Four Ways ACOG Has Impacted Global Women’s Health in Just the Past Year

In 1994, my wife and I arrived for our first two-week mission in the Dominican Republic and were stunned by the line of people waiting outside of the hospital for us. Since medical school more than a decade earlier, we had dreamed of participating in mission projects around the world to help women in dire need of basic medical care. But then my wife began her career as a nurse, we started our family, and after residency I went into private practice. So, that goal went by the wayside. However, our trip to the Dominican Republic quickly reignited our hopes of providing necessary ob-gyn services in low resource settings. Living in the United States, it’s easy to forget that many countries around the world are battling poverty and disease and don’t have the same infrastructure and safety nets we do. After that first trip, I came home to a fully equipped operating room with the proper tools and lights that worked, my wife didn’t have to hold a flashlight during surgery because the power was out. We had carpeting and hot water at home. From that point on, my eyes were opened.

Since that first trip, I’ve continued to travel and offer my services to advance health care in struggling countries. This work has taught me that we can really make a difference in global women’s health by sharing our knowledge and resources as ob-gyns. As my presidential term at ACOG comes to a close, it is an appropriate time to reflect on what we have accomplished from my six-point plan, developed over a year ago, to help improve the health of women and children worldwide, with a focus on training and providing health care around the world.

The first step was to make these kinds of missions more easily identified and attainable. While it’s often not realistic to leave your practice for months; two weeks is doable. That’s why we developed a listing or database of non-profit organizations involved in two-week mission work in which some of our members had participated. Now on the ACOG website there is a global health resource center. ACOG members can discover more information about each organization, check these organizations’ calendars for potential projects, talk with ACOG fellows and junior fellows who have done projects, and sign up. And we must continue to get the word out so more members use and add to the database.

In partnership with the U.S. Department of Health and Human Services, we’ve also formed and grown the Alliance for Innovation in Maternal Health (AIM), which creates instructional and educational portfolios, or “safety bundles,” to fight high rates of maternal mortality in the United States and now Malawi. Women living in rural areas of Malawi give birth at community health centers that can’t perform operative vaginal deliveries or C-sections. When these situations arise or other complications occur, women are transferred to the central hospital in the city, most often without any attempts at stabilization prior to transport. They are often in poor condition when they arrive, which results in many otherwise preventable maternal deaths. The AIM postpartum hemorrhage bundle has been instituted into practice at both the community health clinic and referral hospital. To date, more than 130 local people have participated in vital simulations to help these patients. And while we do not have formal data on the program yet, we know that several women have received life-saving care because the teams were able to communicate and execute care in a way that they didn’t before. We anticipate many more successes that will hopefully mirror the kinds of gains we have seen here in the United States.

In addition, last year ACOG partnered with Health Volunteers Overseas, a nonprofit group that helps educate and train local health providers in underdeveloped countries in various areas of obstetrics and gynecology. It begins with local providers telling us what they need and then we come up with a plan and work together to make it happen. As of today, we have completed four site assessments and will begin offering global service opportunities for fellows in the four countries by May 2017.

Lastly, in Ethiopia, we received a five-year grant to develop a plan in partnership with the Ethiopian Society of Obstetricians and Gynecologists to strengthen their ob-gyn residency training programs and curriculum, improve continuing medical education, support the publishing and accessibility of clinical outcomes research, and develop an ob-gyn examination and certification program. Since its inception, the program has made great strides by working “shoulder-to-shoulder” with the Ethiopians. As a result of this program, there is now interest from other African countries to begin the same program.

The bottom line is, many women around the world are lacking access to quality, evidence-based health care and they are paying the price with their lives. As ob-gyns, we have the power to prevent this by using our skills to help reduce global maternal morbidity and mortality, as well as improved quality of life. These programs are a prime example of how we can achieve that by dedicating some of our time and effort to a cause that is greater than ourselves. While we’ve accomplished a lot, we still have much to do. So, even if you aren’t sure you have the time, consider any way you can contribute. Believe me, it will make a difference.

It’s Time We Talk About Endometriosis

Endometriosis—when the uterine lining grows outside of the uterus, resulting in severe pain, swelling and bleeding—is thought to affect more than 11 percent of all American women between the ages of 15 and 44. This condition impacts 6.5 million U.S. women, and 176 million women worldwide. Yet, it is still not easily recognized. It takes about 10 years from when women experience their first symptoms to receive an endometriosis diagnosis—half that time to recognize and bring up symptoms to a doctor and the other half for the doctor to diagnose it. For Endometriosis Awareness Month this March, we as obstetrician-gynecologists must do our part to raise awareness about the condition with our patients, strive to improve our understanding of the disease, and ensure more timely and accurate diagnoses.

Improving awareness and timely diagnosis of endometriosis helps women avoid unnecessary pain, and decrease infertility rates. Around 40 percent of all women with infertility have endometriosis and, of women diagnosed with endometriosis, about 40 percent experience fertility challenges. Many women struggling with infertility remain undiagnosed; others won’t be diagnosed with endometriosis until they start to experience problems conceiving. It falls to ob-gyns to reverse this trend, particularly as 63 percent of general practitioners feel uncomfortable diagnosing and treating patients with endometriosis, and as many as half are unfamiliar with the three main symptoms of the disease.

Early endometriosis diagnosis and treatment lead to better outcomes. Careful listening and discussion are integral to early detection, as many common symptoms are not so obvious, such as chronic lower back pain and intestinal problems like diarrhea, constipation, bloating and nausea. We can also look for indicators that a woman is at greater risk of having endometriosis, including if she’s in her 30s and 40s; has a close relative who has been diagnosed with endometriosis (which increases risk by five to seven times); and has a higher body mass index (which is thought to promote the development of endometriosis because fat increases estrogen levels).

Raising awareness about endometriosis and increasing its timely diagnosis improves women’s lives. While symptoms may range in terms of severity, nearly all of them take a physical toll on a woman’s day-to-day life—from increasing tiredness to limiting her physical capabilities. It’s time to talk with our patients more regularly about endometriosis, and ensure more women are getting the care and support they need.

Ob-Gyns Can Be the Secret Weapon in the Fight Against Heart Disease

As ob-gyns, we know that the care we provide to women goes far beyond reproductive health. Thirty-five percent of women consider their ob-gyn their sole health care provider, putting us in a unique position to address an array of common health conditions. Since heart disease is the number one killer of women—and February is Heart Health Month—now is a good time to remember the part we can play in changing the outcomes of this devastating disease.

Perhaps the biggest threat of heart disease is lack of awareness of the condition’s prevalence and dangers. Though heart disease causes one in three deaths among American women every year—and 90 percent of women have at least one risk factor for developing heart disease—only one in five believes that heart disease is her greatest health threat, according to the American Heart Association (AHA). Equipped with these statistics, ob-gyns should feel confident initiating a conversation with patients about their heart health.

Helping patients address heart disease risk factors, ideally before a heart disease diagnosis, is key. Nearly two-thirds of women who die suddenly of coronary heart disease have no previous symptoms, according to the Centers for Disease Control and Prevention. For many women, the first signs of heart disease are actually the symptoms of a stroke, heart failure or heart attack, when serious damage may have already occurred. However, a number of risk factors are mostly under a patient’s control: an unhealthy diet and/or lack of exercise (both of which can lead to other important risk factors, including being overweight and having high blood pressure, high LDL cholesterol, and diabetes); smoking; and drinking to excess. When women are educated about how to make important lifestyle changes, it can be lifesaving. According to the AHA, 330 fewer women are dying from heart disease every day as a result of making heart healthy choices.

There are some factors that are out of a patient’s control, including a family history of heart disease, preterm labor and delivery, and preeclampsia. Ob-gyns can play an essential role by communicating the steps women can take to reduce their odds of a heart disease diagnosis. Even by simply acknowledging and discussing the risks, ob-gyns can make a difference. So, while these conversations aren’t always comfortable, they’re important because many women may not be hearing this information from any other health provider.

Lastly, since the symptoms of heart disease are widely misunderstood, particularly in women, it’s critical to share them with at-risk women. While angina is the most common symptom associated with heart disease, women are actually more likely to experience pain in the neck, jaw, throat, abdomen or back; shortness of breath; and nausea/vomiting. Lightheadedness, dizziness or fainting are common signs, as well. These symptoms don’t always occur during exercise or periods of stress; they can happen during rest, too. By ensuring your at-risk patients are aware of these signs, it could mean they get treatment faster, which will ultimately lead to better outcomes.

Ob-gyns have a powerful opportunity to be the secret weapon in the fight against heart disease. We can help inform our patients about the dangers, symptoms, and necessary preventative care. Communicated early and effectively, we can help women manage the factors that are in their control to help them live healthier, longer lives.

OB-GYN’s Crucial Role in Protecting Women from Cervical Cancer

Every year, more than 12,000 American women are diagnosed with cervical cancer, and more than 4,000 of those women die from the disease. And, according to a reevaluation of existing data in a study recently published in the journal Cancer, the cervical cancer death rate may actually be much higher than previously estimated. Since January is Cervical Cancer Awareness Month, now is an excellent time to educate our patients about the steps they can take to not become a part of these terrible statistics.

We know Pap smears are one of the most effective tools we have to improve cervical cancer outcomes. Half of all cases of cervical cancer occur in women between the ages of 35 and 55; it’s rarely found in women under 20, and about 20 percent of cases are in women 65 and older. That’s why we recommend regular cervical cancer screenings in our patients starting at the age of 21 and through the age of 65 or longer based on individual risk factors. Pap smears screen for a cancer that’s often symptomless, and they help spot changes in the cervix before cancer develops—when treatments are most effective. Due to widespread adherence to Pap smear testing, deaths from cervical cancer have decreased by 50 percent over the last 30 years. So, encourage your patients to attend their annual well-woman visits. Along with the opportunity to offer Pap smears and screenings, these visits provide an ideal occasion to educate patients about cervical cancer risks and prevention.

Of course, virtually all cervical cancer cases are linked to HPV. HPV is the most common sexually transmitted infection: 80 percent of all sexually active people will contract the virus in their lifetimes. A family history of cervical cancer increases the risk two- to three-fold, since these women may have a genetically inherited condition that makes it harder for their bodies to fight off HPV infection. The three-dose HPV vaccine protects against 81 percent of cervical cancer cases. The CDC, AAP, AAFP and ACOG all recommend the vaccine for boys and girls between the ages of 11 to 12 years old. Full vaccination reduces risk of certain HPV-related cancer by up to 99 percent; boosting vaccination rates could prevent 29,000 HPV-related cases of cervical cancer every year.

Vaccine adherence rates, however, remain low, with only about one-third of girls and just over one in 10 boys receiving their full vaccination series. Educating your young patients or those who are parents of preteen children is important. Likewise, it’s important to ask your patients in their teens and 20s whether or not they’ve been vaccinated. Even if a patient missed the recommended vaccine as a child and is sexually active, if she’s under the age of 27, it may still be beneficial because there may not have been exposure to all of the virus strains the vaccine protects against. If a patient refuses vaccination at first, it never hurts to keep offering it at future visits.

Like many things we discuss with our patients, there is still a lot of misunderstanding about HPV and cervical cancer.  That’s why it’s so important to continue to encourage annual well woman visits and HPV vaccinations. For more information to help guide your conversations with patients, visit ACOG’s Immunization for Women website, shotbyshot.org, or the National Cervical Cancer Coalitions Cervical Cancer Awareness Month page.

We Cannot Afford to Have the Clock Turned Back on Women’s Health

As we begin a new year, a lot is at stake for Americans’ health. Our nation’s leaders have promised substantial changes to the Affordable Care Act, from partial to full repeal, without the certainty of a replacement plan. While it can be easy to get caught up in the politics of health care, as ob-gyns our focus has always been on our patients and ensuring that they have access to safe, high-quality health care. That is why a critical part of our work here at ACOG is to advocate for the health of women, and as millions of people face the possibility of losing health insurance coverage in the coming months or years, ACOG’s work has never been more important.

Earlier this month, ACOG partnered with three leading medical organizations—the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians—to urge Congress to avoid repealing the ACA without an immediate replacement which would protect and retain the landmark women’s health provisions in the law.

The ACA is not perfect. In fact, ACOG didn’t endorse it originally because we felt it didn’t meet the needs of our physician members. However, while there’s lots to improve, the ACA does include really important protections for our patients’ health. Insurers must now cover maternity and preventive care and contraceptives. It stops insurers from charging women more than men for the same coverage, prevents insurers from denying coverage to women who were victims of domestic violence or who had a Cesarean delivery in the past. The ACA also guarantees women direct access to their ob-gyns without any limitations.

The coverage provided under the ACA allowed many women to schedule routine doctor’s appointments for the first time in their lives. We all know that when people have insurance, they’re more likely to use preventive care like mammogram and diabetes screenings that prevent more costly and life threatening health problems down the line.

Whatever one’s reservations may be about the law, as physicians we know how devastating it would be for a cancer patient to suddenly lose her coverage or for a pregnant woman to go without prenatal care and deliver a baby preterm because she could no longer afford health coverage. The fact is, low-income women are more likely to suffer from often preventable pregnancy complications and, unfortunately, that is the very population that stands to lose the most unless Congress protects these important benefits, including Medicaid expansion.

Today, 31 states and D.C. have expanded their Medicaid programs, offering coverage to 11 million newly eligible individuals. The most important part of the expansion to women is that those Medicaid programs cover low-income women even if they’re not pregnant. Regular Medicaid programs routinely only cover pregnant women through delivery and a few weeks after.

But speaking more broadly, all women stand to lose essential preventive care if the ACA is repealed. Access to breast cancer screenings decreases women’s likelihood of dying from the disease by up to 50 percent. Routine cervical screenings decrease the odds of late-stage cancer diagnosis by 60 percent. Finally, when women have access to more choices of affordable and effective contraception, including IUDs and implants, rates of unintended pregnancy, unplanned birth, and abortion drop dramatically.

In 2016 alone, 6.8 million girls and women gained health insurance coverage. If the law is repealed, those gains will likely be lost. We cannot turn back the clock on women’s health. The care we provide doesn’t stop in our exam or delivery rooms. It’s our responsibility to advocate on our patients’ behalf and protect their access to affordable, comprehensive health care. So let’s mobilize and use our collective community’s influence and expertise to ensure access to health care in this country.

To become involved in ACOG’s advocacy efforts, join us at the 35th Congressional Leadership Conference, The President’s Conference in Washington, D.C., in March.

Prevention of Preterm Birth Starts with a Healthy Mom

November 17 is World Prematurity Day. It gives us, as health professionals, an opportunity to direct our attention to a devastating health issue that impacts 15 million babies each year and rededicate ourselves to reducing that number. Several organizations, including ACOG, are supporting the cause through education, awareness, and advocacy events. However, there’s one event in particular that, coincidentally, started this week and stands to make the most significant impact in terms of lowering the preterm birth rate in this country and that’s open enrollment through the Health Insurance Marketplace.

Prevention of preterm birth starts with a healthy mom and that means access to prenatal care and preventive services. There are several risk factors for preterm birth, some of which include high blood pressure, low pre-pregnancy weight, alcohol and drug abuse, smoking, a prior preterm birth and a birth less than 12 months ago. Adequate health insurance coverage can make the difference between a pregnant woman carrying to term or delivering too early and the Affordable Care Act has helped make that coverage accessible to millions of women.

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ACOG Joins National Obesity Care Week 2016: Take 5 to Change the Way We Care

Today, more than a third of the adult population, 36.5 percent, is affected by obesity. The number of adults who are affected by severe obesity continues to rise. It’s time for a change in obesity care. With senocw-supporter-web-visual-copyvere obesity on the rise, our nation, led by the health care community, must attack this disease from multiple angles and unite to overhaul the treatment of obesity. ACOG recognizes the important role that obstetrician-gynecologists play. Ob-gyns often meet their patients at a young age, when obesity is less likely to be an issue. Therefore, we are in an ideal position to help educate women and provide counsel on the importance of a healthy lifestyle and fighting obesity.

The 2nd Annual National Obesity Care Week (NOCW), October 30 through November 5, seeks to ignite a national movement to ensure anyone affected by obesity receives respectful and comprehensive care. ACOG is proud to join the Campaign, which was founded by The Obesity Society, the Obesity Action Coalition, Strategies to Overcome and Prevent Obesity Alliance and the American Society for Metabolic and Bariatric Surgery.

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“AIM”ing to Reduce U.S. Maternal Mortality

During the past several weeks, you would be hard-pressed not to find an article about the dismal maternal mortality rates in this country. In fact, it was a study published in our very own Green Journal that sparked the latest national conversation (with Texas at the epicenter) about why the most modern, industrialized country in the world is failing so miserably at reducing the numbers of deaths associated with pregnancy and childbirth. However, the truth of the matter is, we already know why.

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World Contraception Day

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Today, September 26th, is World Contraception Day (WCD). Now in its ninth year, WCD envisions a world where every pregnancy is wanted and women are empowered with the resources and knowledge to make informed decisions about their sexual and reproductive health. Part of the larger Family Planning 2020 mission, WCD takes a multi-faceted approach to women’s health, encouraging increased sexual education, improved access to health care services, and eliminating challenges to cultural taboos based on myth or misconception.

As women’s health care providers, this mission aligns with our everyday efforts.  We counsel and educate our patients, helping their personal and professional goals align with their sexual and reproductive choices. Empowering women with choice and control over their contraceptive choices and family planning leads to happy and healthy individuals and families. Continue reading

Setting the Record Straight on Drinking During Pregnancy

When confronted with so many different types of infections and viruses that can threaten the health of an unborn baby, it’s unfortunate that drinking during pregnancy is still the leading cause of birth defects in this country and abroad. Without knowledge of the devastating effects, it’s easy to have a casual attitude toward drinking but when a fetus is exposed to any amount of alcohol it can lead to a number of permanent and debilitating conditions. These are known as fetal alcohol spectrum disorders (FASD) and can include anything from severe brain damage and growth deficits to lifelong learning and behavioral problems in children. September is designated as FASD Awareness Month but my hope is that at some point in the near future there is no longer a need to observe it because the fact is—FASD is 100 percent preventable.

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