A common IVF practice has involved transferring multiple embryos to a woman’s body in one cycle. This was thought to increase the likelihood that at least one embryo would successfully result in a live birth. The average number of embryos transferred at one time is two to three.

While this strategy makes sense theoretically, it is not risk free. Transferring more than one embryo creates a risk for multiple pregnancies, such as twins or triplets, which makes the pregnancy higher risk and increases the risk of premature birth and low birth weight. (Single pregnancies created via IVF are also thought to be at a higher risk for prematurity, low birth weight, and congenital anomalies, though researchers aren’t certain whether this is due to the IVF techniques or the underlying infertility problem.)

Recently, researchers have been studying whether single embryo transfer might be a better option. Some have suggested that birth rates might be similar when single embryos are transferred.

The research has been convincing. In a joint practice committee statement, the Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine concludes that with improving technology, single embryo transfer (SET) is an increasingly better choice for achieving pregnancy while avoiding multiples.

The statement notes that SET may be particularly appropriate for women with the best chance of a good outcome, such as those who are under 35 or on their first or second treatment cycle, and that women ages 35 to 40 could also elect SET if they have “top quality” embryos of the proper stage available for transfer.

The authors also note that the United States has “lagged behind” the rest of the world in focusing on SET. For example, the National Institute for Health and Care Excellence (NICE) in the UK recommends single embryo transfer for most women and no more than two at a time for anyone.

For more on single-embryo transfers, read this excerpt from “Our Bodies, Ourselves.”

The administration is withdrawing its appeal of a ruling that requires emergency contraception pills to be made available without prescription, regardless of age. This is good news for access to the one-pill form of emergency contraception.

In not-so-good news, the administration may still interfere with over-the-counter access to the two-dose form of the drug.

Although the previous ruling required that the two-pill form be made available even before the intended appeal was heard, the Justice Department’s letter indicates that it may still try to require additional data specific to safety of the often more affordable, generic two-dose form in younger adolescents before approving the change.

As SCOTUSblog explains, “the FDA is interpreting Judge Korman’s April order as giving it permission to choose between Plan B One-Step and the two-pill version so that just one of them would be open without restrictions to women of all ages.”

The Center for Reproductive rights, which has been heavily involved in the court cases around this issue, responded:

Now that the appeals court has forced the federal government’s hand, the FDA is finally taking a significant step forward by making Plan B One-Step available over the counter for women of all ages. But the Obama Administration continues to unjustifiably deny the same wide availability for generic, more affordable brands of emergency contraception.

Congratulations and thanks to everyone who has worked for more than a decade to call attention to this important issue. While more work is still needed to make emergency contraception fully accessible to women and girls when they most need it, this recent news puts us much closer to that goal.

You can also follow their excellent reporting at RH Reality Check: Marty is the publication’s senior political reporter, and Pieklo is a senior legal analyst.
   

A couple of months ago a judge ordered that emergency contraception pills (like Plan B) be made available over the counter (OTC) without age restrictions. The U.S. Justice Department appealed that ruling, and asked for a stay so that OTC access wouldn’t take effect during the appeals process.

Around the same time, the FDA approved Plan B One-Step emergency contraception pills for purchase without a prescription for teens ages 15 and older.

On Wednesday, the Second Circuit Court of Appeals denied the stay for two-pill types of emergency contraception. This means that two-pill regimens should become available without prescription to women and girls of all ages even before the government’s appeal is resolved. The Court allowed the stay for one-pill variants of emergency contraception (e.g. Plan B One Step), and stated that the appeal process would be expedited.

Women’s health advocates have been fighting for more than a decade to make OTC emergency contraception a reality.

Nancy Northup of the Center for Reproductive Rights called Wednesday’s order “a historic day for women’s health,” adding: “Expanding access to this safe and effective way of preventing pregnancy after failed birth control or unprotected sex is the among the very best decisions our federal government can make for women’s health.”

Marcia Greenberger of the National Women’s Law Center remarked, “The Center applauds today’s decision, which underscores the simple fact that there is no reasonable basis for restricting access to this safe and effective birth control.”

The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Adolescent Health and Medicine have collectively denounced the administration’s decision to appeal the ruling at all, and issued a strong statement rejecting limited access: “There is no scientific justification for a continued age restriction on emergency contraception. The Administration’s decision puts the health of adolescent girls at risk and is inconsistent with what we know about the safety and benefits of emergency contraception.”

It’s unclear what will happen next in the fight for more accessible emergency contraception. The Justice Department has stated only that they are reviewing the order. According to SCOTUSblog, the administration has the option of asking the Supreme Court to delay all parts of that initial order for OTC access without age restriction. NPR’s Shots explains that “some lawyers say the government might be able to appeal to the full 2nd Circuit. But more likely, if they insist on fighting, government attorneys would have to seek relief from the Supreme Court justice who oversees the 2nd Circuit — Ruth Bader Ginsburg.”

The results of Listening to Mothers III provide insights into numerous issues, including childbirth education; the use and need of government services such as the Special Supplemental Nutrition Program for Women, Infants and Children (WIC); medical interventions during birth; provider choice; and health disparities.

The 2,400 women who completed the online survey were 18-45 years of age, gave birth in a U.S. hospital to a surviving single baby at some point between July 1, 2011 and June 30, 2012, and could participate in English. The research firm Harris Interactive collected the data.

Among the findings, the number one factor driving a woman’s choice of maternity care provider and hospital was acceptance of her health insurance plan. Insurance compatibility ranked higher than  recommendation by a provider, friend or family member, and higher than familiarity due to a previous birth.

Only about half of the women ever saw information that allowed them to compare the quality of potential providers and hospitals, but when they did have that information, 80 percent used it as a factor in their decision.

Pregnant women reported difficulty communicating with their providers at times — 30 percent said that at least once they had let a question go unasked because their provider seemed rushed, and 15 percent reported that their prenatal care provider “always” or “usually” used medical words they did not understand.

The survey provides a variety of data about various medical interventions, including induction, mode of birth, pain relief, labor support.

Close to one-third (31 percent) of survey participants had Cesarean-sections, which is pretty similar to the overall national rate.

There are a number of data points that suggest practices that are not evidence-based or are otherwise problematic, including hospitals not allowing VBAC attempts, somewhat high (17 percent) rate of episiotomy, reports of pubic hair shaving (10 percent for vaginal birth), c-sections performed because the provider had concerns about the baby being too big, and providing formula samples/coupons to moms and bottles with formula or water to babies, even when the moms wanted to exclusively breastfeed.

While it’s not clear how accurately the provider rationale and medical interventions were self-reported by the women, they’re worth a look for women’s perspectives on their care before, during and after childbirth.

The report includes women’s stories about these interventions, and the sometimes-poor communication they experienced with their providers. One respondent commented: “I was not told that I was going to need an episiotomy, and it was done without my permission. I just would have liked to know what an episiotomy was, why it happens, and what it’s like to deal with and take care of after giving birth.”

Another woman reported: “I felt bad because the doctor delivering my baby didn’t give me details. He just told me my baby was in danger and that I needed a c section. I believed him because I care about my baby.”

A companion report, “Listening to Mothers III: New Mothers Speak Out,” will explore postpartum experiences and further explore childbearing and maternity care. It is expected to be released later this month.

Until recently, the term reproductive justice was used mainly by a relatively small number of people involved with abortion rights and women’s reproductive health (read about its history at SisterSong). The phrasing is more inclusive than abortion rights and takes into account all aspects of women’s ability to control their own reproduction, including social inequalities that affect the ability and right to have or not have children and to parent children in healthy environments.

The term has been discussed, and debated, quite a bit lately. Over at RH Reality Check, Jon O’Brien, president of Catholics for Choice, recently argued why reproductive justice cannot be a substitute for the terms “choice” or “pro-choice,” prompting this response from reproductive justice activists (who, it should be noted, consider Catholics for Choice an ally). Their response notes in part:

Women of color struggled within the pro-choice movement to bring their needs to the forefront, and they also created new organizations built on a broad, intersectional analysis and understanding of reproductive rights and health. The shift from choice to justice does not, as O’Brien says, devalue the autonomy of women who face obstacles. Instead, locating women’s autonomy and self-determination in human rights rather than in individual rights and privacy gives a more inclusive and realistic account of both autonomy and what is required to ensure that all women have it. Advocating for reproductive justice was not counter-posed against being “pro-choice” or supporting abortion rights. Rather, reproductive justice re-framed and included both.

The push toward a more comprehensive understanding of reproductive rights has also been adopted by the Unitarian Universalist Association (UUA) of Congregations. Delegates at last year’s General Assembly meeting selected “Reproductive Justice: Expanding Our Social Justice Calling” as the 2012-2016 Congregational Study/Action Issue — meaning congregations and districts are invited to engage and reflect on it, in any way they see fit — and the subject will be the focus of this summer’s GA meeting.

Earlier this year, Billy Moyers invited Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health, and Lynn Paltrow, founder and executive director of National Advocates for Pregnant Women, to discuss the topic.

“What’s happened is that women are beginning to recognize that what’s at stake is more than abortion,” said Paltrow. “It is their personhood — their ability to be full, equal, constitutional persons in the United States of America.”

For more information: Check out the Reproductive Justice Briefing Book. Produced by the Pro-Choice Public Education Project, it offers a comprehensive look at a variety of topics, including sex education, abortion, adoption, pregnancy, disability, incarceration, immigrants, LGBT issues, race, and class.

Facebook pages that had been allowed, despite the company’s existing anti-violence content policy, featured depictions of men kicking “sluts,” images of beaten and restrained women, and numerous rape jokes. A link to examples is provided on this WAM! page.

Smartly, the #FBrape campaign asked supporters to contact advertisers whose ads appear alongside this content, noting that “advertisers should be aware that their brands will appear in positions that sponsor content that mocks, trivializes or promulgates gendered violence.”

Campaign leaders also emphasized that the existing reporting functions were insufficient, providing clear examples where Facebook moderators failed to remove reported content. Meanwhile, we have witnessed instances in which pages created by women that feature photos of moms breastfeeding or health information graphics have been banned.

Some companies responded positively, agreeing to pull their ads from Facebook until it takes real steps to address and remove pages that promote gender-based hate speech. Other companies, including Dove, said that while they object to the content, they could not control placement of their ads — which is why better action on Facebook’s part is necessary.

On Tuesday afternoon, after supporters sent more than 60,000 tweets and 5,000 emails to advertisers and Facebook, Facebook made an official response to the campaign, committing to the following actions:

• Reviewing their hate speech standards and working with representatives of the campaign coalition and others for input
• Updating their training for staff members who evaluate reports of hate speech
• Increasing accountability for content creators
• Establishing more formal and direct lines of communications with representatives of groups working on this issue

You can read the delighted response from the campaign organizers, along with lots of media coverage. And, hey, the campaign made The New York Times – the business section, no less, rather than being placed alongside more “lifestyle”-oriented content where stories that affect women often appear.

Big congrats to WAM!, Everyday Sexism, Chemaly, and everyone who worked to call attention to this issue. One look at the comments on Facebook’s statement reminds us that there is a long way to go toward making the internet a less hostile place, but this is a great step forward.

For example, midwives and birth centers can now be covered by Medicaid, and Pearson provides important details on preventive health services now covered for women:

All insurers now have to cover well-woman exams (thanks to the lobbying efforts of women senators such as Barbara Mikulski), contraception and breastfeeding (even the expensive stuff such as IUDs and breast pumps), cancer screening such as mammograms and Pap smears, domestic-violence screening and STI counseling. If you’re working for Catholic Charities or a religiously affiliated hospital, however, don’t bother asking your HR department about any of this: The Department of Health and Human Services (HHS) has created a work-around so that the bishops don’t have anything to do with your contraceptive coverage.

The print article includes a sidebar (inadvertently left out of the online article) on the not-so-good news: the limitations of the ACA for immigrants and Native Americans, and the political struggles over Medicaid expansion. Check out the full print article for this information and more on enrolling for health coverage, the effects of the ACA on LGBT families, and other issues.

Want more details on health reform and women’s health? Kaiser Family Foundation has published a comprehensive fact sheet on women’s health insurance coverage and an issue brief on Medicaid’s role for women across the lifespan. Plus, you can take this quiz to test your knowledge on women’s health coverage.

The National Latina Institute for Reproductive Health has also produced a fact sheet outlining some of the good and not-so-good aspects of the Act.

Over at the National Partnership for Women and Families, you’ll find 10  Reasons the Affordable Care Act is Good for Moms — a look at how mothers and mothers-to-be, as well as sisters, daughters, grandmothers and aunts, are getting better access to quality, affordable health care — and a state-by-state analysis of how Medicare benefits women.

Below, nurses provide a quick, clear explanation of the Affordable Care Act.

Click here to view the embedded video.

Committed friends of the Vietnamese OBOS project Susan Bailey (left) and Roslyn Feldberg and Nancy Hammett (right), join Project Director Khuat Thu Hong (center) and OBOS’s Judy Norsigian and Sally Whelan.

The Our Bodies Ourselves Global Network is a dynamic coalition of social change organizations, all of whom talk the talk and walk the walk when it comes to the health and human rights of women and girls.

This year, OBOS welcomes two new partners into its growing network.

The Roshan Institute for Persian Studies, in collaboration with the Department of Women’s Studies at the University of Maryland, is adapting sections of “Our Bodies, Ourselves” into Farsi. This is a critical effort to reach Iranian women and girls, especially those living in Iran and routinely subjected to oppression and censorship, both by government and other forces.

Fatemeh Keshavarz, director of the Institute, told OBOS that the Farsi resource, which will be available online, will lead the Institute’s effort to integrate gender into a broader social change framework.

“We have so far been an academic institution with a fairly small reach,” said Keshavarz. “I am trying to expand our reach to Persian speakers across the globe, particularly inside Iran, mostly through the internet. I am also adding gender to the range of lenses we have used for understanding and instigating social change. The current project is one of the very first steps in that direction.”

Further away, in Vietnam, OBOS is working with the Institute for Social Development Studies (ISDS) in Hanoi to provide nearly 3 million women and girls evidence-based, culturally appropriate information based on Our Bodies, Ourselves.

Toolkits with discussion guides, stories and proposed actions will cover such topics as relationships and sexuality, sexual health and reproductive choices, bodies and identities, and post-reproductive years. ISDS will use the resources in trainings across the country, and tap a large, close-knit collaborative network that spans the provinces to maximize print and digital access. One of ISDS’s allies, the Vietnamese Women Union, has 13 million members.

The timing and impact of our Vietnamese partnership are critical. The UNFPA reports that about half the country’s population is under 25, with high rates of unplanned pregnancies, abortions and HIV infection. Yet condom use is low, and young people are continually exposed to inaccurate and misleading information.

In a country where nearly 38 percent of the population subsists on less that $2 a day, millions of poor and rural Vietnamese women and girls are unable to pay for reliable information and services. Access is further limited by the lack of capacity and neglect exhibited by state agencies overseeing sexual health education. A strong response is needed — and the ISDS is well positioned and equipped to lead the way.

Established in 2002, the ISDS is renowned in Vietnam for the quality of its research and ability “to inform as well as influence,” as it applies academic knowledge to meet national challenges. At the community level, the ISDS is strongly rooted in the philosophy of “knowledge as power,” and has successfully adopted an approach that keeps women and girls front and center as it builds public awareness around gender, sexuality and sexual health.

With support in place from Oxfam Novib, the Dutch affiliate of Oxfam, ISDS and OBOS are responding to a growing health crisis in Vietnam. In November 2012, Khuat Thu Hong, ISDS co-director and director of the adaptation project, met with OBOS staff and a circle of committed friends in Boston to formalize our partnership and launch the project.

OBOS is honored to collaborate with ISDS and the Roshan Insitute to bring Our Bodies, Ourselves to Vietnamese and Iranian women and girls. These projects speak to the urgent need for evidence-based, culturally appropriate health resources – and underscore our commitment to ensuring the health and human rights of all women and girls.

Ayesha Chatterjee is the OBOS Global Initiative program manager.

Ayesha and her daughter, Tara

I was welcomed into the Our Bodies Ourselves family in January 2006, soon after I moved to Boston from India. As a die-hard reproductive justice advocate (and unabashed “Our Bodies, Ourselves” fan), I was euphoric to join the team.

The OBOS Global Initiative, which supports women’s organizations developing and using culturally specific materials based on “Our Bodies, Ourselves,” offered the perfect opportunity to weave together my commitment to women’s rights and cross-cultural movement building.

Eight years later, I have helped shepherd the development of resources based on “Our Bodies, Ourselves” in 12 additional languages (with more in development), and coalesced a global network of social change activists.

I have been privileged to meet, learn from, and grow to love this group of women, each on the frontline of human rights work in her country. I know that OBOS’s partnerships with these visionary and tenacious leaders represent a community of shared interests that is pivotal to protecting the lives of women and girls on the ground.

Beyond OBOS, I nurture my decade-long love affair with reproductive justice by supporting families with newborns. As a postpartum doula trained by DONA International, the oldest and largest doula association in the world, and young mum (and as a child who benefitted enormously from the loving arms of extended family), I am personally affected by and committed to changing the state of postpartum care in the United States — one mummy at a time!

My doula-ing started rather unexpectedly and informally in 2009, with the birth of my niece. Though I have always been acutely aware of the growing global crisis in maternal and postpartum care through my work overseas and at OBOS, being with my sister and her family during and after the birth was transformative — the proverbial eye-opener. I quickly became aware of the awesomeness of their task; a task that really does take a village.

At the time, my goal was simple: to love and provide everything my sister and her partner needed to stay nourished and focused on their baby and each other. From hot meals and daily grocery runs, to endless loads of laundry and late-night, sleepy-eyed banter to keep my sister awake (and laughing) through yet another round of pumping, I did my best and loved (nearly) every moment of it.

OBOS, with its four-decade journey and networks of women’s health activists, has connected me with women who, like me, are drawn to the sides of expectant and new mothers. With these relationships, I am now gaining stride in my doula-clogs.

I thank the families that have let me into their homes and lives; I am honored and humbled by their trust. As OBOS expands its global reach, I thank the women who have become our steadfast co-conspirators in a collective struggle. I am inspired by the fire in their bellies.

And to all of you: I thank you for cheering us on and hope you will remain our committed partners as we plough ahead, forging a global community where women live without fear, with dignity, wrought as a fundamental human right.

Ayesha Chatterjee is the OBOS Global Initiative program manager.