Nails, babies and bodies – oh, my!

What do manis and pedis have to do with reproductive health?  And how does this work affect the women who do your nails?

If you’ve ever entered or even passed by a nail salon, you probably noticed a smell that blasts your nostrils.  If you stay for a treatment, the smell slowly dissipates while you pamper your fingers and toes.

What you are smelling is toxins.  Nail salon technicians also get used to the smell – olfactory blindness – as they handle cosmetic products that are harmful to their skin, their respiratory systems and their reproductive health.

I recently trained a group of nail salon technicians as peer educators.  They will teach other workers about the reproductive health effects of the toxic products they use.

The Toronto Healthy Nail Salon Network, an association of nail salon technicians and health advocates, invited me to continue the peer education work they started last year.  Taking the lead from advocates in the US, they invited a trainer to arm nail salon workers with information, gloves and cream,  and to go forth into nail salons across the city and teach their sister workers about the effects on their skin of the chemicals they use.

Now skin is one thing; reproductive health is another.  It is easy enough to see reddened, cracked fingers and hands.  It is another to make the connection between these products and adverse effects on  pregnancies, fetal and children’s health.

I began preparing my workshops nearly a year ago.  As time went on, I realized that not only did I have to learn about these chemicals and their effects, I also had to raise workers’ comfort level talking about sexuality (easy enough), explain birth control methods available in Canada (no problem), walk them through the available research on the potential effects on their reproductive systems (a challenging slog) and teach them how to pass on all of the above to their peers.

One of the main challenges is to offer information which is not yet definitive.  In other words, the research is clear about the potential effects of these toxins, but little research has been done on nail salon technicians themselves.

The only possible message: there is a problem; and workers need to try to reduce their risks in the workplace.

The “toxic trio”

The nail polishes you – and they – use may contain solvents including the “toxic trio” (formaldehyde, toluene, and dibutyl phthalate).

Formaldehyde is a carcinogen, associated with low birth weight in several studies and reduced fertility.

Toluene is an endocrine disruptor.

We pored over an illustration of the endocrine system and learned that breathing in high levels in pregnancy can cause birth defects, slow growth and retard mental abilities of offspring.  There is also an increased risk of reduced fertility and spontaneous abortion.

Dibutyl phthalate is also an endocrine disruptor.  Research on mice has shown female reproductive toxicity (birth defects and reduced birth weight), problems in male genital development and potential permanent effects on development of the central nervous system.

You can read more here.

Many workers in nail salons have heard stories about friends who had trouble getting pregnant or who had multiple miscarriages.  Ideally, nail salon technicians should be able to plan their pregnancies for times when they are not working.  But one of the reasons they work in these risky entry level jobs is because they have to.  New immigrants often have few choices.  They need the money.

There are other issues.  One peer educator asked, “How do I know how long these toxins stay in my body?”

I explained the precautionary principle .  If the women they see want to plan their pregnancies, these peers can now knowledgeably discuss all the birth control methods available, as well as access to abortion.  I suggested that if it was at all possible, they might encourage these women to consider planning a pregnancy for a time when they were not working in a nail salon.

I enjoyed asking the peers about the birth control methods they had used in their home countries of Viet Nam and China.  Of course, it was especially interesting to hear about the one child policy in China as well as attitudes towards abortion.  In their anonymous written questions, like most women, they wanted to know about the safety of birth control pills and which was the best method (one that works and suits you best).  They also wanted to know about the availability and cost of abortion.  The most difficult question was how to demonstrate the effects of toxins on women’s reproductive systems.  Again, all they can really offer is risk reduction.

Reduce the risk

When they go out to speak with nail technicians in salons across the city, they will have brochures in Vietnamese and Chinese which suggest the following:

  • Don’t use products with formaldehyde.
  • Don’t use nail polish removers with acetone.
  • Don’t use nail polish thinners with toluene.

They will further recommend to nail salon technicians:

  • close bottles when you are not using them
  • put garbage with chemicals in a closed bag
    • throw the bag in a garbage with a lid
    • close the lid and keep it closed
  • try to take work breaks away from your work station
  • go outside for fresh air if you can
  • open doors and windows and use fans to increase air circulation
  • do not eat at your work station or near chemicals
  • do not wear jewelry where chemicals and water can stay
  • wash your clothes when you get home

And what about you?  If you love your fingernail and toenail polish, or your artificial nails, you have two options: do it at home with less toxic products, keeping your windows open; or encourage your local nail salon to adopt the risk reduction strategies above.  If more patrons insist on safer working conditions, it will increase the safety for all.

 

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Birth control – what you need to know

My friend’s Huff Post blog on cervical mucus has garnered 26,000 likes and 3,049 shares. Women have written from all over the world to thank her for this information.  Despite our best efforts as sex educators, although we have been teaching specifics about female fertility for decades, it still seems to remains a mystery – not only to those who want to plan a pregnancy – but also to those who are trying to use their knowledge of fertility as a method of contraception.  With the operative word being “trying”.

Yet, clearly Canadians are using some form of birth control, because the age of first pregnancy is continually rising.  According to a report by Statistics Canada “the switch happened in 2010 and widened in 2011, when there were 52.3 babies born per 1,000 women ages 35 to 39 and 45.7 per 1,000 women ages 20 to 24… birth rates for women in their early 40s now are nearly as high as for teens.”

Young adults are trying to figure out how to succeed at work and somehow “work in” a family to their lives.  The most popular methods used by young people today are male condoms, oral contraceptives and withdrawal.

But what is the best method?

There is no “one size fits all”; but there are some serious considerations – especially for women – before making a choice.

  • age
  • number of partners
  • current health and medical history
  • how effective the method needs to be

The last point may seem odd, but a woman needs to ask herself how she would feel about being pregnant if her birth control method didn’t work.  Some women would accept the pregnancy; others would not.  She needs to examine her feelings about abortion as well as its availability.

What works?

Methods that are 98% –99%+ effective:

  • sterilization
  • intra uterine system (Mirena IUS)
  • combined oral contraceptives (the Pill), the Patch or the vaginal ring
  • Depo Provera (depot medroxyprogesterone acetate)
  • IUD (copper intrauterine device)

Effectiveness is measured in two ways: perfect use and typical use.  For example,

“male condoms are an effective method.  However, a man must use a condom correctly from start to finish.  With perfect use, 2 women out of 100 would get pregnant (98%); but with typical use, 15 would get pregnant (85%)”. 

Withdrawal, the third most common method used by young people must also be used carefully.  An inexperienced man may find that its effectiveness drops as his desire to stay inside increases.

What my friend has written about fertile mucus comes in very handy when using withdrawal or condoms.  If a man does not pull out in time and his partner is at the most fertile time in her cycle, she needs to consider using emergency contraception.  The same advice holds true for a condom that breaks.

What influences the method you choose?

“Ask a woman if she is using birth control and she will likely tell you whether or not she is taking “the pill.” For most women, they are synonymous. Often, she’ll ask her doctor to ‘put’ her on the birth control pill, which conjures the image of a five-minute consultation, prescription pad at the ready. Do the words “informed consent” have any real meaning when it comes to birth control?”

Sadly, pharmaceutical companies skip through the loophole in Canadian laws prohibiting direct to consumer advertising in order to sell hormonal contraceptives, especially the pill.  But safety is an issue.  There is a difference between side effects and risks.  As I point out, some hormonal methods and formulations are riskier than others.

This leaves some people wondering about alternatives.

Unfortunately, there isn’t much that’s new on the contraceptive scene.  A few methods are in clinical trials, but nothing that really changes the birth control landscape.

As for men, how about a remote controlled implant or a “vasectomy switch”, the Bimek SLV?  Unfortunately, there doesn’t seem to be anything on the scene that seems workable.

But perhaps youngish women should not practise contraception too long if they want to have a baby “some day” given the decline in fertility after 35.  As a young friend said to me recently, “Just assume that all my friends who are rapidly approaching 40 are trying.”

 

 

Reducing pregnancies for teens and poor women = reduction in poverty: reductio ad absurdum?

This New York Times article http://www.nytimes.com/2015/07/06/science/colorados-push-against-teenage-pregnancies-is-a-startling-success.html?partner=rss&emc=rss&_r=2  asks the following question: “If teenagers and poor women were offered free intrauterine devices and implants that prevent pregnancy for years… would those women choose them?” The answer?  A “resounding yes”, which they deem a “startling success”.

Pregnancies to teenagers and “unmarried women who had not finished high school” plunged, especially in the poorest areas of the state, allowing them time, according to the article, to “gain a foothold in an increasingly competitive job market”.  It was seen as a poverty reduction strategy.

I wish I had been a fly on the wall during the counselling sessions that led these young and poor Colorado women to choose long-acting contraceptives.  Were they fully briefed on the side effects and potential risks?  Did they discuss Sexually Transmitted Infection (STI) prevention?  What was the overall vision of poverty reduction in Colorado?

During my sexual health clinic days, there were women who chose – and continued to use – Depo Provera, a contraceptive injection that lasts for three months.  They did so after I had fully informed them of potential side effects and risks of the progesterone-only method.  Some adolescents who came to the clinic were good candidates for the copper IUD and it worked very well for them.  After a clinic counselling session, when young teens or disadvantaged women opted for a method of birth control that worked for them; or they chose to end a pregnancy realizing that their circumstances would not allow them to raise a child at that time, they were making informed choices.  I recognized then as I do now, that reproductive control and poverty, while linked, are not the only elements in the equation.  After reading the article, I wondered about other measures proposed to reduce poverty in Colorado; and what will happen when the private grant to fund this experiment runs out.

Teenage pregnancy and pregnancy for low income women are complex issues.  Factors that result in unplanned pregnancies to teenagers include lower economic status, sexism, racism, prior sexual abuse and ongoing abusive relationships.  The absence of the social determinants of health can result in risk-taking behaviours, like smoking and unprotected sexual activity.  With regard to sexual abuse, for example, without the benefit of comprehensive counselling, young women run the risk of future sexual assault and abusive, controlling partners.  Some exploitative male partners will refuse to “allow” them to use contraception; or they may refuse to use condoms.  When one has little control in one’s life, reproductive control is not even on the table.

For younger and poor women, while it may not be prudent financially, emotionally or even physically to continue a pregnancy, if poverty itself were eradicated, part of the burden to the state would be eliminated, while still allowing funding to provide parenting support.

I imagine some ideological detractors of the Colorado experiment might accuse them of eugenics, deliberately limiting births to racialized and poor women.  I do not subscribe to this point of view.  However, one must acknowledge the history of eugenics practices in North America and abroad that will inevitably make some people skeptical of the motivation behind this poverty reduction experiment.

And yet, research is conflicting on the relationship between teen pregnancy and poverty.  According to Statistics Canada, “women from disadvantaged backgrounds are more likely to end up disadvantaged even if they delay childbearing. And while teenage childbearing continues to be a significant indicator of lower socioeconomic outcomes, the effect is smaller than originally believed” (http://www.statcan.gc.ca/pub/75-001-x/2008105/article/10577-eng.htm).

While I agree that delaying pregnancy is a tool towards poverty reduction, let’s be frank: only the redistribution of wealth will eradicate poverty.

The second issue in terms of the counselling process is STI prevention and treatment.  Like women who use oral contraceptives, women who use IUDs, injections (and implants in the US) may not see the need for condom use.  I would like to know if they discussed and offered testing and treatment for STIs like chlamydia, the rate of which is especially high in older adolescents and young women.  Because there are no symptoms of chlamydia in the majority of cases, without testing, women may contract Pelvic Inflammatory Disease which, if undetected over time, may lead to infertility – not a recommended form of birth control.

A Public Health map of Toronto that plots adolescent pregnancies follows the same geographical trajectory as STIs in the city, which, in turn, follows the curve representing its poorest neighbourhoods.

And who is at higher risk for poverty in Toronto?  Recent immigrants, Aboriginal people, those who are disabled, elderly and alone, racialized or children (http://www1.toronto.ca/City%20Of%20Toronto/Social%20Development,%20Finance%20&%20Administration/Strategies/Poverty%20Reduction%20Strategy/PDF/povertyinTO.pdf).

Poverty reduction, like unplanned pregnancy to young and poor women, is also complex.  There are no magic wands, but there are proven tools.  If we take the lead from developed countries where there is more economic equity, we see that a higher minimum wage and/or guaranteed income, a fair tax system where the wealthy and corporations paid their fair share and increased services, results in a profound reduction in poverty.

In the meantime, contraception and birth control, including post-coital options and abortion, should be freely available to all as a public health service.

Additional reading

The hidden epidemic: A Report on child and Family poverty in Toronto, November 2014

http://www.torontocas.ca/app/Uploads/documents/cast-report2014-final-web71.pdf

Poverty causes Teen Parenting, Not the other way around

http://rhrealitycheck.org/article/2013/04/29/poverty-causes-teen-parenting-not-the-other-way-around

Good Practices in Anti-poverty Family-focused Policies and Programmes in Developed Countries

http://www.un.org/esa/socdev/family/docs/egm12/PAPER-RICHARDSON.pdf

Choice denied – June 2, 2014

A law with teeth is only as good as its enforcement. But when a law is struck down, politics determines how it will play out in society.

When the Supreme Court struck down the law on abortion in 1988—the famous Morgentaler decision—a woman’s right to choose was enshrined in Canadian society. In 1989, the argument of “fetus as person” was rejected, as was the attempt by men in three provinces (Ontario, Quebec and Manitoba) to stop their partners from having abortions. These legal decisions left the right to choose firmly in the hands of individual women.

But a woman’s ability to exercise her choice is limited by several factors: location (it is hardest to get an abortion in the eastern part of Canada); cost, when a woman has to travel to get an abortion or a province does not fund the procedure; and by people, including doctors, who push their anti-choice agenda on a pregnant woman trying to make her decision. (Read more about which provinces cover hospital and/or clinic abortions and which ones do not).

Only 17.8 per cent of Canadian hospitals provide abortion services. Even hospitals that provide abortions may place obstacles in the way of women who try to obtain one, especially if their administration is anti-choice.

Women’s Legal Education and Action Fund (LEAF) decries these obstacles, particularly for women in rural areas, New Brunswick, Prince Edward Island and the North. They explain that provinces are able to limit access because abortion is on a list of “excluded services” in reciprocal provincial billing agreements. This means that women temporarily living outside their home province may not have access to publicly funded abortion care. Waiting for coverage is not feasible for a woman who chooses to terminate. For a woman who does not want to continue her pregnancy, every day that passes can be excruciating.

The Morgentaler Clinic in New Brunswick announced it would close its doors at the end of July 2014 after a lengthy losing battle to have that province fund clinic abortions, leaving local women bereft of an essential medical service. Moreover, for women in Prince Edward Island, the only province in Canada with no local access to abortion, women have had two choices: the Termination of Pregnancy Unit at the QEII Hospital in Halifax, where the costs of the procedure (but not those of travel or accommodations) are paid by the Province. At the Morgentaler Clinic in Fredericton, all costs have been privately paid by the woman (with many Island women accessing the Clinic’s subsidies). Over the years, roughly half of PEI women seeking abortions have used the services of the private clinic in Fredericton. The clinic was the only private option in the Maritime provinces. After the closure of the Fredericton private clinic, only one option will remain for Prince Edward Island women seeking a surgical abortion: travelling to the hospital in Halifax. (Read more about the current situation in PEI).

Why is this service essential?

It is estimated that 40 per cent of pregnancies in Canada are unplanned. A condom may break or slip, a pill may be forgotten, a woman may be sexually assaulted; or people may be unequipped to gain access to, negotiate or use contraception.

The decision to end a pregnancy is often based on economics, especially when she already has children and simply cannot afford to have another one. When money is tight and jobs are scarce, women think first of their existing children. When I had my abortion, we already had two children; the younger was a year and a half and our financial situation was precarious. Amongst the scores of pregnant women seeking help with their decision whom I counselled in sexual health clinics over the years, their distress was often financial.

But there were also more dramatic cases.

I vividly remember the woman who said she wanted to continue the pregnancy, but was afraid to. Her husband, who refused to allow her to use any form of birth control, had kicked her during a previous pregnancy. She had miscarried.

I remember the young woman who started having sex at 13 who had had three abortions and was a crack cocaine user. I am guessing that prior sexual abuse predisposed her to ongoing risk-taking.

I remember the 28-year-old who had been drugged and raped; the 16-year-old whose boyfriend wanted to trick her into getting pregnant.

These women all lived in a city where there was good access to services. But even when there is adequate access to the procedure, there is another component to the process which is as essential as the service itself. Every pregnant woman who came to the sexual health clinic where I worked was given the time to consider and explore her options. The counselling component is integral to the service of abortion referral and abortion provision. Counselling often leads to other service referrals, as in the case of the woman who was abused by her husband. It is expensive to pay people to help women make a fully informed choice. Whatever a woman chooses, she needs to feel that it is the right choice for her at that moment in her life. This can take time—and time is money. Counsellors who work in abortion clinics are supporting a woman who is facing a life-changing dilemma.

But health dollars are scarce and their distribution is political. For example, there is currently a lobby to extend HPV vaccination to boys despite the lack of evidence that it will save money in the long run. HPV DNA testing, which is part of good management for women over 30 is not covered by every province and territory. Pap screening and follow-up is not available to the women who are most at risk for cervical cancer. Mammography programs are not cost effective in terms of lives saved. Moreover, “potential harms considered by the [Canadian] Task Force [on Preventive Health Care] focus on over-diagnosis of breast cancer which can lead to additional imaging, biopsies and procedures, distress and other psychological responses, and additional radiation exposure from mammograms.” Yet women continue to be screened on a regular basis.

Women’s health facilities tend to be cash poor while hospitals are well-funded and able to raise huge amounts through donations.

Although the current federal government insists it will never reintroduce abortion legislation, they are choking funds for abortion services the same way they starve women’s organizations and women’s health clinics. If there was genuine concern about bringing wanted children into this country, there would be a national child care program and universal student nutrition programs.

Abortion is a medical procedure which should be accessible and fully funded—everywhere. It should be a priority for women to be able to choose when they want to continue a pregnancy and when they want to terminate one.

Women’s reproductive rights are central to their ability to control their lives. Without access to services and funding, the abrogation of a law is toothless.

Read more here:

CWHN Health FAQ on abortion

History of abortion in Canada, National Abortion Federation

Access to hospital abortions, Reality Check, Canadians for Choice report, 2006

Access to abortion in Canada, Women’s Legal Education and Action Fund (LEAF), April 2014

Abortion access for women in PEI, CBC website, April 2014