Two articles available in the January/February edition of Women's Health Issues are described below. For the full articles, purchase this issue.
Use of Complementary and Alternative Medicine Among American Women, Women’s Health Issues 15 (2005) 5-13.
Dawn M. Upchurch, PhD and Laura Chyu, MA
Women are not only the primary consumers of mainstream health-related therapies, but recent trends indicate that the increased use of complementary and alternative medicines (CAM) is occurring at especially high rates among women. Part of the challenge of research in this area relates to defining CAM and identifying its specific differences from mainstream medicine. The distinction between mainstream and alternative medicine is complicated by CAM’s wide range of practices or therapies, and by the growing incorporation of many alternative therapies and treatments into regular practice.
Upchurch and Chyu present one of the first comprehensive investigations of CAM use among American women. Similar to past research, they found that older, white, educated and affluent women are the primary CAM consumers. Upchurch and Chyu surveyed 17,399 women about their use of 12 different CAM therapies. These therapies were divided into 5 different domains: (1) alternative medical systems (acupuncture, homeopathy); (2) mind-body interventions (relaxation techniques, imagery, spiritual healing/prayer, biofeedback, hypnosis); (3) biologically based therapies (lifestyle diets, herbal medicine); (4) manipulative and body-based methods (massage therapy, chiropractic); and (5) energy therapies (energy healing). The four most common types of CAM among women are spiritual healing and prayer, herbal medicine, lifestyle diets, and chiropractic therapy.
Additionally, Chyu and Upchurch found significant differences in use of CAM along race/ethnic lines and income levels. Whites and women of other races are more likely to use CAM than are blacks, Hispanics, or Asians, even when accounting for socioeconomic status. Although the data do not provide clear explanations for this finding, the authors speculate that white women have more positive outlooks on CAM and are therefore more comfortable trying alternative therapies. However, they cite previous studies demonstrating that minorities could be more likely to use traditional healing methods from their respective ethnic or racial traditions. Upchurch and Chyu emphasize the need for more research to determine CAM’s effectiveness and health outcomes.
Willing and Able? Provision of Medication for Abortion by Future Internists, Women’s Health Issues 15 (2005) 39-44.
Eleanor Bimla Schwarz, MD, MS, Anne Luetkemeyer, MD, Diana Greene Foster, PhD, Tracy A. Weitz, MPA, Deborah Lindes, MD, and Felicia H. Stewart, MD.
With the development of medications such as mifepristone (RU486) making medical abortion a possibility and a reality, physician’s attitudes towards and abilities to administer such treatments are of increasing concern for many American women, particularly since the United States has one of the highest abortion rates among developed countries. Schwarz et al. analyzed the knowledge and abilities of residents in internal medicine, as compared to residents in gynecology and family practice, to determine whether medical curricula and training practices adequately prepare internists for providing medication abortion.
The researchers surveyed 212 residents in training in the San Fransisco Bay Area on their attitudes and knowledge of mifepristone and abortion. The survey included 16 potential barriers to providing medical abortion services in the future, each of which residents classified as “strongly prevents,” “somewhat prevents,” or “not likely to prevent” future participation in medication abortion. Additionally, residents were asked to classify themselves as “very religious,” “moderately religious,” or “not at all religious.”
Schwarz et al. found that nearly half of residents in internal medicine were willing to provide medication abortion, confirming results of past research. Interestingly, the willingness of gynecologists and family practitioners to provide mifepristone (83% and 84% respectively) was nearly double that obtained by larger studies, which may reflect new attitudes among residents or increasing acceptance of abortion in the San Fransisco Bay Area. In terms of the barriers that affected the resident’s willingness, personal objection was the single greatest determinant, although only 19% of internists reported such an objection. Religiosity did not appear to strongly affect residents’ willingness, with the majority of both moderately religious and very religious residents reporting that their religious beliefs would not prevent them from providing mifepristone. Rather, as the authors hypothesized, the differences in education and training most greatly affected residents’ views of medication abortion. Internal medicine residents were more likely than gynecology and family practice residents to cite technical issues related to their training, such as concern for adequate vacuum aspiration backup, as barriers to their willingness to provide care. In light of the many women who seek care from general internists in the United States, and of the many residents willing to provide medication for abortion, the authors argue that future internists should be given the necessary training to carry out medication abortions safely.