Contraception

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Reject these Old Memes—2-2014

Posted by on 26 Feb 2014 | Tagged as: Contraception, Family Planning, Population, Reproductive Health

Recently a friend introduced me to the word “meme”. Now I run across this concept frequently.
The word “meme” is analogous to “gene”, but it is information in our culture rather than in our DNA. A meme is a building block upon which our way of life is built. One definition is: “an idea, belief or belief system, or pattern of behavior that spreads throughout a culture”.
An old example is the Pythagorean theorem—the square of the hypotenuse of a right triangle is equal to the sum of the squares of the other two sides. This meme is ancient.
One accidental meme is changing lives in Brazil. The average family size has dropped rapidly. In 1954, when I visited as a child, women had an average of over 6 children. Now the average is 1.8—less than replacement. This big change is largely because of TV telenovelas, where middle class families are all small.
Some memes are harmful. An example is a tradition in Nigeria that leads to the death of many children. For eons Traditional Birth Attendants used mud or other unclean substances to dress newborn babies’ umbilical cord stumps. If tetanus spores are present, the baby can die a horrible death from tetanus. This improved when TBAs were taught the advantages of cleanliness and sterile instruments. Now pregnant women getting prenatal care are immunized against tetanus and there are many fewer deaths.
Galileo, who was born 450 years ago this month, suffered because of a religious meme. This meme slowed the development of knowledge for centuries.
Ancient Egyptians thought that the sun rotated around them—the geocentric model of the solar system. A Greek may have first proposed that Earth revolved around the sun 2500 years ago—the heliocentric model. For centuries people believed that the earth was the center of the universe, supported by theology that interpreted the Bible thusly. One verse that supports this meme is found in Psalms 104:5: “(God) built the earth on its foundations, so it can never be moved”. There are still people who hold that the sun goes around the earth—including 26% of US citizens, according to a recent National Science Foundation survey!
In the early 17th century Galileo defended the heliocentric theory, for which he was accused of heresy and placed under house arrest for the rest of his life. The Inquisition’s ban on reprinting his works was only lifted a century later. It was not until the 19th century that the Roman Catholic Church removed books advocating heliocentrism from its Index of Prohibited Books. Pius XII was the first Pope to acknowledge the many important contributions of Galileo—in 1939. Yet there are people who believe that heliocentrism is a conspiracy (http://www.johnthebaptist.us/jbw_english/default.htm). It is amazing how long this meme has persisted!
Years ago I sold “green umbrellas” at a public health meeting. From a campaign in Bangladesh (where it rains a lot), these umbrellas carry slogans such as “stay well” and “take health services” in Bengali. A doctor from Bangladesh bought one, then a few minutes later returned and wanted his money back. I asked him what was wrong. He replied that one of the sayings is “small families”, and we should have as many children as Allah gives us. This is another case of a religious meme that has outlived its usefulness, since Bangladesh is very crowded.
I find it amazing that some religions have not yet recognized the benefits of contraception to individuals, to families and to the world. The official doctrine of the Roman Catholic Church is that only periodic abstinence (the “rhythm” method) is acceptable. This policy is ignored by many of the 1.2 billion Roman Catholics worldwide—and many women I have talked with have left the Church because of this policy.
In many Catholic countries, such as Brazil and in Western Europe, couples use modern contraception resulting in average family size less than two. There are places, including some of the poorest countries in the world where this prohibition against effective contraception is followed. They will continue to be stuck in poverty so long as people are prohibited from using modern family planning. Rwanda is an example; its rapid population growth was one factor leading to its genocide 20 years ago.
Memes can outlive their usefulness to society. It is time for women to have the same status and rights as men, and for all people to have the access to the means to manage their fertility.

© Richard Grossman MD, 2014

Vasectomy

Posted by on 12 Oct 2013 | Tagged as: Action, Contraception, Medical

“Can vasectomies really make a difference? Mine made a big difference in my life, and to this day, I consider it the single most important contribution I have personally made to the wellbeing of future generations….“ Paul Ehrlich.

 

It was time: I walked across the hall, lowered my pants and lay down on the exam table. Dr. Sam Callaway took good care of me.

We had two great sons and our family was complete. Although my wife volunteered to get her tubes tied, I decided to practice what I preached and went for the vasectomy. That was thirty years ago, and I’ve never regretted that decision.

My largest fear was that Sam’s office nurse would be around still, but Judy had already left. Sam talked to me as he worked and I barely felt any discomfort. He explained that he used a very thin needle for the local anesthesia, made tiny incisions and he was gentle. In a few minutes it was all over and I was on my way.

I’ll admit to some soreness that evening when I spoke at the prepared childbirth class my wife was teaching. And I moved carefully the next day when I needed to perform a cesarean. All in all, I took just a few aspirins (that was before ibuprofen!) and never had any ill effects.

Men have an anatomical advantage when it comes to sterilization. Whereas a woman’s tubes are deep inside her body, a man’s tubes, the vasa deferentia (singular: vas deferens) are much more accessible. When they are interrupted, sperm cannot get released, and the man is unable to cause pregnancy. Fortunately, sperm are only a tiny fraction of the male ejaculate, so sex is unchanged—or better, for lack of fear of pregnancy.

A vasectomy takes only a few minutes, is done with local anesthesia and is amazingly safe and effective.  The main hitch is that it takes several months to wash out all the sperm, and the man should be tested to be sure that he really is shooting blanks before trusting the surgery. Fortunately, the failure rate is less than one in a hundred.

Tubal ligation is more common in the USA than is vasectomy. Among married couples, one in 7 men is sterilized while one in 5 women has had the surgery. Since many sexually active people are not married, the overall statistics show a larger preponderance of women taking control of their fertility—more than a half million women are operated on every year while only half that number of men get snipped.

The popularity of vasectomy varies by country. It is rare in many parts of the world such as in Africa, but a quarter of men in New Zealand have had the surgery.

In Durango perhaps only one physician is left performing this important procedure after Centura took over the family practice group at Mercy. Dr. Mark Forrest has performed hundreds of vasectomies, including on some of my friends—and they have all done well. He says that it usually takes two visits: a consultation, then the actual surgery. He will check semen samples two and three months later, and if both are negative for sperm, the surgery can be considered a success. If this protocol is followed, the failure rate is lower than the rate of pregnancy after tubal ligation.

Furthermore, vasectomy is much less expensive. Nationwide, the price of male sterilization is $350 to 1000. Female sterilizations can now be done without an incision. Essure™ is an office procedure performed through the woman’s cervix, with mild sedation and local anesthesia. Unfortunately, its overall cost is about the same as tubal ligation—$1500 to 6000.

The first World Vasectomy Day will be observed October 18th of this year. This event was decreed by Jonathan Stack, an award-winning documentary filmmaker. The event will be celebrated by Dr. Doug Stein performing his favorite operations—you guessed it!—live from Australia. Dr. Stein has performed over 30,000 vasectomies, perhaps a world record.

Mr. Stack went to Dr. Stein for his own procedure, and thus got the idea for the film. His reasons for favoring vasectomy include: “…it’s time for men to share the burden of family planning” and “…we have to do a fairer job of sharing the planet’s finite resources.”

You can find out more at: www.worldvasectomyday.org, including links to the film’s trailer. They need money to finish this important film. I donated already, and hope that you will also consider supporting this film—because it is time for men to share the burden of family planning!

© Richard Grossman MD, 2013

Promote Health

Posted by on 27 Dec 2012 | Tagged as: Contraception, Reproductive Health, Women's Issues

Quick, how many children does each of the presidential and vice presidential candidates have?

I knew that Michelle and Barack Obama have two daughters, but I had to search to find out about the other candidates. Joe and Jill Biden had four; two sons and two daughters, but tragically one daughter was killed in an accident. Ann and Mitt Romney have five sons, and Paul and Janna Ryan have two sons and one daughter.

Demographers have found that normal, healthy couples who don’t use any birth control will have an average at least eight children during their fertile years. In the past many of those children would have died, causing human populations to be stable. With modern health care (like all the candidates’ families have) fortunately almost all children will live to adulthood. Because of the small family size of all candidates, we can assume that they all have used contraception.

Yet some of these candidates wish to limit access to contraception. Vice presidential candidate Paul Ryan cosponsored H.R. 212, the “Sanctity of Human Life Act”, which is at variance with the medical definition of conception. This bill defines a human being’s life as starting at the unknowable instant sperm and egg unite. Courts could use this rule, if it were to become law, to prevent not only all abortions but also to outlaw the most effective methods of contraception. If it were to become law, H.R. 212 would be a public health disaster!

For centuries well-to-do people have had smaller families than the poor. Indeed, limiting family size has been a way that the rich have gained their wealth. Poor people currently have less access to birth control, unfortunately, and are less reliable in its use.

The United States of America was created on the premise of equal opportunity (“…all men are created equal….”) One way of increasing equality is to provide the means for all people to regulate their fertility. The Affordable Care Act is certainly one of the largest steps our country has ever taken toward equality.

We live in an outstanding nation. We have the richest economy in the world, but we are far from having the best health care in spite of spending more money per capita on health than any other nation.

Here are some health facts. Almost half (49 %) of pregnancies conceived in the USA are unplanned. This helps to explain why our abortion rate is so much higher than the rate in any other rich country. International statistics show that where abortion is illegal it is actually more common. Outlawing abortion, as some candidates promise, might increase its frequency, and women would suffer from illegal procedures.

The numbers are a bit out of date, but (according to the World Health Association) the USA is inferior to many poorer countries in the quality of its health care. We ranked number 37, behind Greece, Costa Rica and Dominica. Why is this? All of the world’s 25 richest countries have universal health coverage—except for the USA. Even our neighbor to the south, Mexico, recently instituted universal health coverage.

The rich can afford insurance and access to excellent health care in the USA. Unfortunately, our lack of universal health coverage leaves more than 48 million people in our great country without health insurance. Many of these poor people wait until too late to access care, and others inappropriately seek routine treatment through emergency rooms. It is no wonder that our health statistics are so bad.

Throwing more money at health cannot solve this public health tragedy. This point is proven by the fact that many countries with poorer economies have better health statistics. We need a new system of health care insurance with universal coverage.

One of our two presidential candidates has designed a health insurance system that will provide coverage to most people in our country. It will provide coverage for people with preexisting conditions, for young people before they have insurance through work and it will protect people with terrible illnesses from bankruptcy. The other candidate has promised to tear down universal coverage. If Mitt Romney is elected I expect that our health statistics will get even worse.

Please vote in this election. Please think about what will happen if women lose the reproductive rights that we have fought for. And please consider the state of our health care system when you are considering which candidates to choose for president and vice president. Our present lack of universal healthcare coverage is a national (and international) disgrace.

© Richard Grossman MD, 2012

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