Letters to the Editor Helminth Infections: A New Global Women’s Health Agenda To the Editor: Hotez et al issue an important alert for reproductive health professionals concerning the millions of Sub-Saharan African pregnant and reproductiveaged women infected with hookworm and Schistocytes. Immigrants from SubSaharan Africa are identified as being at increased risk for helminth infection.1 Notably, Sub-Saharan Africa encompasses the entire continent, save the North African countries of Egypt, Libya, Algeria, Morocco, Tunisia, and Maghreb. As an alternative to a single geographic location, we suggest that a more practical identification of atrisk women would be to describe them as having lived in impoverished, humid areas found in Africa, south East Asia, South America, or the Mississippi Delta and other portions of the rural, southern United States.2 While targeting endemic geographic areas, Hotez et al fail to emphasize poverty as a confounder for helminth infection. In helminthendemic regions, for generations there has been wide economic disparity between the wealthy minority and remaining low-income majority populations. Limited access to clean water, health care, proper sanitation, hygienic living conditions, and proper footwear Letters to the Editor Guidelines. Letters posing a question or challenge to an article appearing in Obstetrics & Gynecology should be submitted within 8 weeks of the article’s publication online. Letters received after 8 weeks will rarely be considered. Letters should not exceed 350 words, including signatures and 5 references. A word count should be provided. The maximum number of authors permitted is four, and a corresponding author should be designated (and contact information listed). Letters will be published at the discretion of the Editor. The Editor may send the letter to the authors of the original paper so their comments may be published simultaneously. The Editor reserves the right to edit and shorten letters. A signed author agreement form is required from all authors before publication. Letters should be submitted using the Obstetrics & Gynecology online submission and review system, Editorial Manager (http://ong.edmgr.com).

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by women with limited economic resources may increase their contact with the helminth organism.3,4 Financial Disclosure: The authors did not report any potential conflicts of interest.

Andrei Nikolai Hastings, BS St. George’s University, Grenada, West Indies Annika Nitra Nadine Chadee, MD Lincoln Medical and Mental Health Center, Bronx, New York Maggie Marie Driscoll, BS St. George’s University, Grenada, West Indies Cassandra E. Henderson, MD Lincoln Medical and Mental Health Center, Bronx, New York

REFERENCES 1. Hotez PJ, Whitham M. Helminth infection: a new global women’s health agenda. Obstet Gynecol 2014;123:155–60. 2. McDonald MC. Neglected tropical and zoonotic diseases and their impact on women’s and children’s health. The causes and impacts of neglected tropical and zoootic diseases: opportunities for integrated intervention strategies. Washington, DC: The National Academies Press: IOM (Institute of Medicine); 2011. 3. Center for Disease Control and Prevention (CDC). Domestic intestinal parasite guidelines. Presumptive treatment and screening for strongloindiasis, schistosomiasis and infections caused by soil-transmitted helminths for refugees. Atlanta (GA): CDC; 2013. Available at: http://www.cdc.gov/ immigrantrefugeehealth/guidelines/domestic/ intestinal-parasites-domestic.html. Retrieved February 3, 2014. 4. Shistosomiasis: status of schistosomiasis endemic countries 2012. Geneva (Switzerland): World Health Organization; 2013. Available at: http://apps.who.int/neglected_ diseases/ntddata/sch/sch.html. Retrieved February 3, 2014.

In Reply: We appreciate the comments from Mr. Hastings and colleagues and their important reminder on the links between poverty and helminth infections among girls and women. Indeed, Dr. Hotez has written a book titled For-

gotten People, Forgotten Diseases1 that explores in-depth the link between poverty and neglected tropical diseases such as hookworm infection and schistosomiasis. A key observation is that helminth infections both occur in the setting of poverty and reinforce poverty because of their long-term effects on child growth and development, agricultural productivity, and pregnancy outcome. We have even turned our global health lens inward on the southern United States to reveal a hidden burden of neglected tropical diseases among the poor, including now several million Americans living on less than $2.00 per day. Financial Disclosure: The authors did not report any potential conflicts of interest.

Megan Whitham Virginia Tech Carilion School of Medicine, Roanoke, Virginia Peter Hotez, MD, PhD National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas

REFERENCE 1. Hotez PJ. Forgotten people, forgotten diseases: the neglected tropical diseases and their impact on global health and development. Washington, DC: ASM Press; 2013.

Abortion and Mental Health: Findings From the National Comorbidity SurveyReplication To the Editor:

Steinberg et al’s1 recent article offers conclusions that go far beyond what their analyses support. Their study of 259 aborting and 677 childbearing women rests on the presumption that these groups are accurately segregated. However, as the authors belatedly note, selfdisclosure studies of this type report fewer than half the abortions projected by national averages. Because the childbearing group includes hundreds of women who concealed their abortion history, the authors’ findings are all inconclusive. There is also an unwise and unexplained decision to include a history of

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