Guest Blog: The Value of Education and Outreach to Improve Global Women’s Health

Taraneh Shirazian, MD

Millions of women around the globe lack basic rights—rights to health care, rights to family planning services, and the right to lead long, healthy lives. Pregnancy and childbirth are major threats to women in underserved areas of the world with over 300,000 women dying yearly from their associated complications, unattended by trained medical professionals. While most of these deaths are preventable, these women need a voice to bring the world’s attention to what is truly a global crisis in women’s health.

As ob-gyns, awareness of the scope of issues faced by women internationally should be integral to our education. Only with this foundation can we prepare ourselves for the monumental challenges of global health care delivery. Ultimately, it is our collective responsibility as women’s health care providers to give voice to and promote care for these women, whether or not we choose to work at home or abroad.

It has been my work and passion over the last seven years to develop educational resources for health care providers interested in global women’s health, including a new online course. Preparing for cultural and ethical aspects of health care delivery abroad is critical and just as essential as our medical knowledge. These skills can also allow us to take better care of women here in the US.

All women’s health providers should educate themselves on these global women’s health topics, including maternal mortality, obstetric fistula, family planning, and female genital cutting.

I encourage you to be part of a global voice for women.

Taraneh Shirazian, MD, is assistant professor and director of Global Health in the department of ob/gyn and reproductive sciences at Mount Sinai School of Medicine in New York.

Million Women March for Endometriosis—Making a Difference!

I am energized to have represented ACOG today at the first Million Women March for Endometriosis. ACOG is a proud co-sponsor of this important event to raise awareness of this debilitating and painful gynecologic condition.

It was an honor to have spent the day with dedicated physicians and most importantly, the women, girls, and their families and friends who are affected by endometriosis and were here to march on the National Mall today in Washington, DC.

Together, we CAN make a difference.

Dr. Conry behind the scenes at EndoMarch 2014 with Drs. Ceana (left) and Camran Nezhat, two of EndoMarch's sponsors.

Dr. Conry behind the scenes at EndoMarch 2014 with Drs. Ceana (left) and Camran Nezhat, two of EndoMarch’s sponsors.

Excited despite the cold! Dr. Conry with Linda C. Giudice, MD, PhD, Immediate Past President of the American Society for Reproductive Medicine, and Marc R. Laufer, MD, Chief, Division of Gynecology at Boston Children's Hospital.

Excited despite the cold! Dr. Conry with Linda C. Giudice, MD, PhD, Immediate Past President of the American Society for Reproductive Medicine, and Marc R. Laufer, MD, Chief, Division of Gynecology at Boston Children’s Hospital.

Building a Better Ob-Gyn—Retooling Resident Education

I recently had the honor to speak with some of our specialty’s greatest leaders—the educators and directors of our obstetrics and gynecology programs across the United States.

It was my first time attending the Association of Professors of Gynecology and Obstetrics (APGO)/Council on Resident Education in Obstetrics and Gynecology (CREOG) Annual Meeting. I was rewarded with inspirational and creative presentations on the challenges facing us about how we educate and how we learn. Do we learn best from the standard lecture and exam model? I don’t think so. Even I realized in medical school over 30 years ago—when I was balancing life with a newborn, a medical school heavy on lectures, and tests every few months—that students retain information better with interactive learning and retain more with case examples.

The APGO/CREOG meeting included engaging roundtable discussions on leadership and advocacy. Ob-gyn professors are looking at how best to train students for the next steps in their education. For instance, do we need to prepare students by instituting “boot camps” before they begin their first year in residency? How do we set milestone expectations for residents in their training? Our educators face the ongoing challenges of developing and maintaining ob-gyn resident surgical skills, teaching empathic patient care, and promoting and sustaining strong leadership in ob-gyn.

Residents and medical student attendees presented poster sessions on how they learn, what training was most effective, and the challenges they face. Some of the best parts of the program were the one-on-one discussions I had with these leaders in women’s health who are at the very early stage of their careers. Of course, I took the opportunity to discuss our national maternal health initiative, describe ACOG’s Well-Woman Task Force, and put in a plug for advocacy and our annual Congressional Leadership Conference (CLC).

Educating the future generations of ob-gyns in today’s challenging and quickly-changing health care environment will require the type of creative and provocative ideas that came out of the APGO/CREOG meeting. Here’s to all the ob-gyn professors and residency program directors who have been devoted to education for all the hard work that they do.

 

The Key to Women’s Health: Collaboration

Collaborative practice is the true hallmark of highly-functioning ob-gyn practices and medical systems. When we use the term ‘collaborative practice,’ we need to focus on the elements that make collaboration a success for our patients.

ACOG benefits when we collaborate with our partner organizations to improve women’s health. The past two weeks have demonstrated extraordinary collaboration.

Dr. Haywood Brown, Chair of District IV, recently led ACOG’s new Well-Woman Task Force, gathering experts from numerous specialties, including physicians from family practice, ob-gyn, pediatrics, and internal medicine, along with nurse midwives, nurse practitioners, and physician assistants. He asked his colleagues to collaborate and define the elements of the annual well-woman visit. Women see a variety of health care practitioners, so we need to ensure that we are consistently addressing the same common elements during a well-woman visit, regardless of patient age or health care provider. The meeting brought focus to the importance of ‘Every Woman, Every Time’ that places women’s health and reproductive needs together.

Carrying on with the collaborative theme, the Council on Patient Safety in Women’s Health Care, convened under Dr. Paul Gluck’s expertise, brought together ob-gyns, family practice doctors, anesthesiologists, midwives, and nurse practitioners, along with the Joint Commission, American Hospital Association, and many others. This group’s “Three Bundles, Three Years” initiative is aimed at improving birth outcomes in every birthing location in the US by tackling the three of the most common complications we see in labor and delivery:

  • Hemorrhage: Every center will have a guideline in place so that we respond effectively when a hemorrhage occurs.
  • Hypertension: Every center will implement the hypertension guidelines outlined recently by ACOG’s Task Force Report on Hypertension in Pregnancy.
  • Blood clots: Every center will focus on reducing the risks of clotting complications, such as pulmonary embolism.

At the SMFM meeting, Dr. George Saade brought together experts to address “Pregnancy as a Window to Women’s Health,” a day-long symposium co-hosted by SMFM, ACOG, and NICHD. We can predict a woman’s risk for later health problems—notably diabetes and hypertension—by evaluating her pregnancy complications or disease processes. Out of this collaborative symposium will eventually come recommendations for care and guidance for future research.

I have already started discussing with my patients at their first prenatal visit how their pregnancy will be a “window to future health.” Afterall, the patient-provider relationship is one of the most important collaborations in our careers.

 

Behind Many Olympic Champions Stands a Mom

I confess: I am an Olympics junkie. In 2012, I had the good fortune to spend two weeks in London for the Summer Olympics. Now, I’m getting ready to watch the Winter Games. I say I’m a junkie because I watch anything and everything leading up to the Olympics, and then I watch any event I can. Luge—wow! Snowboarding—so cool. And there’s curling, of course. And ice skating, downhill skiing, hockey, and speed skating. I love them all!

Now why would I mention this personal passion in my blog? Because of the moms. I enjoy the commercials that highlight the sacrifices of athletes—the arduous practice, the long journey, and living away from home are just a few of them. Then, the athletes acknowledge that it was their mothers who helped them succeed. Well, of course.

As we celebrate the Olympic Games, let’s remember that caring for all moms is our investment in the next generation. Optimum health does not happen by accident. Just as their child’s Olympic success depends on maintaining healthy lifestyle choices, including proper nutrition, avoiding tobacco and alcohol, and getting enough sleep, so, too, do moms need to make their own health a priority.

The Affordable Care Act ensures that moms—indeed all women—are covered for annual well-woman preventive health care with no co-pays or deductibles. Annual well-woman visits are important to help keep mothers healthy and strong so that they can raise healthy children. It’s all full circle!

So, let’s take a minute to applaud these mothers and remind all women that their children’s health begins with them. Here’s to the Olympics, to athletes, and to moms everywhere.

 

The ACA and OTC Medications – What Physicians Need to Know About Changes in Coverage

January 1 has come and gone, but many of us are unaware of some of the changes with the Affordable Care Act, particularly related to coverage of medications and supplements that became effective in 2014. For our patients who are enrolled in ACA-compliant plans, certain over-the-counter (OTC) medications are now covered at no cost when written as a prescription. Translation: Write prescriptions for these medications when medically necessary.

As an example, aspirin is now a covered medication under the ACA for women ages 55–79 when the benefit of reducing heart attacks outweighs the risk of gastrointestinal bleeding. The cost of OTC emergency contraception is also covered if a prescription is written for it. Vitamin D supplements are covered for women ages 65 and older to prevent fractures. And folic acid supplements are covered for women capable of becoming pregnant.

This change in insurance coverage comes at a time when research is looking closely at the benefits of supplements. Certainly all of us are confused at times when related research appears in the media and the benefits of vitamins and supplements are questioned. That’s why we as physicians need to make recommendations to our patients based on their individual needs. This ensures that reproductive-age women don’t forgo important and proven supplements—for instance, folic acid to reduce birth defects like spina bifida—based on a single study.

As physicians, we are in a position to not only recommend, but to reinforce the use of these medications and vitamin supplements for preventive health. It’s up to us health care providers to recommend and prescribe them.

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Guest Post: My Journey to Women’s Health Advocate

E. Christine Brousseau, MD

E. Christine Brousseau, MD

For many years I had no interest in politics. I focused my energy on caring for my patients and my family. My interest in public policy wasn’t cultivated in college, medical school, or at work. Instead, it was born of necessity, groomed by mentors, and became a passion.

In 2010, I was elected the Rhode Island Section vice chair/legislative chair. I was expected to testify at the State House, meet with legislators, and write op-eds. I was invited to ACOG’s Congressional Leadership Conference, which emphasized and trained proper advocacy. Two days into the conference, I met with Rhode Island’s federal lawmakers—alone. I returned home inspired to advocate on behalf of women and women’s health practitioners. Advocacy did not come naturally, but my passion for the issues did.

I was thrilled to be selected as a 2013 McCain Fellow. On my second day, I met with a coalition of lobbyists supporting maternal and childhood health formed to educate Congress on sequestration’s negative effects on families. I was surprised to learn how many bills affect maternal-fetal health. Briefings on the Pregnant Workers Fairness Act and a reproductive rights bill seemed obvious, but the Toxic Substances Control Act hearings were unexpectedly relevant.

I attended numerous meetings with congressional leaders. At one, I sat beside Rep. Tammy Duckworth (D-IL), an Iraq War veteran and one of the first females to fly combat missions in Iraq. During one mission, her helicopter was shot down; she lost both legs and partial use of her arm. When I asked how she handles today’s partisan politics, she replied, “Listen, I’ve been blown up! I think my worst day at the office is behind me.” Rep. Duckworth traces her family’s legacy of military service back to the Revolutionary War. A career in service seemed to be her calling, but she could not have predicted that her greatest service would be in politics, not combat.

Many of my academic and career choices have also been guided by family legacy. My father, Patrick Sweeney, also was a McCain Fellow, something I learned only recently. His dedication to women’s health policy and advocacy led me to practice medicine and has had a tremendous positive influence on countless women. While I never envisioned being involved in politics, advocacy presented me with an opportunity to improve women’s health in Rhode Island and beyond. Like Rep. Duckworth, I will embrace the opportunity with persistence and, hopefully, a sense of humor.

E. Christine Brousseau, MD, is an ob-gyn in Providence, RI and serves as Vice Chair for ACOG’s Rhode Island Section.