Archive for the 'Reproductive Health' Category

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

Remember how Abortion Used to Be

Monday, April 4th, 2016

no such thing as no abortion

I returned to our room in the cheap hotel in Paris to find a bloody mess. My roommate, John, left a note that he had gone to the hospital with his girlfriend.
We were in college and were spending the summer studying the French language. John had met Ruth in London, our first stop. She was already pregnant and had decided, although it wasn’t legal, to abort the pregnancy. She arrived in Paris several days later and thought that everything had gone well. Immediately after she got to our room she started to hemorrhage. John called an ambulance, she was hospitalized, transfused and had a D&C. She recovered eventually.
That was my first introduction, as an innocent 20 year-old, to the subject of abortion, and my first brush with gynecology. It made a lasting impression.
Two years later my fiancée (and later, wife) was in graduate school and I in medical school in a different city. One of Gail’s roommates had been out of town, then spent a night in the hospital. After she returned to the apartment the police came for an official and frightening visit. The hospital reported that Jane had had an abortion and the visit was to find the identity of the doctor who had performed it. The officials interrogated her at length but left without that information.
Fast forward to when I was in general practice in New Mexico. The records of a new patient showed that she had had a hysterectomy—not unusual for a middle-aged woman. But what was surprising was the pathology report. In addition to the expected uterus, it showed a 6-inch long splinter of wood! I asked the woman how the splinter got there. She replied that she didn’t know, that she was as mystified as me. We both knew what the real story was.
During my residency I was called to the emergency room one evening to see a woman who was pregnant and bleeding. This was her 4th pregnancy; she had 3 young children at home. I thought she could be having a miscarriage. Spotting could also be an indication that the woman was trying to cause an abortion by introducing something into her uterus. Abortion was already legal in all states in the USA, although the Supreme Court decision was less than a year old.
Back then I used to warn all women with a threatened miscarriage that it was important to tell me if they had done anything to abort the pregnancy. This was because nonmedical abortions were still common, and because of the risk of a serious infection. This woman responded “no”, she would never do that—she was a member of a religion that didn’t believe in abortion.
I was surprised a few hours later when the same woman returned to the ER. She told me that she returned because what I had told her worried her. She couldn’t be sick because her children needed her. She admitted that she had, indeed, tried to cause an abortion with a knitting needle.
These are cases that I can remember well of women who faced unwanted pregnancies. All of these cases are long past history, thank goodness, because now safe abortion services are available. Regrettably some people are trying to take away access to safe, empathetic and legal abortion. Worldwide over 20 million women have unsafe abortions, resulting in 50,000 maternal deaths and many more serious injuries. “Not Yet Rain” is a video made in Ethiopia about the difficulty young women have in getting safe abortions after rape. Studies show that abortion is actually more common where it is illegal!
An unplanned, unwanted pregnancy is a difficult situation for a woman to face. Sometimes things work out well and the child is adopted. Sometimes the child is raised by the mother and loved despite an inauspicious beginning. But often things don’t work out well. Currently women in the USA occasionally resort to unsafe abortions because of increased difficulty in accessing safe abortion services.
Some politicians are trying to overthrow the Supreme Court’s Roe v. Wade ruling. They put hurdles in the way of women to decrease access to abortions. They also decrease access to contraception, the best way to decrease the need for abortion, by defunding Planned Parenthood. They advocate needless requirements for clinics that have provided safe abortion services for years without them. For women’s sake and for the sake of our already overcrowded planet we must maintain access to safe, legal abortion services.
© Richard Grossman MD, 2016

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