Archive for the 'Reproductive Health' Category

Speak Truth to Power

Wednesday, January 25th, 2017

While watching the presidential election returns in November and disbelieving the results, this poem kept going through my head:

 

Manifesto: The Mad Farmer Liberation Front by Wendell Berry

                                                Used with permission

 

Love the quick profit, the annual raise,

vacation with pay. Want more

of everything ready-made. Be afraid

to know your neighbors and to die.

 

And you will have a window in your head.

Not even your future will be a mystery

any more. Your mind will be punched in a card

and shut away in a little drawer.

 

When they want you to buy something

they will call you. When they want you

to die for profit they will let you know.

So, friends, every day do something

that won’t compute. Love the Lord.

Love the world. Work for nothing.

Take all that you have and be poor.

Love someone who does not deserve it.

 

Denounce the government and embrace

the flag. Hope to live in that free

republic for which it stands.

Give your approval to all you cannot

understand. Praise ignorance, for what man

has not encountered he has not destroyed.

 

Ask the questions that have no answers.

Invest in the millennium. Plant sequoias.

Say that your main crop is the forest

that you did not plant,

that you will not live to harvest.

 

Say that the leaves are harvested

when they have rotted into the mold.

Call that profit. Prophesy such returns.

Put your faith in the two inches of humus

that will build under the trees

every thousand years.

 

Listen to carrion — put your ear

close, and hear the faint chattering

of the songs that are to come.

Expect the end of the world. Laugh.

Laughter is immeasurable. Be joyful

though you have considered all the facts.

So long as women do not go cheap

for power, please women more than men.

 

Ask yourself: Will this satisfy

a woman satisfied to bear a child?

Will this disturb the sleep

of a woman near to giving birth?

 

Go with your love to the fields.

Lie down in the shade. Rest your head

in her lap. Swear allegiance

to what is nighest your thoughts.

 

As soon as the generals and the politicos

can predict the motions of your mind,

lose it. Leave it as a sign

to mark the false trail, the way

you didn’t go.

 

Be like the fox

who makes more tracks than necessary,

some in the wrong direction.

Practice resurrection.

 

Wendell Berry is a renowned writer of prose and poetry, and an activist. Now in his 80s, Berry has given up the bright lights of New York and Palo Alto where he has taught and lives on a farm in Kentucky.

Berry is facetious when he writes “Love the fast profit….” Yet that is what the public in the USA has elected—a man who has little care for the future, nor for people, but has entered politics to further himself and the cadre of the superrich.

The next four years will be a especially difficult for reproductive health issues. The new administration has pledged to get rid of Obamacare, which has put health insurance within reach of millions of people. One of its best benefits is the availability of contraception without copay. Furthermore, the proposed Health Secretary is a foe of abortion.

There are actions bubbling up all over the country and they have already started locally. Dan Olson wrote about “Our 1st 100 Days”: “…a number of folks in the community are organizing a major campaign to combat the hate, fear, and lies so common in this last election cycle by growing and invigorating local efforts to advance social, environmental and economic justice in our community.” For more information: WWW.OUR1ST100DAYS.US.

RESPOND is offering a day of free classes on January 21st. For more information: www.respond2017.weebly.com.

The worst global crisis is climate change. Durango has already responded with a chapter of the Citizens Climate Lobby; https://www.facebook.com/DurangoChapterCCL/?fref=ts. CCL will be showing a video, “The Age of Consequences”, on Wednesday 15 February at both 5 and 8 PM. It will be at the Vallecito Room of the Student Union Building at Fort Lewis College.

In mid-February “Truth to Power: Writers Respond to the Rhetoric of Hate and Fear,” will be available at Maria’s Bookshop. The scores of voices there, including Berry’s, collected and published by local writers Pam Uschuk and Will Root, can strengthen our resolve for the next 4 years.

If you are unhappy about the direction our country is headed, join with your neighbors to regain control. Participate in local actions!

© Richard Grossman MD, 2017

Afterword: This piece is most relevant to the Durango area, but there is concern and action all over the globe–including a demonstration that was held in Antarctica! No one knows what is going to happen, but I am certain that the current administration will set back human rights–especially women’s rights–terribly.

Shape the World You Want by Voting

Monday, October 24th, 2016

constitution_we_the_people

            In November we will have the opportunity to vote, and thus help shape our world—both nationally and locally. Please vote, even if you don’t follow my suggestions!

Most politicians have personality traits that set them aside from the normal populace. Usually those traits are an asset. Unfortunately this is not true with one of the current presidential candidates who has a personality disorder: narcissism. This psychiatric illness is concerning for someone who must make decisions that will affect our country and the whole world. A person with narcissism thinks of himself, not of his constituency. This narcissistic personality disorder has allowed Trump to lie with impunity; he probably believes his own untruths! I fear what might happen if he were president and had to make a decision about launching a nuclear attack. Trump is a disgrace to our country.

Several amendments to the Colorado constitution are on the ballot. One would create a new healthcare system for citizens of our state. Currently we don’t have a healthcare system in our country; we have a tangle of fiefdoms run by overpaid administrators. Insurance companies and other financial parasites suck half of healthcare dollars away from actual care. We need a single payer system such as the other 9 of the richest countries have. Unfortunately, I don’t think that ColoradoCare will do what is needed. I will vote against proposed amendment 69.

My main concern about 69 is women’s issues. The ColoradoCare’s board of trustees might end up with a majority adverse to contraception. It couldn’t happen, you say? Surely the board would realize that reproductive health is a human right and saves up to $7 for every dollar spent? Unfortunately our elected officials don’t always make rational decisions. Remember what happened in the Colorado legislature to the bill that would have paid for effective IUDs? Sponsored by Republican Representative Coram, that bill was killed in our state senate.

There are economic reasons to support Amendment 70, which will raise the minimum wage in Colorado from $8.31 to $12.00 per hour over the next 4 years. Boosting the economy is one. For me, however, it is just ethical to pay employees close to a living wage—about $13.00 for a single person in La Plata County. I will vote for 70.

Using tobacco is incompatible with good health; therefore it is beneficial to decrease its use. Taxing tobacco is a good idea, and increasing the current tax with Amendment 72 is a great plan. The tax is a disincentive, and the money will further healthcare and medical research.

I am of the age when terminal illnesses become common—although I’ve been lucky so far. We have come a long way with hospice and palliative care, but there are people with terminal illnesses whose lives are miserable and would like to take “life-ending, doctor-prescribed sleeping medication”. I have cared for some people whose last days were wretched and who wanted an end to their misery. I support Proposition 106, the “Medical Aid in Dying” initiative.

In La Plata County we have the opportunity with Ballot Issue 1B to fund a new terminal and other improvements to our airport. As one who flies fairly often, I am aware of the problems with our current facilities. However, I see reasons to vote against the expansion. I suspect air service is in its heyday. As the price of fuel rises and constraints on emissions come into play, it seems likely that people will fly less rather than more. Furthermore, the airport expansion would propel county expansion, but is that what we want? Isn’t our population big enough as it is? Let’s not vote for this big tax increase.

There are three Ballot Issues I do support even though they will mean an increase in taxes. 1A will be used to maintain our roads and bridges. Roads are used by everyone and are essential for our economy. I believe that having our roads in good condition is more important than a new airport terminal, and at much less cost. Furthermore, well-maintained roads improve the safety of all who travel in our county, so I consider this an issue of public health. Two Ballot Issues are for money to improve our schools, 3A for Durango and 3B for Bayfield. Educating our children well is vital for our future; please vote for this support.

            I don’t like politics, but chose this subject because this election is so important that we all need to participate in the democratic process.

                                           © Richard Grossman MD, 2016

Advocate for LARC (Long Acting Reversible Contraception)

Tuesday, June 28th, 2016

IUD

This is a picture of an IUD in a mockup of a uterus.

The potential of LARCs (Long Acting Reversible Contraception) is so great that I am advocating that all voters advocate for them to be paid for by government. The savings–both financial and in terms of human potential–are enormous!


 

Your doctor tells you that she can prescribe either of two treatments, but that one is 20 times as likely to fail as the other. Which would you choose?

Over a quarter of women in the USA use birth control pills, which fail much more frequently than Long Acting Reversible Contraception. LARCs, as they are nicknamed, are amazingly effective yet not used as frequently as one might hope.

IUDs (Intrauterine Devices) are the most commonly used LARCs. There are four available now; they are all made out of flexible plastic in the shape of a “T”. Three emit a tiny amount of hormone into the woman’s uterus, where it is most effective. The fourth IUD uses copper to gain effectiveness. IUDs are usually well tolerated, although sometimes they can increase cramps or change menstrual flow. The best medical knowledge is that IUDs do not work by aborting pregnancies.

IUDs can stay in place for a maximum of 3 to 10 years, depending on which type. Since there is a string attached, they are usually easy to remove. The string also allows the woman to check that it is in the correct place. The pregnancy rate is vanishingly small—only a couple of LARC users in 1,000 will conceive each year. This statistic for “the pill” is much higher—almost 50 per thousand will experience an unplanned pregnancy. Apparently the high failure rate of oral contraceptives in the USA is due to noncompliance. In Europe the failure rate is significantly lower; European women take their birth control pills more regularly.

There are two major drawbacks to both IUDs and the implant: they are expensive and they need to be placed by an experienced clinician. IUDs have a further drawback—bad press.

It used to be that only women with health insurance or a plump checking account could afford LARCs, but that is changing. Thanks to the Affordable Care Act (“Obamacare”), any woman with insurance, including Medicaid, can get her chosen birth control without copay. In addition, one IUD, Liletta®, is priced much lower than the others. Here in Colorado there is a program that provides contraception, including LARCs, at little or no cost.

Placing an IUD is not difficult for a trained practitioner. The opening of a woman’s cervix may be tight is she hasn’t borne a child, but a little local anesthesia and gentle dilatation will help with the insertion.

The other type of LARC is the implant, Nexplanon®, which is as effective as an IUD. It is a thin plastic rod that is inserted under the skin of the woman’s arm, where it can stay for up to 3 years. It emits a hormone that is very effective in preventing pregnancy. Although it is in a very low level in the woman’s blood, it is sufficient to change menstrual patterns; most women with Nexplanon® will have spotting or breakthrough bleeding. Perhaps this is why less than 1% of women in the USA choose an implant, whereas about 6% use an IUD.

Unfortunately, reproductive health has become a political football. Here in Colorado a grant demonstrated that access to LARCs can give young women a better chance in life by decreasing teen pregnancies. By taking away the consideration of expense, the use of LARCs expanded 4 fold. Nevertheless, the false fear that IUDs might abort pregnancies kept our legislators from continuing funding to provide this effective contraception. The best way to prevent abortions is with effective birth control!

Ohio took a tip from Colorado with a program to provide LARCs. Part of that state’s motivation is to lower their infant mortality rate. They are targeting young teens and women who have just had a child, since these two groups are at high risk of having an infant die if they were to get pregnant. They also note that the state saves almost $6 for every dollar invested in LARCs.

Ohio has been proactive in another way. Some healthcare providers have misconceptions about IUDs. They think that they should only be used if a woman already has delivered a baby, or that an IUD makes a woman more susceptible to sexually transmitted infections, or teens shouldn’t use IUDs, or that IUDs can lead to sterility. All of these perceptions are wrong! Indeed, almost every woman can safely use an IUD, and start her family as soon as it is removed.

Safe, effective contraception is an important step in empowering women. We should advocate for making LARCs available to all women!

© Richard Grossman MD, 2016

Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.