Monthly Archives: April 2010

Cesarean Sections in the News: Are Women Fully Informed?

Delivery by cesarean section is a hot topic these days.  In recent months newspapers have reported that the rate of c-sections in the U.S. has reached an all-time high; that the federal government has issued new guidelines to encourage vaginal birth after c-section (VBAC); and that health care reform has targeted unfair insurer practices, including the treatment of c-sections as pre-existing conditions.  All of these stories make one wonder, do women understand what they are getting into when they undergo a c-section?    The consequences are far-ranging, and unfortunately, will likely remain until 2014, when most of the health insurance reforms curbing unfair insurer practices go into effect.

The N.Y. Times recently reported that, in 2007 (the most recent year for which data is available), 1.4 million c-sections were performed, accounting for 32% of all births. Although c-sections undoubtedly save the lives of women and children when medically indicated, the World Health Agency suggests that the rate of c-sections should be around 15%.  A c-section is major abdominal surgery, with risks to both mother and child.  Moreover, c-sections increase the risk of complications in future pregnancies and limit women’s future delivery options.

C-sections are also more expensive than vaginal delivery, and can significantly impact a woman’s future insurance coverage, as the N.Y. Times first reported two years ago. Insurers often treat a prior c-section as a pre-existing condition, and take any range of actions including refusing to issue a policy, excluding maternity coverage, or charging a premium. The N.Y. Times echoed the concern of advocacy groups that, “[n]ot only are women feeling pressure to have Caesareans that they do not want and may not need, but they may also be denied coverage for the surgery.”   Insurance companies are not required to provide coverage to adults without regard to pre-existing conditions until 2004.

So why are c-sections on the rise?  One Philadelphia Inquirer piece suggests that two interrelated forces are driving up the numbers: doctors’ increasing use of the “surprisingly unreliable” fetal heart monitoring as a screening tool, and fear of being sued. The N.Y. Times pointed to such factors as higher rates of multiple births due to fertility treatments, a greater number of older mothers giving birth, and the increasingly common tendency to induce labor, which is more likely to result in a c-section than natural labor.

Another major reason that c-sections are on the rise is because of the dropping rates of VBACs.  Repeat c-sections account for 40% of all c-sections, and “[f]ewer than 10 percent of women who had Caesareans now have vaginal births, compared with 28.3 percent in 1996.” Many attribute the drop in VBACs to professional guidelines that “require that surgical and anesthesia teams be ‘immediately available’ during labor if a woman has had a prior Caesarean,” which caused many hospitals to simply ban VBACs. However, a NIH panel is recommending that doctors and professional groups reconsider these guidelines, after finding that “70 percent of women who have had Caesareans are good candidates for trying for a normal birth, and 60 percent to 80 percent of those who try succeed.”

Hospitals have demonstrated that certain measures can reduce the high rate of c-sections.   For example, the N.Y. Times reported on a hospital on Staten Island that has kept its c-section rate around 23%, by prohibiting unnecessary inductions before the 41st week, refusing to provide c-sections that are requested by the mother but not medically indicated, and encouraging VBACs.

Hopefully, advocacy groups and news organizations will continue to keep the debate about c-sections in the spotlight, ensuring that both women and their health care providers understand the risks, alternatives, and the potential ramifications for future healthcare coverage.

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Filed under Childbirth, Health insurance, Pregnancy, Reproductive Rights, Women's health

Study Reports Decline in Maternal Deaths Globally

A study in the medical journal The Lancet recently reported that the global numbers of maternal deaths have been declining significantly. Maternal mortality remains a major challenge to international health systems, and, despite global health initiatives, had seemingly not experienced significant change in recent years. This peer-reviewed study refutes this assumption.

The New York Times reports that this study provides the first important indication of a significant drop in the number of women dying from pregnancy and child birth each year: from close to 527,000 in 1980 to about 342,900 in 2008. The study cites a number of reasons for this improvement including lower pregnancy rates: the increasing availability of “skilled attendants” to provide a level of medical assistance at birth; more education for women; and higher income, which improves nutrition and access to health care. Lower numbers in larger countries like China and India also helped to drive down global death rates.

But India has made steady progress, and because its population is so large, its improvements have helped considerable to decrease the worldwide rate of maternal deaths. China has also made considerable progress. In India, there were 408 to 1,080 maternal deaths per 1000,000 live births in 1980, and by 2008, there were 154 to 395, the new study found. In China, there were 144 to 187 deaths per 100,000 live births in 1980 and 35 to 46 in 2008.

Researchers hope that this new study will inspire additional initiatives aimed at combating maternal mortality. When leaders can see tangible statistics indicating that their efforts are making a difference, the perception of little to no progress will likely disappear. This important positive finding for global health illustrates that the policies and programs pursued may be having an effect.

Dr. Horton contended that the new data should encourage politicians to spend more on pregnancy-related health matters. The data dispelled the belief that the statistics had been stuck in one dismal place for decades, he said. So money allocated to women’s health is actually accomplishing something, he said, and governments are not throwing good money after bad.

One reason for this perception is the prevalence of AIDS-related deaths of pregnant women. This pandemic is, to a large extent, responsible for rising maternal mortality in eastern and southern Africa. Addressing H.I.V. among pregnant women would be the most effective way to tackle maternal mortality in those regions.

This new information confirms that substantial, albeit varied, global progress is being made toward reducing the Maternal Mortality Ration (MMR). This good news will hopefully encourage the interest of investors and politicians to endorse the safe motherhood movement internationally.

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Filed under Pregnancy, Women's health

Vice President Biden and Department of Education Announce Change in Title IX Implementation

Vice President Joe Biden announced yesterday that the Department of Education is rescinding a 2005 policy that allowed schools to show compliance with Title IX by administering email surveys to gauge interest in sports by the underrepresented sex. This is a great step forward in demonstrating the DOE’s commitment to enforcing Title IX and stressing the importance of equitable athletic opportunities for male and female students.

The policy dealt with the third prong for assessing compliance with Title IX, which requires a school to show that it is meeting the athletic interests and abilities of the historically underrepresented sex. The change allowed schools to use email surveys of students to assess their interest in sports and could equate lack of response to the survey with lack of interest in playing sports.

This model put the burden of complying with Title IX on students and provided schools with an easy way to escape accountability in the eyes of the law. Luckily, it was never widely adopted because the NCAA advised its members to ignore it.

This decision stresses the importance of providing equitable athletic opportunities and treatment to male and female athletes. We’re happy to see the Obama Administration and the Department of Education working for gender equity. It also reiterates the need for the Pennsylvania legislature to pass SB 890 and HB 2061, which would give parents, students and community members the tools they need to advocate for gender equity in their schools’ athletics programs. Make sure your state senator and representative know about your support for these bills – take action here.

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Filed under Girls, Pennsylvania, Sports

Four Women Explore Space at the Same Time

Women have come a long way in space travel: Valentina Tereshkova became the first woman in space on June 16, 1963, and since then, 47 different women have flown with NASA. In fact, NASA maintains a Women of NASA website which contains profiles of and information about all of their female astronauts past and present. There are currently four female astronauts from astronaut classes of 2004 and 2009 who have not yet flown in a mission, but will do so in the near future.

Right this minute, there are four women in space (for the first time in history!).  At 3:44 A.M. EST on Wednesday, April 7th during mission STS-131, three space shuttle Discovery female astronauts joined the International Space Station’s Tracy Caldwell Dyson. Mission STS-131 is providing supplies and equipment to the International Space Station, will include three space walks, and will make repairs to the ISS [PDF].

The crew of the Discovery includes Stephanie Wilson, who is the second African-American woman to go into space. She received her BS from Harvard and her Masters at the University of Texas. She has flown in two other missions prior to this one, and is from Boston, Mass. Her profile states that she enjoys “skiing, music, and stamp collecting.”

The second woman aboard the Discovery is Dottie Metcalf-Lindenburger. She received her Bachelor’s in geology from Whitman College, and prior to this was the Educator Mission Specialist for NASA, which means she gets to “spur excitement among the youth of today in maths, science and all things spacey and exploratory.” Dottie has also completed more than 10 marathons.

Naoko Yamazaki, the third woman on the Discovery mission, is a Japan Aerospace Exploration Agency astronaut. She received her Master of Science in Aerospace Engineering from the University of Tokyo, and has been an astronaut since 2001. Fun fact: Ms. Yamazaki has also helped to produce an anime cartoon series in Japan entitled “Rocket Girls.”

Last but not least is Dr. Tracy Caldwell Dyson, who is the woman living at the International Space Station. She is the lead singer of an all-astronaut rock and roll band. Additionally, “she is one of the few people on the planet to have celebrated her birthday (number 38 to be exact) in space.”

These women are making space history, and are paving the way for more female engineers, scientists, and astronauts to come. We wish them well in their missions.

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Pittsburgh Public Schools’ Title IX Audit: Major Problems Found with Gender Equity Throughout the District

Last night, at the Education Committee meeting of the Pittsburgh Public Schools’ Board of Directors, Title IX consultant and auditor Peg Pennepacker presented her findings following an audit of the district’s high school athletics programs. The audit looked at gender equity in the sports programs and assessed compliance with Title IX, the 1972 law banning sex discrimination in most educational institutions.

The audit revealed that the school district is not providing equitable athletic opportunities to girls at any high school in the district, and that there are serious problems with scheduling, uniforms, equipment, coaching, and athletic training district-wide.

Ms. Pennepacker noted that not a single high school provides athletic opportunities to girls proportionate to their enrollment, which is one of the ways a school can comply with Title IX. According to this interpretation, if a school’s enrollment is 50% male and 50% female, then half of the athletes should be boys and half should be girls.

Disparity rates at district high schools ranged from 7% to a shocking 24%. At the school with the disparity rate of 24%, that means that there are 140 missing athletic opportunities for girls at that school. To bring all schools up to proportionality, the district would need to add 784 athletic opportunities for girls at the nine high schools with sports programs.

There has not been a strong expansion of girls’ sports in the district over the past several academic years. Two girls’ varsity sports were added during the 2007-08 school year, the last expansion of the sports program for female students.

Ms. Pennepacker noted serious problems with girls’ sports in the district. Most schools do not have an inventory of uniforms or a rotation schedule for uniforms. Additionally, many schools lack equipment that is suitable for girls and the sports they play. Girls’ sports need more experienced, quality coaches, and when the student to coach ratio exceeds 10:1, the team needs another coach. The district also needs to exercise more control over publicity and ensure that school-sponsored publications cover girls’ and boys’ sports equitably. Scheduling of girls’ sports should be brought up to par with boys’ sports – for example, if a boys’ basketball team at one school plays 22 games in a season, the girls’ basketball team should also be playing 22 games. Access to athletic trainers is also an issue – Ms. Pennepacker noted that currently one trainer is responsible for the teams at three high schools. This could actually be a dangerous situation for the student-athletes. The district also needs to improve policies regarding scheduling for teams that are in season and ensuring that all teams have access to weight rooms. As for facilities, most of them need improvement, but she encouraged the district to make maximum use of Cupples Stadium, using it for as many sports as possible and at the very least, for soccer, lacrosse and football games.

The auditor noted that the district needed a policy to oversee booster club money. The district says that they have one, and Ms. Pennepacker encouraged the district to ensure that schools are aware that they are responsible for correcting any disparity that arises from booster club donations.

Overall, school athletic directors would benefit from training and certification about what their responsibilities are. The auditor noted that the general feeling towards athletics throughout the district is that they are a necessary routine rather than a program with meaning and purpose. She emphasized that athletics are an extension of the classroom and can actually encourage young men and women to take their academics more seriously. She also noted the benefits of participating in sports for girls, including a lower teen pregnancy rate, lowered risk of eating disorders and drug use, and increased physical fitness.

Derrick Lopez, Assistant Superintendent for Secondary Schools, responded to Ms. Pennepacker’s presentation and said that he met with all coaches in the district on March 22, 2010. The school district has a three-step action plan in response to the audit. They plan to take immediate action on the timing of practices and games and on the scheduling of facilities. The second step is to conduct a review of internal practices and procedures to address disparities. As for the third action, they plan to establish an Athletic Program Task Force, which “will study athletics within the district and examine ways to address more systemic issues, i.e., participation in athletics by young women within the district.” The task force will be comprised of school district personnel, administrators, coaches, parents, students, and community members.

In light of the fact that this audit was commissioned to examine gender equity in the Pittsburgh Public Schools, we hope that the task force will be comprised of equal numbers of men and women who are committed to increasing girls’ athletic opportunities in the district. We commend the Pittsburgh Public Schools for undertaking the audit and planning to take steps to correct the inequities that were found in this report. Girls deserve the same opportunities that are available to their male peers, and we look forward to continuing to advocate for gender equity in athletics in western Pennsylvania and beyond.

Every day that goes by is another day that Pittsburgh’s young women are deprived of the equality that is theirs according to federal law.

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Filed under Education, Equality, Girls, Pittsburgh, Sports, Title IX

Pittsburgh Public Schools’ Title IX Audit: The Results Are In

In late 2008, the Women’s Law Project met with members of the Pittsburgh Public Schools’ board of directors and their counsel to advocate on behalf of female athletes in the district and discuss preliminary findings from Right-to-Know requests of several PPS high schools which indicated that girls were not receiving equitable athletic opportunities in their school athletics programs.

Soon afterward, the school board approved a Title IX audit of all high school athletics programs in the district. The audit was to focus on the availability of equal opportunities for female athletes to participate in competitive sports and on the treatment that female athletes receive in matters including athletic facilities, fields, equipment, uniforms, scheduling, publicity, coaching, and travel.

Now the audit has been submitted to the school board, and the Title IX consultant who conducted the audit will present her findings and recommendations at a meeting of the Education Committee of the board. The district’s counsel will also present their plan for implementing the auditor’s recommendations.

The meeting is Wednesday, April 7, at 5:30 PM in the Board Committee Room, Administration Building, 341 S. Bellefield Avenue (Oakland). The meeting is open to the public, and we hope to see many of our readers there to hear the results of the audit and hold the school district accountable for providing equal athletic opportunities to all students, regardless of sex. See you there!

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Filed under Education, Girls, Pittsburgh, Sports, Title IX

What Title IX Has Done for Women’s Sports at Pennsylvania’s Largest University—And What Remains to Be Done

What impact has Title IX had for women’s sports at Penn State University?

“I remember women’s teams like lacrosse didn’t even have their own uniforms. They would share with other teams,” [former women’s basketball coach] Domitrovitz said. “The only thing female athletes got was a voucher for a single pair of tennis shoes downtown. Basically, things weren’t satisfied until Title IX.”

Domitrovitz, along with other former women’s sports coaches discussed the effects of Title IX and how far the nation still has to go in ensuring equality for male and female athletes at an event held at Penn State last week.

According to the Women’s Law Project’s 2005 study [PDF] of athletic opportunities for women at the collegiate level in Pennsylvania, Penn State did a pretty good job when it came to gender equity in the athletic department. From that report:

Penn State’s equitable numbers for its main campus, along with the school president’s statements endorsing Title IX’s application to his school, demonstrate that a school with a nationally-prominent and competitive football team can, with a commitment to Title IX, provide equitable athletic opportunities to its female students.

But there is still work to be done. The 2005 report showed that there were 8,000 missing athletic opportunities for women in colleges and universities throughout Pennsylvania, and the need to continue pressing for gender equity in athletics can be seen in the Women’s Law Project’s litigation efforts at Slippery Rock University and Delaware State University.

In the end, it comes down to equality:

“It’s surprising to me how long it’s taken. We still aren’t there,” [former rifle team coach] Harpster said. “Eighty percent of schools today, even with Title IX, do not follow it to the ‘t.’ “

Penn State Assistant Athletic Director Sue Scheetz agreed. She said there are still roads to travel and progress to be made.

“Forty-five percent of all college athletes are women, but they only receive 37 percent of scholarship funds,” [moderator Jackie] Esposito said.

While all the women said they were happy with the progress made under the act, Harpster lamented its necessity.

“Imagine, if everyone did it how it should be done, what we could be doing right now,” she said. “It should be automatic. We shouldn’t even need a Title IX.”

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Filed under Education, Equality, Sports, Title IX