Advancing Women’s Health Care at Home and Abroad

Every year on March 8 we mark the occasion of International Women’s Day. For women’s health care providers, it creates an opportunity to reflect upon the patient population we serve, at home and the world. This year, to commemorate International Women’s Day, I’d like to celebrate ACOG’s recent successes in women’s health, while they are proud achievements to be sure, there is still significant work to be done to gain sustainable improvements around the globe.

ACOG is committed to leveraging the expertise and commitment of our Fellows to support women’s health programs around the world through the Office of Global Women’s Health (OGWH). Our mission is to increase women’s access to quality health care:

  • by building provider skills,
  • supporting implementation of high impact interventions,
  • and scaling proven solutions to decrease maternal mortality and morbidity.

OGWH has a portfolio of programs in 11 countries, including Malawi, Uganda, Rwanda, Ethiopia, the Dominican Republic, El Salvador, Guatemala, Honduras, and more. While our work in each country is unique, it’s guided by a shared set of goals.

It would take a great many pages to provide a detailed overview of all OGWH’s efforts, but I’ll share two success stories from different parts of the globe.

In Malawi, ACOG implemented a demonstration project based on the Alliance for Innovation on Maternal Health. Together with the Malawi Ministry of Health and Baylor College of Medicine, ACOG tailored post-partum hemorrhage (PPH) bundles to improve recognition and management of obstetric complications. Hundreds of local hospital staff were trained in team communication and PPH management, and prepared for implementation of the bundles. The program reduced incidences of maternal hemorrhage and increased lifesaving interventions from 3.7 percent to 34.4 percent for patients who had uterine atony after delivery.

In Central America, ACOG works to enhance professional education and training standards through the Central American Residency Program. Our efforts support development of residency accreditation and administration of in-service exams, establishment of minimal educational standards, quality assurance processes and mentorship of hospital leaders. Over time, we’ve built very strong relationships and now engage with 75 percent of all ob-gyn residency programs in Central America.

These are just two snapshots of OGWH’s work to advance women’s health across the globe, but they help to illustrate the breadth of opportunity – from preventing maternal deaths to raising the standard of medical practice. As women’s health care providers, we must continue to work together with our colleagues near and far to build a health care system that serves every woman’s needs. In addition to the programs outlined above, ACOG annually hosts a meeting of academic ob-gyn from across the globe to ensure a continuous exchange of knowledge and experience sharing.

ACOG has a unique platform to share knowledge and resources to improve the delivery of care globally. If you’re interested in learning more about how to become involved with these opportunities, visit

How Dedication to Black Maternal Health Honors the Legacy of Henrietta Lacks

Sixty-seven years ago, two tissue samples taken from a young, African-American woman diagnosed with cervical cancer led to the most important cell lines in medical research. Her name was, of course, Henrietta Lacks. Today, it would be difficult to find someone who isn’t familiar with her story. The “immortal” He-La cells have been used in more than 74,000 studies and have led to the discovery of the Polio and HPV vaccines, treatments for diseases, including diabetes and AIDS and other life-saving research around the world.

The contributions Lacks made to medical science have been heralded in the best-selling book, “The Immortal Life of Henrietta Lacks,” by the foundation created in her name, in countless news stories, in an HBO movie starring Oprah Winfrey and by the National Institutes of Health (NIH) through the establishment of a working group in her honor. In 2013, the NIH stated that Lacks and her family were the “greatest philanthropists of our time.” However, it wouldn’t be until 1987, 36 years after her cells were replicated and shared widely amongst the research community, that the NIH would institute a policy “encouraging” the inclusion of minorities in clinical studies. And it would be another six years before Congress would make it law through a section in the NIH Revitalization Act of 1993 entitled Women and Minorities as Subjects in Clinical Research. The reason for this move by the NIH is obvious. We cannot appropriately evaluate the effects of drugs in clinical trials without a racially diverse sample.

Therefore, it should be considered one of the greatest conundrums of our time that a black woman is responsible for thousands of breakthroughs in biomedical research and yet, in 2018, black women are three or four times more likely to die during childbirth than their white counterparts. When it was discovered that Lacks had cervical cancer, she had just given birth to her fifth child. At 31 years of age, Lacks suffered from a severe hemorrhage after childbirth and died eight months later after receiving routine cancer treatments and experiencing continued abdominal pain.

By today’s definition, Lacks would be counted among the women lost to maternal mortality. According to the Health Resources and Services Administration, the maternal mortality rate in the 1950s was 83.3 deaths per 100,000 live births. And while that number has decreased significantly since then, it is well-known that the United States is considered one of the most medically advanced developed countries— and yet, it has the highest maternal mortality rate amongst its peers, with even higher numbers for minority women.

I’ve done several media interviews on the topic of racial disparities in maternal mortality. Reporters always ask why these disparities exist, especially among well-educated, affluent black women where access to care is not an issue. In my interview with Essence magazine, I explain that there is a complex web of causes, but it often involves social determinants of health and structural barriers to health care. Whether an African-American woman is rich or poor, has a GED or a PhD, she is susceptible to morbidity and mortality and implicit biases of race and class. This not only impacts the quality of care she receives, but can also have negative physiological effects. The relationship between stress and how we respond to that stress physiologically has well-documented associations with prematurity and cardiovascular disease. The “microaggressions” that black women endure throughout their lives also make them predisposed to chronic conditions that can make a pregnancy high risk, such as hypertension and diabetes. It is a failure in our medical care as providers if we do not 1) recognize and accept this and 2) meet the necessary cultural and systemic challenges that impact health outcomes.

During my ACOG presidency, much of my focus has been on providing guidance on how to make these system level changes. In May, ACOG will release a revised “Optimizing Postpartum Care” Committee Opinion developed by my presidential task force, “Redefining the Postpartum Visit,” and the Committee on Obstetric Practice. It will stress the importance of the fourth trimester and propose a new paradigm for postpartum care. When women fail to receive postpartum care, it impedes management of chronic health conditions. Attendance rates are often lower among populations with limited resources, which contributes to health disparities.

As we celebrate Black History Month and the contributions of African-American mothers like Henrietta Lacks, we must honor her legacy by not accepting the deaths of black women from pregnancy and childbirth as a reality of race.

Putting Preventive Care Front and Center

ACOG has long been dedicated to the advancement of women’s health care, with particular focus on ensuring every woman has access to care in a safe, timely and affordable fashion. Over the last five years, this has included a dedicated effort to guarantee women coverage for the full range of necessary preventive services without additional out of pocket costs. Just five years ago, Dr. Jeanne Conry set this work in motion with her presidential initiative, Every Woman, Every Time. In the time since, we’re proud to say we’ve accomplished a lot, from generating new clinical guidance to support ob-gyns in the delivery of comprehensive care to advocating on behalf of women everywhere to protect their coverage.

Today, we’re marking the continuation of that progress with the launch of, a campaign that brings together women’s health leaders to increase patients’ knowledge about covered preventive health services available. This project calls upon the Women’s Preventive Services Initiative, an ACOG led program that, since 2016, has focused on developing, reviewing, and updating recommendations for women’s preventive healthcare services, including HRSA-sponsored Women’s Preventive Services Guidelines.

Though the Affordable Care Act requires the coverage of these vital preventive health services for women, too many of our patients are unaware of the benefits available to them with no additional out of pocket costs. The services covered include annual well-woman visits, cervical and breast cancer screenings, breastfeeding support, contraceptive coverage and counseling, domestic violence screening and counseling, STI screening and counseling, and screening for gestational diabetes; and just recently it was announced this list would be expanded to include post-partum screening for diabetes and screening for urinary incontinence, beginning in 2019.

I do not have to impress upon you the importance of each of these services to helping our patients maintain healthy lives. When our patients receive proper, comprehensive preventive care they are less likely to suffer from undiagnosed or untreated conditions, and when they want to become pregnant, they have healthier pregnancies and births, that lead to healthier children.

Our role many times is to help our patients to first access care, and then to help them plan for what comprehensive care looks like for them at every age. For many women, this includes helping them navigate the health care system and identifying the care that’s already covered and available to them. provides numerous resources that clearly identify covered preventive health services, and why they’re important to women – including young women who may feel that because they’re presently healthy they don’t need to come in for routine care!

We’re excited about this new campaign, and the part it will play in continuing to advance women’s health care. In the coming months, we hope to also expand this effort to include resources for providers to share in their offices to help increase patient awareness. Likewise, we’ll continue our parallel work and leadership on WPSI, to make sure the most up to date and evidence based content is available to women’s health care providers everywhere. In the meantime, let’s all commit to ensuring every patient gets the care she needs, when she needs it.

For more information about ACOG’s leadership on WPSI, please visit:


4 Simple Steps Ob-Gyns Can Take to Increase Flu Vaccination Rates Among Pregnant Women

Recently, the Centers for Disease Control and Prevention (CDC) released data indicating that about two-thirds of pregnant women have not been vaccinated against the flu this season. As clinicians, we know that the flu shot is safe, effective and the best protection our patients have against influenza. It is our job to communicate these messages to all of our patients, especially pregnant women.

The flu vaccine is safe and recommended during all trimesters of pregnancy, especially the second and third trimesters, when there is an increased risk of severe disease, hospitalization and even death as a result of contracting the flu. By getting vaccinated, pregnant women can protect themselves while also providing protection to their babies through placental antibody transfer until they are able to be vaccinated at six months of age.

Despite the benefits of vaccination, the latest CDC data shows us that low vaccination rates among pregnant women are pervasive. They are not just low among all age groups, but also among women of different races and ethnicities, across all education levels and regardless of whether women have health insurance or not. Among white, black and Hispanic women, the vaccination rate is 35.9, 31.5 and 35.4 percent, respectively. Also, while roughly 39.1 percent of pregnant women with a college degree were vaccinated, that is only 4.4 percent higher than women with a high school education or less.

However, one interesting data point indicates that flu vaccination is highest among women who reported that their doctor offered or recommended the vaccine. Among women who visited a health care provider at least once since July 2017, 52.4 percent received the flu vaccine from a provider who offered it. Also, according to the data, 50.1 percent of pregnant respondents received their vaccination at their ob-gyn’s office, which far surpassed other locations, including other doctor’s offices (29.2 percent); the drugstore, supermarket or pharmacy (10.3 percent); and work or school (5.9 percent).

This indicates that we, as ob-gyns, have a lot more influence over our patients than we think we do and that they trust us when we counsel them on their health and well-being. By simply educating women about the benefits and recommending the vaccine or offering them the opportunity to get vaccinated, we have the power to increase vaccination rates among pregnant women in this country.

Four steps you can take today:

1. Educate all pregnant women about the flu vaccine and the severity of influenza disease.

2. Strongly recommend and offer flu shots to all patients in your practice, particularly pregnant women. Flu shots can and should be given as soon as the vaccine is available.

3. Document flu conversations and flu vaccine administration in your patients’ chart and, when possible, your state’s immunization information system.

4. Lead by example—educate and vaccinate yourself and your staff against influenza.

For more information and updates on the 2017-18 flu season, visit and

It’s Never Too Early to Prepare for an Emergency

Last month, I shared an up-close look at Puerto Rico and the challenges facing their health care system following two major hurricanes. Officials were working hard to put emergency protocols into place and restore regular delivery of care. As a follow-up this month, I’d like to focus on how every hospital can evaluate and prepare for disasters and emergencies.

Large-scale catastrophic events and infectious disease outbreaks require disaster planning at all community levels well in advance. An updated Committee Opinion, released last week, outlines the key components to preparation and communication for the successful management of obstetrical care during emergencies.

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Puerto Rico: A Long Road to Recovery

Weeks after Hurricanes Irma and Maria devastated the island of Puerto Rico, I had the privilege of speaking with Dr. Nabal Bracero, ACOG’s Puerto Rico section chair, at the Annual ACOG District IV Meeting in Charlotte, North Carolina. It was an opportunity to discuss the immense challenges patients and the medical community are currently facing but also to answer the question many ACOG members have been asking—“What can we do to help?”

The news stories about the recovery effort have been grim. While things are slowly getting better, 84 percent of the island is still without power, 40 percent lacks running water and the death toll has been steadily increasing—now at 43. A portion is attributed directly to the storms, however many deaths are now a result of the developing medical crisis in the storms’ aftermath. While it’s been reported that 98 percent of hospitals are currently open, including Puerto Rico Medical Center in San Juan, a majority are low on medication and medical supplies, inhibiting the quality and level of care they can provide. And patients, particularly those in critical condition that rely on ventilators, fetal heart rate monitors and other life-saving equipment, are dying due the lack of fuel to keep the generators running. In my conversation with Dr. Bracero, he said the medical center is managing but, like many hospitals, they are at capacity which limits their ability to accept new patients.

The lack of communication channels and resources, led to a conversation about how pregnant patients are faring and gaining access to needed medical services. According to Dr. Bracero, there are thousands of women at provisional sites that are in very poor conditions. These women will not be able to visit a doctor in the near term and there is no system to link ob-gyns outside of the metro areas with physicians at larger medical centers. For the patients that are in the vicinity of a provider, old-fashioned word of mouth has been the main mode of communication. Dr. Bracero said many patients simply made the trip to the office to find out if they were open. However, the section has also been working closely with ACOG to send email blasts to members in Puerto Rico to get a more comprehensive list of hospital units and offices that are open. Dr. Bracero plans to communicate that information via social media or main stream media outlets to let patients know where they can go for ob-gyn care.

ACOG has been working with CREOG and ABOG leadership, as well, on behalf of the medical students and residents in Puerto Rico to secure deadline extensions for applicants until they are able to gain access to adequate electronic communications. There is also a need to work with residency programs to potentially find alternate opportunities for residents who may be unable to complete the gynecology portion of their training programs on the island. However, Dr. Bracero pointed out that junior fellows were among the first responders with regard to ob-gyn care. Junior fellows from Districts I and IV here on the mainland have been eager to help in their own way and have started a fundraiser to help raise money for the residents of Puerto Rico.

But looking at the bigger picture, Dr. Bracero pointed out that there is still a need to do more and medical care will continue to be a top priority. There is a long road to recovery ahead and it will require advocacy, not just in our individual communities but in the nation’s Capital.

Listen to a portion of my interview with Dr. Bracero below.

For more information on how you can help, visit the following websites:

American Red Cross

United Way

United for Puerto Rico


Center for Popular Democracy

Hispanic Federation’s “Unidos”

International Medical Corps

Former U.S. presidents have expanded their One America Appeal to include recovery efforts in Puerto Rico and the U.S. Virgin Islands.

Catholic Relief Services


Direct Relief

Save the Children

Global Giving

For Ob-Gyns, Zika is Still News

Around this time last year, the Zika epidemic was covered by every major news outlet across the country and ACOG issued a statement reaffirming the latest warning from the U.S. Centers for Disease Control and Prevention (CDC) advising pregnant women not to travel to a specific area in Miami, Florida. We had recently learned that it was possible for the virus to be transmitted during all trimesters of pregnancy and ob-gyns were actively advising pregnant patients and their partners who had lived or traveled to Zika-affected areas to use contraception or abstain from sex for the duration of the pregnancy. While it was critical to get information out as soon as possible, we acknowledged that there were still many unknowns regarding transmission and the various harmful birth defects that can result from an infected fetus. During that time, we joined the CDC in recommending that all pregnant women be assessed for possible exposure at each prenatal care visit and that pregnant women with exposure be tested regardless of symptom status.

Since that time, the amount of data we have on Zika has increased and the realities regarding transmission of the virus have changed. For one, we’ve learned that the Zika virus antibodies can persist for months in some pregnant women, which makes it difficult for providers to know with certainty whether infection occurred before or during pregnancy. And, overall, the number of people infected with the virus in the United States and U.S. territories such as Puerto Rico has declined since 2016, making false-positives more likely when there is a lower occurrence of the disease. Therefore, the CDC, working with ACOG, announced at the end of July new guidance for pregnant women with possible Zika exposure. One of the significant changes is that we no longer recommend routine testing of pregnant women who are not experiencing symptoms and do not have ongoing exposure. In addition, to help address known issues with available Zika tests, pregnant women who are tested should receive concurrent IgM and NAT testing. ACOG continues to update a Practice Advisory, which further explains these changes and several others, as well as the new focus on shared decision-making when it comes to screening and testing patients, particularly those who are not experiencing symptoms.

While these new recommendations reflect the best data available on the virus to date, educating providers in a climate with rapidly changing recommendations remains challenging. It is certainly good news that the spread of the virus is on the decline in some areas, but Zika still poses a very real threat and we must remain vigilant. There is already a lot to cover at each prenatal care visit, but screening for Zika virus must continue to be a priority. Additionally, education about family planning for women who do not wish to become pregnant and condom use for pregnant women and their partners at risk of exposure are still essential. We can’t forget that contraception is an important tool in our fight against birth defects caused by Zika.

Also, adequate funding for needed resources to better understand and combat Zika are still a necessity. We need to be able to continue to track the virus through tools like the U.S. Zika Pregnancy Registry, deepen our understanding of its impact on pregnant women and fetuses, simplify and improve Zika virus testing and develop an effective vaccine. We must also remember that continued funding for Medicaid expansion and coverage of essential health benefits increases access to maternity, preventive and primary care for women at risk for the virus.

So, while Zika headlines might not be as prevalent anymore, we have a responsibility as physicians to keep it top-of-mind because there is still much work to be done.

To access ACOG’s Zika resources, visit

Guest Blog: Hurricane Harvey Has Shown the Resilience of My Community

Over the past few days, I’ve seen up close and personal the catastrophic damage Hurricane Harvey has caused Texas and our patients.  In my role with Texas Children’s, I’ve worked with our team to coordinate disaster and recovery operations across our system of hospitals, out-patient clinics and our health plan.  Yesterday, when on-site to evaluate damage at one of our closed clinics, a pregnant mom drove up with her sick daughter, and my co-CMO and I were able to remove the sandbags, access our clinic, and provide urgent care to this frightened family.

The need is great. The scale of flooding is just disastrous, but I have been heartened to witness the resilience of my community and the immediate urge to help from across America.

As one individual on the front lines of this catastrophe, and on behalf of ACOG leadership, thanks to each of you for your outpouring of concern, thoughts, prayers, and offers to assist in any way you can.  We also extend our sincerest gratitude to federal, state and local workers and volunteers whose heroic efforts are saving lives in Texas and on the Gulf Coast.

Our work in Houston and along our Texas Gulf Coast is very far from done.  Recovery will take years of work and mountains of resources.  While ACOG is not a disaster relief organization, nor can we vet relief organizations, those of you who want to help can find options on the State of Texas Emergency Website.

Thank you, sincerely, for your concern and for your dedication to your patients.

Lisa Hollier, M.D., ACOG President-Elect

Charlottesville Reminds Us: We Must End Racial Bias in Medicine and Society

Earlier this year ACOG issued a Statement of Policy, originated in our Committee for Underserved Women, which acknowledges the many ways that racial bias affects our patients and colleagues. In the document, ACOG calls on all physicians to work together to create an equitable health care system that serves all women.

Reflecting on the recent events in Charlottesville has been a chilling experience for many of us, and brought to mind the, fortunately, very few experiences in my career where I was faced with racial and gender bias. In the mid-1970s, when I was a third-year medical student on General Surgery, I was assigned the task of a physical examination on a patient admitted for radical surgery for breast cancer. The patient promptly announced that she would not be examined by me because of my race. While not totally surprised to be confronted with this encounter at a southern medical school, I was surprised that someone with a potentially fatal condition was more concerned about my race than her disease and the radical surgery she was about to face.

The chief of General Surgery, when informed, entered the patient’s room on rounds and explained that he would have to cancel her surgery because she declined to have a member of his team perform her pre-operative physical examination. He could have assigned her to another team member but chose not to and gave this patient a choice. She agreed and I was assigned as the primary point of contact throughout her postoperative care until discharge. How the chief handled this event reflected his moral and core values and had a profound effect on my professional development because it taught me how to handle racial and gender bias, which I, in turn, taught to my trainees over the past 35 years.

The hate and bigotry on display in Charlottesville reminds us that we still have a lot of work to do in medicine and in society when it comes to ending racial discrimination and gender bias. We must continue to challenge them wherever they exist and encourage diversity at all levels of our profession from medical school to residency to practice to leadership positions for the benefit of our patients and society. Additionally, how can we ever achieve gender equity without ensuring women’s right to control their own reproduction in the United States and globally? The two issues are intricately tied. There is no place for legislative interference in the ob-gyn-patient relationship.

Recently, I had the occasion to attend a 50th anniversary commemoration for the Sri Lanka College of Obstetricians & Gynaecologists, along with past presidents Thomas Gellhaus, M.D., and Jeanne Conry, M.D. The highlight of the meeting was an address by Lesley Regan, M.D., D.Sc., president of the Royal College of Obstetricians and Gynaecologists, on the impact of the global gag rule on women’s health care worldwide. ACOG has opposed this rule for many years. Regan quoted in her presentation from the book by Nicholas Kristof and Sheryl WuDunn, “Women hold up half the sky.” She reminded us that in the 19th century we were confronted with abolition of slavery, in the 20th century racial discrimination, and in the 21st we must challenge gender inequity throughout the world.

I believe we, as obstetricians and gynecologists, must stand up against acts and policies that disadvantage women and show our patients that we will not tolerate any discrimination based on race, gender, color, national origin, disability, age, religion, marital status, sexual orientation, or any other basis. There is no neutral ground, and staying silent only supports their continuation and growth.

Building Strong Patient Relationships Begins in Adolescence

While many people are eager to leave their adolescence behind them, as ob-gyns, we know all too well that the development that occurs during these years lays the foundation for the rest of our lives. Not only are bodies and minds maturing, but adolescence is also defined by exposure to new ideas, experiences, and beliefs. Ideally, it is also the age where girls and young women begin to routinely visit the ob-gyn.

ACOG recommends that girls have an initial visit for screening and the provision of reproductive preventive health care services and counseling between the ages of 13 and 15 years. Caring for patients beginning in adolescence gives ob-gyns an important opportunity to focus on establishing a relationship of trust and ensuring young women are empowered with comprehensive knowledge about their reproductive health. Ensuring women get this knowledge helps them at every stage, not just adolescence. It informs all kinds of life decisions– from becoming sexually active to planning when and if to have a baby.

Of course, we cannot have these important conversations without acknowledging that while the United States has made progress reducing rates of unplanned pregnancy among teenagers, our rate remains among the highest in the developed world. Recent guidance, “Adolescent Pregnancy, Contraception, and Sexual Activity,” directly addresses the role ob-gyns can play to support adolescent girls in preventing unintended pregnancy. Contraceptive access to highly effective methods remains one of the most important factors, but comprehensive sexual education is also critical.

The success of this education relies on trust. In new guidance out this month, “Counseling Adolescents About Contraception,” ACOG highlights the importance of listening carefully to young patients concerns and priorities when discussing which contraceptive method choices are best for them. By the time they are teenagers, many young women have already been exposed to different ideas about contraception through friends, family, and pop culture. At the same time, they’re making decisions for themselves about their health care and what is important to them; physicians should be aware of these preferences and concerns and should partner with young women to assist them in making choices about their reproductive health.

Listening and respecting a patient’s perspectives and priorities truly should define the patient-provider relationship, not just one conversation. In many instances, ob-gyns may be the most trusted adult for teens who are ready to have essential conversations about their reproductive health, sexual activity, sexual orientation, gender identity, and/or mental health. We must be mindful of the sensitivities around these topics, and do our best to provide each patient with the care and knowledge she seeks. This also may include helping patients and parents navigate this new territory together; ob-gyns should encourage and support this communication when appropriate.

As late summer approaches, and more adolescents cross our paths, checking off annual doctor visits before the school year begins, we should each take time to reflect on our effort to have a lasting impact on patients’ reproductive health knowledge and relationship to their ob-gyn.

For a comprehensive overview of ACOG’s adolescent health care guidance, head to: