World Trade Center Fallout: Health Impacts on Fetuses and Pregnant Women
	New York City Disaster Interrupts Critical Services to Women
	Local Not-for-Profits Struggle for Funding

By Rachel K. Sobel

When terrorists attacked New York and Washington, the explosions and
collapsing of buildings released billions of particles into the air.
Pulverized concrete, singed metal, and fiery building materials quickly
created a gray cloud of dust. No one knows exactly what kinds or levels
of toxicants spewed forth. Many people are wondering what, if any, will
be the lasting effects of this pollution on their health. Even with brief exposure, could there be harm?
For pregnant women, these questions are relevant both to the expecting mother and her developing fetus.

Reassuring Words

Experts say that no one should panic. "The word should be reassurance," says Mary D'Alton, director of maternal-fetal medicine at Columbia College of Physicians and Surgeons. "I'm very reluctant to get people worried about it." A number of pregnant patients who lived in lower Manhattan came to her for care and advice in the days after the attacks. If they didn't have any symptoms--some women may have had temporary respiratory irritation--she told them that to her knowledge there should be no longer term ill-effects.

Her advice is based upon the Environmental Protection Agency and Occupational Safety and Health Administration's air, dust, river, and drinking water assessment tests in the affected areas. So far, the analyses show that the levels of asbestos, radiation, mercury and other metals, pesticides, PCBs, or bacteria are generally "at low or nonexistent levels."

But There Are Exceptions

* Of 442 samples at ground zero, 27 had levels of asbestos above EPA standard. OSHA found all 67 air samples below workplace standard.
* Early samples from water runoff into the Hudson and East Rivers showed some elevated levels of polychlorinated biphenyls (PCBs), dioxin, asbestos and metals, later results find non-detectable levels of asbestos, and PCBs and polycyclic aromatic hydrocarbons (PAHs) and metals below the level of concern.
* Although EPA has measured dioxin levels in and around the World Trade Center site that were at or above EPA's level for taking action, the risk from dioxin, according to EPA, is based on long-term exposure. EPA and OSHA expect levels to diminish as soon as the remaining fires on the site are extinguished.

Tips for Staying Healthy

Most of the concern about environmental hazards has focused on ground zero and the rescue workers. These folks are being exposed to asbestos and other toxicants for longer durations and higher levels than residents or workers who were in the area for a brief time after the blast. Effects are generally worse under these concentrated conditions. Gas masks and special procedures are helping to reduce the risks.

Although the same concerns do not apply to expectant mothers who live in the vicinity, they should make sure their clothes are well-washed and that their apartments are rid of the dust before going back to live. It's best to hire a company to do it. But if that is not possible, remove the particles by wet wiping and mopping--do not dry sweep or dust. This just spreads the dust around. Also, use a HEPA vacuum cleaner, which does not disturb and spread small dust particles. Air-conditioning filters should be changed. And heavy outdoor exercise should be done uptown.

Concern About the Future

While government agencies and many physicians are quick to restore confidence, at least one environmental health and fetal development expert says that there is "potential concern." Philip Landrigan,
pediatrician and chairman of the Department of Community and Preventative Medicine at the Mount Sinai School of Medicine in New York, has proposed a study to follow a couple hundred women who were either in the towers or in the vicinity of the disaster during the hours or days after the attacks. The researchers would monitor effects of short-term exposure on maternal and fetal health.

"At the present time, nobody is completely sure what risks there may be," he says. "There's enough residual concern [to merit a study]--but maybe we'll find nothing." If the study gets approval and funding, Landrigan will work in conjuction with Dr. Frederica Perera, director of the Columbia Center for Children's Environmental Health, which has developed several ways to monitor toxicants in the context of prenatal exposure.

A few chemicals in particular are of concern:

* Dioxins: These toxic solid materials may have been formed by the burning of plastic, pipes, and furniture. Prenatal exposure to these chemicals has been linked to reduced IQ and has affected endocrine and reproductive function.
* Polycyclic Aromatic Hydrocarbons (PAHs): These compounds could have been released by the burning of fossil fuels, wood, and building materials. Adult exposure has been linked with cancer and fetal exposure has been linked with smaller birth size and smaller head circumference.
* Psychological stress: This condition has been linked with premature delivery and could affect the care a child gets.

Don't Panic

The results could take months or years, if the study gets carried out.
For now though, Landrigan does not want to cause alarm: "We are not saying this is drastic or that damage is definitely going to happen…we want to look and see what's there."

The best advice, he says, is to get good medical care. Worried mothers should see their health care providers. Or they could look up a local toxicant experts: http://www.otispregnancy.org "It's easy to pick up a lot of confusing information on the Internet that could just make you crazy," says Landrigan.


Rachel K. Sobel is an Associate Editor at U.S. News and World Report.
This article was commissioned by Face to Face International

By Katrina Coddington and Kate Levitt

As New Yorkers began to assess the appalling damage caused by the attack on the World Trade Center, two terrible certainties regarding women emerged. Tragically, thousands of women died in the attack. Tens of thousands more women lost family members and other loved ones.
Less horrifying, but still worrying, is the ongoing impact of this crisis on women throughout the city who rely on a network of services. Face to Face contacted some of the service providers who focus on women's health for their assessment of how to respond to new, often overwhelming, demands.

Planned Parenthood Rises to the Challenge

As the world's largest voluntary family planning organization, Planned Parenthood of New York City was in a position to aid the overwhelming number of women who were displaced. And they did. A group of the senior staff met immediately after the attacks to discuss what actions they should take. They decided that the three Planned Parenthood health centers in New York City would open their doors for free comprehensive reproductive health services from the 18th to the 22nd of September. They offered all regular services, including GYN care, birth control, emergency contraception, and STD and HIV testing and counseling.
With the help of television and radio stations who gave them free access to make public announcements, and numerous emails and press releases they distributed around the country, Planned Parenthood obtained the support required to reach thousands of women in need. The response they received was so overwhelming that the health centers continued to offer free services until the 29th of September.
Roger Rathman, a director at Planned Parenthood, explained that after the attack many women were without their birth control pills and other medications because they were forced to leave their apartments with nothing but the clothes on their back. Many have been unable to contact their doctors who had offices in or around the Frozen Zone, so in some cases the health centers of Planned Parenthood were the only places offering the services that these women needed.

Department of Health Waits for Full Impact

Barbara McTague, director of the Women's Health Division of the New York State Department of Health, related that she has not yet seen a gender-specific response. In general, however, many health care providers in the area were impacted and were unable to provide normal services, which translated into a drastic decrease in revenue. Also, the providers that were able to act have reported a great deal of need for mental health trauma counseling, particularly for women. For now, she said, they are simply trying "to reach the basic needs" of those affected in the area and commented that it is "too soon to tell" how women's health has specifically been affected.

Tragedy Overwhelms Domestic Violence Programs

In contrast, Sherry Frohman, Executive Director of the New York State Coalition Against Domestic Violence (a division of the New York State Department of Health), outlined how hard domestic violence programs were hit. The Coalition Against Domestic Violence was already struggling to find space and funds for the women demanding its services before September 11th. Now, according to Frohman, "the implications [of the tragedy] are unbelievable."
The Domestic Violence hotline phones were down for several days, as the wires were located beneath the World Trade Center. Also, many non-residential programs were shut down or have been unable to function as a result of their proximity to Ground Zero. These programs are essential because they provide victims of domestic violence with a variety of options, and handle the excess demand overflowing from related programs and battered women shelters. These shelters were at 98% occupancy even before the incident.
While finding a safe haven has become nearly impossible for victims of domestic violence, getting a criminal justice response is even more difficult. Because of the ongoing rescue efforts and the new priorities of the police force, officers have not been able to visit homes with complaints, leaving battered women and children helpless. In addition, during the first week after the attacks, the courts were not open to hear cases or give orders of protection. When they did re-open, the police officers that serve as crucial witnesses were often unavailable to testify, rendering the case obsolete.
Frohman cited instances of increased violence towards Arab and Arab-looking women. Programs began giving these women money to take cabs or have food delivered so as to avoid the risk of being outside at night, when most of the hate crimes have occurred. In other cases, Muslim women have opted to remove their head scarves to protect themselves from verbal and physical abuse.
Frohman also expressed concern about the mental health impacts of the disaster. She explained that previous trauma tends to reappear in the form of flashbacks when new trauma is introduced, whether or not it is sexual. The repercussions of these flashbacks will haunt domestic violence and sexual assault programs for years to come. Furthermore, many counselors and staff at the forty programs in the five boroughs of New York City are so traumatized by the situation or the loss of a loved one that they are unable to help the battered women who seek them out.

By Katrina Coddington and Kate Levitt

In less than three weeks following the New York City World Trade Center tragedy, Americans "donated nearly $600 million in cash, checks and pledges to more than 100 charitable funds for those whose lives were shattered on September 11th," according to the October 8th issue of Time. And while the world refocuses its attention many not-for-profit organizations that rely on charitable donations are being neglected.

One such organization is Planned Parenthood NYC,whose reproductive health services may not remain a priority for funders. In fact, Director Roger Rathman is sure funds will decrease, reducing the programs and services the organization will be able to offer.

Sherry Frohman of the Domestic Violence division of the New York State Department of Health concurs that charity for those not directly affected by the World Trade Center attack will decrease. Even before the attack, battered women's programs were straining to meet demand, and shelters were full to 98% capacity. Now, domestic violence and sexual assault continue at the same rate, and programs are burdened with additional victims of trauma. Donations that fund these programs, however, are declining. While domestic violence and sexual assault continue at the same rate, the donations battered women programs depend on to function have been declining.

The Red Cross, the relief agency leading the way in dealing with the disaster, has not donated any money to domestic violence programs in New York. The state does not provide an operating budget either. Consequently, a dramatic cut back of these services will be necessary. While the Mental Health Division of the Department of Health received a $25 million grant to set up counseling services, no money went to sexual assault and domestic violence divisions, both of which have extensive experience in trauma counseling. Frohman emphasized that the Mental Health Division will use the grant to set up traditional counseling services, and these might not reach out to all ethnicities and classes or provide forms of alternative counseling for those uncomfortable with the traditional system.

Social Agenda, a New York State not-for-profit whose mission is "to eradicate poverty by allotting value to what has traditionally been women's work, [or] caregiving," worries about where their funding might come from. As Liz Ezratty, Co-Director, described, "the idea behind Social Agenda is to give caregivers money, primarily through tax credits," so as to stop the cycle of poverty that plagues single mothers and their children and give credibility to the job of motherhood. In the wake of the events, the organization has had boost services because "the bombings created many more people that need care," such as orphaned children and injured adults. As a result, they are currently reevaluating fund-raising efforts and adjusting their budget for the increased need.

The outlook for many of the charitable organizations not directly involved in relief efforts is grim. Some foundations have even told former grantees "not to bother applying for grants," because their funding has been spent on relief efforts. As funds are redirected to the more pressing issue of caring for and compensating victims, many not-for-profits struggle to maintain hope for the future.

To send donations or give support to the programs for the victims of domestic violence and sexual assault, make checks payable to the New York State Coalition Against Domestic Violence, with NYC DV Fund in the memo, at 79 Central Drive, Albany NY, 12206. You can also contact them at (518) 432-4864.

To give donations to Planned Parenthood of New York City, make checks payable to PPNYC and send them to Planned Parenthood of New York City, Development Department, 26 Bleecker Street, New York NY, 10012.