Women’s Health: More Than Our Uteruses, Breastmilk, or Offspring

An interesting conversation is brewing among New York Times readers about a recent post in the paper’s “Well” blog about prescription drug sharing among women. Blogger Tara Parker-Pope wrote, “…drug-sharing rates were highest among younger women ages 18 to 44, raising special concerns about side effects and health risks of unchecked prescription drug use among women who might become pregnant,” prompting comments by many women “of child-bearing age” who expressed frustration over being considered “pre-pregnant,” and often nothing more, by the medical community. Particular sobering was comment #172, which drew a line between this type of attitude and the Bush administration’s proposal requiring health organizations receiving federal aid to hire health care providers regardless of whether they refuse to prescribe birthcontrol, emergency contraception, or perform abortions.

Although she responded defensively to women’s comments at first, Tara Parker-Pope has followed up with a podcast of an interview with Cindy Pearson from the National Women’s Health Network, in which they discuss in greater depth the implications of the medical community’s difficulty in seeing “women of childbearing age” as valuable patients in their own right. I recommend checking out the conversation if you have time.

Coincidentally, I read the “Well” column about five minutes after getting somewhat worked up about this article, titled “Vitamin D Deficiency May Lurk in Babies.” The article explores some recent findings that babies who are exclusively breastfed may be at higher risk for vitamin D deficiency and related conditions such as rickets. I’ll be honest and say that I was nervous while reading the article, afraid that it would draw the conclusion that formula is healthier than breastmilk and was relieved when they reported that vitamin D deficiency in babies can be prevented with a few vitamin drops.

“I completely support breast-feeding, and I think breast milk is the perfect food, and the healthiest way to nourish an infant,” said Dr. Catherine M. Gordon, director of the bone health program at Children’s Hospital Boston and an author of several studies on vitamin D deficiency, including Aleanie’s case.

“However,” Dr. Gordon continued, “we’re finding so many mothers are vitamin D deficient themselves that the milk is therefore deficient, so many babies can’t keep their levels up. They may start their lives vitamin D deficient, and then all they’re getting is vitamin D deficient breast milk.”

Wait a minute, mothers are vitamin D deficient themselves? That seems important, especially because, according to this very article, vitamin D deficiency can cause osteopenia (low bone mineral density), osteoporosis, diabetes, autoimmune diorders, and cancer. Surely the article addresses ways women themselves can end their vitamin D deficiencies, even if only as a means of being better breastmilk providers for their children!?!?

Sorry, no dice. As far as this article is concerned, the only thing newsworthy about women’s vitamin D deficiencies is that they are crummy vitamin D delivery systems for their children.

This article’s failure to address adult women’s health concerns reminded me of an experience I had last summer when my friend Rebecca called me in a panic one morning, asking for me to drive her to the hospital after she had unexpectedly broken her foot while walking across a parking lot. When the doctor heard that the brake hadn’t occurred during a fall or other serious impact, she recommended getting a test for vitamin D deficiency and made several suggestions about tips for building healthy bones as an adult woman.

Because osteoporosis is a potential side effect of vitamin D deficiency, here are some tips for women at different ages in their life interested in preventing the disease:

  • Up through your twenties, you build bone density; after that, you maintain what bone density you have. Keep this in mind when considering your diet, at any age. If yours is low in calcium or vitamin D, consider changing it or taking supplements.
  • Get some sun! Even though it is wise to be cautious about skin cancer, ten to thirty minutes of sunlight (depending on your skin tone and personal needs) helps decrease vitamin D deficiency.
  • If you have risk factors such as a family history of osteoporosis, consider getting a bone density test at menopause. Otherwise, consider getting one at the age of 65. Transwomen should consult with their endocrinologist about how hormone levels have affected their bone density and when to have bone density tests.
  • Do weight bearing exercise if you are able (such as dancing, jogging, or other movement where you hold your weight up), which builds bone matrix.

This is nowhere near a complete list, but is perhaps slightly more helpful than the generic “take more calcium” advice that seems to be the party line re: osteoporosis. I’m about the farthest thing from a doctor and this list is a compilation of tips I’ve heard from doctor friends of mine, internet resources, and conversations I’ve had with my own doctor. For a much more exhaustive collection of health resources for women, Our Bodies, Ourselves has gathered many women-oriented web-resources.

Regardless of the specific health issue, we all (regardless of gender) hope for access to quality medical care with providers we trust, who take our concerns seriously, and who put our needs and desires as patients first. Unfortunately, the idea that women’s health concerns are obscured when they are of “child bearing age” by the health of their children and (more insultingly) the children their doctor believes they might conceive, is another obstacle to quality medical care.

How do your experiences compare to those of the women responding to Parker-Pope’s column?


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25 comments for “Women’s Health: More Than Our Uteruses, Breastmilk, or Offspring

  1. August 28, 2008 at 11:34 pm

    Don’t forget that there are two forms of Vitamin D in supplement form: D2 (ergocalciferol) and D3 (cholecalciferol).

    One of the problems is that until a few years ago, women were taking mostly D2 in the USA, which apparently isn’t as potent or as easily absorbed in many people. (This is still being debated, but I am personally convinced.) Make sure you are taking D3; the cost is not appreciably different.

    If the label of your multivitamin doesn’t specify which form of D it contains, it is usually D2.

    The case against ergocalciferol (vitamin D2) as a vitamin supplement

  2. August 28, 2008 at 11:37 pm

    Oooh! Thanks for the information! I had no idea.

  3. August 29, 2008 at 12:07 am

    Taking too much calcium can be counterproductive. Magnesium is also necessary to prevent osteoporosis, and the two of them compete for absorption spots. The magnesium regulates calcium, keeping in bones instead of being excreted, so your absolute level of calcium can rise even as you drop the consumption of calcium.

    There’s a solid but hideously formatted rundown of this here

  4. Sarah
    August 29, 2008 at 2:22 am

    At my college, the first question we’re asked when we go to the health clinic for basically *anything* is whether or not we’re pregnant. (This is, I might add, an all-women’s college. Not a lot of het sex going on at any given time…) And sometimes it’s particularly stupid. Sure, “are you pregnant?” makes sense for a student complaining of missed periods or trying to get on the pill, but my friend went in with a migraine one time and got the same question. She was like, “um, no? But I’m in a great deal of discomfort? And mostly blind? Can I get that seen to?” It seems a little weird that that is pretty much the *first* thing we’re asked, like being knocked up is the default for women, and they have to make super sure we aren’t.

  5. August 29, 2008 at 3:42 am

    sarah, I went to an all women’s college too, and I remember encountering the same.

    although, since I was in for seriously debilitating cramps, I just raised my eybrows, looked at the nurse askance, and said “no” – and then realized later that the question actually made sense

    in the case of migraines, however, that question only makes sense when it comes to precribing medicine. at which point the medical professionals should be able to simply wait to ask until they get to that stage (if neccessary). asking up front is bad bedside manner, if nothing else.

  6. SoE
    August 29, 2008 at 5:07 am

    I read those articles, too, and found them equally outrageous. The vitamin D thing is so ridiculous because the best solution would be to inform pregnant women about possible deficiency, offer a test and prescribe appropriate prenatal vitamins. So you would get healthy moms and fetuses/babies which in my opinion is a lot better than “fixing” the babies after the birth when damage has already occured.

    What also works me up a bit is that they focus so much on women when the study itself finds no difference in levels of borrowing from friends, only in sharing. And as TPP stated, nobody really knows what dangers to male fertility may lukr around because there’s little research. The numbers presented in the article are a bit misleading because they’re the combined stats. So the questions should focus more on why women hand out more medicine. Are they prescribed more drugs so they always have some spare pills? Do they feel more pressure to help a friend out?

  7. August 29, 2008 at 8:13 am

    I write a blog about my experiences as a black breastfeeding mom and I wrote about this and didn’t make the connection you made. Thanks for opening my eyes. I was more concerned about the fact that this vit d deficiency seems to affect mostly black and latino and other dark-skinned folks because we don’t absorb the vit d from the sun as well into our skin.
    Also, a little Googling shows that the maker of the vit d drops recommended by pediatricians is made by Enfamil, the formula company. This makes me uncomfortable. They also now make a DHA/ARA supplement for pregnant and nursing moms. I guess they are determined to make money off of EVERY mother, regardless of her infant feeding choices.

  8. Vail
    August 29, 2008 at 8:42 am

    I can’t get pregnant even if I wanted to, so when my doctor keeps asking if I’m pregnant (the same one who diagnosed me with PCOS and prescribes birth control pills for me) it peeves me. It’s also another shot to the heart, a painful reminder that I’m not like other women. I wish they would spend as much time talking to men about their sperm count.

  9. Lara
    August 29, 2008 at 8:56 am

    I was having problems with my gall bladder several years back, and every time I had an attack, the medical staff that helped me asked me if I was pregnant. I usually made it into a joke — have to be having sex to get pregnant, ha ha — but it made me angry the more they did it, particularly because they didn’t properly diagnose me for years.

    Now, I don’t really blame the professionals I deal with for asking; I think it might be required by law to ask (don’t quote me on that). But even if I wasn’t a lesbian who never intends to have children, I wouldn’t want potential reproduction to be the focus of any visit. I’m going to ask my primary physician if that question can be exempted in the future.

  10. BeccaTheCyborg
    August 29, 2008 at 9:41 am

    Every time I’ve seen a new doctor, I get the “are you pregnant?” after I describe my symptoms. I refer them to March of this year on my chart, when I got my tubes tied. And that I’m still on the pill.

  11. August 29, 2008 at 9:49 am

    Sarah, I also went to a women’s college, and it was the same deal there. I vividly remember a friend of mine screaming into the phone “NO, I’M A LESBIAN” when she was trying to get a nurse consultation to see if she should go to the infirmary.

    I have not yet been treated like a pre-pregnant baby-machine by any particular doctor, but that rhetoric scares me. I have, however, been treated like a dirty, dirty slut [/sarcasm] by a doctor when I asked if an antibiotic would interfere with my BCP.

  12. Ali
    August 29, 2008 at 10:20 am

    Reminds me of the first time I was discussing birth control with my OB and I was trying to get from her all the info I could regarding side effects and such. I mentioned that I wanted to know everything I could because I was nervous about taking artificial hormones everyday for the next 20 or 30 years of my life. She immediatedly responded that I wouldn’t need to take them WHEN I wanted to get pregnant. I felt so invisible. Way to miss the point of the question and my obviously not wanting children in the first place.

  13. oxygengrrl
    August 29, 2008 at 12:31 pm

    When I was in college (late 80s), the question one got asked at student health when one came in for whatever reason (and regardless of gender) was “are you sexually active?” The comedy skit group even did a sketch on it:
    Student: “help! i just spilled flesh eating bacteria all over myself in bio lab, aaah! it’s eating me alive!”
    Nurse: “Are you sexually active?”
    That was annoying; the pregnancy thing is offensive. Although I personally don’t intend to give birth to live young, my childbearing friends tell me that their doctors seem far more concerned with their fetuses than with them, and they’ve had to push to get attention paid to their own needs. It’s not a friendly world, health care. You really have to look out for yourself and you can’t count on your doctors to do it.

  14. August 29, 2008 at 12:35 pm

    I love my doctor and the medical center where she works. It’s an all-women’s clinic that provides general medical care, obgyn appointments, sterilization, and abortion. It’s the most respectful place I have ever visited. I’m never asked if I’m pregnant or even if I might be pregnant. I’m a person, not an incubator. It’s worth every penny to go here, rather than the big hospital system that’s within my insurance network.

    I don’t want to move out of my crummy apartment because I am literally right next door. I certainly don’t want to leave this city, for fear that I will never find such a great place ever again.

  15. UnFit
    August 29, 2008 at 1:44 pm

    Sounds like heaven, earlgrey.

    I always have to laugh when I get th pregnant question. Both my boyfriend and I are sterilized, with my lovers I use condoms. We keep joking that, should I get pregnant, we’ll have to keep the kid just to find out what the hell’s up with THAT. And because everybody who makes it against those odds deserves a chance.

    That bit though, is fun whenever I get asked what kind of birth control I use.

    Always gets me a raised eyebrow, a skeptical look at my chart and “At your age!?” (I’m 29)

  16. RacyT
    August 29, 2008 at 7:50 pm

    My older sister had a doctor when she was about 20 who would always give her a pregnancy test, despite my sister repeatedly telling her she was a virgin. Once she became sexually active, she went in and told the doctor she thought she might be pregnant. The doctor basically said, oh don’t worry you’re not pregnant, we won’t bother with the test.

    She got a new doctor that week. Obviously. It reads like a bad joke.

    An aside about osteoporosis — I read recently that too much protein in your diet can cause the calcium to leach from your bones and be excreted in your urine. One more reason to cut back on animal products (or abstain, if you so choose).

  17. OB/GYN doc
    August 29, 2008 at 9:07 pm

    Docs should always ask about the possibility of pregnancy. The pros greatly outweigh the cons. I cant tell you how many times I’ve been consulted in the hospital for symptoms of an ectopic pregnancy or other ob-related conditions and I ask the referring doc if they asked about pregnancy and the response is “uhhh no I forgot”

    Being pregnant is a game changer and affects too much of what we do to ignore it. Obviously if the doc is inappropriately focusing on pregnancy and ignoring other aspects of womens health then its a problem, but from my experience its FAR more likely that they are going to miss a pregnancy that has profound implications for diagnosis and treatment, rather than inappropriately narrow the scope to a pregnancy focus while missing the real story of whats happening to the patient.

    I’d bet that for every incidence of a doc who inappropriatley narrows the focus of the patient visit to pregnancy-related issues, that there are at least 20 or 30 times where a doc didnt ask the simple question and in which it created a problem in terms of diagnosis/treating the patient.

  18. OB/GYN doc
    August 29, 2008 at 9:29 pm

    I wouldn’t want potential reproduction to be the focus of any visit. I’m going to ask my primary physician if that question can be exempted in the future.

    Asking “is there any possibility you could be pregnant” means the visit is “focused” on pregnancy? I strongly disagree.

    Every single abdominal complaint should have the “pregnancy” question. Every single time. Even if you’ve had chronic abdominal pain for he last 25 years, when you see a new doc they should ALWAYS ask that question. And asking that question does not mean they are inappropriately “focusing” on the potential pregnancy to the detriment of your general health. They should ask, you should respond, and then they should move on to other differential diagnoses. But not asking the question at all is poor medical care, bar none.

    Even if the symptoms are not abdomen-related, there are a ton of meds that are contraindicated in pregnancy, many of them are teratogenic in the very early weeks of pregnancy before you even know you’re pregnant. Thats why the question is so important. When you weigh the risk of offending the woman by asking the pregnancy question, vs the risk of teratogenic effect by selecting a medication that caused harm because you didnt ask the question, I side with the option of asking the question.

  19. August 29, 2008 at 9:51 pm

    I can see how the prescription drug sharing article frames women as pre-pregnant, but I think it emphasizes pregnancy because embryos and fetuses are more susceptible to the effects of medication compared to people, and potential babies have live with the consequences of their biological mothers. If having a child was a possibility for me, I would definitely take different kinds of risks with respect to health.

    I don’t see a problem with the “Vitamin D Deficiency May Lurk in Babies” article, because the article is about babies’ health, not women’s health. It’s like if there was an article about women’s health and deficiencies, and a man complained, “Wut about teh menz?”

  20. August 29, 2008 at 11:37 pm

    og/gyn,

    see oxygengrrl’s post for the absurd extreme to which this is taken

    yes, the question often needs to be asked, and yes, the skit was exaggerating for comedic effect but…

    It’s just silly for it to be asked all the time (see Vail’s post) and to be asked in the manner that it is often asked.

    For an example of the stupid way in which this question is often asked, see my earlier post. Gently asking if I could be pregnant and not realize it makes sense,
    is good bedside manner, and takes care of what’s necessary. (Especially since good bedside manner makes me less likely to get flustered and lie to the nurse my parents pay for.) Flat out asking if I could be pregnant was pretty ridiculous since I’d come in complaining that my periods had been getting increasingly painful, until the one I was on at the moment had left me feeling faint, dizzy, and very nauseous the day before.

    Doctors and nurses aren’t always the friendliest people, but they tend to not be overly stupid. So I have to think that when they ask questions like that, they ask them for mainly malpractice reasons rather than for medical reasons. (or they think I’m that stupid, which I have run into before, but not at my fancy schamncy private college)

    “When you weigh the risk of offending the woman by asking the pregnancy question, vs the risk of teratogenic effect by selecting a medication that caused harm because you didnt ask the question, I side with the option of asking the question.”

    Yes, but, as I pointed out earlier, you don’t always need to do that in the diagnostic stage. And certainly it doesn’t need to be the first question out of you mouth. It’s not as if you don’t give her the option of taking the medicine anyway, yes? (and if not, why the fuck shouldn’t she have that choice? I can think of lots of not life threatening reasons why I might terminate a pregnancy – and then try later – in order to take medicine that would help me but might harm the fetus.)

  21. SophiaPriskilla
    August 30, 2008 at 6:43 pm

    I do agree that the way our culture, medical and general, treats pregnant women is problematic – way too much thinking of them as incubators. That said, I too am more in the doctors’/nurses’ general corner on this one (unless it gets out of hand). If they don’t ask whether a woman is pregnant, and she is given an unwanted-abortifacient or teratogenic therapy of any kind, that’s a medical and ethical lapse, not to mention a huge lawsuit. Whether or not a patient is pregnant is a relevant medical consideration, just like blood pressure.

    As for treating women as “pre-pregnant”… If it’s applied to ALL women, it’s a huge problem. If it’s applied to women who are trying to become pregnant, it makes sense: the most crucial time for a lot of development is in the period before a pregnancy is likely to be detected. Better to avoid alcohol for four months before you get pregnant than to risk fetal alcohol syndrome. On that note: a deficiency/excess of a particular nutrient, mineral, etc. does not necessarily, or even usually, have the same effects on adult physiology as it does on fetal development. If a grown woman is deficient in vitamin B12, for example, it’s not ideal for her health. If a pregnant woman is deficient in it, it can lead to spina bifida in the baby, usually an extremely painful and sometimes a fatal condition. So I think there are two factors at play in considering the whole issue: women’s autonomy, and the differences between adult metabolism and fetal development.

  22. Frumious B
    August 30, 2008 at 8:09 pm

    TPP is tool. For years I thought that column was written by a man because it never occurred to me (Silly Bandersnatch!) that a woman could be clueless and condescending to women. I was seriously stunned when I learned she is a woman.

    The thing about breastmilk is that it is deficient in vitamin D even when the mother is not. That’s just how human milk is. Cow’s milk isn’t so fabulous either, incidentally, which is why it’s supplemented in the box. Nursing moms need to get their vitamin D and calcium not because the baby is at risk (cuz the milk will still be low in vitamin D) but because she is excreting so much calcium that she needs to make sure she can absorb as much of what comes into her body as possible. Her body will put the calcium in the milk preferentially over putting it in her bones. Sunlight is contra-indicated for babies under six months, so vitamin D supplementation for exclusively nursing babies is necessary during this time.

  23. Broce
    August 30, 2008 at 11:49 pm

    Quick note about osteoporosis: If you are small boned and petite, and come from Northern European stock, it’s worth getting checked out *before* menopause. I’ll be 50 in a week, and I’m not menopausal yet – still regular as clockwork, no premenopausal symptoms.

    But I’m petite, I smoke, and while I used to rock climb and dance, I also detest milk and probably don’t get enough calcium in my diet. Several years ago I went in for a regular check up, and the nurse ran a quick scan on my wrist. “I’m getting the doctor” she said. Further testing revealed that I was already what they called osteopenic, and was on the border for osteoporosis. I’d already broken a bone in an accident I thought should have only resulted in a bruise, but I didnt even think of this at the time because I wasnt menopausal.

    I’ve been on an osteoporosis medication since, and my most recent bonescan had me on the border between normal and osteopenic, so it’s apparently working. It’s worth getting checked out early if you have any of the risk factors other than age.

  24. Alara Rogers
    August 31, 2008 at 2:49 am

    The migraine thing actually *does* make sense. My first pregnancy, the one that ended in a miscarriage, was notable for the migraine headaches I suffered throughout the three months that I was actually pregnant.

    Pregnancy has *so* many side effects on the body it really *should* be the first thing you ask for anything less obvious than “I have an arrow stuck in my back, can I get it removed?”

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