A word from Curtis Chan


Good evening San Francisco!  I hope everyone was able to enjoy the perks of folic acid awareness week.  This week was just the beginning of a new year, a year where awareness and action will be the driving force taking control of our very own health!

Today’s blog comes to us from the fabulous Curtis Chan, MD, MPH, Medical Director of Maternal, Adolescent & Child Health in SF.  Let’s here what he has to say….

  1. Importance of Folate
  • Vitamin B9, also called folic acid or folate is found naturally in some foods, including leafy green vegetables, citrus fruits, beans, salmon, and whole grains.   However, most women do not eat enough of these foods to provide the optimal health benefit of folic acid.
  • B9 is an essential nutrient for amino acid synthesis and DNA replication.  Hence, it’s particularly important during the critical first 8 weeks of pregnancy, during the critical window of early brain and spinal cord development of the fetus.
  • Compelling research showing that folic acid drastically prevented neural tube defects caused the US Preventive Services Taskforce and the National Academy of Sciences (1996) to recommend daily consumption of 400 mcg of folic acid.
  1. Study Findings
  • In July 2014, the American College of Obstetricians and Gynecologists (ACOG), the main professional organization for OB-GYN physicians, published in its highly reputable peer-reviewed scientific journal, Obstetrics and Gynecology, a research article from Harvard Medical School, “Maternal pre-pregnancy folate intake and risk of spontaneous abortion and stillbirth.”
  • The study showed that the risk of miscarriage (or spontaneous abortions) was 20% lower among women taking high amounts of folate acid (730 ug/d) compared to those with the lowest intake (0 ug/d).
  • Since 1992, public health and medical authorities have recommended that all women U.S. Preventive Services Task Force and Centers for Disease Control and Prevention recommend that all women capable of becoming pregnant take 400 micrograms of folic acid daily to prevent neural tube defects.  While many women aren’t familiar with the brain and spinal cord deformities of neural tube defects, research has since shown other health benefits of folic acid to the mother and infant.
  • The significant risk reduction in miscarriage is another important reminder about the benefits of women taking folic acid vitamins as part of their daily routine, before becoming pregnant.

Curtis Chan, MD, MPH

Medical Director of Maternal, Child & Adolescent Health

San Francisco Department of Public Health

30 Van Ness Avenue, Suite 260b, SF, CA 94102

Weekly Round-Up: Women’s Health News 8.16.13


In this week’s news – more benefits to breastfeeding, the wide use of withdrawal as birth control, post-partum depression among urban women, a new HIV treatment, help for smokers who want to quit, and decreases in the U.S. infertility rate.

One Third of All U.S. Women Uses Withdrawal for Birth Control
If you and a partner have used withdrawal for birth control, you’re not alone.  A new study found that up to 1/3 of sexually active U.S. women between the ages of 15-24 has done so.  While withdrawal can be almost as effective as condoms for pregnancy prevention when used perfectly, it is a very difficult method to use, resulting in a failure rate of 30%.  While many women use withdrawal when they cannot afford more effective hormonal methods of birth control, this will hopefully become less common since the Affordable Care Act requires that all insurance plans cover contraception with no co-pay.  If you are using withdrawal, it is very important to take a daily vitamin with folic acid in case you do get pregnant (see the Go Folic! website). Click here to learn more about the study.

New Moms – Breastfeeding May Reduce Your Risk of Breast Cancer!
A new analysis published in this month’s Journal of Clinical Nursing found that breastfeeding for more than six months may safeguard nonsmoking mothers against breast cancer. The same does not seem to hold true for smoking mothers, though. These findings add to the list of benefits of breastfeeding for women and their babies. Click here to learn more.

Urban Moms at Greater Risk for Post-Partum Depression
A new Canadian study found that that women living in urban centers with more than 500,000 inhabitants were at higher risk of postpartum depression than women in other areas. Postpartum depression is a serious health concern for women and their children and women who lack of social support and/or have a history of depression are at greater risk.  To learn more about the study, click here.

Thinking of Becoming an Ex-Smoker? Meditation May Help
One of the first actions doctors recommend to a woman smoker who wants to get pregnant is to quit smoking. But that can be easier said than done. A small study conducted by the University of Oregon’s department of psychology found that learning a particular type of meditation technique might make it easier for smokers to cut down, at least on a short-term basis. Mindfulness meditation is designed to help people to relax, focus on the current moment and, essentially, go with the flow of thoughts and sensations. Click here to learn more.

Good News for Would-Be Parents – U.S. Fertily Rate is Decreasing!
A couple is considered to be infertile if they have been having unprotected vaginal intercourse for 12 months in a row without experiencing a pregnancy. According to the National Health Statistics Report, the rate of infertility among U.S. couples, ages 15-44 declined between 1982 and 2010, from 8.5% to 6.0%. Click here to download the full report (PDF).

New HIV Drug Just Approved
On August 12, 2013, the U.S. Food and Drug Administration approved Tivicay (dolutegravir), a new drug to treat HIV-1 infection. It can be used to treat HIV-infected adults who have never taken HIV therapy (treatment-naïve) and HIV-infected adults who have previously taken HIV therapy (treatment-experienced). The drug is also approved the drug for children ages 12 years and older weighing at least 40 kilograms. Visit the FDA website to learn more.

Weekly Round-Up: Women’s Health News 7.26.13


This was another week full of women’s health news. If you see that we’ve missed something, please post a comment or email it to us and we will publish an addendum!

New standards for STIs screening and treatment in TeensYouth and Sexually Transmitted Infections (STIs) As reported by the National Partnership for Women and Families, Linda Carmine of the Division of Adolescent Medicine at Cohen Children’s Medical Center of New York and her colleagues provided updates on the diagnosis and management of sexually transmitted infections in adolescents and young adults, “with an emphasis on ‘what’s new’ in the field.”  The review was published in the 6/17 issue of the Journal of Pediatric and Adolescent GynecologyClick here to read a summary of the findings.

Does your reproductive health provider ask you about your stresses?Does your family planning provider ask you about the stresses in your life? A study published in the June issue of the journal, Contraception, found that, in young women who experience depression or elevated stress are less likely to consistently use hormonal contraceptive methods like the pill.  The researchers recommend that health providers address clients’ psychological and emotional status when helping them make decisions about birth control methods. Click here to read the study abstract.

What if barbie dolls looked more real than this>Barbie and Body Image – What if Barbie looked like a normal woman? It’s not exactly news that few women, if any, look like Barbie in real life.  It’s also not news that Barbie is not the best tool for encouraging healthy body image among little girls.  But what would happen if Mattel(T) modified Barbie, giving her more realistic body proportions?   One enterprising artist decided to see. Would we like her better? Would she be better for little girls’ self-esteem?  We’ll let you be the judge!  Click here to see a blonde Barbie’s before and after picture (on Upworthy)!

7 of 10 women in u.s. seek reproductive health services every year7 of 10 Women Use Reproductive Health Services A new report from the Guttmacher Institute found that 70% of U.S. women of reproductive age make at least one medical visit for sexual and reproductive health (SRH) services each year. Uninsured women are significantly less likely than either privately or Medicaid-insured women to receive SRH services. Our hope is that the provisions for women’s preventive care included in the Affordable Care Act (ACA, also known as Obamacare), will make a difference for uninsured women who are currently going without.  To read the report, click here.  To learn more about ACA requirements for women’s health care, click here.

the HPV vaccine may protect against throat cancerGet Vaccinated, Prevent Throat Cancer? A new study suggests that young women who are vaccinated against the human papillomavirus (HPV) not only protect themselves from cervical cancer, but from throat cancer as well.  HPV is responsible for up to 70 percent of oral cancers, so getting the vaccine is an important step towards keeping your throat healthy!  Click here to read more about the study.

Weekly Round-Up: In the News!


Welcome to our first weekly round-up.  Every Friday, Go Folic! will provide a review of some of the most important news stories concerning young women’s health, including research, legislation/reproductive rights, and health care access.  We’ll also provide you with links to learn more.  This week’s stories both involve contraception.  Please, read on!

The Birth Control Pill May Lower the Risk of Ovarian Cancer

various types of birth control pillsA new study reported in the journal, Obstetrics & Gynecology, Women found that women who use birth control pills are less likely to develop ovarian cancer later in life.  The study, which examined data from 24 past studies that included thousands of women who took birth control pills for various lengths of time found that women who used oral contraceptives had a 27% lower risk of developing ovarian cancer and women who took the pills for at least 10 years were half as likely to develop the disease, compared with women who never took the pills.

FURTHER READING
The Pill Tied to Lower Ovarian Cancer Risk (Reuters News Service)

Plan B Emergency Contraception Available with no Age Restrictions

Back up your birth control with EC

Image courtesy of the “Back Up Your Birth Control” Campaign

On Monday, June 10, the Obama administration announced that it would no longer fight to maintain age restrictions on over-the-counter sales of the emergency contraceptive (EC), Plan B.  This announcement followed a decision by the 2nd U.S. Circuit Court of Appeals that the FDA must make two-pill versions of EC available without age or point-of-sale restrictions while the court considered the government’s appeal of a judge’s order to drop restrictions on all EC products.  Before this decision, girls under the age of 17 could not buy the product, one of several types of “morning after” pill, without a prescription.

Plan B can be used after intercourse to prevent pregnancy if taken within 72 hours of rape, condom failure or forgetting regular contraception.  It works by preventing ovulation and can cut the chances of pregnancy by up to 89 percent.  If a girl or woman already is pregnant it has no effect.  However, it works best within the first 24 hours, and requiring a woman to get a prescription may delay being able to take it at the most effective time.

Research has established that emergency contraception is safe and that teenagers are capable of taking it correctly. Many medical associations, including the Society for Adolescent Medicine and the American Academy of Pediatrics, had criticized the FDA age limit for making it harder for teens in the U.S. to prevent pregnancy. Some organizations are now expanding the fight for birth control access to make it easier for women to access generic forms of EC (read more).

What does this mean for teenagers?  Currently, anyone under the age of 17 needs a prescription to get emergency contraception.   All youth clinics in San Francisco will see a teen who needs EC on the same day, although many of these sites are closed during the weekend.  Plan B should be available over-the-counter (without a prescription at pharmacies) without age restricts in July or August 2013.  Certain other forms of EC will still require a doctor’s prescription.  These forms include generics, which are less expensive, and Ella, which is considered to be more effective than Plan B.

FURTHER READING
Women’s Health Policy Report
Learn more about the history of the decision
Association of Reproductive Health Professionals FAQ
For a complete explanation of the laws regarding teen use of EC
Teen Source Clinic Finder
To find a youth clinic in California by zip code

Featured YouTube Video: “Safe Sex” A Story of Birth Control Sabotage

Video


When we feature videos, we try to choose media that makes the viewer think about the various issues of today and how information is passed along in this fast-paced social media-oriented world. So check out this video, because this is one of the first music videos we’ve seen about the issue of contraceptive sabotage. 

Researchers who work in the area of relationship violence have found that up to 50% of all unintended pregnancies happen when a male partner messes with his female partner’s birth control.   Some questions – has this happened to you or any of your friends?  How do you think women should deal with this? Do you think this is an effective way to spread information about this issue?  We want to hear your thoughts!

Need birth control? Bedsider.org and Other Great Online Resources


Access to affordable birth control and accurate birth control info is a major health concern for most women who have male romantic and/or sexual partners.   Googling “birth control” will give you 76,800,000+ results.  The first three of these are ads that will take you to a drug company peddling a specific method.  So where can you go for accurate, unbiased information?   We decided to answer that question with a list of our favorite birth control websites. 

Choosing a method     

Quick Guide: Which Birth Control ‘Fits’ You?
WebMD’s birth control quiz can give you information to start making an informed decision before you ever get to a clinic.

Method Explorer
Birthsider.org’s method explorer includes search filters like “most effective”, party-ready (mix better with booze), and do me now (allow for spontaneous sex).  It also provides video clips of real 20-something women talking about their personal experiences, likes and dislikes of each individual method.

Birth Control Q&A
Have additional questions about specific birth control methods?  Check out Planned Parenthood’s FAQ section.

Birth Control Info in 7 Languages
California’s Family PACT website has client info sheets on each of the birth control methods in English, Spanish, Chinese, Vietnamese, Korean, Russian, and large print English.

Where to go for birth control and emergency contraception       

Inside California

Outside California

Want a reminder?        

Bedsider.org provides two text reminder services:

If you have a favorite website of your own, we invite you to post it either here, or on our Facebook page.

Will the pill make me gain weight? And other common birth control pill questions


Pack of birth control pills - will these make you fat?

Will these make you gain weight?

The pill is one of the most studied medications in history, and taking it is far less risky for most women than giving birth(1).  However, up to 20% of unplanned pregnancies may be the result of common misconceptions about its safety (2).  So, we decided to continue this week’s birth control theme by addressing some of the most common concerns about birth control pills. 

1. Will the pill make me gain weight? Not necessarily 

Most women – 60% – don’t gain or lose weight while on the pill.  Between 15-20% actually lose weight, while 20-25% gain more than 4.5 pounds.  Pills with more estrogen may cause water retention, and progesterone in some pills may increase appetite, both of which may lead to weight gain. Switching to another brand may solve these problems.

2. Does the pill cause cancer? Not necessarily

Here’s what the research shows:

  • Taking the pill for at least three years reduces ovarian cancer risk by 30%-50%;
  • Women who use the pill are 1/3 less likely to get uterine cancer than those who don’t;
  • Ever using birth control pills may reduce colorectal cancer risk by up to 20%;
  • The jury is still out on breast cancer.  Women with a family history of breast cancer should discuss this with their clinician when considering the pill. 

3. Aren’t all birth control pills the same? No

There are many different brands and varieties of the pill.  Each type has its own combination of estrogen and progesterone and so can affect an individual woman’s body chemistry differently.  That’s why you might have troublesome side effects on one type of birth control pill, but not on another.

4. I smoke.  Does this mean I can’t use the pill? Not necessarily

While some pill brands are suitable for smokers, most doctors will not prescribe combination pills (those with estrogen and progesterone) for smokers who are age 35 or older. Women who smoke and take the pill have a higher risk for both stroke and blood clots.  Both of these risks increase even more in smokers who are age 35 or older.  

5. Don’t I need to take a breaks from the pill ? No

There’s no medical reason for a healthy woman to take a break.  Since most side effects occur during the first months of pill use, women who go on and off the pill may experience side effects repeatedly.  Doctors do advise women to review their contraceptive needs after 15 years of being on the pill or at age 35. 

6.  Can taking the pill make it harder for me to get pregnant? No

There is NO connection between taking the pill and infertility. Fertility can return almost immediately after stopping the pill, which is why it’s important not to miss pills.

7. Does the pill have other benefits besides preventing pregnancy? Yes

The pill may provide many additional health benefits, including:

  • More regular periods
  • Control over when you get your period
  • Stopping ovulation pain
  • Reducing menstrual cramps
  • Minimizing PMS symptoms
  • Lowering the risk of anemia (which can result from having heavy periods)

Additionally, pill use can provide protection against:

  • Ectopic pregnancy
  • Acne
  • Non-cancerous breast growths
  • Pelvic inflammatory disease
  • Osteoporosis
  • Excess facial and body hair
  • Some types of migraine

8. If under 18, don’t I need my parents’ permission to take the pill? No

In California you do not need parental permission to get birth control.  California teens, click here to find a teen friendly clinic near you.

 ____________________________________
RESOURCES:
Mayo Clinic: http://www.mayoclinic.com/health/birth-control-pill/WO00098
Planned Parehnthood: http://www.plannedparenthood.org/health-topics/ask-dr-cullins/cullins-bc-5398.htm

Coming Tomorrow:
Our favorite web resources on birth control