Elizabeth M. Armstrong

Risk and the Pregnant Body

November-December 2009 The first trimester of pregnancy had not been an easy one for Andrea—mornings brought waves of nausea and vomiting, and afternoons, debilitating fatigue.1 What got her through were two things: the hope that her symptoms would start to lift when she got past her first trimester, and, of course, the promise of a baby in December. Unfortunately, neither of these came to pass. Andrea had just reached fifteen weeks’ gestation when she arrived in the emergency room at a major academic medical center. After a short week of relief, her nausea had returned, accompanied by a lowgrade, persistent, gnawing abdominal pain, and— perhaps of more concern—a conviction that something was badly wrong. Given the signs, her attending obstetrician ordered a CT scan, the gold standard for ruling out what would be inexcusable to miss: appendicitis. Yet the medical imaging team, nervous about radiation exposure with a pregnant patient, resisted the CT scan. First they attempted to image without radiation, but an ultrasound and an MRI yielded no useful information. The team then requested extra layers of documentation verifying that risks of radiation exposure to the fetus were discussed with the Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor

''Good Girls'': Gender, Social Class, and Slut Discourse on Campus

Women’s participation in slut shaming is often viewed as internalized oppression: they apply disadvantageous sexual double standards established by men. This perspective grants women little agency and neglects their simultaneous location in other social structures. In this article we synthesize insights from social psychology, gender, and culture to argue that undergraduate women use slut stigma to draw boundaries around status groups linked to social class—while also regulating sexual behavior and gender performance. High-status women employ slut discourse to assert class advantage, defining themselves as classy rather than trashy, while low-status women express class resentment—deriding rich, bitchy sluts for their exclusivity. Slut discourse enables, rather than constrains, sexual experimentation for the high-status women whose definitions prevail in the dominant social scene. This is a form of sexual privilege. In contrast, low-status women risk public shaming when they attempt to enter dominant social worlds.

Prospective cohort study comparing intravenous busulfan to total body irradiation in hematopoietic cell transplantation.

We conducted a prospective cohort study testing the noninferiority of survival of ablative intravenous busulfan (IV-BU) vs ablative total body irradiation (TBI)-based regimens in myeloid malignancies. A total of 1483 patients undergoing transplantation for myeloid malignancies (IV-BU, N = 1025; TBI, N = 458) were enrolled. Cohorts were similar with respect to age, gender, race, performance score, disease, and disease stage at transplantation. Most patients had acute myeloid leukemia (68% IV-BU, 78% TBI). Grafts were primarily peripheral blood (77%) from HLA-matched siblings (40%) or well-matched unrelated donors (48%). Two-year probabilities of survival (95% confidence interval [CI]), were 56% (95% CI, 53%-60%) and 48% (95% CI, 43%-54%, P = .019) for IV-BU (relative risk, 0.82; 95% CI, 0.68-0.98, P = .03) and TBI, respectively. Corresponding incidences of transplant-related mortality (TRM) were 18% (95% CI, 16%-21%) and 19% (95% CI, 15%-23%, P = .75) and disease progression were 34% (95% CI, 31%-37%) and 39% (95% CI, 34%-44%, P = .08). The incidence of hepatic veno-occlusive disease (VOD) was 5% for IV-BU and 1% with TBI (P < .001). There were no differences in progression-free survival and graft-versus-host disease. Compared with TBI, IV-BU resulted in superior survival with no increased risk for relapse or TRM. These results support the use of myeloablative IV-BU vs TBI-based conditioning regimens for treatment of myeloid malignancies.

Expanding Access to Emergency Contraception in Developing Countries

Emergency contraception has been called the best-kept contraceptive secret. Previous research shows that several regimens of postcoital contraception offer safe and effective ways for women to avoid pregnancy. Yet the methods are typically unavailable to women in developing countries. In this article, the authors review the main methods of emergency contraception and describe experience with them to date. The prevalence and urgency of the need for making these methods available to women in developing countries are assessed. The necessary elements for creating such access are described. In several developing countries, conditions for introducing the methods may be more favorable than in industrialized countries. These advantages are reviewed. Finally, the authors describe the challenges anticipated for broadening the availability of postcoital methods in the developing world. They conclude with a brief series of recommendations for policymakers.

Whose Deaths Matter? Mortality, Advocacy, and Attention to Disease in the Mass Media

Diseases capture public attention in varied ways and to varying degrees. In this essay, we use a unique data set that we have collected about print and broadcast media attention to seven diseases across nineteen years in order to address two questions. First, how (if at all) is mortality related to attention? Second, how (if at all) is advocacy, in the form of organized interest group activity, related to media attention? Our analysis of the cross-disease and cross-temporal variation in media attention suggests that who suffers from a disease as well as how many suffer are critical factors in explaining why some diseases get more attention than others. In particular, our data reveal that both the print and the broadcast media tend to be much less attentive to diseases that disproportionately burden blacks relative to whites. We also find a positive link between the size of organizational communities that take an interest in disease and media attention, though this finding depends on the characteristics of those communities. Finally, this study also reveals the limitations of relying on single-disease case studies-and particularly HIV/AIDS-to understand how and why disease captures public attention. Many previous inferences about media attention that have been drawn from the case of AIDS are not reflective of the attention allocated to other diseases.

Lessons in Control: Prenatal Education in the Hospital

As childbirth has become medicalized, a gap has opened between the needs and wishes of the individual woman giving birth and the dictates of the institution where birth occurs, the hospital. One way the medical establishment has sought to reconcile these differences is through prenatal education. Drawing on participant observation of a series of prenatal classes for poor and working-class women at a large urban hospital and interviews with the participants in the program, I argue, however, that the class neglected many of the needs that pregnant women and their partners expressed. Moreover, the class engaged a variety of strategies to socialize women to comply with hospital routines and expectations, even at the expense of their own interests. This process, through which organizational needs are defined as therapeutic needs, was first described by Erving Goffman in Asylums (1961). Using Goffmans “medical service model,” I contend that hospital-based prenatal education is primarily organized and designed to meet not individual, but institutional needs. Rather than empowering women to achieve their own goals in birth, the classes teach women to be compliant with the institutionally determined regimen for labor and delivery. Thus, prenatal education illustrates the growing gap between individual needs and institutional needs in the realm of health care in the U.S., as well as the growing burden placed on individuals to be responsible for their own health regardless of the powerful social configurations that constrain individual choices and experiences.

Case Studies in Emergency Contraception From Six Countries

emergency contraceptive methods are marketed legally, but family planning organizations shy away from offering them. In China, postcoital methods have long been offered by the government family planning service. However, these methods have not been separated into those advocated for emergency use only and those recommended for ongoing use. Finally, in Mexico and Nigeria, awareness of emergency contraception continues to be low among both health care providers and the public. Research, both on a way to create knowledge of emergency contraception and on a way to publicize the methods, has been largely concentrated in European countries; many developing countries, and even many developed ones, have yet to conduct any research on this topic. For example, Mexico’s first clinical trial of an emergency contraceptive method (a combination of levonorgestrel and ethinyl estradiol, administered orally or vaginally) is under way, fully 30 years after the original research on the method was conducted. In the case studies that follow, we summarize information on experiences with emergency contraception in each of these countries. We then draw on these experiences to suggest lessons for other countries seeking to introduce or expand the use of this method. United Kingdom History of Emergency Contraception

Emergency Contraception in the United Kingdom And the Netherlands

In both the UK and the Netherlands, emergency contraception is an established part of family planning practice and its cost is covered by the national health insurance systems. The experience in these two countries points to the needs both for education of providers and potential acceptors and for a comprehensive network of sources of method supply. In the UK, where the Department of Health has approved emergency treatment for up to 72 hours postcoitally, there is support for making PC4 (50 mcg of ethinyl estradiol and 0.5 mg of norgestrel) available from pharmacists without a physicians prescription. 2.5 million packets of PC4 have been sold since the regimen was licensed in 1984. A PC4 dose costs US

Home Birth Matters—For All Women

19-74 and saves the government health service

Shared subjects, divergent epistemologies: Sociology, social work, and social problems scholarship

727-806 per unwanted pregnancy averted. Emergency contraception users in the Netherlands tend to be adolescents who have never been pregnant and seek the method from a family planning clinic. There are serious concerns about the strength of the hormonal dose required in the Yuzpe method and calls from the medical profession to make RU-486 available. In both the UK and the Netherlands, the success of postcoital contraception as a method of last resort is related to the overall high quality and accessibility of the national family planning programs.