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Population

Vote for Improvement

“The vote is precious, the most important non-violent tool we have in a democratic society, and we must use it.”           

The late Congressperson, John Lewis

            I received an unexpected call from a social worker friend whose client was pregnant and wished to have an abortion.

            The story was a sad one. The young woman had used drugs and realized that the fetus might have been harmed. She also knew that she probably would not be able to parent if she continued the pregnancy. Her 3 previous children had been taken away by social services.

            The hitch, my friend told me, was that the woman was already 23 weeks pregnant, much too late to have an abortion locally. Could I help? my friend asked.

            There are only a few places in the country where later abortions are performed safely. With the help of friends, I was able to arrange for the abortion to be paid for and done safely. The young woman did well.

            Proposition 115 on the November ballot would make it illegal to perform an abortion after 22 weeks. Currently there are only 6 other states that do not have gestational age limits. Fortunately requests for abortions after 22 weeks are very rare, and almost always due to unusual circumstances. I suspect that it took the young woman months to become sober enough to make the decision to abort.

            If this Proposition became law the only exception would be to save the life of a pregnant woman due to a physical health problem. The law would make no exception for a mental health problem, or for rape, incest or a nonfatal health problem. Please vote NO for Proposition 115.

            Reproductive health has taken a hit from the coronavirus, which makes it difficult for many people to get the care they need.  However, the problems caused by politicians have been worse and are longer-lasting than the pandemic. Soon we will have the opportunity to improve the situation when we vote in the national election on November 3rd.

            It appears to me that Mr. Trump has used religion and reproductive health issues to serve his own narcissistic needs. His past history shows little respect for women except as means to satisfy his own desires. Yet the religious conservatives have been taken in by Trump’s antiabortion stance. The religious right and Trump seem to have a pact that leaves out reproductive healthcare.

            In “Pro-life voices for Trump”, Trump brags that he has transformed the courts with antiabortion judges and extended the global gag rule to include the USA. This means that family planning clinics lose their funding if they perform or even counsel patients about abortion. The end result is there are more unintended pregnancies and more unsafe abortions. Trump hopes to fully defund Planned Parenthood and to pass a nationwide abortion ban. All of this is in opposition to the wishes of people in our country, where only about one out of 5 people wants abortion to be illegal in all circumstances.

            Another important issue will appear on the ballots in Colorado. Our electoral system to vote for the president is anachronistic. It was set up when horses were fastest means of transportation and before modern communication. Although it made sense to have the Electoral College in 1789, it is archaic and prevents truly democratic presidential elections. A vote for Proposition 113 will add Colorado to the 14 states already in the National Popular Vote Interstate Compact, and bring us closer to a true democracy.

            I also support Proposition 118, the Paid Family and Medical Leave Insurance Program. If passed, it will increase benefits for people who are sick or need to care for sick family members. It is especially important for young families after giving birth or adopting a child, because it extends state and federal benefits that already exist.

            Proposition EE doesn’t have much to do with reproduction. If passed, it will increase taxes on tobacco products. The money raised will support education and other good causes. Even more important is the public health benefit, because it will induce people to quit using tobacco. Come to think of it, there is a reproductive benefit: smoking during pregnancy increases the risk of small, premature babies and of birth defects.

            To summarize, I recommend voting YES for Propositions EE, 113 and 118, but NO for Proposition 115. The people I will vote for include Diane Mitsch Bush, John Hickenlooper and—well, you can guess my favorite presidential and vice-presidential candidates.

© Richard Grossman MD, 2020

Categories
Population

Observe World Contraception Day

            Recently I responded to a blog that was decrying the lack of male contraception. I wish I had better news on that front, but there is good news about women’s birth control.

            In response to the question: “Why do women have to take the hit of contraception?” I wrote that I am a retired male OB-GYN who has had a vasectomy. I believe in contraception for men! The blog’s author only listed two male methods—condom and vasectomy. She apparently didn’t know about withdrawal.

            In the 1980s I practiced in Puerto Rico where people typically had large families. Often women had several children close together, then went a decade or more without modern contraception and without a pregnancy. When I inquired about birth control, some women replied “My husband takes care of me.” My wonderful nurse/translator told me that the couple was using withdrawal. Currently the Puerto Rican Total Fertility Rate is an incredibly low 1.1—most women on the crowded island are having only one child! Although withdrawal statistics show a high failure rate, this method seems to work well for some couples.

            What makes it easier to halt female fertility rather than men’s? Remember from that 8th grade sex talk that women usually create one egg a month? Men make a thousand sperm every second! Egg production depends on a woman’s hormones working in an amazing, well-balanced sequence. It is fairly easy to disrupt the sequence with tiny amounts of exogenous hormones, as with the birth control pill.

            In 1963 I met an assistant of Dr. John Rock, one of the developers of “the pill”. She told me that another of Rock’s projects was nicknamed “the Rock Strap”. Insulated briefs for men raised testicular temperature high enough to stop sperm production. Research along these lines is still ongoing in France.

            The good news is that there are 4 new contraceptive methods for women. One is a hormonal IUD that is a little smaller and has less levonorgestrel than others, but is still effective for 5 years. It has a very low failure rate similar to other LARCs (Long Acting Reversible Contraceptives)—less than 1% per year. Kyleena® is similar to Mirena®, the first hormonal IUD, but may be better tolerated by some women because of its smaller size.

            Currently, nonoxynol-9 is the most common agent used in vaginal spermicides. While the vagina is acidic and hostile to sperm, alkaline cervical mucus helps guide them as they swim toward fertilization. Phexxi™, a new spermicide, is a “Vaginal pH Regulator” that is 90+% effective in preventing pregnancy. It also acts as a lubricant and may increase sexual satisfaction, but is expensive if you don’t have insurance.

            Contraceptive diaphragms have been around longer than a century. They have none of the side effects of hormonal contraception, but their failure rate is higher. Although most diaphragms require fitting, Caya® is available in just one size and fits most women. It should be used with a spermicidal jelly or cream, like any other diaphragm. People with latex allergy can use it since it is made from silicone rubber. A Caya® costs about $85 and should last for years.

            All IUDs currently available in the USA are “T” shaped. Most women tolerate them well, but some don’t. A novel IUD, Ballerine®, provides an alternative. Unique in design, a soft, springy strand in spherical shape has 17 tiny copper balls strung on it. The Ballerine® is straight in its inserter, then curls up to conform to the uterine cavity. It has been well received for a number of years in Europe and other countries where it has been used by over 94,000 women. Like other LARCs, fewer than one woman in 100 will conceive with Ballerine®, and its complication rate is low. Although not available yet in the USA, its manufacturer is planning to start the approval process soon.

            Annovera® is a hormonal contraceptive vaginal ring that lasts a whole year. After it has been in place for 21 days, the user removes it for a week to bring on her period. It has two drawbacks: the cost, for someone who doesn’t have insurance, is about $2000! Also, the failure rate is higher than a LARC, although better than “the pill”.

            With new contraceptive methods there is more choice—for women, at least. Please observe World Contraception Day, September 26th, whose purpose “…is to improve awareness of contraception and to enable young people to make informed choices on their sexual and reproductive health.”

© Richard Grossman MD, 2020