EQUALITY ARCHIVES From The Archives From The Archives Health Healthcare THE FRONT ARCHIVES

When an Abortionist Dies

Dr. Spencer, 1889–1969: Last Trip to Ashland

One month, to the date, before his death last Tuesday, I was privileged to meet the legendary Dr. Robert Douglas Spencer. The trip to Ashland, which was more in the nature of a pilgrimage than a quest for an interview, had come about through the good graces of Dr. Nathan H. Rappaport. A chance to meet Spencer, and through the entree of another abortionist, was an unusual opportunity. Arrangements were made and carried out on a day’s notice. Rappaport drove us to the Pennsylvania coal country in his Citroen. The other passengers were Carol Kahn, a reporter for Medical World News, and her husband, Ira.

We were a high-spirited group, Carol, Ira, and I, and we must have sorely taxed the ego of our friend during the four-hour drive to the little town near Pottsville, pumping him as we did for details of Spencer’s life. It was a journey to Ashland that, I expect, was quite different from the more than 30,000 other journeys that travelers had made to this village, travelers with a secret, urgent mission.

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Spencer, I knew, was back in business again, at the age of 79. The justifiedly famous doctor had reopened his clinic on Centre Street and was now charging the incredible sum of $200, a concession, as he later told us, to the higher cost of drugs and supplies. At $200, Spencer’s price was still hard to believe, well under the going rate for such things. He was still unique in American history.

I tried to recall during our journey just when it was that Dr. Spencer of Ashland had first come into my consciousness. It was, I determined, about 12 years ago. A friend, a painter, had called one day to report that she was pregnant and desperate and did I know of anyone. The only abortionist I had heard of was one another friend, a model, had told me about. She had been taken to him blindfolded and he had charged her $1000. The model had not seen her doctor’s face without his mask and she did not know his real name. The painter, however, was able to make better arrangements. She called back to say that she had gotten wind of a Spencer in Ashland, Pennsylvania, who was supposed to be great, kind, and medically responsible, and who did abortions for practically nothing because he believed in them. A week later my painter friend came over to see me. Spencer in Ashland was a reality. He was, she reported with wonder, a kindly old man. His clinic was spotless. He had a nurse and an attendant. She had slept over at the clinic and had met some other girls who were in a similar plight. The next day, when she departed, he had given her an assortment of pills to ward off infection and build up her strength. He seemed concerned about her, downright fatherly. He didn’t make her think she had done something wrong. The operation hadn’t caused her much pain, and, the biggest wonder of all, it was only $50.

And so it was that Spencer went into my telephone book, under “A” for abortionist. I am poor at remembering telephone numbers, but Spencer’s old number is still in my memory. It was Ashland 404. I was an aspiring actress in those days, and much taken with Tennessee Williams. I remember once passing along the Spencer number to another friend and saying in my best “Summer and Smoke” voice, “Really, I think of it as the telephone number of God.” Young acting students are all over-dramatic, but there was good cause for such intense language when talking about Spencer. Spencer meant deliverance, it was as simple as that. Going to Spencer meant taking an alternative that the culture was doing its damnedest to hide or distort. The public image of an abortionist, through books, plays, movies, articles, or whatever, was of an evil, leering, drunken, perverted butcher at worst, and a cold, mysterious, money-hungry Park Avenue price-gouger at best. And then there was Spencer with his clinic on the main street of a small American town, who charged $50, who believed in abortions, and who was kind. Knowing about Spencer in Ashland was one irrefutable piece in the logic which led one to the conclusion that the culture was capable of the big lie.

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As the years passed, Spencer’s name would come up from time to time. The price had gone from $50 to $100. Some people remembered when it had been $25, or even $10. There were long stretches when the doctor in Ashland would go into retirement, and there were stories of treks to Ashland only to find the clinic boarded up and silent. There was, we heard, a death on his operating table from a reaction to the anesthesia. There was a trial and there was, miraculously, an acquittal. We heard misinformation, too. Spencer had become an abortionist, the rumor went, because his own daughter had died on the operating table of an abortionist-butcher. This story was untrue, unfortunately popularized in a bad novel based loosely on the life of Spencer by a lady novelist with one of those awkward three-name combinations. Maybe the lady meant it symbolically. Spencer’s real-life daughter, better information had it, was alive and well, and so was his son. Other information I absorbed about Spencer, I was later to learn, was quite accurate. He was a committed atheist and free-thinker who often pressed his literature into the hands of the girls along with the antibiotics and vitamin pills. He had gotten into abortion work during the ’20s through the supplication of the miners’ wives in the Pennsylvania coal country, and his work for the miners — he was a pioneer in the technique of bronchoscopy — won him a heavy workmen’s compensation caseload, and, some said, the protection of the United Mine Workers during the years when the protection of the mine workers was something that counted.

Ashland, Pennsylvania. Principal products: coal, homemade wine, and abortions. The sort of Americana that always evaded the Saturday Evening Post. The town of Ashland is in some parts as narrow as the width of two streets. One of those streets is Centre Street, which is also a state highway. For some romantic reason I’d pictured Spencer’s clinic as a rambling, gabled mansion with a front porch. It was, instead, a very ordinary three-story, brick-face structure, flat, characterless, and attached on both side to similar-looking units. Diagonally across from it was the local movie theatre, which bore the legend, “We Burn Coal.” Most of the private homes and business in Ashland resist installing oil burners, and show their defiance with a printed placard.

Spencer’s home was on South 9th Street, just a few blocks from the clinic. It was a little house with a storm door and no lawn. There was a Christmas wreath in the window. The hour was late when we rang the bell. Spencer’s wife, a tall, big-boned woman, greeted us and led us past the formal parlor to a back room: Spencer’s study.

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And there he was, a tiny wisp of a man, frail, dry as dust, with sharp, thin features and bright eyes. He was wearing a suit of some dark material and it hung on him loosely. Rappaport had told us that Spencer had more or less stopped eating this last year, convinced that his health was irrevocably failing. There were signs of his eating habits about: two opened packages of pistachio nuts. He sat in a rocker, with what looked like a bear rug slung over his knees. He hardly looked capable of the energy required to attend to three or four abortions a day, which was his current schedule. (In his heyday, he had handled 10 to 11 patients.)

We were introduced, and we gravely paid our respects to his reputation, which I think pleased him. The interests of the man were evident in his study. Books of every description, some still in their mail-order wrappings, lined the walls and were stacked on tables, fighting for space with the mementoes of his travels: large chunks of mineral rock, strange and beautiful Indian masks, a blow gun, and a fine collection of rifles. “Douglas likes to go boar hunting. Show them your boar-hunting pictures,” Rappaport said, and Spencer got up and obliged. The snapshots showed the tiny figure with a big, red hunter’s cap on his head, standing in a group with four or five other hunters, towering men, each with his rifle proudly stuck in the ground. Behind the hunting party, 11 large black boars were strung up in a neat row, quite dead. Dr. R. D. Spencer was, he informed us, firmly against gun registration.

Carol or Ira called attention to the microscopes. Several of them were about the room, some with camera attachments and light boxes, and one which Spencer himself had designed. Spencer’s training had been in pathology. Happy to show us the microscopes, he went to one of his cabinets and pulled out some slides. As we took turns at the microscope, intently viewing the various specimens of single-celled life that Spencer had prepared, the man grew increasingly more animated. He was entertaining his guests, and thoroughly enjoying it, and we in turn were thoroughly charmed and engaged, so much so that our friend Rappaport withdrew somewhat testily to the front parlor to converse with Mrs. Spencer.

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Warming to his audience, Spencer brought out further treasures. “This,” he announced of one exhibit, “is the life history of a fly.” And it was, from an insignificant speck to the insect as we know it. “Do you know what this is?” he queried, showing us a small, clear plastic block with something red and curled imprisoned in the center. It was, he told us, the embryo of a pig. We passed it from had to hand, marveling at its tiny perfection, examining it more closely under one of the microscopes. Spencer showed us another red, curled specimen in plastic. “A human embryo,” he announced. “Less than four weeks old.” Unbelievable, but there it was, tiny, more intricate than the pig, with a spot for the eye and the definite tracing of a spinal column. In all, he showed us three tiny human embryos, none more than a thumbnail long, but the third larger and more developed than the first. The only human embryos I had ever seen were those in a big picture layout in Life Magazine. These were in my hand, three-dimensional and real. I took the largest human one and compared it with the pig. A sentence from biology class popped into my head. “Well, ontogeny certainly does recapitulate phylogeny, doesn’t it?”

We were gripped by the human embryos and would have liked to see more, if there were any, but Spencer was digging in his cabinet for other exhibits. He showed us something pitch-black ad vaguely cloth-like in a glass slide. “I’ll give you a hint about this one,” he said, playing a game. “It’s animal and mineral and indigenous to the region.” We were stumped. “Carbon?” I ventured. “That’s the mineral part of it,” he admitted. “Well, a fossilized animal in coal?” I tried again. “This is a piece of a miner’s lung,” he stated simply. “The miner died, obviously.”

We didn’t leave Spencer’s house until close to 1 a.m., and we returned the next day. “He’s been expecting you all morning,” his wife said as she brought us to the rear study. We had thought, Carol and I, that we had better make a stab at a proper interview this time, particularly since Carol’s magazine was paying for her part of the trip. She set up her tape recorder and I reluctantly brought out my notebook. It seemed unfair to ruin a social visit. Spencer apparently though so, too. It was hard to keep him to the subject and several exasperated looks were exchanged among us as our host got involved in anecdote after anecdote, complex stories involving his diagnostic skills, but not at all about abortion.

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Trying our best to pin him down to his very first abortion, we discovered that there really was no such thing as a first abortion, a conscious decision to break the law, with trumpets. He had gotten requests from some local women, and he had obliged. “But why,” I persisted, “did you oblige? Most other doctors don’t. Why were you different? Why did you do abortions for women?” He rocked back and forth in his chair. “Because,” he said slowly, “I could see their point of view.”

For Carol, he attempted to describe his medical procedure. After using the packing method for a couple of years, one day he got a circular in the mail for Leunbach paste, manufactured in Germany. “By golly, it worked,” he told us. Later, when the Leunbach was taken off the market, he began manufacturing his own product in his laboratory, a mild soft-soap solution, which he used to dilate the cervix and loosen the conceptus in the first stage of his procedure. The following day he would complete the curettage. Spencer refined his own technique and he stuck with it for 40 years. The newer methods didn’t interest him.

Spencer told us that he was following with keen interest the recent attempts to liberalize abortion laws in several states. He himself had written Governor Shafer of Pennsylvania. “I told him that most of our laws are from the English,” he said spiritedly, “so why don’t we go to work and copy the one they just passed?” He talked about his letter-writing with the righteousness of an American Legionnaire or a Rotarian, which was not surprising, since he later told us that he was a founder of the Pennsylvania Legion and had been an active Rotarian all his life. His father had been the district attorney of the neighboring country. Did that explain his remarkable record of longevity in a career which is usually marked by the law crashing down on the practitioner’s head? “No,” he said thoughtfully. “I’ve been here since 1919. I daresay I’ve helped out half the town. Even on the abortion end, there is probably one of my patients related to a family in half of the town. I think most of the town would stand up for me.”

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It was 4 p.m. and beginning to snow, and Rappaport was urging us to get going. We said our goodbyes reluctantly. “Please come back and visit again soon,” Spencer urged. I had noticed that among his vast collection of books was a Writer’s Market ’69. Had he been thinking of publishing something, I inquired. Spencer smiled wistfully. Did he want an article about him in a major magazine, with a picture, I pushed. He allowed as how once the New York Times had been interested, but his lawyer had thought that the time wasn’t right. He still had an indictment hanging over his head. References to Spencer had appeared in print, but usually he was “the legendary Dr. S.” Time Magazine, as far as I knew, was the only mass circulation magazine to print his name in full. I told him I thought the time couldn’t be more right for publicity. The idea seemed to appeal to him. Punctiliously he gave me the address and telephone number of his lawyer in Pottsville, and then, special privilege, his own private unlisted number at the house. “We’ll do it for your 80th birthday,” I promised. He had told us that his birth date was March 16, and he was going to celebrate by shutting the clinic for a month and taking his wife on a trip around the world.

Last week I got a call from Dr. Rappaport. Spencer had died that morning at 5 a.m. ❖


Medical Alert

To the 3.3 million women living in New York City:

We thought you—among the toughest and most streetwise women in the country—ought to know the state of your health.

A report released this spring by the city’s health department emphasized that although New York’s poorest women disproportionately experience health problems, women representing every age group, race, and income bracket have reasons to be concerned about themselves too.

Some health crises target the young: AIDS is the number one killer of women ages 25 to 44, with 322 deaths per year—ending more lives than breast cancer and drug use combined. Others, like heart disease, are far more common in women 45 and older.

Neighborhoods where 30 percent of the population lives in poverty have the highest rates of obesity among women—not surprising, considering 44 percent of New York City’s women who are heads of households make less than $25,000 a year. Only 24 percent of the city’s adult women exercise.

Lower-income women, particularly Hispanic women, more frequently described feeling “emotional distress,” a measure of anxiety, depression, and similar problems. Fifty-six percent of women in distress also reported fair or poor health. Another potential measure of distress: One in three white women ages 18 to 24 binge-drink—compared to fewer than one in 10 black women in the same age group.

In 2003, an estimated 661,000 women in New York City were uninsured at some point. Twenty percent of the uninsured made less than $25,000 a year. Women without insurance are almost three times more likely to go to an emergency room for care than those with coverage—an indicator of lack of access to regular doctors.

Cancer—especially of the breast, cervix, bronchus, trachea, or lung—causes the most premature deaths among women. The average smoker dies 14 years younger than a nonsmoker. What you do now—smoke—or what you don’t do now—get Pap tests and mammograms—could translate into entire years cut from your life.

So take care of yourselves! We’ve included listings of clinics, hotlines, and services you can use to get in the best shape possible.


Women’s Health, 2005


The Mount Sinai Adolescent Health Center
312 East 94th Street, 212-423-2900,

The center provides free and confidential mental health, family planning, and health education services to young people ages 10 to 21. Special programs include youth parenting classes and support groups for rape and incest survivors.

National Women’s Health Network

This D.C.-based advocacy group fights for gender parity in health care through critical analysis of women’s health issues. For a $10 fee, it will provide an information packet on a topic such as saline breast implants, endometriosis, or female orgasm; the cost includes lists of glossary terms, resources, and additional reading. Free fact sheets on issues like emergency contraception and access to health care are also available online.

National Women’s Health Information Center

Part of the U.S. Department of Health and Human Services, the center offers comprehensive women’s health information on some 800 subjects, from nutrition and body image to menopause and hormone therapy. It also offers news and resources, including health publications, statistics, and medical glossaries, as well as a National Breastfeeding Helpline that gives free counseling to nursing mothers.

NYC Free Clinic
Sidney Hillman Clinic, 16 East 16th Street, 917-544-0735,

Every Saturday from 8:45 a.m. to noon, physicians and students of the NYU School of Medicine provide a variety of free health care services to the uninsured, from physical exams to pharmaceuticals to prenatal care. Appointments are only taken on Mondays between 4 and 5 p.m.

Women’s Health Line
311, 718-230-1111, or 212-230-1111

The New York City Department of Health and Mental Hygiene runs a call center that provides information on a wide array of topics affecting women, including family planning, pre- and post-natal care, and menopause. Counselors will take into account the caller’s location and financial situation before scheduling an appointment at a clinic, hospital, or other health services provider. Hotline services are available in English, Spanish, French, and Haitian Creole, as well as for the hearing impaired.

Women Veterans Health Program
Multiple locations, 212-686-7500,

Women vets are eligible for an extensive list of services through the VA Healthcare Network, offered at centers in Manhattan, Brooklyn, Queens, and the Bronx. They include cancer, heart disease, and osteoporosis screenings; breast and pelvic exams, to nutritional counseling and weight management, and substance and sexual abuse counseling.

Pregnancy, Parenting & Reproductive Health

The Alan Guttmacher Institute
120 Wall Street, 21st floor, 212-248-1111,

This nonprofit advocates for reproductive choice, and features a state-by-state breakdown of abortion policies, including insurance restrictions. It also provides information and statistics on abortion cost, safety, and legality.

National Abortion Federation

The free, anonymous hotline run by this professional association of abortion providers will give you a referral to a member clinic, plus answer questions you may have about procedures, in English or in Spanish. You can also search for a list of local providers on its website.

New York City Department of Health and Mental Hygiene Maternal, Infant and Reproductive Health Clinics
Multiple locations, 311 or 212-442-1740,

Walk-in pregnancy testing, counseling, and referrals for delivery and pre- and post-natal care are among the free services offered at these city-run clinics, which serve pregnant women and mothers with children under a year old.

Planned Parenthood of New York City
Multiple locations, 212-965-7000,

Free pregnancy testing and options counseling are offered by this organization, which advocates for and provides women’s reproductive health services. Also available by sliding-scale payment: birth control and emergency contraception, gynecological exams, and breast and cervical cancer screenings. Abortions, performed through the second trimester, require full payment.

The Postpartum Resource Center of New York

This nonprofit provides educational information and telephone support, including health care referrals and links to local support groups for mothers suffering from prenatal and postpartum depression.

Urban Baby

An online community of city mamas and mamas-to-be discuss only-in-New York topics such as organic baby food, au pairs, and stylish maternity wear. The site also features informative sections on everything from special-needs support groups to hospitals with progressive birthing policies, not to mention lists of popular NYC baby names by nabe.

Cancer & Life- Threatening Illnesses

American Cancer Society
19 West 56th Street, 3rd floor, 800-ACS-2345,

The Manhattan regional office offers a variety of free programs for cancer patients and their families, including “Look Good . . . Feel Better,” which teaches women undergoing chemotherapy or radiation treatments beauty techniques that will enhance their appearance and self-image. The service is also available to the Spanish and Chinese language communities; call for location and times and to register.

Breast Examination Center of Harlem
163 West 125th Street, 4th floor, 212-531-8000,

Women ages 40 and up should have regular mammograms to detect breast cancer, while sexually active women ages 18 to 65 should have routine Pap smears to test for cervical cancer. Both are offered for free at this Memorial Sloan-Kettering Cancer Center outreach program, founded to improve the early detection of breast cancer in Harlem residents, as well as offer them access to high-quality healthcare.

Colorectal and Prostate Initiative

Women ages 50 and up, or who are at high risk, are advised to get a colonoscopy to prevent colon cancer. The New York State Department of Health provides free colorectal cancer screenings to persons ages 50 and older who are uninsured or underinsured; those deemed at risk are referred for a colonoscopy.

The Family Center
66 Reade Street, 212-766-4522, 584 Nostrand Avenue, Brooklyn, 718-230-1379,

The center helps create a more secure environment for children whose parents—most of whom are single mothers—suffer from life-threatening illnesses, including cancer and HIV. Among the free services available: support groups, counseling, youth programs, and respite services for caregivers.

Gilda’s Club
195 West Houston Street, 212-647-9700; 502 8th Avenue, Brooklyn, 718-788-1600,

Named after comedienne Gilda Radner, the club provides members free services such as support and networking groups, workshops and lectures, and special programs like Noogieland, which is specifically aimed at children. Membership is open to persons with cancer and/or their family and friends.

Manhattan Breast Health Partnership
American Cancer Society, 19 West 56th Street, 3rd floor, 212-237-3910

The American Cancer Society offers free mammograms and Pap smears to uninsured and under-insured women with an income no higher than 2.5 times the current federal poverty line. Women 18 and over are eligible for a clinical breast exam and pelvic exam with Pap smear; you must be 40 and over or have a family history of breast cancer to receive a mammogram. Callers will be referred to one of the Society’s mobile units, regularly available in all the boroughs.

Women and Family Services, Gay Men’s Health Crisis,
119 West 24th Street, 6th floor, 212-807-6655,

This nonprofit offers an array of services for women and families living with HIV/AIDS, as well as for those at risk. They include crisis intervention, child sitting, legal workshops, and alcohol and substance abuse counseling.

Emotional Well-Being

Caregivers and Professional Partnership Resource Center
Mount Sinai Hospital, 19 East 98th Street, 9th floor, Suite 9E, 212-241-2277,

The center helps caregivers locate neighborhood services and programs to assist them, including organizations that provide respite care, at no charge. Bilingual services for Spanish speakers are also available.

Domestic Violence Hotline
1-800-621-HOPE, or 311,

The NYC Mayor’s Office to Combat Domestic Violence runs this 24-hour hotline, which offer information on shelters, counseling, legal assistance, and healthcare. The office also provides an array of services for victims, from permanent housing to emergency cell phones.

Inter-Group Association of Alcoholics Anonymous of New York
307 Seventh Avenue, Room 201, 212-647-1680,

There are meetings for recovering alcoholics every day of the week in every borough, including dozens of women-only support groups. Meetings are free and open to anyone with a desire to stop drinking.

The Lesbian, Gay, Bisexual & Transgender Community Center
208 West 13th Street, 212-620-7310,

The center provides mental health services, including those that address the unique emotions associated with gender transition. There are also programs such as the Lesbian Cancer Initiative, which makes available free short-term counseling and support groups for cancer survivors and care partners.

800-LIFE-NET (English), 877-298-3373 (Spanish), 877-990-8585 (Mandarin or Cantonese), 212-982-5284 (TTY for the hearing impaired)

This telephone crisis hotline run by the Mental Health Association of New York provides crisis intervention, as well as information on free or low-cost mental health care, including referrals. Treatment options for drug and alcohol abuse are also given.

Women’s Program at Payne Whitney Manhattan
525 East 68th Street, 888-694-5700,

This psychiatry program offers a variety of mental health services geared specifically toward women, as they are much more likely than men to experience anxiety or depression during their lives. Among the life events that may be triggers: infertility, pregnancy, pregnancy loss, menopause, breast cancer, and domestic violence. Ethnic and cultural considerations are also taken into account.

Diet & Body Image

National Association of Anorexia Nervosa and Associated Disorders

This nonprofit organization provides free support groups, treatment referrals, and information to both individuals struggling with eating disorders and their family members. The hotline is open Monday through Friday from 10 a.m. to 6 p.m.

The New York Obesity Research Center
St. Luke’s—Roosevelt Hospital Center, 1090 Amsterdam Avenue, 212-523-4196,

The mission of the center is to conduct research to help reduce the incidence of obesity. The center also has an outpatient weight-loss program that includes a full physical with blood work, followed by a dietician-designed food plan and weekly group meetings.

The Renfrew Center of New York
11 East 36th Street, 800-RENFREW,

This offshoot of the Philadelphia clinic, the nation’s first freestanding facility dedicated to treating eating disorders, offers outpatient services such as therapist-led support groups and young-adult psychotherapy groups.

Sexual Well-Being

New York City Department of Health and Mental Hygiene STD Clinics
Multiple locations, 311 or 212-427-5120,

The city’s health department has free, confidential STD clinics in all five boroughs, as well as medication and follow-up treatment. The clinics also offer emergency contraception, vaccines for hepatitis A and B, and HIV/AIDS testing on a confidential or anonymous basis, all at no charge.

New York Center for Human Sexuality
Columbia University Medical Center, Irving Pavilion, 11th floor, 161 Fort Washington Avenue, 212-305-0123

The center performs research and provides care relating to female sexual dysfunction, including problems with desire, arousal, orgasm, and pain caused by sexual activity. Hormone therapy, sex therapy and marital counseling are among the available treatment options.

The Women’s Sexual Health Foundation

From information pamphlets and public seminars to lists of support groups and health care specialists, this nonprofit provides a range of resources to educate the public and medical community on female sexuality. Among the topics explored: the difficulties with desire and arousal associated with female sexual dysfunction, and communicating such problems with your doctor.

Aging & Menopause

American Menopause Foundation
350 Fifth Avenue, Suite 2822, 212-714-2398,

The nation’s only independent nonprofit health organization dedicated to menopause provides up-to-date information on scientific research, as well as a network of volunteers who do community outreach.

The Mount Sinai Visiting Doctors Program
1 Gustave L. Levy Place, 212-241-4141,

This program provides medical care for the homebound elderly, including those who are uninsured. Visiting doctors make both routine and urgent visits, provide diagnosis and treatment and coordinate ongoing care with community groups and other health care professionals.

Osteoporosis Prevention Center at the Hospital for Special Surgery
635 Madison Avenue, 5th floor, 212-224-7935,,

This center is part of the New York State Osteoporosis Prevention & Education Program, an initiative aimed at increasing awareness of the disease, which causes bones to become thin and weak, and is often associated with menopause or advanced age. It offers bone density testing and individualized treatment, as well as community outreach, including free lectures to organizations.


Mothering the Mother

Former Brooklyn resident Robbie Bent called a mothers helpline six weeks after giving birth, feeling incapable of motherhood. A woman answered and it took minutes before Bent stopped sobbing long enough to tell her, “I’m exhausted, I’m crying all the time, and I don’t know what to do.” The woman’s advice: Hire a postpartum doula—a woman who “mothers the mother,” according to Dr. Dana Raphael’s The Tender Gift.

Bent is one example of the approximately 10 percent of new mothers affected by postpartum depression. Developing in the year following childbirth, symptoms can include irritability, sadness, and ambivalence toward one’s child. Treatment includes psychotherapy, medication, or a combination of both, but health professionals are increasingly recommending doula care in addition to these.

Part teacher, sounding board, and household help, doulas are experienced with newborns, offer a listening ear, and have been known to spoon-feed nursing mothers too busy to eat. “My main concern is that you’re bonding with your baby,” said Kathy Koncelik, a doula from East Islip, New York. Doulas keep households running with grocery shopping, cooking, and light housekeeping while helping parents learn skills like comforting, diapering, and bathing their babies. “Doulas are there to facilitate,” said Ruth Callahan, owner of Doula Care Postpartum Services, a Manhattan-based business.

Doulas do not provide medical services or medical advice but can guide new mothers and families to resources including local lactation consultants, mental health providers, and support groups as necessary.

To become a doula, neither training nor motherhood are required, but professional organizations have developed certification programs to help standardize the industry. These requirements vary among organizations so it is important to inquire about a doula’s training, recognizing that some may have tremendous experience without certification.

At $25 to $40 an hour in New York City, postpartum doula care is pricey, but temporary. Special needs like multiple births or mood disorders may make extended care preferable, but doulas typically work with a family part-time for one to four weeks (depending largely upon budget) while gradually reducing their hours. “The goal is for you not to need us,” Callahan said.


Chances Are

She triumphed over breast cancer 12 years ago, but Ivis Febus-Sampayo stared it in the face again this January when a genetics test revealed she carried a specific gene mutation, which put her chances of developing a cancerous lump in her breast at a roughly estimated, and frightening, 45 percent.

A 50-year-old wife and mother of two boys, Febus-Sampayo took aggressive action against the deadly disease. She went under the knife and preemptively had her ovaries removed, narrowing the likelihood of a malignant growth in her breast. With early detection of tumors directly linked to cancer survival rates, Febus-Sampayo has regular mammograms and oncologist visits. Additionally, she has an annual breast MRI (magnetic resonance imaging), recommended only for high-risk patients. While MRIs have been shown to find tumors when they are smaller and easier to treat, misreading the findings can result in false alarms and numerous painful biopsies.

Credit the field of genetics with giving Febus-Sampayo the heads-up about her genetic risks. Today, women are only a blood test away from knowing their susceptibility to breast cancer, giving those who test positive for key gene mutations the time to weigh their options. Some women choose to attack the disease, no holds barred, by having their ovaries or breasts removed. Others opt for preemptive drug treatments. Almost all step up the pace and intensity of their regular exams.

The two most famous inherited genes linked to breast, as well as ovarian and prostate, cancer are BRCA1 and BRCA2, located on the 17th and the 13th chromosomes respectively. The mutation, most prevalent among Eastern European Ashkenazi Jews, the Dutch, and Icelandic people, accounts for the vast majority of breast cancer cases chalked up to genetic mutations. (Only 5 to 10 percent of all breast cancer is pinned solely on the genes.) While possessing the mutation does not guarantee a person will develop tumors—individual factors, like obesity and lack of exercise, play a role—it does make it much more likely that the carrier will be one of the 211,240 new breast cancer cases the American Cancer Society expects to be diagnosed in 2005.

Physically speaking, genetic testing is as easy as giving blood. But the emotional implications seem heavy as stone. Many fear that a positive result will cost them, or their family members, health insurance or jobs. If insurance doesn’t cover the testing, costs can run up to $3,000, said Carolyn Farrell, director of clinical genetics services at Roswell Park Cancer Institute in Buffalo, New York. Others fear the reaction of relatives. “Some people are afraid that if they have the mutation, their children will have it,” Farrell said. “They feel guilty.” As a nurse practitioner and genetic counselor, Farrell’s job includes accessing a patient’s cancer risk via family history and helping patients tackle the psychological issues of the testing. “If their siblings have cancer and they don’t have a mutation, they feel guilty and fear their family’s anger,” she added.

Febus-Sampayo agonized over being tested for two years before taking the plunge. This despite the fact that she works as director of LatinaSHARE, the Hispanic-oriented branch of SHARE: Self-Help for Women with Breast or Ovarian Cancer. Not only was she concerned about her family’s health insurance coverage, but she found it difficult to broach the subject of her results—that she was BRCA2-positive—with her female relatives. She ended up telling her two sisters, giving them her genetic counselor’s contact information. She never told her mother, a known worrier.

In addition to leading the way in cancer prevention, genetics has opened doors to cancer treatment. The latest wonder-drug is Herceptin, which targets a genetic defect in certain cancer cells, and is highly effective when used with chemotherapy. “That is probably the most significant advance in systemic therapy in 10 years,” said Dr. Deborah Axelrod, director of clinical breast services and surgery at New York University Clinical Cancer Center. While she is excited about Herceptin, Axelrod also sees it as a launching pad for other therapies targeting even greater numbers of cancer cells.

Axelrod believes genetics will give health professionals more insight into each patient’s illness, allowing doctors to fine-tune treatments for individuals. “We’re going to try to predict the biology of breast cancer,” she said.


The End to Endometriosis

For years I thought I was cursed. My monthly “curse” was worse than that of anyone I knew. My father would snicker at me and call me baby as I lay in bed. My female family members would roll their eyes and say that they didn’t even notice their “special friend.” I hated them. Every month, I imagined that tiny man-dwarves were hacking away at my insides, gleefully twisting up the muscles, punching, hitting, and scraping away for hours on end. A kung fu master kicking me in the stomach would have been preferable to getting my period.

Each time, I’d search for a cure. I’d take four Aleves, a fistful of aspirin; I’d try muscle relaxants, and painkillers—sometimes all together. Once I had morphine. Nothing worked. Surprisingly, marijuana was the only thing that gave any relief, but I couldn’t tell if it was the natural medicinal qualities of the herb, or the fact that I was simply stoned enough not to care about the pain.

It wasn’t until a few years ago that I was diagnosed with endometriosis. My fantastic doctor assured me that I was not alone. Endometriosis—a condition that afflicts approximately 5.5 million women in the United States and Canada of childbearing age—is a chronic disease that occurs when the endometrial tissue normally found in the uterus drifts to other parts of the body—the fallopian tubes, the cervix, even the bladder. These lesions grow with each cycle, but unlike menstrual blood, the buildups can’t exit the body, and scars or cysts form. The results are an increase in pain before, during, and after the menstrual cycle; gastrointestinal complications like diarrhea, constipation, and nausea; and risk of infertility.

For some, surgery is an effective option. A minimally invasive laparoscopic operation removes the endometrial growth via small incisions and only requires a one-day hospital stay. Additionally, doctors lessen the amount of bleeding via hormonal treatments—prescribing the more conservative birth control pill treatment, or more radical drugs like Lupron, which temporarily induces medical menopause, and Danazol, which inhibits ovulation. Three years after surgery, period pain is a distant memory.


Is He Spongeworthy?

Good news! The days of hoarding your dwindling supply of Today Sponges are over. Though it’s still worthwhile to test whether a prospective lover is “spongeworthy,” as Elaine did on Seinfeld, the sponge has bounced back and is available after an 11-year hiatus.

The once popular over-the-counter form of birth control won re-approval for marketing from the FDA this April. Though the sponge’s safety and effectiveness were never in question, the previous manufacturer, took the sponge off the market in 1994 when they decided not to upgrade their plant because of cost. Allendale Pharmaceuticals bought the rights to the Today Sponge in 1998 and recommenced distribution this summer.

Between 1983 and 1994, when the Today Sponge was previously offered in the U.S., roughly 250 million sponges were sold. The soft, disk-shaped foam device is coated with sperm-killing nonoxynol-9 and prevents pregnancy by killing sperm in the vagina and blocking the cervix to hinder the progress of sperm into the uterus.

The sponge is not messy like creams or foams, does not have to be fitted by a doctor like a diaphragm, and contains no hormones like the pill. It has few side effects and can be used at a moment’s notice. However, it needs to be moistened with water before it is inserted. Protection begins once you position the sponge. A ribbon loop aids in removing the device, which must remain in place for at least six hours after the last intercourse—the time it takes the spermicide to kill sperm in the vaginal canal.

As with most contraceptives, there are shortcomings. The sponge has a success rate of about 90 percent. Also, removing the device can be tricky—there is a toll-free number for users who find the entire sponge or parts of it stuck inside them. Another drawback is that the sponge offers no protection from sexually transmitted diseases.

Though the sponge has its faults, its return is being celebrated by women who cannot tolerate hormonal contraceptives, are sensitive to latex, or choose not to use these methods. Moreover, it provides women with another choice in birth control—good news, indeed.


Our Bodies, Our Books

Our Bodies, Ourselves: A New Edition for a New Era
by The Boston Women’s Health Book Collective (Touchstone, 2005)

With colorful photos of hymens, this “book by and for women” has sold more than 4 million copies in 18 languages. The latest edition is a bit trendier than earlier ones, featuring info on boob jobs, bikini waxes, and the meaning of “vulva chic.”

Women’s Bodies, Women’s Wisdom: Creating Physical and Emotional Health and Healing
by Christiane Northrup, M.D. (Bantam, 1998)

The author, a feminist holistic physician, believes bodily dysfunctions can be healed, and even prevented, by utilizing herbs, receiving acupuncture, and making more friends.

Woman: An Intimate Geography
by Natalie Angier (Anchor, 2000)

Addressing the reader as “Sister,” Angier, a Pulitzer Prize-winning biology writer for The New York Times, offers a “scientific fantasia of womanhood,” celebrating all aspects of the female body. The X chromosome, she says, has a “vastly higher gene richness” than the “depauperized little stump” we call the Y.

Health Issues for Women of Color: A Cultural Diversity Perspective
edited by Diane L. Adams, M.D. (SAGE Publications, 1995)

Black, Native American, Asian, and Middle Eastern women in the United States are dying far earlier than the rest of the American population. This book was the first to carefully explore, and protest, the disparity.

The Second X: The Biology of Women
by Colleen Belk and Virginia Borden (Custom Publishing, 1998)

The authors upset the conventional idea that women are mini-versions of men.

The New Harvard Guide to Women’s Health
by Karen J. Carlson, M.D.; Stephanie A. Eisenstat, M.D.; Terra Ziporyn, P.H.D. (Belknap Press, 2004)

An upbeat, alphabetized encyclopedia with entries on ordinary bodily concerns—anxiety, fat-fear, mysterious rashes—as well as rare reproductive diseases.

The Big Bang: Nerve’s Guide to the New Sexual Universe
by The Writers at Nerve (Plume Books, 2003)

Good pictures of twiggy hipsters, mostly naked, accompany explanations of concepts like “foreplay,” “female ejaculation,” and “sexual fitness.” The chapter on STDs is simply titled “Read This Chapter.”

The V Book: A Doctor’s Guide to Complete Vulvovaginal Health
by Elizabeth G. Stewart, M.D. and Paula Spencer (Bantam, 2002)

The authors encourage women to “loosen up” and talk about what’s “down there.” The guide covers anatomy, self-care, a vast array of minor diseases, and strategies for better communicating with your doctor.