Tag Archives: family planning

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

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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

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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

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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?

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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.

The Birth Control Black Market

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Birth Control PillsAmidst all the hoopla about birth control access in the media recently, the Huffington Post reported that some people have resorted to buying their prescription birth control off of Craigslist: “The online marketplace is filled with ads for discounted birth control, including many types of contraceptive pills as well as the NuvaRing…Lisa sold her two unopened packages of the NuvaRing for $75 earlier this week. Without insurance, each one can cost as much as $80.”

You know, I almost don’t hate this. Women, sick of seeing their reproductive independence held financially out of their reach, helping each other out by selling their extra birth control online. A mini-black market rising in response to a failure of the system to meet their needs.

Ultimately, of course, this is very dangerous; if you are a buyer, then you don’t know if the medication you purchase has been tampered with, or left in extreme heat and no longer effective, for example.  If you are a seller, you don’t know if the person to whom you are selling the medication has medical conditions that could make the pill unsafe for them, and who’s to say you won’t be held liable?

Selling birth control through Craigslist is illegal, though to my knowledge no one has been prosecuted. And I sincerely hope no one is, because it isn’t their fault.  If women have to resort to buying birth control through Craigslist of all places, is that not a sure sign that our current healthcare system is failing women in a major way?

President Obama’s healthcare plan will make birth control more accessible for millions of women…unless he’s voted out with this election, in which case all of his healthcare plans will surely be thrown out.  But hey, maybe politicians in this country will stop pretending that birth control is controversial or immoral and stop attacking women’s sexual health for the sake of distracting us all from the real issues! But until hell freezes over, you can try your local health department, free clinic, or your friendly Planned Parenthood for affordable birth control.

Feronians, have you ever had to obtain your birth control through not-so-legit methods?  Would you buy your birth control through Craigslist?

Birth Control Pills: Then and Now

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First Birth Control PillsCheck out this image of the first birth control pill. Strange, huh? Aside from the difference in dosage (5 mg – goodness!), what really blew my mind was the packaging. It never occurred to me before that the pill is one of the only medications I know of that comes packaged with careful such consideration to memory. In case you aren’t a pill user, the pills we use now generally look like this:

Helpfully labeled by date so we can remember if we took them or not.

According to this article on BC packaging at SocImages, back then “[w]omen were supposed to take 20 pills in a row, then none during their period. It was up to them to keep track of everything and remember when it was time to start taking the pills again.” Frankly, even with the carefully labeled packaging we use now, many women have a hard time remembering to take the pill on time (no judgment here, ladies, I’m a terrible pill taker myself. Nuva Ring for the win!)  I imagine there were many problems with taking it correctly, because it wasn’t long before an engineer created a pack that held exactly one month of pills, so that you knew when it was time to stop and have your period (Did you know that you don’t have to have a period on the pill? We’ll talk more about that another time). It came with a watch that had a calendar for your husband … I don’t know, it was the ‘60s. Finally, in 1965, we got day labels and placebo pills so we knew when to start a new pack.

Though it seems we’ve got the scheduling thing as nailed down as possible, birth control pill packs have still gotten more elaborate over the years (Alarms! Flowers!) Most of the fancy designs you can buy now seemed to be aimed at concealing the fact that you are carrying around birth control (sooo many make-up compact dupes!) or just looking as girly as possible – not bad things, of course, just interesting. The pill isn’t just another medication to many people – it’s a private matter you don’t want someone catching a glimpse of in your purse, or maybe something to dress up and celebrate.

If you want, you can see more cool images of old-school pill packaging here at PBS. And just for kicks, check out this timeline of contraceptive history at PBS.

Plan B One Step: Too Complicated for Some, Limited Access for All

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The week before last, Department of Health and Human Services Secretary Kathleen Sebelius blocked the recommendation from the FDA to lift age restrictions on Plan B One-Step (emergency contraception that helps to prevent fertilization from occurring up to 72 hours after unprotected intercourse – not the abortion pill).

What that means is that the FDA, after years of careful review and analysis, had decided that there was no scientifically indicated reason why the medication should require a prescription for users under 17 (and remain behind pharmacy shelves for the rest of us). This highly anticipated recommendation would have allowed Plan B to move (without prescription) from behind the pharmacy counter to where it would be most effective: on store shelves next to the condoms and pregnancy tests.

As someone who has had to resort to “Plan B” after my “plan A” failed at age 16, I feel personally outraged that the Obama administration has supported the HHS and blocked Plan B, an easy-to-use and incredibly important medication that has less physical risk than Tylenol or tampons!

Despite the FDA’s 10 years of scientific investigation on the medication, Sebelius’s rationale was that 11-year-old girls might not follow the directions correctly and, thus, need continued formal medical oversight (a clinician to tell them to take one pill as soon as possible within 72 hours after unprotected intercourse).

What?! In a nation where just about half of all pregnancies are unplanned, where too many of our teenagers are pregnant, and where millions of women lack health insurance, you’re ignoring their needs because the 1% of 11-year-old girls who might be having sex might take the one pill incorrectly?

Medical experts, including the American Academy of Pediatrics have come forward recommending that Plan B be made available for all ages without prescription; experts in the field agree the directions are simple enough, the medication is safe enough, and that there are no legitimate scientific or social reasons why this prescription/behind pharmacy counter barrier should continue to exist.

Experts aside, what if that eleven year old did take Plan B incorrectly? Logic and science tell me that:
1. The medication would be ineffective and her chances of pregnancy would not be decreased.
2. The medication would be ineffective and her chances of pregnancy would not be decreased.
3. The medication would be ineffective and her … should I go on??

Either she would reduce her chances of becoming pregnant or not. And if we are taking the “common sense” approach that Obama cited, my common sense tells me the physical, emotional  and societal risks of an 11-year-old becoming pregnant and having a child are more realistic than her misreading instructions that say “take this pill within 72 hours of unprotected intercourse.” What are the real-life consequences of a girl taking the medication incorrectly? Well, pregnancy!

My “common sense” tells me this decision is not about 11-year-old girls. My unfortunate suspicion is that the Obama administration is buckling to the demands of conservative political opponents and, recently, the Catholic Bishops. I understand that I’m ignorant to behind-the-scenes politics, but I do know that the decision contradicted this administration’s policy to choose science over policy To quote the President in 2010:

“… In this new Administration, we base our public policies on the soundest science; that we appoint scientific advisors based on their credentials and experience, not their politics or ideology; and that we are open and honest with the American people about the science behind our decisions.”

In the spirit of his conservative predecessors, politics trumped science again; and in the spirit of systematic patriarchy, ideology trumped women’s health again.

With Obama entertaining an exemption to the Affordable Health Care Act that would allow religious affiliations to reject contraception coverage for their insured employees on moral grounds, and the stunning blow to Plan-B accessibility, it’s almost like the President has forgotten that it’s election season and WOMEN ARE WATCHING.

Dear Mr. President

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President Obama will decide at any moment now whether to keep birth control coverage in place for millions of women. The President has been a great supporter of women’s health — but he’s facing tremendous pressure from anti-choice groups and religious leaders to exempt religiously-affiliated hospitals, universities, parochial schools, and other organizations from offering their employees coverage for birth control with no co-pays (no cost!). That means millions of women and their dependents would lose access to this wonderful benefit.

Coverage of birth control with no co-pays is one of the most popular benefits of the Affordable Care Act (“Obamacare”). At a time when many families are struggling with high health care costs, affordable birth control is a tremendous benefit. The reality is, one in three women voters (34 percent) have struggled to afford prescription birth control at some point in their lives.

Come on, Mr. President: do the right thing!

For more reading on the attempt to eliminate birth control coverage, read this article from The Huffington Post.

To Cut or Not to Cut: The Dreaded Episiotomy

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An episiotomy is a surgical procedure done during a vaginal delivery that consists of cutting the perineum (the tissue between the vaginal opening and anus) to assist the birthing process. Once a common practice, the overall rates for the procedure have fallen drastically within the United States over the past 30 years. One study published in the American Journal of Obstetrics and Gynecology found that in 1979, episiotomies were performed during 60.9% of vaginal deliveries, while in 2004 the rate had dropped to just 24.5%. Another found declining episiotomy rates were due to local peer pressure among health care providers and responses to significant research that came out against the routine use of the surgery. Interestingly, nurse midwives are less likely to use episiotomy to assist during labor than physicians.

Risks/complications from the surgery include:

  • tearing of the anus
  • blood loss
  • infection
  • pain
  • swelling
  • sexual dysfunction

Moreover, in the book Misconceptions: Truth, Lies, and the Unexpected on the Journey to Motherhood, author Naomi Wolf asserts:

“What anxious women are not usually advised is that an episiotomy is a serious cut right into the muscle; many women remember it as the most painful and traumatic part of a medicated hospital birth. Nor are women generally informed that, since women’s sexual responsiveness derives largely from the rich network of nerves and blood vessels in just that area, an episiotomy can cause pain during sex, and loss of sexual responsiveness, for up to seven years.”

Alternatives to episiotomy include:
○ Natural tearing: Many experts argue a natural tear is less likely to lead to further medical complications and has a speedier recovery time than episiotomy.
○ Wait it out: Episiotomies can make delivery happen faster, and can be used to expedite the process. If not medically contraindicated, you might avoid the incision by waiting it out.
○ Massage: prepare your perineum ahead of time by massaging it with vegetable oil or personal lubricant.
○ Water birth: studies have indicated that water births are less likely to create tearing or warrant episiotomy.

If you decided against an episiotomy, here are some ways to prepare for your delivery:

● Ask your physician or midwife their thoughts on episiotomy, and how often they perform them. If they’re proponents, you might consider finding another provider.
● Make a plan ahead of time. Tell your doctor, nurse, and/or support person your feelings about the procedure ahead of time. Ask them to do whatever is necessary to avoid the surgical incision before you feel yourself receiving one.
● Get an advocate: get a birthing coach or doula to be your advocate during delivery. If your doctor wants to clock out early by inducing an episiotomy, your advocate can step in and remind the medical staff of your established no-cutting policy.

NO on 26: Highlights from the Campaign Trail

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On October 21st I received an email about an opportunity to volunteer on the ground with Mississippians for Healthy Families, the campaign against the Personhood Amendment, AKA “Initiative 26” in Jackson, Mississippi. Within hours I was making plans to get my feet on the streets in MS and, with the full support of my affiliate, I was able to go. I had some of the most rewarding and remarkable six days of my life working on this campaign, and I’m back to share with you some highlights, day by day.

Day 1 “Welcome to Mississippi” (November 3, 2011):
Read more…