Reply turned post, religion and reproduction style

The blogosphere has been full of posts about a soon to be published study in Reproductive Health (one of my favorite journals!) about state teen birth rates and religiosity being correlated.

I posted a reply on one of the posts, the one on the New York Times parenting blog Motherlode.

What a shame.

I am proud to have a member of the Religious Coalition for Reproductive Choice speaking at our medical school next month. She is a Baptist minister and is a Doctor of Divinity. And she is adamantly pro-choice, provides condoms to teenagers at her inner city church, and also provides information about and promotes access to emergency contraception in her community.

There is nothing about religiosity or Christianity that inherently means that one cannot promote contraception, comprehensive sex education or safe and legal abortions. I am a member of Medical Students for Choice, and interact with many abortion providers and pro-choice activists whose faith has an important role in their lives and in their promotion of women’s health.

Dr. Tiller was assassinated while serving at his church. More pro-choice Christians need to stand up to the loud, reactionary ones who are trying to turn our country into a fundamentalist third world nation.

“Natural” birth control pill

Bayer Schering Pharma, the makers of Yaz, has launched a birth control pill in the United Kingdom that is bioidentical to female hormones. It is synthesized from plants.

Fascinating.

Yes, it’s 3 a.m. I had way too much coffee when I was studying. I will be trying to sleep soon, I promise.

ETA: I wonder if they will have to retract any of the advertising for this birth control pill. I don’t think they are allowed to advertise prescriptions directly to the consumer in the UK.

Pull and pray – taking withdrawal seriously

A new Guttmacher Institute report, published in Contraception, treats the withdrawal method (aka “pulling out” or coitus interruptus) like a serious method of birth control. This is creating a few ripples in the women’s issues blogosphere.

I was not surprised at all when this article was written, since other sources have long included withdrawal in the discussion. I have always included withdrawal when comparing methods of birth control with poor success rates. The sponge and the cervical cap, especially in parous women (women who have already had a child), spring to mind. Neither offer much STI protection, and the sponge may have side effects such as local irritation. I was surprised, years ago, when I saw a comparison of success rates, and the much derided non pharmaceutical methods such as withdrawal and the fertility awareness (aka symptothermal method, natural family planning, rhythm method) had moderate success rates and fit firmly in the sorta crappy second tier of birth control.

This is the tier my two sons come from. My older, condom son and my younger, vaginal contraceptive film son. I would have never considered withdrawal or fertility awareness. I was in long term monogamous relationships both times and knew that STIs were not a problem. Both would have been good options for me. I cannot use hormonal methods, since I get migraines. Many women don’t want to use hormones or get significant side effects from hormonal methods. I am not saying they don’t work remarkably well for many women, and may even have some therapeutic applications. Different women with different health issues have different needs.

I have known women who have used the withdrawal method intentionally. No, not drunken teenagers, but a woman with a master’s degree in a long term relationship and a midwife(!) who knew the odds and decided it worked for her and her partner. At least one of the sites I linked to above says it shouldn’t be ignored but it shouldn’t be encouraged (and one questioned the ability of teenagers to use the information wisely, which I think is the problem with abstinence only education).

I don’t think any method of birth control should be encouraged. I think every method should be presented without bias, either bias from the sex-is-bad-don’t-encourage-it camp or the must-be-a-pill-or-a-medical-device-or-it-doesn’t-count camp. I thank the medical science gods (ha!) every day for my copper IUD. If it wasn’t refused to me (with bias and non-scientific information from an ob/gyn) I wouldn’t have a contraceptive film child. If I didn’t succumb to “I don’t care what the failure rates say, if it’s a pharmaceutical method, it must be better than our other options” bias in my own head, I wouldn’t have a contraceptive film child. Don’t get me wrong, I love Z and without being refused my IUD the first time and having him, I wouldn’t be the MomTFH I am today, since I ended up training as a midwife at the birth center.

But, I love my IUD now. It is the ideal option for me. It doesn’t protect against STIs. It has a fantastic pregnancy prevention rate. It’s ideal use rate is almost identical to its real use rate, which is what I need. Less room for human error. When I talk about my IUD, I try to present it as honestly as possible. Mutual masturbation is a very viable option that is enjoyed by teenagers extensively. That may not have been ideal for my marriage in my twenties, but at 16 it was a fine option. I know women who are passionately dedicated and successful (to different degrees) with the symptothermal method. I know women who love their pill, hate their pill, and swear they have gotten pregnant on the pill. Hell, IUDs are the top of the top tier of pregnancy prevention, and at the recent ACM some medical students were joking about how their reproductive endocrinologist professor got his wife, their maternal fetal medicine professor, pregnant with twins even while she had an IUD in!

Let’s talk about it all. My ideal teen sex education program would talk about withdrawal and mention how it is dependent on the male being able to control himself, be trustworthy, be sober, and will not prevent STIs. Then I would present the failure rate. I would also talk about sex toys, masturbation, homosexuality, abstinence, anal sex, oral sex, abortion and other topics.

My (almost) ideal sex ed program may be coming to teenagers soon, actually. But it’s not going to be in schools. Rumor has it the Midwest Teen Sex Show is coming to Comedy Central. I hope it does to abstinence only education what the Daily Show has done to cable news.

Good things a brewin

I haven’t had time to post recently. But, good things have been brewing, so I wanted to throw up some links.

First, a study finds homebirth as safe as hospital birth. Of course, this occurred in the Netherlands. I would love to practice there one day. An American DO needs to pave the way, since our licensing is ambiguous in that country. Note the complication rate was 7 per 1000. That includes NICU admission or any neonatal mortality.

Note that in the United States, our infant mortality rate alone is 7 in 1000.

Hillary Clinton gave a rousing defense of comprehensive international reproductive medicine. I still get misty when I hear our administration advocating for evidence based, women centered medicine that will save more lives of women and children.

Also good stuff, the FDA is going to be extending over the counter, non prescription status for plan B to 17 yr olds. It is safer than a pregnancy for all ages, children who can’t talk to their parents about it are high risk and should have more access. Unfortunately, proving your age requires ID. I think the requirement should be lifted because privacy outweighs the negligible risk. If a young woman is in a small town, she will be forced to show her license in order to get Plan B. We need mroe progress on this issue. Plan B needs to be available without a prescription, end of story.

The New England Journal of Medicine published a study on using PCR, a cheap DNA analysis is better than a pap smear when screening for cervical cancer. Very interesting. I may be doing some research on PCR testing for HPV during my research fellowship.

And, finally, Shakesville has been cracking me the hell up.

I love a good point

Dr. Russell Turk, M.D., wrote a column celebrating the FDA decision to expand Plan B over-the-counter availability to 17 year olds. (H/t RH Reality Check)

I agree with this board certified ob/gyn on many of the same points I have made myself: that it is better than the alternative, that pregnancy occurs at those ages, so all options should be available, and that delaying or impeding reproductive care for minors who can become pregnant is never a good thing.

Then he throws out this piece of brilliance:

The irony is that once a girl is pregnant, she’s legally considered an “emancipated minor” — which means she can make medical decisions of a much more serious nature without adult supervision. And yet we can’t trust her to make a decision that will keep her from getting pregnant?

Of course! This not only addresses why Plan B should be available over the counter for minors, but also supports why birth control and comprehensive sex ed should be available to minors. And, it also provides yet another reason why parental notification and consent laws directed at minors seeking abortions are hogwash. I knew about parenthood being emancipatory, but I never did the second level thinking that links preventing pregnancy as being an equally important mature right of minors.

Thanks, Dr. Turk!

Reply turned post, I’ve heard this song before style

Pretty soon I may actually come up with an original post, and stop doing only replies-turned-posts. I have recently added more sites to my feeder. I deleted some, too, so that may be a moot point. I also just finished classes and S’s birthday party, and am looking forward to a week “off”. I have a lot planned for this week, including a trip to a Medical Students for Choice convention on Friday. I also have to catch up on a lot of business I let slide until this week off. Not to mention, I have a written final in Osteopathic Principles and Practice, and a cumulative practical, on Tuesday after spring break. That includes license and car registration renewals, quizzes for my public health class, plans for my research project, my FAFSA, exercising and gardening…and catching up on hundreds of updates in my blog feeder. This catching up process explains a lot of replies. Some turn into posts. I like doing these because it shares other sites with people who have similar interests, and at least half of my ranting occurs on other sites.

So, this was a reply on a post about the resistance to the increased Medicaid contraception coverage in the stimulus package on RH Reality Check. I am not sure why this was being discussed now, since it happened in January, even though I welcome this kind of an article anytime. I swear, even thought I am backlogged, the post on RH Reality Check and the original article from FAIR were both published yesterday. It may be timely, since this provision as supposed to be added to the budget that just got passed.

Anyway, the reply:

Not only is the corporate media guilty of not challenging talking points or critical attacks by politicians, but this case was even more egregious. The mainstream media, even liberal sources, tend to treat women’s reproductive health, especially contraception and abortion, as a political third rail. It’s automatically “controversial”, so everyone’s outrageous statements are accepted under the umbrella of controversy.

By including women who would qualify for Medicaid if they got pregnant to Medicaid’s contraception program, women would have more control over their reproductive autonomy, not less.

It didn’t even matter that this provision would PREVENT abortions, not increase them, so it could not fund the nonexistent “abortion industry”. It most certainly would not impose them on pregnant citizens like the Chinese government.

I really wonder why Rep. Boehner and his ilk are opposed to contraception if they are supposedly interested in decreasing abortions. They need to add “anti contraception” to their platform. I would be interested in seeing the reaction to that.

Good news

I guess this is what my research methods professor meant when he was talking about regression toward the mean. There is so much back-asswardness left over, health and science wise, from the last administration that it seems like Obama is really churning out a lot of liberal policies when, in actuality, his policies are just righting some wrongs and supporting evidence and better outcomes.

Here is a good example: A federal court ruled the FDA was wrong when it dragged its feet over approving OTC (over the counter) availability of Emergency Contraception (EC). It will now be available to 17 year olds (good!). This was something that was recommended by the FDA’s own panel of doctors advised that it be available OTC for all ages way back in 2003. We are getting there. Slowly.

My conscience clause comment

My comment to the Department of Health regarding the proposed rescission of the Bush era conscience rule. For information on making your own comment, please visit Rachel at Women’s Health News.

This comment is in regards to the rescission proposal.
I am a medical student, a future ob/gyn, a mother, and a concerned citizen. I think there was no current need for the new conscience clause ruling. The former HHS secretary, Mike Leavitt, purposefully mischaracterized the state of licensing for ob/gyns in order to forward a political ideology. The American Board of Obstetrics and Gynecology publicly demanded that the HHS show even one case of discrimination against a practitioner who exercised his or her right to refuse to participate in an abortion, and Secretary Leavitt was unable to produce even a single example.

The Obama administration states that it is committed to changing the unfortunate recent history of overlooking science and truth in order to advance political ideology in health policy. In fact, most of these decisions have been based on opinions that only represent a minority ideological belief of the citizenry. The rescission of this ruling is imperative to reestablish faith in our national health policy.

The current conscience legislation is already too overreaching. I am concerned that requiring health care entities to pre-certify that they do not discriminate in hiring, specific to conscience refusal, will hamper the ability of certain organizations to fulfill their mission statements. For example, in my high risk area, South Florida, the Department of Health has family planning clinics established and funded for the sole purpose of providing birth control to the underserved. With the climate encouraged by this recent legislation, it is entirely plausible that these facilities would be forced to hire employees that are opposed to birth control.

In fact, some sections of the rule do not refer to abortion at all, and could be construed to apply to any practice that a potential employee finds unethical. Birth control is not abortion according to medical definitions of pregnancy and the methods of action of birth control, but many extremists see forms of birth control as abortion, and the law caters to such a worldview. How long until observant Christian Scientists are applying for jobs at surgery centers with the intent of obstructing surgical procedures? It seems like this rule is likely to increase costly lawsuits. It also seems like health care entities will be almost forced to hire employees that will expressly NOT fulfill their job duties in order to avoid such lawsuits. Where is the pressing need to increase such lawsuits? In actuality, there is a pressing need for more abortion providers and more contraception access, not less. There is a pressing need to reduce health costs, not increase them. There is a need to increase common ground, not accentuate difference and encourage uncooperation when there is already more than adequate provisions protecting conscientious objection in health care.

Bursting with pride

I am so proud to be included as an ally in the wonderful Tell it WOC Speak blog carnival. Renee of Womanist Musings is a radical’s radical, a blogger’s blogger, and, dare I say, a feminist’s womanist. She is fiercely intelligent and, I am guessing, very picky. I am very proud that my post on teen births rates being up, and the analysis of the rise being blatantly racist, was included.

Please go check out the entire “Hear us roar” carnival of posts.

Reply turned post, octuplet style, take three

On the slippery slope argument, I have written two replies. I wrote one on Shakesville:

As for the slippery slope argument, slippery slope is not a two word phrase that means analyzing any health decision = oh no, there goes reproductive rights. Much of this was done in the name of radical anti-choice positions, in which frozen embryos are precious snowflake babies, and selective reduction, regardless of the outrageous medical risk of a high order multiple pregnancy, is outright killing of babies and should not be done.

There is nothing wrong with asking for an acceptable ethical standard of care for women seeking IVF. In fact, outrageous cases like this and the unwanted quadruplets the same doctor transferred into another woman (without medical insurance to pay for her pregnancy) are much more likely to endanger women’s reproductive rights due to the huge, predictable (and yes, frequently out of control, hostile, sexist and classist) backlash than looking at these situations critically and making sure they do not happen.

There are multiple position statements on how many embryos to transfer that do not violate anyone’s reproductive rights. Medicine is not the same thing as ordering off of a menu. Health care practitioners should follow standard of care guidelines that protect their patients.

And, I wrote an earlier one on altdotlife:

I also wanted to answer the earlier post comparing controlling embryo transfer via IVF and requiring a patient to agree to selective reduction, to refusing to fill a prescription for birth control. I see many differences between these two examples. First of all, a licensed doctor wrote the prescription for the birth control. Birth control is standard medical care. 98% of women in the United States use birth control of some sort at some point in their lives. A pharmacist refusing to fill a birth control prescription is refusing to fill the prescription because it goes against his or her religious beliefs, not out of some concern for the health of the patient.

Now, if a doctor didn’t want to write a prescription for birth control for someone who has a history of deep vein thrombosis, (which can lead to pulmonary embollism or stroke and then death) then I would see it as being a similar situation to refusing to transfer six embryos. Health risk trumps reproductive rights. I would not write that prescription. I would offer her a copper IUD or some other non hormonal method.

If a doctor refuses to transfer six embryos or wants an agreement that HOMs will be reduced, we are talking about preventing or refusing a highly unusual situation outside of the standards of medical care. Many people have posted various links to position statements of medical organizations of fertility specialists about this topic. There is a difference between an intervention like this and standard medical care. No doctor should have to perform a procedure that he or she knows opens the patient and the future fetuses to extreme risk. One of the links from upstream has an infertility ethical specialist saying 50% of HOMs end in death or severe disability of the offspring. That is not acceptable risk, in my book. Birth control and abortion is remarkably safe in most situations, and is almost always safer than a full term pregnancy for most people.

Plus, do not forget, any doctor, resident, medical student, nurse, orderly, etc can easily refuse to participate in abortion services or refuse to prescribe birth control or perform sterilizations. Entire Catholic hospital systems do this, and it is even a struggle to get them to give emergency contraceptions to rape victims, even if they are the only place in town for a rape victim to be treated. It is not even questioned in the medical community (except for the EC for rape victims part. Some places states have passed legislation on this, thank goodness.)

A slippery slope is not a straight line. There is a lot of nuance here.