(Q2, 2024) The Women’s Health Activist Newsletter!

Quarter 2, 2024

All the articles for the latest quarter two, 2024 issue can be accessed by scrolling down this page, or by jumping to the articles that interest you specifically by clicking on the headings in our handy table of contents below.

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The Newsletter Archive

NWHN Values

We believe that…

  • Health is a human right.
  • Our gender identity, race, ethnicity, sexual orientation, disability, geographical location, socioeconomic status, insurance status, and/or immigration status should not dictate the quality of healthcare we receive.
  • This work is intersectional and must be conducted through a lens of diversity, equity, inclusion, and justice.
  • Lived experience and scientific evidence must drive health policy and shape healthcare.
  • Maintaining the integrity of our work is essential.

A Message From the Executive Director

Executive Director of the National Women’s Health Network

Dear Supporters,

First, I want to thank you for voting new board members to the National Women’s Health Network’s (NWHN) board of directors. Also, a huge thank you for supporting our need to amend the bylaws that will allow us to be more flexible and responsive to the needs of the organization and to the needs of the millions of people who seek us out annually for the latest in health information. The fight continues and we remain determined. The decades may have changed policies, and there are new faces behind the messaging, but the challenge remains the same…education, advocacy, and fighting for women’s health care rights.  

Our attention remains steadfast on the pressing challenges that women face in obtaining or maintaining health care. It can be discouraging that we continue to face disparities in critical health care issues and that women must navigate the many obstacles affecting their health and wellbeing. At the NWHN, we are change leaders with the obligation to raise awareness, our voices and our influence for what’s right and equitable in, for example:  

  • Health care access – despite the scientific advances we do see, many women still face barriers to receiving quality care in 2024. Factors such as limited resources, financial constraints, geographical/location constraints, and cultural norms can prevent women from accessing essential health care services, screenings, services, and treatments
  • Reproductive health – remains the number one concern for women. Access to contraception, maternal health care, birth control, and safe abortion services are essential for women’s well-being. Restrictive policies backed by conservative extremists, stigma, and lack of information impedes a woman’s ability to make informed decisions rooted in their own bodily autonomy. The NWHN remains committed to women’s reproductive rights through the technical assistance provided to the HEALTH program and by fiscally sponsoring initiatives such as Plan C, M&A Hotline, Appellation Abortion Support Collective, HYDRA and similar organizations providing public health services to people on the ground
  • Mental health – every day we read about how women are disproportionately affected by mental health issues such as depression, anxiety, and trauma. Gender-based violence, “societal expectations/media” and the vast issues related to women’s bodies as we age contribute to mental health and wellness. The NWHN continues to support collaborations that address research, advocacy, and services reaching women and empowering them to seek balance and mental wellness. We know women’s health research continues to address mental health and including women of all races and ages in clinical trials and research remains paramount. 
  • Chronic conditions – cardiovascular disease, diabetes, and autoimmune disorders, are a few of the conditions that impact women more adversely than men. Gender specific risk factors, hormonal influences and overall disparities in health care access affect the prevention, diagnosis, and management of these conditions for women. Again, we are looking to speak truth to power and build ally-ship in ensuring women’s health needs are addressed. The NWHN has centered many of these lived experience stories on our podcast, and we have plans to do more.  

The process of protecting women’s health care rights also lies with the power of the vote. Watch for NWHN’s 4Her2024 campaign where we provide education on voting. A lot is riding on ballots across the country and we all can make a difference. 

For more information on our 4Her2024 campaign, or on how you can support NWHN’s work through donations, visit www.nwhn.org/4her2024   

 

-Denise Hyater-Lindenmuth, Executive Director

 

Deep Dives

Go below the surface on health topics you care about.

Paragard Breakage: A Call to Action to Protect Women’s Health 

By: NWHN Staff in Cooperation with the NWHN Policy Associates

The Current Paragard Situation  

Recent data suggests that almost 14% of women between the ages of 15-44 in the United States used an intrauterine device (IUD) as their primary form of birth control [1]. There are two different forms of IUDs: a copper nonhormonal form (known as Paragard) and another hormonal form. A study shows over 6,000 women have experienced IUD breakage when getting their Paragard IUDs removed. 80% of them, or 4,800 women, have experience serious complications from the breakage [2]. Complications have ranged from the need for surgical removal of the device to a hysterectomy or removal of the colon from the pieces migrating and embedding into tissue. Other complications have included sepsis, extreme bleeding, and infertility [2].  

 In 2023, 1,231 Paragard IUDs were reported to the FDA’s Adverse Event Reporting System (FAERS) [2]. According to a study published in February 2023, copper IUDs, like Paragard, are reported to break at a rate of 9.6% compared to just 1.7% for other IUDs [3].  

Paragard has been marketed as an easy to remove IUD, however, several women have alleged that the plastic arms at the base of the device do not flex upward as they are supposed to during removal – leading to breakage of the device [4]. This breakage leads to pieces of plastic being stuck in the uterus, with some women requiring surgical removal of these plastic shards, and others having long term complications.  

The affected women have filed a lawsuit against the manufacturer of Paragard, CooperSurgical (and the former manufacturer of the IUD, Teva Pharmaceuticals), arguing that there are product liability claims based on the defective design of the IUD, a failure to warn of the potential risk of breakage and other serious complications, and general negligence on behalf of the manufacturer [4].  

Paragard Background 

Paragard is a non-hormonal IUD that has a soft copper wire around the device and was FDA approved in 1984 [1]. Paragard is a long-acting reversible contraception (LARC) and has been used by millions of women for its many benefits. Those benefits include [5]:  

  • Up to 10 years of constant birth control 
  • Up to 99% effectiveness for preventing pregnancy 
  • Hormone-free contraceptive  
  • Immediately reversible  
  • No significant changes to the natural menstrual cycle 

 

Despite the many benefits, Paragard comes with many risks and side effects [5][6]:  

Common side effects include:  

  • Anemia 
  • Vaginitis 
  • Painful sex  
  • Spotting  
  • Prolonged or painful periods  
  • Expulsion  

Serious side effects include: 

  • Sepsis  
  • Ectopic pregnancy  
  • Pelvic inflammatory disease or endometritis  
  • Full or partial expulsion of the IUD 
  • Embedment  
  • Perforation  

It is important to note that on the Paragard website, the risk of breakage is not disclosed on the patient side of the website; this is only mentioned on the site for Healthcare Professionals or under the Full Prescribing Information. 

History of CooperSurgical and the Paragard IUD  

CooperSurgical, Inc. acquired Paragard from Teva Pharmaceuticals Industries Ltd in November 2017[6]. 

In March of 2022, the FDA issued a warning regarding product breakage. The warning states that CooperSurgical did not determine the root cause of why Paragard was breaking or implement changes to the manufacturing of the device [2]. Currently, there is no statutory or regulatory requirement for a company to respond to this type of warning, and the FDA is not required to follow up on it.  

Analysis of the Paragard Situation by Rachel Grimsley, RN, BSN, MSN, Nurse Writer 

Paragard and CooperSurgical must protect women from the flawed design of Paragard and provide health care providers and patients with accurate risk assessments for their device.  

Paragard continues to be advertised as a form of emergency contraception to women in crisis, and as an easy form of birth control that does not require pills, injections, or frequent doctor appointments and can last up to 10 years. However, women are not being thoroughly counseled on the risks of this device, and CooperSurgical and the Paragard website are not providing this information to women directly.  

There is no mention of the risk of breakage of the device on the Patient Fact Sheet or Patient Brochure provided on Paragard’s website. 

The full prescribing information on Paragard’s website includes one statement regarding breakage, “Breakage of an embedded Paragard during non-surgical removal has been reported.” This statement does not specify that a routine removal of a non-embedded Paragard can lead to breakage of the device and migration or perforation from the broken pieces.  

It is essential that the breakage of the Paragard IUD be better described on Paragard’s website, in the patient brochure, patient handout, and the full prescribing information. 

Health care providers can not thoroughly educate their patients about the risks and benefits of long-acting contraceptives like Paragard if the company omits these risks and does not test their device to ensure the safety of women and those seeking long term birth control.  

Additionally, CooperSurgical perform a root cause analysis as to why the device is breaking and implement changes to their device.  

Analysis of the Paragard Situation by Raaya Alim, MPP, Policy Associate  

The National Women’s Health Network represents the health interests of women across the life continuum with an intersectional focus on sexual and reproductive health, maternal health, and the health and well-being of aging women. We work to improve health outcomes through state and federal advocacy, consumer health education, and grassroots technical assistance initiatives.  

We are deeply troubled by the significant increase in reports of Paragard breakage incidents. Between 2021, and 2023, the number of reported breakage incidents nearly doubled from 3,200 to almost 6,000. In contrast to other IUD breakages, where breakage accounted for only 2% of reported adverse events, Paragard breakages constituted 10% of all issues reported. This discrepancy suggests that Paragard may be more susceptible to breakage compared to other IUDs, raising concerns about its reliability and safety. This doubling of breakage incidents within a year signals a potential systemic issue that cannot be ignored, and that necessitates thorough investigation by both the manufacturer, CooperSurgical, and regulatory agencies (e.g. FDA) to ascertain the root causes of these failures. 

Furthermore, the lack of comprehensive disclosure regarding the risks associated with Paragard is alarming. Patients are often not adequately informed about the potential for device breakage, migration, or perforation, which undermines women’s ability to make informed decisions about their reproductive health. CooperSurgical’s failure to provide transparent and accessible information directly to patients, both on their website and through patient materials, exacerbates this issue. Health care providers also face significant challenges in educating patients about the risks of LARCs like Paragard when critical information is omitted or downplayed by the manufacturer. Without accurate and comprehensive information, providers cannot fulfill their duty to fully counsel patients on the potential risks and alternatives, compromising patient autonomy and safety.  

Broader Contraceptive Policy Recommendations by the National Women’s Health Network  

The issues regarding Paragard underscore the urgent need for comprehensive policy interventions to safeguard women’s health and rights in the realm of contraceptive devices. A robust policy framework must be established to address the systemic shortcomings in the development, regulation, and communication of the risks of contraceptive devices like Paragard. 

1.) Regulatory Reform and Oversight Strengthening: The current regulatory framework governing contraceptive devices, particularly LARCs like Paragard, requires significant reform to enhance patient safety and ensure rigorous oversight. This reform should include:  

    1. Post-Market Surveillance Enhancement: Regulatory agencies such as the FDA must implement more stringent post-market surveillance mechanisms to systematically monitor the safety and performance of contraceptive devices. This should involve proactive monitoring of adverse event reports, signal detection, and timely investigation of emerging safety concerns.

2.) Mandatory Risk Disclosure and Informed Consent: To ensure that patients are fully informed about the risks and benefits of contraceptive devices like Paragard, policymakers should mandate the inclusion of comprehensive risk disclosure in all patient-facing materials and communications. This should encompass: 

    1. Transparency Requirements: Manufacturers must be obligated to disclose all known risks associated with their products, including the risk of breakage, migration, and perforation, in a clear and accessible manner. Patient information materials, such as brochures, fact sheets, and prescribing information, should all be considered. 
    2. Informed Consent Standards: Health care providers should be required to obtain informed consent from patients prior to the insertion of contraceptive devices, ensuring that patients are fully aware of the potential risks and alternatives. Informed consent processes should be standardized and documented to facilitate accountability and patient autonomy. 

3.) Manufacturer Accountability and Quality Assurance: Manufacturers of contraceptive devices bear a significant responsibility for ensuring the safety and reliability of their products. Therefore, policymakers should implement measures to enhance manufacturer accountability and quality assurance, including:  

    1. Root Cause Analysis and Corrective Action: In cases where contraceptive devices like Paragard exhibit a pattern of breakage or failure, manufacturers should be mandated to conduct thorough root cause analyses to identify underlying issues. Based on these analyses, manufacturers should be required to implement corrective actions, such as design improvements or manufacturing process modifications, to mitigate risks and enhance device safety.  
    2. Post-Market Monitoring and Reporting Obligations: Manufacturers should be required to continuously monitor the performance of their contraceptive devices in real-world settings and promptly report any adverse events or safety concerns to regulatory authorities. Timely reporting and transparency are essential for facilitating rapid intervention and risk mitigation.  

4.) Provider Training and Patient Education: The medical community and women’s health organizations should prioritize initiatives aimed at enhancing health care provider training and patient education regarding contraceptive options, including LARCs. This may involve:  

    1. Continuing Education Requirements: Health care providers should be required to undergo regular training and education on contraceptive counseling, including the risks and benefits of different contraceptive methods. Continuing education requirements can help ensure that providers are equipped with the knowledge and skills necessary to facilitate informed decision-making and patient-centered care. 
    2. Public Awareness Campaigns: The medical community and women’s health organizations should invest in public awareness campaigns to educate patients about contraceptive options and empower them to make informed choices about their reproductive health. These campaigns should emphasize the importance of seeking comprehensive information and engaging in shared decision-making with health care providers. 

To conclude, addressing the systemic issues surrounding contraceptive device safety, particularly in the case of Paragard, requires a multifaceted policy approach that encompasses regulatory reform, enhanced transparency, manufacturer accountability, provider training, and patient education. By implementing comprehensive policy interventions, policymakers, the medical community, and health organizations can ensure that women are protected from faulty contraceptive devices and empowered to make informed decisions about their reproductive health. 

[1] Published: Sep 09, 2020. (2020, September 9). Intrauterine devices (iuds): Access for women in the U.S. KFF. https://www.kff.org/womens-health-policy/fact-sheet/intrauterine-devices-iuds-access-for-women-in-the-u-s/  

[2] Latack, K. R., & Nguyen, B. T. (2023). Trends in copper versus hormonal intrauterine device breakage reporting within the United States’ Food and Drug Administration Adverse Event Reporting System. Contraception, 118, 109909. https://doi.org/10.1016/j.contraception.2022.10.011  

[3] La Saponara, V., Wan, S., Nagarkar, B., Zwain, F., & Creinin, M. D. (2024). Understanding the mechanical behavior of intrauterine devices during simulated removal. Contraception, 133, 110399. https://doi.org/10.1016/j.contraception.2024.110399 

[4] Forbes Magazine. (2024, April 26). Paragard lawsuit update. Forbes. https://www.forbes.com/advisor/legal/product-liability/paragard-lawsuit-update/  

[5] Paragard. (February 2024). Paragard Official Site. Retrieved April 10, 2024, from Paragard® IUD | Official Site 

[6] Ghoshal, M. (2023, March 7). Paragard side effects: What they are and how to manage them. Healthline. https://www.healthline.com/health/drugs/paragard-side-effects  

[7] The Cooper Companies Completes Acquisition of PARAGARD IUD from Teva. (November 1, 2017). CooperCompanies. Retrieved April 10, 2024, from The Cooper Companies Completes Acquisition of PARAGARD® IUD From Teva – CooperCompanies (coopercos.com) 

The Policy Pages

Updates on how we’re making change at the highest levels of government.

A Summary of Action- Quarter Two, 2024

By: Raaya Alim, Policy Associate

The National Women’s Health Network works with members of Congress to improve the health and well-being of women across the life continuum. This article provides the highlights of our women’s health policy work during the second quarter of 2024. Please contact Raaya Alim at [email protected] with any questions or comments.  


Women’s Health and the 118th Congress – Our Priorities  

In the 118th Congress, the Network’s top priorities include expanding access to family planning services, improving and diversifying perinatal and postpartum care, and increasing access to preventative screenings.  

Key Women’s Health Legislation:  

The Network is happy to see introductions and reintroductions of key women’s health legislation. You can learn more about key legislation the Network supports and why on our virtual bill tracker here 

Other recently introduced women’s health bills we now support include: 

Sexual and Reproductive Health:  
  • Endometriosis CARE Act: This bill aims to enhance research, education, and access to care for individuals suffering from endometriosis. 
  • Right to IVF Act: This legislation seeks to ensure insurance coverage for in vitro fertilization (IVF) and related fertility treatments.  
Maternal Health:
  • Maternal Health for Veterans Act: This bill requires the Department of Veterans Affairs to improve and report on maternal health outcomes for veterans.  
  • SAFER Health Act: This act focuses on enhancing patient safety by implementing improved health care protocols and reducing medical errors.  
Aging Women and Health Equity:  
  • Advancing Menopause Care and Mid-Life Women’s Health Act: This bill aims to improve health care services and support for women experiencing menopause and other midlife health issues.   
  • WARM Act: This legislation seeks to provide better resources and support for women in the workforce through measures such as paid leave and workplace accommodations.   
Photo by Bernd 📷 Dittrich on Unsplash

Activity on the hill…

The Network Hosts Advocacy Day on the Hill 

The Network recently hosted an advocacy day on Capitol Hill with its second cohort of the Health Access and Equity Leadership Training Hub (HEALTH) Program. During this event, members of the cohort came to Washington D.C. and engaged with lawmakers and staff, leaving behind information packets and materials highlighting key initiatives and policies aimed at enhancing maternal and reproductive health. These packets detailed the importance of supporting legislation to improve health outcomes for women and underscored the critical need for research and resources in this area. The advocacy day was successful in building connections between our cohort and legislative offices and also achieved the overarching goal of fostering informed policy decisions that benefit maternal and reproductive health in their states and communities.

The Network Attends Endometriosis Caucus Reception for Women’s Health Month

In celebration of Women’s Health Month, our policy team had the privilege of attending the Endometriosis Caucus reception on May 23, a pivotal event dedicated to advancing awareness and support for endometriosis research and care. This event also served as a Congressional briefing for the Endometriosis CARE Act, an initiative sponsored by Representative Nikema Williams (GA-05), which aims to enhance research, improve patient care, and provide comprehensive education on endometriosis, a condition that affects millions of women worldwide. The Network is dedicated to advocating for policies like the Endometriosis CARE Act that advances research and enhances knowledge on critical women’s health issues.  

Fiscal Year 2024 Appropriations  

First, a quick primer on the appropriations process:  The president submits a budget to Congress for the federal government for the federal government fiscal year (October 1 through September 30). Congress must pass 12 appropriations bills or pass a continuing resolution (also called a stopgap bill) before the October 1st deadline to fund the government for the following year. The NWHN Policy Department is both closely monitoring this process and fighting every day to make sure that programs promoting the health and well-being of women are back with federal dollars. Here’s where we stand: 

On March 23, after months of intense negotiation, Congress successfully finalized the Fiscal Year 2024 appropriations, passing a $1.6 trillion package that funds various federal departments and agencies through September 2024. The comprehensive funding package includes critical investments in defense, health care, education, and other essential services. The legislation saw significant bipartisan support, with the Senate approving the final set of bills by a 72-24 vote, and the House following suit with a 286-134 vote.

 

Key highlights of the FY24 appropriations include: 

  • Health and Human Services: Significant funding boosts for Title X family planning services and maternal health programs, aimed at reducing maternal mortality and improving access to reproductive health services.  
  • Education: Increased investments in early childhood education, public K-12 schools, and Pell Grants, supporting students and educators nationwide.  
  • Defense and National Security: Enhanced funding for defense programs, including a 5.2% pay raise for troops and additional resources for national security initiatives.  
  • Childcare and Early Learning: A $1 billion increase to help families afford childcare and support early learning programs like Head Start.  

The FY24 appropriations package includes significant provisions affecting women’s health. Key allocations and policy decisions are as follows:  

  • Title X Family Planning Services: Increased funding ensures that low-income women have access to contraceptive services, cancer screenings, and other preventive health services. 
  • Maternal Health: Enhanced investments are directed towards reducing maternal mortality rates, particularly among Black women, through improved prenatal and postnatal care programs. 
  • WIC Program: The Special Supplemental Nutrition Program for Women, Infants, and children received a $1 billion boost, ensuring continued support for nutritional assistance to pregnant women, new mothers, and young children.  
  • Mental Health and Substance Abuse: Additional funding is allocated to mental health services and substance abuse treatment programs, addressing critical areas that impact women’s health.  

To provide further context on how the House and Senate appropriations proposals will affect women’s health care, the Network has created a resource page that will be updated throughout the appropriations cycle.  

Activity in the Courts… 

The Network will continue to track court cases and decisions that affect women’s health, and we have joined our colleagues in advocating against court decisions that ignore legal precedent and medical expertise in favor of ideology. Here are the cases and decisions we are watching closest right now:  

  • Alliance for Hippocratic Medicine v. FDA:  On June 13, 2024, U.S. Supreme Court ruled 9-0 in Alliance for Hippocratic Medicine v. FDA that the plaintiffs, including various anti-abortion groups, lacked standing to challenge the FDA’s approval of the abortion drug mifepristone. Justice Kavanaugh, writing for the Court, stated that the plaintiff’s claims of potential harm, such as being forced to perform abortions against their conscience or dealing with complications from the drug, were too speculative and indirect to meet the stringent requirements for federal court standing.  
    • This decision reverses the lower court’s ruling that had suspended the FDA’s approval of mifepristone. The Supreme Court’s emphasis on the necessity of concrete and particularized injury for standing underscores the importance of maintaining clear and direct disputes in the federal judiciary.  
  •  Idaho v. US: Earlier this year, the Supreme Court examined Idaho v. United States which challenged the state’s restrictive abortion law and whether it is preempted by the federal Emergency Medical Treatment and Labor Act (EMTALA), which mandates that hospitals provide necessary stabilizing treatment in emergencies, including abortions. In June 2024, the Court issued a per curiam opinion dismissing the petitions as improvidently granted, without ruling on the merits. Additionally, the Court vacated the stay it had previously entered, which had permitted Idaho’s near-total abortion ban to take effect while the case was pending.

 

The NWHN Policy Team is Growing! 

The Network is excited to introduce two new additions to our policy and communications team! Please join us in welcoming Bria Fitz, who has joined us to further our advocacy efforts as the new policy associate, and Lili Szafir who is interning with the Network this summer as our policy and communications intern. We are thrilled to have them onboard to further our mission of empowering women’s health! 

Network News

Can’t-miss updates from Headquarters.

4Her2024: A Get Out the Vote Campaign by the National Women’s Health Network

By: Adele Scheiber, Director of Communications

This Independence Day, the National Women’s Health Network (NWHN) launched the 4Her2024 Get Out the Vote Campaign with a free sticker giveaway.

From now until Election Day, the NWHN will work tirelessly to educate the American people on:  

  • The voting basics (registration, pledging, key deadlines, and making a voting plan)  
  • How to vote if you’re facing complex “what if” scenarios – e.g., you’re a student living away from home, trans, recently incarcerated, a new citizen, or will be abroad on election day 
  • How our votes can save lives, support science-based health care, and restore bodily autonomy for women and people assigned female at birth 

“All you need to do is check the daily news to see what’s at stake for women’s health care in this country,” said Denise Hyater-Lindenmuth, Executive Director of the NWHN. “We have a sworn duty to educate the public on these issues and their rights – and we have partnered with some exciting entities to do just that this election season.”   

Starting today, those who sign up for the Network’s Voter Empowerment Alerts will get a free limited edition sticker designed by activist artist Sarah Epperson (while supplies last).  

Claim your free sticker and learn more at www.nwhn.org/4her2024

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Introducing the Network’s New Board Members

By: Adele Scheiber, Director of Communications

In June of 2024, new terms for five board members officially began. These board members replace Abigail Aarons, Julie Thai, Kim Robinson, Yamini Osaguera-Bhatnagar, and Meredith Field, whose terms came to an end that same time. We hope you will join us in thanking them for their service, and welcoming these new board members to their 4-year terms:

Senior Vice President of Diversity and Inclusion

Brodeur Partners

Angela is an accomplished public relations leader with extensive expertise in brand development, product life-cycle strategy, multicultural engagement, corporate social responsibility, cause marketing, and innovation. As a 29-year veteran of the nonprofit industry, she has helped numerous organizations, ranging from grassroots nonprofits to multi-national organizations, navigate through major revitalization initiatives by building communications strategies to better position them for growth. Currently, as SVP of Diversity and Inclusion at Brodeur Partners, she leads a practice area to help create relevant engagement across diverse audiences.

Angela Collins Headshot

Population Health Specilist/Midwife

CareOregon

Christina Clay, LDM, CPM, MPH is a Community Midwife in Portland, Oregon with over 15 years of community health experience and a passion for addressing maternal health disparities. She currently serves as a Population Health Specialist with a Medicaid health plan that serves low-income rural, urban, and suburban Oregonians. Christina has a demonstrated commitment to reproductive health through her continued advocacy for expanded access to Community Birth, teaching childbirth education, developing reproductive health curriculum, and currently practicing as a part-time home-birth midwife, primarily serving families receiving health coverage through the Oregon Health Plan. In her spare time, Christina enjoys exploring the world with her family and is always eager to try new things – from unique cuisine to outdoor adventures in sunshine or rain. She is thrilled to serve on the Board of Directors for NWHN to continue to build partnerships and support health outcomes across the U.S.

Christina Clay

Campaigner

Center for Biological Diversity

Kelley Dennings is a senior campaigner with the nonprofit Center for Biological Diversity where she develops and executes advocacy and outreach initiatives that address the connections between reproductive health, gender equity, endless growth and the climate and extinction crises. Her campaigns focus on solutions from voluntary family planning to alternative economies to address how the effects of patriarchy, capitalism, and other systems of oppression affect people and the environment. Prior to the Center, she worked in waste management and forest conservation. She holds a bachelor’s degree in natural resources from N.C. State and a master’s degree in public health from the University of South Florida. She is certified in public health and as a family planning health worker and is a member of the American Public Health Association, the National Family Planning and Reproductive Health Association, Nurses for Sexual and Reproductive Health and SisterSong. She is the founding president of the nonprofit Social Marketing Association of North America. She has been published in EcoWatch, Environmental Health News, Journal of Environmental Health, Journal of Extension, Journal of Population and Sustainability, Journal of Social Issues, Ms. Magazine, Nonprofit Quarterly, Resource Recycling, Rewire, Social Marketing Quarterly, Sustainability Times and The Hill.

Dennings headshot

Certified Life Coach

Purpose Driven Life Coaching

Kendel Paulsen is a Certified Life and Career coach and speaker. She helps women at all stages of life and careers to define success on their terms, discover their life’s purpose, and lead a life with vision and strategy. With more than 30 years of experience in corporate and non-profit, Kendel brings a wealth of practical knowledge to his/her coaching work. Kendel received her BA degree from the University of Mary Washington and her MA from the University of Phoenix. Kendel earned her Board-Certified Coach (BCC) certification from the Center for Credentialing and Education (CCE) and her Associate Coaching Certification (ACC) from the International Coaching Federation (ICF). She also holds a Career Development Coaching Services (CDCS) certification from the Institute for Life Coach Training. Kendel lives in Northern Virginia with her husband of 30 years and is the mother of 3 adult children. When Kendel is not working, you can find her hiking or planning for a visit to her children. Kendel can be reached at [email protected] or www.kendelpaulsen.com.

Kendel Paulsen225121

Associate

NPAG

Tyra Maya Gravesande is a bioethics and sexual and reproductive health and justice leader who works at the intersections of the reproductive health, rights, advocacy, and social justice movements. She is a MS in Bioethics Candidate at Mount Sinai Icahn School of Medicine at Mount Sinai and holds a BA in Comparative Women’s Studies from Spelman College. 
 
As an Associate at NPAG, a consulting firm that supports clients in the health and social impact sectors, she manages outreach, data analysis, and narrative development to source and engage diverse and qualified candidates for leadership roles. As Chief of Sexual and Reproductive Health Equity at ONYX, a femtech start-up that creates innovative reproductive wellness solutions, she leads strategic partnerships, data analytics, and deal flow opportunities to drive growth and impact in the femtech and health tech sectors. 
 
Tyra combines her passion for women’s health, social justice, and innovation to create a more equitable and inclusive world. She has multiple publications, grants, and awards in the field of bioethics and reproductive justice, and has participated in several prestigious programs and fellowships at Harvard Business School, Yale University, McKinsey & Company, and JPMorgan Chase & Co. She is motivated by a vision of modernizing menstruation and enhancing access to sexual and reproductive health products and services across all demographics.

Tyra Gravesande Headshot

 In Case You Missed It…

By: Adele Scheiber, Director of Communications 
  • New Webinar: How the US Can Keep Moms Healthy and Save Hundreds of Lives Nationwide – The NWHN hosted the virtual Healthy MOM webinar on April 10 at 2:30 EST to discuss how we can all work together to prevent post-partum maternal death. Watch the recording or read the transcript.  
  • What You Need to Know About the Idaho v. United States Supreme Court Case – Our policy shop has put together a digestible post about the latest abortion-related case making its way through the Supreme Court. Check it out here.  
  • The Network Supports the Society for Women’s Health Research – The Network was honored to attend the SWHR 34th Annual Awards Dinner last Thursday. Congrats to Maria Shriver on being presented with the SWHR Women’s Health Visionary Award for her unwavering advocacy for women’s health and Alzheimer’s disease research. See pictures of us out and about here. 
  • The Network Hosts 2nd Annual HEALTH Program Hill Day -The Network was thrilled to host the second annual HEALTH Program Hill Day on Tuesday! Representatives from our 2024 HEALTH Program cohort met with legislators yesterday to advocate for their reproductive justice and health care access priorities. Stay tuned for more in-depth coverage on what was discussed coming soon! See pictures and learn more here. 
  • The Network Endorses Legislation Calling for Equitable Access to Reproductive Health Care For People with Disabilities – The resolution, which Rep. Pressley and advocates unveiled at a press conference earlier this week, recognizes the barriers disabled people encounter to accessing sexual and reproductive health care due to systemic discrimination, leaving many with unmet and underserved health needs. Learn more here.   
  • Relief in Supreme Court Ruling on Mifepristone Case – The Network is relieved that the Supreme Court did not decide to roll back access to mifepristone or undermine the FDA’s authority on Thursday. However, the decision still invites the opportunity for a future case to be brought by other groups that may have more obvious standing. Read our full statement here. 
  • The NWHN Policy Team is growing! The Network is pleased announce two new additions to our Policy Team, Bria Fitz (our new Policy Associate) and Lili Szafir (Policy and Communications Intern). With their help, we will expand our capacity of advocating for better women’s health policies on the Hill. You can read more about them on our staff page. 
  • The NWHN Released Health Pro Tips for April, May, and June – In April, these tips focused on Black maternal health, STIs, sexual assault awareness, and minority health. In May, we went deep on issues like menstrual hygiene, osteoporosis, health as we age, and mental health. And in June, we brought you the best content related to HIV, LGBT+ health, and Alzheimer’s.
HIV Must-Knows for Women in 2024 with the Positive Women's Network
Podcast cover: Living with Rheumatoid Arthritis - Erin's Story with Erin Evans

Young Feminist

Articles by the future, for our future.

Fibroids- A Growing Canker

By: Janet Awobode, Rockefeller College Center for Women in Government & Civil Society Fellow

The incessant beeping sounds of the cardiotocography machine in the labor and delivery ward gave a glimpse of real-life scenarios. As a medical student, I’d always envisioned myself as a pediatric specialist. However, on the first day of my obstetrics and gynecology rotation, witnessing the miracle of childbirth firsthand ignited a passion within me and caused a paradigm shift in my interests. Through my curiosity, I discovered a very worrying condition among women—fibroids. These are non-cancerous tumors in or around the uterus, silently woven into the fabric of many women’s lives – particularly Black women’s lives. 

This initial observation culminated in a heartbreaking reality when a close friend of mine was diagnosed with fibroids while pregnant. We watched as the tumors grew, competing with her developing baby for space and blood supply. The result? Disrupted fetal growth leading to low birth weight at delivery. In that moment, I developed an interest to drum home a stronger advocacy for women’s health with its impact on the unborn child. 

Fibroids are far from uncommon. About 20% to 50% of women of reproductive age have them, with a staggering 77% developing them at some point during their childbearing years. Due to their often-undetectable nature, countless cases go undiagnosed as only one-third of fibroids are large enough to be felt during a physical exam. Studies have shown that African-American women are two to three times more likely to develop fibroids than white women and often present with larger, more symptomatic types. Additionally, Black women are less likely to experience the shrinking or reduction of fibroids compared to their white counterparts. These disparities aren’t mere numbers; they translate to real pain, fear, irregular bleeding, and the potential for devastating complications during pregnancy or even infertility. These symptoms could significantly impact women’s health, particularly their mental health. 

The Disparity Gap: Why Black Women Have an Increased Prevalence 

The reasons behind this racial disparity and prevalence are unclear. Although, research suggests a notable correlation with the use of certain personal care products. Hair straighteners and relaxers, commonly used by Black women, often contain endocrine-disrupting chemicals such as phthalates, which can contribute to hormonal imbalances and accelerate the growth of uterine fibroids. 

Another crucial factor contributing to the prevalence of fibroids among Black women is a lack of awareness. There is limited knowledge of how fibroid symptoms present, and many women might dismiss the symptoms as simply a part of their period. This leads to delayed diagnoses and health-seeking behavior, resulting in more invasive treatment options and complications. 

Social determinants of health also play a major role in this racial disparity. Factors such as socioeconomic status and access to quality health care significantly impact the development and management of fibroids. Black communities often face higher exposure to environmental toxins and greater challenges accessing quality healthcare and healthy food options, negatively affecting overall health and potentially increasing the risk of fibroids. Limited access to health care further exacerbates the impact of fibroids for Black women. Issues such as lack of health insurance, transportation challenges, and implicit bias within the medical system can lead to delayed diagnoses and limited treatment options. Unconscious bias, where stereotypes about pain tolerance or symptom exaggeration by Black women come into play, can result in misdiagnosis or inadequate treatment. 

A Personal Journey

Reflecting on my dear friend’s experience, her journey emphasizes the need for stronger advocacy for women’s health, especially its impact on maternal and child health. Unfortunately, my friend’s story is not unique, it mirrors the experiences of countless Black women who navigate pain, fear, and the potential for complications during pregnancy especially with fibroids. Throughout her pregnancy, she experienced extreme discomfort, which led to numerous emergency room visits. Each visit was fraught with fear and uncertainty. The fibroids continued to grow, creating a constant threat of preterm labor. She was determined to do everything as recommended by her doctors. She adhered to a strict regimen of bed rest and medication to manage pain and prevent premature labor. The physical and emotional toll was immense, which left her bedridden for days. 

In the final trimester of her pregnancy, her doctors decided that a scheduled cesarean section would be the safest option to mitigate the risks posed by the fibroids. The weeks leading up to the delivery were filled with anxiety, as the size and position of the fibroids made the procedure more complex. On the day of the delivery, the operating room was filled with a mix of anticipation and tension. The medical team worked meticulously to ensure the safety of both mother and baby. The delivery was successful, and she gave birth to a healthy, albeit low birth weight, baby. The joy of holding her newborn was immeasurable, overshadowing the months of pain and fear. However, the journey didn’t end there, she had to undergo myomectomy which is the removal of uterine fibroids immediately after her baby was delivered.  

Further Learning

If you’re looking to learn more about fibroids and women’s experiences with them, check out the White Dress Project. They are a nonprofit organization dedicated to raising awareness about fibroids, highlights stories like that of my friend to educate, empower, and support those who are managing life with fibroids. Their work emphasizes the importance of community support, advocacy and the need for more inclusive research to understand why fibroids disproportionately affect Black women as well as ensuring that all treatment options are available to those in need.  

Every medical statistic about fibroids captures the lived experiences of countless Black women who navigate pain, fear, and the potential for complications during pregnancy. It’s a story that demands attention, understanding, and action. We must ensure easy access to health care by addressing the social determinants of health and create awareness about fibroids.  

Since You Asked

Answers to your burning health questions.

Everything You Ever Wanted to Know About Menstrual Hygiene 

By: NWHN Staff

Maintaining menstrual hygiene is a concern for many women who contact us here at the NWHN. We get questions about sports and activities, douching, period product options – you name it. This article aims to debunk myths, provide information on different forms of period hygiene products, and educate women on common questions regarding menstruation

Q: Should I avoid exercising during my period? 

A: There’s no reason to avoid exercising during your period. In fact, gentle exercise can help reduce period symptoms. Consider reducing the intensity of your workouts if you feel fatigued, otherwise, honor what your body is capable of during your period.  

 

Q: Can I swim while on my period? 

A: Yes, women can swim while on their period. Consider using tampons or menstrual cups to keep your flow inside your body and off your bikini. 

 

Q: What are all the options for period hygiene?  

A: Some of the most common options for period hygiene include pads, tampons, menstrual cups, period underwear, and period sponges and discs. 

  • Pads are made of an absorbent cloth which adheres to underwear and can come in various sizes to suit individual flow.  
  • Tampons are absorbent devices inserted into the vagina which may or may not come with applicators and are a popular option for individuals looking to have a more active lifestyle.  
  • Menstrual cups are inserted into the vagina and collect blood for up to 12 hours at a time and only need to be washed twice a day. This device is eco-friendly and can last from one year to several years.  
  • Period underwear is another reusable option that is easily washed like regular underwear. This leak-proof option has a built-in absorbent layer to collect menstrual blood, although it may not be suitable for heavy flow days.  
  • Sponges and discs are inserted in the vagina to collect menstrual blood. Both are reusable, but they must be cleaned properly to avoid infection. Menstrual sponges are not sold in the US. 

Q: How often should you change your pad?  

A: Pads should be changed every few hours, typically 4 to 8, to avoid leaks and maximize comfort. How often you change your pad depends on how heavy your flow is, which can vary from person to person. 

 

Q: Do I have to change my pad during the night?  

A: Most pads and tampons can be worn during the night. It’s best to go to bed with a fresh pad or tampon and adjust depending on your flow. You may need to wear overnight pads or pads with wings to help prevent leaks at night. 

 

Q: How long can I wear a tampon?  

A: Tampons should only be worn for 4 to 8 hours to prevent the development of toxic shock syndrome (TSS). Don’t wear a tampon for more than 8 hours and choose the size that best fits your flow. It shouldn’t be uncomfortable, and you shouldn’t have leaks. 

 

Q: What is Toxic Shock Syndrome (TSS) and how do I avoid getting it?  

A: Toxic shock syndrome (TSS) is a rare but sometimes deadly condition caused by bacteria that make toxins or poisons. You could be at risk for TSS if you use more absorbent tampons than you need for your flow or if you don’t change your tampon often enough. Menstrual cups, cervical caps, sponges, or diaphragms (anything inserted into your vagina) may also increase your risk for TSS if they are left in place for too long (usually 24 hours). 

Always consult your doctor with questions about specific medical conditions, however, common symptoms of TSS includes sudden high fever, vomiting, diarrhea, dizziness, and a faint rash. 

 

Q: How should I dispose of used pads and tampons? 

A: Used pads and tampons should be disposed of by wrapping them in toilet paper or another barrier and throwing them into the trash. Never flush them down the toilet, even if they’re advertised to be flushable, as they can cause an obstruction in plumbing. 

 

Q: What’s the normal amount to bleed during your period? 

A: Periods vary from person to person, but a normal period usually lasts from 2 to 7 days with the amount of blood lost during one period being about 60 milliliters (around 2 ounces).

2 oz. of liquid is approximately four tablespoons

Q: How much is “heavy” bleeding? 

A: Heavy bleeding requires you to change your pad or tampon after less than 2 hours, and you may pass blood clots the size of a quarter or larger. Periods may also last longer. It’s important to contact your doctor if you have consistently longer periods or have heavy bleeding. 

 

Q: How often should I wash my genital area during my period? 

A: During your period, it is recommended to wash twice daily, in the morning and at night. Always wash and wipe from front to back to prevent bacteria from fecal matter entering the vagina.  

 

Q: Should the inside of the vagina be washed?  

A: No. The vagina is a self-cleaning organ and maintains a delicate balance of normal flora to stay healthy. Douching and other methods used to wash the inside of the vagina are not supported by scientific evidence and increase the risk of infections and pelvic inflammatory disease. Only wash the outer female genitalia, knowns as the vulva, with water or a mild, unscented soap. 

 

Q: What are safe ways to prevent feminine odor during your period?  

A: The following are some of the most common ways to prevent vaginal odor: 

  • Wear cotton underwear or loose-fitting clothing so the area can breathe 
  • Shower daily, or more frequently if needed 
  • Drink enough water. Staying hydrated helps your body flush out toxins that can cause odor 
  • Change your pad or tampon at least every 4 to 8 hours 
  • Avoid douches or scented soaps, deodorants, sprays, and powders 

 

Q: How do I remove period stains from clothes or sheets?  

A: The fresher the stain the easier it will be to remove. Use cold water to soak the garment, then use a paste made from salt to rub the stain away. If you have dried stains on your clothes or bed sheets, you can use lemon juice, vinegar, or hydrogen peroxide to help lift the stain after rinsing and soaking in cold water. Be warned – these products can have a bleaching effect on darker clothes and sheets.  

We hope you found this information helpful. If so, please consider joining the NWHN family by becoming a member here. Have a question of your own? Email us at [email protected] 

The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. All content, including text, graphics, images, and information, contained on or available through this website is for general information purposes only. 

The continued availability of external resources is outside of the NWHN’s control. If the link you are looking for is broken, contact us at [email protected] to request more current citation information. 

Study Snapshots

Readable summaries of the latest medical research.

All Snapshots Researched & Summarized By: Lili Szafir, Policy & Communications Intern

New studies find that LGBTQ-affirming health care settings, combined with recommendations from providers, can increase uptake of Hepatitis A & B vaccines among LGBTQ people 

A study conducted by Fenway Health and MPact Global Action suggests that provider education and culturally sensitive care can increase Hepatitis A & B vaccination rates among LGBTQ individuals. Despite the availability of Hepatitis vaccines, there has been an increase in the number of Hepatitis A cases in the U.S. Only 1,390 cases were reported in 2015, while 18,846 were reported in 2019, a 13-fold increase. The study explores some of the barriers to vaccination in the LGBTQ community, citing medical mistrust and fears of homophobia in health care spaces. Additionally, providers often only mention Hepatitis in reference to childhood vaccines rather than suggesting current vaccinations. However, LGBTQ patients are many times more likely to get a Hepatitis A vaccine when a health care provider recommends it. The analysis, therefore, concludes that providers must communicate responsive and culturally relevant information to promote vaccine uptake.  

Bidirectional Associations of Depressive Symptoms and Cognitive Function Over Time 

A 16-year study of over eight thousand participants 50 years and older finds a correlation between depression and memory decline. Depressive symptoms and cognitive decline frequently co-occur among older adults and demonstrate a reciprocal relationship. In the results, initial depressive symptoms were correlated with an accelerated decline in memory. Conversely, poor baseline memory was associated with an increase in depression. These findings have significant guiding implications for older adults’ cognitive and mental health treatments. The authors of the study recommend that providers assess the memory of patients who present symptoms of depression. This step can help promote the psychological well-being of patients while slowing mental decline over time. Health care providers should also consistently monitor patients with signs of depression or memory loss for early detection of cognitive changes. The study encourages integrated treatment approaches to address these complex and interrelated psychological issues.  

Hypertension, Cardiovascular Risk Factors, and Uterine Fibroid Diagnosis in Midlife 

Research on 2,570 participants with new-onset hypertension found that those taking hypertension medication were less likely to develop uterine fibroids. Specifically, they were 20 percent lower risk compared to individuals without hypertension and 37 percent lower risk than untreated participants with hypertension. Physical body measurements and blood tests did not provide correlational evidence of fibroid development. Uterine fibroids, benign tumors, occur in 70 to 80 percent of people with uteruses aged 50 or older. These tumors can be painful and cause fertility issues, but treatment and understanding of how they develop is limited. Growing evidence, corroborated by the study’s findings, does suggest that hypertension and other cardiovascular factors might be linked to fibroids. These results are crucial in uncovering the cause of a condition that affects most women by midlife and often reduces their health and well-being. 

Tribute Gifts

The National Women’s Health Network thanks our members for their generous donations.

Marie R. Carrier In Honor Of Millie Blackburn Latiolais 

Jane Pincus In Honor Of Ruth Bell 

Donna S. Kohlhepp In Honor Of Dr. Donna Sell Kohlhepp 

Lisa Handwerker In Honor Of Minnie Handwerker 

Sheila Attaie In Honor Of  Shawn Attaie 

Miriam Tannen In Honor Of Abortion Providers 

Robert Friedman In Honor Of Sherry Leibowitz 

Elisheva Yuan In Honor Of Alyssa McGrath 

Nicole Yost In Honor Of E Everett 

Sarah Rodgers In Honor Of Evelyn St. Amant 

Bernard Larner In Honor Of Leslee Larner 

The Clarius Group LLC In Celebration of Teresa McCann’s Birthday 

Christopher Hanson In Honor Of Norma Jean Hanson 

Katie M Cox In Honor Of Norma Jean Hanson 

*Donor is a member of Collective Champions, or giving recognition program for monthly donors. Join today at https://nwhn.org/donation/programs/ or call us at 202 682 2648.

If your name is missing, incorrectly listed, or misspelled, please accept our sincere apology and contact our Development Department at 202 682 2640

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