a step back and consider these factors as well. Why was the work and perspectives of women who support other women during childbirth an overlooked piece of historical research? Why did histories of women’s health reform efforts largely exclude childbirth reform? Why had there been no history of the women who were involved in childbirth education; in labor and delivery nursing; in the mainstream arena of birth care in the US? So as not to be accused of ignoring the scholarship that does exist in this area, I acknowledge my debt to Margot Edwards and Mary Waldorf; to Judith Walzer Leavitt, to Barbara Katz Rothman, Robbie Davis-Floyd, Margarete Sandelowski, Deborah Sullivan and Rose Weitz, Judith Rooks and Richard and Dorothy Wertz (I can make my full bibliography available to those interested). I have been inspired by these histories, but they focused less on the women (childbirth educators) who were making history and more on the larger cultural shifts in beliefs about medicine, technology, women’s bodies and reproduction.

When childbirth education per se was a topic of inquiry, the research focus tended to be on the primary sources of the male physician champions – Grantly Dick-Read, whose work informed the natural birth movement, and Ferdinand Lamaze (and his US counterparts – Thank you Dr. Lamaze author Marjorie Karmel and Elisabeth Bing) who formulated a method for accomplishing unmedicated, awake and aware childbirth. However, most of this scholarship makes unsubstantiated generalizations about what particular childbirth educators (of various philosophies /organizations) believed, and how they taught. There is surprisingly little in the way of empirical research – few scholars interviewed childbirth educators or conducted systematic observation of their classes over time.

So after completing my dissertation on the emergence of the doula role, I had the great opportunity to continue with my research interest through a research grant from Lamaze International to conduct an ethnographic investigation of childbirth education, with my colleague, medical anthropologist Clarissa Hsu. We talked to educators, observed their classes and analyzed our data.

We found that educators who were actively practicing doulas drew heavily on their direct labor support experiences as authoritative resources for stories and examples that supplemented the material they taught. Actively practicing doulas also included more curricular content on early labor than educators without such experience. Having real births to draw upon provided doula-educators a different type of credibility and authority than educators without such current labor support experience. These educators relied on other mechanisms to establish their authority, such as knowledge of the latest research on birth and use of more authoritarian teaching styles.

We found that the intersection of doula practice and childbirth education has significantly affected how childbirth preparation classes are taught, and this new infusion of practice and ideology is worth exploring. I encourage you to explore this with us, and welcome your thoughts.

*Note: this column was originally posted on the Science & Sensibility blog.

For this month’s column, I had the pleasure of emailing with Chris Bobel, Ph.D. about her new book which deftly tackles a taboo topic.

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You explore new feminist activism that focuses on menstruation. Historically, how have feminists viewed menstruation, and why menstrual activism now?

The issue of menstruation has not been a top feminist priority, though, since at least the 1970s, a few bold feminists have recknoned with socio-cultural and political dimensions of the menstrual cycle. I argue that the menstrual taboo–which impacts us all, even feminists–often puts the issue off-limits. In mainstream culture, the only menstrual discourse that gets any play is making fun of women with PMS. I studied menstrual activists who want to widen and complicate the conversation. Menstrual activism is part of an enduring project of loosening the social control of women’s bodies, moving women’s bodies from object to subject status–something absolutely foundational to addressing a range of feminist issues, from human trafficking to eating disorders to sexual assault.

What do you think of Kotex’s new ad campaign “Break the Cycle,” which lampoons traditional menstrual product ads?

The new campaign could be a game change, but I’m doubtful. First, the campaign only works as long as the menstrual taboo persists; otherwise, their frank talk doesn’t stand out, does it? While I can join in the joke of the industry poking fun at itself–and I love the message of “no more shame”–in the end, it’s the same, just repackaged.

Second, I resent this campaign for exploiting shame to sell product for nearly a centuray and then exploiting THEIR overdue pronouncement–“enough with the euphemisms, and get over it”–to sell product.

Also, you’ve got to wonder if not only Kotex but their whole industry is now pulling out all the stops to try to hold onto its market share as menstrual suppression drugs–like Seasonique and Lybrel–are gaining interest.

So, what do you think of pharmaceutical industry arguments that support these menstrual suppressants?

Their quasi-feminist arguments co-opt feminism to push drugs. Big Pharma is marketing suppression as a ‘lifestyle choice’, but what most don’t realize is that “menstrual suppression” is actually cycle-stopping contraception that does not only reduce or eliminate menstrual bleeding but also suppresses the complex hormonal interplay of the menstrual cycle. We don’t yet have adequate data to really show if this is a safe long-term practice for otherwise healthy women. Check out this position statement.

Furthermore, ad campaigns represent the menstrual cycle as abnormal, obsolete, and even unhealthy. These messages underscore that women’s natural functions are defective, dysfunctional and need medical intervention. This can lead to negative body image, especially in young women. How is this feminist? ‘Choice’ without good, fact-based information based on thorough medical studies isn’t real choice, and a campaign that exploits women’s negative attitudes about their bodies isn’t feminist either.

Your work uses menstrual activism as an analytical lens through which to view continuity and change in the women’s movement, from what some call the “second wave” of feminism through the “third wave.” So, given that the ‘wave’ distinctions are not without controversy among feminists, what do you see as setting third wave feminism apart? Is it truly unique, or is it merely a label that recognizes the next generation?

There’s a lot of continuity between the waves–mostsly in the tactical sense. Today’s feminist blogs are yesterday’s zines, which reflect earlier mimeographed manifestos; radical cheerleading recalls street theater and public protests, like early second-wavers at the 1969 Miss America pageant. Second-wavers practiced what third-wavers call DIY (Do It Yourself) healthcare when they modeled pelvic self exams. But, most third-wavers depart from most (but not all) second-wavers by troubling the gender binary. For example, the radical wing of menstrual activism movements reers to “menstruators”, instead of assuming that everyone who menstruates gender-identifies as a woman.

Tell me more about that!

Most assume that a female-bodied person, with breasts and a vulva, is a woman, and usually that’s true. We also assume that menstruation is a near-universal experience for women. Radical menstruation activists question these assumptions. Menstruation is not and has never been EVERY woman’s experience. Women don’t menstruate for lots of reasons, and they don’t menstruate their whole lives. Also, some transmen and intersex people DO menstruate. So, equating menstruation with womanhood is problematic. Saying “menstruators” makes room for more people, more experiences. This linguistic move is boundary smashing, inclusion-in-action and bodes well for feminism’s future.

But, you’ve written that menstrual activists are not successful at all attempts at inclusion.

The first face of the feminist movement may have been white and middle class, but poor white women and women of color across the class spectrum have always been there, often toiling in relative obscurity. This could be the case with menstrual activism, too. However, I’m a white, privileged academic, and this biases my world view. I looked for women of color doing this work and found a few. But, was I looking in the right places? Was I using the right language? One activists of color said that I was likely missing Black women because I wasn’t clarifying how race and gender intersect in menstrual health. Also, menstrual activism is risky business for all, and especially for women of color, whose bodies have been denigrated throughout history. Taking on the menstrual taboo can make others see you as nasty, gross, improper…and if you’re already struggling to be accepted and taken seriously, then why go “there”?

Well, I and many other women’s health activists appreciate that you ‘went there’!

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For more on this topic and her research, check out Chris’s new book — New Blood: Third-Wave Feminism and the Politics of Menstruation (Rutgers University Press, 2010), previewed in the Our Bodies, Ourselves blog and in a provocative article in the Guardian last fall.

Health posts are my thing, and today I cannot stop thinking about the health of the Gulf Coast…which clearly impacts the health of more living creatures than we can fathom.  News coverage may talk about bodies of water like they are distinct things, but ‘the Gulf’ is merely a cartographer’s distinction.  It’s hard to watch the live feed of the endless spray of oil shooting into the ocean.  It feels like watching a massacre, like a spray of machine-gun bullets ending life after life.  Calling this catastrophe a “spill” is like calling an amputation a “boo-boo.”    And, frankly, I can think of nothing more important to write about for this month’s column. 

So, allow me to compare our planet to a patient, a very ill patient who has suffered a severe injury and is receiving really crappy medical care.  Or, let’s take it to a more intimate-level: we can anthropomorphize one affected area, the Mississippi Spillway, as the vulva of the U.S.  One of my favorite sociologist bloggers, Mimi Schippers, Ph.D. (a.k.a. Marx in Drag), did just that in a post where she calls British Petroleum (BP) a pimp — and not the MTV/”pimp my ride”/bling-bling/Snoop Dogg kind of pimp.  No, we’re talking a stone cold, cruel, exploitative, abusive, criminal.  In the words of Dr. Schippers:

 BP and the rest of the oil industry are the johns and the federal government is the pimp.  Federal, state, and local politicians pimp us out to put money and power in their own pockets while, by paying the right price, Big Oil gets to take what it wants and needs.  And they-the pimp and the johns, do so with absolutely no regard for the needs or well-being of the body they use.  The body—the living environment, including the people—is, however, a breathing entity.  And though it appears as if it is just an object to be used, the people know what they are doing.  They strike a bargain that, for the moment, benefits themselves but sacrifices the rest.  You give me jobs, and I’ll give you whatever you want.  Invoking the vulva as metaphor suggests there is something feminine or female about this place and that masculine or male power is the problem.  But don’t let that confuse the issue.  This is about class and economics. 

Whether you prefer to see the U.S. government as an incompetent physician (allowing a patient to inch towards death) or as a corrupt police officer (being too kind to a felon), we have got to ramp up our demands for swift, safe, effective action.  And, perhaps, we need to think seriously about how to safely shut-down all of the deep-water drilling before the next tragedy.  All the money in the world cannot buy a healthy ocean.  Even if this torrent of BP oil is the last one we ever have to deal with, don’t think that we’re close to knowing how bad things really are..in the words of that 70’s BTO classic:

Here’s somethin’ that you’re never gonna forget. B-, b-, b-, baby, you just ain’t seen na, na, nothin’ yet!

I dedicate this month’s column to parents who are in the midst of crises which are well-articulated on the website A Heartbreaking Choice:

Pregnancy does not end happily for everyone. Sadly, some parents receive grim prenatal news that something is seriously or fatally wrong with their loved and wanted unborn baby. They have to make a decision about continuing or ending pregnancy. We realize that all parents make a loving choice, one they feel is better for their baby. Regardless of the fetal anomaly found, the decision to end a pregnancy is always a difficult one.

Although it is estimated that between 80 and 95 percent of parents receiving a severe prenatal diagnosis choose to end the pregnancy, those who face this nightmare often feel alone. There is very little in the way of support programs for them. With this site and the dedication of courageous parents willing to reach out, we hope to create a safe haven of encouragement, validation, hope and healing.

How many of us have thought about all that is involved with therapeutic abortions?  Parents in these situations have to navigate a medical system which is under the influence of a legal system which (in my humble opinion) has succumbed to a failure of the separation between church and state. It saddens and infuriates me that these mothers — especially those in their third trimesters — may be denied access to medical options which could best protect their physical and mental health. In this day and age of U.S. abortion policies, should we be grateful that any states allow any options at all?  Gratefulness is hard to come by in the face of so much suffering.  My prayers and love go out to all parents who face these heartbreaking choices.

Taking a break from somber topics of health and medicine, I wanted to share a fun experience — I participated in my first “Clothing Exchange” party last month, hosted by the fabulous women of Exurb Magazine.

It was a chance to make new friends, catch up with old ones, clean out my closet, update my wardrobe, and help less fortunate women. The hosts provided drinks and appetizers, all of us brought clean, ‘gently-used’ clothing, and we got to know each other while we picked through the offerings. At the end, our hosts took all that was left over (and there was a lot!) to a local women’s shelter.

It’s always fashionable to reduce, reuse, recycle…and reinforce other women’s acts of courage!

[Those interested in hosting may want to check out these guidelines for a children’s clothing exchange and modify as you wish.]

Coco Chanel has often been quoted as saying, “A woman who doesn’t wear perfume has no future.” If perfume staves off doom, then perhaps that’s what inspired this otherwise-inexplicable new ad by GlaxoSmithKline for its HPV vaccine:

As you can see, it leads with a blue-eyed, fair-skinned, made-up (and apparently affluent) young woman lounging on an antique sofa on the first floor of a mansion. But softly shimmering lights and fairy-like chimes distract the waif from her book. She dreamily follows the golden twinkling lights up an impressive staircase, where she gazes with a beatific smile upon a champagne-colored perfume bottle magically floating in mid-air. As the bottle rotates to reveal the words “CERVICAL CANCER“, the young woman’s expression switches from bliss to frowning concern. Enter the narrator’s voice:

Maybe it’s unfair to get your attention this way, but nothing’s fair about cervical cancer. Every 47 minutes, another woman in the U.S. is diagnosed. But, there are ways to prevent it. Talk to your doctor.

Unfair? I would have said “insulting.” As in, maybe it’s insulting to assume that the best way to attract a young woman’s attention to a serious health issue is to dupe her into thinking she’s watching a perfume commercial? But, if you want to talk ‘unfair’…Maybe it’s unfair that there hasn’t been a public health campaign to educate teens, women and men about sexually-transmitted HPV (human papillomavirus), which can cause not only cervical cancer but also other serious cancers in men and women? Maybe it’s unfair that the only public “education” about the HPV epidemic has come in the form of pharmaceutical ads that continue to narrowly brand and market HPV vaccines as “cervical cancer” vaccines?

The ad finishes by presenting a GlaxoSmithKline website — which troubles me, as a sexual health researcher, because it does not offer visitors a comprehensive HPV education. But that may have been too much to hope for, given that their HPV vaccine (Cervarix) received FDA approval for use in girls and women (ages 9 to 26) just this past October.

So, skip this ad and website if you’re looking for a more neutral source of information about HPV vaccine options, and visit the CDC instead. And those who’d like a more thorough STD/STI education should check out the American Social Health Association and other website resources which are not funding by pharmaceutical companies.

Note: while GSK has disabled adding comments to their series of new ads, you may rate not only this ‘perfume’ ad but also their ‘front porch‘ and ‘night out‘ ads with the start-ratings you feel they deserve. And, for more on the mis-marketing of HPV vaccines, read my article, “Why Men’s Health is a Feminist Issue,” in the Winter issue of Ms., on newsstands now.

(Originally posted on Ms. blog, cross-posted at Sociological Images and AdinaNack.com)

Last week, the NYT reported “Merck: Studies Boost Gardasil for New Uses“; this week the CDC’s Advisory Committee on Immunization Practices (ACIP) met to discuss these new results. It will be interesting to see what, if any, changes result from new clinical evidence that (1) the vaccine is effective in preventing anal precancers in males and (2) the vaccine is effective in women 27-45 years old.

Those who’ve followed HPV research for the past decade were not surprised by the findings of either study. What has surprised me is how little attention ‘male’ Gardasil has attracted since receiving FDA approval last October. Writing a feature article for the Winter 2010 Ms. magazine gave me the opportunity to more deeply explore this topic and hopefully raise awareness — not only about Gardasil, a.k.a. the “cervical cancer” vaccine, but also about the full range of male HPV-related cancers that it might also prevent. 

So, this month’s column is inspired by my desire to respond to some of the interesting questions, comments and accusations that I’ve received via the blogosphere (like WashingtonCityPaper and HugoSchwyzer) in these first days following the publication of my article. I’ll start by acknowledging that my article’s title seems to have pushed more than a few buttons: apparently not everyone wants to know “Why Men’s Health is a Feminist Issue.” One comment asked “Why does the burden for sexual health need to fall, yet again, to women?” My response: It’s a burden for only girls/women to be responsible for sexual health, so prioritizing equal access to STI/STD vaccines results in a more fair sharing of this ‘burden.’ From the opposite side, a comment criticized this angle as being self-interested: “…when feminists speak of male health issues, it is usually in the context of the way they affect women.” To that, I reply: if you read the full article, you’ll see that boys/men have plenty of reasons to care about having access to this vaccine that have to do with protecting their own health, regardless of whether or not they ever have a female sexual partner.

This leads to another trend in responses: What’s in it for men?  Or, as one comment put it, “The only reason for males to get the vaccine would be to prevent HPV in women.” Really? How about the variety of serious HPV-related male cancers (oral, penile, anal, and others) that are (1) on the rise, (2) often fatal due to lack of accurate testing/screening, and (3) in the U.S. likely result in more combined deaths in men than cervical cancers in women? (See my Ms. article for an overview of these stat’s or, if you love charts check out p. 4 of the American Cancer Society’s 2009 report).

And, media coverage of Gardasil would not be complete without questions/concerns focused on whether or not Gardasil does more harm than good. For the record: I have not taken a pro-vaccine or anti-vaccine stance on Gardasil or any other vaccine. But, I speak in favor of equal access to vaccines, support the conducting and media coverage of medical studies that reveal the full range of potential health costs and health benefits of any vaccine,  and argue for funding public health campaigns about HPV and other sexually transmitted epidemics. And, though some blog comments reveal confusion over the possibility of being “required” to get the Gardasil vaccine, I’m not aware of any current U.S. vaccination policy that does not allow for ‘opting out.’ (Note: as of December 14, 2009 Gardasil was no longer required for female green card applicants.)

A less popular theme, though one that intrigues me, came from those who took the angle of “What’s in it for big pharma?” One comment hypothesized, “…you can’t help but suspect Merck’s money motive is playing a role in the push for expansion to men.”  And, I reply, what PUSH? If money was their motive, then wouldn’t they have updated the Gardasil.com website to encourage male consumers? Visit that site prior to March 1, and you’d think that it was still only approved for girls/women.

I’ll end this post by expressing my thanks to all of the journalists and blog authors who are raising awareness about this topic, including Ms.‘s own Executive Editor Katherine Spillar on the Huffington Post. I also send out my gratitude to blog readers who add insightful, thoughtful, sociological, and truly feminist comments like Annie‘s. In my opinion, to be feminist is not to be pro-women, it is to be pro-equality and pro-justice (not to mention anti-sexism, anti-racism, anti-homophobia, anti-ageism…you get my drift). I don’t know if the pro- and anti-vaccine folks will ever see eye to eye, but there’s absolutely nothing to lose and everything to gain by being pro-HPV-education.

January is Cervical Health Awareness Month, making it the perfect time to post a follow-up to Part I which featured my concerns about potential unintended consequences of new Pap test guidelines (from ACOG, the American College of Obstetricians and Gynecologists). To recap, it is vital that we do not confuse a recommendation of less frequent Pap tests with the unchanged recommendation of annual pelvic/sexual health exams (see the National Cancer Institute for explanations of both).

So, let’s look back at a letter dated November 20, 2009, in which the President of ACOG clarified:

Cervical cancer screening should begin at age 21 years (regardless of sexual history). Screening before age 21 should be avoided because women less than 21 years old are at very low risk of cancer. Screening these women may lead to unnecessary and harmful evaluation and treatment.

Medically speaking, why should this recommendation disregard an individual woman’s sexual history? His letter continues on to state:

Cervical cytology screening is recommended every 2 years for women between the ages of 21 years and 29 years. Evidence shows that screening women every year has little benefit over screening every other year.

Doesn’t this depend on how many new sexual partners a woman has in a given year? Are the revised guidelines assuming monogamy (or at least long-term, serial monogamous relationships) which decrease odds of a woman contracting a new cancer-causing strain of HPV in less than a 2-year period? Where are the conclusive findings of large-scale sexual-behavior surveys to support this assumption?

ACOG’s November 2009 press release featured these quotes from Alan Waxman, M.D.:

Adolescents have most of their childbearing years ahead of them, so it’s important to avoid unnecessary procedures that negatively affect the cervix. Screening for cervical cancer in adolescents only serves to increase their anxiety and has led to overuse of follow-up procedures for something that usually resolves on its own.

I agree with GWP reader anniegirl1138 who commented on my previous post that over-treatment is no joke. However, we have not been presented with data that a Pap test — the test, itself, not over-treatment based on test findings — is directly linked to significant increases of any negative health outcome.

Cervical HPV infections can be detected by Pap tests: ACOG acknowledges that, “the rate of HPV infection is high among sexually active adolescents, but counters with, “the large majority of cervical dysplasias in adolescents resolve on their own without treatment.”

Why should that smaller group of girls and young women (whose pre-cancerous lesions do not resolve without treatment) miss the annual opportunity to receive an early diagnosis? Early-stages of cervical HPV infection can often be resolved with less-invasive treatment options.

More-invasive treatment options, such as the “excisional procedures for dysplasia” that have been linked to increased risk of premature births, are one of several medical treatments for cervical HPV.

And, what about the possibility that an increased risk of premature births may not be the paramount concern for every female patient? Not all women want to or can biologically become mothers. What if an individual female patient would rather seek medical treatment for a HPV infection that has resulted in cervical dysplasia so that she has greater peace of mind in knowing that she has reduced her risk of cervical cancer and reduced the likelihood of transmitting HPV to her sexual partner(s) and/or future babies?

Call me a feminist, but I still believe that knowledge is power and that every sexually-active girl and woman should be encouraged to consider the benefits of annual Pap tests. When Pap smear results show “abnormal” cellular changs, then healthcare practitioners should explain the potential for false-positives and discuss the pro’s and con’s of moving forward with different diagnostic and treatment options.  

ACOG acknowledges that, “HPV also causes genital and anal warts, as well as oral and anal cancer.” A Pap test may be a girl/woman’s first chance to learn of a cervical HPV infection, which can result in her having a colposcopy exam. This procedure helps a practitioner find HPV-infected cells not only on the cervix but also in other anogenital areas (the vaginal canal, the labia, the perineum). Beyond the cervix, a Pap test that is positive for HPV may be a wake-up call to get a thorough oral screening for serious oral cancers which have been linked to sexually transmitted HPV.

In addition, my research and others’ studies have found that STI diagnoses can lead to attitudinal and behavioral changes which can decrease risks of contracting other STIs, including HIV. For all of these reasons, a Pap test that leads to a diagnosis of a sexually transmitted cervical HPV infection can bring unintended positive consequences.

In light of the new Pap smear guidelines, I hope that U.S. girls and women who get less frequent Pap tests will more frequently ask their healthcare practitioners to educate them about cervical cancer, about the full range of STIs, and about FDA-approved vaccines against viruses that can be sexually transmitted (HPV and Hepatitis B).

For the medical facts about HPV and HPV vaccines, check out the book The HPV Vaccine Controversy by Shobha Krishnan, M.D., a member of the Medical Advisory Board of the National Cervical Cancer Coalition. 

The Bottom Line: a recommendation for less frequent Pap tests does not mean you should forgo your annual pelvic exam. In our busy lives, e-reminders can make the difference:  PromiseToMe.com allows you to schedule an annual email reminder. [Note for boys/men: make sure to get an annual sexual health exam, too!]

Recently, I had the pleasure of corresponding with sociologists Chloe Bird and Pat Rieker about their book Gender and Health: Constrained Choices and Social Policies (Cambridge University Press, 2008), credited as the “first book to examine how men’s and women’s lives and their physiology contribute to differences in their health.” I was curious how the authors see their research relating to some of the health topics that have made headlines in recent months.

Nack: Starting off with the topic of mental, health, you’ve written about sex-based differences.  Reflecting on recent articles, like NYT’s In Anxious Times, Medical Help for the Mind as Well as the Body, how does your book add to our understanding of and concern for policies like the Mental Health Parity Act?

Rieker:  Our book provides concrete data for why the Mental Health Parity Act is such a strategic and critical addition to general health care policy.  We focus on gender differences in mental health, particularly depression and substance abuse disorders.  Although the overall rates of mental illness are similar between men and women, if you look at it by specific disease, then you see large gender differences.  Women’s depression and anxiety rates are double that of men’s; while men’s rates of substance abuse and impulse control disorders are double that of women’s. Available research shows that individuals with serious mental health problems also have more physical health issues, including a lower life span. Both social and medical interventions are needed to prevent and treat these socially and financially costly conditions which create enormous health burdens on individuals, who may become unable to perform work and other social roles, and their families, Employers and society, as a whole, bear additional costs. 

Bird:  Also, differences in men’s and women’s lives can affect their utilization of mental health care and the effectiveness of specific interventions. We need systematic assessments of the effectiveness of treatments/approaches for both men and women, which can ultimately lead to better physical and mental health outcomes. The US has fallen behind Canada and other countries which require this approach in federally-funded research. 

Nack: How are the differences between men’s and women’s mental health problems particularly relevant as we consider the impact of the economic downturn, in general, and, with regard to healthcare coverage, the rising numbers of uninsured and underinsured Americans?

Rieker:  In the current poor economic climate, many men and women are experiencing increased stress/anxiety when losing jobs which may have provided dependable incomes and health insurance. Constant worry, itself, leads to ill health and exacerbates existing underlying conditions (e.g., cardiovascular and respiratory conditions).  Our framework of constrained choice illustrates how social and economic policy can reduce or enhance the options and opportunities for individuals to engage in healthy behaviors such as not smoking, not drinking to excess, eating well, and exercising.  While some individuals respond to economic downturns by temporarily limiting costly habits of smoking or drinking, we argue that more could be done at different policy levels to encourage positive health behaviors and coping strategies that improve physical and mental health.

Nack: Let’s switch our focus to the connection between work policies and health. Your research addresses some ways in which workplace policies (or lack thereof) are likely impacting individuals and public health.

Rieker: Lots of companies have worksite day care. Daycare concerns affect men and women and how they balance family and work. That attempt to balance is one of the greatest sources of stress in American life.

Nack: A recent NYT article cautioned “Lack of Paid Sick Days May Worsen Flu Pandemic.” How does your book’s discussion of worksite daycare expand our understanding of the concerns expressed in this article and those articulated in a recent GWP post by fellow sociologist Virginia Rutter?

Bird:  Both the NYT article and Rutter’s post point to costs faced by individuals who need to stay home due to their own illness or to care for sick family members.  The flu pandemic has brought greater attention to the constraints individuals face in bearing the costs and other penalties (explicit and implicit) for taking a paid or unpaid sick day.  Social and labor policy decisions, as well as employer practices, affect an individual’s opportunity to pursue a healthy life and to work in an setting where coworkers are able to stay home when they or their family members are not well.  Moreover, as labor economist John Schmitt stated (and Rutter cited in her GWP post),

Denmark, Germany, and seven other countries with more generous statuatory paid sick days policies all have lower sickness absence rates than the United States. 

Cross-national comparisons of policies and of health and health care utilization can help us learn to support individuals in staying home as needed and reduce the risk to coworkers of flu exposure or workplace accidents caused by coworkers who are working while ill. 

Nack: Staying on the topic of worksite daycare as a policy issue that directly impacts health, in a previously published interview, I appreciated how you expanded the conversation to breastfeeding.

Bird: Onsite day care also provides a greater possibility for women to breastfeed. This is another example of how biology is relevant to this discussion. Both men and women benefit from onsite child care, but breastfeeding is proven to lessen women’s chances of breast cancer, so this policy benefits women physically as well as mentally and emotionally. There are also the public health benefits to consider as well; breast-fed babies are sick less often than formula-fed babies.

Nack: Your book addresses how workplace policies, like onsite daycare, can support breastfeeding as a choice that research shows to likely improve the health of mothers and babies. What role do you see the media, in particular recent celebrity endorsements of breastfeeding, as potentially influencing women’s choices? And, do you see it as a positive or a negative if articles, like the NYT’s “Breast-Feed the Baby, Love the Calorie Burn“ spotlight postpartum weight-loss as a reason to breastfeed?

Bird:  Promoting breastfeeding as a way to “get your body back” brings to mind Shari Dworkin and Faye Wachs’ book Body Panic which examines how health and fitness magazines encourage the creation of gendered bodies, rather than healthy and fit bodies.  Breastfeeding has multiple benefits for mothers and their babies including short and long-term health effects and substantial savings on infant formula.  Overemphasizing the potential for weight-loss may leave some mothers feeling frustrated or misled.  Many moms find that breastfeeding makes it harder to lose the last of their pregnancy weight due to increased appetites, and for some, breastfeeding appears to cause the body to hold on to some extra weight. 

Rieker:  Having celebrities or others endorse breastfeeding for the purpose of weight loss reinforces the appearance of women’s bodies over their health.  This is one of many gendered expectations that feminist women’s health movements were designed to challenge.

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With President Obama asking Congress to focus on our nation’s healthcare problems, we need to keep in mind the findings of social and behavioral health researchers and make sure that issues of sex and gender are factored into new policies.