women’s health update
Creating community support through the Big Latch On
vol 15 no 3 • July 2011
I n s i d e ●
HPV vaccines
The Big Latch On will be turning seven this
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Our new Director
year and each year has seen increasing
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Latest cancer statistics
involvement and support for the event from communities large and small around New
year’s event, again being held at the Levin Cinema, will get the word out to a new group of breastfeeding mums.
Zealand. Better still, the positive impacts of the Big Latch On have extended past the event itself. The Big Latch On has prompted the establishment of breastfeeding support groups in areas where mothers are isolated; and events like this help us as a community to reach out and support one another. To help share ideas, Nikki Whyte profiles one of the events that has grown over the years and has had success not only in getting people along in a small town, but also creating community support for breastfeeding: Levin. The first event in Levin was in 2008, held in a local woman’s house and had one other mum participate in the count. Not to be discouraged, the two women got together for the following year’s Big Latch On with the aim of increasing attendance and creating an event which aimed to treat breastfeeding
combination of comfy seats and security. One woman in particular took the time to thank the organisers for providing her with an opportunity to feed her 4 week old in public for the first time and gave her the courage to try breastfeeding in other public places.
mums to something special. Cat Atkinson,
One other success from the Levin Big
that original participant, approached the local
Latch On was the establishment of the
Council to get them on board and help with
Levin Breastfeeding Support Group. Cat had
promoting the event. Inspired by the event
recognised that there was a lack of support
being held that same year in Auckland in
services available for breastfeeding mothers
the cinema at Sylvia Park, Cat investigated
in the small town of Levin, often having to
the option of holding the Levin event at their
head to Palmerston North or Wellington to
local cinema and was pleased to receive their
access services or receive support. Names
support for the idea.
and numbers were gathered from the event
The 2009 event managed to increase
and a local support group was formed
participation from one to twenty-four and
that went on to meet monthly. The group’s
proved to be a great venue for women who
membership has declined since then as
were new to breasteeding – with the perfect
babies grew up but they are hoping that this
The Levin event has shown how the Big Latch on can become an event that is pivotal to the creation of community support for breastfeeding. Breastfeeding has a positive influence on the health status and social wellbeing of baby, mother, family and community. Activities that support breastfeeding in the community contribute to the long-term health of the population and help to reduce health inequalities between population groups. Anyone can organise a venue and it can be as large or as small as you are able to coordinate. Each and every latch counts toward the Big Latch On and we encourage first time coordinators to give it a go. We are more than happy to assist with anyone in hosting their Big Latch On event so don’t hesitate to contact us on 09 520 5295 or breastfeeding@womens-health.org.nz To register your venue, see www. biglatchon.org.nz and head to our Facebook page www.facebook.com/biglatchon
Women’s Health Update features women’s health news, policy and scientific findings, to enable health care professionals and community-based workers to be at the forefront in women’s health. Women’s Health Update is published by the Women’s Health Action Trust
2 • Women’s Health Update • vol 15 no 3 • July 2011
New research supports sexual health information as part of young women’s HPV vaccine decision making Meeting young women’s human papillomavirus (HPV) information needs, particularly about HPV as a sexually transmitted infection (STI) and the role of safer sex in helping prevent HPV transmission, continues to be challenging in the third year of the HPV immunisation programme. Christy Parker, WHA Policy Analyst, reviews new research which supports the inclusion of tailored sexual health information about HPV as part of young women’s and their parents’ informed HPV vaccine decision making. It appears that age appropriate information about the sexual transmissibility of HPV does not reduce intention to have the vaccine and may in fact support uptake. Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the world and has a significant impact on women’s health. Two genital HPV types (16 and 18) are responsible for 70% of cervical cancers and types 6 and 11 are responsible for 90% of genital warts. The introduction of HPV vaccines globally over the past five years, now join safer sex practices and regular cervical screening to make cervical cancer one of the most preventable cancers. This three pronged approach to cervical cancer prevention has been advocated by the World Health Organisation (WHO). In its guidelines on the introduction of HPV vaccines the WHO (2009: 130) state: HPV vaccines should be introduced as part of a coordinated strategy to prevent cervical cancer and other HPV diseases. This strategy should include education about reducing behaviours that increase the risk of acquiring HPV infection, and information about the diagnosis and treatment of precancerous lesions and cancer. Aotearoa New Zealand’s HPV immunisation programme is now in its third year. It offers the Gardasil vaccine free to young women in years 7 and 8 (12 year olds) and a two year catch up programme for girls in years 9-13 (aged 13-18 years) which ends on the 31st December this year. Young women born from 1992 onwards have until their 20th birthday to start the immunisation programme. Gardasil helps to prevent HPV types 6, 11, 16 and 18. The vaccine is recommended prior to young women becoming sexually active to be most effective. Younger women are also believed to have a greater immune response
to the vaccine (Caseldine-Bracht, 2010). The challenge for HPV immunisation programme developers has been how to reach sexually inexperienced women with information about the potential to help protect against a sexually transmitted infection and its effects. There has been concern that highlighting the sexual transmissibility of HPV may act as a barrier to HPV vaccine acceptance and uptake because of the stigma associated with STI’s and the age of recipients. This concern has led programme developers both here in Aotearoa New Zealand and in other countries rolling out publically funded HPV immunisation programmes to largely exclude sexual health information about HPV, its effects and prevention; and to market HPV vaccines as ‘Cervical Cancer Vaccines’. The risks of this approach are many. It risks compounding the already established lack of knowledge about HPV and its effects in the population. It also compromises young women’s and their parent’s informed decision making which is guaranteed under the Code of Health and Disability Services Consumer Rights. However two new studies in countries with similar HPV immunisation programmes to Aoteaora New Zealand, Australia and Canada, support a different approach. These studies have found that the inclusion of information about the sexual transmissibility of HPV, and HPV’s causal roll in genital warts as well cervical cancer, that is tailored to sexually inexperienced young women, does not reduce the intention to vaccinate and may in fact result in higher intention to be vaccinated (Baxter & Barata, 2011; Juraskova et al, 2011). Consistent with other studies, Juraskova et al (2011: 77) identified significant gaps in the HPV knowledge of the young women who participated in their study. Approximately half of the young women in their study had not heard of HPV infection despite the study occurring immediately after the vaccine publicity campaign in Australia. They note (pg. 77): ‘Notably, HPV transmission mode and risk factors should be a particular focus of such discussions [between GPs and young women], because only a minority of participants had knowledge in these areas’. Juraskova et al also found that highlighting the sexual transmissibility of HPV, and framing the HPV vaccine as for genital warts and cervical cancer, rather than
just cervical cancer, did not seem to influence vaccination intention or behaviour in their sample. Likewise Baxter & Barata’s (2011) study found that sexually inexperienced women’s intentions to receive the HPV vaccine were higher when they received a tailored message that included information about the sexual transmissibility of HPV and the benefit of receiving the vaccine prior to becoming sexually active. This was compared to two control groups, one which excluded information about HPV as an STI, and one that provided detailed untailored information about sexual transmissibility. Baxter & Barata state of their findings (2011: 242) ‘It is also important to note that the control condition, which avoided all mention of sexual transmission, did not improve sexually inexperienced women’s intentions to vaccinate. This demonstrates that avoiding information about the sexual transmission of HPV in an effort to increase vaccine intentions for sexually inexperienced women is misguided’. More research is needed on young women’s and their parents’ HPV knowledge, and their information needs, as the HPV immunisation programme enters its third year here in Aotearoa. However these studies support the framing of HPV vaccines as just what they are- HPV vaccines, and the provision of age appropriate and tailored information about HPV as a sexually transmitted infection both to support informed decision making and encourage uptake. References Baxter, C. Barata, P. (2011). The paradox of HPV vaccines: How to reach sexually inexperienced women for protection against a sexually transmitted infection. Women’s Health Issues, Vol 21, No 3, pp. 239-245. Caseldine-Bracht, J. (2010). The HPV vaccine controversy: where are the women? Where are the men? Where is the money?. The International Journal of Feminist Approaches to Bioethics, 3(1), 99-112. Juraskova, I, Bari, R. O’Brien, M. McCaffery, K. (2011). HPV Vaccine promotion: does referring to both cervical cancer and genital warts affect intended and actual vaccination behaviour? Women’s Health Issues, Vol 21, No 1, pp. 71-79. World Health Organisation. (2009). Human papillomavirus vaccines WHO position paper. Weekly Epidemiological Record, 84: 15, 117-132.
Women’s Health Update
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Introducing our new Director Women’s Health Action has recently welcomed Maree Peirce as our new Director. Maree has had a long and varied career in the health sector and is excited to join a small but dynamic public health NGO focused on the promotion of women’s health and wellbeing. Christy Parker, WHA Policy Analyst, introduces Maree and asks her what attracted her to the role at Women’s Health Action and how she sees women’s and children’s health promotion as an integral part of the health sector. Welcome Maree, can you tell us a bit about your experience in the health sector? I’ve worked in the health sector for 30 years. I have a nursing background although haven’t worked in a clinical role for many years. I have had experience in both the public and private sectors and also the religious and welfare sector. I have a broad range of experience including working in the community as a public health nurse, involvement in nursing education, service development, and funding and planning public health as well as disability support services. My most recent role was Manager of the Northern Cancer Network with the Northern DHB Support Agency. What attracted you to the role of Director of Women’s Health Action? I was looking for an opportunity to gain some experience in the NGO sector. Women’s Health Action Trust has a strong history and reputation and I value what the organisation stands for. There is growing awareness of the need for strong consumer participation in health service development and improvement. There is also increasing recognition of the importance of well informed health consumers who take responsibility for their own health. Women’s Health Action has a leading role in assisting women to access sound evidence-based health information and improving health literacy. How do you view the role of public health NGOs, and in particular women’s and children’s health promotion, in the wider health sector? These are challenging times for NGOs given the recession and Christchurch earthquake. NGOs need to demonstrate that they add value. I consider NGOs to be a critical component of the wider health sector because we often provide a collective
voice for consumers that may otherwise not be heard. With an increasing policy focus on children it is important that to recognise that children’s issues are inseparable from women who are generally the main caregiver. Founded by health activist Sandra Coney, Women’s Health Action came to national prominence when it broke the story of “the Unfortunate Experiment” at National Women’s Hospital in Auckland which cumulated in the Cartwright Inquiry, a watershed moment in the delivery of health care, particularly women’s health care in Aotearoa New Zealand, and internationally. Do you think the learnings from Cartwright continue to inform health care delivery or are the lessons of the past being forgotten? The learnings from the Cartwright Inquiry are as relevant today as they were when they were first released. We have certainly made good ground with the introduction of the Health and Disability Commissioner, Code of Consumer Rights and the establishment of the national cervical screening programme. I believe we need reminders from time to time of the intent of the Cartwright recommendations for example protecting consumer privacy rights with the emergence of electronic shared care patient records and the role of health and disability ethics committees in protecting the interests of health consumers when they participate in clinical trials. The function of New Zealand’s system of ethics committees has recently been the subject of a select committee inquiry and Women’s Health Action reminded the select committee of the “unfortunate” events at National Women’s Hospital that led to the rigorous system we have today. Women’s Health Action is highly regarded as a provider of health consumer representation and advice in support of consumer-centred health care. Do you think consumer voice and representation have an important role to play in the health sector? Yes definitely! There should be ‘nothing about us without us’. Times are changing and there is increasing recognition of this within the health sector. In recent times there has been a focus on clinical leadership in decision making within the health sector. While this is clearly important let’s not lose sight of the need to balance this with a consumer perspective because after all we are the end
users of the services. What do you see as the biggest challenges to women’s and children’s health at present? Aotearoa New Zealand’s high rates of family violence are a concern for women’s and their children’s health. There is now extensive evidence of the impact of violence against women and children as a significant burden on their health. Women’s sexual and reproductive health needs on-going focus to improve the quality of sexuality education and information for young women and ensure timely access to quality contraception and abortion services. Higher rates of poverty experienced by women in Aotearoa has an on-going impact on their health, and health inequalities between different population groups of women are a concern, particularly between Maori and non-Maori. Increasing the rates of breastfeeding after six weeks of age is an on-going but important challenge. Do you have a vision for Women’s Health Action for the next 5 years? I’d like to see Women’s Health Action continue to be recognised as the leading provider of evidence-based consumer focused health information for women in Aotearoa New Zealand. I’d also like to see us recognised as the go to point for the health sector when seeking consumer engagement especially on issues that will impact on women’s wellbeing and health in its broadest sense.
Latest cancer statistics released The Ministry of Health has recently released ‘Cancer: New registrations and deaths 2008’, the annual statistical publication which records cancer incidence and deaths. The latest report, released in June, collates and analyses new cancer registrations and deaths for 2008 as reported to the New Zealand Cancer Registry. These yearly reports are a vital tool for tracking changes in cancer incidence and deaths over time; the impact of screening programmes; on-going ethnic and socioeconomic inequalities in who gets, and dies from cancer; and sex and gender differences in cancer incidence and death. A snapshot of the impact of cancer on women’s health in 2008 reveals: • For females, breast cancer was the most frequently registered cancer, accounting for 28 percent of female registrations. • Lung cancer caused the highest number of deaths for women (19 percent), followed by breast cancer (15 percent) and then colorectal cancer. While registration rates for breast cancer in females remained relatively similar between 1998 and 2008, rates of death have trended downwards, with a drop in 19 percent, likely
attributable to an effective breast screening programme (pg. 75). • Registrations for cervical cancer show a general downward trend between 1998 and 2008, falling 22 percent, as have rates of death from cervical cancer, which have fallen 43 percent although rates have stabilised since 2005. This decline also likely reflects the existence of a successful screening programme (pg. 83). • Uterine cancer accounted for 4 percent of registrations and 2 percent of deaths from cancer for women in 2008, with rates in registration having increased over the past decade by 26 percent (pg. 87). • Ovarian cancer accounted for 3 percent of female registrations but 5 percent of all deaths from cancer in women in 2008 being a very lethal form of cancer for women in part because it is difficult to detect early (pg. 91). • Ethnic and socio-economic differences between women continue to result in significant inequalities in who gets, and dies from, cancer overall and from female-specific cancers, including those cancers with effective screening
programmes i.e. breast and cervical screening. In 2008 the Maori registration rate for breast cancer was 29 percent higher than the nonMaori rate, and the mortality rate was 78 percent higher. Rates of death from breast cancer for Maori women over the past decade are almost unchanged (pg.75). The registration rate for cervical cancer for Maori women was twice that of non-Maori in 2008 and Maori women had a mortality rate more than three times that of nonMaori women. While overall rates of cervical cancer have fallen for both Maori and nonMaori women over the past decade, the large disparity between Maori and non-Maori women has remained relatively unchanged (pg. 83). ‘Cancer: New registrations and deaths 2008’ demonstrates the important impact of cervical and breast screening programmes on women’s health. However it also presents the on-going urgent challenge to continue to address inequalities in the prevention, detection and treatment of femalespecific cancers. The report can be accessed from the Ministry of Health website: http://www. moh.govt.nz /moh.nsf/indexmh /cancer-newregistrations-deaths-2008
Noticeboard DEPARTMENT OF PSYCHOLOGY SEMINAR (AUCKLAND) 2 – 3pm, July 22nd 2011 Room 604 HSB, Auckland University Pamela Scully, Professor of Women’s Studies and African Studies at Emory University gives a seminar on Best Practices Guidelines in Post-Conflict Settings: A Case Study from Liberia. For more information, contact Nicola Gavey on n.gavey@auckland.ac.nz
JOAN DONLEY MIDWIFERY RESEARCH FORUM 2011 (NEW PLYMOUTH) 4 – 5 August 2011 Quality Hotel Plymouth International, New Plymouth The 5th Biennial Joan Donley Midwifery Research Forum - Celebrating New Zealand Midwifery Research and Knowledge. www.midwife.org.nz
WHO GLOBAL WOMEN’S SUMMIT (AUCKLAND) 9am – 5pm, 6 August 2011 Kia Aroha College, 51 Othello Drive Otara Learn, listen, share and care! Enlighten women’s minds, empower women’s hearts… for a better world. 100 women gather to learn from Dr. Fellingham, local leaders and experts in their nation, and to discuss 3 important women’s initiatives relative to particular women’s issues in their nation and globally regarding education, hunger, poverty and increased peace. For more information see http://globalwomenssummits.com/auckland-new-zealand
CARTWRIGHT ANNIVERSARY SEMINAR “WHO’S COUNTING THE COSTS? WELFARE REFORM, WOMEN’S HEALTH AND HUMAN RIGHTS” (AUCKLAND) 1 - 3pm, 12 August 2011 Women’s Health Action with the Public Policy Group at the University of Auckland present a seminar looking at the proposed welfare reforms and the potential impacts on women’s health and human rights. For more information contact Nikki on info@ womens-health.org.nz
AMAZING ASSERTIVENESS FOR WOMEN (AUCKLAND) 6 – 8pm, starts 16 August 2011 - $40-$80 Auckland Women’s Centre, Grey Lynn Join other women in a supportive environment to find out how to make positive changes in your life through being assertive (7 wks). For more information, contact info@womenz. org.nz or visit www.awc.org.nz
7TH NZ NATIONAL IMMUNISATION CONFERENCE – “TO IMMUNITY AND BEYOND” (ROTORUA) 19 – 20 August 2011 Novotel Rotorua Lakeside, Rotorua For all those involved in immunisation research and service delivery to network, present their science and recent research both locally and internationally, and grow through the sharing of knowledge and experiences. www.imac2011.co.nz
NEW ZEALAND LACTATION CONSULTANTS ASSOCIATION CONFERENCE 2011 (AUCKLAND) 19 – 21 August 2011 Waipuna Hotel and Conference Centre, 58 Waipuna Road, Auckland Breastfeeding: Passport to Life - Ko te Kai U te Mana Oranga. www.workz4uconferences. co.nz/Conference-Calendar/NZLCA-2011.aspx
CREATING OUR FUTURE NOW – PHA CONFERENCE (CHRISTCHURCH) 31 August – 2 September 2011 Lincoln University, Christchurch The three themes for the conference are vision, sustainability and diversity. www.pha.org.nz/phaconference.html
WHA ANNUAL SUFFRAGE BREAKFAST 7 – 9am, 16 September 2011 More information available soon on www.womens-health.org.nz
HOME BIRTH AOTEAROA NATIONAL CONFERENCE: TODAY’S CHOICES, TOMORROW’S PARENTS — BRIDGING HEARTS, HOMES AND HUMANITY (NEW PLYMOUTH) As a change-making event, this conference aims to energise parents, Lead Maternity Carers and other health professionals, including midwifery students and childbirth educators. So if this is you, or you are interested in community social services benefiting women and families, plan to come NOW! For more information see www.todayschoices.org/
LET’S TALK ABOUT IT - SANDS NEW ZEALAND NATIONAL BIENNIAL CONFERENCE (WANGANUI) 11 – 12 November 2011 Wanganui Function Centre, Purnell St, Wanganui For more information, visit www.sands.org.nz/sands-national-conference.html
Women’s Health Update is produced by Women’s Health Action Trust • Edited by Jo Fitzpatrick To receive copies of Women’s Health Update, make suggestions about future contents or send items for publication please contact: Women’s Health Action Trust • PO Box 9947, Newmarket, Auckland, NZ 2nd Floor, 27 Gillies Avenue • Ph (09) 520 5295 • Fax (09) 520 5731 • email: info@womens-health.org.nz Women's health information - www.womens-health.org.nz Breastfeeding Friendly Workplaces - www.bfw.org.nz