Archive for the ‘Birth Control & Family Planning’ Category

June 7, 2013

New Developments in OTC Emergency Contraception Court Case

First, a quick refresher:

A couple of months ago a judge ordered that emergency contraception pills (like Plan B) be made available over the counter (OTC) without age restrictions. The U.S. Justice Department appealed that ruling, and asked for a stay so that OTC access wouldn’t take effect during the appeals process.

Around the same time, the FDA approved Plan B One-Step emergency contraception pills for purchase without a prescription for teens ages 15 and older.

On Wednesday, the Second Circuit Court of Appeals denied the stay for two-pill types of emergency contraception. This means that two-pill regimens should become available without prescription to women and girls of all ages even before the government’s appeal is resolved. The Court allowed the stay for one-pill variants of emergency contraception (e.g. Plan B One Step), and stated that the appeal process would be expedited.

Women’s health advocates have been fighting for more than a decade to make OTC emergency contraception a reality.

Nancy Northup of the Center for Reproductive Rights called Wednesday’s order “a historic day for women’s health,” adding: “Expanding access to this safe and effective way of preventing pregnancy after failed birth control or unprotected sex is the among the very best decisions our federal government can make for women’s health.”

Marcia Greenberger of the National Women’s Law Center remarked, “The Center applauds today’s decision, which underscores the simple fact that there is no reasonable basis for restricting access to this safe and effective birth control.”

The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Adolescent Health and Medicine have collectively denounced the administration’s decision to appeal the ruling at all, and issued a strong statement rejecting limited access: “There is no scientific justification for a continued age restriction on emergency contraception. The Administration’s decision puts the health of adolescent girls at risk and is inconsistent with what we know about the safety and benefits of emergency contraception.”

It’s unclear what will happen next in the fight for more accessible emergency contraception. The Justice Department has stated only that they are reviewing the order. According to SCOTUSblog, the administration has the option of asking the Supreme Court to delay all parts of that initial order for OTC access without age restriction. NPR’s Shots explains that “some lawyers say the government might be able to appeal to the full 2nd Circuit. But more likely, if they insist on fighting, government attorneys would have to seek relief from the Supreme Court justice who oversees the 2nd Circuit — Ruth Bader Ginsburg.”


May 2, 2013

One Step Forward, Two Steps Back: The Week in Over-the-Counter Emergency Contraception

Plan B on a drugstore shelf in Canada.

Plan B on a drugstore shelf in Canada. Photo / Cory Doctorow

What a frustrating week in the ongoing battle over evidence-based health policy.

To the surprise and disappointment of women’s health advocates, the U.S. Justice Department on Wednesday filed an appeal to prevent girls under age 15 from gaining over-the-counter access to emergency contraception.

Approaching the date U.S. District Judge Edward Korman’s order making levonorgestrel-based emergency contraceptive pills (such as Plan B and Next Choice) available without restrictions would go into effect, the Obama administration also requested a stay pending appeal, meaning the judge’s order would not be implemented according to schedule.

The judge’s ruling last month was in response to the Center for Reproductive Rights’ renewed lawsuit seeking over-the-counter access to the morning-after pill.

Responding to the appeal, Nancy Northrup, CRR president and CEO, said in a statement:

Women who urgently need emergency contraception have been delayed in getting it or denied access entirely for more than a decade because of the political maneuverings of the last two presidential administrations. The federal court has made clear that these stalling tactics were based purely on politics, not science.

We are deeply disappointed that just days after President Obama proclaimed his commitment to women’s reproductive rights, his administration has decided once again to deprive women of their right to obtain emergency contraception without unjustified and burdensome restrictions.

In the appeal documents, the administration argues that the court overstepped its authority and improperly interfered with the rulemaking process; the judge should have instead sent the issue back to the FDA for further action.

“We aren’t focused in this appeal on the merits of the secretary’s decision,” a Justice Department official, who spoke on condition of anonymity, told The New York Times. “What we’re focused on is that the remedies that the judge ordered were beyond his authority.”

Ironically, overstepping is what many would argue the administration did in 2011 when HHS Secretary Kathleen Sebelius overturned a decision by FDA scientists to make the contraceptive pills available without restriction.

The administration also argues that since the actual plaintiffs in the case are all over age 15, and it’s not a class action suit, that no harm is done to the plaintiffs by granting the stay (see below). By making this argument, the administration avoids addressing the potential harm to girls who are prevented from accessing a drug both FDA scientists, and the judge, said should be available.

The administration claims that the public would suffer irreparable harm if the stay is not granted; if the ruling is allowed to go forward and later overturned, it would create confusion for women, who might “mistakenly believe that they can obtain the drug without a prescription or at certain locations where it used to be available, but is no longer.”

We’re also supposed to believe the appeal has nothing to do with politics. A Justice Department official told The New York Times: “This is a decision that the Justice Department is making in representing our client: FDA. This is not a political decision. It’s not had White House intervention or involvement. This in our judgment is the right legal step to take in this case.”

Meanwhile, FDA Approves Making Plan B Available to Teens Age 15 and Up
The decision to appeal came just one day after the FDA announced its approval of Plan B One-Step emergency contraception pills without a prescription for teens age 15 and older. The drug was previously only available without a prescription to women 17 and older.

It’s a great step forward; however, younger women, for whom access to a healthcare provider may be most difficult, are still left without prescription-free access to the drug, which must be used within a limited window.

The FDA adds to the burden by specifically requiring proof of age. From the FDA’s press release:

The product will now be labeled “not for sale to those under 15 years of age *proof of age required* not for sale where age cannot be verified.” Plan B One-Step will be packaged with a product code prompting a cashier to request and verify the customer’s age. A customer who cannot provide age verification will not be able to purchase the product. In addition, Teva has arranged to have a security tag placed on all product cartons to prevent theft.

In addition, Teva will make the product available in retail outlets with an onsite pharmacy, where it generally, will be available in the family planning or female health aisles. The product will be available for sale during the retailer’s normal operating hours whether the pharmacy is open or not.

The ID/proof of age requirement is a big hurdle for many teens. Many states set an age requirement of 16 for a driver’s license or learner’s permit. Obtaining a state ID (related to driving or not) costs money, and hours for doing so are often limited. And undocumented teenagers are unable to obtain a legal ID at any age.

“While welcomed by some as an acceptable compromise,” said Nancy Stanwood, Physicians for Reproductive Health board chair-elect, the “FDA decision to approve the sale of emergency contraceptive Plan B One-Step to those 15 years and older with government-issued identification does little to improve real access for already-vulnerable women and young teens. Plan B has a time limit, and too many women in the U.S. have gone without it because of unfair, unnecessary, and medically unjustified barriers to access.”

Writing at ThinkProgress, Tara Culp-Ressler explains other reasons why the policy shift is still problematic, noting in part that it simply isn’t based on science, and the high cost remains a barrier.

The FDA’s ruling was in response to an amended application request by Teva Women’s Health, the company that makes Plan B One-Step, to make the drug available without a prescription to women age 15 and older. The FDA in 2011 denied Teva’s application to make Plan B One-Step available for all females of reproductive age. And still the debate goes on.


April 23, 2013

Study: IUDs Offer Safe Contraception Option for Teens But Rarely Prescribed

Intrauterine devices (IUDs) are a fairly safe, long-acting form of contraception, but many myths about the devices persist. For example, it’s somewhat common to hear that women who haven’t already had a baby, and especially teenagers, are not good candidates for IUDs; neither of these is true.

For a new study published in the journal Obstetrics & Gynecology, researchers reviewed data from health insurance records of more than 90,000 women who had IUDs inserted (including both hormonal and copper IUDs). They looked specifically at how many records indicated a IUD-related complication, discontinuation, or pregnancy.

When the researchers looked at the data by age group, they found that women ages 15-19 did not discontinue using IUDs any more frequently than older women. Teens were slightly more likely than older women to experience dysmenorrhea (menstrual cramps) or absence of menstruation within one year of insertion, or failure of the IUD to prevent a normal pregnancy, but rates for both of these were very low. Only 1.8 percent of teens using a levonestrogel-releasing IUD experienced a pregnancy (3.6 percent for copper), and 2.4 percent experienced cramping (6.2 percent for copper).

Pelvic inflammatory disease occurred in less than half a percent of teens. Women of all ages using a copper IUD were much more likely to stop using it than women using the hormone-releasing IUD, and this was most true for teens, although it’s not completely clear why. Rates of removal within 30 days for any complication were estimated to be very low for teens (2.9 percent for hormone IUD, 5.2 percent for copper) as well as older women.

The researchers conclude:

Overall, these data indicate that the IUD is an appropriate contraceptive for younger women and is not likely to cause serious side effects among teenagers. Physician recommendations play an important role in their patients’ decision-making, and their recommendation of the IUD could increase the use of this cost-effective and safe method of birth control among teenagers. Thus, physicians should include information about this highly effective method when they counsel young patients on their contraceptive options to help reduce the unintended pregnancy rate among teenagers in the United States.

The authors cite evidence that teens may indeed face clinician education barriers when seeking an IUD. One survey found that “only 19% of obstetrician–gynecologists surveyed in a 2010 study stated that they would offer an IUD to an unmarried 17 year old who had never been pregnant.”

With more evidence like the current study on hand, we hope it will become easier for teens to access this long-acting, effective form of contraception.

Related: Revisiting the IUD for Contraception – Pros and Cons for Women looks at the rise in IUD use and the safety record.


April 12, 2013

The Long Political History of Increasing Access to Emergency Contraception

Last week, a judge ordered the FDA to make emergency contraception pills available over the counter, with no age restrictions, capping a long and frustrating legal battle to increase access.

Versions of levonorgestrel-based emergency contraceptive pills (such as Plan B and Next Choice) are expected to be made available without restriction within 30 days, but it’s not clear whether there will be some administrative interference. The FDA might decide on new labeling or to limit the forms of emergency contraception made available. There is also the possibility that the decision will be appealed.

OTC access for all ages is essential because most emergency contraception pills are most effective when used as soon as possible, and time, distance, money, and privacy can be serious barriers, especially for teenagers, to obtaining and filling a prescription in time to prevent pregnancy.

The push to make emergency contraception pills (also known as morning-after pills) available to all ages without a prescription suffered a major setback in 2011, when HHS Sec. Kathleen Sebelius blocked the FDA’s decision to remove the age barrier. Since 2009, emergency contraception has been available without a prescription for anyone age 17 and older.

Sebelius’s objections focused on the idea that young girls would use EC in unsafe ways. Susan Wood, A former director of the FDA’s Office of Women’s Health who in 2005 resigned over political delays around emergency contraception, rejected Sebelius’s claim that more data was needed on safety and label comprehension, noting that “this type of age restriction, and worries about the use of medicines by teenagers, have not been applied to other products.”

U.S. District Judge Edward R. Korman, in reversing the FDA’s decision to deny a citizen petition for all-ages access, seems to agree that the “What about 11-year-olds?” objection is merely a smokescreen. From the memorandum:

This case is not about the potential misuse of Plan B by 11-year-olds. These emergency contraceptives would be among the safest drugs sold over-the-counter, the number of 11-year-olds using these drugs is likely to be miniscule, the FDA permits drugs that it has found to be unsafe for the pediatric population to be sold over-the-counter subject only to labeling restrictions, and its point-of-sale restriction on this safe drug is likewise inconsistent with its policy and the Food, Drug, and Cosmetic Act as it has been construed.

Instead, the invocation of the adverse effect of Plan B on 11-year-olds is an excuse to deprive the overwhelming majority of women of their right to obtain contraceptives without unjustified and burdensome restrictions.

Korman characterized Sebelius’s actions as “obviously political” and “arbitrary, capricious, and unreasonable,” and wrote:

Nevertheless, even with eyes shut to the motivation for the Secretary’s decision, the reasons she provided are so unpersuasive as to call into question her good faith. While the Secretary has strung together three factual statements in her memorandum to Commissioner Hamburg, she has failed to offer a coherent justification for denying the over-the-counter sale of levonorgestrel-based emergency contraceptives to the overwhelming majority of women of all ages who may have need for those drugs and who are capable of understanding their correct use.

While we’re celebrating the judge’s ruling, we should also keep in mind the fact that President Obama is still praising Sebelius’s unprecedented, access-denying interference and overriding of the FDA’s scientific review process.

More coverage:

Background information from Our Bodies Ourselves:


April 2, 2013

Lessons in Denial: A Student Perspective on High School Health Class

by Hanna Pennington 

Hanna PenningtonNo one ever really wants to take health class; it’s a required course, something people try to get out of the way so they aren’t that about-to-graduate senior who still has to take health. And that’s because at most high schools, health class doesn’t offer much — and everyone knows it.

I spent 80 minutes every other morning in health class during the second semester of my sophomore year, and when faced with an end-of-the-year survey about the class, I realized that the time had not been “spent,” but wasted.

We had not discussed birth control; condoms were the only form of contraception mentioned, and they came up only in the context of preventing STIs. A significant number of high school students are already taking hormonal birth control, like the pill, for a variety of reasons, whether to regulate hormone imbalances that can cause acne, reduce the pain of bad menstrual cramping, or because they are having sex, but the pros and cons of the pill were never addressed.

Through reading “Our Bodies, Ourselves” and other feminist websites and books, I have learned about many types of birth control. But this is because I care about this kind of thing. Most people don’t know what they should have been taught until it’s too late.

Another way in which my health class was insufficient, and also offensive, was that LGBTQ people were only mentioned in the context of HIV/AIDS, which we learned about by watching the film “And The Band Played On.” There was no other discussion.

As a bisexual person, I felt shortchanged. I sought out resources online, much the way I did with birth control, but again, this didn’t make up for the lack of class information. The majority of high school students are straight, but it is important to provide for those who aren’t, or who might be questioning. It is important to learn about how to have safe gay sex, not only safe straight sex; that information is a lot harder to find, unless you know where to look.


Related: A “Real” Sex Ed Story: A Teenager Recalls Lessons From “Our Whole Lives”


Another issue we did not discuss is consent. People need to learn not only that it’s OK to say no, but that enthusiastic consent is the key to happy, healthy sex (in fact, there’s a petition to make consent a mandatory part of sex-ed in public schools).

Abuse, both physical and sexual, should also be discussed. And resources should be provided for everything: where to get help if you’re being abused, where to purchase prescription contraception at a discount, where to get tested for STIs, and the number for the closest Planned Parenthood, for starters.

Finally, we never discussed masturbation. It is important for students to know that instead of it being something unholy or disgusting, masturbation is a perfectly healthy and important way to explore one’s own body and sexuality.

According to research by the Sexuality Information and Education Council of the United States (SIECUS), comprehensive sex education is more effective in preventing teen pregnancy than abstinence-only education. In her 2008 New Yorker article “Rex Sex, Blue Sex,” Margaret Talbot analyzed the differences in sexual patterns of teenagers living in different parts of the country, including the prevalence of teen pregnancies and STIs and use of contraception.

In conservative red states, where abstinence-only education is the norm and religion dictates much of the discourse, teenagers have sex earlier, usually without protection. In more liberal blue states, where there is often (but not always) more comprehensive sex education, teenagers wait longer to have sex and use protection more often when they do.

Although I live in blue-state New York, my health class was not all that. It is possible to acknowledge teenagers being sexual without encouraging it, but our teachers didn’t acknowledge any part of it. It is irresponsible to teach the class assuming that everyone is and will remain abstinent until marriage.

The 2009 documentary “Let’s Talk About Sex” examines young people’s attitudes toward and knowledge of sex and sexuality, comparing America’s largely insufficient programs to those of places like the Netherlands, where parents and children talk openly about sex (and which have lower rates of teen pregnancy and STIs).

Although I was briefly tempted to move overseas, there are comprehensive sex-ed curriculums in the United States, even if they can be hard to find.

One of my friends attends Rye Country Day School in Rye, N.Y. A program there encourages underclassmen to ask upperclassmen leaders whatever they want about sex, relationships, and so on. I was really impressed when I first heard about this, as it fosters an environment that removes shame from asking questions, which is how people get the answers they need.

At Manhattan Country School, there is a sex-ed curriculum, designed by Dr. Cydelle Berlin, that involves theater arts and peer education. Trained actors answer questions while in character. There is a box in every classroom in which students can leave anonymous questions.

The Unitarian Universalist Church, instead of strictly discouraging or not discussing sex as other churches often do, teaches a K-12 sex ed curriculum called “Our Whole Lives.” As stated on the website, the program “not only provides facts about anatomy and human development, but also helps participants clarify their values, build interpersonal skills, and understand the spiritual, emotional, and social aspects of sexuality.”

This curriculum is based on SIECUS’ “Guidelines for Comprehensive Sexuality Education,” which spans the same age range and includes such important topics as body image, gender identity, masturbation, abortion, and sexuality and society.

When reading this curriculum, I was pleasantly surprised how enlightened, inclusive, and accurate it was. But this should not be surprising; accurate language should be the norm.

It is bad enough that decisions about women’s health are made mostly by male politicians, but it is even more disheartening when you realize that some of them have no idea what they’re talking about. High school students aren’t the only ones who need basic education about reproduction, but it’s a good place to start.

Hanna Pennington is a high school senior in New York whose first foray into feminist activism was at age 7, when she wrote a letter to a children’s magazine protesting the omission of Sacagawea in an article about the Lewis and Clark Expedition. 


March 29, 2013

Access to Contraception Increases Social and Economic Benefits for Women And Society

The Guttmacher Institute recently published a report examining how access to and the use of effective birth control affects women’s lives.

The Social and Economic Benefits of Women’s Ability to Determine Whether and When To Have Children“ reviews more than 66 studies over the past 30 years. According to researchers, access to contraception and avoidance of unplanned pregnancy have led to:

  • increases in young women obtaining at least some college education
  • increases in college-educated women pursuing advanced professional degrees
  • increased participation in the workforce by women
  • increases in women’s earning power and decreases in the gender gap in pay

The researchers identify several gaps in the literature as well as areas where additional research is needed, such as how contraception benefits older women and women with low incomes, of racial and ethnic minorities, single mothers, and women with other sociodemographic factors that might prevent them from getting the full benefits of contraception.

The authors conclude with an important call for ongoing efforts to enhance access to contraception:

Clearly, access to reproductive health care and the recognition of reproductive rights cannot be addressed in isolation from the rest of an individual’s life, or from the rest of society’s inequities. Rather, policies and programs that advance contraceptive access and those that affect whether a woman is still able to achieve her life goals if and when she becomes a mother should be considered as part of a greater whole.

By helping women and couples, regardless of background or income, determine and exercise their own reproductive choices, government and organizational policies can help advance broader economic equality and social justice for individual women, families and society.

The report is available online as a PDF; a summary with links to more information is also provided. Also check out OBOS’s Brief History of Birth Control and discussion of Global Access to Birth Control.


March 5, 2013

Europe Takes on Review of Birth Control Pills Containing Drospirenone

While most birth control pills currently available in the United States are safe for most women, some newer pills that contain the progestin drospirenone have come under scrutiny because of an increased risk of blood clots. Birth control pills containing drospirenone include Beyaz, Gianvi, Loryna, Ocella, Safyral, Syeda, Yasmin, Yaz and Zarah.

The European Medicines Agency (EMA) announced late last month that it would take another look at so-called third and fourth generation oral contraceptives, including those with drospirenone, and consider whether use of these drugs should be limited.

The agency also plans to review whether current product information is enough to properly inform women and their health care providers of the risks. The agency has also said, though, “There is no reason for any woman to stop taking her contraceptive” — a rather confusing message for women wondering if they should switch to other types of pills.

The EMA previously reviewed whether this type of drug (specifically Yaz) could be marketed for use in preventing acne, but decided it could not based on concerns about the clot risk; it factored in that if women who no longer needed contraception or no longer needed the acne treatment continued on the drug, they would be exposed to unnecessary additional risk.

The U.S. FDA also did a review of pills with drospirenone, and is requiring language about the higher risk of blood clots to be added to the labels. As we noted last year, women’s health experts, including OBOS, have concerns about that review, and about leaving these pills on the market when safer alternatives exist.

That’s a key point in considering pills with drospirenone. While the risk of clots is small, we know the risk is higher with these pills than with other oral contraceptives. As one expert testified before the FDA, “I don’t usually vote against choices, but this time I did. And the reason is because on the benefit side, I didn’t see any improved benefit over the existing available choices.”

In the Women’s Health Activist newsletter in spring of 2012, Amy Allina, program and policy director of the National Women’s Health Network, wrote:

The question for a woman is, what should she weigh these risks against? As some have pointed out, the blood clot risks of pregnancy are greater than those of drospirenone pills. Is that the right basis of comparison? The Network does not believe it is. There are other, safer, ways women can avoid the risks of pregnancy – including contraceptive pills that don’t contain drospirenone. Drospirenone pills don’t provide a unique benefit over other available contraceptive pills. We’re also concerned that most women using drospirenone pills are unaware that other contraceptive pills are safer.

The NWHN has asked the FDA to remove these pills from the market. Allina wrote: “We believe that women who are looking for contraceptive options to help them postpone or prevent pregnancy should not be unnecessarily exposed to a higher risk of blood clots when there are safer alternatives with the same benefits available.”


February 28, 2013

Delivery of “Our Bodies, Ourselves” to Members of Congress Launches on Capitol Hill

Erin Thornton, Judy Norsigian, Rep. Jim McGovern, and Christy Turlington Burns

Last fall, following a sex-ed road trip with The Ladydrawers to deliver “Our Bodies, Ourselves” to former Rep. Todd Akin (of “legitimate rape” fame), Our Bodies Ourselves launched Educate Congress, a campaign to deliver the book to all members of Congress and key administration officials.

The basic premise: Everyone deserves access to accurate information concerning women’s reproductive and sexual health — especially those who write the laws.

Today OBOS kicked off delivery of the book, as Judy Norsigian, OBOS executive director and one of the original authors of “Our Bodies, Ourselves,” hand-delivered copies of the newest edition to about 20 legislators and staff members.

The point was made that the problem isn’t just poorly chosen words; rather, a lot more needs to be done to advance evidence-based health policy.

Norsigian walked the halls of Capitol Hill with Christy Turlington Burns, founder of Every Mother Counts, and EMC’s executive director, Erin Thornton. They submitted EMC’s petition to female members of Congress, asking them to support policies that protect the health and well-being of girls and women around the world, especially those that will reduce infant and maternal mortality rates.

Doing this on the day that the House finally passed the Violence Against Women Act made it particularly poignant.

NWHN interns Allyson Reddy and Grace Adofoli with Judy Norsigian and Rep. Chellie Pingree

Thanks to Allyson Reddy and Grace Adofoli, interns at the National Women’s Health Project, the book launch was a success. More books will be delivered in the coming weeks, until every member of Congress has, in their office, up-to-date information they can rely on when drafting bills that have a real impact on girls and women.

A big thank you to the supporters of Educate Congress! And a special shout out to fellow road-trippers Anne Elizabeth Moore, Rachel N. Swanson, Nicole Boyett and Sara Drake; Congress scheduler Christina Knowles; everyone who participated in the making of the Educate Congress video, especially Paul Noble and Anthony Cupaiuolo (bro!); and Malcolm Woods, who helped organize the Educate Congress launch at the National Press Club and kept the word going on Twitter (with the aid of “The West Wing” staff). All of you made this happen!

Erin Thornton, Christy Turlington Burns (holding the film “No Woman, No Cry”) Rep. Gary Peters, Judy Norsigian, Allyson Reddy, and Grace Adofoli


February 19, 2013

New Coverage May Spur Younger Women To Use Long-Acting Contraceptives

by Michelle Andrews | Kaiser Health Newskaiser health news logo

Even though they’re more effective at preventing pregnancy than most other forms of contraception, long-acting birth-control methods such as intrauterine devices and hormonal implants have been a tough sell for women, especially younger ones.

But changes in health-care laws and the introduction of the first new IUD in 12 years may make these methods more attractive. Increased interest in the devices could benefit younger women because of their high rates of unintended pregnancy, according to experts in women’s reproductive health.

IUDs and the hormonal implant – a matchstick-sized rod that is inserted under the skin of the arm that releases pregnancy-preventing hormones for up to three years — generally cost between $400 and $1,000. The steep upfront cost has deterred many women from trying them, women’s health advocates say, even though they are cost-effective in the long run compared with other methods, because they last far longer.

Under the Affordable Care Act, new plans or those that lose their grandfathered status are required to provide a range of preventive benefits, including birth control, without patient cost-sharing. Yet even when insurance is covering the cost of the device and insertion, some plans may require women to pick up related expenses, such as lab charges.

Long-acting reversible contraceptives (LARCs) require no effort once they’re put into place, so they can be an appealing birth-control option for teens and young women, whose rates of unintended pregnancy are highest, experts say.

Across all age groups, nearly half of pregnancies are unintended, but younger women’s rates are significantly higher, according to a 2011 study from the Guttmacher Institute, a reproductive health research organization. Eighty-two percent of pregnancies among 15- to 19-year-olds were unintended in 2006, and 64 percent of those among young women age 20 to 24 were unintended, the study found.

Although the use of LARCs has more than doubled in recent years, it is a small part of the contraceptive market. Among women who use birth control, 8.5 percent of women used one of those methods in 2009, according to the Guttmacher Institute. The use of LARCs by teenagers was significantly lower at 4.5 percent, while 8.3 percent of 20- to 24-year-olds chose this type of contraception.

In October, the American College of Obstetricians and Gynecologists reiterated its strong support for the use of LARCs in young women.

Yet many young women are unaware that long-acting methods could be good options for them, in part because their doctors may be reluctant to prescribe them, experts say. That is partly the legacy of the Dalkon Shield, an IUD that was introduced in the 1970s whose serious defects caused pain, bleeding, perforations in the uterus and sterility among some users. The problems led to litigation  that resulted in nearly $3 billion in payments to more than 200,000 women.

In addition, providers may hesitate because there’s a slightly higher risk that younger women will expel the device, experts say.

But expulsion is a problem more likely associated with the size of the uterus, which is not necessarily related to a patient’s age, says Tina Raine-Bennett, research director at the Women’s Health Research Institute at Kaiser Permanente Northern California and chairwoman of the ACOG committee that released the revised opinion on LARCs. “Expulsion is only a problem if it goes unrecognized.” (Kaiser Health News is not affiliated with Kaiser Permanente.)

The new IUD Skyla became available in mid-February. It is made by Bayer, the same company that makes Mirena, another IUD sold in the United States. Unlike Mirena, which is recommended for women who have had a child, Skyla has no such restrictions (nor does ParaGard, the third type of IUD sold here). Mirena is currently the subject of numerous lawsuits alleging some complications, such as device dislocation and expulsion.

Skyla is slightly smaller than the other two IUDs on the market and is designed to protect against pregnancy for up to three years, a shorter time frame than the others.

This shorter time frame may make Skyla more attractive to younger women who think they may want to get pregnant relatively soon, some experts say, although any IUD can be removed at any time.

“More providers are spreading the word that it’s okay, and more young women are demanding it,” says Eve Espey, a professor of obstetrics and gynecology at the University of New Mexico.

This article was produced by Kaiser Health News with support from The SCAN Foundation. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.


February 6, 2013

In Armenia, Abortion Rates are High and Access to Contraception is Limited

Taleen MoughamianTaleen K. Moughamian, a women’s health nurse practitioner in Philadelphia, traveled to Armenia in the fall of 2012. Working with the Children of Armenia Fund, she conducted  health exams, including breast and cervical cancer screenings, and provided contraceptive counseling. The following account is based on her work and conversations with Armenian women.

 

by Taleen K. Moughamian

The differences between Armenia’s capital, Yerevan, and the rest of the country are vast. While Yerevan has most of the modern-day conveniences you could ask for, the villages I visited in the Armavir region have populations between 300 and 1,000, mostly comprised of women.

Their husbands have gone –- off to neighboring countries, especially Russia, to find work. They usually stay away for 10 months out of the year. Some men have even started new families in their work countries.

It was not uncommon to meet women who needed to be treated for sexually transmitted infections (STIs) because their husbands are having extra marital affairs while abroad. They are upfront about this, though it surprised me how openly they talked about it.

I heard so many of them say, “They are men. They have needs. What can we do?”

This has created a huge problem and is one of the reasons why STIs, including HIV, are on the rise in Armenia.

There is limited access to effective contraception, so the rate of abortion, which is legal up to 12 weeks, is high. Most of the women who seek an abortion are married, already have two or three children, and do not feel they can provide for a larger family.

Sex-Selective Abortions
For some women, this means having three or four or even 15 abortions over the course of their lives as they struggle to create a family they can support. The median number of abortions for women over 40 is eight, according to a 1995 study conducted at a Yerevan abortion clinic.

Sex-selection has also become a huge issue. Since women leave their homes and join their husband’s family after marriage, a son provides a source of security for his parents. I met so many women who have had multiple abortions because the sex of the child was not what they had wished; for more data, see this UNFPA report on sex selection in Armenia and this story in The Armenian Weekly.

If you look at recent family planning data, it appears the number of abortions is going down, but from what I observed, that is not necessarily the case. Rather, more abortions are going unreported.

Rise in Unsupervised Abortions
Women are using an over-the-counter medication called Cytotec (the brand name for misoprostol) to induce abortions at home without the supervision of a trained medical professional. Cytotec’s indication is to treat ulcers, but it also acts as an abortifacient. Fifty cents worth of Cytotec can induce an abortion, whereas a surgical abortion usually costs about $35-$50.

When used properly, Cytotec is very safe, even without clinical supervision. But it is most effective when used in combination with a second drug, mifepristone (see more on this below).

Women in the villages I visited were not familiar with the World Health Organization guidelines now used by women all over the world. (Note: Women on Waves offers guidance, based on the WHO research, on how to do an abortion with pills.)

Many Armenian women are therefore in a dangerous situation, as they are using Cytotec without the relevant information about its efficacy or side effects, which can range from an incomplete abortion to bleeding to death.

Barriers to Contraception
As part of my work with the Children of Armenia Fund (COAF), I counseled women on birth control options. This has been quite a challenge, as there are so many myths surrounding birth control, and it’s expensive for rural women. One pack of birth control pills costs about $15-20 a month in Armenia. For a village family barely making $100 a month, it is completely unaffordable.

Besides the cost and access issues, social factors also influence a woman’s reproductive health. Although many husbands are supportive, others do not allow their wives to use birth control.

Sometimes the mother-in-law gets involved, too. When a woman in Armenia gets married, she moves in with her husband and his mother. The mother-in-law is usually the matriarch of the family, so she has a lot of pull in decision-making, even when it comes to her daughter-in-law’s reproductive health.

Changing Patterns, Changing Lives
During my last week in Armenia, I met a woman who had come to her village clinic for an abortion. She had two children and this was going to be her fourth abortion. She told me that her husband wants to have another child, but that he’s an alcoholic -– has been since the day they got married –- and he beats her.

She doesn’t think it’s right to bring a child into this world when her life at home is so unstable, and yet she is completely dependent on him for financial security. Living in the village, there are very few resources for either of them to get any help.

Stories like this are difficult to hear; you quickly realize how vital organizations like COAF are to these women. COAF provides free screenings for breast and cervical cancer and free treatment for STIs. With the help of the UNFPA, I inserted intrauterine devices (IUDs) for free to eligible women. This provides them with one of the most effective forms of birth control for up to 10 years.

On my final day working with COAF, one of the women was so thankful that as soon as the IUD procedure was complete, she jumped up and gave me a big kiss. She had had six surgical abortions, and she could not remember how many times she had taken Cytotec to end her other pregnancies.

It amazed me how much the women opened up to me. They are yearning for accurate information and resources, and they are deeply grateful not only for the health care that is provided but for the conversations about their bodies and their health.

Some women may not change their minds about birth control right away, but I know they at least have the information they need to consider it, and sometimes that is enough to start changing attitudes.

Despite all the economic and cultural barriers, I believe things are changing for women in Armenia -– slowly, of course, but moving in the right direction. There is no reason why Armenian women should have to keep relying on abortions for family planning, or why they should be misinformed about their reproductive health.

My hope is that educating women about their health and family planning options will empower them to take control of future. At the very least, they know where and when to seek care if they need it.

Related: Learn more about OBOS’s partner in Armenia, “For Family and Health” Pan Armenian Association (PAFHA), and efforts to adapt and distribute women’s health information based on “Our Bodies, Ourselves.” The preface to the Armenian edition is available in English.
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Ed. note about mifepristone and misoprostol:
Mifepristone and misoprostol are now frequently used together to produce what is called “medication abortion” for women who are less than eight weeks pregnant. The drugs are not identical and perform different actions. Mifepristone, often known by its manufacturing name RU-486, is almost always used for abortion or to end missed miscarriages. Misoprostol has wider applications and may be used in place of prostaglandins to create cervix softening prior to birth. It can also help prevent stomach ulcers that are caused when people take non-steroidal anti-inflammatory drugs (NSAIDS).

Under the supervision of a health care provider, women choosing a medication abortion typically use an oral dose of mifepristone first, followed by either an oral or vaginal suppository dose of misoprostol several hours later. In slightly more than 90 percent of women, this induces abortion within two days, provided it is used in early pregnancy. Misoprostol becomes increasingly less effective in more advanced pregnancies, and other, more effective drugs may be chosen for pregnancies that are more than eight weeks along.

The different actions of mifepristone and misoprostol explain their effectiveness in inducing abortion. Mifepristone works to separate the placenta from the uterine lining, and it causes uterine contractions. Additionally, the drug has some effect on the cervix and may cause it to soften.


January 28, 2013

When it Comes to Abortion Rights, the Issue is Access

Although we celebrated the 40th anniversary of Roe last week, access to abortion is not only difficult for many women, but legislators are working to make it even more difficult.

On Saturday, Melissa Harris-Perry opened a discussion on her show with these remarks:

Before 1973′s Roe v. Wade, complications from abortion was the leading cause of death among women of childbearing age. This was especially true for women of color. As access to abortion once again narrows, it puts women’s lives in danger. So while much of the debate about reproductive rights is focused on the legal interpretation and the Constitution and the bodily rights of women, we can’t forget the basic issue of access. [...] Access is the frontier on which we need to be fighting. 

It was a great conversation (watch above if you missed it!), and we were thrilled to see Steph Herold, a New York Abortion Access Fund board member and a contributor to the new edition of “Our Bodies, Ourselves” (which we’re aiming to send to all members of Congress; learn more here), and Feministing editor Chloe Angyal taking part in the round table, along with The Nation editor/publisher Katrina vanden Heuvel and Demos senior fellow Bob Herbert.

Herold talked about the implications of the Hyde Amendment, which since 1976 has banned Medicaid coverage of abortion, and how that limits access for low-income women.

“We really believe that however people feel about abortion, politicians shouldn’t be be able to deny women health care coverage just because they’re poor,” said Herold.

As legislatures reconvene for the new year, we’re keeping an eye on proposed bills that further restrict access to abortion.

In the states:
Proposed bills in Arkansas would prohibit all abortions after 20 weeks, ban the practice of remotely prescribing medication for abortions (otherwise known as telemedicine), and ban abortion coverage in health insurance exchanges.

A bill has been introduced in Florida to ban all abortions except in medical emergencies and to sentence abortion providers (or those who assist or own/run clinics) with up to life to prison. The bill has failed in previous years.

The previously defeated personhood bill is back in Oklahoma.

You may have seen news of a New Mexico bill from Republican state Rep. Cathrynn Brown, which would make it a felony for a woman to have an abortion if the pregnancy resulted from rape or incest. The bill frames such abortions as “evidence tampering.”

Brown claims the bill is being misunderstood; at the very least, it’s poorly written, as it very clearly prohibits not only “compelling or coercing another to obtain an abortion” but also “procuring or facilitating an abortion.” The bill is reportedly being re-written; advocates should keep an eye out for clarification of the language.

Here’s another summary on more abortion restrictions being proposed around the country.

At the federal level:
Multiple bills have been proposed by Tennessee lawmakers to prohibit Planned Parenthood from receiving Title X family planning funding (here’s my personal take as a Tennessean).

A bill has been introduced to define “life” as starting at fertilization.

Other bills would require hospital admitting privileges nationwide for abortion providers (a medically unnecessary move intended to restrict access), and would criminalize people who take a minor across state lines to access abortion, including a sister or aunt as well as other relatives and friends.


December 21, 2012

Fan of Female Condoms? Enter International Film Contest

If you’re a filmmaker with an interest in spreading the word about female condoms, check out this contest from PATH, a global health organization:

Why does the world need female condoms? How can female condoms enhance your life? Submit a short film (1:00–5:00 minutes) that tells a story about what Female Condoms Are to you and your community. The deadline to enter is March 1, 2013.

First prize receives $5,000. Winning entries will also be screened at the 2013 Women Deliver conference. Full details and rules are on the contest website.

To learn more about female condoms, see our previous posts and this excerpt from the most recent edition of “Our Bodies, Ourselves.”


December 10, 2012

PBS American Voices: Our Bodies, Ourselves and the History of the Women’s Health Movement

Watch American Voices: Our Bodies Ourselves on PBS. See more from Need To Know.

The most recent episode of the PBS news show “Need to Know” featured an excellent yet disturbing segment about state legislatures slashing funding to women’s health clinics.

Mona Iskander looks at the effects this is having on women — particularly low-income women — and their ability to obtain birth control, STI screenings, and other reproductive health care services. Our own Judy Norsigian, OBOS’s founder and executive director, weighs in at the end about women’s health activism.

As part of the show’s online series “American Voices,”  Judy covers the beginnings of the women’s health movement in the United States and the launch of “Our Bodies, Ourselves.” She discusses the long history of denying women access to services as well as information about their bodies, and notes the effects of so many years of misinformation:

Over the years, we saw repeated attacks on good sex education. So much so that we then ended up with federally funded abstinence-only sex education in many of our schools. And the damage done there is still showing, well into the 21st century. I’ve met professors at medical schools who have said incoming medical students have said that using condoms promotes HIV/AIDS. And that comes straight from their abstinence only sex education in high school.

Watch the video above (just 3.5 minutes) for a look at how hard women have worked to ensure access to accurate, evidence-based information, and why it’s more important than ever  that politicians use this information when setting health care policy.

Want to help educate Congress? Send a copy of “Our Bodies, Ourselves” to your favorite representative or senator. It makes a great holiday gift!


December 6, 2012

Pros and Cons of Making the Birth Control Pill Available Without a Prescription

condom and the pill

Though it won’t be as accessible as condoms, health experts are proposing to make the birth control pill available without a prescription. Photo / Jenny Lee Silver

This month, the American College of Obstetricians and Gynecologists released a statement calling for oral contraceptives to be sold over-the-counter, no longer requiring a doctor’s prescription.

ACOG considered a host of issues, including the safety of birth control pills; whether pharmacists could screen for who shouldn’t get them, or if women could self-screen; adherence to taking the pill; whether women would skip other preventive care if they didn’t visit a health care provider for a prescription; and cost.

Notably, ACOG addresses frequent objections to OTC oral contraceptives by concluding that “several studies have shown that women can self-screen for contraindications,” and “cervical cancer screening or sexually transmitted infection (STI) screening is not required for initiating OC use and should not be used as barriers to access.”

As Kevin Drum points out at Mother Jones, most countries outside of North America and Europe do not require a prescription for these drugs.

ACOG notes, though, that making the pill non-prescription might increase the cost for women who have health insurance — especially since under health care reform, contraception can be purchased without a co-pay. Over-the-counter costs might end up being anything from the $4 deals many pharmacies offer to more than $100. Dr. Kent Sepkowitz also explores this concern at The Daily Beast:

Yes, your life is easier because you will be able to get the pill right this second, without calling my office. No, you don’t need to fill out forms and show insurance cards and wrangle over copay. But guess who is paying for the whole shabang? You. Yes, you.

Another concern is that if the pill were dispensed by pharmacists, we might see the more of same kinds of refusals as have happened with emergency contraception.

However, many patients may experience increased access with an OTC model. The National Latina Institute for Reproductive Health issued this response:

The recommendation that birth control be available over-the-counter supports what we know about Latinas and contraception: over-the-counter access will greatly reduce the systemic barriers, like poverty, immigration status and language, that currently prevent Latinas from regularly accessing birth control and results in higher rates of unintended pregnancy.

Pre-Prescribing Emergency Contraception to Teens
Another professional medical organization, the American Academy of Pediatrics, issued a statement recognizing high teen birth rates in the United States and barriers to access to emergency contraception for adolescents 17  and younger. The AAP strongly admonishes pediatricians who refuse to discuss or provide contraception to teens based on their own beliefs, stating:

Pediatricians have a duty to inform their patients about relevant, legally available treatment options to which they object and have a moral obligation to refer patients to other physicians who will provide and educate about those services. Failure to inform/educate about availability and access to emergency-contraception services violates this duty to their adolescent and young adult patients.

The AAP recommends that physicians provide prescriptions to emergency contraception like Plan B in advance, so teens have it ready if and when the need arises. They also urge physicians to provide accurate information to teens on this topic, and, “At the policy level, pediatricians should advocate for increased nonprescription access to emergency contraception for teenagers regardless of age and for insurance coverage of emergency contraception to reduce cost barriers.”

Nice job, AAP!

HHS Urged to Remove Restrictions on Emergency Contraception
Finally, a petition is circulating urging the U.S. Department of Health and Human Services to remove restrictions on emergency contraception and make it available to women of all ages without a prescription. To learn more, see RH Reality Check’s audio news conference and related links and commentary from Kristin Moore. Our previous posts provide background on why EC is not *already* available OTC to all women:


November 28, 2012

CDC Releases New Data on U.S. Abortions

Each year, the Centers for Disease Control and Prevention (CDC) releases information on the number of abortions in the United States. Newly published data from 2009 shows that rates of abortion overall have decreased 5 percent since 2008 to the lowest levels since 2000. In general, rates of abortion were highest right after legalization, fell steadily in the 1980s and 1990s, and started to level off in the past decade.

It is not clear why rates have fallen. Possible contributors range from the expanded use of contraceptives and better sex education to the declining number of abortion providers and increases in restrictive abortion laws. Unintended pregnancy rates have not changed in decades – about half of all U.S. pregnancies are unintended — so that is not responsible for any decline.

As we know, many myths persist about who gets abortions and why. The following details shed some light on the topic:

  • Women in their 20s have the highest rates of abortion (ages 20–24: 27.4 abortions per 1,000 women / ages 25–29: 20.4 abortions per 1,000 women), and account for 57.1 percent of all abortions.

This doesn’t seem terribly surprising given that women in their 20s are more likely to be fertile. In addition, they are more frequently uninsured. The insurance factor likely decreases their use of the most effective birth control methods –IUDs and implants –as those methods require a visit to a health care provider.

  • The majority of women (55.3 percent) having abortions have not had a previous abortion. About 25 percent have had one previous abortion, and about 11 percent have had two previous abortions. Only about 8 percent have had three or more abortions, suggesting that the overwhelming majority of women having abortions do not fit the “using it as birth control” myth.
  • Six out of every 10 women having abortions have already had one or more children. Women very frequently say that they chose abortion in order to best be able to care for their existing families.
  • Abortions are usually performed early in pregnancy, with 64 percent done at less than eight weeks gestation, and about 92 percent done by or before 13 weeks.

There has been a clear shift to earlier abortions, with an almost 50 percent increase in abortions done at less than six weeks’ gestation. The CDC report is not able to address the reasons why; the increase may be caused by the greater availability of medication abortion (medication abortions are performed only up to 9 weeks) or an increased number of abortion laws that make later abortions more difficult to obtain.

Other points of interest:

  • Use of medication abortion continues to increase; 16.5 percent of abortions in 2009 were done medically instead of surgically, a 10 percent increase from 2008.
  • Abortion ratios (the number of abortions for every 1,000 women) decreased among non-Hispanic white women but not among women in any other racial/ethnic group.

Poor women, young women, and women of color are less likely to have access to reproductive health care services, more likely to have an unintended pregnancy, and more likely to have an abortion.

The CDC concludes its report with public health recommendations, including support for no-cost birth control. The Affordable Care Act comes close by eliminating co-pays for insured women (though employers who oppose reproductive rights are still fighting this provision), making birth control available without a co-pay for an estimated 47 million women. Here’s what the CDC has to say:

Moreover, although use of the most effective forms of reversible contraception (i.e., intrauterine devices and hormonal implants, which are as effective as sterilization at preventing unintended pregnancy ) has increased, use of these methods in the United States remains among the lowest of any developed country, and no additional progress has been made toward reducing unintended pregnancy. Research has shown that providing no-cost contraception increases use of the most effective methods and can reduce abortion rates. Removing cost as one barrier to the use of the most effective contraceptive methods might therefore be an important way to reduce the number of unintended pregnancies and consequently the number of abortions that are performed in the United States.

See our analysis of a recent study on unintended pregnancies in St. Louis for further discussion of how improved access to free birth control reduces abortions. The study is important for its role in dismantling persistent myths about contraception and abortion.

Plus: Though some members of Congress with less-than-accurate ideas about women’s bodies lost re-election, that doesn’t mean Congress is apt to back smarter policy. Let’s remind all members about the importance of access to contraception and reproductive health services. Join the Educate Congress campaign to send “Our Bodies, Ourselves” to every elected senator and representative. You’ll receive an “I Educated Congress” button (and other perks) showing you did your part!