Most countries offer the Pill over-the-counter

NEW YORK (Reuters Health) - Unlike women in the U.S., Canada and much of Europe, most women in the world can access the birth control pill without a prescription, according to a new study.
As medical organizations and other groups push to ease the prescription requirements for the Pill in the U.S. and elsewhere, "we can start to use this information to... get a sense of the safety of women having access to this method where no prescription is required," said Kari White, who studies birth control at the University of Alabama in Birmingham.
The Pill is generally considered safe, said White, who was not involved in the new work, and some studies have shown that, without a doctor's input, women can accurately screen themselves for risk factors to steer away from using the Pill if it's not appropriate for them.
Earlier this year, the American College of Obstetricians and Gynecologists, a leading group of women's doctors, endorsed the idea of making the birth control pill available without a prescription (see Reuters Health report of November 20, 2012 here: http://reut.rs/UH0Zz9).
In a survey of government health officials, pharmaceutical companies, family planning groups, medical providers and other experts in 147 countries Dr. Daniel Grossman, of Ibis Reproductive Health in Oakland, California, and his colleagues found that women in the U.S. and 44 other countries need a prescription to get birth control pills.
The group reported in the medical journal Contraception that while another 56 countries had laws requiring prescriptions, in practice women could access the contraception over-the-counter.
Thirty-five countries legally allowed access to oral contraceptives over-the-counter, and 11 countries allowed over-the-counter access as long as the woman is screened to ensure that she is a good candidate.
"The patterns we saw were interesting," said Grossman. "Higher income countries - western Europe, Australia, Japan and North America - generally require a prescription."
Grossman told Reuters Health he couldn't explain why these patterns have emerged.
"Perhaps in places like China and India that have pills available over-the-counter formally without a prescription might be consistent with strong national family planning programs," he speculated.
Dr. Ward Cates, of FHI 360, a research organization in Durham, North Carolina, said the lack of a prescription requirement might also reflect a general approach to making health care more accessible in countries where it is less available.
In some countries, "healthcare tends to be more fragmented and healthcare oversight tends to be more fragmented. Therefore the availability of products tends to percolate to outlets that tend to be more accessible to the public," said Cates, who was not part of the study.
Grossman said it will be useful for countries looking to ease restrictions on birth control access to look to the experiences of these countries.
"Will this information about the availability of pills being over-the-counter in other countries influence policy here? Probably not," Grossman told Reuters Health.
"But I do think it helps to put it in perspective that this is not something revolutionary."
SOURCE: http://bit.ly/S51BnH Contraception, online December 10, 2012.
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Annual Pap tests? For some in U.S., old habits die hard

CHICAGO (Reuters) - An increasing number of younger women in the United States are delaying their first Pap test for cervical cancer until after they reach 21, reflecting new U.S. guidelines, health officials said on Thursday.
But 60 percent of U.S. women who have had a total hysterectomy and no longer have a cervix are still getting the tests, a sign that old habits may die hard, experts said.
Although an annual Pap test was once the standard of care, most professional groups including the American Cancer Society, the American College of Obstetricians and Gynecologists, and the U.S. Preventive Services Task Force, a government-backed panel, now recommend that most women get tested every three to five years, and that younger women delay their first test until 21.
And these same three groups agree that screening is unnecessary for most women who have had a total hysterectomy - the removal of the uterus and cervix - for non-cancerous reasons. Likewise, women over 65 who have had years of negative tests no longer need to be screened.
The guidelines are meant to curb overscreening, which increases the risk of unnecessary surgery and preterm birth in younger women, and adds unnecessary cost to the care of women over 65 who have never had a problem Pap and those who have had their cervix removed.
In light of the changes, two teams at the U.S. Centers for Disease Control and Prevention analyzed Pap test data from 2000 to 2010 to see how well doctors were adjusting to the call for less frequent screening.
They found the number of women aged 18 to 21 who had never been screened doubled, rising to 47.5 percent in 2010. The team also found that in 2010, women age 30 and older were less likely to report having a Pap test in the last three years.
And while Pap testing fell among women who had a hysterectomy, dropping to 60 percent in 2010 from 73 percent in 2000, the number still reflects significant overtreatment.
Meg Watson, an epidemiologist with CDC's Division of Cancer Prevention and Control, said there are some women who need to continue screening after a hysterectomy, including those whose surgery was done to remove cancers. But that number is small.
"We feel that this would still be a minority of women, and it should not be the 60 percent that we're seeing now," she said.
CDC researchers said the guideline changes are recent, but the trends do reflect a shift toward adhering to them.
TEST 'DEEPLY ENTRENCHED'
Dr. David Chelmow, a professor of obstetrics and gynecology at Virginia Commonwealth University Medical Center, who helped write the latest ACOG guidelines, concedes that it makes little sense to continue to give regular Pap smears to so many women who already have had a hysterectomy.
"It's tough to get cervical cancer without a cervix," he said.
Chelmow said widespread cervical cancer screening has significantly reduced cervical cancer rates in the United States, which have fallen by 70 percent in the last four decades.
The practice of annual Pap tests is "deeply, deeply entrenched," he said.
Although overscreening adds to health costs and unneeded worry and procedures for everyone, overscreening young women may carry even greater risks because treatments can weaken the cervix and hamper a young woman's chances of carrying a child full term, said Watson of the CDC.
Cervical cancer is a slow-growing cancer caused by exposure to certain strains of the human papillomavirus (HPV), a common sexually transmitted disease that causes precancerous abnormalities of the cervix.
In women under 21, HPV infection is very common, but cancer itself is "vanishingly rare," occurring at a rate of about one in 1 million, Chelmow said.
Cervical cancer is the second most common cancer in women worldwide, with about 500,000 new cases and 250,000 deaths each year, according to the World Health Organization.
In the United States, about 12,000 women developed new cases of cervical cancer last year, and 4,220 women died from their cancer, according to the American Cancer Society.
Most deaths occur in women who were infrequently screened or were not screened at all.
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Julia Roberts to star in HBO film on early AIDS epidemic

LOS ANGELES (Reuters) - Julia Roberts will star as a paraplegic physician treating patients early in the AIDS epidemic in the stage-to-screen adaptation of the Tony Award-winning drama "The Normal Heart," U.S. cable television network HBO said on Friday.
"The Normal Heart," set to air on HBO in 2014, tells the story of the dawning of the epidemic in 1980s New York.
Oscar-winner Roberts plays Dr. Emma Brookner, who treats several early patients infected with the HIV virus that causes AIDS. Co-star Mark Ruffalo plays Ned Weeks, an eyewitness to how the disease ravaged the city's gay community.
The film will be directed by "Glee" creator Ryan Murphy and was adapted by the play's author, Larry Kramer, an early advocate for AIDS prevention and care.
"Ryan has assembled an extraordinary cast to bring Larry Kramer's landmark theatrical achievement to the screen for the first time, and we couldn't be more thrilled to bring this important film to HBO," Michael Lombardo, HBO's president of programming, said in a statement.
"The Normal Heart" debuted on stage in 1985 in New York and was revived on Broadway in 2011, winning the Tony Award for best revival.
The movie version was originally envisioned as big screen release before HBO took it up as a television film.
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Presidents of Sudan, South Sudan to meet Friday

ADDIS ABABA, Ethiopia (AP) — Ethiopia's Ministry of Foreign Affairs says the presidents of Sudan and South Sudan, two countries which were at the brink of all-out war last year, are to meet Friday in Ethiopia's capital.
Spokesman Dina Mufti said Thursday that Ethiopia is optimistic the meeting will advance stalled peace deals.
Sudan President Omar al-Bashir and South Sudan President Salva Kiir signed deals in September to restart the south's oil industry. South Sudan's oil flows through Sudan's pipelines, bringing in revenue for both countries. The south shut down its oil industry last year after accusing Sudan of stealing its oil. Disagreements on the implementation of the September deal persist.
Ethiopian Prime Minister Hailemariam Desalegn and African Union mediators are expected to push the two leaders for a rapid implementation of the September deals.
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Ethiopian police says Qaida terror cell arrested

ADDIS ABABA, Ethiopia (AP) — Ethiopia's spy agency says that security forces have arrested 15 people alleged to be members of a terror cell linked with al-Qaida.
The spy agency says military training manuals, videos and weapons were seized from the suspects. The agency announced the arrests late Wednesday.
Authorities said the suspects were trained by al-Shabab militants in neighboring Somalia and Kenya. They alleged the group was planning to launch attacks based in Ethiopia's Somali and Harara regions.
On Tuesday the country's federal high court convicted 10 people on similar terror charges.
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AP names Torchia as bureau chief in South Africa

JOHANNESBURG (AP) — Christopher Torchia, The Associated Press bureau chief in Turkey who has reported from five continents, has been appointed chief of bureau for AP for southern Africa.
The appointment was announced Thursday by Africa Editor Andrew Selsky.
"Torchia is one of the best foreign correspondents in the business and has the experience and talent to deliver fascinating stories from this important and diverse region," Selsky said.
As southern Africa bureau chief, Torchia, 45, will oversee coverage of South Africa, Zimbabwe, Mozambique, Botswana, Namibia, Zambia, Angola, Madagascar, Lesotho, Swaziland and Malawi. He will be based in Johannesburg and report directly to Selsky.
He joined the AP in Albany, the New York state capital, in 1989 after a stint at The Albuquerque Journal in New Mexico. He moved to the AP's Boston bureau and the international editing desk in New York, and then transferred to Colombia in 1994, covering drug cartels and rebel and paramilitary groups.
He was posted to Indonesia during the Asian economic crisis that helped oust President Suharto in 1998 and served as bureau chief in South Korea and Singapore, reporting on events including the North Korean nuclear standoff and the Indian Ocean tsunami in 2004. In late 2006, he moved to Istanbul, where he drove coverage of Turkey's rising diplomatic and economic profile and contributed to reporting on the Mideast and on the Arab spring uprisings and Syria's civil war.
He also has reported frequently from Iraq and Afghanistan, covering the 2006 execution of Saddam Hussein in Baghdad, among other stories.
Torchia holds a bachelor of arts degree from Yale University. He is the co-author of "How Koreans Talk" and "Indonesian Slang: Colloquial Indonesian at Work."
An American, Torchia lived in South Africa as a youth. His father, Andrew Torchia, a foreign correspondent for AP before retiring in 1994, also served as AP's bureau chief in Johannesburg in the 1980s.
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Nigeria airline in June crash resumes flights

LAGOS, Nigeria (AP) — The Nigerian airline involved in a June crash that killed at least 163 people resumed domestic flights Thursday, even though officials acknowledge they still don't know what brought the aircraft down and that the families of the dead still haven't received insurance settlements.
Government authorities cleared Dana Air to again fly the same type of planes involved in the crash, despite public outrage over the disaster in a nation with a long history of airplane tragedies. Meanwhile, passengers still nervously board flights, even though the country's aviation industry remains mired in financial problems and is governed by lax oversight.
Smiling staffers stood Thursday at empty check-in and ticket counters at a domestic wing of Murtala Muhammed International Airport in Lagos, as only a few passengers paid for seats on its 4:20 p.m. flight Thursday to Nigeria's capital, Abuja. The private airline planned to have a flight Friday morning carrying local celebrities, government officials and journalists to the capital and back as a sign that the carrier was again open for business, said Tony Usidamen, a Dana spokesman.
The carrier was offering tickets as cheap as 14,400 naira ($90) one-way to the capital, about half the price of its competitors, as a means of luring back passengers. However, Usidamen said the carrier planned a limited flight schedule for the coming weeks and acknowledged it would be a while before its flights were full again.
"It's going to take time to publicize the resumption of flights and to regain the public's confidence," the spokesman told The Associated Press.
On June 3, a Dana Air MD-83 twin-engine jet crashed in a crowded neighborhood on the outskirts of Lagos, killing all 153 people onboard and at least 10 on the ground, authorities have said. The pilots told air traffic controllers that the plane lost power to both engines just before the crash. The reason for the power loss remains unclear. Crash investigators in Nigeria have said the flight data recorder on the plane melted in the ensuing fire.
Dana will fly its remaining stock of five MD-83s, airplanes built by McDonnell Douglas, which was later bought by Boeing Co. The aircraft series is a mainstay of airlines around the world, with a large number still flown by American Airlines, owned by AMR Corp. Joe Obi, a spokesman for Nigeria's Aviation Minister Stella Oduah, pointed to that when asked if authorities had any concerns about Dana continuing to fly that model.
"Until we are sure what caused the crash, we can't make a decision on the MD-83," Obi told the AP.
Federal officials have given Dana Air a two-month window to complete insurance payments to the bereaved, Obi said. That could prove difficult, as Usidamen said the airline's insurers have made full payments to only five families of victims so far. Usidamen blamed the delays on families not getting needed documents from probate courts.
Nigeria has suffered a series of plane crashes over the last decades, with authorities never offering clear explanations for why the disasters happened. Obi said Nigeria's government planned to immediately publicize the cause of the Dana crash as soon as it knew, but the government has previously declined to publish the causes of other crashes.
Other airlines in Nigeria, Africa's most populous nation, have collapsed or faced dire financial straits over the last year.
Air Nigeria, the nation's second-largest carrier, collapsed in September amid allegations of financial mismanagement. Arik Air Ltd., the country's largest and perceived safest carrier, recently halted domestic flights after its management alleged Oduah had a financial interest in seeing the airline fail. The carrier later resumed its flights, but raised its prices as authorities halted other smaller carriers from flying due to financial and safety issues.
Air travel, despite its perils, represents the quickest way for those who can afford it to travel across Nigeria, a nation twice the size of California and with decrepit and dangerous roads. However, experts say Nigerian aviation authorities remain overworked and safety regulations are laxly enforced in a nation where bribery is an epidemic.
The Dana Air crash represented the worst airline disaster in the country since Sept. 27, 1992, when a military transport plane crashed into a swamp shortly after takeoff from Lagos and killed all 163 people onboard. The worst air disaster in Nigeria happened in 1973, when a Jordanian Boeing 707 crashed at Nigeria's Kano international airport and killed 176 people.
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C. African Republic leader fires son from post

BANGUI, Central African Republic (AP) — Facing an insurgency by a new rebel coalition, the president of Central African Republic consolidated military power under his control Thursday after dismissing his own son as acting defense minister along with his army chief of staff.
President Francois Bozize said in a decree read on state radio late Wednesday that he was taking over the position held by his son, Jean Francis Bozize as neighboring countries sent troops to help.
Hundreds of soldiers from Chad, Republic of Congo, Gabon and Cameroon have been in arriving this week in this desperately poor, landlocked country where rebels have seized 10 towns in a month's time.
Rebel spokesman Col. Djouma Narkoyo reiterated Thursday that they were holding their position at the transportation hub of Sibut pending negotiations in Gabon. They have apparently made no further advance toward the capital since taking the town on Dec. 29.
"Our position today is that we respect the decision of the Economic Community of Central African States," he said by satellite phone. "That's why we are staying in Sibut and are not advancing."
In New York, France's U.N. Ambassador Gerard Araud said there will be a meeting in Libreville, Gabon on Jan. 8 to promote a political solution to the crisis, mediated by President Denis Sassou Nguesso of the Republic of Congo.
"The goal is to have a political agreement in Libreville, a national unity government ... and eventually a peaceful settlement," he told reporters after a closed-door briefing to the U.N. Security Council Thursday on the latest developments in the Central African Republic by U.N. political chief Jeffrey Feltman.
Araud said the African Union and regional groups are in the lead and have been very active, and the Security Council is supporting them and will likely issue a press statement Friday. He said France planned to circulate the text to the 14 other council members on Thursday evening.
"They have stopped the rebels, and they have ideas about a national unity government," Araud said of the AU and regional groups. "So everything will be discussed in the meeting in Libreville on the 8th, and after the meeting in Libreville we'll see whether the U.N. has to do something."
Residents in the capital of Bangui said Bozize's decision to fire his own son was not surprising given the recent military losses. But some noted Bozize may be making his moves too late.
"It's coming too late because the security of our country is already in the hands of rebels," said Jean Nestor Kongbu as he watched fishermen cast their nets in the Obangui River that separates Central African Republic from Congo. ... They say they won't advance, but the government could provoke the rebels or the rebels could provoke the government. They need to negotiate for the Central African people."
The sudden military reorganization also suggests that Bozize's regime may be weakening, said Thierry Vircoulon, the project director for Central Africa at the International Crisis Group.
"If he is dismissing his own son, it means he is getting more and more isolated," Vircoulon said.
Jennifer Cooke, director of the Africa program at the Washington-based Center for Strategic and International Studies, said people see Bozize "as a losing ticket right now."
"People are losing confidence in him and he has every reason to be a bit paranoid right now watching the disintegration of the country," she said.
The United Nations called for talks between the government and rebels and the Security Council scheduled closed consultations on the Central African Republic on Thursday afternoon.
The rebels have indicated they will participate in upcoming talks in Gabon but are also insisting that Bozize go. The president says he will not leave before finishing his term in 2016.
Bozize himself took power in 2003 following a rebellion with the help of Chadian forces. He later went on to win elections in 2005 and 2011, though the opposition and international observers have called the votes deeply flawed.
The rebels behind the latest challenge to Bozize's rule are made up of four separate groups all known by their French acronyms — UFDR, CPJP, FDPC and CPSK. They are collectively known as Seleka, which means alliance in the local Sango language, but have previously fought one another. In September 2011, fighting between the CPJP and the UFDR left at least 50 people dead in the town of Bria and more than 700 homes destroyed.
Just 70 miles (112 kilometers) to the south of Sibut, government and regional forces are fortifying the town of Damara, where truckloads of Chadian troops patrol with rocket-propelled grenades and other weapons.
Gen. Jean Felix Akaga, who heads the regional force known as FOMAC, says a push on Damara, 45 miles (75 kilometers) north of the capital, would be "a declaration of war" on the 10 Central African states.
"For us, Damara is the red line that the rebels cannot cross," Akaga said Wednesday. "If they attack Damara, we will attack.
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US rate on 30-year mortgage rises to 3.71 pct.

WASHINGTON (AP) — Average rates on fixed mortgages rose this week, the first increase in seven weeks. But mortgage rates remain near historic lows, boosting prospects for home sales this year.
Mortgage buyer Freddie Mac said Thursday that the average rate on the 30-year loan increased to 3.71 percent. That's up from 3.67 percent last week, the lowest since long-term mortgages began in the 1950s.
The average rate on the 15-year mortgage, a popular refinancing option, rose to 2.98 percent. That's up from 2.94 percent last week, also a record low.
The rate on the 30-year loan has been below 4 percent since early December. Low rates are a key reason the housing industry is showing modest signs of a recovery this year.
In April, sales of both previously occupied homes and new homes rose near two-year highs. Builders are gaining more confidence in the market, breaking ground on more homes and requesting more permits to build single-family homes later this year.
Low rates could also provide some help to the economy if more people refinance. When people refinance at lower rates, they pay less interest on their loans and have more money to spend.
Still, the pace of home sales remains well below healthy levels. Economists say it could be years before the market is fully healed.
Many people are still having difficulty qualifying for home loans or can't afford larger down payments required by banks. Some would-be home buyers are holding off because they fear that home prices could keep falling.
The economy is growing only modestly and job creation slowed sharply in April and May. U.S. employers created only 69,000 jobs in May, the fewest in a year.
Mortgage rates have been dropping because they tend to track the yield on the 10-year Treasury note. Uncertainty about how Europe will resolve its debt crisis has led investors to buy more Treasury securities, which are considered safe investments. As demand for Treasurys increase, the yield falls.
To calculate average rates, Freddie Mac surveys lenders across the country on Monday through Wednesday of each week.
The average does not include extra fees, known as points, which most borrowers must pay to get the lowest rates. One point equals 1 percent of the loan amount.
The average fee for 30-year loans was 0.7 point, unchanged from last week. The fee for 15-year loans also was unchanged at 0.7 point.
The average rate on one-year adjustable rate mortgages slipped to 2.78 percent from 2.79 percent last week. The fee for one-year adjustable rate loans was 0.5, up from 0.4.
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US fixed mortgage rates fall to new record lows

 Fixed U.S. mortgage rates fell again to new record lows, providing prospective buyers with more incentive to brave a modestly recovering housing market.
Mortgage buyer Freddie Mac said Thursday that the average on the 30-year loan dropped to 3.62 percent. That's down from 3.66 percent last week and the lowest since long-term mortgages began in the 1950s.
The average rate on the 15-year mortgage, a popular refinancing option, slipped to 2.89 percent, below last week's previous record of 2.94 percent.
The rate on the 30-year loan has fallen to or matched record low levels in 10 of the past 11 weeks. And it's been below 4 percent since December.
Cheap mortgages have provided a lift to the long-suffering housing market. Sales of new and previously occupied homes are up from the same time last year. Home prices are rising in most markets. And homebuilders are starting more projects and spending at a faster pace.
The number of people who signed contracts to buy previously occupied homes rose in May, matching the fastest pace in two years, the National Association of Realtors reported last week. That suggests Americans are growing more confident in the market.
Low rates could also provide some help to the economy if more people refinance. When people refinance at lower rates, they pay less interest on their loans and have more money to spend. Many homeowners use the savings on renovations, furniture, appliances and other improvements, which help drive growth.
Still, the pace of home sales remains well below healthy levels. Many people are still having difficulty qualifying for home loans or can't afford larger down payments required by banks.
And the sluggish job market could deter some would-be buyers from making a purchase this year. The U.S. economy created only 69,000 jobs in May, the fewest in a year. The unemployment rate rose to 8.2 percent last month, up from 8.1 percent in April.
The government reports Friday on June employment.
Mortgage rates have been dropping because they tend to track the yield on the 10-year Treasury note. A weaker U.S. economy and uncertainty about how Europe will resolve its debt crisis have led investors to buy more Treasury securities, which are considered safe investments. As demand for Treasurys increase, the yield falls.
To calculate average rates, Freddie Mac surveys lenders across the country on Monday through Wednesday of each week.
The average does not include extra fees, known as points, which most borrowers must pay to get the lowest rates. One point equals 1 percent of the loan amount.
The average fee for 30-year loans was 0.8 point, up from 0.7 percent last week. The fee for 15-year loans also was 0.7 point, unchanged from the previous week.
The average rate on one-year adjustable rate mortgages fell to 2.68 percent, down from 2.74 percent last week. The fee for one-year adjustable rate loans rose to 0.5 point, up from 0.4 point.
The average rate on five-year adjustable rate mortgages was unchanged at 2.79 percent. The fee stayed at 0.6 point.
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