Welcome AMWA members!

These summaries have been put together to provide a short introduction to the positions the American Medical Women’s Association (AMWA) has taken politically and socially. We hope this is a helpful way for members to familiarize themselves with the positions the organization has taken on difficult health related topics, however it is important to note that these positions do not represent the opinions of all individual AMWA members.  The topics covered below are nuanced, and therefore by definition not covered to their fullest extent in these introductions. You can read more about any of these positions and corresponding references in the full length papers here:  http://www.amwa-doc.org/advocacy/position-statements. Submit any questions or comments to the student advocacy chair at advocacy@amwa-student.org.

 

Co-authored by:
Alisa Eanes, AMWA Student Advocacy Chair and MS2 UNC School of Medicine
Katherine Pryor, MS1 Duke University School of Medicine

NEWLY RELEASED

Gender Equity
The Universal Declaration of Human Rights gives women and men the right to be free from gender discrimination. AMWA advocates for a zero tolerance policy toward gender stereotyping, gendered harassment, disparities in compensation, disparities in access to career development resources, and hostile work environments.

Sex and Gender Specific Medicine
While most research includes both men and women, only 25% analyze their data on the basis of gender differences. Moreover, the differences research has exposed based on gender have widely not been implemented into clinical practice and medical education. AMWA advocates for 1) public policy that reflects that all people’s health is impacted by their gender, 2) public policy that preserves and promotes national offices of women’s health, 3) continuing research that not only includes both genders but analyzes and reports data pertaining to gender differences, 4) the incorporation of that research into medical education and 5) a method of certification edifying a care-providers proficiency in gender-specific medicine.

Cervical Cancer Prevention
Nearly all cases of cervical cancer are associated with an infection with Human Papilloma Virus (HPV), which is transmitted during sex (however not all women that contract the virus will go on to develop cancer). A multicenter case-control study in 25 countries showed that a vaccine with two virulent strains of HPV (HPV-16 and HPV-18) could prevent 71% of cervical cancers worldwide, and another vaccine with 7 strains of the virus could prevent 87% of cervical cancers worldwide. In order to be effective, these vaccines should be administered to women prior to initial sexual activity.  AMWA advocates for health initiatives (and appropriate public health policies) that promote 1) awareness of the widespread vulnerability of women to HPV infection, 2) the recognition of the role of HPV in cervical cancer, 3) access for all women to obtain appropriate screening and HPV prevention, and 4) protection from cervical cancer if a vaccine is shown to be safe and effective.
AMWA also advocates for the continued research, development, and approval of safe and effective HPV vaccines and to promote its use.

Health Care for All
AMWA advocates for 1) comprehensive health care reform to improve access and affordability of health care for all US inhabitants, 2) health care reform that recognizes that large number of uninsured, the current barriers to equitable care, incorporates leadership from healthcare professionals and commits to developing a comprehensive national health care plan.

Osteoporosis
While osteoporosis affects both men and women, it disproportionately affects aging women. Osteoporosis puts patients at increased risk for fractures and disability and is among the most common debilitating disorders that decrease function and quality of life. AMWA advocates for 1) acquisition of peak bone mass during adolescence, 2) prevention and risk factor modification for osteoporosis, 3) awareness of the risk of osteoporosis, 4) appropriate use of tests and procedures to follow patients, 5) knowledgeable use of current treatments.

CAREER AND EDUCATION

Abuse in Medical Education
To protect the education and training of women physicians, the relationship between the teacher and student must be one of mutual trust and respect. Behaviors that disrupt this relationship and the learning process are considered abusive, and often lead to diminished learning, less effective patient care, cynicism, lower self-esteem, depression, and diminished humanitarianism. Examples of abuse include derogatory, demeaning, or discriminatory comments, physical violence or threats, sexual harassment, requests for personal services, unfair grading or grading threats, and student policies that violate individual rights or place students at medical and psychological risk. AMWA therefore promotes programs that 1) Educate students, faculty, and staff about their rights and responsibilities, 2) Provide mechanisms of reporting and evaluating alleged mistreatment, and punishing repeat offenders 3) Protect privacy, 4) Permit evaluation and promotion of faculty based on their teaching and evaluation, and 5) Involves students and residents in the process of establishing performance goals and methods of evaluation.

Maternity Leave During Training
Given that 50% of physicians will have a first baby during residency, and 25% a second baby, it is important to have firmly established regulations within medical schools and training programs to prevent discrimination and ensure adequate coverage during maternity leave. AMWA supports 1) The establishment of clear policies concerning pregnancy and disability leave that are distributed to all applicants, 2) A maternity leave of at least 6 weeks in addition to scheduled leaves, 3) The coverage of maternity leave by disability insurance, 4) The disclosure of pregnancy to training directors or medical schools as early as possible, and 5) A non-discriminatory and respectful response by residency training directors and house staff that complies at the minimum with the Pregnancy Discrimination Act.

Pregnancy During Schooling, Training & Early Practice Years
There are currently few regulations that address the rights of women in family planning. Uncomplicated pregnancies can present with side effects that may temporarily impair a woman’s ability to work and complicated pregnancies may require extensive leave. Recognizing the relevance of this topic to many female medical students and physicians, AMWA supports 1) the right of a woman to raise her family without compromising her medical career, 2) the selection of an obstetrician aware of the normal disabilities of pregnancy, 3) a two week pre-partum leave for uncomplicated pregnancy, which is not to be counted as vacation, and the same length of disability absence, leave, or reduced schedule as a disabled person would be awarded, 4) protection from on-the-job hazards during pregnancy, and 5) program flexibility to support only the level of work appropriate to a woman’s condition during pregnancy.

ETHICAL ISSUES

Genetic Testing for Breast and Ovarian Cancer Susceptibility
Genetic testing for alterations predisposing women to breast cancer and ovarian cancer is increasingly available. This information can be extremely helpful, but requires some responsible and ethical reflection. AMWA recommends enacting federal and local legislation that protects the individual including required consent, confidentiality, health insurance protections, protection from employer discrimination, and more. Until legislation is enacted, AMWA also recommends education about breast and ovarian cancer risks and genetic markers, accuracy and limitations of available tests, as well as potential medical interventions. Moreover, information about psychological consequences of testing and potential discrimination should also be taken into account.

Aid in Dying
AMWA acknowledges that physician assisted dying elicits a broad range of response from its members. Taking this into consideration, AMWA advocates for 1) The rights of terminally ill patients to hasten the end of life to shorten potential pain and suffering and preserve dignity, 2)Physicians rights to provide (but not administer) a terminally patient with a means of assistance in his/her death, 3) Appropriate and timely use of advanced directives, palliative care, and hospice, 4) Communication free from coercion, 5) Referral to a psychiatrist  if appropriate, 6) Physician rights to decide whether or not to participate in assisted dying for their patients, 7) the passage of aid in dying laws which empower mentally competent terminally ill patients and protect physicians (i.e. the Oregon Death with Dignity Act)
Additionally, AMWA opposes 1) aid in dying in the mentally incompetent and 2) any role of non-physicians in the performance of aid in dying, with involvement of significant others/family as appropriately determined by the patient and physician. End of life decisions are individual and complex, thus AMWA maintains that courts are an inappropriate place for these issues to be resolved.
Moreover, AMWA supports the following practices in the care of terminally ill patients that are not considered physician assisted dying: 1) provision of palliative care even with death as a possible side effect, 2) withdrawal or withholding of life-sustaining efforts if requested by a patient or surrogate, 3) Providing only supportive care to those who voluntarily stop eating and drinking.

HEALTH & WELLNESS

Detection of Breast Cancer
Early detection of breast cancer through breast examination and mammography is important in reducing morbidity and mortality; however, many health care providers do not adequately interpret breast examinations or refer women for mammograms and AMWA therefore recommends greater emphasis on these prevention efforts. AMWA advocates for 1) Screening mammograms by age 40, followed by yearly physical examinations and regular mammograms at one to two year intervals until age 49, 2) Yearly screening mammograms by age 50, 3) Research funding to better define the ideal age range for which mammography would be a benefit, and 4) Continuing professional education on the subject of breast cancer screening and access to prevention efforts.

Breast Cancer Screening
Up to 1/3 of the 43,000 premature deaths attributable to breast cancer could be delayed or eliminated through joint use of regularly scheduled breast cancer examinations and mammography. The cost benefit of breast cancer screening in women age 40-49 and age 70 and over remains controversial, but AMWA firmly supports that women over the age of 40 be offered 1) Regular breast cancer screening, 2) High-quality follow-up care, and 3) Treatment regardless of socioeconomic status.

Diagnosis & Treatment of Breast Cancer
Breast cancer is the second leading cause of cancer deaths in women. Although the incidence of the disease continues to rise, mortality has remained unchanged over the past 40 years. While early detection and treatment remains essential, AMWA advocates for improved preventive measures and recommends 1) A multi-specialty approach to breast cancer diagnosis, 2) Close follow-up of lumps and equivocal findings on mammography, and needle aspiration or ultrasound to distinguish between a cyst and solid mass, 3) Monitoring of all breast symptoms to resolution, and 4) Professional education addressing breast cancer risk management principles.

Cerebrovascular Disease in Women
Stroke is the 3rd leading cause of death in the US and a great economic burden to society and to victims and their families. High risk groups include African American women and those over the age of 75. There are many gender-specific risk factors, including multiparity, use of oral contraceptives, greater susceptibility of women to the cerebrovascular complications of diabetes. AMWA advocates for 1) Increased community education efforts on stroke symptom recognition, immediate response, and available therapies, 2) The inclusion of women in primary and secondary prevention trials, as well as stroke therapy trials, 3) The development of more specialized stroke units and rehabilitation centers.

Prevention & Early Detection of Colorectal Cancer in Women
The development of colorectal cancer is a slow process that often begins with a benign polyp that is easily detected through screening tests that include the fecal occult blood test, the flexible sigmoidoscopy, colonoscopy, and the double-contrast barium enema. However, mortality rate has declined only slightly because colorectal cancer is often not detected until an advanced and incurable stage. Women in particular are less likely to have had the recommended tests and the appropriate time intervals. Therefore, AMWA advocates for 1) Counseling of patients on available and recommended colorectal cancer screening measures, with particular emphasis on the equal risk of men and women, 2) The promotion of colorectal screening training and credentialing standards through partnership with the NCCR, 3) Coverage of screening measures by private and public plans.

Domestic Violence
AMWA is concerned that domestic battery is often undiagnosed and untreated, and advocates for the development of an education curriculum to be implemented in medical school and at the post graduate level in order to 1) Increase clinician awareness of the signs and physical and psychological symptoms of abuse, 2) Develop and present models for taking an abuse history, 3) Improve medical student and physician awareness of community resources, 4) Develop specialized hospitals and facilities for victims of domestic abuse, 5) Support legislation and funding for domestic violence treatment programs, 6) Improve funding for research on the incidence, treatment, and prevention of domestic violence.

Lesbian Health Issues
Legal discrimination against homosexuals in the United States is a reflection of the homophobic societal and family attitudes towards the gay and lesbian community that have serious psychosocial and medical consequences. Limited research indicates that lesbians may be at higher risk for certain cancers and heart disease because of higher body fat, lower parity, fewer and less frequent visits to the physician, higher rates of smoking and alcohol use and abuse. AMWA advocates for a policy of nondiscrimination against lesbian, bisexual, and gay individuals and in particular calls for 1) Legislation to end civil discrimination, 2) Condemnation of anti-gay prejudice and violence by leaders in all sectors, 3) Education programs about lesbian, bisexual, and gay individuals to be implemented in schools, religious institutions, and the community, 4) Initiation and NIH support of research on lesbian health issues, and 5) Recognition by health care providers that homophobia compromises health care delivery.

Minority Women’s Health
Position summary to be added soon!

Obesity & Overweight in the US
The prevalence of obesity and overweight in the US continues to rise, increasing our population’s risk for coronary heart disease, elevated blood pressure, diabetes mellitus, osteoarthritis, cancer, and social and psychological comorbidity. Overweight and obesity are caused by a number of genetic and environmental factors. Since the treatment of overweight and obesity can be difficult, prevention through good nutrition and physical activity is the most desirable strategy. AMWA advocates for 1) nutrition education, 2) mandatory physical activity, 3) balanced school meals, 4) improved access to and availability of physical activity centers. AMWA recommends that 1) health care professionals view overweight and obesity as a lifetime health risk and learn and implement prevention and treatment efforts, 2) health care professionals refer patients to obesity specialists when necessary, 3) the FDA simplify food labels for consumer use and 4) more priority be given to research focusing on the causes, prevention, and treatment of overweight and obesity.

Tobacco Control & Prevention
Smoking is the leading cause of preventable deaths in the United States, with the majority of deaths attributed to lung cancer, coronary heart disease, emphysema, and chronic bronchitis. Environmental tobacco smoke from second hand smoke is responsible for increased comorbidities such as asthma and ischemic heart disease. Women who smoke are at specific risk for cervical cancer, premature menopause, and reduced fertility. Moreover, smoking during pregnancy is associated with pre-term birth and lower birth weight babies. AMWA advocates for 1) continued research and refinement of effective smoking cessation techniques, particularly those suitable for women and girls, 2) tobacco prevention curriculum in schools, 3) a ban on tobacco product advertising, 4) tobacco taxes, 5) protection of non-smokers from environmental tobacco smoke through legislation, 6) Protection of youth from purchasing tobacco products, 7) limitation of cigarette export, and financial support to monitor the epidemic of tobacco use, 8) support for programs enabling tobacco farmers to transition to growing non-lethal crops, and 9) elected officials to refuse campaign funds from the tobacco industry.

Women & Coronary Heart Disease
Heart disease is the leading cause of death in American women, and it is critical that we take into account gender specific aspects in its risk factors, presentation, diagnostic testing, and treatment. Risk factors include tobacco use, elevated cholesterol levels (specifically elevations in LDL), hypertension, diabetes mellitus, postmenopausal status, and obesity/sedentary lifestyle. Health care professionals are slower to diagnose and treat women suffering from acute MI, and management of chronic heart disease has been hampered by a more limited understanding of the disease in women. AMWA advocates for 1) greater education on heart disease in women, and attention to at-risk subpopulations, 2) continuing funded research in primary and secondary prevention, 3) Continuing funded research on acute and chronic treatments, 4) support for risk factor modification, including tobacco cessation and control policies, 5) hormone replacement therapy when appropriate, and 6) research on hormone replacement therapy and its effect on the development of breast cancer and potential role in risk reduction for colon cancer, Alzheimer’s and osteoporosis.

POLICY AND LEGISLATION

Care for the Dependent Elderly
Women make up a disproportionate percentage of the growing elderly population, and consequently are likely to be affected by the medical problems associated with this population. Additionally, a large number of women family members are the care takers for aging relatives. AMWA advocates for 1) encouraging employees to use the family and Medical Leave Act without fear of job loss, 2) better care programs for the elderly nationally (such as adult day care), 3) increased study and certification of physicians in geriatrics, 4) research and evaluation of innovation care programs for the elderly, and 5) appropriate management of funds for programs and services that preserve dignity and physical independence of the elderly, provide equitable pay to health care providers, and eliminate fraudulent expenditures.  

Dependent Care
One of AMWAs missions is to advocate for support programs which improve the health of women and their families. Women are often the caretakers of the dependent elderly as well as children. Women’s lives and careers are impacted by the lack of affordable, quality care facilities. AMWA advocates for the passage of legislation and funding that allows for affordable day care programs for children and the elderly.

Health Care Reform & Women's Health
AMWA is committed to advocating for the needs of women patients under health care reform. Women patients present health concerns that are unique to women (i.e. pregnancy), predominate in women (i.e. osteoporosis or depression) or manifest themselves differently in women (i.e. heart disease). AMWA advocates for 1) universal coverage, 2) basic benefits package (including preventative services), 3) improved physician and patient autonomy, 4) enhanced tracking of health care outcomes, 6) mandated employer benefits and 7) substantial excise taxes on alcohol and cigarettes to finance reform.

Universal Access to Health Care & Health System Reform
AMWA advocates for 1) universal access to health care for all pregnant women, 2) appropriate education and care for reproductive health in females and males (sex education, contraception, abortion, STI protection), 3) universal access to care for all children to age twenty-one (including dental care, psychiatric care, and chemical dependency treatment), 4) equal access for all people to cost-effective interventions and early detection programs, 5) financial incentives (scholarships, low interest loans, loan forgiveness) and innovation in medical curricula to encourage medical students to pursue primary care, 6) approval for innovative state Medicaid programs that address access to care problems and 7) the formation of medical and consumer groups supporting  and advocating for public awareness and support of universal health care.

REPRODUCTIVE HEALTH

Abortion
AMWA upholds that the decision to continue or interrupt a pregnancy belongs to the pregnant woman, in consultation with her physician.  While all pregnancies carry potential health risks, unwanted pregnancies carry represent a greater medical risk for the woman. Furthermore, abortions will be chosen whether or not they are legal.  Recognizing that Roe vs. Wade established a fair balance between a woman’s right to make a personal choice and the responsibility of the state to protect a potentially viable third trimester fetus, AMWA opposes 1) efforts to overturn Roe vs. Wade and 2) measures that limit access to care for pregnant women. AMWA will support 1) the development of safer methods of contraception and abortion, 2) the integration of abortion training into medical education, and 3) the improvement of public knowledge and responsibility about sexual matters to reduce the number of unintended pregnancies.

Abortion & Access to Comprehensive Reproductive Health Services
Pregnancies involve potential health risks, both physical and mental, and AMWA believes that a pregnant woman has the right to a full range of reproductive health services, including abortion as part of comprehensive health care for all women. Abortions will be chosen whether or not they are legal or illegal; however, illegal abortions can be dangerous and result in tissue damage, infection, bleeding, sterility, or death. To support availability of and access to abortions, AMWA will 1) work to increase the number of abortion providers by increasing training opportunities in the full range of abortion procedures, 2) support the development of new, safe, and effective methods of contraception and abortion, and 3) support initiatives that increase the awareness, use, and availability of emergency contraception for preventing unwanted pregnancy.

Emergency Contraception
Unwanted pregnancies have a detrimental impact on women’s health, with nearly half of unintended pregnancies resulting from contraceptive failure. Emergency contraception works to prevent pregnancy after an act of unprotected intercourse or contraceptive failure; since these methods work prior to implantation, they are viewed by AMWA as contraceptives, not as abortifacients. Emergency contraception is safe, but there are still barriers to access that need to be addressed. AMWA is committed to 1) educating its membership about emergency contraception, 2) encouraging widespread release of information on emergency contraception to both the medical community and the general public, 3) encouraging the use of written information in health care facilities, 4) Recommending preventive prescriptions be issued at routine exams, and 5) Advocating for programs to improve access to emergency contraception, including a prompt, non-judgmental referral to other pharmacies in cases where a pharmacist uses the “conscience clause” to deny needed access.

Hormone Therapy
AMWA enthusiastically supports the July 9th statement of the North American Menopause Society on appropriate use of hormone therapy in symptomatic women. The conclusions of their study state: “Recent data support the initiation of hormone therapy around the time of menopause to treat menopause-related symptoms and to prevent osteoporosis in women at high risk of fracture. The more favorable benefit-risk ratio for estrogen therapy allows more flexibility in extending the duration of use compared with estrogen-progestogen therapy, where the earlier appearance of increased breast cancer risk precludes a recommendation for use beyond 3 to 5 years.” You can read the statement and about the study here: http://www.amwa-doc.org/cms_files/original/NAMS_on_Hormone_Therapy_7_2012_.pdf.

Reproductive Health
Throughout the United States and the world, there is an acute need for better reproductive health care in order to promote general health, and reduce rates of maternal and infant mortality. Current challenges include unsatisfactory contraceptive choices, difficulty obtaining safe abortions, missed diagnoses of STDs, pregnancies treated as illnesses, and inferior primary care for infertility. While AMWA advocates generally for medical education institutes and other areas of health training to broaden reproductive health curriculum, AMWA considers that each of these areas of reproductive health merit their own discussion and are worthy of individual objects.

AMWA advocates for efforts to improve reproductive and sexual health through activities that 1) increase knowledge about sexual and reproductive health including through sexual health education in schools, counseling, and multi-disciplinary collaboration, 2) encourage informed choices, 3) promote confidentiality and protection, 4) increase access to services, 5) protect individuals from the causes of infertility, and 6) encourage the medical and health care community to deliver high quality care to minorities and those in underserved communities.

Unwanted pregnancies are an important niche of reproductive health, as these represent nearly half of all pregnancies in the United States each year. AMWA is committed to 1) reducing unwanted pregnancies by promoting sexual education, removing barriers to contraception, and improving access to abortions, 2) opposing measures limiting access to abortions, particularly in underserved or underrepresented populations, 3) supporting federal and state funds for a full range of reproductive health services, 4) opposing efforts to overturn Roe vs. Wade, 5) improving access to emergency contraception, and 6) supporting the development of new methods of contraception and abortion.

Sexually transmitted illnesses are a common illness in America and the subject of stigma and misinformation. Critical statistics include the following: 56 million Americans may have an incurable viral STD, pelvic inflammatory disease from an STD causes infertility in roughly 15% of American women, and AIDS is the second leading cause of death among African American women aged 25-44. AMWA supports programs and policies that educate and train health care providers on the diagnosis, treatment, and prevention of STDs including HIV/AIDS.

Sexual and interpersonal abuse, which include coercion, violence, rape, incest, and poorly protected intercourse, are other critical issues within reproductive health that diminishes a woman’s ability to care for herself and children. AMWA supports programs and policies that protect individuals and train health care professionals to recognize and treat signs of abuse.

Finally, these challenges facing reproductive health exist in our national and international communities, and AMWA supports efforts that promote regionally appropriate methods of education and health care that address the many aspects of reproductive health.

 

JOIN AMWA TODAY!