March 13, 2013 Dear ProLife Colleague, The February AAPLOG CME meeting provided excellent and unique content. The entire summary is found at: https://www.aaplog.org/aaplog-annual-educational-meeting/ In the next 3 letters, we will share this material, written by Dr. Mary Davenport: The 2013 AAPLOG educational meeting in February 23rd featured a number of outstanding speakers. Named after Matthew Bulfin, AAPLOG’s founder, the 12th educational symposium delved deeply into behavioral aspect of reproductive health, reproductive biology, medical ethics, clinical aspects of women’s health care, and psychological effects of abortion. Our conference was enriched by the presence of 22 medical students, some of whom drove many hours to be with us. Jokin DeIrala, Professor of Epidemiology at the University of Navarre, introduced us to the best thinking on epidemiology in reproductive health in an absorbing presentation. Mainstream assumptions in reproductive health are ideological and not evidence based. He emphasized that risk avoidance is an accepted strategy regarding smoking and seat belts, but not HIV AIDS. The behavioral strategies of abstinence and life-long monogamy (risk avoidance) are proven HIV prevention methods and have great potential for a large part of the population. A condom strategy for HIV merely provides risk reduction for HIV, and may even increase the incidence of infection due to increased sexual activity (risk compensation) because of false perception of protection. Dr. De Irala also pointed out the true meaning of studies of sexual debut (first age of intercourse) which was an eye-opener to most in the audience. He and his team examined sexual debut in El Salvador, Peru and Span. In El Salvador and Peru fewer than 50% of adolescents were sexually active by age 18-19. Yet the mean age of sexual debut is in the range of 14-15, but this is only among those who are sexually active; this calculation does not include the majority of teens who remain virgins. So this statistic can give a completely false impression to some 15 year olds, who may feel abnormal that they are not sexually initiated, even though the majority of their peers are virgins! Another very important concept we learned was “segmentation” in public health education. A serious mistake of the AIDS establishment has been to give the same message to 13 year old girls as to sex workers – “use a condom!” Condom distribution as a universal strategy is a proven failure, especially in Africa, causing millions of unnecessary deaths. Freda Bush, in a talk echoing her new book, Girls Uncovered, discussed how educational administrators, social leaders, and many parents have withdrawn from the role of protecting young women, who are vulnerable. In the past, parents and older adults guided young adults toward making wise decisions regarding sexuality and marriage, but this is no longer the case. The media assaults youth with contrary messages. Dr. Bush reviewed newer brain research that confirms that the prefrontal cortex, the portion of the brain guiding sound judgment, is not fully developed until the mid-twenties. In addition to sexually transmitted infections and unintended pregnancy, girls are especially vulnerable to depression and later marital breakup as a consequence of premature sexual activity. Byron Calhoun apprised us of the prevalence of substance abuse among pregnant women – much more common than many people would assume. He recommends universal screening as the standard of care. This is done in his community collaboratively by both clinics and private physicians. He busted a number of myths about addiction to opiates during pregnancy. He demonstrated that it is much better for the mother to be slowly weaned off the addictive substance than to assume “maintenance” is less risky. Neonatal withdrawal is difficult and painful, and can be avoided if substances are gradually withdrawn from the mother before delivery. This takes knowledgeable supervising physicians, and counselors as a support system for the patients. Dr. Calhoun was particularly critical of methadone and buprenorphine programs that merely hand out the drugs, and have minimal or no counseling or treatment. These programs substitute much more addictive substances then the typical prescription drugs the patients are using initially. The babies end up sicker in these programs, and with their mothers’ substance problem worsened. Next letter, next 3 speakers!
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