Nearly two years after Texas’ six-week abortion ban, more infants are dying | CNN



CNN
 — 

Texas’ abortion restrictions – some of the strictest in the country – may be fueling a sudden spike in infant mortality as women are forced to carry nonviable pregnancies to term.

Some 2,200 infants died in Texas in 2022 – an increase of 227 deaths, or 11.5%, over the previous year, according to preliminary infant mortality data CNN obtained through a public records request. Infant deaths caused by severe genetic and birth defects rose by 21.6%. That spike reversed a nearly decade-long decline. Between 2014 and 2021, infant deaths had fallen by nearly 15%.

In 2021, Texas banned abortions beyond six weeks of pregnancy. When the Supreme Court overturned federal abortion rights the following summer, a trigger law in the state banned all abortions other than those intended to protect the life of the mother.

The increase in deaths could partly be explained by the fact that more babies are being born in Texas. One recent report found that in the final nine months of 2022, the state saw nearly 10,000 more births than expected prior to its abortion ban – an estimated 3% increase.

But multiple obstetrician-gynecologists who focus on high-risk pregnancies told CNN that Texas’ strict abortion laws likely contributed to the uptick in infant deaths.

“We all knew the infant mortality rate would go up, because many of these terminations were for pregnancies that don’t turn into healthy normal kids,” said Dr. Erika Werner, the chair of obstetrics and gynecology at Tufts Medical Center. “It’s exactly what we all were concerned about.”

The issue of forcing women to carry out terminal and often high-risk pregnancies is at the core of a lawsuit filed by the Center for Reproductive Rights, with several women – who suffered difficult pregnancies or infant deaths shortly after giving birth – testifying in Travis County court this week.

Prior to the recent abortion restrictions, Texas banned the procedure after 20 weeks. This law gave parents more time to learn crucial information about a fetus’s brain formation and organ development, which doctors begin to test for at around 15 weeks.

Samantha Casiano, a plaintiff in the suit filed against Texas, wished she’d had more time to make the decision.

“If I was able to get the abortion with that time, I think it would have meant a lot to me because my daughter wouldn’t have suffered,” Casiano said.

When Casiano was 20 weeks pregnant, a routine scan came back with devastating news: Her baby would be stillborn or die shortly after birth.

The fetus had anencephaly, a rare birth defect that keeps the brain and skull from developing during pregnancy. Babies with this condition are often stillborn, though they sometimes live a few hours or days. Many women around the country who face the prospect choose abortion, two obstetrician-gynecologists told CNN.

But Casiano lived in Texas, where state legislators had recently banned most abortions after six weeks of pregnancy. She couldn’t afford to travel out of the state for the procedure.

“You have no options. You will have to go through with your pregnancy,” Casiano’s doctor told her, she claimed in the lawsuit.

In March, Casiano gave birth to her daughter Halo. After gasping for air for four hours, the baby died, Casiano said during her testimony on Wednesday.

“All she could do was fight to try to get air. I had to watch my daughter go from being pink to red to purple. From being warm to cold,” said Casiano. “I just kept telling myself and my baby that I’m so sorry that this had to happen to you.”

Casiano and 14 others – including two doctors – are plaintiffs in the lawsuit. They allege the abortion ban has denied them or their patients access to necessary obstetrical care. The plaintiffs are asking the courts to clarify when doctors can make medical exceptions to the state’s ban.

Casiano and two other plaintiffs testified Wednesday about hoping to deliver healthy babies but instead learning their lives or pregnancies were in danger.

 Plaintiffs Anna Zargarian, Lauren Miller, Lauren Hall, and Amanda Zurawski at the Texas State Capitol after filing a lawsuit on behalf of Texans harmed by the state's abortion ban on March 7 in Austin, Texas.

“This was just supposed to be a scan day,” Casiano told the court. “It escalated to me finding out my daughter was going to die.”

Lawyers representing the state argued Wednesday that the plaintiffs’ doctors were to blame, saying they misinterpreted the law and failed to provide adequate care for such high-risk pregnancies.

“Plaintiffs will not and cannot provide any evidence of any medical provider in the state of Texas being prosecuted or otherwise penalized for performance of an abortion using the emergency medical exemption,” a lawyer said during the state’s opening statement.

Kylie Beaton, another plaintiff, also had to watch her baby die. Beaton, who didn’t testify this week, learned during a 20-week scan that something was wrong with her baby’s brain, according to the suit.

The doctor diagnosed the fetus with alobar holoprosencephaly, a condition where the two hemispheres of the brain don’t properly divide. Babies with this condition are often stillborn or die soon after birth.

Beaton’s doctor told her he couldn’t provide an abortion unless she was severely ill, or the fetus’s heart stopped. Beaton and her husband sought to obtain an abortion out of state. However, the fetus’s head was enlarged due to its condition, and the only clinic that would perform an abortion charged up to $15,000. Beaton and her husband couldn’t afford it.

Instead, Beaton gave birth to a son she named Grant. The baby cried constantly, wouldn’t eat, and couldn’t be held upright for fear it would put too much pressure on his head, according to the suit. Four days later, Grant died.

Amanda Zurawski of Austin, Texas, center, is the lead plaintiff in the lawsuit.

Experts say that abortion bans in states like Texas lead to increased risk for both babies and mothers.

Maternal mortality has long been a top concern for doctors and health-rights activists. Even before the Supreme Court decision, the United States had the highest maternal mortality rate among wealthy nations, one study found.

Amanda Zurawski, the lawsuit’s lead plaintiff, testified Wednesday that her water broke 18 weeks into her pregnancy, putting her at high risk for a life-threatening infection. Zurawski’s baby likely wouldn’t survive.

But the fetus still had a heartbeat, and so doctors said they were unable to terminate the pregnancy. She received an emergency abortion only after her condition worsened and she went into septic shock.

Zurawski described during Wednesday’s hearing how her family visited the hospital, fearing it would be the last time they would see her. Zurawski has argued that had she been able to obtain an abortion, her life wouldn’t have been in jeopardy in the same way.

“I blame the people who support these bans,” Zurawski said.

Zurawski previously said the language in Texas’ abortion laws is “incredibly vague, and it leaves doctors grappling with what they can and cannot do, what health care they can and cannot provide.”

Pregnancy is dangerous, and forcing a woman to carry a non-viable pregnancy to term is unnecessarily risky when it’s clear the baby will not survive, argued Dr. Mae-Lan Winchester, an Ohio maternal-fetal medicine specialist.

“Pregnancy is one of the most dangerous things a person will ever go through,” Winchester said. “Putting yourself through that risk without any benefit of taking a baby home at the end, it’s … risking maternal morbidity and mortality for nothing.”

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A 45-year-old got pregnant in a state with a ban on abortions. She flew across the country to get one | CNN



CNN
 — 

When 45-year-old Victoria realized she was five weeks late and the lines showed as positive on two pregnancy tests, the New Orleans resident dreamed up a plan to get an abortion.

Traveling out of state was the only abortion option for Victoria, who asked CNN to withhold her last name out of fear of backlash against her and her family. Louisiana is one of several states that have essentially banned all abortions.

“It was probably one of the hardest things I’ve had to go through, from the moment of discovering that I was pregnant at age 45 to actually having to have to take time off work, travel across the country, do a meeting with a doctor, and then take the pills and then skedaddle back home and then go to work like nothing had happened,” Victoria told CNN of her experience earlier this year.

Victoria’s story about the distance she traveled and the hardships she endured to get an abortion reflects a wider American reality, where women seeking the procedure must navigate through a patchwork of states with varying levels of access.

The average travel time to an abortion facility more than tripled, from less than 30 minutes to more than an hour and a half, after the US Supreme Court overturned Roe v. Wade in 2022, according to a November study in the Journal of the American Medical Association. And for women in Texas and Louisiana, average travel times to the nearest abortion facility were seven hours longer – almost a full workday in travel time to get an abortion.

Victoria says she was grateful she could drop everything and afford to spend $1,000 for the procedure, including same-week airfare with connections both ways and appointment and medication fees.

“It was so hard for me wrap my head around the fact that I was able to do this, but I’m one of the lucky ones and that there are so many women who are in much tighter positions,” Victoria said. “And, God, what are they going to do?”

Victoria says plans materialized quickly once she knew which states seemed more accessible.

She researched the parameters for abortion in a state, how long she would have to take off work, travel options and how soon she could get an appointment. She found abortionfinder.org to be a helpful and reliable source, she says.

“Because the situation is so fluid, it changes from day to day, that was really of paramount importance for me to be able to have a reliable source of information,” she said.

Driving to a neighboring state was not an option, as every state adjoining Louisiana has a similarly restrictive law that bans virtually all abortions. Victoria says she considered close states, like Florida, but she ultimately dismissed them because available appointments were farther out.

“Once I saw that Oregon was so, so protective of reproductive rights, I said, ‘Why would I think about going anywhere else?’” she said. “The second I got the definitive pregnancy result, I was like, ‘OK, let’s book a flight to Oregon. When can we do this?’”

She reached out to a friend from college and asked if she could stay with her, detailing the reason for her visit. She then made an appointment and booked a flight for that week, she says.

The provider sent instructions, including that the patient must be in Oregon for the telehealth appointment, according to documents provided to CNN. They contacted her within an hour of making the appointment to make sure she had proof of travel documents because she had made it from Louisiana, where the procedure is illegal.

Victoria planned to take a day off to fly across the country and work remotely for two days, which fits her hybrid work situation. She says she was grateful to have a supportive, female boss who showed understanding for why she had to take the unexpected time off.

“She was the only person I actually kind of broke down and cried for,” Victoria said. “I think it’s because I had been holding it back all week, and telling her was sort of the last thing that I needed to get in place before I could do everything.”

Victoria says the hardest part of her experience was telling her mother because she didn’t know how her mom would feel about it. Victoria and her siblings were raised Catholic. Her father had a strong faith and her mother was a non-practicing Catholic, her mother says. Victoria’s mom asked not to be named for privacy reasons.

Victoria’s mother says she wanted to support her daughter, even if she does not agree with what her daughter did. Victoria coming to her with tickets purchased and a full plan made it easy for her mother to support her, the mother says.

“I agreed to drive her to the airport and that that was the only thing I could do because this would be a real game-changing thing in her life,” her mother said. “I wanted to support what she wanted to do because she has supported me on several family crises. I just wanted to do it because I love her. “

Victoria said she appreciated her mom for being supportive in a way she didn’t expect. They talked about some of her mother’s friends who had abortions throughout the years, both say. Victoria’s mother even told her about when she tried to get her tubes tied, but her husband found out and she did not pursue it.

“I feel like, if anything, it’s made our relationship stronger,” Victoria said. “We already had a fantastically strong relationship, though. So, it’s another rock in the wall.”

After boarding early on a Wednesday in March, Victoria traveled for eight hours on two flights and landed in Portland, Oregon.

Victoria reunited with her friend, and they did the things that old friends do, from staying up late talking about college memories to talking about why Victoria was there. They both described the situation as surreal.

“The vast majority of reproductive conversations I have with friends at this point are people who are trying desperately to get pregnant,” said her friend, Emily, who asked that CNN not use her last name to keep Victoria’s privacy. “The sort of irony is that there could still be an unplanned pregnancy and it would still be just as devastating as it would have been when we were in our teens and twenties was kind of a shock to me.”

Emily, who has been friends with Victoria for about 25 years, says it took so little effort for her to drive to the airport and let her friend stay with her.

“I felt honored that she trusted me,” she said. “I was really proud of Victoria. I was impressed that she had taken this in stride and that she had reached out to someone she knew – I think a lot of people would have been ashamed or hidden it.”

After the telehealth appointment the next day, Victoria received an overnight package.

Victoria took two medications as part of a medication abortion. She took mifepristone at her friend’s home. The next day she took misoprostol before boarding her flight home – she was careful not to take them in her home state, where it’s illegal.

Misoprostol, taken after mifepristone, is a common combination prescribed for a medication abortion.

“It was like a heavy period,” she said. “I took some Aleve, had to get some extra jumbo pads, and I bled a lot on the flights home, but it was fine.”

Physically, she felt fine – it was more of what was happening psychologically that she noticed, she says.

“I had this feeling that I should be having some kind of deep, psychological moment of reckoning or something, but I didn’t really feel that,” Victoria said of the experience. “I’ve never wanted to have a kid. I wasn’t torn about this decision.”

When Victoria learned she was pregnant, a big part of the shock came from not thinking she could get pregnant at age 45, she says.

“You hear so much culturally out there about you’re in your forties, are told you’re too old to get pregnant and carry a child to term,” she said. “I feel like I had sort of a false sense of security.”

Victoria joked that she’s “careening toward menopause,” but she says she has not been diagnosed as perimenopausal.

Her pregnancy news came several months after she was treated for a uterine fibroid, a benign growth, in July 2022, according to medical records. Victoria also tested positive for a PALB2 gene mutation, which can lead to an increased chance of breast cancer, according to a study in the New England Journal of Medicine. She underwent a preventative double mastectomy and reconstruction earlier in 2022, according to medical records provided to CNN.

She says she got an excellent standard of care around her surgeries, but it felt dissonant with her state’s laws around abortion.

“It felt so surreal to get this really high standard of care around my secondary sexual characteristics, but then to have that freeze, slam shut when it comes to reproductive health, it just felt abrupt,” she said.

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Zika Virus Infection Fast Facts | CNN



CNN
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Here’s a look at Zika virus, an illness spread through mosquito bites that can cause birth defects and other neurological defects.

Sources: Centers for Disease Control and Prevention (CDC), World Health Organization (WHO) and CNN

Zika virus is a flavivirus, part of the same family as yellow fever, West Nile, chikungunya and dengue fever.

Zika is primarily transmitted through the bite of an infected female Aedes aegypti mosquito. It becomes infected from biting an infected human and then transmits the virus to another person. The Aedes aegypti mosquito is an aggressive species, active day and night and usually bites when it is light out. The virus can be transmitted from a pregnant woman to her fetus, through sexual contact, blood transfusion or by needle.

The FDA approved the first human trial of a Zika vaccine in June 2016. As of May 2022, there is still no available vaccine or medication.

Cases including confirmed, probable or suspected cases of Zika in US states and territories updated by the CDC.

Most people infected with Zika virus won’t have symptoms. If there are symptoms, they will last for a few days to a week.

Fever, rash, joint pain and conjunctivitis (red eyes) are the most common symptoms. Some patients may also experience muscle pain or headaches.

Zika virus infection during pregnancy can cause microcephaly, a neurological disorder that results in babies being born with abnormally small heads. Microcephaly can cause severe developmental issues and sometimes death. A Zika infection may cause other birth defects, including eye problems, hearing loss and impaired growth. Miscarriage can also occur.

An August 2018 report published by the CDC estimates that nearly one in seven babies born to women infected with the Zika virus while pregnant had one or more health problems possibly caused by the virus, including microcephaly.

According to the CDC, there is no evidence that previous infection will affect future pregnancies.

(Sources: WHO, CDC and CNN)

1947 – The Zika virus is first discovered in a monkey by scientists studying yellow fever in Uganda’s Zika forest.

1948 – The virus is isolated from Aedes africanus mosquito samples in the Zika forest.

1964 – First active case of Zika virus found in humans. While researchers had found antibodies in the blood of people in both Uganda and in Tanzania as far back as 1952, this is the first known case of the active virus in humans. The infected man developed a pinkish rash over most of his body but reported the illness as “mild,” with none of the pain associated with dengue and chikungunya.

1960s-1980s – A small number of countries in West Africa and Asia find Zika in mosquitoes, and isolated, rare cases are reported in humans.

April-July 2007 – The first major outbreak in humans occurs on Yap Island, Federated States of Micronesia. Of the suspected 185 cases reported, 49 are confirmed, and 59 are considered probable. There are an additional 77 suspected cases. No deaths are reported.

2008 – Two American researchers studying in Senegal become ill with the Zika virus after returning to the United States. Subsequently, one of the researchers transmits the virus to his wife.

2013-2014 – A large outbreak of Zika occurs in French Polynesia, with about 32,000 suspected cases. There are also outbreaks in the Pacific Islands during this time. An uptick in cases of Guillain-Barré Syndrome during the same period suggests a possible link between the Zika virus and the rare neurological syndrome. However, it was not proven because the islands were also experiencing an outbreak of dengue fever at the time.

March 2015 – Brazil alerts the WHO to an illness with skin rash that is present in the northeastern region of the country. From February 2015 to April 29, 2015, nearly 7,000 cases of illness with a skin rash are reported. Later in the month, Brazil provides additional information to WHO on the illnesses.

April 29, 2015 – A state laboratory in Brazil informs the WHO that preliminary samples have tested positive for the Zika virus.

May 7, 2015 – The outbreak of the Zika virus in Brazil prompts the WHO and the Pan American Health Organization (PAHO) to issue an epidemiological alert.

October 30, 2015 – Brazil reports an increase in the cases of microcephaly, babies born with abnormally small heads: 54 cases between August and October 30.

November 11, 2015 – Brazil declares a national public health emergency as the number of newborns with microcephaly continues to rise.

November 27, 2015 – Brazil reports it is examining 739 cases of microcephaly.

November 28, 2015 – Brazil reports three deaths from Zika infection: two adults and one newborn.

January 15 and 22, 2016 – The CDC advises all pregnant women or those trying to become pregnant to postpone travel or consult their physicians prior to traveling to any of the countries where Zika is active.

February 2016 – The CDC reports Zika virus in brain tissue samples from two Brazilian babies who died within a day of birth, as well as in fetal tissue from two miscarriages providing the first proof of a potential connection between Zika and the rising number of birth defects, stillbirths and miscarriages in mothers infected with the virus.

February 1, 2016 – The WHO declares Zika a Public Health Emergency of International Concern due to the increase of neurological disorders, such as microcephaly, in areas of French Polynesia and Brazil.

February 8, 2016 – The CDC elevates its Emergency Operations Center for Zika to Level 1, the highest level of response at the CDC.

February 26, 2016 – Amid indications that the mosquito-borne Zika virus is causing microcephaly in newborns, the CDC advises pregnant women to “consider not going” to the Olympics in Rio de Janeiro. The CDC later strengthens the advisory, telling pregnant women, “Do not go to the Olympics.”

March 4, 2016 – The US Olympic Committee announces the formation of an infectious disease advisory group to help the USOC establish “best practices regarding the mitigation, assessment and management of infectious disease, paying particular attention to how issues may affect athletes and staff participating in the upcoming Olympic and Paralympic Games.”

April 13, 2016 – During a press briefing, CDC Director Thomas Frieden said, “It is now clear the CDC has concluded that Zika does cause microcephaly. This confirmation is based on a thorough review of the best scientific evidence conducted by CDC and other experts in maternal and fetal health and mosquito-borne diseases.”

May 27, 2016 – More than 100 prominent doctors and scientists sign an open letter to WHO Director General Margaret Chan, calling for the summer Olympic Games in Rio de Janeiro to be postponed or moved “in the name of public health” due to the widening Zika outbreak in Brazil.

July 8, 2016 – Health officials in Utah report the first Zika-related death in the continental United States.

August 1, 2016 – Pregnant women and their partners are advised by the CDC not to visit the Miami neighborhood of Wynwood as four cases of the disease have been reported in the small community and local mosquitoes are believed to be spreading the infection.

September 19, 2016 – The CDC announces that it has successfully reduced the population of Zika-carrying mosquitoes in Wynwood and lifts its advisory against travel to the community.

November 18, 2016 – The WHO declares that the Zika virus outbreak is no longer a public health emergency, shifting the focus to long-term plans to research the disease and birth defects linked to the virus.

November 28, 2016 – Health officials announce Texas has become the second state in the continental United States to confirm a locally transmitted case of Zika virus.

September 29, 2017 – The CDC deactivates its emergency response for Zika virus, which was activated in January 2016.

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It’s a myth that women don’t want sex as they age, study finds | CNN



CNN
 — 

It’s a myth that women lose interest in sex as they enter midlife and beyond, according to research that followed more than 3,200 women for about 15 years.

“About a quarter of women rate sex as very important, regardless of their age,” said Dr. Holly Thomas, lead author of an abstract presented during the September 2020 virtual annual meeting of the North American Menopause Society.

“The study showed substantial numbers of women still highly value sex, even as they get older, and it’s not abnormal,” said Thomas, an assistant professor of medicine at the University of Pittsburgh.

“If women are able to speak up with their partner and make sure that they’re having sex that’s fulfilling and pleasurable to them, then they’re more likely to rate it as highly important as they get older,” she said.

“That’s actually quite refreshing, that there were a quarter of women for whom sex remains not just on the radar but highly important,” said Dr. Stephanie Faubion, medical director for the North American Menopause Society, who was not involved in the study.

“Studies like these provide valuable insights to health care providers who may otherwise dismiss a woman’s waning sexual desire as a natural part of aging.”

It’s true that past studies have found that women tend to lose interest in sex as they age. But women’s health practitioners say that attitude doesn’t jibe with the reality they see.

“Some of the prior studies had suggested that sex goes downhill and all women lose interest in sex as they get older,” Thomas said. “That really isn’t the type of story that I hear from all my patients.”

One issue, she said, is that past studies took a single snapshot of a woman’s desire at one point in her life and compared it with similar snapshots in later decades of life.

“That type of longitudinal study would just show averages over time,” Thomas said. “And if you look at things on average, it may look like everyone follows one path.”

The study presented in 2020 used a different type of analysis that allowed researchers to follow the trajectory of a woman’s desire over time, Thomas said then.

“We wanted to use this different type of technique to see if there really were these different patterns,” she said. “And when you look for these trajectories, you see there are significant groups of women who follow another path.”

The research, which analyzed data from a national multisite study called SWAN, or the Study of Women’s Health Across the Nation, found three distinct pathways in a woman’s feelings about the importance of sex.

About a fourth of the women (28%) followed traditional thinking on the subject: They valued sex less during midlife years.

However, another fourth of the women in the study said the exact opposite. Some 27% of them said sex remains highly important throughout their 40s, 50s and 60s — a surprising contradiction of the belief that all women lose interest in sex as they age.

“Sex is going to look different,” said Faubion, who is director of the Mayo Clinic’s Center for Women’s Health.

“It’s not going to look the same at 40 as it does at 20; it’s not going to look the same at 60 as it does at 40, and it’s not going to look the same at 80 as it did at 60,” she said. “There may be some modifications that we have to do, but people in general who are healthy and in good relationships remain sexual.”

Women in the study who highly valued sex shared the following characteristics: They were more highly educated, they were less depressed, and they had experienced better sexual satisfaction before entering midlife.

“Women who were having more satisfying sex when they were in their 40s were more likely to continue to highly value sex as they got older,” Thomas said.

There could also be socioeconomic factors at play, she added. For example, more highly educated women may have higher incomes and feel more stable in their lives with less stress.

“Therefore they have more headspace to make sex a priority because they’re not worrying about other things,” Thomas said.

The study found another factor important to both lower-interest and high-interest pathways — race and ethnicity.

African American women were more likely to say sex was important to them for the duration of midlife, while Chinese and Japanese women were more likely to rate sex as having low importance throughout their midlife years.

“I do want to emphasize that it’s much more likely to be due to sociocultural factors than any biological factor,” Thomas said. “Women from different cultural groups have different attitudes … different comfort levels about getting older … and whether it’s ‘normal’ for a woman to continue to value sex as she gets older.”

The majority of women (48%) fell into a third pathway: They valued a healthy sex life as they entered the menopausal years but gradually lost interest throughout their 50s or 60s.

There are a number of emotional, physical and psychological factors that might affect how a woman views sex, experts say. Most can be divided into four categories:

Medical conditions: As women enter perimenopause in their 40s and 50s, they begin to experience hormonal changes that can cause sex to become less satisfying or even painful.

The drop in estrogen causes the vulva and vaginal tissues to become thinner, drier and more easily broken, bruised or irritated. Arousal can become more difficult. Hot flashes and other signs of menopause can affect mood and sleep quality, leading to fatigue, anxiety, irritability, brain fog and depression.

Many medical conditions can arise or worsen during midlife that can also affect libido.

“Do they have medical conditions like hip arthritis that cause pain with sex? Or hand arthritis that can make it more difficult? Or things like diabetes where their sensation is not the same, or do they have heart disease?” Faubion asked.

“But there are modifications that we talk about all the time to help people remain sexual, even for quadriplegics,” she said. “There are ways to stay sexual despite disability.”

Mental and emotional considerations: The psychological component of sex can have a huge influence on a woman’s levels of sexual desire. A history of sexual or physical abuse, struggles with substance abuse and depression, anxiety and stress are major players in this category.

“I can’t tell you enough about the impact of anxiety and stress on sex,” Faubion said. “Think of that fight or flight mechanism — your adrenaline’s pumping so you’re back in caveman days and a lion is chasing you.

“Are you going to lie down on the grassy knoll and have sex when the lion is chasing you? The answer is no. And that’s how women with anxiety are all the time, so anxiety is a huge, huge factor for whether women will be sexual.”

While the study did not look specifically at anxiety, results showed women with more symptoms of depression were much less likely to rate sex as a priority in life. In addition to the emotional impact, a reduced libido is a side effect of many antidepressants prescribed to treat depression.

Partner component: Women in midlife can also face dramatic and disturbing changes in their romantic lives that can take a major toll on their interest in sex.

“Are they losing a romantic partner to divorce or to death? Is a romantic partner developing health issues that make sex more difficult or inconvenient? Are they getting busy in other aspects of their life — their career, caring for grandchildren or even grown children who are moving back in? That makes it hard to prioritize sex,” Thomas said.

Even if they have a partner, relationships may have had ups and downs that can affect how a woman feels about intimacy with a significant other.

“Do you like your partner?” Faubion asked. “Is your communication good? Even logistics can get in the way — are you in the same place at the same time?”

Social mores: Society also affects how a woman feels about sex. Religious, cultural and family values about the topic can play a large role in sexual ease and satisfaction.

“Then there’s what society teaches us about aging women,” Faubion said. “And so for some women being sexual is somehow bad. Women aren’t supposed to like sex.”

“I’ve seen plenty of women in my clinic in the 60-to-65 age group who never got any sex education, their partners never got any sex education, and they don’t really want to know about all that stuff.”

Of course, if a woman isn’t bothered by a lack of sex, then there’s no reason to see a doctor, Faubion and Thomas said. But they both said that past studies have shown that about 10% to 15% of women who do have a lower interest in sex are bothered by it and would like to seek a solution.

There are ways in which physicians can help, including medications and therapies, but first a woman must reach out and talk to her doctor.

“Prior research has shown that women often really do hesitate to reach out to their doctors, perhaps because they’re embarrassed or they see it as part of normal aging and and don’t think it’s worth bringing up,” Thomas said.

Faubion added, “Bottom line: Women should talk to their providers if they’re having concerns about their sexual health. It’s an important part of life, and there are solutions for women who are struggling with that.”

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How a medication abortion, also known as an ‘abortion pill,’ works | CNN



CNN
 — 

While legal battles over access to mifepristone, one of two drugs used for medication abortions, play out in court, the drug continues to be available in states which consider abortion legal.

“While many women obtain medication abortion from a clinic or their OB-GYN, others obtain the pills on their own to self-induce or self-manage their abortion,” said Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

“A growing body of research indicates that self-managed abortion is safe and effective,” he said.

Mifepristone blocks the hormone progesterone, which is needed for a pregnancy to continue. The drug is approved to end a pregnancy through 10 weeks’ gestation, which is “70 days or less since the first day of the last menstrual period,” according to the FDA.

In a medication abortion, a second drug, misoprostol, is taken within the next 24 to 48 hours. Misoprostol causes the uterus to contract, creating cramping and bleeding. Approved for use in other conditions, such as preventing stomach ulcers, the drug has been available at pharmacies for decades.

Together, the two drugs are commonly known as the “abortion pill,” which is now used in more than half of the abortions in the United States, according to the Guttmacher Institute, a research group that supports abortion rights.

“Some people do this because they cannot access a clinic — particularly in states with legal restrictions on abortion — or because they have a preference for self-care,” said Grossman, who is also the director of Advancing New Standards in Reproductive Health, a research group that evaluates the pros and cons of reproductive health policies and publishes studies on how abortion affects a woman’s health.

What happens during a medication abortion? To find out, CNN spoke with Grossman. The conversation has been edited for clarity.

CNN: What is the difference between a first-trimester medication abortion and a vacuum aspiration in terms of what a woman experiences?

Dr. Daniel Grossman: A vacuum aspiration is most commonly performed under a combination of local anesthetic and oral pain medications or local anesthetic together with intravenous sedation, or what is called conscious sedation.

An injection of local anesthetic is given to the area around the cervix, and the cervix is gently dilated or opened up. Once the cervix is opened, a small straw-like tube is inserted into the uterus, and a gentle vacuum is used to remove the pregnancy tissue. Contrary to what some say, if the procedure is done before nine weeks or so, there’s nothing in the tissue that would be recognizable as a part of an embryo.

The aspiration procedure takes just a couple of minutes; then the person is observed for one to two hours until any sedation has worn off. We also monitor each patient for very rare complications, such as heavy bleeding.

Grossman: A medication abortion is a more prolonged process. After taking the pills, bleeding and cramping can occur over a period of days. Bleeding is typically heaviest when the actual pregnancy is expelled, but that bleeding usually eases within a few hours. On average people continue to have some mild bleeding for about two weeks or so, which is a bit longer than after a vacuum aspiration.

Nausea, vomiting, fever, chills, diarrhea and headache can occur after using the abortion pill, and everyone who has a successful medication abortion usually reports some pain.

In fact, the pain of medication abortion can be quite intense. In the studies that have looked at it, the average maximum level of pain that people report is about a seven to eight out of 10, with 10 being the highest. However, people also say that the pain can be brief, peaking just as the pregnancy is being expelled.

The level of cramping and pain can depend on the length of the pregnancy as well as whether or not someone has given birth before. For example, a medical abortion at six weeks or less gestation typically has less pain and cramping than one performed at nine weeks. People who have given birth generally have less pain.

CNN: What can be done to help with the pain of a medication abortion?

Grossman: There are definitely things that can be used to help with the pain. Research has shown that ibuprofen is better than acetaminophen for treating the pain of medication abortion. We typically advise people to take 600 milligrams every six hours or so as needed.

Some people take tramadol, a narcotic analgesic, or Vicodin, which is a combination of acetaminophen and hydrocodone. Recent research I was involved in found medications like tramadol can be helpful if taken prophylactically before the pain starts.

Another successful regimen that we studied combined ibuprofen with a nausea medicine called metoclopramide that also helped with pain. Other than ibuprofen, these medications require a prescription.

Another study found that a TENS device, which stands for transcutaneous electrical nerve stimulator, helps with the pain of medication abortion. It works through pads put on the abdomen that stimulate the nerves through mild electrical shocks, thus interfering with the pain signals. That’s something people could get without a prescription.

Pain can be an overlooked issue with medication abortion because, quite honestly, as clinicians, we’re not there with patients when they are in their homes going through this. But as we’ve been doing more research on people’s experiences with medication abortion, it’s become quite clear that pain control is really important. I think we need to do a better job of treating the pain and making these options available to patients.

CNN: Are there health conditions that make the use of a medication abortion unwise?

Grossman: Undergoing a medication abortion can be dangerous if the pregnancy is ectopic, meaning the embryo is developing outside of the uterus. It’s rare, happening in about two out of every 100 pregnancies — and it appears to be even rarer among people seeking medication abortion.

People who have undergone previous pelvic, fallopian tube or abdominal surgery are at higher risk of an ectopic pregnancy, as are those with a history of pelvic inflammatory disease. Certain sexually transmitted infections can raise risk, as does smoking, a history of infertility and use of infertility treatments such as in vitro fertilization (IVF).

If a person is on anticoagulant or blood thinning drugs or has a bleeding disorder, a medication abortion is not advised. The long-term use of steroids is another contraindication for using the abortion pill.

Anyone using an intrauterine device, or IUD, must have it removed before taking mifepristone because it may be partially expelled during the process, which can be painful.

People with chronic adrenal failure or who have inherited a rare disorder called porphyria are not good candidates.

CNN: Are there any signs of trouble a woman should watch for after undergoing a medication abortion?

Grossman: It can be common to have a low-grade fever in the first few hours after taking misoprostol, the second drug in a medication abortion. If someone has a low-grade fever — 100.4 degrees to 101 degrees Fahrenheit — that lasts more than four hours, or has a high fever of over 101 degrees Fahrenheit after taking the medications, they do need to be evaluated by a health care provider.

Heavy bleeding, which would be soaking two or more thick full-size pads an hour for two consecutive hours, or a foul-smelling vaginal discharge should be evaluated as well.

One of the warning signs of an ectopic pregnancy is severe pelvic pain, particularly on one side of the abdomen. The pain can also radiate to the back. Another sign is getting dizzy or fainting, which could indicate internal bleeding. These are all very rare complications, but it’s wise to be on the lookout.

We usually recommend that someone having a medication abortion have someone with them during the first 24 hours after taking misoprostol or until the pregnancy has passed. Many people specifically choose to have a medication abortion because they can be surrounded by a partner, family or friends.

Most people know that the abortion is complete because they stop feeling pregnant, and symptoms such as nausea and breast tenderness disappear, usually within a week of passing the pregnancy. A home urine pregnancy test may remain positive even four to five weeks after a successful medication abortion, just because it takes that long for the pregnancy hormone to disappear from the bloodstream.

If someone still feels pregnant, isn’t sure if the pregnancy fully passed or has a positive pregnancy test five weeks after taking mifepristone, they need to be evaluated by a clinician.

People should know that they can ovulate as soon as two weeks after a medication abortion. Most birth control options can be started immediately after a medication abortion.

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FDA advisers vote unanimously in support of over-the-counter birth-control pill | CNN



CNN
 — 

Advisers for the US Food and Drug Administration voted unanimously on Wednesday in support of making the birth-control pill Opill available over-the-counter, saying the benefits outweigh the risks.

Two FDA advisory panels agreed that people would use Opill safely and effectively and said groups such as adolescents and those with limited literacy would be able to take the pill at the same time every day without help from a health care worker.

The advisers were asked to vote on whether people were likely to use the tablet properly so that the benefits would exceed the risks. Seventeen voted yes. Zero voted no or abstained.

Opill manufacturer Perrigo hailed the vote as a “groundbreaking” move for women’s health.

“Perrigo is proud to lead the way in making contraception more accessible to women in the U.S.,” Murray Kessler, Perrigo’s president and CEO, said in a statement. “We are motivated by the millions of people who need easy access to safe and effective contraception.”

The FDA doesn’t have to follow its advisers’ advice, but it often does. It is expected to decide whether to approve the over-the-counter pill this summer.

If it’s approved, this will be the first birth-control pill available over the counter in the United States. Opill is a “mini-pill” that uses only the hormone progestin.

At Wednesday’s meeting, Dr. Margery Gass of the University of Cincinnati College of Medicine thanked the FDA for its consideration of switching Opill to an over-the-counter product.

“I think this represents a landmark in our history of women’s health. Unwanted pregnancies can really derail a woman’s life, and especially an adolescent’s life,” she said.

The FDA has faced pressure to allow Opill to go over-the-counter from lawmakers as well as health care providers.

Unwanted pregnancies are a public health issue in the US, where almost half of all pregnancies are unintended, and rates are especially high among lower-income women, Black women and those who haven’t completed high school.

In March 2022, 59 members of Congress wrote a letter to FDA Commissioner Dr. Robert Califf about OTC contraception.

“This is a critical issue for reproductive health, rights, and justice. Despite decades of proven safety and effectiveness, people still face immense barriers to getting birth control due to systemic inequities in our healthcare system,” the lawmakers wrote.

A recent study showed that it’s become harder for women to access reproductive health care services more broadly – such as routine screenings and birth control – in recent years.

About 45% of women experienced at least one barrier to reproductive health care services in 2021, up 10% from 2017. Nearly 19% reported at least three barriers in 2021, up from 16% in 2017.

Increasing reproductive access for women and adolescents was a resounding theme among the FDA advisers.

“We can take this opportunity to increase access, reduce disparities and, most importantly, increase the reproductive autonomy of the women of our nation,” said Dr. Jolie Haun of the James A. Haley Veterans’ Hospital and the University of Utah.

Dr. Karen Murray, deputy director of the FDA’s Office of Nonprescription Drugs, said the agency understands the importance of “increased access to effective contraception” but hinted that the FDA would need more data from the manufacturer.

Some of the advisers and FDA scientists expressed concern that some of Perrigo’s data was unreliable due to overreporting of “improbable dosing.”

Murray said the lack of sufficient information from the study poses challenges for approval.

“It would have been a much easier time for the agency if the applicant had submitted a development program and an actual use study that was very easy to interpret and did not have so many challenges. But that was not what happened for us. And so the FDA has been put in a very difficult position of trying to determine whether it is likely that women will use this product safely and effectively in the nonprescription setting,” she said. “But I wanted to again emphasize that FDA does realize how very important women’s health is and how important it is to try to increase access to effective contraception for US women.”

Ultimately, the advisers said, they don’t want further studies of Opill to delay the availability of the product in an over-the-counter setting.

“I just wanted to say that the improbable dosing issue is important, and I don’t think it’s been adequately addressed and certainly leads to some uncertainty in the findings. But despite this, I would not recommend another actual use study this time, and I think we can make a decision on the totality of the evidence,” said Kate Curtis of the US Centers for Disease Control and Prevention.

Curtis said she voted yes because “Opill has the potential to have a huge positive public health impact.”

Earlier in the discussion, Dr. Leslie Walker-Harding of the University of Washington and Seattle Children’s Hospital said the pill is just as safe as many other medications available on store shelves.

“The safety profile is so good that we would need to take every other medicine off the market like Benadryl, ibuprofen, Tylenol, which causes deaths and people can get any amount of that without any oversight. And this is extremely safe, much safer than all three of those medications, and incorrect use still doesn’t appear to have problematic issues,” she said.

Dr. Katalin Roth of the George Washington University School of Medicine and Health Sciences also emphasized the safety of the pill over the 50 years it has been approved as a prescription drug in the US.

“The risks to women of an unintended pregnancy are much greater than any of the things we were discussing as risks of putting this pill out out over-the-counter,” she said. “The history of women’s contraception is a struggle for women’s control over their reproduction, and we need to trust women.”

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Chinese postpartum confinement, called ‘zuo yue zi,’ is gaining Western appeal | CNN


Hong Kong
CNN
 — 

You cannot carry heavy things. You should sleep more. No working. No household chores.

And the list goes on as Carol Chan explained her postpartum instructions for new mom Taylor Richard.

Chan is a “pui yuet,” also called a confinement nanny, who lives with families after a baby is born. She prepares meals and herbal medicines, takes care of the baby and provides guidance on being a new mother.

Richard, a content creator from Canada, traveled to Hong Kong to become a model and fell in love with her husband, Tom, there. They married in November 2018, and Richard gave birth to their son, Levi, in March 2022.

Richard decided to hire Chan, who lived with the family for a month and spent an additional month helping out.

Richard vlogged about her experience with Chan on her YouTube channel, and that video went viral with 2.9 million views. The reaction was mostly admiration and praise from Richard’s primarily Western followers.

The concept of Chinese confinement — “zuo yue zi,” or “sitting the month”— is when a new mother stays at home for one month to allow her body to rest after giving birth.

During that time, the pui yuet makes dishes catering to the mother’s physical needs and helps her with milk production and other concerns. The pui yuet also cares for the mother with massage, body wraps and lessons on how to take care of the new baby.

Richard and Chan declined to share the cost of Chan’s services. Few entities track the pricing of nannies in Hong Kong on a consistent basis because most negotiations are directly between clients and the nannies.

The estimated cost for a pui yuet in Hong Kong ranges from 63,800 Hong Kong dollars (US $8,100) to 268,000 Hong Kong dollars (US $34,100) for 26 to 30 nights for a live-in nanny, according to a 2021 survey by the Consumer Council, a statutory body in Hong Kong dedicated to protecting consumer rights. The council, which surveyed 19 companies or organizations that provide postnatal care, also reported that the cost of a pui yuet working eight hours a day for 26 days ranges from 21,000 Hong Kong dollars (US $2,600) to 34,000 Hong Kong dollars (US $4,300).

This tradition isn’t without criticism, and some have questioned whether the traditional methods of confinement in the Chinese community are too extreme and may be dangerous. In 2015, a new mother in Shanghai following the custom died of heatstroke after wrapping herself in a quilt and turning off the air conditioner, state media reported.

Chan has gotten calls from the US and UK to be a pui yuet after a YouTube video about her went viral.

In recent years, some people have adapted the tradition to more modern ways, taking advantage of available technology. It’s important to turn the air conditioner on when the weather is hot, Chan said, or else you could get sick. The traditional practice had been to avoid anything cold regardless of the weather.

Richard, now 34, said she loved the time she spent with Chan.

“It meant everything! My husband and I both don’t have any family members in Hong Kong, and as new parents we were pretty clueless,” she said via email. “Having someone take care of my body and gently guide me through my transition into motherhood made for a very positive beginning of my baby’s life. I’m forever grateful for Carol!”

Richard was the first Western mother whom Chan cared for in her 12-year career. But since Richard’s YouTube video went viral, Chan said she’s gotten calls from Westerners asking for her services from as far away as the United States and United Kingdom. She’s now headed to Vancouver, British Columbia, in July to work as a pui yuet for a family there for a month.

The kind of care Richard received is expensive, whether the new parents live in Hong Kong or elsewhere. One US location, Boram Postnatal Retreat, opened last year in New York City.

“It was very challenging to get the concept received by others,” cofounder Boram Nam told CNN. “It was a lot about the education process — information is abundant up to until you give birth, and the spotlight completely shifts over to the baby — so we get into that discussion, and people get it.”

Cofounder Boram Nam opened Boram Postnatal Retreat last year in New York for new mothers.

But her program comes with a hefty price tag, starting at three nights for $2700.

“This is the price we do need to charge for the level of service that we provide within the guidelines of what postpartum care looks like in the US,” said Nam, adding that she hopes eventually to get services covered by insurance. “We want to make sure this can be accessible by others, by more women, a more diverse group of people.”

Mandy Major, owner of Major Care, a virtual postpartum doula service based in the US, has noticed a lack of postpartum education in her country.

“We have a lack of systematic postpartum here within our health care system,” Major said. “We have a go-go, hyper-productive, hyper-independent culture, but we also don’t have paid leave.”

Richard’s mostly Western followers on YouTube noted that pressure, commenting on the luxury of taking a month off to spend time recovering and connecting with their babies.

“As an American woman who has given birth 4 times and been booted immediately out of the hospital expected to figure it all out on my own, I can undoubtedly say had this been an option, it may have changed my whole mothering experiences!!” one person said.

“I returned to work 2 weeks postpartum in America,” another mother wrote. “I never felt that I was able to fully bond with my child.”

The month of confinement came to an end for Richard last April. In Richard’s YouTube video, Chan holds Levi one last time and passes him back to his mother as she put her shoes on to leave.

Richard’s eyes begin to fill with tears, surprising herself at her emotional reaction.

“I feel like I’m losing a family member,” she says as the door slowly closes behind Chan, according to the video.

Even after the confinement experience, Chan remains close with Richard’s family, stopping by for lunch occasionally and still giving baby advice.

“If I have another baby, I would love to have it in Canada with my family, but I want Carol to come with me if I do!” Richard said in a video chat later, smiling. “I can’t imagine going through this again without her.”

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New approach gets newborns with opioid withdrawal out of the hospital sooner and with less medication | CNN



CNN
 — 

Rates of neonatal abstinence syndrome surged in recent years, but a newer approach to caring for newborn babies exposed to opioids during pregnancy gets them out of the hospital sooner and with less medication, according to a study published on Sunday in the New England Journal of Medicine.

Newborns in opioid withdrawal may experience upset stomach, inconsolable crying, seizures and extreme discomfort. The study looked at the impacts of the Eat, Sleep, Console care approach on 1,300 infants at 26 US hospitals, and compared them with the current standard for caring for infants exposed to opioids.

Eat, Sleep, Console encourages involvement from parents, and prioritizes care that doesn’t involve medication, such as swaddling, skin-to-skin contact and breastfeeding. The usual approach involves a nurse measuring a baby’s withdrawal symptoms – such as their level of irritability, pitch of crying, fever or tremors – before providing treatment such as methadone or morphine.

“Compared to usual care, use of the Eat, Sleep, Console care approach substantially decreased time until infants with neonatal opioid withdrawal syndrome were medically ready for discharge, without increasing specified adverse outcomes,” the researchers wrote in the study.

The infants assessed with the Eat, Sleep, Console care method were discharged after eight days on average, compared with almost 15 days for the infants who were cared for by the standard approach, the researchers said. Additionally, infants in the Eat, Sleep, Console care group were 63% less likely to receive opioid medication – 19.5% received medication compared with 52% in the group receiving usual care.

The current approach to usual care “is a very comprehensive and nurse-led way of assessing the infant, whereas the Eat, Sleep, Console approach involves the mom in the way that you assess the infant, and allows the mom to take part in trying to soothe the infants and see if the infant is able to be soothed or is able to eat or is able to sleep,” according to Rebecca Baker, the director of the NIH HEAL Initiative, which provides grants to researchers studying ways to alleviate the country’s opioid health crisis.

“So, in that way, it’s a little bit more functional, like looking at the abilities of the infants versus how severely the infant is affected.”

Assessment results determine whether a baby should receive medication to control withdrawal symptoms, Baker said.

“So even with Eat, Sleep, Console, some infants that were exposed to a lot of opioids during a mother’s pregnancy, they’ll still need medication-based treatment for withdrawal. It’s just fewer of them need it and when they need it, they need less medication to manage the withdrawal symptoms,” she said.

The Eat, Sleep, Console method was developed about eight years ago, and some hospitals have already implemented it. But Baker said the study’s findings could change how more hospitals practice caring for infants with neonatal abstinence syndrome, which primarily occurs in infants who were exposed to opioids while in utero.

“The rise of really powerful fentanyl, the synthetic opioid, means that if a mother has used drugs during pregnancy, the baby will be exposed to more powerful drugs, which likely has an effect. We haven’t had a chance to study it in detail yet, but it will affect how they feel when they’re born and separated from the mom,” Baker said.

Findings from the study, which were presented at the PAS 2023 Meeting on Sunday, could have a big impact on hospitals by freeing up bed space in the neonatal intensive care unit and boosting morale among nurses at risk of burnout.

“We trained over 5,000 nurses as part of the study. They felt really empowered to help the mom care for the infant to help the infant recover, and so I think from a morale perspective, that’s incredibly important and valuable,” Baker said. “And as you know, nurses are facing really severe staffing shortages and morale challenges so having this tool available to them where they are kind of able to do something positive in the life of the infant and the connection with the mom is really important.”

The researchers are currently following up with a subgroup of the infants from the study for up to two years to see how they grow and develop.

“One of the things that we want to be really sure of is that there are no negative consequences associated with taking less medication, so we’ll be looking for that,” Baker said.

The United States has seen an explosion in the number of infants born with neonatal abstinence syndrome in recent years, swelling by about 82% between 2010 and 2017, according to the US Centers for Disease Control and Prevention. The number of maternal opioid-related diagnoses is also on the rise, increasing by 131% during that same time frame.

Nearly 60 infants are diagnosed with NAS each day, based on data from the U.S. Agency for Healthcare Research and Quality in 2020.

The United States’ opioid epidemic has been expanding in recent years and opioid deaths are the leading cause of accidental death in the US.

More than a million people have died of drug overdoses – mostly opioids – in the two decades since the US Centers for Disease Control and Prevention began collecting that data. Deaths from opioid overdoses rose more than 17% in just one year, from about 69,000 in 2020 to about 81,020 in 2021, the CDC found.

Most are among adults, but children are also dying, largely after ingesting synthetic opioids such as fentanyl. Between 1999 and 2016, nearly 9,000 children and adolescents died of opioid poisoning, with the highest annual rates among adolescents 15 to 19, the CDC found.

Opioid use during pregnancy has been linked to maternal mortality and risk of overdose for the mother, according to the CDC, while infants risk preterm birth, low birthweight, breathing problems and feeding problems.

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How to support your loved one during the infertility journey | CNN

Editor’s Note: Chloe Melas is a reporter for CNN, covering all things entertainment for the network across platforms. After nearly two years of fertility treatments, she and husband Brian Mazza now have two sons. Melas was a recipient of Resolve’s 2020 Hope Award for Advocacy.



CNN
 — 

“Bobby and Sara are having twins!”

I remember my husband coming into the bathroom where I was taking a bath to tell me about his childhood best friend’s happy news.

We had been trying to get pregnant for several months at that point, and we were going through rounds of intrauterine insemination, better known as IUI.

I wanted to genuinely give a nice response, but I just sank down further in the tub, my eyes welled up with tears. I felt nauseous and angry. I let out a mumble: “Great.” But what I wanted to do was scream, “Why them and not us?!”

I carried around such bitterness and resentment throughout our yearslong struggle to start a family.

As it turns out, we were in the same boat as millions of people all over the world.

Infertility affects about 1 in 6 people, according to a recent report from the World Health Organization previously covered by CNN. Rates of infertility — meaning the inability to conceive after 12 months of having sex without protection — are similar across all countries and regions, according to the WHO report.

During our fertility treatments to get pregnant with our first child, Leo, I kept our fertility treatments a secret from my family and friends. I didn’t want to have to deal with answering any questions or let anyone down if the procedures didn’t result in a baby.

But it was difficult to mask my overwhelming despair. At one point during my first round of in vitro fertilization, or IVF, I finally saw a psychologist. I’m not sure if it had to do with the copious amounts of fertility drugs, the daily injections or the months of failed treatments — but it was a perfect emotional storm. I needed validation that what I was feeling was, in fact, normal.

As it turns out, lots of people feel this way. Receiving a psychiatric diagnosis, most commonly anxiety or depression, is something up to 40% of women affected by infertility face, according to the American Psychiatric Association.

“During the journey, there are often long wait times with appointments or providers. Waiting to get test results, waiting to hear something was effective, waiting for next steps. All that waiting can really put us in a non-ideal mental health space,” psychologist Dr. Heather Tahler told CNN. She is the mental health services lead at women and family telemedicine startup Maven Clinic in New York City.

“I think another big stressor people feel is the societal pressure for family building to look a certain way. We don’t talk enough about all the different paths that people go through to build their family.”

This kind of distress can be severe. Dr. Elizabeth A. Grill, associate professor of psychology at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at Weill Medical College of Cornell University, equates the stress of an infertility diagnosis to that of a terminal illness.

“The research shows that the distress levels of those going through infertility are equal to patients diagnosed with heart disease, cancer and HIV,” Grill said.

Part of my sadness was how isolating it all felt. When my husband and I initially began tracking my ovulation and good old-fashioned sex wasn’t working, I would talk to my girlfriends and certain family members, who would brush my worries aside and tell me the key to getting pregnant was to lower my stress levels. “Just have a glass of wine before sex,” one friend said. “Take a trip,” a relative suggested. They were trying to be helpful, but it was hurtful.

To find out what could be helpful for others, I talked to several people for their advice on what to do and not do when supporting a loved one going through infertility.

Talk less and listen more, advised Grace Bastidas, the editor-in-chief of Parents. She regularly covers the topic of infertility and recently published a piece about how to help people going through infertility.

“If a friend or a relative tells you they’re having a tough time conceiving, try not to minimize it by saying, ‘Just try to relax.’ That’s really not helpful,” Bastidas said.

“It really doesn’t validate how they are feeling in the moment,” she said. “If you don’t know what to say, sometimes just listening and being that ear or that shoulder and letting them know they can count on you is what you can do.”

It sounds awful but for more than a year, I found it very difficult to be happy for anyone becoming pregnant. I’d get invites to baby showers and dread having to go. I’d see pregnant women in the checkout aisle at the grocery store and feel pangs of sadness.

It felt like every woman on the planet was pregnant, except me.

Elizabeth Angell, editor-in-chief of Romper, a website for millennial moms, advises people not to hide your happy news but have grace and understanding for the ones around you who are struggling.

“Events like baby showers and christenings can be minefields for anyone going through infertility. I would take your cues from them,” said Angell, who has a section at Romper dedicated to trying to conceive.

“You should invite your good friends to any such celebration, but don’t be offended if they choose not to come. It doesn’t mean they aren’t happy for you. Give them the space to grieve and reassure them that you’re there for them when they’re ready to talk about it.”

Stepping up for your loved one, whether that means taking them to doctor’s appointments or sending a small gift can go a long way, Grill told me.

“If the person you are trying to support is open to ideas, try to think of what you would do for a friend diagnosed with any other illness,” Grill said. “Call or text to ask how they are doing, bring them dinner, offer to take them to appointments.

“Let them know you love them and are there for them. Learn to listen, support and show trust more than offering advice. Most importantly, validate their experience and learn to sit with them in the discomfort of their pain.”

Angell agreed. “Infertility treatments are often physically taxing. If that’s something your friend is going through, send food or a nice bathrobe or pajamas — something they can use when they’re resting and recuperating.”

Although well intended, “seemingly innocuous questions of curiosity … can trigger feelings of devastation and anxiety for those trying to conceive,” Grill told CNN.

Nora DeBora, who hosts The Ultimate Pregnancy Prep Podcast, has been open about how her desire to start a family hasn’t happened yet.

“As a single woman in my late 30s who deeply desires a family, it can be off-putting and uncomfortable when people ask ‘when are you going to have a baby?’ There is a lot of pressure that women put on themselves already while feeling like their biological clock is ticking with each passing year.”

Some days you might be handing your loved one a tissue, and others they may seem closed off.

“Being present for someone on their journey means meeting them where they are at,” Tahler said. “Some days it could be talking, some days it could be a hug. There are a variety of emotional responses day-to-day. It is best to remind yourself of this, so you don’t take it personally.”

It has been liberating but sometimes incredibly vulnerable ever since my husband and I first began sharing our story in 2018.

CNN's Melas with her husband, Mazza, and their two sons.

Recently, I went on the Pregnantish podcast with host Andrea Syrtash, who told me that the stigma around infertility is still very prevalent. That’s why she is compelled to feature stories of people who go the distance to create their families and how their relationships are impacted.

“‘First comes love, then comes marriage, then comes a baby carriage’ is an outdated narrative for millions of people,” she told me.

“Modern family building and infertility impact every relationship we have. With our partners, friends, family, workplace and most importantly, the relationship we have with our bodies and ourselves.”

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Amid contradictory laws, hospitals in one state were unable to explain policies on emergency abortion care, study finds | CNN



CNN
 — 

Oklahoma’s laws restricting abortions have created a confusing, contradictory environment that may have a chilling effect on health care, new research says.

After the US Supreme Court overturned the right to an abortion last year with the Dobbs v. Jackson Women’s Health Organization decision, several states quickly passed laws that restricted such procedures. A report released Tuesday and described in the medical journal the Lancet finds that the laws in at least one state left workers at many hospitals confused about how to proceed.

When the court made its decision, the Oklahoma law that criminalized abortion in 1910 went back into effect, according to the state’s attorney general. Lawmakers then created multiple overlapping laws that further criminalized abortion and increased penalties for those who performed or assisted in an abortion procedure, according to the new report from Physicians for Human Rights, Oklahoma Call for Reproductive Justice and the Center for Reproductive Rights.

The Oklahoma laws allow abortion in the case of a medical emergency, but one doesn’t define a medical emergency. Another says it allows for the “preservation of life in a medical emergency,” defined as causing “substantial and irreversible body of bodily impairment” – which is not a medical term, experts say.

To understand exactly how well Oklahoma hospitals understood the laws, the researchers used a “secret shopper method,” study co-author Dr. Michele Heisler said.

Researchers posed as prospective patients and called 34 hospitals to ask about the emergency pregnancy care they offered.

Heisler said that when the researchers designed the study, she expected the hospitals to tell the patients that they could get help in an emergency but that a second provider might have to sign off on an abortion or that a doctor would have to get the decision past an “onerous” hospital oversight committee.

“What we weren’t expecting is that there would be so much confusion and contradictory information and really not clear information,” said Heisler, who is medical director at Physicians for Human Rights and a professor of internal medicine and public health at the University of Michigan.

The researchers said that none of the hospitals they contacted in Oklahoma was totally able to articulate clear, consistent policies for emergency obstetric care to potential patients.

Specifically, 65% – 22 of the 34 hospitals – were unable to provide information about policies, procedures or the support provided to doctors when it is clinically necessary to terminate a pregnancy to save the life of a pregnant patient.

In 14 of the 22 cases, hospital representatives provided unclear and/or incomplete answers about whether doctors require approval to perform a medically necessary abortion.

Three of the hospitals said they do not provide abortions at all, even though it remains legal in the case of a medical emergency or to “preserve the life” of the pregnant person. Four others provided information that was factually wrong, the report says.

Four hospitals said they had formal approval processes that clinicians must go through if they have a situation in which it is medically necessary to terminate a pregnancy; they cannot make that decision on their own.

Three hospitals indicated that they have policies for these situations but refused to share any information about them.

“Unfortunately, it is being just left up to individual health systems and clinicians to try to make sense of these laws and provide guidance and support,” Heisler said.

The Oklahoma Hospital Association said it has been in conversations with Oklahoma’s medical licensure boards to seek clarity about the state’s conflicting abortion laws.

The association sent guidance to its members in September to explain what it interpreted as “saving the life of a pregnant woman” and what the laws would mean for a person made pregnant through rape or incest, among other issues. The guidance explains that the state’s criminal laws do not make an exception for these circumstances unless it is to save the life of someone who is pregnant in a medical emergency.

The guidance also warns that a person convicted of “administering, prescribing, advising, or procuring a woman to take any medicine drug or substance, or a person convicted of using or employing any instruction or ‘other means whatever,’ with the intent to procure an abortion, shall be guilty of a felony punishable by two (2) to (5) years imprisonment. From August 27, 2022, forward, a person convicted of performing or attempting to perform an abortion shall be guilty of a felony punishable by a fine not to exceed One Hundred Thousand ($100,000.00) and/or imprisonment not to exceed ten (10) years.”

The guidance says the “persons potentially liable” are the provider, not the pregnant person.

Study co-author Rabia Muqaddam, a senior staff attorney at the Center for Reproductive Rights who is working on multiple cases challenging the abortion bans in Oklahoma, called the overlapping laws a “bizarre” situation.

“Aside from the fact that there are so many of them is that they all conflict,” she said. “All of the laws have inconsistent definitions, which is where a lot of the confusion comes from for health care providers. What’s most dangerous for patients is the fact that the definitions of medical emergency and life-preserving abortions is unclear and inconsistent.”

“If I was the hospital general counsel and I was looking at these laws, I have absolutely no idea what my physician could or could not do in any particular circumstance,” she said.

When there is a lack of clarity and when penalties are involved, “what you get is massive chill.”

“Physicians are terrified. They’re terrified that if they make the wrong decision, they’re going to go to jail. They’re going to lose their license. And at the other end of that is that patients are being seriously harmed,” Muqaddam said.

Sonia M. Suter, a professor of law at George Washington University who was not involved in the new research, said recent abortion laws have created “such a mess.”

“You are telling physicians that they have two conflicting obligations,” said Suter, whose scholarship focuses on issues at the intersection of law, medicine and bioethics, with a particular focus on reproductive rights.

There is an obligation to stabilize patients in emergencies that may not always qualify as “life-threatening,” but doctors and hospitals could also risk being sued because the doctors are not following the standard of care, “which you can’t do with how some of these exceptions are worded.”

She said hospitals also don’t know how the laws will be applied. Lawyers typically will instruct institutions to interpret the law as conservatively as possible, and physicians may be equally conservative because they don’t want to risk their licenses or face stiff penalties.

“It’s just devastating for everybody,” Suter said. “It’s just cruel.”

Molly Meegan, general counsel for the American College of Obstetricians and Gynecologists, said state laws to restrict abortion with emergency exceptions are not comprehensive.

“They can’t be applied in a medical situation. They just aren’t practical,” she said. “They have an ethical and personal duty to their patients to do what is best for their patients. It can at times be in direct conflict with whatever the laws are, especially if they’re vague, and most of the ob/gyns throughout the country, including in Oklahoma, are in an impossible situation.”

Meegan and Suter both believe the confusion will lead to the deaths of more women. Those who survive may be left with dire health problems, including losing the ability to have children in the future.

“They already have horrific maternal mortality and infant mortality rates,” Suter said. “It feels like the end of evidence-based medicine.”

According to the US Centers for Disease Control and Prevention, Oklahoma persistently ranks among the states with the worst rates of maternal deaths, even before the new abortion laws went into effect. The state had a maternal mortality rate of 25.2 deaths per 100,000 live births for 2018-20, well above the national average.

For communities of color, the rate is significantly worse, according to the Oklahoma Health Department.

White women had 23.2 maternal deaths per 100,000 live births for 2018-20, the lowest rate overall in Oklahoma. The rates for Black women and Native American women were about twice as high: 49.4 and 44.4, respectively.

Oklahoma is not alone. The 13 states where most abortions are banned generally have some of the highest infant and maternal mortality rates in the country, Heisler said. Even more states could be restricting abortion access soon, the experts believe, with potentially more problems to come.

“The hostile climate many states are creating for the health care field by enacting criminal and other penalties for abortion care is an outcome whose reverberations we are only just beginning to see,” said Kelly Baden, vice president for public policy at the reproductive health nonprofit Guttmacher Institute.

Heisler noted that the researchers don’t blame the hospitals or the doctors for this confusion. Overall, she said, the staffers who talked to the researchers “were wonderful,” despite the circumstances.

“They were empathetic. They said, ‘I completely understand.’ They tried to give answers. They acted in good faith. But really, none of the hospitals were really able to say what we were hoping for, which is to unequivocally state that they would stand behind their clinicians and that clinicians at their facilities would be able to use their best clinical judgment for the individual case and that it would be made as medical decisions should be in collaboration with the patient, taking into account to their needs, their preferences and their values,” she said.

“We are recognizing that hospitals and clinicians are in an untenable situation,” Heisler added.

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