Tag Archives: family planning

Condom Use Among Young African American Men

Today’s guest post was written a sex educator who specializes in peer-to-peer pregnancy prevention programs. He understands the cultural nuances that influence the decisions young people make and works to help youth realize their potential. 

Condom use can be a taboo topic, especially within certain cultures and ethnic communities, including the African American community. When you dissect the African American community into subsets (by age, for example) you see trends in attitudes about condom use. According to the Black Aids Institute, young African American men report a 20.5 percent condom usage rate. It’s alarming to consider that 4 out of 5 young black men are not using condoms during sexual intercourse. Lack of condom use among African-American men can be seen as a direct correlation to higher rates of unplanned pregnancies, HIV, and other STI’s within the African American community.

couple

Research done by the Pacific Institute for Research and Evaluation conducted a qualitative study on condom use behaviors among urban African-American men ages 18-24. That research revealed various reasons for non-condom use:

  • Lack of interest in condom use
  • Lack of immediate access to condoms
  • Inconvenience
  • The mood-killing length of time it takes to put on a condom
  • Partner’s disinterest in condom use

The most commonly expressed rationale for not using condoms among the research participants was their general disinterest in using condoms. It is evident that there may be some cultural perceptions among young African-American men that promote the non-use of condoms during sexual intercourse. Education is a critical component to refute many of the misconceptions that this population has in regards to condom use and it may be highly beneficial for Sexual Health Educators to consider the use of peer-to-peer education.

Some of the perceptions of condom use among young African-American men are driven by peer influence. A literature review of peer-to-peer programs done by Advocates for Youth revealed the following results:

  • Improved reproductive and sexual health outcomes, including reduced incidence of pregnancy, births and STIs
  • Reduced sexual risk behaviors, including delayed initiation of sex, increased contraceptive use and condom use, reduced number of new sexual partners as well as increased abstinence among sexually experienced youth, reduced incidence of unprotected sex, reduced frequency of sex, and increased partner communication
  • Increased incidence of testing and sharing test results, including testing for HIV, for STIs, and sharing positive test results with a partner

Lack of condom use among African-American men has far-reaching public health consequences and effective strategies must be implemented to mitigate the cultural behavioral norms that promote non condom use. Peer education appears to be a promising model to educate young African-American men about the benefits of consistent and appropriate condom use.

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Abortion: One in Three

When someone asks me what women who have abortions are like, I ask them what one in three women are like. There is so much stigma attached to abortion – from the procedure itself to those who perform it to those who elect to undergo it – that it can feel safer to be silent than to advocate the truth.

The truth is: one in three females in the United States will have an abortion by age 45. Females of all ages, races, ethnicities, classes, genders, sexualities, of different religions, traditions, norms, values, ethics, and moral compasses face unintended pregnancies every single day.

Now, I’ve had much first-hand experience emotionally consoling females who are seeking abortion services, as Planned Parenthood requires patients to undergo an education and informed consent process before the procedure. During this time, the first question I ask the patient if she is “firm and clear” in her decision, and if she is being “coerced in any way.” This often prompts an emotional whirlwind as the patient tries to justify her choice, and explain away the stigma. She is often convinced that she is alone in her decision and that if anyone else in her life knew, she would be a target for scrutiny. Her nerves are often pacified as I explain how likely it is that females all around her have also had abortions – they just don’t talk about them.

I can’t help but find myself so frustrated by the shame-induced gag order that choice-opponents have papier-mâchéd all over the truth about abortion and those who undergo it. It’s time to rip down the propaganda for the sake of autonomy. It’s time to trample stigma. It’s time to take back the real experiences of abortion:

I was at a family planning conference recently, and a woman stood up and said we need a campaign like It Gets Better for abortion to raise awareness and decrease stigma. We need speak-out videos where people who have had abortions are willing to illuminate the other side: how their abortion did not ruin their life.

So, one in three of you, will you stand against stigma and stereotyping?

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Contraceptive Use in Developing Countries: A Growing Concern

Today’s post is by “Obi,” a Nigerian doctor conducting his field experience at Planned Parenthood as part of his MPH program. He was a general practitioner in his home country with main interest and expertise in maternal and child health.

Health demonstration, Nigeria.The issue of contraception is a continuing concern around the globe. This concern is elevated among women of reproductive age who live in developing countries and can’t afford to sustain large families nor have access to adequate health care. Providing couples, especially women, in third world countries with access to effective contraceptives would improve the health status of individuals and the nation as a whole. There are numerous reasons and advantages to improving the availability, access, and use of contraceptive for women in third world countries.

More women are seeking effective contraception in order to prevent unwanted pregnancies. This number has risen from 716 million in 2003 to 867 million in 2012 and keeps rising. Most of this need for contraception was among women in the poorest countries, which also saw the highest population growth within this period (Guttmacher Institute, 2013). These nations also had the worst maternal and child health outcomes with very high rates of morbidity and mortality.

A report by the United Nations Population Fund (UNPF) in 2012 stated that greater access to family planning methods would save developing countries more than $11 billion a year. These savings would come from reduced costs of care for mothers and newborn babies. The report also states that about $2 billion a year would provide enough contraceptives to meet the needs of developing countries. This point is further buttressed by the fact that having fewer children has been very beneficial for developed countries both financially and with regards to health outcomes.

Using Nigeria as an example, the UNPF study revealed that if the fertility rate fell by one child per woman, the economy would grow by at least $30 billion!

In 2012, the United Nations declared access to contraception to be a ‘universal human right’. However, this human right isn’t being realized for millions of women around the world especially for women in developing countries. Sadly, these women are continually faced with difficult choices and serious consequences of unintended and unwanted pregnancies.

The agencies and organizations that are trying to empower women in these nations are faced with constant social, political, and religious oppositions. They are also faced with persisting negative cultural ideas about contraception. Real change requires community-wide, multifaceted interventions, life skills, access to youth-friendly services, women-friendly policies, and the support of the country’s leadership. Changing negative perceptions of modern contraceptive methods would go a long way in improving women’s health by preventing unwanted pregnancies and even reducing the burden of STIs.

Saving lives, improving the quality of life, and empowering women is a goal that can be achieved in developing nations with continuing effort and dedication. My firsthand experience of this issue has really made it a very important topic to me and I would love to hear about your experiences and comments with regards to women’s health in developing countries.

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A Gender Neutral Menstruation Calculator!

MCALC is a new gender and LGBT friendly calculator that helps you keep track of your menstrual cycle. The idea began as a simple app that is gender neutral but it has expanded so that it is more inclusive. It is diverse in that it allows you to set what is important to you, like “Baby Mode” which is meant to help increase your chances of getting pregnant when planning. You can even set the app to remind you when you should restock on pads and tampons! The app is still in beta but it is available for people to download and give feedback on. It is currently available on Android and a version for iPhones is currently being developed. You can find out more here.

mcalc

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

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.

 

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Need a Pregnancy Test? Read This First

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.

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Family Planning in Botswana, Zambia and Zimbabwe

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.

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Contraceptive Coverage is Here … Mostly

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.

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Nuva Ring: A Testimonial

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?

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Quick Tips on Choosing Prenatal Vitamins

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.
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