What can health-care providers, friends and parents do to help young women focus on their reproductive goals? Ask â€œone key question,â€ which is: â€œWould you like to become pregnant in the next year?â€
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 doesnâ€™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: â€œAre you currently using a contraceptive method that you are satisfied with?â€ 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 counselingâ€”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, ellaÂ® (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 ParagardÂ®. It works as EC for up to 5 days after sexâ€”and can provide protection against pregnancy for as long as a decade.
Now you can now purchase Plan B and EllaÂ® 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 â€œthe pillâ€ 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 â€œover the counterâ€. 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 â€œone key questionâ€ 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 â€œone key questionâ€, 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: firstname.lastname@example.org; please remember the hyphen!
Â Â Â Â Â Â Â Â© Richard Grossman MD, 2017