Family Planning Medical Population Public Health Women's Issues

Know About Contraception

If you need contraception, use it; if you don’t, be a source of information for other people. For many people, particularly teens, abstinence is the ideal contraception. Since contraception is the best way of decreasing the need for abortion, most people agree that good contraceptive services are beneficial.
We have come a long way in the eighty years since Margaret Sanger started the first family planning clinic in this country. Contraception is legal, we have much more effective methods, and contraception is available from many sources. You don’t have to go to a special clinic any more. Furthermore, people talk about family planning more freely. Do you remember when “rubber” was a dirty word?
There is room for improvement, however. We need new, better methods of family planning. How about a pill for men, for instance? We especially need methods that protect against sexually transmitted diseases (such as AIDS) as well as prevent pregnancy. Most of all, we need less irresponsible sex, both in real life and in the media. In the average year of watching TV an adolescent is exposed to over 12,000 sexual encounters, but only 1 percent mention contraception. Abstinence is still the best way to avoid pregnancy for most teens.
For specific questions about birth control, you should contact your health care provider. The most authoritative source of information on contraception is Contraceptive Technology (Irvington Publishers, New York). My favorite web site is; look under “Health Info”.
Unfortunately, there are many misconceptions about contraceptive methods. For instance, some people are afraid to take birth control pills because they think that “the pill” causes cancer. The truth is that birth control pills protect against cancer of the uterus and of the ovary. They also help prevent anemia, ovarian cysts, breast lumps, menstrual cramps and pelvic inflammatory disease. Although they do have some serious side effects, these are amazingly rare with the newer, low dose pills.
The same hormones as in “the pill” also offer protection against pregnancy if a woman takes them after unprotected intercourse. Called emergency contraception pills (ECP’s) or “the morning after pill”, this is one of the best-kept medical secrets. ECP’s are indicated in cases of rape, a condom failure or if a couple fails to use contraception. ECP’s can reduce the proportion of unplanned pregnancies in the USA.
Innovative means of delivering hormonal contraception are available. Some women love the shot that lasts three months, Depo Povera, although it usually causes menstrual irregularity. It often eventually stops all bleeding, which many women like. There is also a monthly shot. Lunelle has the advantage of relatively normal periods. Using it means a trip to the office or clinic every month, but women appreciate its dependability.
Hormone patches have proven popular with menopausal women. Soon a contraceptive patch, Evra, will be available. Each Evra lasts seven days. The first is placed while the user is menstruating, then she replaces it at the end of a week. After the third, she goes patch-free for a week, during which her period will start.
The Nuvaring is a small ring placed in the woman’s vagina for three weeks. It is then removed, and during the week without the ring, her period will start. Neither man nor woman is aware of Nuvaring when it is in place. Both Evra and Nuvaring have been shown to be more effective than birth control pills, although women who cannot take hormones shouldn’t use them.
Barrier methods are designed to prevent sperm and egg from getting together. They include male and female condoms, diaphragm and cervical cap and several different forms of spermacides (foam, creams, gels and film). Some barrier methods are available without prescription, and some provide partial protection against sexually transmitted diseases.
Perhaps the most cost-effective means of family planning is the Intrauterine Device (IUD). Recent studies suggest that it is even safer than previously thought. There are two available in the U.S.A. The Paragard lasts for up to ten years and uses copper to be 99% effective in preventing pregnancy. Mirena is good for up to five years. It is filled with a hormone to make it 99.7% effective while decreasing menstrual bleeding and cramps. Either can be removed in case of problems of if the woman wishes to conceive.
Fortunately, there are many contraceptive methods that are effective, safe, and some even stop the transmission of disease. Hopefully the future will bring even better methods. We should all be well informed about family planning techniques.

© Richard Grossman MD, 2004

Action Durango Herald Medical Population

Include Men

How can we influence more people to use modern contraception? The answer is simple—include male partners in making family planning decisions. This ploy works in many different cultures.
Why have men been left out of family planning? In the past, planners have focused on women since only they get pregnant. The family planning movement started with Margaret Sanger over 75 years ago. For many years clinics catered to women’s needs, and only recently have they started to provide reproductive health care for men. There is another reason, too. Men make millions of sperm, but women only make one egg a month. It is easier to stop the production of a single egg than of all those sperm.
Furthermore, demographic studies of fertility usually focus on women. This is because it is easier to trace the parentage of a child to the mother. For example, the total fertility rate is defined as the number of children per woman. Only recently have demographers studied the fathering of children.
Now we acknowledge the importance of men in family planning. Especially in “macho” societies where men tend to be the decision-makers, women don’t have much control over the use of contraception unless their husbands concur.
Worldwide there are successes when men are included in family planning decisions. One comes from Ethiopia. Community family planning workers visited two different groups of married couples at home. In one group only the wife was present. The husbands also were present with the other half of the couples. Few of these couples were already using modern contraception.
Did these visits make a difference? Yes! One or two visits increased the use of pills, IUD’s or condoms. Did the presence of the husband improve the acceptance of contraception? You bet it did! At the end of a year, a third of couples were still using a method if their husbands had participated in the contraceptive decision. Only half that many used family planning where the husband was excluded.
Here in the United States the story is similar. Education, along with the AIDS scare, has doubled teens’ use of condoms in the past decade. In the past men assumed that women would take full responsibility for contraception. Now guys are more likely to share this responsibility and to use condoms. The availability of clinics where men feel comfortable has helped catalyze this change. Whether they attend alone or with their partners, it is important to involve men.

When asked, most males believe that preventing pregnancy is partly a male responsibility. Sad to say, only 2% of federal family planning dollars are allocated to reproductive services for men. Fortunately, some programs succeed in reaching young men.
Male service providers have found several steps to build successful programs. They use mass media to reach young men and to encourage them to communicate with their partners. Then they provide information about condoms and vasectomy where men tend to gather—a favorite place is in barbershops.

Teens on Track (TNT) is a program sponsored by Planned Parenthood of Southern New Jersey. Their first step was to hire male clinic workers. Then they built a program that incorporates recreation, education and medical care. The local YMCA hosts “Teen Night”. An hour of education on male health and sexuality is followed by sports—swimming or basketball. Attendance has been excellent.
In Houston the Baylor Teen Health Clinic hired a sports medicine physician to help draw teens to their “Males Only” program. Outreach workers recruit young men from housing projects and juvenile probation centers. The programs have helped the guys stay in school, improve academic performance and prevent unplanned pregnancies.
In one of the poorest countries of Africa “…men are deliberately constructing their family sizes and structure.” Researchers conclude: “Our perception is that in the communities studied in the rural Gambia, men’s contribution to the costs of bearing and raising their children is smaller than that of their wives…. It may be that the key shift precipitating fertility transition in high fertility societies in West Africa will be the growing financial burden of fatherhood.” The Gambia has one of the highest growth rates in the world. We can only hope that the men sense this burden quickly and plan for smaller families.
It is possible to change attitudes. Including men in family planning decisions increases their use of male methods, and improves their cooperation with their partners’ use of contraception. The result is fewer unplanned pregnancies, and better communication between men and women.
© Richard Grossman MD, 2005