contraception

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Mass. Candidates React To ‘Abhorrent, Disturbing’ Hobby Lobby Decision

u.s. supreme court

It doesn’t have the local angle of last week’s abortion-clinic buffer zone decision. But reactions to today’s Supreme Court Hobby Lobby decision, allowing some companies to refuse to cover contraception, have begun to roll in from Massachusetts gubernatorial candidates. We have four so far, from — in alphabetical order — Democrat Don Berwick, Democrat Martha Coakley, Evan Falchuk of the United Independent Party and Democrat Steven Grossman, and will update as statements come out:

Don Berwick:

“Today’s abhorrent Supreme Court decision is yet another affront to women’s health. Every woman deserves access to quality reproductive health care, and I hope that Congress will take swift action toward ensuring that contraceptives are available to women, regardless of their employer’s religious affiliation.

“This ruling also serves as a reminder that it is past time to decouple health coverage from employment and move to a publicly accountable single payer health care system, similar to Medicare for all.”

Martha Coakley:

“Today’s ruling undercuts important protections for women seeking access to affordable contraceptive services. For-profit corporations should not be allowed to prevent women from receiving necessary health care based on the religious beliefs of managers and shareholders. This decision undercuts vital efforts to ensure equality both here in Massachusetts and across the country, and we will continue our fight for quality health care coverage.”

In January 2014, AG Coakley, along with California Attorney General Kamala Harris, led a coalition of 14 other states in filing an amicus brief with the U.S. Supreme Court supporting access to FDA-approved contraceptive coverage.

Evan Falchuk:

Today’s 5-4 Supreme Court decision in the Hobby Lobby case, allowing companies to opt out of the federal mandate to cover certain contraceptives, is a disturbing precedent for those who care about women’s health and access to reproductive health services. I wholeheartedly agree with Justice Ginsburg when she writes in her dissent “The court, I fear, has ventured into a minefield.” Continue reading

Morning-After Pill Disappoints, On To Plan C: More Effective Methods

Morning After Pill

They were splashy headlines this week: The emergency contraceptive pill “Plan B” does not work well in heavier women, and appears not to work at all in women over 176 pounds.

The FDA is considering whether the pills’ labels should be changed to warn heavier women not to count on their contraceptive powers, NPR reported; the French maker of a similar pill is already planning such a warning.

But the controversial morning-after pill has a bigger problem than that. Family planning advocates have fought hard to make Plan B easier to get in order to bring down the high American rates of unintended pregnancy. But so far, on that score, it’s looking like a dud.

Plan B hasn’t made a dent in the stunning statistic that a full one-half of U.S. pregnancies are unintended. This despite its FDA approval way back in 1999 and the growing access to emergency contraception over the last couple of decades — and despite major recent victories for family planning advocates: Plan B is now available over the counter to all ages.

“While there’s a lot of data to show it can prevent pregnancy in individual women, we’ve all been disappointed that on the population level, it just hasn’t had the effect we hoped,” said Dr. Deborah Nucatola, senior director of medical services at the Planned Parenthood Federation of America. “The unintended pregnancy rate hasn’t changed at all.”

Why might that be? There are two main theories, Dr. Nucatola said: Maybe the women who most need Plan B aren’t using it when they are actually at highest risk for pregnancy. Or maybe they’re just not using methods that are effective enough, and women should shift to more effective types of emergency contraceptives.

Enter what we might call Plan C. Around the country, Planned Parenthood affiliates are launching a new campaign called EC4U to educate women and clinical staffs about two more effective methods of morning-after help: Paragard, the copper IUD, and “ella,” a relatively new pill that uses the hormone ulipristal acetate, rather than the levonorgestrel in Plan B and a similar pill, Next Choice.

Accumulating data suggest that Plan B has two main weak points. One is weight; it was highlighted in this week’s reports, but contraceptive specialists had known for many months that the pill’s effectiveness drops in overweight women and approaches nil in women with a Body Mass Index above 35. Continue reading

Birth Control: Talking ‘Bout The Pullout Generation

When a recent study concluded that nearly 1 in 3 straight, sexually active young women used the withdrawal method for contraception, the media breathlessly coined a neat phrase to characterize these 15- to 24-year-olds: “The Pullout Generation.”

Elite Daily asked: “Gen-Y Or Gen-Pullout? Coitus Interruptus Is The New Form Of Birth Control” and New York Magazine breezily headlined its coverage, “No Pill? No Prob. Meet The Pullout Generation.” The Huffington Post held a forum, asking “Is this an appropriate method of birth control in this day and age?”

youngloveThe truth is, “pulling out” is old news. Indeed, it’s perhaps the oldest form of contraception (besides abstinence) and has been practiced for millennia. Though clearly not the most effective method of birth control, and offering no protection against STIs, withdrawal is free and when done with skill it can be somewhat effective.

According to Planned Parenthood:

–Of every 100 women whose partners use withdrawal, 4 will become pregnant each year if they always do it correctly.
–Of every 100 women whose partners use withdrawal, 27 will become pregnant each year if they don’t always do it correctly.
–Couples who have great self-control, experience, and trust may use the pull out method more effectively. Men who use the pull out method must be able to know when they are reaching the point in sexual excitement when ejaculation can no longer be stopped or postponed. If you cannot predict this moment accurately, withdrawal will not be as effective.

To find out more, I crowd-sourced the issue on SurveyMonkey and asked why my 20-something peers — savvy, educated — relied on such a frowned-upon form of contraception. I got over 30 responses that fell into five overarching categories: Continue reading

Should Parents Stock ‘Plan B’ At Home In Case Teens Need It?

Plan B emergency contraception (AP photo)

Plan B emergency contraception (AP photo)

I’ve been thinking lately about the sexual stupidity of my youth. The foolish chances I took. The silly expectations born of “uncontrollable passion” scenes in bodice-buster books. The deep need for approval as demonstrated by desire.

The trigger for these regretful ruminations was last Friday’s landmark ruling on “Plan B,” also known as “the morning-after pill.” A federal judge ruled that it should be available over the counter to all ages. He not only overruled an Obama administration decision to require prescriptions for girls under 17, he derided that age limit as “scientifically unjustified.”

That ringing endorsement prompted this disconcerting train of thought: “Wow, Plan B sounds amazingly safe. Wish they’d had it when I was young and stupid. Hey, wait. Does this mean that when my kids are old enough to enter the danger zone, I should stock some Plan B for them? If it’s stocked on store shelves, does that mean we should stock it on our closet shelves?”

It felt outlandish and loving at the same time. I could already imagine the speech: “Please, please, please don’t have unprotected sex. But if somehow you do, you don’t even have to face me or talk to me. The Plan B is on the top shelf in the bathroom. Use it as soon as possible. And I hope when you’re ready, we can talk.”

If it’s stocked on store shelves, does that mean we should stock it on our closet shelves?

Could that kind of tactic even make any sense? And mightn’t it encourage irresponsible behavior? And is Plan B really that safe, or does it carry even minor risks?

I called over to the contraception and sexual education experts at the Planned Parenthood League of Massachusetts, who had — unsurprisingly — heartily praised last week’s ruling.

First, their medical reassurance, from Dr. Danielle Roncari, the league’s medical director:

“Emergency contraception, we know, is safe and highly effective. We also know from multiple research studies that it’s safe for women of all ages to use, and that increased access to emergency contraception doesn’t lead to increased sexual activity, it just leads to increased use of contraception.

We also know that it’s a very safe medication. There’s really virtually nobody that this medication isn’t safe for, and we also know that teenagers are able to use it just as easily as adult women. Research backs this up.”

Two additional safety points she mentioned: Plan B will not impact an existing pregnancy, so no pregnancy test is needed; and repeated usage is not unsafe either, though it is a concern because emergency contraception is not as effective as regular contraception – Plan B is up to 89% effective at preventing pregnancy, compared to daily birth control pills, which are up to 99% effective.

So, then, I asked, is this a good idea, to keep Plan B in the house? Continue reading

ACOG: Screen for Lesser-Known Abuse, ‘Contraception Sabotage’

According to the nation’s leading obstetricians and gynecologists, “reproductive and sexual coercion” — behavior intended to maintain power and control in a sexual relationship — is, sadly, not uncommon.

While homicide is one of the leading causes of death for pregnant women, The American College of Obstetricians and Gynecologists (ACOG) reports that many abused adolescent girls and women are also the subject of another, lesser-known form of abuse: “contraception sabotage,” the most common form of reproductive coercion.

In a just-released committee opinion ACOG notes that victims of such abuse have “male partners who intentionally sabotage their contraception, deliberately give them sexually transmitted infections, or force them into having unwanted pregnancies or abortions.” This type of “reproductive coercion” says ACOG, can even go as far as male partners “forcefully remove intrauterine devices (IUDs) and vaginal rings, poke holes in condoms, or destroy birth control pills.”

 (zeevveez/flickr)

(zeevveez/flickr)

ACOG reports:

Sexual coercion includes a range of behavior that a partner may use related to sexual decision making to pressure or coerce a person to have sex without using physical force. This behavior includes repeatedly pressuring a partner to have sex, threatening to end a relationship if the person does not have sex, forcing sex without a condom or not allowing other prophylaxis use, intentionally exposing a partner to a sexually transmitted infection, including human immunodeficiency virus (HIV), or threatening retaliation if notified of a positive STI test result. Continue reading

Pregnancy Prevention Progress: Easier Pills, Plan B At Teen Check-Ups

Birth control pills


This looks like quite a convergence. In a country where roughly half of conceptions are still accidental, we’ve just seen two significant steps toward helping women avoid unwanted pregnancy, both coming from groups of doctors who can rule on safety as well as urgent need.

On WBUR’s Cognoscenti, writer Judy Foreman posts here today:

Earlier this month, the American College of Obstetricians and Gynecologists, the country’s leading professional group for ob/gyn physicians, recommended that oral contraceptives — on the market for more than half a century now — finally be available over-the-counter.
It’s about time.

And also last week, the American Academy of Pediatrics recommended that doctors routinely counsel teenagers about emergency contraception — better known as Plan B or the morning-after pill — and prescribe it in advance, even if the teen is not sexually active. Currently, girls under 17 need prescriptions for the pills.

WBUR’s Here & Now discusses the issue here, and the segment elicited this cogent comment:

Well how about the boys? Isn’t it time we gave them a script for the morning-after-pill to give to their partners?

Readers? Interesting scenario, isn’t it? How might that dialogue in the steamed-up car go?

Single Guy’s Lament: What Became Of The Female Condom?

female condom

(Anka Grzywacz, Wikimedia Commons)

By David C. Holzman
Guest contributor

David C. Holzman writes from Lexington, Mass., on science, medicine, energy, environment, and cars. He is Journal Highlights editor for the American Society for Microbiology and won a Plain Language Award last year from the National Institutes of Health. This essay began as a response to a CommonHealth post on why people have unsafe sex, and turned into much more.

Caution genes run in my family. My parents put seat belts in the ’57 Chevy in 1960, eight years before they became mandatory. In July, 1975, I bought Bell bicycle helmet serial number 7022. My cycling ensemble also includes one of those lime green jerseys that’s visible from the International Space Station.

And I was asking sex partners about Sexually Transmitted Diseases beginning in the early 1980s, when herpes — not HIV — was the main subject of such conversations. This despite the fact that the first time I did, the woman refused to discuss it, saying I could go to bed with her when I was ready to trust her. Condoms? Of course.

Journalist David C. Holzman

Now, in 2012, I still wouldn’t dream of leaving my seatbelt unbuckled, or biking without my helmet and jersey. I’ve never stopped asking new sex partners about STDs. But recent news reports have suggested that among the middle aged, rates of sexually transmitted diseases are rising while condom use is falling, and I have to confess:

At 59, I’ve worn condoms probably fewer than five times since the millennium, despite having been single for six of those years, during which time I’ve averaged one or two new partners a year, and despite the admonitions of my wonderful primary care doctor. The reason is simple: in my 20s and 30s, sex with a condom felt like getting massaged over a shirt. Now it feels like a massage through a winter overcoat.

I did don a condom last fall, when a new partner made a big deal of it. As a precaution, I took half a Viagra beforehand. (I don’t normally need the pharmaceutical pump; it was left over from earlier, when an antidepressant that I have long since discontinued had turned a Corvette into a Yugo.)

Despite my precaution, our effort to couple resulted in a deflationary event. I couldn’t feel a thing. Actually, I take that back. I did feel the condom squeezing me like a latex boa constrictor, then a softening like a leak in a bicycle tire. And then I felt lost. With that thing on, I would have needed a GPS to find my way in.

I’d like to note here that I take good care of my body. My diet is Michael Pollan-approved, my body mass index is 20, and I run more than 1,000 miles a year. But studies have shown that penile sensitivity declines steadily after the teens and 20s, so that by the 40s and 50s, men require more intense stimulation, says Culley C. Carson, III, Rhodes Distinguished Professor of Urology at the University of North Carolina. “And condoms add to the disability, if you will.”

female condom

Female condom (Wikimedia Commons)

I knew that there was an alternative — at least, there had been once. In 1993, I dated a woman who worked on reproductive issues at the National Institutes of Health. We initially used male condoms, but she soon introduced me to something called a female condom, which we used from then on. Then made of polyurethane, it fit inside the vagina, clinging snugly to the walls, held there by an inner and an outer ring. The sensation wasn’t quite as wonderful as using nothing, but for me, the sense of touch was like 20-20 vision rather than the somatosensory blurring that condoms induce. I marveled at the wonder of this device.

Nonetheless, for nearly the next two decades, I never even heard the phrase, “female condom,” nor did I read it, in the mainstream media or any health news outlet. It made few headlines at the major international AIDS conference this week.

Just prior to the date of the deflationary event, knowing that my hydraulics were not what they’d once been, I called a few drug stores to ask if they had female condoms. No one had heard of them.

New HIV diagnoses in people over 50 had doubled from 2000 to 2009.

Soon after, I began seeing news reports with titles like “Seniors’ sex lives are up — and so are STD cases,” and “Condom Use Lowest…Among Adults Over 40?”

In case you missed all that, there were two major sources. One was an editorial last winter in the Student British Medical Journal, written by Rachel von Simson, a medical student at King’s College London, and Ranjababu Kulasegaram, a consultant genitourinary physician at St. Thomas’ Hospital London. The two investigators found that in the UK, new HIV diagnoses in people over 50 had doubled from 2000 to 2009.

How much of that jump comes from unprotected sex? Not clear. They did not break it down by method of transmission, and von Simson says there are no data on condom use in older adults in the UK: “No one was interested in measuring rates until we already had a problem, making past comparison impossible, and still no one has got around to a large study.” Continue reading

Longtime Mass. Planned Parenthood Leader Stepping Down

Dianne Luby, longtime head of the Planned Parenthood League of Massachusetts

This just in from the Planned Parenthood League of Massachusetts: Dianne Luby, who has led the league for 13 years, has told the board that she’ll step down at the end of this year.

(My first thought: “Wow, 13 years is a long time to endure the level of controversy that swirls around a group like Planned Parenthood, with all its work on contraception and abortion.”)

The Planned Parenthood press release says that Ms. Luby worked to “change the public conversations around sexual health,” to introduce a new approach to sex ed, and to expand access to sexual health care, particularly in “underserved communities.”
From the press release:

“Thirteen years ago, my overarching vision was to make PPLM an essential part of the mainstream healthcare community and I am so pleased about how far we’ve come,” said Ms. Luby. “I feel that this is an excellent time for me to be moving on. Not only are we successfully completing our five-year strategic plan, we have also reached our $30 million Sexual Health Matters campaign goal, which funded a broad range of health care initiatives.”

Under Dianne’s leadership, some of PPLM’s most notable accomplishments include:

•Opening five new health centers in Springfield, Fitchburg, Marlborough, Milford, and Somerville and building a new, eco-friendly facility in Worcester.
•Broadening public understanding of the full scope of PPLM’s programs and services by introducing its “Sexual Health Matters” brand.
•Developing a comprehensive sexuality education curriculum for middle schools and high schools that is now in 131 schools and reaching over 30,000 students. Wellesley Centers for Women is conducting a rigorous five-year evaluation of the middle school program’s effectiveness with very positive early results. Continue reading

Politico: From Death Panels to Birth Panels, Bachmann Weighs In

Michelle Bachman speaking (markn3tel/flickr)

Didn’t Michelle Bachmann exit the GOP race for president already?

No matter, here she is, reports Politico, not so subtly suggesting that the Obama administration’s birth control coverage policy for women might lead inexorably to a government-mandated childbirth policy. Wow.

The Minnesota congresswoman said the Obama administration’s contraception coverage mandate could be a slippery slope to a point where a “health dictator” decrees that women could only have one or two children. Continue reading

Considering The Vasectomy

(kristykay22/Flickr)

Who knew a vasectomy could make such a great read? But here it is, in GQ, a gripping, hilarious, heart-breakingly honest account of one guy’s decision to take charge of family planning by knife.

As he awaits the surgeon, author Benjamin Percy notices the “walls are busy with gruesome anatomical diagrams, cross sections that make the male genitalia resemble charcuterie.” Then the action begins: “They go to work, flopping back my penis, arranging tools on a tray, positioning a stool between my legs. I squint into the blinding lights while the nurse snaps on latex gloves and my doctor shaves my scrotum. Then it’s time.”

Percy takes us through his decision to get a “v-sec,” noting that he loves, loves, loves his two children. “But a third?” he writes. “Outnumbered, we would have to switch from man-on-man to zone defense, and I can’t help but shudder when I imagine a red-faced baby wailing through the night, the bank statements withering further, the walls crayoned, and the laundry hampers reeking of spit-up and poo. An unexpected pregnancy, in other words, would be a nightmare.”

So he takes the plunge and makes a date with the surgeon:

I don’t scream, but I clamp my jaw so tightly it clicks. I arch my back so much I end up looking behind me at the door. The technique differs from doctor to doctor. Some cut diagonally. Some puncture “keyholes” with a hemostat on either side of the scrotum. Mine scalpels a vertical slash right down the middle. The room is cold, but I am sweating. How I regret not accepting the Valium. The doctor explains the procedure as it progresses. Apparently some men don’t have pronounced enough vas deferens, the tubes that carry sperm outward from the testicles, making the vasectomy impossible. But mine look great, he says. I would tell him thank you if I had a voice.

He will now sever the right vas deferens and excise a length of the tube, making recanalization close to impossible. “Now,” he says, his voice lowering, “you may feel a hot nauseating spike of pain that reaches up your right side.” Nobody I have spoken to, nothing I have read, mentioned anything about hot nauseating spikes of pain. Before I can steel myself to the idea, I hear a snip. The noise of garden shears deadheading geraniums.

I am unable to breathe. I cannot see what the doctor is doing, but he very well might have shoved a furnace-baked length of rebar through my groin and into my torso. I am introduced to vast, intricate networks of pain I never knew existed. Continue reading