Archive for the 'Reproductive Health' Category

Reduce Barriers to Family Planning

Sunday, December 24th, 2017

There’s no good news about male contraceptives yet, but there is much progress in the field of family planning for women. This column will touch on some of the high points.

Perhaps the best news is that, globally, more women who want to avoid pregnancy are using an effective contraceptive method. The number who weren’t using modern contraception was estimated to be 225 millionin 2014but is 214 million now. The decrease is partly due to huge efforts from Family Planning 2020 to make better family planning available in developing countries. With local support as well as funding from rich countries and foundations, FP2020 has provided over 30million women with effective contraception.

The goal of FP2020 is to reach 120 million previously unserved women with effective family planning by the year 2020. In many places couples only had access to one or two methods, such as condoms or tubal ligation. FP2020’s strategy includes avoiding coercion and offering a choice of several methods.

Please remember that it is not just developing countries that wrestle with unintended fertility. In 2008 in the USA 51% of pregnancies were unintended. There is good news here, too; it is now just 45%. This decrease, and the significant decrease in abortions, is thought to be due to Long Acting Reversible Contraception—LARCs. These methods include IUDs, implants and the 3-month shot. One in 7 women in the USA is now using these most reliable types of birth control.

LARCs have two shortcomings, however. In general they are expensive—but remember that dollar-for-dollar, contraception saves more than any other health intervention!

The other problem with LARCs is convenience, since most require a health care professional. An exception is the 3-month shot, “Depo” or DMPA. This has been in use for birth control for almost 50 years, but requires a clinic visit 4 times a year.

Sayana Press® is an innovative solution that is accepted very well. It is a small plastic bubble filled with the medication and a short attached needle. The woman just punctures her skin, squeezes the bulb and she is protected against pregnancy for 90 days.

Malawi, a small East African country with large families, compared women who went to the clinic to get their shots with women who injected the medicine themselves. They found that women who were given the first shot at the clinic then took home 3 Sayana Presses® were much more likely to use the medication for a full year.

Birth control pills are available without prescription in many countries, and the USA will be following suit if Daniel Grossman has any say. Grossman and I may be distantly related, and we are very close in our belief that “the pill” is amazingly safe and there should be minimal barriers to its access. Grossman has started the “Free the Pill” campaign. This would follow the way Emergency Contraceptive (EC) pills have gone over the counter; Amazon.com now sells EC pills!

Another physician named Grossman—Jessica—heads up Medicines 360. This organization has as its mission “…to expand access to medicines for women regardless of their socioeconomic status, insurance coverage, or geographic location.” Their first product is a big success! Liletta® is an IUD that releases a hormone over 4 years, is safe and very effective, and decreases menstrual bleeding and cramping. It is primarily sold to clinics and is significantly less expensive than similar IUDs.Recently there is good news about all IUDs; they reduce the risk of a woman getting cervical cancer.

When Trump reinstated and expanded the Global Gag Rule, the Dutch started “SheDecides” to replace essential funding for reproductive health. More countries, foundations and individuals have stepped up to pledge $200 million! This amazing organization’s goal is to make it possible for “…girls and women to decide freely and for themselves about their sexual lives, including whether, when, with whom and how many children they have.”

Most couples in the USA use contraception at some time in their lives, even if their religion opposes birth control. In much of the global south, however, this is not the case. There the Roman Catholic hierarchy turns most women away from birth control. This might change, however. The Pontifical Gregorian University in Rome will be holding a series of talks on the 50th anniversary of Humanae Vitae, according to the National Catholic Register.

Despite political forces in this country that are trying to erect barriers around access to family planning, there is a lot of good news about contraception for women.

© Richard Grossman MD, 2017

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

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