ENID, Okla. — May is Women's Health Month, and the Garfield County Health Department and Enid Community Clinic want area women to know there are resources available for their preventive health care, regardless of income level.

Oklahoma State Department of Health (OSDH) has identified five priority areas that continue to negatively impact women's health in Oklahoma: availability of breast and cervical screenings, preconception health, congenital syphilis, smoking and using e-cigarettes during pregnancy, and postpartum depression.

“Women’s Health Month is a great opportunity to remind women to make their health a priority, and to build positive health habits,” said OSDH Director of Maternal and Child Health Service Joyce Marshall. “We encourage women of all ages to talk to a health care provider about recommended preventive screenings and ways to develop healthy living habits.”

Barriers to preventive health care

Maggie Jackson, OSDH Regional Director for Garfield, Blaine, Grant, Major, Woods and Alfalfa counties, said there remain gaps between those preventive screenings and the women who need them, particularly among low-income women.

"I think a lot of women don't know what services are available," Jackson said. "We want the health department to be a welcoming place where they feel comfortable, even if they don't have SoonerCare or other insurance, where they know they'll be able to come here and be seen."

Enid Community Clinic, 1106 E. Broadway, offers free health care services, including a monthly women's clinic, free of charge for low-income people who have no insurance coverage. County health department locations offer services on a sliding scale for any services not covered by SoonerCare, Oklahoma's Medicaid program, or other insurance.

But, even with those resources available, Janet Cordell, clinic coordinator at Enid Community Clinic, said many low-income women don't seek out preventive health services, because they are so focused on making ends meet at home.

When women do come to the clinic, Cordell said it's often a new experience for them.

"All their efforts go to their husbands and their kids," Cordell said, "and a lot of them go out of here with tears in their eyes, because it's the first time anyone has paid any attention to them like that."

Cheryl Peters, nurse practitioner at Garfield County Health Department, said many women are so focused on their families, they neglect their own health.

"I think women do for everyone else a lot of times, and they don't necessarily focus on their own health," Peters said. "They like to take care of everyone else."

But, women need to take the time to care for themselves, Jackson said, and regular screenings can prevent more serious health issues in the future.

"When someone comes in for a screening, they are also able to talk about any family planning needs they have, or any other health issues, and we can refer them to the resources they need," Jackson said. "And, the earlier we detect a problem, the better chance you have of getting it taken care of and successfully treating it."

Breast and cervical cancer screenings

Breast cancer is the most frequently diagnosed cancer, and is a leading cause of death among Oklahoma women, according to OSDH figures. Most women should begin receiving mammograms at age 40, according to OSDH, but specific recommendations vary by age and other risk factors.

American Cancer Society (ACS) guidelines call for annual mammograms to start by age 45, and can change to having mammograms every other year beginning at age 55.

All women should begin cervical cancer testing, or Pap screening, at age 21, according to ACS guidelines. Women aged 21 to 29 should have a Pap test every three years. Beginning at age 30, ACS recommends a Pap test combined with an HPV (human papillomavirus) test every five years continuing until age 65. As an alternative, ACS recommends women aged 30 to 65 to get tested every three years with just the Pap test.

About 90 percent of all cervical cancer cases are preventable with the HPV vaccine and regular screenings, according to OSDH.

Oklahoma Project Woman

In order to help low-income women receive those needed cervical and breast health screenings, Enid Community Clinic has partnered since 2013 with Garfield County Health Department, St. Mary's Regional Medical Center and Integris Bass Baptist Health Center in Oklahoma Project Woman.

Oklahoma Project Woman is a statewide comprehensive program providing free mammograms, diagnostic procedures and surgical services for Oklahomans with no health insurance and limited financial resources, according to the group's website.

Through Oklahoma Project Woman, low-income women with no insurance can receive cervical and breast screenings through Enid Community Clinic, and may be referred there by the health department.

The clinic offers a monthly women's clinic, relying on the volunteer services of female physicians from both hospitals. Pap tests are provided through a partnership with Diagnostic Laboratory of Oklahoma (DLO), and coupons are issued for mammograms at either Integris or St. Mary's.

Oklahoma Project Woman also provides for any necessary follow-up mammograms or ultrasounds.

Cordell said the combination of the Oklahoma Project Woman screenings and the monthly women's clinic gives women access to more than just a one-time screening.

"The problem with a lot of programs is, they will do screenings, but if they find a problem they'll tell you to go find a doctor," Cordell said. "Well, if you don't have any money or insurance, how are you going to get a follow-up with a doctor?"

Giving women access to follow-on care through the clinic, and helping them access preventive screenings through Oklahoma Project Woman, is one of Cordell's favorite accomplishments in her long career in public health nursing.

"Of all the things I've done in the community, that is one of the best things," Cordell said, "because it really does meet a need."

For women who do have SoonerCare or other insurance, Garfield County Health Department also offers cervical cancer screenings, breast exams and refers for mammograms, with services provided on a sliding scale for anything not covered by insurance.

Whether it is at the clinic or health department, Cordell said it's essential low-income women take advantage of access to preventive health care. She said the greatest hurdle is getting women in for their first visit.

"Preventive care, for a lot of our patients, it's the last thing on their mind," Cordell said. "But, once we get them started, they're very faithful about coming back every year."

In addition to the breast and cervical screenings, OSDH recommends women take preventive care measures in several areas related to maternal health, sexually transmitted disease and birth defects.

Preconception health

In order to increase the chance of having a healthy baby, women are encouraged to build healthy habits before getting pregnant, according to an OSDH press release.

Those habits include being free of tobacco and e-cigarettes, maintaining a healthy weight, taking multivitamins with 400 mcg of folic acid daily, managing stress and getting tested or treated for sexually transmitted diseases (STDs).

Peters, at Garfield County Health Department, has launched a pilot program in northwest Oklahoma to complete a preconception survey with all child-bearing age women when they come into the health department.

Peters said the goal of the survey is to identify any areas where they might need additional screenings, counseling or health care before they get pregnant.

Jackson said the initiative has the potential to head off many health problems for mom and baby before they become an issue.

"That affects not only the woman's health, but also the future health of her children," Jackson said, "and hopefully will prevent any complications in pregnancy."

OSDH also provides assistance with pregnancy testing at its county clinics, and health department staff help pregnant women access available services through the Women, Infants, and Children Nutrition Program (WIC).

Smoking and using e-cigarettes during pregnancy

A recent OSDH study shows one in 10 women in Oklahoma used electronic vapor products around the time of pregnancy. So-called "vape" products are not safe to use during pregnancy because most contain nicotine and other harmful additives, according to OSDH.

"Quitting all forms of tobacco, including e-cigarettes, is best for the mother and baby," according to an OSDH press release. "Regardless of how far along a mother is in her pregnancy, she and her baby will be healthier after quitting."

The Oklahoma Tobacco Helpline offers assistance to all people who need help quitting tobacco and nicotine at 1-800-QUIT-NOW (784-8669).

Postpartum depression

Postpartum depression is a type of major depression, which affects about one in eight new mothers within the first year after childbirth, according to OSDH.

"Many new mothers experience the 'baby blues,' which do not tend to be severe, do not need treatment and generally do not last more than two weeks," according to an OSDH press release. "Postpartum depression symptoms often last longer, are more intense and have an impact on a new mother’s health and her ability to care for her baby."

A new mother may experience insomnia, irritability, mood swings, persistent sadness, and thoughts of harming herself or the baby, according to OSDH.

"These symptoms can significantly impact the mother’s ability to parent the way she would like to," according to the press release. "While it is a serious condition, it can be treated successfully with medication and counseling. Family and friends should know the signs and help their loved one seek help."

In order to help women identify any help they need, and access available resources, the health department provides postpartum depression screenings for women up to a year after their pregnancy.

For assistance, contact the postpartum helpline at 1-800-944-4773, by text at 503-894-9453, or visit http://www.postpartum.net

Congenital syphilis

Congenital syphilis is a disease which occurs when a mother with syphilis passes the infection on to her baby during pregnancy, according to OSDH. It can cause miscarriage, stillbirth, prematurity, low birth weight, extreme health problems or death shortly after birth.

But, according to OSDH, syphilis is easy to cure with antibiotics if caught early.

"All pregnant women should be tested for syphilis, as many people who are infected do not have any symptoms," according to the OSDH press release. Testing is available at county health department locations.

For more information on services and assistance available through the Garfield County Health Department, visit their Facebook page or call (580) 233-0650. For more information on the Enid Community Clinic, call (580) 233-5300.

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Neal is health, military affairs and religion reporter and columnist for the Enid News & Eagle. Follow him on Twitter, @jamesnealwriter, and online at jamesrneal.com. He can be reached at jneal@enidnews.com.

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