Alexa Stanard's blog

Democrats Stall on Birth Control Coverage for Women

2008-07-23T08:00:00-04:00

Michigan women with health insurance can find themselves paying up to $65 a month for a prescription to prevent an unwanted pregnancy. Meanwhile, their insured male counterparts can pick up a free prescription for Viagra.

Michigan is one of 23 states that doesn't require insurance companies to cover birth control pills. However, Viagra and other impotence medications are covered widely. In August 2006, the Michigan Civil Rights Commission issued a nonbinding ruling that failure to cover contraceptives in the same way as other prescriptions constitutes sex discrimination.

"Women spend about 68 percent more on health care each year than men do," said Lori Lamerand, board chair of Planned Parenthood Advocates of Michigan. "In general we women spend way more out of pocket on our health care than men will ever be asked to do. This is the most dramatic example of inequity."

In February 2007, state Rep. Steve Bieda, D-Warren, introduced House Bill 4295 to require insurance companies to cover all contraceptives approved by the U.S. Food and Drug and Administration. The bill has languished since in the Health Policy Committee, which is chaired by Rep. Kathy Angerer, an anti-choice Democrat from Monroe.

Angerer did not return a call seeking comment.

"We don't have what we think of as enlightened folks on the pregnancy prevention front right now sitting in Lansing," Lamerand said. "On one level we're glad we have a Democratic majority, but we don't have a pro-family planning policy."

The issue of contraceptive coverage made news recently just after Sen. John McCain visited Michigan. On his campaign bus a reporter asked whether he thought it was fair that insurance companies cover Viagra but not birth control.

McCain responded with a long, awkward silence before saying it was an issue he hadn't "thought much about" and that he didn't know enough to give the reporter an "informed response." However in 2003, McCain voted against the Murray Amendment, which would have improved the availability of contraceptives for women and required insurance coverage of prescription birth control.

"I think he was simply really unprepared," Lamerand said of McCain's response. "He's not a supporter of women's health or contraception. And that should worry us."

There is no federal law requiring insurance companies to cover birth control. McCain's home state of Arizona is one of 27 states that do so.

According to the Guttmacher Institute, a nonprofit organization focused on sexual and reproductive health research, 98 percent of sexually active women used at least one method of birth control in 2002.

Teen Sexual Behavior Does Not Predict HPV Risk

2008-07-16T08:00:00-04:00

A teen's sexual activity doesn't predict her future risk for HPV, and shouldn't determine whether she receives the HPV vaccine, according to University of Michigan researchers.

The U of M study conducted by C.S. Mott Children's Hospital's Child Health Evaluation and Research Unit found that the sexual activity of adolescents did not predict future contraction of HPV as adults. HPV, genital human papillomavirus, is the most common sexually transmitted infection, according to the Centers for Disease Control and Prevention.

The findings support the CDC's recommendation for universal vaccination for all women ages 11 to 26, regardless of sexual experience, said Dr. Amanda Dempsey, the study's lead researcher.

"We couldn't find any discernible adolescent behavior, including sexual activity, that was associated with an increased risk of HPV infection as a sexually active young adult," Dempsey said. "HPV is so prevalent that everyone who becomes sexually active is at risk."

Dempsey says she and her colleagues undertook the study because of a continued "reluctance among parents to be okay with vaccinating their younger female adolescent children. In clinic, I hear some parents expressing that their adolescent child wouldn't need the vaccine because she's not at risk. We wanted to examine more closely a girl's risk for HPV during adolescence based on her behaviors."

They also wanted to address conflicting recommendations about who should get the vaccine, Dempsey said. While the CDC recommends it for all women age 11 to 26, the American Cancer Society recommends that women 18 and older talk with their doctors about whether they're at risk for the virus based on their sexual history.

The problem with that approach, the study results indicate, is that "you really can't pick out one or two behaviors that predict if you've been exposed to HPV," Dempsey said. "HPV is just so common and so easily transmitted from person to person that it doesn't take more than one partner to get exposed. It doesn't matter what you did as an adolescent. Most people are going to become sexually active and at that point are going to be at risk."

The prospective study -- one that relies on information gathered at the time of a person's life being studied rather than asking participants to remember information retrospectively -- examined data on 3,181 adolescents who participated in a long-term study. Researchers were able to use data collected on participants from early adolescence on to link their HPV status with the behaviors the girls reported several years earlier.

The U of M researchers found no correlation between an adult woman's HPV infection and her number of sexual partners, her history of having an older male sexual partners and/or a new sex partner with the past year, her illegal drug use, her history of sex while alcohol-impaired or her regular use of cigarettes or alcohol.

HPV infection generally occurs shortly after a woman becomes sexually active. Most women never know they have the virus because it usually goes away on its own and may not cause any symptoms.

The HPV vaccine guards against four types of HPV: two that cause 70 out of 100 cases of cervical cancer and two that cause 90 out of 100 cases of genital warts. There are more than 100 types of HPV, but only some types lead to cervical cancer or genital warts.

Because the vaccine protects against only four strains, even women who have tested positive for HPV should still get vaccinated, Dempsey said.

The study appears in the July issue of Pediatrics.

Companion Drug to RU-486 Could Be Dangerous If Not Taken Properly

2008-06-18T08:00:00-04:00

Misoprostol, a companion drug to RU-486 that is used during medication abortions, is safe when taken orally but could reduce the body's immune response when used vaginally, according to a study released Monday by researchers at the University of Michigan.

Vaginal use of the drug may be responsible for the deaths by rare infection of eight women since 2000, the study's authors said.

Misoprostol is approved by the U.S. Food and Drug Administration to be taken orally along with RU-486 to end an early-term pregnancy. RU-486 stops the pregnancy, while misoprostol allows the uterus to contract and the cervix to dilate so that a woman will expel the embryo. More than a half-million women in the United States have used the two drugs safely since the FDA approved the method in 2000.

But many women have used the drug vaginally, a delivery method the FDA has not evaluated.

Misoprostol is a synthetic version of a natural prostaglandin called E2. Prostaglandins are compounds that regulate the body's immune response, and E2 can be a potent suppressor of that response, said Dr. David Aronoff, an infectious disease specialist who led the study.

His immunology lab began its study after the U.S. Centers for Disease Control reported in 2005 on four of the deaths, all of healthy women who died after medication abortions. Another had died as well.

"What struck me in those five cases is the women had previously been healthy, then died after taking fairly high doses of synthetic prostaglandin E2, which is misoprostol," Aranoff said.

"Vaginal application seems to be more effective, and women tolerate it better. It became quite popular," he added. "But in Europe they don't use misoprostol vaginally, and no deaths had been reported there. We wondered if maybe high concentrations of this stable prostaglandin in the vaginal tract might lower a women's ability to fight bacterial infections."

In animal and cell culture studies, the researchers found that when used vaginally, misoprostol can allow Clostridium sordellii, a normally non-threatening bacterium, to flourish and cause deadly infection. When absorbed through the stomach, however, the drug did not compromise immune defenses or cause illness.

Women rarely harbor the infection vaginally in the first place, Aranoff said, indicating an additional risk factor must exist in order for the infection to occur.

"It needs to be emphasized that the termination of pregnancy with these is drugs very safe," he said. "What our research does is maybe make a safe procedure even safer. These infections are very rare."

When taken orally, misoprostol gets absorbed into the bloodstream and distributed throughout the body. Vaginal use forces the drug to be absorbed initially in the soft tissue, leading to high concentration in one area before the subsequent absorption into the bloodstream.

Misoprostol is occasionally used as an immunosuppressant for organ transplant patients and most commonly as prevention against stomach ulcers by those taking high doses of aspirinlike compounds.

"Those patients show no immunosuppressant problems," Aranoff said. "That further substantiates how safe this drug is when taken by mouth."

In 2006 Planned Parenthood, the nation's largest provider of abortions, stopped offering misoprostol vaginally as a precaution. The study supports that decision, Aranoff said.

It appears online ahead of print in the Journal of Immunology.

Michigan Anti-Abortion Bill Faces Veto, Remains In-Waiting

2008-06-12T08:00:00-04:00

A controversial bill that criminalizes the performance of certain abortion procedures and that faces a veto by Gov. Jennifer Granholm remains in the Michigan House one week after its passage.

Supporters of Senate Bill 776, which passed the House on May 27, suspect the House is deliberately delaying sending it to Granholm. But a spokesman for the House speaker dismissed the charge.

"The fact that the bill remains in possession of the House tells you that games are being played," said Michigan Right to Life Legislative Director Ed Rivet.

But Greg Bird, spokesman for House Speaker Andy Dillon, D-Redford Township, said the bill is under review by House clerks.

"My understanding is it's being proofread," Bird said. "If there are no changes from the Senate version, it would go next to the governor's desk. There have been a number of what some folks would call a controversial bill that have come out of the chamber before."

SB 776 bans the removal of a fetus until the head or fetal trunk is outside a woman's body with the intention of aborting it. The procedures banned by the bill are collectively referred to by opponents as partial birth abortion, though the term has no medical relevancy.

The bill allows for exceptions only in situations of threat to a woman's life. It is a replica of a federal law that was upheld by the U.S. Supreme Court in January. Michigan is covered under the federal law.

Liz Boyd, spokeswoman for Granholm, said she did not know when the bill would arrive on Granholm's desk, but said she opposes it.

"She will veto that bill," Boyd said. "The bill is unnecessary. It does not take into consideration the health of the mother."

The House passed the bill with 70 votes, sufficient to override a veto. But the Senate was one vote short of a veto-proof supermajority.

And people on both sides of the issue said a veto will be tough to override.

"I don't know a lobbyist in this town who's confident of an override," Rivet said. "It's just very, very difficult. We have to be realistic."

Margy Long, vice president of public advocacy and communications for Planned Parenthood of Mid and South Michigan, said members of a governor's party are typically under considerable pressure to not override a veto.

Long said Planned Parenthood was encouraging its members to urge Granholm to veto the bill and for legislators to sustain the veto.

"It's already federal law," she said. "So they don't need this bill at all."

Michigan House Passes Federal Abortion Ban Copy

2008-05-29T12:18:07-04:00

And we wonder why Michigan residents hold their state Legislature in such low regard.

Late Tuesday night, the Democratic-led House passed Senate Bill 776, a bill banning certain abortion procedures. The bill's fate had occupied legislators' time and attention for days, as the right-to-life lobby threatened to withdraw its endorsements from waffling legislators and its elected allies threatened to stop all House business until the bill came to a vote.

Pro-life Michigan residents might be inclined to breathe a sigh of relief. But the bill is an exact replica of a federal bill the U.S. Supreme Court has upheld. A brief lesson in federalism: federal law covers all residents of the United States, regardless of whether a state has a similar law on its books. In other words, the legislators in a state with one of the worst economies in the nation -- with crumbling roads, failing schools, threatened wetlands and a foreclosure crisis that seems to worsen daily -- spent days debating whether to pass a law that already exists.

That's because House Speaker Andy Dillon, D-Redford Township, has been so cowed by the failed recall attempt against him that he buckled when threatened with losing Michigan Right to Life's endorsement. The bill, whose deliberately vague language could apply to abortion procedures used as early as the beginning of the second trimester, makes no exception for protecting a woman's health. As passed by our House, it includes no support for contraception. The entire purpose of the vote was to force state legislators to take a public stand in an election year on controversial abortion procedures. Thirty-two legislators were brave enough to stand their ground and not cave into manipulative political maneuvering.

In 2004, Democrats picked up five House seats against the odds. Two years later, for the first time since 1994, the party took back the House from Republicans, who had lost the public's favor because they were so beholden to special interests.

Sadly, that hard-won majority has been reduced to this -- a Democratic leader so beholden to a narrow special interest that he's willing to symbolically sell half this state's population down the river to protect his own hide. Beyond tossing an occasional endorsement to a Democrat (and nearly always to his or her Republican opponent), the right-to-life lobby has done nothing to help the party's candidates. Meanwhile, the pro-choice crowd has gone to the mats for the Democrats in election after election, coughing up money, volunteers and time. And the majority they helped build just told them to shove it.

Michigan Abortion Bill Could Come to Vote This Week

2008-05-23T08:00:00-04:00

A symbolic bill designed to force state legislators to take a stand on certain abortion procedures appears to be rearing its head once again this week, about a month after Democratic legislators managed to fend off a vote on the bill.

The Lansing-based Citizens for Traditional Values on Monday sent an e-mail alert to its members titled, "Partial Birth Abortion Vote Coming May 21-22; Forces Finally Negotiate Their Surrender." The e-mail said House Speaker Andy Dillon, D-Redford Township, had "personally (face-to-face) assured" Right to Life Michigan President Barb Listing that Senate Bill 776 would come to a vote this week.

The bill would ban the removal of a fetus until the head or fetal trunk is outside a woman's body with the intention of aborting it. The procedures banned by the bill are collectively referred to by opponents as partial birth abortion, though the term has no medical relevancy.

SB 776 allows for exceptions only in situations of threat to a woman's life. It is a replica of a federal law that was upheld by the U.S. Supreme Court in January. Michigan is covered under the federal law.

Supporters of the bill failed to secure a vote in April during a right-to-life legislative day. It passed the Republican-led State Senate bill in January, and has stalled since in the Judiciary Committee.

CTV, which lists its mission as "to promote and defend Judeo-Christian values in society and government," urged its members to contact their state representatives and pressure them to support the bill.

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Alexa Stanard, Michigan Democrats Delay Anti-Abortion Bill

A Conversation With Abortion Rights Pioneer Dr. Ken Edelin

2008-05-21T08:00:00-04:00

Dr. Ken Edelin nearly went to jail for performing a legal abortion.

In October 1973, just months after the U.S. Supreme Court decided Roe v. Wade, Edelin performed an abortion on a 17-year-old girl who had come with her mother to request the procedure at the Boston hospital where Edelin worked as an obstetrician/gynecologist. Both women signed consent forms.

Two months later, the local prosecutor, a member of the Knights of Columbus and the leader of its right-to-life committee, subpoenaed the private medical records of 88 women who had come to Edelin's hospital for abortions. Edelin himself was subpoenaed to testify before a grand jury, which chose to indict him for manslaughter. An African-American, he was tried before a jury of 16 people - all of them white, 13 of them men, 11 of them Catholic. They voted to convict him.

Edelin, facing 20 years in prison and the loss of his medical license, immediately appealed to the Massachusetts Supreme Court. The court overthrew his conviction and entered its own verdict of not guilty, an unusual move that ensured the prosecutor could not come after him again.

Edelin went on to become a national activist and spokesman for reproductive rights, chairing the board of Planned Parenthood and, recently, publishing "Broken Justice," a book about his experiences with the Boston case.

Edelin spoke with RH Reality Check's Alexa Stanard about the continuing challenges women face in the battle to preserve their reproductive rights.

Alexa Stanard: What do you see as the greatest threat today to women's reproductive rights?

Ken Edelin: The upcoming election. I think this is a crucial election as it relates to reproductive choice. [Both Democratic candidates, Sen. Hillary Clinton and Sen. Barack Obama, are pro-choice; Republican nominee Sen. John McCain has consistently voted against women's reproductive rights.] The Supreme Court has been tilted by the current administration toward those who are not fully supportive of Roe v. Wade. I think the federal abortion ban they upheld a year ago [that outlawed medical procedures often used in late-term abortions] is evidence of that. I think that over the next four to eight years there are going to be two and probably three justices who need to be replaced. Unfortunately, I think they're the justices who have consistently supported women's right to choose on the Supreme Court.

AS: Why has the anti-choice fringe been so successful in promoting its agenda, with things like spousal notification, waiting periods and bans on late-term abortions?

KE: Because I think the vast majority of Americans who are pro-choice have lost focus and have not kept their eye on the ball so that elections, both on the state level and national level, have been waged and won on other kinds of issues. In the last two weeks I've visited Michigan, Pennsylvania and Rhode Island, and all those states have legislators that have been trying to pass bills that really do put a burden on women who are trying to exercise their reproductive rights, whether it's bills that require ultrasounds, or bills that require waiting periods, or in Michigan where there's an attempt to reproduce the federal abortion ban on the state level. We, the pro-choice majority, are not as focused on this issue as those that are anti-choice. Those that are opposed to women's right to choose really become very threatening to legislators to make sure their view is heard and carries the day. We tend to be much more forgiving, much more trusting, but they're very focused. Bush's appointments of [Supreme Court Justices John] Roberts and [Samuel] Alito were really a payback to the conservative wing of the Republican Party, the anti-choice wing.

AS: Where are the greatest opportunities for the pro-choice community to press its agenda of support for reproductive rights and access to contraception and sex education?

KE: I think the most immediate opportunity is in the federal elections coming up in November. If we lose this presidential election, if we elect an anti-choice president and he is able to make two or three more appointments to the Supreme Court, then we're not talking about a temporary setback, we're talking about a setback that's going to last several generations of women. It's scary that so much is depending on this next election, but it is and people need to wake up to that.

AS: What do you make of the situation here in Michigan -- a Democratic leader helping Right to Life to push a bill on late-term abortion?

KE: I think your state points up what the truth of the matter is, which is that just because someone is a Democrat or Republican doesn't make them pro-choice, it doesn't make them in favor of a woman's right to choose. We've got to look beyond party affiliation and party labels at what a candidate believes in. You're not unique, unfortunately. I was just in Rhode Island, and as they like to describe themselves, they're a solidly blue state. But the Legislature is very anti-choice, even though the people don't want to see Roe v. Wade overturned.

AS: You've said that the Supreme Court decision a year ago upholding the federal abortion ban opens the door to bans on all abortion procedures. Can you explain why?

KE: If you read the decision that they handed down, you'll see a couple of things which should be alarming. One of the things they talk about in both the law and the decision is so-called post-abortion syndrome women are supposedly suffering from, where they become depressed. There is nowhere in the medical literature where women are suffering from a post-abortion syndrome. It just doesn't exist. But they repeat it as though it's fact, as though if they say it often enough it's going to become true. But it's not.

No. 2, if you look at the description of the procedure in the ban, it could be language used to describe any abortion procedure, at even eight weeks or 12 weeks. If you're opposed to a woman's right to choose those descriptors apply to any abortion procedure.

AS: You've said some have told you your story is passé because it happened 30 years ago. How can those who work to support reproductive rights for women best counter apathy about the issue?

KE: That is a great question and it is the area of great frustration for me. In the pro-choice movement we're always talking about language, how we can craft a message, do a better job of getting our message through. I think our message is good. I think there are large parts of the public who are pro-choice but not willing to vote on that issue. They're willing to give anti-choice folks a pass on it if they agree with them on other issues like the war in Iraq and the economy, but they're not going to hold their feet to fire on the issue of choice. We could get the war turned around but lose on women's right to choose, which I believe is fundamental to a free and open society, and women being able to enjoy the fruits of this democracy.

Related Post

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Michigan Democrats Delay Anti-Abortion Bill

2008-04-30T09:44:21-04:00

A symbolic bill designed to force Michigan state legislators to take a stand on certain abortion procedures failed to move last week, representing at least a momentary failure for an anti-abortion group pushing for its passage.

House Democrats spent hours in caucus last Wednesday debating how to proceed on the Senate Bill 776, which would ban the abortion of a fetus by removing the fetus until the head or fetal trunk is outside a woman's body before completing the abortion. The procedures banned by the bill are collectively referred to by opponents as partial birth abortion, though the term has no medical relevancy. Doctors sometimes recommend the procedure for pregnancies that pose risks to the mother's health.

When they emerged from caucus, Majority Floor Leader Steve Tobocman, D-Detroit, used a parliamentary maneuver to quickly adjourn session. That move prevented action on the bill and led to chants of "776" by some House Republicans.

The bill, which allows for exceptions only in situations of threat to a woman's life, is a replica of a federal law that was upheld by the U.S. Supreme Court in January. Michigan is covered under the federal law.

Nonetheless, Ed Rivet, legislative director for Michigan Right to Life, has said his group was engaged in "active negotiations" with House Speaker Andy Dillon, D-Redford Township, to bring the bill to a floor vote and planned to use the day a couple hundred of its members descend on the Capitol to push for the bill.

"There isn't any reason the deal can't be done," Rivet said April 16. "The pressure isn't necessarily on the Speaker so much as on pro-choice Democrats who find this unpalatable."

The Republican-led State Senate passed the bill in January. It was then sent to the Democratic-led House, where it has stalled in the Judiciary Committee.

Though Democrats' decision to sit on the bill Wednesday represents a defeat for Michigan Right to Life, it may be only temporary. Yesterday's lack of action didn't kill the bill, and Republicans' dramatic chants indicate they don't intend to let it die.

Michigan Seeking Federal Abortion Ban Copy

2008-04-18T09:50:21-04:00

Michigan House Speaker Andy Dillon, D-Redford Township, is negotiating with Michigan Right to Life to bring to a House vote a symbolic bill banning certain abortion procedures.

The Republican-led state Senate in January passed Senate Bill 776, which would prevent so-called partial birth abortions, defined in the bill as removing a fetus until the head or fetal trunk is outside a woman's body with the intention of aborting it. It allows for exceptions only if a woman's life is threatened. The bill is a replica of a federal law that was upheld by the U.S. Supreme Court in January. Michigan is covered under the federal law.

The state bill won't change anything for women and their doctors facing the difficult decisions around late-term abortion. The bill's fate is uncertain at best. After passing the Michigan Senate, it was sent to the Democratic-led House for consideration, where it has stalled in the Judiciary Committee.

"We think this bill is totally unnecessary and completely an effort by Right to Life to do a political move in an election year," said Margy Long, spokeswoman for Planned Parenthood of Mid and South Michigan. "It's identical to the federal bill, so there is no need for Michigan to have a similar law. This is really just Right to Life pushing to have all the legislators on record as to whether they would support an anti-abortion ban."

Ed Rivet, legislative director for Michigan Right to Life, said his group is engaged in "active negotiations" with Dillon about how to move the bill forward.

"These negotiations can be tricky," Rivet said. "We're hoping to break through in the next day or two. Then timing becomes less critical. Once we agree what we're going to do, we can decide when we're going to do it."

The window for the negotiations, Rivet said, will close this week. Next Wednesday the group has its annual lobby day, when about 200 of its members come to the Capitol to promote anti-abortion legislation.

"This has been something we discussed with [Dillon] since the beginning of the session," Rivet said. "The Speaker has been very involved."

Rivet said his group has been waiting a long time for this bill to pass, and he alluded to political consequences for legislators if they refuse to take it up.

"We're moving toward action in one format or another," he added. "We want to negotiate the least amount of collateral damage on the House floor, on both sides."

The Judiciary Committee is chaired by Rep. Paul Condino, D-Southfield, a left-leaning legislator with a history of staring down Republicans. But Dillon could move for a discharge motion, whereby a majority of the House could vote to remove the bill from committee and bring it to a floor vote. Dillon and Condino could not be reached for comment.

Michigan's bill, like the federal ban, does not allow the procedure in situations where there is a threat to a woman's health - only when there is a threat to her life. The ban is opposed by numerous medical organizations, including the American College of Obstetricians and Gynecologists and the American Nurses Association.

Rivet said the groups' opposition is "just part of their abortion ideology" and rooted in a "longstanding pro-abortion stance."

But Long disagreed. "The Michigan chapter of ACOG - that's a group of physicians," she said. "I think they're more knowledgeable about health care and the best way to practice health care than Michigan Right to Life is."

Both Rivet and Long agreed that the majority of the House supports the ban. But Long said she's optimistic that legislators on both sides of the issue will pressure Dillon to avoid taking up a redundant bill.

"We just have to wait and see," she said. "I think the legislators know it's not necessary. It's not about making policy in Michigan, it's about a political vote for Right to Life."

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Health Providers Unsurprised by Teen STI Rate

2008-03-20T09:41:20-04:00

Last week's revelation by the U.S. Centers for Disease Control that one-quarter of teen-age girls have at least one sexually transmitted disease came as no surprise to some southeast Michigan health providers, who say such an epidemic is the fruit of a widespread failure to teach teens about sex.

The study, released last Tuesday at a conference in Chicago, was the first of its kind on this age group. It found that 3 million teen-age girls nationwide have an STD, with human papilloma virus, which causes cervical cancer, the leading infection. It also found that nearly half of all black girls have an STD, compared with 20 percent of white and Mexican-American girls.

"Certainly the study just underscored what we've know for years - that teens need to know how to protect themselves against STDs and unintended pregnancy, and the way they do that is by real, live sex education," said Lori Lamerand, president and CEO of Planned Parenthood Mid and South Michigan.

Indeed, some of the studied teens identified sex as vaginal intercourse only, even though other forms of sexual contact can spread STDs.

"The first thing is I think they're in denial," said Dr. Natalia Turner, an attending physician at Children's Hospital in Detroit and clinical professor at Wayne State University's Division of Adolescent Medicine. "They think if they have sex, they aren't going to get pregnant and aren't going to get an STD. It's part of being mature enough to have abstract thinking."

Turner encourages parents to vaccinate their daughters against HPV and the study renewed calls by medical providers for widespread vaccination. The vaccine, however, is expensive and typically not covered by insurance. And some parents resist vaccinating their daughter against a disease that is only transmitted through sexual contact.

"It's all about HPV being sexually transmitted is what really blocks it," Lamerand said. "When parents say, `I'm not going to vaccinate my 14-year-old daughter because that's giving her permission to have premarital sex,' my jaw hits the floor."

HPV can cause genital warts as well as cervical cancer, but often has no symptoms. Chlamydia and trichomoniasis, the second- and third-leading infections, respectively, can be treated with antibiotics. The CDC recommends annual chlamydia screening for all sexually active women under age 25. It also recommends the HPV vaccine for all females younger than 26.

The astronomical rates of STDs among black girls are especially troublesome in Metro Detroit. The numbers reflect African-Americans' inequitable access to health care across the board, Turner said, adding, "Look at statistics for breast cancer - the mortality rate is much higher among African-Americans because they don't get mammograms and they don't get health care."

Lamerand agreed. "Health disparities among races is a given in our society, but it's unconscionable," she said. "Some of it is related to what happens in schools. Unfortunately Southeast Michigan, where most minorities live, is also where schools aren't addressing this with comprehensive education."

Turner said routine preventive health care with a physician who specializes in treating adolescents is key to teens' health and keeping them free of STDs.

"Preventive health care is what they really need. … But parents don't bring them in," she said. "At those appointments I explore how they're reacting with parents, school, community, a healthy lifestyle. If they come every year to their health provider, one who has special training in adolescent medicine, they're going to stay healthy."

HPV Vaccine Access Should Be Unrestricted

2008-02-25T08:46:21-05:00

A new University of Michigan study has found that administering the human papillomavirus vaccine based on a woman's risk factors could keep the vast majority of eligible women from getting the cancer-fighting vaccine.

The results support a federal recommendation that all females ages 11 to 26 should get the vaccine, the study's lead researcher said.

The study finds that using risk factors including sexual history would not only exclude about 80 percent of eligible women but also would likely vaccinate a large number of women already infected with at least one of the four HPV strains the vaccination helps protect against.

"We found that the more risk factors a woman had, the more likely they were infected with one of the four strains of HPV, but we couldn't find a specific threshold of risk factors that would predict which women would have HPV and which wouldn't," said lead researcher Dr. Amanda Dempsey.

"What we found was whether you used risk factors or didn't, either was very poor for selecting women who were at risk for HPV," she added. "There's really no way to use risk factors to sort out women into who would or wouldn't benefit from the vaccine."

The study was published Wednesday in the journal Vaccine by researchers at U of M's C.S. Mott Children's Hospital's Child Health Evaluation and Research Unit.

The study was an attempt to address issues raised by the vaccine's high cost and conflicting recommendations for which patients should be vaccinated.

The American Cancer Society advocates vaccinating all females younger than 18, and selectively vaccinating women ages 19 to 26 based on a discussion between the patient and her doctor about her sexual history. However, the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunizations Practices recommends universal vaccination for all females ages 11 to 26, regardless of sexual experience.

The HPV vaccine is the most expensive routinely recommended vaccine and is not fully covered by all insurance plans or by state and federal financing. So researchers set out to see if there was a way to target its use based on a woman's risk factors for contracting the virus, Dempsey said.

"It's very exciting for people in medicine because now there's a way you can potentially prevent cancer through vaccination," Dempsey said. "That's the positive side. On the less exciting side is … there are some concerns raised as to whether the price will serve as a major barrier to vaccination."

The researchers used data from the National Longitudinal Study of Adolescent Health to test the effectiveness of a targeted approach to vaccination. The study looked at 3,276 women, ages 19 to 24.

There are more than 100 strains of HPV; about 40 of those effect the genital area and about 15 of that 40 can cause cancer. It's estimated that within about three years of becoming sexually active, about half of all women will be infected with genital HPV, even those with only one partner, Dempsey said. Most people who are infected have no outward symptoms, though the virus can be detected during an annual pap smear.

The vaccine helps protect against two high-risk HPV strains responsible for about 70 percent of cancer cases and two low-risk strains responsible for more than 90 percent of genital warts cases.

The researchers made no personal recommendations, but Dempsey said their conclusions support the Advisory Committee on Immunizations Practices' guidelines. She said the American Cancer Society's recommendations to use a selective approach for women over 18 "isn't a reasonable goal to be able to achieve."