Tag Archives: Contraception
I used to blog here, right?
I had company in town and a lot of social commitments over the Thanksgiving holiday. I have had a few ideas for posts, but no time to write them. In the meantime, in light of the total lack of any contraceptive coverage requirements in either health care bill, and the Stupak amendment, here’s a cartoon:
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.
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.
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.
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.
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!
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.
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.