THE BIRTH OF THE BLUES
Postpartum depression has long been a focus of concern, but it is no more common or severe than depression during pregnancy, according to results of a British study of women who gave birth in 1991-1992.1 Using a standard scale that indicates probable depression among women who have recently given birth, researchers compared symptoms of women at two points during pregnancy and two points postpartum. Among more than 9,000 women who completed the scale at all four points, scores rose between weeks 18 and 32 of pregnancy, then fell significantly by eight weeks postpartum and again by eight months after the birth. Similarly, the proportion of women whose scores reached the threshold suggesting depression increased during pregnancy, peaking at 14% at 32 weeks; by contrast, 9% of women scored at this level eight weeks postpartum and 8% at eight months. A smaller proportion of women reached the threshold after giving birth than did so during pregnancy. As the investigators point out, depression during pregnancy "may have an important effect on the uterine environment, and research is urgently needed into the consequences for the child....Offering treatment may be important for both the mother and the future wellbeing of the child and family."
1. Evans J et al., Cohort study of depressed mood during pregnancy and after childbirth, British Medical Journal, 2001, 323(7307):257-260.
BIRTHS TO SOME WOMEN ON WELFARE DROP
In Washington State, 42 women of every 1,000 receiving public assistance gave birth in 2000--30% fewer than did so in 1994.1 The 2000 rate among women on welfare also was 30% lower than the rate for all women in the state. With a lack of similar statistics from other states, it is not possible to know whether the decline is unique to Washington, but some public health experts believe that the change largely reflects the influence of the state's welfare-to-work program. When women apply for benefits, they receive a packet of information about child care and family planning services; once enrolled, they have coverage for the pill, the implant and sterilization. While the program does not penalize women for having additional children, its staff try to encourage them to envision the ramifications of doing so. A state researcher admits that Washington is unlikely to reach its goal of eliminating births among women on welfare, but acknowledges that the state "will keep trying."
1. Fryer A, Fewer babies born into welfare, Seattle Times, Oct. 4, 2001, <http:// archives.seattletimes.nwsource.com/cgi-bin/texis/web/vortex/display/slug= welfare04m&date=20011004>, accessed Oct. 22, 2001.
NEW CONTRACEPTIVE WINS APPROVAL
The Food and Drug Administration has approved a seven-day contraceptive patch that was as effective as the pill in clinical trials.1 Ortho Evra, which delivers continuous levels of progestin and estrogen to the bloodstream through the skin, was 99% effective in trials involving more than 3,000 women aged 18-45 who used it for up to 13 cycles. The patch adhered well to the skin, even if users swam or used a treadmill, sauna or whirlpool; only about 5% of patches had to be replaced because of complete or partial detachment. In a trial that compared patch and pill users, women wearing the patch were significantly more likely than those taking the pill to use their method consistently and correctly (89% vs. 79%). The most commonly reported side effects associated with use of the patch were breast discomfort, headache, nausea, and mild or moderate skin irritation around the patch.
1. Reuters, FDA approves new weekly birth control patch, Nov. 20, 2001, <http://dailynews.yahoo.com/htx/nm/20011120/h1/birthcontrol_1.html>, accessed Nov. 21, 2001; and Ortho-McNeil Pharmaceutical, Data presented show investigational birth control patch 99 percent effective, news release, Raritan, NJ: Ortho-McNeil Pharmaceutical, Oct. 22, 2001.
NEWS FROM STATE HOUSES
State legislatures passed a variety of measures in 2001 that should help advance women's reproductive health and rights.1 California enacted a law allowing pharmacists to dispense emergency contraceptive pills without a prescription if they follow a protocol developed with the participation of a provider who is authorized to prescribe medication, and Illinois passed a measure requiring hospitals to provide information about the method to women who have been sexually assaulted. Four states adopted laws or regulations requiring health insurers that offer prescription drug coverage to cover all government-approved contraceptive drugs and devices; 17 states now have such laws. In addition, 19 states enacted laws facilitating the safe abandonment of newborns, bringing to 35 the total number of states with such provisions. Not all issues fared quite as well, however: A total of seven states passed new restrictions on family planning funding, mandatory waiting periods for women seeking abortions, a ban on the use of public funds for abortion, and a law effectively mandating parental involvement in minors' abortion decision. South Carolina passed a law permitting proceeds from the sale of license plates with antiabortion slogans to go to organizations that oppose abortion. To the surprise of many analysts, no state imposed restrictions on medical abortion in the wake of federal approval of mifepristone.
1. Gold RB and Nash E, State policy in 2001: major reproductive health-related developments, The Guttmacher Report on Public Policy, 2001, 4(6):11-12 & 14.
JAPANESE BABIES ARE SHRINKING
Babies born in Japan in 2000 were nearly a quarter of a pound lighter and almost one-fifth of an inch shorter than newborns 10 years earlier, according to results of a government study.1 Government researchers acknowledge that several factors have contributed to the declines, including women's attention to weight control during pregnancy to avoid toxemia and technological advances that increase survival rates among premature infants. However, they say that the main reason underlying the changes is that pregnant women have grown increasingly likely to smoke: Ten percent did so in 2000, compared with 6% a decade earlier.
1. Birthweight of Japanese newborns decreases due to increased smoking among pregnant women, Kaiser Daily Reproductive Health Report, Oct. 25, 2001, <http://report.kff.org/archive/ repro/2001/10/kr011025.7.htm>, accessed Nov. 21, 2001.
SHOULD PILL USERS FLY?
The British government has advised all women who are at risk of deep vein thrombosis to consult a doctor before taking long airplane or car trips, because the condition, which is associated with long periods of sitting, can cause clots to form in the legs; if the clots travel to the lungs, they can be fatal.1 But who is at risk? The list includes pill users, women on hormone replacement therapy, and those who have recently given birth or are pregnant. Government guidelines recommend the use of support stockings, "in-seat exercises" and blood-thinning drugs to help the flow of blood to the legs. The World Health Organization and the airline industry have called for comprehensive research to study the risks of blood clots among high-risk groups, including women using hormonal drugs for contraception or after menopause.
1. U.K. health department warns women using oral contraceptives about risks of long flights, car trips, 2001, Kaiser Daily Reproductive Health Report, Dec. 3, <kaisernetwork.org/daily_reports>, accessed Dec. 5, 2001.
WHEN TO CLONE
The dangers of reproductive cloning that justify a ban on this procedure do not apply to therapeutic cloning, a process by which stem cells are created for clinical and research purposes, according to an expert panel convened by the National Academy of Sciences.1 While the scientists agreed that efforts to reproduce mammals entail substantial risks and thus should be banned, they concluded that research involving embryonic stem cells should be permitted because of its "considerable potential for developing new medical therapies to treat life-threatening diseases and advancing biomedical knowledge." The panel issued its recommendations as the Senate prepares to consider legislation, backed by President Bush, that would ban cloning of any type.
1. The National Academies, U.S. policy-makers should ban human reproductive cloning, news release, Washington, DC: The National Academies, Jan. 18, 2002.
THE LATEST ON HIV AND AIDS
Eastern Europe and Central Asia have the fastest-growing AIDS epidemic of any world region; 250,000 of the one million HIV-infected people living there in 2001 received their diagnosis that year.1 HIV diagnoses have almost doubled annually since 1998 in Russia, and the number of infections reported in Estonia soared from 12 in 1999 to 1,112 in the first nine months of 2001. With rates of other sexually transmitted diseases, as well as rates of injection-drug use among young people, high in the region, no end to these trends is in sight. In the United States and other higher-income countries, meanwhile, the threat of a resurgent epidemic looms as progress in treatment is overshadowed by increases in unsafe sexual behavior, widespread public complacency and stalled prevention efforts. In terms of sheer numbers, the profile of the epidemic remains staggering in Sub-Saharan Africa, where 28 million people are now infected. National prevalence levels throughout Asia, the Pacific, Latin America and the Caribbean vary and can be quite low; in these regions, however, particular areas or population groups are disproportionately affected. Finally, prevalence is low in most parts of North Africa and the Middle East, but the number of infections is growing in several countries.
1. Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO), AIDS Epidemic Update: December 2001, Geneva: UNAIDS and WHO, 2001.
• In Dire Demographics: Population Trends in the Russian Federation, researchers from RAND update trends in fertility, population growth, contraceptive use and abortion in Russia, and provide an analysis of the policy implications of these trends. The report is available through RAND's Web site at www.rand.org/publications/MR/ MR1273. [RAND, Memo to journalists, news release, Santa Monica, CA: RAND, Nov. 15, 2001.]
• Catholics for a Free Choice (CFFC) has launched a global campaign to end the church's ban on condom use. In the first phase of the campaign, which began in November 2001, newspaper and billboard ads aimed at raising public awareness of the effect of the ban are being placed in the United States and countries with a substantial Catholic population or AIDS crisis. The campaign's Web site, www.condoms4life.org, offers visitors an opportunity to view the ads and encourages them to contact policymakers, expressing support for the availability of condoms. [CFFC, First global campaign to end Catholic bishops' ban on condoms launched on Internet, billboards, in subways and newspapers, news release, Washington, DC: CFFC, Nov. 21, 2001.]
• The 2001 edition of Making the Grade on Women's Health: A National and State-by-State Report Card, now available from the National Women's Law Center (NWLC), provides information on women's health status, federal policies and programs of importance to women's health and well-being, gaps in health research, and health disparities based on race, ethnicity, sexual orientation and disability. The Report Card compares 65 measures across states and examines progress made since 2000. To order, visit <www.nwlc.org/pubcenter>. [NWLC, news release, Washington, DC: NWLC, Dec. 27, 2001.]