Tag Archives: family planning

EXHALE: If You Don’t Feel Relief After An Abortion


Posted on September 25, 2012 by

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When I speak with people presenting for abortion care, the majority of patients report that they’re nervous. They’re nervous for a variety of reasons, but for most of them it seems that the greatest fear is of having a stranger in a very private area of their body during a very private time in their life. They tend to be nervous about the discomfort they may experience and are anxious to feel “normal” again. Most patients report relief after their procedure is complete. They can begin to adjust back to their normal life.

For some people, though, abortion can bring on a gamut of negative emotions, from shame and embarrassment to feelings of guilt or isolation. While these emotions do not appear to occur as often as stereotypes may portray, there are absolutely pressures (society, religion, culture, family) that make some people second-guess their decision to postpone parenthood.

When this is the case, I recommend people turn to Exhale. Exhale is a toll-free talk-line for people experiencing emotional issues related to abortion. Callers are people who have personally had abortions, partners, friends, family members, or people considering abortion as an option who need a confidential non-judgmental ear to confide in.

I find Exhale to be a beautiful resource to those in need of emotional support after an abortion, and I’ve linked a video from Exhale’s website that explains what you can expect when you call one of its counselors.

Remember, one in three people in the U.S. will have at least one abortion by age 45. You are not alone; your feelings are respected and understood.

And always remember that we’re Planned Parenthood, and we’re here for you.

 

Need a Pregnancy Test? Read This First


Posted on August 30, 2012 by

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If you’ve missed a period or are having pregnancy symptoms, your next step is a pregnancy test. Just taking the test alone can be somewhat overwhelming because there are so many options and sometimes the directions aren’t clear. Here’s what you need to know about getting a pregnancy test:

When do you take them?

Most pregnancy tests will be accurate around two weeks after conception. This does not necessarily mean two weeks after you’ve had sex, as the date of conception may not be precisely the date of intercourse. Sperm can live for up to 5 days inside the vagina or uterus so if, for example, you have sex on a Monday and ovulate on Wednesday, you might get pregnant on Wednesday. Some women find their tests are negative for longer than two weeks, so if you have a negative test and still have not gotten your period or are experiencing pregnancy symptoms, take a repeat test after a week or consult your doctor.

Generally speaking, positive is positive

The most common test uses a control line and a test line, with two lines meaning positive. It’s important to know that even a very faint second line is positive. Sometimes I find that a faint line confuses people and leads them to believe that it is not negative or unclear. That is absolutely not true, if there is a second line the test should be read as positive.

Another thing to know is that pregnancy tests look for HCG, or human chorionic gonadotropin, which is a hormone produced during pregnancy. This is important because there is a myth that taking emergency contraception or the birth control pill may cause a false positive, and this is absolutely untrue. False positive results can occur due to some medications or illnesses, and false negatives can occur due to a faulty test, taking the test too early in your pregnancy, or not following instructions. If you are unsure of your test results, contact your doctor for a repeat test or a blood test.

Home test vs. a clinic test

The pros of an at-home test: you have privacy, and it may be cheaper and faster than taking a test in a doctor’s office.

The cons: you may experience confusion about performing the test correctly, and you may have questions about your results that you are unable to answer yourself or find online. Some people find it awkward to buy tests at the store.

The pros of a clinic test: it’s performed by professionals who use high quality tests. Also you have immediate support, information and referrals at your disposal.

The cons: it may be less cost effective, and you may have to wait for an appointment.

If you take a home pregnancy test:

  • Follow instructions! Make sure to perform the test as directed and read the test within the correct time frame.
  • Some recommend taking the test first thing in the morning, as urine is more concentrated at this time. While this is true and it may be helpful if you are early in your pregnancy, it is not 100% necessary for an accurate test.
  • Take the test in the morning on a weekday. Why? Because if you take the test at night or on the weekend, you may find yourself having to anxiously wait until you can get in to see your doctor or contact someone for information. The morning on a weekday gives you plenty of time to call your doctor and make an appointment.
  • Have a companion. You may want privacy and if that’s what you need then go with that! But sometimes having someone you trust to support you whether this is a happy or a sad time can be helpful.

Don’t forget your local Planned Parenthood offers affordable and accurate pregnancy tests with helpful educators to answer your questions.

Family Planning in Botswana, Zambia and Zimbabwe


Posted on August 9, 2012 by

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I recently spent 15 days traveling in Africa and, naturally, my curiosity about all things sexual led me to ask questions. I was pleasantly surprised by how open and willing people were to talk. All three countries I visited - Botswana, Zambia and Zimbabwe - had free and readily accessible family planning through their Ministries of Health. The most common methods used were pills (known as tablets), the shot (known as injectable) and implant. I’ll cover condom use and HIV in a future blog.

My first conversation about family planning was on a 5-seater plane between Chobe National Park and the Okavanga Delta in Botswana. A former Peace Corps volunteer, Debbie, was the roving nurse for the Wilderness Safari Company. She flew between tented camps throughout all three counties we visited, administering to the various needs of the extensive staff at each camp. She said family planning was readily accepted, free and easy to get. Botswana, in particular had a relatively low birthrate for many years. A bit of research led me to the fact that International Planned Parenthood Federation started work with the government of Botswana in 1969.

According to Mwani, the manager at the Lufapa Tented Camp in Zambia where we spent 3 days, all types of birth control are available in Zambia at no cost. Usually, birth control is not given until after the first child is born. Most commonly, a shot is given, unless the new mom strongly objects, at her six-week postpartum visit. The pill and shot are what is most used, but when I mentioned the ring, patch, IUD and implant, she said they were all available, too.

One of the most interesting conversations was with the daughter of a village headman in very rural Zimbabwe. Our group of 12 was seated in a large circular mud and thatch hut where the patriarch and leader of a village of around 500 held his regular meetings to solve family and village disputes. Mr. Johnson was surrounded by his sons, their wives and children, his wife, and his father’s second wife, who happened to be 7 years younger than him. Any question about “women’s issues” he deferred to his daughter and daughter-in-law.

When asked about family planning, his daughter confirmed what I had heard in Zambia. All methods were available. The average family size was 2 or 3 children. A van from the Ministry of Health came to the village once a moth to distribute supplies, give prenatal care, immunizations and administer basic health care. Babies were now delivered in the hospital instead of within the villages.

Every conversation I had was so matter-of-fact and natural. Even though all 3 countries are mostly Christian, there was no controversy about the use of family planning. Sometimes where you least expect it, sanity reigns.

Contraceptive Coverage is Here … Mostly


Posted on August 1, 2012 by

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Birth Control PillsThis guest post provided by our Medical Director.

A hard-fought day is finally here! Today, mandatory 100% coverage of a number of women’s preventive services, including the frustratingly controversial contraception provision, will go into place for many women. If you have an insurance plan written on or after today, it will now have to cover the following women’s preventive services with no copay:

  • Well women visits
  • HPV DNA testing
  • STI – including HIV – counseling
  • Breastfeeding support, supplies and counseling
  • Domestic violence screening
  • Contraception and contraceptive counseling

These are in addition to all the other preventive services that must already be covered. Not everyone will instantly have coverage today, though. First, you must already have insurance, and then you might have coverage right away if your insurance plan chooses. You might not have coverage until your plan renews. And if you work for a religious employer, you will probably have to wait another year as they have until August 2013 to implement the regulation. But woman are gaining ground.

However, there are still threats to contraceptive coverage. Two weeks ago, a federal judge dismissed a suit filed on behalf of seven states (Florida, Michigan, Nebraska, Ohio, Oklahoma, South Carolina, and Texas) who claimed that the contraception mandate violated their religious freedom because (I’m going to just directly quote from the Huffington Post, because the argument is convoluted):

“The states claimed that the contraception mandate violates religious freedom rights under the First Amendment by only carving out an exemption for those religious organizations that primarily serve and employ people of their own faiths. A Catholic charity, the attorney generals contended, would have to stop serving people of other religions in order to avoid having to pay for its employees’ birth control, and then those unserved people would have to turn to the state for assistance.”

And there are still two dozen other suits from religiously affiliated institutions such as universities that are pending. One of these was recently dismissed, but there are many more to come. And this past Friday, the birth control mandate suffered its first court loss in Colorado. But for the most part, for now, the contraception mandate is safe and we can celebrate one more step in the right direction for reducing the health disparities between men and women.

Nuva Ring: A Testimonial


Posted on June 19, 2012 by

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little plastic ring
master of my uterus
no babies for me

Yes, that’s a haiku, what can I say; I really love my Nuva Ring. I spend a lot of time at work counseling women on their birth control options, and I’ve noticed that sometimes when women request the pill, it’s with a sigh and a “Well I’ll just try to set my phone alarm or do it when I get up in the morning,” after telling me how last time they just couldn’t remember to take it. You know, I can’t take pills either. I’m forgetful, and worse, when I do remember sometimes I’m just too lazy to get up and go to the other room to get them. Luckily I discovered the Nuva Ring. We’ve all seen the commercial with the annoyingly catchy jingle (Oh oh, oh oh oh oh!), but it’s still something a lot of women aren’t very familiar with.

The gist: It’s a plastic ring, you place it at the top of the vagina by your cervix, where it releases hormones over the course of 3 weeks and prevents ovulation, just like the birth control pill does. The Nuva Ring site does a nice job of explaining how to insert it: “After washing and drying your hands, remove NuvaRing from the foil pouch. Holding NuvaRing between your thumb and index finger, press the sides together. Insert NuvaRing while lying down, squatting, or standing with one leg up – whatever is most comfortable for you. Gently push the folded ring into your vagina. The exact position of NuvaRing is not important for it to be effective. If you feel discomfort, NuvaRing is probably not inserted back far enough into the vagina. Use your finger to gently push the NuvaRing farther into your vagina. Rest assured, NuvaRing cannot be pushed too far up or get lost in your body. In fact, NuvaRing cannot go farther than the cervix. Once inserted, keep NuvaRing in place for three weeks in a row.” To remove, just reach up with your finger, hook it around the edge of the ring, and pull it right out. After seven days (just like your seven days of placebo pills in your pill pack), put a new one in.

There is nothing else quite like the Ring on the market yet, so I get some strange looks when I tell women about it. “Oh … no.” “It just sits there inside you?” “I feel weird having some foreign object inside of me.” Fair enough! Yes, it’s a plastic ring; yes, you have to keep it inside your vagina; yes, it stays there for at least three weeks. It’s a little weird. But I promise you don’t feel it when it’s there, and usually your partners can’t feel it (and if they can, it’s not ever-present, and it’s not uncomfortable). It’s the most convenient method that has combined hormones, which are best for keeping your periods regular (unlike the Depo shot or the Mirena IUD which, while more long-term, alter or end your period while in use). Although you can leave it in for a full four weeks if you like, and insert a new ring right away, allowing you to skip your period if that’s more your style. (Always ok this with your doctor first.)

To recap:
- You deal with it twice a month, once to insert, once to remove.
- You don’t have to have a period if you don’t want to.
- It doesn’t interrupt sex.
- It’s super-comfortable.
Caveats:
- Obviously, it doesn’t protect you against STIs.
- After intercourse, please check to make sure the ring is still in place afterwards! Because you can’t feel it when it’s in place, you may not notice right away if it’s been pulled out.

Have you guys ever tried it? What was your experience?

Quick Tips on Choosing Prenatal Vitamins


Posted on May 24, 2012 by

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If you are thinking about becoming pregnant or recently found out you are pregnant, then you need to take a daily prenatal vitamin. As always, it is a good idea to check with your physician before taking a new medicine. When looking at the sea of choices at your local pharmacies it can be overwhelming. Most medical providers are now recommending a prenatal with DHA. Here are a few things you can do to ensure you are choosing a good prenatal vitamin:

  • Ask the pharmacist which brand she would recommend and make sure it is third party tested. This helps to ensure the potency level listed on the bottle is accurate and is free of contaminants and/or heavy metals.
  • Make sure that it is enteric coated to prevent a fishy aftertaste. This is something you definitely don’t want when you are pregnant and possibly experiencing nausea.
  • Once you have started prenatal care, ask your medical provider if you should continue to take your over-the-counter vitamin or start taking a prescription. If you can, bring your OCV with you to your first visit to ensure it contains the correct amounts of folic acid, iron and calcium with D3. Here’s a more detailed description of the exact amounts of each vitamin and mineral.
  • Many people have sensitive stomachs and may need to also look for a prenatal that does not contain artificial colors, flavors or preservatives.
  • Some people have a hard time swallowing pills or feel nausea during the first trimester when taking a vitamin. You can contact your local medical provider for help choosing a different prenatal or try a gummy, liquid or chewable vitamin.
  • It is important to remember that a vitamin is a supplement and should be used in addition to a diet that contains lots of fruits, veggies (especially leafy greens for calcium), and good sources of protein.

Self-Injecting Depo: Our Affiliate’s First Research Study


Posted on May 17, 2012 by

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In this month’s issue of the reproductive health journal Contraception, our very own research department has published its first research project. The study, “Self-Administration of subcutaneous depot medroxyprogesterone acetate for contraception: feasibility and acceptability,” followed 50 women for 1 year as they self-injected the contraceptive into their thigh or belly. (Find a link to the article’s abstract here.)

For those of you who aren’t familiar with Depo (aka DMPA), it is a progestin-based hormonal contraceptive method that is injected every three to four months by a healthcare professional, intramuscularly (in upper buttocks or upper arm). It is more than 99% effective in preventing pregnancy, though it does not protect against sexually transmitted infections.

Depo is routinely given in healthcare settings intramuscularly, though another formulation exists that can be administered subcutaneously into fatty tissue in the belly or upper thigh.

The objective of the study was to assess feasibility and acceptability of self-injecting the subcutaneous method, Depo SubQ. Subjects were enrolled in one of two health centers, were taught self-injection by research staff, and after successfully injecting in the health center, were sent home with three additional doses of the medication for at-home use. Subjects were then asked to complete a short survey regarding their experience with self-injection, including how easy/difficult it was, how willing/unwilling they were to recommend the method to a friend, whether they had any side-effects, and how satisfied/unsatisfied they were with the method.

Survey results concluded that participants felt the method was convenient (95%), easy (87%) and recommendable to others (94%). Twenty percent of injections were met with difficulty, most commonly cited as plunger resistance.

Though we do not currently offer this formulation of Depo in our health centers, it has already been approved for use by the FDA and we hope our contribution will lead to better uptake of the method.

We are very proud to have contributed to such a respected scientific journal, and look forward to continuing to contribute to the reproductive science community! We’re Planned Parenthood – and we’re more than you think!

So, would you be willing to self-inject your birth control method?

Melinda Gates: A Leader in Reproductive Healthcare


Posted on May 14, 2012 by

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Great news for reproductive healthcare across the globe: last week in Newsweek, Melinda Gates announced that her central philanthropic issue moving forward is family planning! Historically, the Gates foundation has not funded abortion-related programs, though they have funded some family planning programs during their tenure. I am elated at her decision to bring access to contraception into the global healthcare conversation!

Melinda and Bill Gates (of Microsoft) are the founders of a massive philanthropic organization called The Gates Foundation, whose core belief is that “all lives have equal value.” This multi-billion dollar nonprofit supports both domestic and international efforts to curb poverty and improve the health and well-being of people in need. Further, when the Gates Foundation commits to a project, world leaders pay attention, and media attention follows.

In an article published last week on The Daily Beast, Gates discussed her struggles balancing her Catholic faith with her desire to assist the global need for contraception. I strongly recommend checking out the article – it’s very well written and very interesting!

What this landmark decision means is more funding for international contraceptive programs, and investment in research dedicated to improving and (even inventing!) effective contraception. As a member of a Planned Parenthood affiliate that conducts clinical research trials, my mind is bending at what opportunities may come. (By the way, did you know Planned Parenthood does medical research? We’re the leading reproductive healthcare provider in the United States, and one day we plan to be a leader in reproductive health research, too.)

A final flower in this bouquet of great news is the website they launched called “No Controversy,” which asks people from all over the world to share stories of how contraception has changed their lives. From their website: “There is no controversy in matters of equality. More than 200 million people worldwide don’t have access to contraceptives. Everyone deserves the tools they need to improve their life and provide opportunities for their children. The power to decide if and when to have a child has far-reaching impact for families, communities, and nations. Raise your voice for equal access to contraceptives. We all have a story. What’s yours?”

The site includes a stream of photos and text from people all over the world, sharing their stories of how contraception has helped them or changed their life. I’ve been hoping for an online community that raises awareness and normalizes contraceptive use for a while now, and I think they struck gold with this one. Check it out, add your story … because all people deserve the right to family planning.

This Week In: Abortion


Posted on May 10, 2012 by

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“The Republican-led Arizona legislature has now taken measures to cut off Planned Parenthood’s access to taxpayer money funneled through the state for non-abortion services.” Use of taxpayer money for abortion was already illegal, but apparently that wasn’t good enough – now Planned Parenthood will receive no funding. It is unclear at this time exactly how this will affect its services, but it is certain that this inhibits its ability to provide health care services at a reasonable cost. For people – especially women – in Arizona without health insurance, this is a direct hit to their ability to receive lifesaving cancer screenings, STD prevention and treatment, and affordable birth control.

Utah now requires a 72 hour waiting period before an abortion. Previously, there was a 24-hour waiting period but, as of Tuesday, it has expanded to three full days. I’ll be honest: waiting period laws make me angrier than any other abortion law. There’s no pretense of protecting fetuses here; it’s all about “protecting” fragile women from their emotionally burdened lady brains. As if women need the government to remind them to think about their decision, to take it seriously! It’s insulting. The real kicker here is that there’s no loophole for non-viable fetuses, so women are forced to carry a pregnancy that could not and will not result in a live birth for three extra days which, frankly, is just plain cruel.

Wisconsin’s Planned Parenthood suspends non-surgical abortions. There is a new law in effect that “requires women visit a doctor at least three times before having a drug-induced abortion, forces physicians to determine whether a woman is being coerced into having an abortion, and prohibits women and doctors from using web cams during the procedure.” Three times? How unnecessary. In case you’re wondering about the web cam thing, they are referring to the possibility of a doctor counseling the woman about her medication via webcam – a good option when there is are a limited number of abortion providers in your state. Aside from the obvious problems here, like interfering with the relationship between the patient and her doctor and limiting a woman’s access to abortion, this poses an issue for women unique to this law – insisting that women have a surgical rather than a medical abortion. There are pros and cons to both methods (look for an upcoming post about abortion options!), but some women prefer the medical because it is more private and less physically invasive. Losing this option may make their abortion experience even more difficult for Wisconsin women.

If you live in Arizona, Utah or Wisconsin, consider contacting your representatives to let them know you’re unhappy with their shenanigans. If you want to do something about anti-choice activities in your area, contact your local representatives or sign up at Planned Parenthood Action Network to keep up to date. (Please note that our “action” site is provided by our C4, or political advocacy, arm.)

The Final Frontier: Birth Control…for Men?


Posted on May 2, 2012 by

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The Male Birth Control PillEvery once in a while, a news story pops up about some new male birth control that’s in the works, and I always think the same thing: “I’ll believe it when I see it.” Although we get an occasional tease in the media, birth control has always largely been the domain of women.  Sure, vasectomies have been around for a long time now, but when it comes to reversible birth control men have condoms, withdrawal, and…what else? Let’s do a quick run down of male birth control options, the current and the (allegedly) upcoming.

Condoms. You know how these work; if you don’t, we’ve covered it here on the Feronia Project.

  • Pros: Up to 98% effective when used correctly every time. Easily available and simple to use, and you can get them for free at the Health Department and Planned Parenthood.  Try using them with some water-based lubricant (not nonoxynol-9, which can cause irritation which may increase the chance of getting an STI) and spermicide.
  • Cons: feels unnatural to some people, may decrease sensation or cause allergies in the latex-sensitive (try polyurethane condoms!), and you have to interrupt foreplay to put them on.
  • Biggest bonus: Condoms are the only method on this list which protect both partners from sexually transmitted infections.

Withdrawal. Also known as the pull out method. I’m super biased against this method for three reasons which we’ll discuss.

  • Pros: It’s available to everyone with a willing partner, free, and doesn’t require health insurance or seeing a doctor.
  • Cons: It’s only 73-94 % effective, and here’s the catch: you have to do it right (that’s what she said! Sorry). Men have to have a lot of self-control and knowledge about their bodies, which takes experience and practice. Pre-seminal fluid, the fluid that comes out of the penis before the man ejaculates, can still contain sperm so pregnancy can still happen. Also, if the man ejaculates on the vulva (outside the vagina), pregnancy can still occur – sperm really can swim.

Here are my thoughts:

  1. 73% effective with typical use? When there are methods out there that are up to 99% effective? No thanks.
  2. Trust no one, that’s my motto.  Even the most well-meaning man can forget, or get caught up and lose control, and hey, pre-seminal fluid is beyond their control anyway. Too risky.
  3. The plural of anecdote isn’t data, but I swear that I’ve seen so many positive pregnancy tests in my day by women who checked the “withdrawal” box on their birth control questionnaire. Scary.  Still, I know it’s not easy for everyone to obtain other birth control methods for financial, time, or other personal reasons, so withdrawal may be your best option at times.

Vasectomy. Story time! I was on a first date with this guy, and he mentioned that he wanted to get a vasectomy soon and was just waiting for an appointment with his doctor. Instantly, music swelled and cartoon birds started flying through the air, and my eyes turned into hearts and sprung out of my head. (That really happened. We broke up, though.)

Vasectomies deserve their own post (which is coming soon!) because there are a lot of myths and misinformation surrounding them. I think the biggest barrier to a vasectomy is getting the man to agree because a lot of men think you’re cutting off their testicles or forcibly removing their manly essence or something. In reality, vasectomies are safe, quick, and easy. Ejaculation still occurs, but the vas deferens (the tube that carries sperm) is blocked so that there is no sperm in the seminal fluid. Sex still looks and feels totally normal. No organs are removed, hormones and sperm production continues; sexual pleasure and sexuality are not effected.

  • Pros: Birth control that doesn’t interrupt sex and is nearly 100% effective and I don’t have to do anything – and it’s permanent? Sold. As you can tell, I love vasectomies.
  • Cons:  It’s permanent. Reversal surgery is expensive, complicated, and there’s no guarantee, so you need to be sure that it’s what you want.

(PS: Our local Planned Parenthood offers vasectomies; if you’re in Florida and interested in a vasectomy, check out our man Dr. Stein at his site).
RISUG. The most exciting up-and-comer. The hard-to-pronounce acronym stands for Reversible Inhibition of Sperm Under Guidance and in the US is called Vasalgel.  I’m not a fan of the names, but otherwise it sounds amazing.

The vas deferens is numbed with an anesthetic and then a polymer gel is injected into it and kills sperm – for up to 10 years. Then, when the man decides he’s ready to have kids, there’s another injection to get rid of the polymer and welcome back sperm. It’s been in trials for about 15 years in India, and starting trials this year in the US with hopes that it will be available in the United States by 2015.  I’m really hoping this becomes available and catches on, because it sounds like it could be a revolutionary new family planning tool for men and women both.

What else?
Apparently there are other things potentially on the horizon, creams, implants, and pills, which I can’t find a lot of information on, individually. However, you can read this article on male birth control options on MSNBC and the men who are trying them out.

Here’s my question, though. Say we finally get reversible male birth control on the market – will men use it? Would women want them to?

For a lot of people, the answer is an obvious yes. Many men will be delighted at the chance to have more control over the decision of when to get pregnant. Women who have experienced bad side effects on hormonal birth control will be happy to let their men try it out so they can have a break. I think a lot of men may be suspicious and hesitant; men aren’t used to their sexuality being medicalized like women’s sexuality has. Plus, for some men, there may be psycho-social factors to take into account, given the cultural links between masculinity, power, the penis, testicles, virility, etc.  For women, giving up control may feel too risky – if a guy misses his pill or his birth control otherwise fails, he’s not the one getting pregnant.

What do you all think? Would any of you try RISUG? Have you had experiences with condoms or vasectomies, good or bad? Dudes, would you take a birth control pill? Ladies, would you feel comfortable with your man being the one on the pill? Tell me about it.