Global Translation/Adaptation Program

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Global Translation/Adaptation Program
The Transnational Journey of a Womens Health
Classic

• Womens Collective Strength and Knowledge

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The first newsprint edition appeared in 1970.
In 1971 the book was re-titled Our Bodies,
Ourselves.
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• www.ourbodiesourselves.org

In 2005, this eighth edition was produced under
the leadership of a new generation
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GLOBALLY DISPARITIES CONTINUE TO BE STARK

• In Africa, the figure is about one in twenty-six
  women.

• In industrialized countries, one in 7,300 women
  die during pregnancy or childbirth.

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OBOS ADAPTATIONS NOW UNDERWAYArmenia
ArmenianChina ChineseIndia Bengali (for India
and Bangladesh)Israel Arabic and HebrewNepal
NepaliNigeria Pidgin English and Yoruba
Russia RussianTanzania Kiswahili (for East
Africa)Turkey TurkishWe are also exploring
possible adaptations of OBOS in Finnish, Hindi
and Kinyarwanda
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Article about the Turkish OBOS, 2007 The
coordinating group, Mavi Kalem, expects to
publish its edition in 2009 and has positioned
its website www.bedenimveben.org as a key
networking and lobbying tool for Turkish womens
groups.
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Nepal The coordinating group, Womens
Rehabilitation Center, is adapting OBOS into 7
booklets in Nepali. In 2007, despite ongoing
political turmoil in the country and persecution
by local communities, the coordinating group and
its partners facilitated the inclusion of
reproductive health and rights in Nepals new
interim constitution.
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• Nigeria
• The coordinating group, Women for
• Empowerment, Development and
• Gender Reform, is adapting OBOS into
• Pidgin English and Yoruba, in alternative
• formats such as posters.
• In 2009, they will reach 1.5 million people
• through outreach on the local canoe
• transport system, peer health educator
• trainings with village hair dressers, and a
• motorcycle campaign to bring health
• information to neighboring villages.

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IsraelWomen and Their Bodies, a group of
Palestinian and Israeli women, is developing new
Arabic and Hebrew adaptations. The old
versions depicted below are out of print.

Hebrew 1982, Israel
Arabic 1991, Egypt
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 Russia
  "Ourselves and Our Body" Electronic adaptation only available online at www.womenhealth-spb.org/. By Women's Health in St Petersburg
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Armenia Menk ou Mer Marmine (We and Our Body) 

• Type Cultural Adaptation
• Format Print Edition
• Language Armenian
• Country Armenia
• Coordinating Group Charitable Foundation on
  Population Development
• Published 2001
• Second edition forthcoming in 2009

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BulgariaNasheto Tyalo, Nie Samite (Our body,
Ourselves)

• Type Cultural Adaptation
• Format Print Edition
• Language Bulgarian
• Country Bulgaria
• Coordinating Group Women's Health Initiative in
  Bulgaria
• Published 2001

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China The 1998 Chinese edition depicted
alongside - is out of print. Another group is
currently developing content into print and
digital format for web downloads and text-capable
mobile phones. This pioneering project will reach
roughly 1.5 million people in China.

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SenegalNotre Corps, Notre Sante (Our Body, Our
Health) French Edition for French-Speaking
Africa

• Type Inspired by Our Bodies, Ourselves
• Format Print Edition
• Language French
• Country Senegal
• Coordinating Group Groupe de Recherche sur Les
  Femmes et Les Lois au Senegal
• Published 2004 Reprinted in 2007

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(Left) Codou Bop, the coordinator of Notre
Corps, Notre Sante in Senegal, and (Right) Jane
Pincus, an OBOS co-founder and co-author of Our
Bodies, Ourselves
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Japan

• Type Cultural Adaptation
• Format Print Edition
• Language Japanese
• Country Japan
• Coordinating Group Shokado Womens Bookstore
• Published 1988

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Korea

• Type Cultural Adaptation
• Format Print and Electronic Editions
• Language Korean
• Country South Korea
• Coordinating Group Alternative Culture
  Publishing Co.
• Published 2005

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PolandNasze ciala, nasze zycie (Our Bodies, Our
Lives)

• Type Cultural Adaptation
• Format Print Edition
• Language Polish
• Country Poland
• Coordinating Group Network of East/West Women -
  Polska
• Published 2004

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RomaniaTu Si Curpul Tau Pentru un Nou Secol

• Type Cultural Adaptation
• Format Print Edition
• Language Romanian
• Country Moldova
• Coordinating Group National Women's Studies
  Information Center
• Published 2002

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SerbiaNasa Tela, Mi

• Type Cultural adaptation
• Format Print Edition
• Language Serbian
• Country Serbia
• Coordinating Group Autonomous Womens Center
  Against Sexual Violence
• Published 2001

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Spanish, USANuestros Cuerpos, Nuestras Vidas
(Our Bodies, Our Lives)

• Type Cultural Adaptation
• Format Print Edition
• Language Spanish (for the U.S)
• Country United States of America
• Coordinating Group Our Bodies Ourselves
• Published 2000 (Seven Stories Press, NYC)

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IndiaA Hundred Thousand Questions about Women's
Health

• Type Inspired by Our Bodies, Ourselves
• Format Print Edition
• Language Telegu (an English adaptation of this
  edition called Taking Charge of Our Bodies was
  published in 2004)
• Country India
• Coordinating Group Hyderabad Women's Health
  Group
• Published 1991

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IndiaHealthy Body, Healthy Mind

• Type Inspired by Our Bodies, Ourselves
• Format Print Edition
• Language Tibetan (back-translated into English)
• Country India
• Coordinating Group Tibetan Nuns Project
• Published 2005

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Lobsang Dechen, coordinator of the Tibetan project
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Editions in Progress
Published Foreign Editions of Our Bodies,
Ourselves
Books Inspired by Our Bodies, Ourselves
Editions in Progress
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• What are some key challenges facing womens
  health advocates today?
• Media portrayals of new medical research are
  often inaccurate or incomplete
• The media often endorse or reinforce our societal
  tendency to embrace the quick fix or pill for
  every ill approach

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• Key Challenges.
• Increasing influence of the pharmaceutical
  industry over physician prescribing practices as
  well as the educational and advertising materials
  aimed at the consumer or patient

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The failure to utilize best practices largely
because of perverse payment incentives well
described in Dr. Atul Gawandes June 1, 2009 New
Yorker piece entitled The Cost Conundrum.In
womens health, maternity care is a primary arena
where there are multiple examples reflecting the
failure to utilize best practices. As a result,
we have rising cesarean section rates, falling
VBAC (Vaginal Birth after Cesarean) rates, rising
rates of premature births, rising rates of
unnecessary medical interventions that are
increasingly shown to be associated with harms,
and falling breastfeeding rates in some regions.
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• Evidence-Based Maternity-Care What It Is and
  What It Can Achieve
• Issued by the Milbank Memorial Fund, the
  Childbirth Connection, and the Reforming States
  Group (2008)

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What is Evidence-Based Maternity Care?

• Definition
• Uses best available research on the safety and
  effectiveness of specific practices to help guide
  maternity care decisions and facilitate optimal
  outcomes in mothers and newborns
• Gives priority to effective care paths and
  practices with least harm

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What is Evidence-Based
Maternity Care?

• Corollaries
• Avoid practices with no clear benefit and
  established or plausible harms
• Avoid practices with marginal expected benefit
  that is overshadowed by established harm.
• FIRST DO NO HARM

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• Imperative for Maternity Care Quality Improvement

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Imperative for Maternity Care Quality Improvement

• Scale
• United States over 4.3 million births/year
• Childbirth In United States
• the leading reason for hospitalization
• mothers newborns are 23 of all discharges
• procedure intensive 6 of 15 most commonly
  performed hospital procedures in entire
  population associated with childbirth

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Imperative for Maternity Care Quality Improvement

• Costs and Charges
• Childbirth especially impacts 2 purchaser groups
• private insurers/employers pay for 51 of
  hospital stays
• Medicaid/taxpayers pay for 42 of hospital stays
• Combined maternal/newborn hospital charges far
  exceed charges for any other condition
  79,277,733,843 in 2005
• private insurers/employers 39,726,164,301
• Medicaid/taxpayers 34,164,460,561

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Addressing Underuse in Maternity Care

• Examples of Practices to Use Whenever Possible
  and Appropriate
• Smoking cessation interventions
• Ginger for nausea and vomiting
• Preterm birth prevention
• External version to turn breech
• presentation babies
• VBAC

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Addressing Underuse in Maternity Care

• Examples of Practices to Use Whenever Possible
  and Appropriate
• Continuous labor support
• Non-supine positions for giving birth
• Measures to relieve pain, bring comfort, and/or
  promote labor progress
• Early skin-to-skin contact (versus mother-baby
  separation)
• Breastfeeding and interventions to promote its
  initiation and duration

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Context Lactation support ranks lower than pet
insurance(thanks to Cate Colburn-Smith)
Comparison of employer benefits All companies Large companies (500 employees) Small companies (lt100 employees)
Chiropractic coverage 91 83 79
Well-baby program (post-natal) 77 79 77
Prenatal program 67 66 67
Accupressure/ Accupuncture 31 33 31
Onsite lactation/mothers room 25 35 13
Postal services 24 27 22
Massage therapy services 14 19 9
Dry cleaning services 13 18 9
Pet insurance 7 10 5
Lactation support services 6 10 2

• Starting in 2008, lactation program/designated
  area was separated into on-site lactation/
  mothers room and lactation support services
• Other family-friendly benefits included on-site
  parenting seminars (4) and on-site vaccinations
  for infants/children (3)
• The number of employees with lactation programs
  has grown from 16 in 1999
• Source Society of Human Resource Management 2008
  Benefits Report

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A Statement by Physicians, Midwives and Womens
Health Advocates who Support Safe Choices in
Childbirth

• That communities preserve the option of vaginal
  births after cesarean (so-called VBACs)
• That options for hospital-based midwifery care
  (utilizing Certified Nurse Midwives and Certified
  Midwives) be made available in all communities
• That Certified Professional Midwives (CPMs) be
  licensed and regulated in order to make the
  option of homebirth as safe as possible.

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• Breast augmentation statistics from the
  American Society of Plastic Surgeons
• 212,500 2000
• 291,350 2005
• 329,396 2006
• 55 increase between 2000 and 2006

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• Breast augmentation has always been among the
  top five surgical procedures, but until now has
  never been number one.
• ASPS Press Release, March 22, 2007
• (ASPS began collecting statistics in 1992)

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• MORE PUBLIC SCREENINGS OF THE DOCUMENTARY
  ABSOLUTELY SAFE ARE NEEDED.
• See also the booklet prepared by the US Food
  and Drug Administration for photographs and
  descriptions of adverse implant outcomes such as
  disfigurement, capsular contracture (when the
  breast becomes hard and misshapen), and
  deflation
• www.fda.gov/cdrh/breastimplants

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• A survey by the American Society of Plastic
  Surgeons showed that nearly 40 percent of plastic
  surgery patients believe they should have been
  more proactive in learning about potential side
  effects and complications before surgery.

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Milking Cancer Partners                         
                                                  
                                                  
                                            
                                                  
                                        
                                                  
             

• Eli Lilly is now the sole manufacturer of rBGH
  the artificial growth hormone given to dairy cows
  that increases peoples risk of cancer. Eli Lilly
  also manufactures breast cancer treatment
  medications and a pill that reduces the risk of
  breast cancer. Eli Lilly is milking cancer. Tell
  them to stop making rBGH.

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• A large coalition of groups
• See www.safecosmetics.org
• Skin Deep a report of the Environmental
  Working Group, helps consumers and workers to
  better protect themselves from known or suspected
  carcinogens and reproductive toxins.

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• "It is simply no longer possible to believe much
  of the clinical research that is published, or to
  rely on the judgment of trusted physicians or
  authoritative medical guidelines. I take no
  pleasure in this conclusion, which I reached
  slowly and reluctantly over my two decades as an
  editor of The New England Journal of Medicine.
  Marcia Angell, MD

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• Direct-to-Consumer Advertising of Prescription
  Drugs
• Misleading Ads and How They Hurt Us

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The Public Gets Misinformation

• Benefits are often overstated, while risks are
  understated
• FDA warning letters are issued after the ads run
• Corrective ads are rarely required
• Withdrawal of an ad is the only penalty

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• Ads are geared primarily to selling more drug
  product, not educating the user
• The ads work the most highly advertised drugs,
  accompanied by promotional campaigns geared to
  physicians, sell extremely well

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To promote The Hunt for the
Pink Viagra(Slide Courtesy of Leonore
Tiefer)
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• For more information about female sexual
  problems, see the website of the Campaign for a
  New View of Womens Sexual Problems
• www.fsd-alert.org

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Removing healthy ovaries

• US federal data from the late 1990s
• 78 of women 45-64 who have had a hysterectomy
  also had healthy ovaries removed (even though
  most were not at particular risk of developing
  ovarian cancer).

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Ovarian Conservation at the Time of Hysterectomy
and Long-Term Health Outcomes in the Nurses
Health Study by William H. Parker et al. Obst
Gyn May 2009
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• Compared with ovarian conservation, bilateral
  oophorectomy at the time of hysterectomy for
  benign disease is associated with a decreased
  risk of breast and ovarian cancer but an
  increased risk of all cause mortality, fatal and
  nonfatal coronary heart disease, and lung cancer.
  "

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• This reconfirms findings in an earlier study by
  Parker et al (Obst Gyn Aug 2005)
• For 10,000 women 50-54 yrs old who undergo a
  hysterectomy with oophorectomy, there will be 47
  fewer cases of ovarian cancer by the time these
  women reach 80 when compared with a similar group
  who keep their ovaries.

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• BUT the oophorectomy group will suffer 838
  additional deaths from coronary heart disease as
  well as 158 more deaths from hip fractures.
  (Numbers reflect women who do NOT have estrogen
  therapy there is a smaller survival benefit to
  keeping the ovaries in women taking estrogen.)

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• Media attention to this critical issue has been
  minimal, and the practice of removing healthy
  ovaries continues.
• 300,000 US women have a prophylactic
  oophorectomy every year at the time of a
  hysterectomy.

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• The Marketing of Osteoporosis by Maryann Napoli
• American Journal of Nursing
• April 2009 (V.109),4, p58-61
• http//journals.lww.com/ajnonline/Fulltext/2009/0
  4000/The_Marketing_of_Osteoporosis.41.aspx
• Chronicles how a risk factor became a disease

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Research did not support the DXA scanning of
well women at or near menopause as a means of
predicting future fractures
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4 year trial of alendronate in elderly women
with bone loss but no vertebral fracturesHip
fracture rate virtually no different for the
drug-treated participants than for the placebo
group (1 vs. 1.4, respectively)
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Alendronates -Improve bone density but not
effective at reducing hip fractures- Longterm
harms now emerging (eg, risk of severe and
sometimes incapacitating musculoskeletal pain)
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See the 2002 guidelines for osteoporosis
screening from the Agency for Healthcare Research
and Quality They recommend that bone-density
scanning not begin until age 65 (or 60 in some
high-risk cases)
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Risks to Womens Health from Multiple Egg
Extraction Procedures

• An issue for women considering egg donation
  whether to help infertile women or to provide
  eggs for research cloning, also known as somatic
  cell nuclear transfer (SCNT).

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