Access to affordable birth control — just what the doctor ordered

As a doctor and a researcher, I spend my days working with women in St. Louis as they navigate some of the most important decisions of their lives, including their reproductive decisions. I see the impact of political decisions — decisions that are disconnected from the lived experiences of women — in my daily work as I talk to women about finding the best contraceptive method for them. That is why I am so concerned about the Zubik v. Burwell case currently at the Supreme Court.

Birth control gives women the agency to determine if and when to have children. But as a doctor who works with women every day, I know that it provides women with more than that. Women also need contraceptive care for other medical reasons, including preventing ovarian or uterine cancers and regulating painful periods. That’s why the Affordable Care Act covers contraceptive care with no co-pay. Birth control is fundamental basic health care that every woman — regardless of where she works — should have access to.

Decisions about reproductive care are not just health decisions; they are economic as well. An IUD can cost up to $1,000. That’s more than a minimum wage worker would earn in an entire month. Without insurance, an IUD would be a totally inaccessible option for those women.

In fact, nearly one in three women said they would change their contraception method if cost were not an issue. One of the greatest contributions the ACA’s contraception benefit has offered to women is the ability to remove cost from the equation when determining the best method of contraception for them so they can focus on their health and wellness without exception.

I have seen firsthand the benefits of providing women with the contraceptive method of their choice at no cost — which is what the ACA contraceptive benefit does. My colleagues and I recently concluded a multiyear study on the impact of long-acting reversible contraception on decreasing rates of unintended pregnancy. We offered over 9,000 St. Louis women the reversible contraception method of their choice at no cost, along with education about the different methods. The results were not surprising. With education and access, most women chose long-acting reversible contraceptive methods like the IUD or implant, and ultimately demonstrated a significant reduction in the rate of unintended pregnancy.

The findings of our study, the Contraceptive CHOICE Project, showed that user-independent methods of birth control are more effective than others. Effective use of an IUD or implant is not reliant on a woman’s memory, or a trip to the pharmacy or a visit to the doctor, and therefore does a better job at preventing unintended pregnancies. We found that easing access to these methods of contraception results in a decrease of unintended pregnancies, which in turn means that women have control over their lives and better social, financial, economic and educational outcomes.

It is clear that women succeed when they are able to access contraception with no obstacle. And yet, the case at the Supreme Court threatens to reintroduce obstacles as women seek to access contraceptive care. The Supreme Court will soon hear oral arguments in Zubik v. Burwell, a case that would dramatically and seismically expand the ability of people to use their religion to harm a woman’s capacity to make smart medical decisions for herself.

The Zubik case follows on the heels of Burwell v. Hobby Lobby Stores Inc., which came to the conclusion that closely held religious for-profit employers could refuse to provide contraception coverage required by the ACA. However, in its decision, the court pointed to an “accommodation” offered to religious nonprofits, which allows them to opt out of providing contraception coverage by filling out a one-page form. After the employer opts out, the insurance company provides contraception coverage directly to the employees. The court recognized that this accommodation ensures that women would still get the health care they need as promised under federal law. After Hobby Lobby, the federal government extended the opt-out to closely held for-profit companies with religious objections to providing contraception.

But in the case now before the court, religious nonprofit organizations claim that their religion is burdened by the solution that the Supreme Court pointed to two years ago in Hobby Lobby.

We need to recognize these lawsuits for what they are: continued attacks on women’s access to contraception. Religious employers’ attempts to prevent women from accessing the health care they need have real world implications that play out every day, and will have a direct effect on women’s health and lives.

This case threatens to take choice away from women and make the most effective methods of contraception inaccessible, simply based on where they work. As a doctor, I know that’s not how these decisions should be made. I hope the Supreme Court will agree.

Access to affordable birth control — just what the doctor ordered

HEALTH EDCO W43092 Six-Piece Pocket-Size Labor and Birth Demonstration Set, Includes Models of Baby, Uterus, Amniotic Sac, Pelvis, and Detachable Placenta/Umbilical Cord

The Health EDCO W43092 six-piece labor and birth demonstration set is used to demonstrate the birthing process in one-on-one patient education. The pocket-size kit enables the kit to be transported for in-home visits. A knit uterus model simulates contractions and cervix dilation and effacement, and the pelvis demonstrates passage through the birth canal. A detachable placenta, umbilical cord, and amniotic sac demonstrate the separation process. The set comes with a 5-1/2″ long baby and proportionally-sized components, including uterus, amniotic sac, pelvis, placenta, umbilical cord, receiving blanket, and tote bag. Health education models are typically used as educational aids in medical and scientific classrooms and office settings.

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HEALTH EDCO W43092 Six-Piece Pocket-Size Labor and Birth Demonstration Set, Includes Models of Baby, Uterus, Amniotic Sac, Pelvis, and Detachable Placenta/Umbilical Cord

Middle schools: More birth control training, says CDC

The United States Center for Disease Control (CDC) announced that more young teens attending middle schools need to be trained how to use a slew of contraceptives, including condoms, abortifacients and other modes of artificial birth control.

The government agency also stressed that middle school teenagers need to be taught “necessary skills” so that they won’t contract a plethora of sexually transmitted diseases, such as HIV and herpes. In its report, the CDC also said in its report that the “preventative measures” American middle schoolers must learn are to avoid unplanned pregnancies.

The results of CDC’s latest survey of American middle schools and high schools — administered once every other year — were published Wednesday to divulge the evolving health behaviors of students. Its 2014 School Health Profiles Survey findings were presented last week at the National HIV Prevention Conference, prompting the CDC to press for more aggressive sex education programs.

According to a CDC press release, students’ sex ed training in schools is not up to par.

“[F]ewer than half of high schools and only a fifth of middle schools teach all 16 topics recommended by … [the CDC] as essential components of sexual health education,” the government agency reported.

Some of the topics covered include the importance of using “condoms consistently and correctly,” the “benefits of being sexually abstinent,” the “importance of limiting the number of sexual partners,” and using condoms “at the same time as another … [kind of] contraception.” The CDC also states that 6th graders through high school seniors must also receive training about how to get condoms, “how HIV and other STDs are transmitted,” the “efficacy of condoms,” “how to correctly use condoms,” and the health consequences of HIV, other STDs and pregnancy.”

Sex ed. the CDC’s way

Included in the CDC study is the examination of the percentage of schools that are taught each of the recommended areas of sexual education, LifeSiteNews.com reports. It also discloses the median of each state before providing its national assessment of teen behavior.

“A median of 75 percent of schools taught ‘[h]ow to create and sustain healthy and respectful relationships,’ while education on how HIV and other STDs are transmitted and ‘health consequences of HIV, other STDs, and pregnancy’ were taught 75 percent of the time,” LifeSiteNews’ Dustin Siggins points out. “Schools least often taught ‘how to obtain’ and ‘how to correctly use’ condoms, at 27 percent and 23 percent. Seventeen percent of middle schools taught all 16 recommended aspects of sexual education.”

Ranked number one on the list is STD prevention, with 95 percent of middle and high schools instructing their students on “how HIV and other STDs are transmitted,” as well as about the “health consequences of HIV and other STDs and pregnancy.” A close number two was abstinence, which registered at 94 percent. For high schools, the lowest two on the CDC’s recommended list of 16 were “how to obtain condoms,” (60 percent trained students on this) and “how to correctly use a condom” (54 percent of high schools). Nearly half (46 percent) of high schools in America teach each of the  CDC’s 16 recommended aspects of sex ed.

Honing in on public school education on seven specific contraceptives, the CDC obtained information on IUDs and several other forms of birth control that can also be used as abortifacients by teenage students.

“Sixty-six percent taught how to ‘the pill,’ 61 percent the ‘patch,’ 58 percent the ‘ring,’ 61 percent the ‘shot,’ 55 percent implants, 60 percent the IUD, and 49 percent emergency contraception,” the CDC divulged, according to LifeSiteNews.com. “Forty-three percent of schools taught all seven methods of birth control. Nineteen large urban communities were also sampled, though New York City was notably excluded. While the urban communities’ median numbers were often within five percent of the national median, both middle schools and high schools were far more likely to teach students about condoms.”

More exposure?

CDC National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention Director Jonathan Mermin stated that public schools must be more aggressive in its training of American teenage students.

“We need to do a better job of giving our young people the skills and knowledge they need to protect their own health,” Mermin insisted in his CDC press release. “It’s important to teach students about healthy relationships and how to reduce sexual risk before they start to have sex.”

Also noted in the press release is how condoms and other artificial birth control methods, devices, and drugs such as abortifacients are “essential topics in HIV, STDs, pregnancy prevention, and other health subjects.” The CDC called these classroom discussions “age-appropriate topics for middle and high schools based on the scientific evidence for what helps young people avoid risk.”

Even though a CDC media spokesperson would not tell LifeSiteNews whether it suggests educating students about the side effects of contraception or how numerous contraceptives can act as abortifacients, confirmation was given that it supports the public schools’ greater role in training kids to make “educated” sexual choices.

“CDC does not recommend the selection of a specific curriculum, but recognizes the authority of local school districts to make sexual health education curriculum decisions,” the spokesperson told LifeSiteNews. “CDC emphasizes that all sexual health education should be medically accurate and consistent with scientific evidence.”

The CDC also suggested that its brand of sexual morality should be inculcated in students to bring about what it considers society’s good, giving what many consider to be lip service about trying to accommodate local mores.

“[Sex education] should allow students to develop and demonstrate developmentally appropriate sexual health-related knowledge, attitudes, skills, and practices,” CDC continued. “It should also be consistent with community values, and developed with the active involvement of parents. What is critical is that our students get age-appropriate instruction across key areas of sexual health in both middle and high school in order to develop the skills they need to be healthy in adulthood.”

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Middle schools: More birth control training, says CDC

Public Sexual Health In Venezuela Looking Bleak As Condoms, Birth Control, And HIV Anti-Virals ...

Venezuela is currently facing a condom shortage. According to reports, a 36-pack of Trojan condoms now costs around $750. In a country already facing some of the highest teen pregnancy, STD, and HIV infection rates in South America, health experts are fearful that the recent inflation of condom prices could dangerously compromise citizens’ sexual health.

Venezuela is financially dependent on its oil trade, and a recent drop in oil prices has seriously affected the country’s economy. As reported by Business Insider, the Venezuelan economy is set to shrink by seven percent in 2015, and every industry is feeling the financial crunch. However, it’s the scarcity of condoms that have many in the health industry most worried. Business Insider reported that the products are absent from pharmacies throughout the country. For condoms which are available to buy, the prices are seriously inflated. An auction website is selling a pack of 36 condoms for $750, while a smaller pack of only three condoms costs around $62.

“Without condoms we can’t do anything,” Jhonatan Rodriguez, general director at the not-for-profit health group StopVIH, told Bloomberg Business. “This shortage threatens all the prevention programs we have been working on across the country.” Venezuela already has the second highest rate of teen pregnancies on the continent.

According to Carlos Cabrera, a gynecologist working in Caracas, teen pregnancies are “a mark of government’s failure: failure of its economic, public health, and educational policy.” To reflect this teen pregnancy epidemic, clothing shops in Venezuela have recently begun to fill their shop windows with tiny mannequins wearing school girl uniforms.

“Yes, it’s disturbing to see in a window,” Auriselvia Torrealba, 20, a Caracas local told Reuters. “But it’s the truth. You see pregnant girls all the time on the streets. So this forces you to think about the problem, doesn’t it?”

It’s not just condoms that are disappearing; Time reported that other forms of birth control, such as the pill, have also become harder to come by. Although abortion is illegal in Venezuela, it’s been disputed that in the long term the condom shortage could send more women to black-market abortion clinics. Here they may be subjected to dangerous procedures that may increase their risk of maternal death.

On top of the lack of birth control, Bloomberg Business also reported that anti-viral drugs for HIV patients have also hit critically low numbers, and with Venezuela having the third highest number of HIV infection rates in South America, this could mean that thousands will have to go without their life-saving drugs. 

Public Sexual Health In Venezuela Looking Bleak As Condoms, Birth Control, And HIV Anti-Virals ...

Sex after giving birth: How a caesarean could ruin your sex life

Have a c-section might not be the solution to safeguarding your sex life Photo: ALAMY (POSED BY MODEL)

Brazil

is in the throes of a ‘caesarean epidemic’. The number

of babies being born following a caesarean section is at an all time high of

52 per cent – an average based on 40 per cent of state hospital patients and

84 per cent of private ones undergoing the procedure.

Why? Well, sex.

“The Brazilian woman is concerned with her sexuality and fears that giving

birth will alter the perineum, which is a myth,” explained Vera Fonseca, the

director of the Brazilian Federation of Gynaecological Associations.

In the UK, caesareans were always a clinical decision until the law changed in

2013 and patients were allowed to decide whether or not they wanted one. The

rate has crept up – not as dramatically as it has in Brazil – by 0.5 per

cent in 2013, with 25.5

per cent of British babies now born following the op.

GP Dr Arun

Ghosh, from the Liverpool Spire One clinic, told me: “There’s

definitely an element of the ‘too posh to push’ factor coming through.

People see it as a bit of a ‘designer’ choice.

“But when it comes to your sex life, they’re not always a good choice – in

fact, although you’ll retain vaginal tightness, which is great for your

partner, there’s nothing about the procedure which is great for you.”

He adds “Caesarean sections can actually make vaginal intercourse more

painful. There’s a greater risk of surgical scarring around your uterus, and

you’re much more vulnerable to infection.

“There’s also the hormone issue to consider. With a vaginal birth, your body

gets to release all the hormones that have been built up over the course of

the pregnancy. Dramatic hormone changes can cause anorgasmia, which means

that you can’t orgasm regardless of what’s happening in the vaginal area.

There’s a greater chance of this happening following a c-section as your

hormonal balance isn’t naturally restored.”

Dr Ghosh points out that, when possible, a vaginal birth is generally best for

the baby, too. According to him, babies are more likely to have breathing

difficulties if they come out before they’re ready.

His words come as something of a revelation.

I had always understood a c-section was not without its risks, but I had no

idea that, in many instances, a vaginal birth (with all those associated

horror stories of ‘tearing’ and ‘stitches’ we hear about) might be better

for a new mother’s sex life.

_{Mums need to be able to merge their old and new identities}

Socially, I think we have an enormous problem helping mothers to reconcile

their old selves and sexual identity, with their brand new job looking after

a newborn.

Of course, no-one should feel obliged to start going crazy in the bedroom

after they’ve given birth. But the statistics from Brazil, and surprising

counter argument from Dr Ghosh, made me think about how little public

information mothers can access about sexual health after childbirth – and

how we don’t make it enough of a priority.

My friend Emma, 32 and a new mum, tells me: “Honestly, I feel so many

conflicting things. I’m a bit frightened of it and no-one has really brought

it up. People at my NCT class ‘joked’ about it being safe three weeks

afterwards, but added – ‘although you’ll probably never want to have sex

again. Ha ha!’

“My husband is being really sweet about it and I just want to find the words

to tell him that I do want to. But I’m just so tired. I need someone, or

something, to actually make me feel sexy because my identity is now ‘mum’.

And while it’s the best thing I’ve ever done, I’m finding it so hard to

reconnect with who I was before.”

Emma’s friend Alis agreed. “I didn’t want to be the mum who waited until her

child’s 5th birthday, so I read a lot of forums online. I had a c-section

for various reasons, but smugly thought, ‘at least that will make sex

easier’.

“Happily it’s all worked out. But if I’d known more about the sexual risks, I

think I might have opted for a vaginal birth.”

Alis added: “I had no idea how much motherhood would test my self confidence.

Every time I see a picture of a celebrity mum looking amazing – and there’s

a caption about how motherhood really suits Kim Kardashian or Beyoncé, -

it’s really easy to read it as a passive aggressive putdown if you’re a

normal mum.

“Unless you’re a celeb, we’re told you can’t be a mother and be hot. I have to

consciously fight my feelings because those images make me feel wobbly. It

usually helps to imagine Blue Ivy was sick into her Mum’s very expensive

handbag immediately after the picture was taken.”

_{Bey and Blue Ivy – unattainable perfection}

Back in Brazil, it’s thought that the c-section rise is also down to a

different medical culture – patients report that they have felt pressured

into opting for one as Simone Diniz, associate professor in the department

of maternal and child health at the University of São Paulo, told
The Atlantic.

“It [natural childbirth] takes long, and the idea is we have to make it fast.

It’s impolite for doctors to leave cases for the doctors on the next shift –

there’s a sense that you need to either accelerate it or do a c-section.”

But Dr Ghosh says that unless the baby is exceptionally large, or the birth

will involve some trauma, they’re really not for everyone.

“Why have an operation if you don’t need an operation?” he asks.

Even from speaking to just a handful of people, it’s clear that we need to

address the culture of misinformation that surrounds motherhood, and

challenge head on the idea that your sexuality, post birth, is a misty,

mysterious land that is going to be difficult to rediscover whatever you do.

All adult women are entitled to a healthy, happy sex life at any age,

regardless of significant life events. It’s great to give us options in

order to help us make this happen – but it’s much more effective to give us

plenty of accurate information.

Even in researching this article, I’ve already learnt to question the received

wisdom around caesareans. For someone about to get married and approaching

the age where you might start thinking about having a family, it’s thrown up

plenty to think about. Not to mention giving me a new found understanding

around my new-mum pals.

This is the start of a journey for me. But if you’ve already set off on yours

– and have a caesarean story to share, why not get

in touch with me on Twitter, or message Telegraph

Wonder Women. We’d love to hear what you’ve got to say.

Find

the official NHS guidance on caesarean sections here.

Sex after giving birth: How a caesarean could ruin your sex life