Archive for the 'Women’s Issues' Category

Ask Young Women One Key Question

Sunday, July 23rd, 2017

What can health-care providers, friends and parents do to help young women focus on their reproductive goals? Ask “one key question,” which is: “Would you like to become pregnant in the next year?”

Obviously this takes a special relationship with the women. That relationship is assumed with a doctor or other health-care provider, but may not be practical with some other relationships. However, if you do have such a relationship with a young woman, asking this question may help her clarify her goals.

One advantage of this question is that it is nonjudgmental. Furthermore, it doesn’t ask about the distant future, but only asks about the next 12 months. These are both reasons that it is a well-accepted way of opening an important conversation.

How have women responded? Apparently many women already have a pregnancy plan and know what their reproductive goals are for the next year. If the woman wishes to conceive, the discussion can then go toward having a healthy baby. Among other actions, she should start on prenatal vitamins, eat a healthy diet and avoid tobacco, alcohol and drugs.

If the woman responds that she does not want to become pregnant in the next year, or if she is unsure, there is a follow-up question: “Are you currently using a contraceptive method that you are satisfied with?” When the reply is, yes, she is happy with her birth control method, she is reminded about emergency contraception (EC). However, if a woman answers that she is not pleased with her contraceptive method, or is not using any birth control, this is a perfect time for contraceptive counseling—including a reminder about EC.

EC pills such as Plan B are now available without prescription and are safe, although not 100% effective. They are good up to 3 days after unprotected sex, and work best if taken within 12 hours of exposure. There is a relatively new EC pill, ella® (ulipristal); it has the advantage of being more effective (especially for heavy women), and works up to 5 days after sex. Neither of these will cause an abortion if a pregnancy is already established.

Most effective is an IUD which contains copper, such as the Paragard®. It works as EC for up to 5 days after sex—and can provide protection against pregnancy for as long as a decade.

Now you can now purchase Plan B and Ella® on the Internet! Go to www.prjktruby.com and you will find both of these are available (they sell a generic equivalent of Plan B). In addition, women can get “the pill” through this same website. The world of reproductive health is changing!

The yearly Pap smear is a thing of the past. Now women can go several years without seeing a provider for reproductive health care, if ever. Although this saves the embarrassment of a pelvic exam and saves money, it also means that women may not have the opportunity to update their knowledge about contraception. In addition, birth control pills are available without a provider visit, including at Planned Parenthood, through www.prjktruby.com and in some states.

Both Oregon and California have passed laws that allow women to purchase oral contraceptives (if they are in good health) just by speaking with a pharmacist. Do you remember when ibuprofen was only available with a prescription? Fortunately there is a way to petition to make a prescription medication available “over the counter”. This is what happened to Plan B as well as ibuprofen. Oral contraceptives are so safe that there is pressure on the FDA to make them available without prescription in all 50 states.

As the barriers to family planning are overcome it is important to be certain that women are aware of the method that is best for them. This is why the “one key question” is important. In Oregon, where this campaign got started, it is recommended that all family practice doctors and other practitioners who care for women of reproductive ages routinely inquire if they plan to conceive in the next year.

The birth rate in the USA is dropping, but still almost half of the pregnancies conceived are unplanned. This one key question could help to decrease the numbers of unintended pregnancies, and of abortions.

Recently a reader was kind enough to suggest that I write about “one key question”, and I am happy to follow up on the suggestion. I welcome feedback from readers, whether you like what I have written or hate it. My email address is: richard@population-matters.org; please remember the hyphen!

             © 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.

Promote Health

Thursday, December 27th, 2012

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

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