• Hillary Election 2016

  • Obamacare Now Welcome to the official source for everything to show your support
  • Interview

    A dark political satire film set in the future in the fictional desert country of Turaqistan.

    It stars John Cusack, Hilary Duff, Marisa Tomei, Joan Cusack, Ben Kingsley, and Dan Aykroyd.
    107 min., Rated R, 2008.
  • Movie Review

    Choices of the Heart: the Margaret Sanger Story (True Stories Collection)
    Starring Dana Delany and Henry Czerny, Directed by Paul Shapiro
    Rated: NR

    The movie tells the story of Margaret Sanger (Dana Delany, China Beach) fight for women’s health through family planning and sex education in the early 1900s. The story takes place in New York City where despairing, women are forced mainly by economics to end unwanted pregnancies themselves.

    Outraged and saddened by what she sees, Sanger takes on her life work to fight against the moral zealots that have created chaos in women’s lives.

  • Book Review

    Margaret Sanger: A Life of Passion
    Trained as a nurse and midwife in New York’s Lower East Side gritty slums, Margaret Sanger grew aware of the dangers of unplanned pregnancy—both physical and psychological. Sanger ignited a movement that has shaped our society to this day. Her views on reproductive rights have made her a frequent target of conservatives and moral zealots.

    In this captivating new biography, the renowned feminist historian Jean H. Baker rescues Sanger from such critiques and restores her to the vaunted place in history she once held.

  • Book Reviewed

    An American Prophecy: What the Cycles of History Tell Us About America's Next Rendezvous with Destiny By William Strauss and Neil Howe
    400 pages. Broadway 1997.
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    The Inside Story of the Struggle for Control of the United States Supreme Court

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    368 pages. Penguin Press HC. 2007.
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The War on Women’s Health, Part 3: Maternal Fetal Medicine

The War on Women’s Health

Part 3: Maternal Fetal Medicine

Planning for knowns while anticipating the unknowns.

By Truthmonk
October 30, 2012

Contraindications for pregnancy

Why unplanned pregnancies are bad


Women who are aware that a pregnancy would be high-risk may decide to delay getting pregnant. A high-risk pregnancy is one where there are potential complications that could affect the mother, baby, or both. Good medical practice requires high-risk pregnancies to be managed by a specialist to help ensure the best outcome for the mother and baby.

Risk come from a multitude of sources. Some conditions that can make a pregnancy high-risk include: the age of the mother,1 chronic diseases like cancer,2 – 13 infections and STDs,14 – 17, 21, 30 mental health medication,18, 31, 32 and recreational drug use including alcohol and tobacco,19, 20, 33environmentally imposed risks,22 – 24 inheritable genetic disorders.25 – 29

Contraindicated medical conditions that primarily affect (by medical dysfunction class):
Age related risks
1 Older mothers  
Chronic disease risks
2 Asthma
3 Thyroid Disease – hyperthyroidism (GravesÕ disease)
4 Thyroid Disease – hypothyroidism
5 Cancer
6 Epilepsy
7 Hypertension (High blood pressure)
8 Diabetes
9 Heart disease
10 Obesity
11 Anemia
12 Lupus
13 Kidney Disease
Infection risks
14 Congenital Rubella Syndrome
15 Varicella (chickenpox)
16 Sexually Transmitted Diseases
17 General infections
30 Viral hepatitis
Mental health risks
18 Schizophrenia 31 Severe depression
32 Bipolar Disorder
Recreational drug risks
19 Illicit drug use
20 Smoking
33 Alcohol (Fetal alcohol syndrome (FAS))
Environmental risks – Chemical Exposure
  22 Agrichemicals
23 Pesticides
Environmental risks – Radiation Exposure
  24 Radiation Exposure
Genetic disorder risks
  25 Down syndrome
26 Cystic fibrosis
27 TayÐSachs
28 Sickle-cell anaemia
29 Thalassemia
For the contraindicated medical conditions’s citations in the inforgraph, see the matching number in the sources.

Teratogenic Effects34

Many developing fetal systems are vulnerable to outside influences called teratogens, especially during the first 4 to 10 weeks after conception. The fetal neurological system can develop neural tube defects, spina bifida, and mental retardation. The cardiovascular system is susceptible to birth defects such as truncus arteriosus, atrial septal defects, and ventricular septal defects. The skeleton can develop with musculoskeletal anomalies and clubfoot. Myasthenia gravis and severe combined immune deficiency affect the immune system. Female fetuses can suffer from the masculinization of their external genitalia. Other fetus components that are susceptible to birth defects include: ears, eyes, teeth, upper lip, palate, upper & lower limbs, kidneys, and lungs.

Teratogens also produce effects on the fetus indirectly through the mother. Maternal teratogens effects include creating susceptibility to premature birth, intrauterine growth retardation (small for gestational age infants), and placental development interruptions.

Teratogens effects on fetal and maternal systems during pregnancy

Pregnancy35, 36

A woman may not be aware that she is pregnant.

The early signs of pregnancy are variable between women and even from pregnancy to pregnancy in the same woman. Adding to the confusion is that the early symptoms of pregnancy also resemble symptoms before and during menstruation. Even more confusing is some women have periodic bleeding during pregnancy mimicking their menstrual period.

While some women are so aware of their bodies, they seem to know from the start when they become pregnant, most don’t realize they are pregnant until they miss their menstrual period.

A woman’s menstrual period isn’t a sure fire way to determine if she is pregnant. For some women, an irregular period will make it difficult to recognized if an atypical event such as a pregnancy has occurred.

Irregular periods often occur during the first few years after menarche just when women start to explore their sexuality. Irregular periods usually occur just before memopause. Menstrual irregularities can be caused by diseases such as irritable bowel syndrome, tuberculosis, liver disease, and diabetes.

Even a missed menstrual period doesn’t necessary mean a pregnancy. Other causes for a missed period include: excessive weight loss or gain, eating disorders such as anorexia or bulimia, increased exercise, emotional stress, illness, travel, pelvic organ problems such as impeforate hymen, and polycrystic ovary syndrome, or Asherman’s syndrome. This is by no means an complete list.

A pregnancy test in the only reliably way to know for certain if a woman is pregnant.

Pregnancy test
This pregnancy test on the left shows a negative result because the results window has no pink line. The pink line in the control window shows that the test is working. The right pregnancy test shows a positive result because there is a pink line in the results window.

Photo from Photo from US Department of Health and Human Services

The only way a woman can avoid the birth defect dangers caused by teratogens is to know when she is pregnant. And the only way for a sexually active, fecund, non-pregnant or postpartum abstinence woman to be certain of not becoming pregnant is through the use of adequate family planning and modern contraceptives.

Only then can a woman take into account their personal and family situation and make appropriate medical decisions that are best for her and her baby’s health.

Other overlooked benefits of oral contraceptive pills37

According to the American College of Obstetrics and Gynecology (ACOG), oral contraceptive pills (OCPs) help relieve or reduce the symptoms of dysmenorrhea (menstrual pain), normalization of irregular periods, acne treatment, treatment of endometriosis caused pelvic pain, prevention of menstrual-related migraines, menorrhagia (excessive menstrual bleeding), bleeding due to uterine fibroids, hirsutism (excess hair growth), suppression of menstruation.

National data from the 2006–2008 National Survey of Family Growth shows 58% of women on the pill use it for some type of noncontraceptive reason. Noncontraceptive reasons are the only reason for 14% of the women on the pill. In addition more than one-third of the women, which use the pill for noncontraceptive reasons, have multiple non-birth control health benefit reasons.

Use of oral contraceptive pills

Life Changes

Or pregnancy is for life

During a woman’s pregnancy, some cells from the fetus traverse through the placenta into the maternal circulation (fetal microchimerism (FMc)) and some cells from the mother travel to the fetus (maternal microchimerism(MMc)).38

  A fraction of these immigrant cells will survive in their new host. This intermingling of foreign DNA or cells is called microchimerism (Mc).39  

“Fetal cells have been detected in the human maternal circulation as early as 4 weeks and 5 days post-conception” to “as long as 27 years after the birth of a male.”40

This exchange of cells is expected since the placenta rather than being an impassable gate, must act like a selective porous filter to allow the developing fetus to obtain nourishment etc. These immigrant cells “persist in their new host, circulating in the blood and even taking up residence in various tissues.”41

  During pregnancy, some cells from the fetus traverse through the placenta into the maternal circulation (FMc) and some cells from the mother travel to the fetus (MMc). A fraction of these immigrant cells will survive in their new host. This is called microchimerism.  

The immigrant maternal cells in the fetus can persist well into adult life.42 Another probable source of Mc in the fetus is from an older sibling or previous pregnancy of the mother.43

This means that every woman harbors foreign DNA derived from the fetuses of all her pregnancies and all fetuses harbor foreign DNA derived from their mothers and the fetuses of all her previous pregnancies. They may harbor this DNA for the remainder of their lives.

Various studies have implicated microchimerism in diseases such as systemic sclerosis (SSc), primary biliary cirrhosis (PBC), Sjögren’s syndrome, polymorphic eruption of pregnancy, myositis, and thyroid disease.39

Eighty percent of people with autoimmune diseases are women.44 Several autoimmune diseases affect women in their postpartum years. Fetus-maternal microchimerism is one hypotheses proposed to explain the gender difference.

Hashimoto’s thyroiditis is an autoimmune disease believed to be the most common cause of primary hypothyroidism. It is characterized by a range of symptoms including weight gain, depression, fatigue, mania, memory loss, panic attacks, and hair loss. Sjogren’s syndrome is an autoimmune disease. It has symptoms such as dry mouth and dry eyes. Other autoimmune diseases where fetal DNA was detected, sometimes decades after pregnancy, include progressive systemic sclerosis (PSS) and systemic lupus erythematosus.

Other diseases fetus-maternal microchimerism has been implicated in include steatosis, hepatitis C, primary biliary cirrhosis, and cardiovascular disease.43 Its role in several cancers has been the subject of investigation including thyroid cancer, cervical cancer, lung cancer and melanoma.

Its role in degenerative diseases such as Alzheimer’s disease is intriguing. It has been suggested that an abnormal accumulation of fetal origin microchimerism is responsible for the increase risk with increase number of pregnancies for Alzheimer’s disease and the five fold increased risk in mothers who gave birth to a child with down syndrome.

Fetus-maternal microchimerism derived cells have been found in bone marrow, thyroid, lungs, lymph node, skin, kidney, liver, heart, intestine, gallbladder, cervix, brain, blood, spleen, pancreas, and other tissues.

Yet there is some evidence that fetal-derived cells may provide some protection against breast cancer.45

Mc caused disease isn’t a one-way street. Chronic inflammatory disease in offspring has been linked to MMc.46 In neonatal lupus syndrome-congenital heart block (NLS-CHB), an acquired autoimmune disease, the hearts of patients have been found containing maternal myocardial cells.47 In juvenile dermatomyositis (JDM), a multisystem autoimmune disease, the presence of maternally derived chimeric cells was found and data indicates they have a direct role in the JDM disease process.48

  Various types of microchimerisms affect humans. The common mother-Mc and fetus-Mc and the organs/presumed cell types affected by them are shown.  

The foreign DNA derived from siblings from previous pregnancies that a child harbors could be to its benefit or detriment.43

The research into FMc and MMc, is still in its infancy. The jury is still out as to the relationship that FMc and MMc may play in disease. What can be said is pregnancies make permanent changes to a women’s body. Some of these changes are on a large scale. Some, like FMc and MMc, are small scale.

Next: The War on Women’s Health, Part 4 – Contraceptive Coverage Economics

Previous: The War on Women’s Health, Part 2 – Family Planning

Mayo Clinic Guide to a Healthy Pregnancy

Women looking for authoritative, accurate information from a reputable source will appreciate this pregnancy book from the world-class Mayo Clinic. Features include week-by-week updates on baby’s growth and month-by-month changes for mom, a 40-week pregnancy calendar, a symptoms guide, and a review of important pregnancy decisions. In this illustrated book you’ll also receive advice on how to get pregnant, meal planning, exercise, medication use and parenthood. Plus, you’ll find answers to difficult or embarrassing questions. Mayo Clinic Guide to a Healthy Pregnancy is an essential pregnancy resource for parents-to-be.

Pregnancy, Childbirth, and the Newborn (4th Edition): The Complete Guide

This comprehensive, authoritative “bible” provides expectant couples with abundant, valuable, research-based information about pregnancy, labor, birth, the postpartum period, and newborn care. The book has been redesigned so it’s more accessible and reader-friendly, with more photos, illustrations, and boxed features that allow for important information to be highlighted. Also included in the new design are fun and informative sidebars, such as “Fact or Fiction?” in which the authors present common misinformation and the facts. New to this edition is a website with additional maternity care information as well as helpful forms and worksheets.


Numbers 1 – 33 are also for the contraindicated medical conditions’s cited in the inforgraph.

1 ø | Trying to get pregnant: Pregnancy after 35 (Webpage) | March of Dimes Foundation | May 2009 | Accessed February 27, 2012 @ http://www.marchofdimes.com/pregnancy/trying_after35.html.
2 ø | NAEPP Working Group Report on Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment, Update 2004 | U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute: Bethesda, MD | NIH Publication No. 05-5236 | March 2005 | Available @ http://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg/astpreg_full.pdf | Accessed February 27, 2012.
3,4 ø | Thyroid Disease and Pregnancy | American Thyroid Association | 2005 | Available @ http://www.thyroid.org/patients/brochures/Thyroid_Dis_Pregnancy_broch.pdf | Accessed February 27, 2012.
5 ø | Pregnancy and Cancer (Webpage) | American Society of Clinical Oncology | May 2011 | Accessed February 27, 2012 @ http://www.cancer.net/patient/Coping/Emotional+and+Physical+Matters/
6 Staff | Epilepsy and pregnancy: What you need to know (Webpage) | Mayo Clinic | July 30, 2011 | Accessed February 27, 2012 @ http://www.mayoclinic.com/health/pregnancy/PR00123.
7 ø | High Blood Pressure in Pregnancy (Webpage) | U.S. Department of Health & Human Services; National Institutes of Health; National Heart Lung and Blood Institute | Not dated | Accessed February 27, 2012 @ http://www.nhlbi.nih.gov/health/public/heart/hbp/hbp_preg.htm.
8 ø | Type 1 or Type 2 Diabetes and Pregnancy, Problems of Diabetes in Pregnancy (Webpage) | Centers for Disease Control and Prevention | Updated: June 7, 2010 | Accessed February 27, 2012 @ http://www.cdc.gov/NCBDDD/pregnancy_gateway/diabetes-types.html.
9 ø | Impact on Females | American Heart Association (Webpage) | Updated: Mon, 24 Jan 2011 | Accessed February 27, 2012 @ http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/
10 Rasmussen, Sonja A | Human Teratogens | Centers for Disease Control and Prevention | June 26, 2011 | Available @ http://www.teratology.org/pubs/2011_human_teratogens_update.pdf | Accessed February 27, 2012.
11 Keller, Scott | Anemia in Pregnancy (Webpage) | WebMD | Reviewed: January 08, 2012 | Accessed February 27, 2012 @ http://www.webmd.com/baby/anemia-in-pregnancy?page=2.
12 ø | Pregnancy and Lupus (Webpage) | Lupus Foundation of America | No date | Accessed March 9, 2012 @ http://www.lupus.org/webmodules/webarticlesnet/templates/new_donate.aspx?articleid=314&zoneid=6.
13 Krane, N Kevin; Feinfeld, Donald A; Talavera, Francisco; Legro, Richard S; Batuman, Vecihi | Renal Disease and Pregnancy, Pregnancy and Underlying Renal Disease (Webpage) | Medscape Reference | Updated: Mar 29, 2011 | Accessed February 27, 2012 @ http://emedicine.medscape.com/article/246123-overview#aw2aab6c15.
14 ø | Chapter 19 Rubella; Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book), 12th Edition | Centers for Disease Control and Prevention, Atlanta, GA | Updated: April 15, 2011 | Accessed February 27, 2012 @ http://www.cdc.gov/vaccines/pubs/pinkbook/rubella.html.
15 ø | Vaccines and Immunizations, Vaccines and Preventable Diseases: Varicella Vaccine – Q & As about Pregnancy | Centers for Disease Control and Prevention | Reviewed on June 1, 2009 | Accessed February 27, 2012 @ http://www.cdc.gov/vaccines/vpd-vac/varicella/vac-faqs-clinic-preg.htm.
16 ø | Sexually Transmitted Diseases (STDs), STDs & Pregnancy – CDC Fact Sheet | Centers for Disease Control and Prevention | Updated: February 27, 2012 | Accessed February 27, 2012 @ http://www.cdc.gov/std/pregnancy/STDFact-Pregnancy.htm.
17 ø | Pregnant Women Need a Flu Shot! (Webpage) | Centers for Disease Control and Prevention | Updated: February 27, 2012 | Accessed March 10, 2012 @ http://www.cdc.gov/Features/PregnancyAndFlu/.
18 Nilsson, E; Lichtenstein, P; Cnattingius, S; Murray, RM; Hultman, CM | Women with schizophrenia: pregnancy outcome and infant death among their offspring | Schizophrenia Research | Volume 58, Number 2-3, Pages 221 – 229 | December 1, 2002.
18 Jaffe, D.J., | Pregnancy pointers for women with Schizophrenia | Schizophrenia.com | No date | Accessed February 27, 2012 @ http://www.schizophrenia.com/schizoph/NBDpreg.html.
19 Nihira, Mikio A. | Health & Pregnancy: Drug Use and Pregnancy (Webpage) | WebMD | Reviewed: December 20, 2009 | Accessed February 27, 2012 @ http://www.webmd.com/baby/drug-use-and-pregnancy?page=2.
20 ø | Smoking during pregnancy (Webpage) | March of Dimes Foundation | April 2010 | Accessed February 27, 2012 @ http://www.marchofdimes.com/pregnancy/alcohol_smoking.html
21 ø | Pregnancy and Childbirth (Webpage) | Centers for Disease Control and Prevention | Reviewed: October 10, 2007 | Accessed February 27, 2012 @ http://www.cdc.gov/hiv/topics/perinatal/index.htm
22 Winchester, Paul D; Huskins, Jordan; Ying, Jun | Agrichemicals in surface water and birth defects in the United States | Acta Paediatrica | Volume 98, Number 4, Pages 664–669 | April 2009.
23 Sanborn, M.; Kerr, K.J.; Sanin, L.H.; Cole, D.C.; Bassil, K.L.; Vakil, C. | Non-cancer health effects of pesticides, Systematic review and implications for family doctors | Canadian Family Physician | Volume 53, Number 10, Pages 1712 – 1720 | October 2007.
24 ø | Emergency Preparedness and Response, Radiation and Pregnancy: A Fact Sheet for the Public | Centers for Disease Control and Prevention | Reviewed March 29, 2011 Accessed February 27, 2012 @ http://www.bt.cdc.gov/radiation/prenatal.asp.
25-29 ø | Frequently Asked Questions About Genetic Disorders (Webpage) | U. S. Department of Health and Human Services; National Institutes of Health; The National Human Genome Research Institute | Updated: February 27, 2012 | Accessed February 27, 2012 @ http://www.genome.gov/19016930.
30 ø | Protect Your Baby for Life, When a Pregnant Woman Has Hepatitis B | Centers for Disease Control and Prevention | Publication No. 22-0432 | October 2010 | Accessed February 27, 2012 @ http://www.cdc.gov/hepatitis/HBV/PDFs/HepBPerinatal-ProtectWhenPregnant.pdf.
31 Staff | Antidepressants: Safe during pregnancy? (Webpage) | Mayo Clinic | January 10, 2012 | Accessed February 27, 2012 @ http://www.mayoclinic.com/health/antidepressants/DN00007.
32 Chang, Louise | Bipolar Disorder in Pregnancy | WebMD | Reviewed: July 13, 2010 | Accessed February 27, 2012 @ http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-in-pregnancy.
33 ø | Alcohol Use in Pregnancy (Webpage) | Centers for Disease Control and Prevention | Updated: October 6, 2010 | Accessed February 27, 2012 @ http://www.cdc.gov/ncbddd/fasd/alcohol-use.html.
34 Professordoktor | Chart of critical periods of humandevelopment (Weblog) | SciTechLab |20120612 | Accessed 20120618 @ http://scitechlab.wordpress.com/2012/06/12/chart-of-critical-periods-of-human-development/.
35 Chang, Louise (Reviewer) | Health & Pregnancy, Pregnancy Symptoms (Online) | WebMD | Reviewed on August 09, 2010 | Accessed April 29, 2012 @ http://www.webmd.com/baby/guide/pregnancy-am-i-pregnant.
36 ø | Women’s Health, Missed or Irregular Periods – Topic Overview (Online) | WebMD | Updated on /2, 09 1 | Accessed April 29, 2012 @ http://women.webmd.com/tc/missed-or-irregular-periods-topic-overview.
37 Jones, Rachel K. | Beyond Birth Control: The Overlooked Benefits Of Oral Contraceptive Pills | Guttmacher Institute, New York, NY, USA | November 2011.
38 Pritchard, Stephanie; Wick, Heather C.; Slonim, Donna K.; Johnson, Kirby L.; and Bianchi, Diana W | Comprehensive Analysis of Genes Expressed by Rare Microchimeric Fetal Cells in the Maternal Mouse Lung (Online) | Biology of Reproduction Papers in Press | 20120606 | Accessed 20120618 @ http://www.biolreprod.org/content/early/2012/06/01/biolreprod.112.101147.
39 Nelson, J Lee | Microchimerism in human health and disease | Autoimmunity | Volume 36, Number 1, Page 5-9 | February 2003. http://informahealthcare.com/doi/abs/10.1080/0891693031000067304
40 Bianchi, D W; Zickwolf, G K; Weil, G J; Sylvester, S; and DeMaria, M A | Male fetal progenitor cells persist in maternal blood for as long as 27 years postpartum | Proceedings of the National Academy of Sciences of the United States America | Volume 93, Number 2, Page 705 – 708 | 19960123.
41 Nelson, J. Lee | Your Cells Are My Cells | Scientific American | February 2008 | 20080117 | http://www.scientificamerican.com/article.cfm?id=your-cells-are-my-cells.
42 Nelson, J. Lee | Microchimerism (webpage) | No date | Accessed 20120619 @ http://www.microchimerism.org/.
43 Nelson, J. Lee | The otherness of self: microchimerism in health and disease | Trends in Immunology | TREIMM-939, Pages 7 (Not in print) | 20120523 | Accessed 20120622 @ http://www.ncbi.nlm.nih.gov/pubmed/22609148.
44 Knippen, Maureen A. | Microchimerism: Sharing Genes in Illness and in Health | ISRN Nursing | Volume 2011, ID 893819, Pages 4 | 20110523 | Accessed 20120622 @ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169192/.
45 Gadi, Vijayakrishna K.; Malone, Kathleen E.; Guthrie, Katherine A.; Porter, Peggy L. | Nelson, J. Lee | Case-Control Study of Fetal Microchimerism and Breast Cancer | PLoS ONE | Volume 3, Number 3, e1706 | 20080305 | Accessed 20120619 @ http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0001706.
46 Stevens, Anne M | Do maternal cells trigger or perpetuate autoimmune diseases in children? | Pediatric Rheumatology (Online journal) | Volume 5, Article ID 9 | 20070516 | Accessed 20120623 @ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892552/
47 Stevens, A. M.; Hermes, H. M.; Lambert, N. C.; Nelson, J. L.; Meroni, P. L.; and Cimaz, R. | Maternal and sibling microchimerism in twins and triplets discordant for neonatal lupus syndrome-congenital heart block | Rheumatology | Volume 44, Issue 2, Pages 187-191 | February 2005 | Accessed 20120623 @ http://rheumatology.oxfordjournals.org/content/44/2/187.short.
48 Reed, Ann M.; McNallan, Kelly; Wettstein, Peter; Vehe, Richard; and Ober, Carole | Does HLA-Dependent Chimerism Underlie the Pathogenesis of Juvenile Dermatomyositis? | The Journal of Immunology | Volume 172, Number 8, Pages 5041-5046 | 20040415 | Accessed 20120623 @ http://www.jimmunol.org/content/172/8/5041.abstract?ijkey=fbe3e730b4a2d4cd19087a084b8efef6c0cce2d0&keytype2=tf_ipsecsha


The War on Women’s Health, Part 2: Family Planning

The War on Women’s Health

Part 2: Family Planning

It’s all about keeping mothers well and making healthly babies.

By Truthmonk
October 29, 2012


The CDC called family planning one of the ten greatest achievements in public health in the 20th century.1 Family planning is about deciding how many children couples want to have and when they want to have them.

Family planning has allowed the United States to achieve desired birth spacing and smaller family size. The success of family planning has been instrumental in the decline of infant, child, and maternal deaths as well as improving the overall health of infants, children, and women.2

Reproductive events in a woman’s life

The typically American woman spends about five years pregnant, recovering from being pregnant, or trying to get pregnant. However, she’ll spend most of her reproductive life, almost 40-years or 87%, trying to avoid getting pregnant. In the end she’ll have two children.3

Without family planning and modern contraceptives, the average woman would have 12 to 15 pregnancies in her lifetime.4

American Family Size

The colonial family from the founding of the Plymouth colony in 1620 to the Revolutionary War in 1775 had on average at least seven children and sometimes as many as nine or 10.5

But with the start of the Industrial Revolution, the American family size started to drop.6 The interrelationships between the social, economic, and political arenas caused fundamental changes to occur. One change was the increased opportunities for upward social and economic mobility brought about by the construction of industrial mills, primarily iron and textiles.

Peale family Portrait by Charles Willson Peale.
Peale family Portrait by Charles Willson Peale in 1771-1773.
Some of Charles Peale 17 children.
All this economic growth “led to increases in the quality and quantity of available consumer products and services, expected consumption standards rose, and individuals were required to spend more money simply to maintain the new normal standard of living.”

Adults sought to take advantage of these opportunities for themselves and their families. However, the urban locations of the mills, required them to move from the farms to the cities. Moving to the cities meant they had to give up self-sufficiency in exchange for the necessity of paying cash for housing, food, clothing, and other essentials.

Another change was the downward adjustment in the parental benefits of having children. This came from two directions. First the benefits of having a large number of children while economical on the farm had little purpose in the cities, especially after “the passage of laws restricting child labor and mandating compulsory education.” Second children in the cities cost money. The cost of supporting each additional child at a new normal level became increasingly apparent.


Herdandez tidily summed up the situation said, “In addition, the newly available goods and services competed with children for parental time and money. Since each additional child in a family requires additional financial support and makes greater demands on parental time and attention, the birth of each child reduces the time and money parents can devote to their own work or career as well as to recreation and to older children.”

Parents met this challenge “at least in part by limiting their fertility,” i.e. family planning.

Short birth intervals has medical risks for mother and fetus

Short birth intervals not only plays a significant role in determining the weight and health of the newborn baby, but has ramifications for the mother and fetus as well.

A short list of maternal risk include infection, premature rupture of the amnion and chorion membranes, third-trimester bleeding, and postpartum hemorrhage;7 placental abruption, placenta previa, and uterine rupture;8 and even maternal morbidity, and death.9

Some maternal medical conditions that can emerge during the pregnancy are anemia7 and macro- and micro-nutrient nutrient depletion.9

These conditions can affect the developing fetus causing low birthweight and small size for gestational age;8 retarded fetal growth;9 preterm births, miscarriages and stillbirths.10

Short birth interval leads to low birthweight infants

In the last three decades, advances in medical technology and neonatal intensive care have significantly improved the survival rates of infants born preterm. Yet, these very small premature babies, those under three pounds, are at high risk for delayed growth and lasting developmental problems.

Low birthweight baby
A neonatal intensive care nurse holds a very small premature baby weighing less than 3 pounds.

Photo from
CarmenWiki, The Ohio State University

The spacing between births, called the birth interval, plays a significant role in determining the weight of the newborn baby, thus the health of the baby.11 Normal, healthy babies weigh at least 2,500 grams or 5 pounds 8 ounces. Babies weighing less at birth are classified as follows: low birthweight (LBW) infants (less than 2,500 grams or 5 pounds 8 ounces), moderately low birthweight (MLBW) infants (1,500-2,499 grams, or 3 pounds 4 ounces to 5 pounds 8 ounces), and very low birthweight (VLBW) infants (less than 1,500 grams, or 3 pounds 4 ounces).

The correlation between subnormal birthweight risk and birth interval is direct as shown in the graph. There is a substantial increase risk of low birth weight when babies are born less than 18 months after a previous live birth. The risk for low birth weight increases after 48 months. The best birth interval is between 24 to 47 months, i.e. the birth interval associated with the lowest risk for having a low birth weight baby.

Low birthweight has medical risks for infant and children

  The smaller an infant is at birth, the greater the risk of health and developmental complications.12

As advances in medical technology have for low birthweight (LBW) infants greatly increased their survival odds, there remains troubling medical outcomes for them.

Surviving LBW infants are three times more likely to have neurodevelopmental handicaps and twice as likely to have a serious congenital anomaly.11

Studies have shown LBW children have “significantly greater risk for developing respiratory symptoms, including wheezing, coughing and pulmonary infections”13 and “that these respiratory problems may persist well beyond their infancy and childhood and into adulthood.”14

LBW children are “at higher risk for psychiatric disturbances from childhood through high school” including delinquent & aggressive behavior in boys15 and anxiety & depression in girls.16 The incidence of ADHD is higher for LBW children.15

The additional familial stress puts them at higher risk for abuse and neglect.17

They have an increased risk of developing serious or prolonged illnesses throughout their lives. A host of medical complications developing in later life such as cardiovascular diseases, high blood pressure, type II diabetes (adult onset diabetes)18, and asthma19 are associated with low birthweight.

Low birthweight leads to higher risk of infant death

Obviously the worse medical risk for an infant is death. The risk of dying at less than 1 year of age sharply increases with declining birth weight.12 In the first year of life the risk of dying for very low birth-weight babies is 105 times higher than for normal birth weight babies. Even for moderately low birth-weight babies there is a 6 times higher risk of death during the first year.

Dr. Maureen Hack, the Director of the High Risk Follow-Up Program in the Department of Pediatrics and Department of Obstetrics and Gynecology at Case Western Reserve University, tidily summed up:
•  Cerebral palsy, blindness, deafness and other neuromotor dysfunction are potential risks of low birth weight.
•  Though the mean IQ score of low birth weight children falls within the average range, there are higher rates of deficient and subnormal intelligence.
•  Higher rates of health problems result in more medical and surgical procedures, frequent rehospitalizations after surgery, and limitations to the activities of daily life.
•  The rates of conduct disorder, hyperactivity and attentional weakness increase with decreasing birth weight and are associated with brain injury due to low birth weight.
•  Low birth weight has significant negative effects on families, including financial impact, increased caretaker burden, and general family burden.
•  Parents of low birth weight children exhibit higher levels of parental protection at school age than normal birth weight children.
•  Mental or emotional delay can limit a child’s ability to participate in physical activities and to play or socialize with others.
•  Health problems contribute to an increased number of days spent in bed, restricting children’s activity, decreasing their school attendance, and limiting their social interactions.
•  Learning problems at school place LBW children at greater risk for grade repetition or placement in special education programs.
•  LBW teens are involved in fewer risky behaviors in adolescence, including lower rates of alcohol and marijuana use, less contact with police, and lower rates of pregnancy than normal birth weight teens.
•  Growth attainment is generally lower than normal birth weight peers.
•  Compared to their peers, children born with low birth weight are more likely to experience functional limitations.
Hack, Maureen | Focus on Research at Case Western Reserve University | Policy Brief | Schubert Center for Child Studies (Case Western Reserve University) | Policy Brief 6 | October 2007.


Next: The War on Women’s Health, Part 3 – Maternal Fetal Medicine

Previous: The War on Women’s Health, Part 1 – In the Beginning

Family Life in 17th- and 18th-Century America (Family Life through History)

Colonial America comes alive in this depiction of the daily lives of families—mothers, fathers, children, and grandparents. The Volo’s examine the role of the family in society and typical family life in 17th- and 18th-century America. Through narrative chapters, aspects of family life are discussed in depth such as maintaining the household, work, entertainment, death and dying, ceremonies and holidays, customs and rites of passage, parenting, education, and widowhood. Readers will gain an in-depth understanding of the world in which these families lived and how that world affected their lives. Also included are sources for further information and a timeline of historic events.

The book focuses on the day-to-day lives and roles of families throughout history. The roles of all family members are defined and information on daily family life, the role of the family in society, and the ever-changing definition of family are discussed.

America’s Children: Resources from Family, Government, and the Economy (Population of the United States in the 1980s: A Census Monograph)

Chapter 2 (The family-size revolution: From many to few siblings) reports the dramatic decline in the number of children in families, the change in sibling relationships, and the corresponding competition for limited family resources between the siblings.


A Population History of North America

The book discusses the fine details of many broad trends of North America’s population history from pre-Columbian times to the present.


1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC | Ten Great Public Health Achievements — United States, 1900–1999 | MMWR | Volume 48, Number 12, Pages 241 – 243 | 19990402.
2 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC | Achievements in Public Health, 1900–1999: Family Planning | MMWR | Voloume 48, Number 47, Pages 1071 –1081 | 19991203.
3 Gold, Rachel Benson; Sonfield, Adam; Richards, Cory L.; Frost, Jennifer J. | Next Steps for America’s Family Planning Program: Leveraging the Potential of Medicaid and Title X in an Evolving Health Care System | Guttmacher Institute, New York, NY, USA | 2009.
4 Ø | Fact Sheet On Benefits of Family Planning | Bixby Center for Reproductive Health Research & Policy (University of California, San Francisco) | Version 3 | June 2006.
5 Volo, James M.; Volo, Dorothy Denneen | Family Life in 17th- and 18th-Century America (Family Life through History) | Greenwood (2005) | Page 45.
6 Herdandez, Donald J. | America’s Children: Resources from Family, Government and the Economy | Russell Sage Foundation (New York, New York, USA) | 1993 | Pages 36 – 38.
7 CATALYST Consortium | Systematic Literature Review and Meta-Analyses on Birth Spacing: How Birth Spacing Relates to Infant and Child Mortality, Maternal and Perinatal Health, and Maternal and Child Nutrition Outcomes | U.S. Agency for International Development | April 29, 2005.
8 Mayo Clinic staff | Family planning: Get the facts about pregnancy spacing | Mayo Clinic | May 27, 2011 | Accessed 20060226 @ http://www.mayoclinic.com/health/family-planning/MY01691.
9 King, Janet C. | The Risk of Maternal Nutritional Depletion and Poor Outcomes Increases in Early or Closely Spaced Pregnancies| Journal of Nutrition | Volume 133, Number 5, Pages :1732S-1736S | May 2003.
10 USAID | Family Planning, Birth Spacing (Webpage) | U.S. Agency for International Development | Updated June 02, 2009 | Accessed 20060226 @ http://www.usaid.gov/our_work/global_health/pop/techareas/birthspacing/index.html.
11 Taffel, SM | Trends in low birth weight: United States, 1975-85; Vital Health Statistics | National Center for Health Statistics | Series 21, Number 48 | October 1989.
12 Mathews, T.J.; MacDorman, Marian F. | Infant Mortality Statistics From the 2007 Period Linked Birth/Infant Death Data Set | National Vital Statistics Reports (National Center for Health Statistics; Hyattsville, MD) | Volume 59, Number 6 | 20110629.
13 Ø | Full-Term, Low-Birth-Weight Babies At Significantly Greater Risk For Early Respiratory Symptoms (Webpage) | ScienceDaily’s Science News | May 15, 2007 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com.
14 Ø | Low Birth Weight Linked To Long-Term Respiratory Problems (Webpage) | ScienceDaily’s Science News | July 7, 2009 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com.
15 Ø | Low Birth Weight Children Appear At Higher Risk Of Psychiatric Disturbances (Webpage) | ScienceDaily’s Science News | Sep. 1, 2008 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com.
16 Ø | Low Birth Weight May Predict Depression In Teen Girls (Webpage) | ScienceDaily’s Science News |Mar. 5, 2007 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com.
17 Ø | Small Birthweight And Premature Births Associated With Higher Risk Of Child Abuse (Webpage) | ScienceDaily’s Science News | Mar. 14, 2006 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com.
18 Ø | Low Birth Weight Of A Baby Entails Risks For The Baby’s Father (Webpage) | ScienceDaily’s Science News | June 30, 2005 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com.
19 Ø | Impaired Fetal Growth Increases Risk Of Asthma (Webpage) | ScienceDaily’s Science News (Oct. 12, 2009 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com.

The War on Women’s Health

The War on Women’s Health

Part 1: In the Beginning

What all the fuss is about.

By Truthmonk
October 26, 2012


In a repeat of history, the conservative Republicans are once again attacking what they perceive as a soft target – women. As is typical for their species, conservative Republicans look backward to the past, for their vision of the future.

Margaret Sanger
Margaret Sanger. Photograph by Underwood & Underwood in 1922.

Photo from
Famous People Collection of the Library of Congress

Stepping through a crack of time, we see a woman, dressed in gray, in a bleak concrete jail cell. The time is 1917. The middle-aged women, Margaret Sanger, is pacing with an urgency born out of real-life experience. Earlier Sanger had been found guilty of distributing information for the prevention of conception. For in this age of darkness, it was considered an evil to tell of “any recipe, drug, or medicine for the prevention of conception.”1

She had tried to argue “exposing women, against their will, to the danger of dying in childbirth violated a woman’s right to life.” Therefore any law prohibiting distribution of contraception or information about contraception, must be unconstitutional. The trail judge bellowed from his high throne of justice, that no woman had “the right to copulate

with a feeling of security that there will be no resulting conception.”

With that he brought down his gavel, its sound echoing the impeding doom through the chamber.

Sanger had to get out and continue the fight.

Courtroom Scene
Artist’s conception of Margaret Sanger’s trail.


Just Another Right-wing-conservative Fake Controversy

The brouhaha over the U.S. Department of Health and Human Services (HHS) ruling is too little, too late. The new guidelines are designed to ensure women will receive preventive health services* at no additional cost.

Kathleen Sebelius
US Department of Health and Human Services Secretary Kathleen Sebelius.

Photo from
US Department of Health and Human Services

“ ‘The Affordable Care Act helps stop health problems before they start,’ said HHS Secretary Kathleen Sebelius. ‘These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need.’ ”2

As stated in a January 20 HHS press release3, the rules would:

  • require most health insurance plans to cover women’s preventive services without charging a co-pay, co-insurance or a deductible
  • exemption allowing certain non-profit religious organizations not to provide contraception coverage similar to the regulations in 28 states
  • other nonprofit religious employers will be provided an additional year to comply with the new rules.
  • The guidelines also mandated coverage in many other women healthcare areas from breast feeding support to well-women visits.

    To accommodate non-profits employers such as charities, hospitals, schools, universities, or other religious organizations that may have “a religious objection to providing contraceptive services as part of its health plan,” President Obama modified the guidelines4 so they no longer have to include contraceptive services. Instead, the health insurance company will cover the women’s contraceptive services needs. Thus the new guidelines “accommodates religious liberty while protecting the health of women.”

    Catholic Health Association, Catholic Charities, and Catholics United have praised the new guidelines — White House (Feb 12)4.

    Even with this olive branch offered to the right-wing religious community, the critics keep babbling about the infringement of their religious liberty.

    Some Facts about the new law — White House (Jan 20)5:

  • Churches are exempt from the new rules.
  • No doctor will be forced to prescribe contraception when it violates their religious or moral beliefs.
  • No individual will be forced to buy or use contraception.
  • Abortifacient drugs like RU486 are excluded from the list of contraceptive drugs that must be covered, period. No Federal tax dollars are used for elective abortions.

    The eight new additional women’s preventive services that will be covered without cost-sharing requirements include:

    • Well-woman visits: This would include an annual well-woman preventive care visit for adult women to obtain the recommended preventive services, and additional visits if women and their health care providers determine they are necessary. These visits will help women and their health care providers determine what preventive services are appropriate, and set up a plan to help women get the care they need to be healthy.
    • Gestational diabetes screening: This screening is for women 24 to 28 weeks pregnant, and those at high risk of developing gestational diabetes. It will help improve the health of mothers and babies because women who have gestational diabetes have an increased risk of developing type 2 diabetes in the future. In addition, the children of women with gestational diabetes are at significantly increased risk of being overweight and insulin-resistant throughout childhood.
    • HPV DNA testing: Women who are 30 or older will have access to high-risk human papillomavirus (HPV) DNA testing every three years, regardless of Pap smear results. Early screening, detection, and treatment have been shown to help reduce the prevalence of cervical cancer.
    • STI counseling: Sexually-active women will have access to annual counseling on sexually transmitted infections (STIs). These sessions have been shown to reduce risky behavior in patients, yet only 28 percent of women aged 18-44 years reported that they had discussed STIs with a doctor or nurse.
    • HIV screening and counseling: Sexually-active women will have access to annual counseling on HIV. Women are at increased risk of contracting HIV/AIDS. From 1999 to 2003, the Centers for Disease Control and Prevention reported a 15% increase in AIDS cases among women, and a 1% increase among men.
    • Contraception and contraceptive counseling: Women will have access to all Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling. These recommendations do not include abortifacient drugs. Most workers in employer-sponsored plans are currently covered for contraceptives. Contraception has additional health benefits like reduced risk of cancer and protection against osteoporosis.
    • Breastfeeding support, supplies, and counseling: Pregnant and postpartum women will have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment. Breastfeeding is one of the most effective preventive measures mothers can take to protect their health and that of their children. One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies.
    • Interpersonal and domestic violence screening and counseling: Screening and counseling for interpersonal and domestic violence should be provided for all adolescent and adult women. An estimated 25% of women in the United States report being targets of intimate partner violence during their lifetimes. Screening is effective in the early detection and effectiveness of interventions to increase the safety of abused women.

    Members of Congress are already have coverage for these preventive services. The National Business Group on Health recommends these services and many private employers already cover them.

    Source: Ø | Affordable Care Act Rules on Expanding Access to Preventive Services for Women | U.S. Department of Health & Human Services | Posted on: August 1, 2011; Last updated: July 31, 2012; Accessed September 7, 2012 @ http://www.healthcare.gov/news/factsheets/2011/08/womensprevention08012011a.html

    National Academy of Sciences Report

    Advise from The Supreme Council of Nerds

    Where could more unbiased, dispassionate, honest, factual advice be found than with our very own National Academy of Sciences’ Institute of Medicine?

    IOM Logo
    The Institute of Medicine6 (IOM) has an international reputation for scholarly independence and the highest quality reports. Their reports are regularly used internationally.

    The IOM7 found that “evidence exists that greater use of contraception

    within the population produces lower unintended pregnancy and abortion rates nationally” and the removal of co-pays, co-insurance, and deductibles will greatly increase the use of contraception.

    IOM states that preventive contraceptive services is the healthcare industry standard for both federal and private insurance programs. All federal employees, including members of congress have no-cost contraceptive services benefits.

    The IOM concluded that “ the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity” should be provided as a preventive service for women. (Page 165)

    By accepting the IOM expert advisory panel recommendations for contraceptives, supplies, and counseling services, the HHS wants to eliminate financial disincentives to using effective preventive care and improving the subsequent health outcomes.

    National Business Community

    The Gold Star Standard in Healthcare

    The National Business Group on Health represents large employers on national health policy issues.8 In their report Investing in Maternal and Child Health they reported that all

    Gold Star
    contraceptive methods produced a significant cost-savings.[2-83] They came from both financial savings and health gains. Compared to no contraception, oral contraceptives resulted in cost-savings of $8,827 and the monthly injectable resulted in cost-savings of $8,770.

    Among NBGH’s unintended pregnancy prevention services recommendations is to include, even in their most basic benefit set:

    1. “all FDA-approved prescription contraceptive methods (e.g., pills, patches, IUDs, diaphragms, vaginal rings);”
    2. “voluntary sterilization” procedures (e.g., tubal ligation, vasectomy);
    3. “medically appropriate laboratory examinations and tests, counseling services, and patient education;” and
    4. with no coverage limits or cost-sharing on counseling services, medication, procedures, or prescribed devices.

    The report concluded, “In order to reduce unintended pregnancy, employers should provide comprehensive contraception coverage for employees and dependents. Employers should also consider removing cost barriers by eliminating cost-sharing requirements on contraceptive medications, devices, procedures, and office visits. Expanding coverage and removing cost barriers is particularly important for adolescents because many can not afford to pay for contraceptives out-of-pocket.”[4-27]

    Doing this will the raise preventive contraceptive services coverage in ObamaCare to near the national business community standard.

    28 States Have Similar Requirements

    Or the Horses Have Already Left the Barn

    Most of our citizens already live in state with similar contraceptive health requirements as the proposed federal requirements.

    Twenty eight states9 require insurers to provide full coverage of all FDA approved contraceptive drugs and devices if they cover prescription drugs.

    Eight states have no exemptions — Colorado, Georgia, Iowa, Montana, New Hampshire, Vermont, Washington, and Wisconsin.

    Another four states allow only churches and their associations an exemption: Arizona, California, New York, and Oregon. The remaining 16 states require coverage very similar to the federal plan.

    Contraceptive Map

    Right now 178 million people have full coverage under their state plans and the federal plan would have little, if any effect on them. The federal plan would be bringing the other 133 million people up to par.

    The religious right’s outrage seems to have gone awol concerning the 28 states that have full coverage requirements where over half the population lives.

    The Economics of Providing Contraceptive Coverage

    Saving money by preventing unplanned pregnancies

    “Debates over improving insurance coverage of contraceptives invariably touch on the issue of cost. Research and experience now suggest that contraceptive coverage does not raise insurance premiums and that employers providing such coverage can, in fact, save money by avoiding costs associated with unintended pregnancy.”10

    Multiple studies from 1987 to 2010 have found contraceptive coverage does not cost more but saves money both for public Medicaid and private insurers.

    Cost Savings of Contraception Graph

    Results varied from a National Business Group on Health study that had results of $0.16 for the private insurers to a Business and Health study finding of $28.57 also for private insurers. Public Medicaid savings were about $3 to $4.

    Business and Health in a 1993 special report for employers, found the average costs associated with the birth of a healthy baby was $10,000 (prenatal care, delivery and newborn care for one year following birth). It also reported that the cost for oral contraceptives was $300–350 per year. Avoiding the cost for unintended pregnancies was a major factor in the savings for an insurer.

    The cost looked at in the studies are only the easily determined direct cost “associated with normal live births (vaginal and cesarean), abortions, miscarriages and ectopic pregnancies.” 10 There is also the saving of indirect costs which “include wages and benefits associated with employee absences, maternity leave, and pregnancy-related sick leave, as well as costs associated with reduced productivity during an employee’s pregnancy and with replacing employees who do not return to work after a pregnancy.”

    Business employers not covering contraceptives in their employee health plans pay at least an additional 15 – 17% more than if they had coverage.

    Providing contraceptive coverage does not increase the bill an employer is required to pay. And may in fact reduce the bill.

    Next: The War on Women’s Health, Part 2 – Family Planning

    Choices of the Heart: the Margaret Sanger Story (True Stories Collection)

    Starring Dana Delany and Henry Czerny, Directed by Paul Shapiro
    Rated: NR

    The movie tells the story of Margaret Sanger (Dana Delany, China Beach) fight for women’s health through family planning and sex education in the early 1900s. The story takes place in New York City where despairing, often poor, women are forced by their situation to end unwanted pregnancies themselves.

    Sanger, a registered nurse, crosses paths with some of these women and sees the resulting mayhem and death. Outraged and saddened by what she sees, Sanger takes on her life work to fight against the moral zealots that have created chaos in women’s lives.

    Margaret Sanger: A Life of Passion

    Trained as a nurse and midwife in New York’s Lower East Side gritty slums, Margaret Sanger grew aware of the dangers of unplanned pregnancy—both physical and psychological. A botched abortion resulting in the death of a poor young mother catalyzed Sanger, and she quickly became one of the loudest voices in favor of sex education and contraception.

    Sanger ignited a movement that has shaped our society to this day. The movement she started spread across the country, eventually becoming a vast international organization with her as its spokeswoman.

    Her views on reproductive rights have made her a frequent target of conservatives and moral zealots. Yet lately even progressives have shied away from her, citing socialist leanings and a purported belief in eugenics as a blight on her accomplishments. In this captivating new biography, the renowned feminist historian Jean H. Baker rescues Sanger from such critiques and restores her to the vaunted place in history she once held.


    1 Lepore, Jill | Birthright, What’s next for Planned Parenthood? (Webpage) | The New Yorker Digital Edition | 20111114 | Accessed 20120301 @ http://www.newyorker.com/reporting/2011/11/14/111114fa_fact_lepore.
    2 HHS Press Office | Affordable Care Act Ensures Women Receive Preventive Services at No Additional Cost | U.S. Department of Health & Human Services | 20110801 | Accessed 20120213 @ http://www.hhs.gov/news/press/2011pres/08/20110801b.html.
    3 HHS Press Office | A statement by U.S. Department of Health and Human Services Secretary Kathleen Sebelius | U.S. Department of Health & Human Services | 20120120, Last revised: 20120202 | Accessed 20120213 @ http://www.hhs.gov/news/press/2012pres/01/20120120a.html.
    4 Palmieri, Jennifer | What They Are Saying: Preventive Health Care and Religious Institutions | The White House Blog | 20120212, Last revised 20120213 | Accessed 20120218 @ http://www.whitehouse.gov/blog/2012/02/12/what-they-are-saying-preventive-health-care-and-religious-institutions.
    5 Muñoz, Cecilia | Health Reform, Preventive Services, and Religious Institutions | The White House Blog | 20120201, Last revised 20120201 | Accessed 20120213 @ http://www.whitehouse.gov/blog/2012/02/01/health-reform-preventive-services-and-religious-institutions.
    6 Wilkinson, Emma | The science behind the policy | European Heart Journal | Volume 30, Number 24, Pages 2955 – 2956 | December 2009.
    7 Committee on Preventive Services for Women | Clinical Preventive Services for Women: Closing the Gaps | IOM (Institute of Medicine), The National Academies Press; Washington, DC | 2011.
    8 Campbell, Kathryn Phillips: editor | Chapter 2, Maternal and Child Health Plan Benefit Model: Evidence-Informed Coverage; Investing in Maternal and Child Health: An Employer’s Toolkit | Center for Prevention and Health Services, National Business Group on Health, Washington, DC | 2007 | 89 Pages.
    9 State Policies in Brief: Insurance Coverage of Contraceptives | Guttmacher Institute | February 2, 2012.
    10 Dailard, Cynthia | Special Analysis: The Cost of Contraceptive Insurance Coverage | The Guttmacher Report on Public Policy | Guttmacher Institute, New York, NY, USA | Volume 6, Number 1 | March 2003.