Category: Family Planning

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Family Planning Media Reproductive Health

Utilize the Media for Reproductive Health

“To be effective, we need to tell our story in many songs and films.”

David M. Johns, in“Our Real Challenge: Managing Ourselves Instead of Nature”The media are valuable to keep people informed about the problems caused by our growing population. In addition, they can broadcast information about ways to slow our expansion. Even more important is their success in motivating people to change their beliefs and lifestyle.My wife and I recently visited Washington, DC for the Population Institute’s annual Global Media Awards. This column won the “Best Columnist” prize for the article I had written from India about the influence of poverty on population growth.There were thirteen other awardees attending, including people from Canada, Malawi and Cameroon. Except for me, all were professional journalists.The Population Institute (www.populationinstitute.org) has been working domestically and internationally for 38 years to promote interest in the effects of our mounting numbers. It has used education and political lobbying in attempts to slow our growth.One of its techniques has been to encourage coverage of population issues in the media. It runs its own news service to feed information about population to the media. Its annual Awards are given in different categories, including “Best Cartoonist” and “Best Electronic Forum.” The Durango Herald earned an early award. In 1971 the Herald was named “Best Daily in the US.” It is probably the only daily paper that runs a regular column on human population.In the past the Awards have been an excuse to travel. I explored Egypt and Thailand with the PI. Now, with new consciousness about global warming (and limited budgets) the ceremony was held on the PI’s home turf. They are located on Capitol Hill, easy walking distance to the heart of our national government.An advantage of attending the Awards was the opportunity to network. We traded ideas, and I picked up several themes for future columns.One of my goals has been to find a wider readership for this column. From the start Morley Ballantine was kind enough to allow me to keep the copyright to these articles for this purpose—thank you, Morley! I hope that new contacts will help me find new outlets for my writing.The editor of E-Magazine won an award for his story on the “birth dearth”. Some people are upset that many rich countries don’t have enough young people to perform menial labor. In fact, worldwide there is no lack of births, but the vast numbers of babies are born in poorer countries. Jim Motavalli pointed this out in his prize winning article. Jim has suggested that the online version of E-Magazine might be an appropriate medium for this column.My favorite winning entry was “Youth Alert!” from Africa. Victor Gama came all the way from Malawi to accept the award; it was his first time outside of his small, landlocked country. HIV is a serious problem there, as in most of sub-Saharan Africa. About one in seven young people carries the virus. Furthermore, the average Malawian woman bears more than six children.“Youth Alert!” works to keep people in their teens and early twenties safe. The program focuses on fighting pressure to have sex. The “Real Man” doesn’t succumb to peer pressure to have sex too early. Nor does the “Real Woman” yield to pressure from a “sugar daddy”, an older man who offers money or presents in exchange for sex.Delaying sexual debut is the goal for this program, which is described more fully at: www.psimalawi.org/youth_alert.html. The ultimate goal is similar to the failed abstinence-only programs here in the USA. Indeed, the Malawian program is partly funded by our government through USAID. Victor’s approach is playful, however. He held a nationwide competition to find amateur singing groups with songs that had the correct messages. The six winners (three female groups and three male) made professional music videos that will be screened on Malawian TV.Bill Ryerson, founder of the Population Media Center (www.populationmedia.org), won an award for their use of radio and TV soap operas for social change. Empowerment of women, education about contraception and prevention of HIV transmission are the primary goals of their programs in a dozen countries.There are many ways to tell the story of population and reproductive health. Music videos and soap operas can reach wide audiences in developing countries. Fortunately, newspapers and magazines still have devoted readers back home. Thank you for reading this column. May your holidays be wonderful and filled with joy!© Richard Grossman MD, 2007[The article above may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at: richard@population-matters.org]

Categories
Contraception Durango Herald Family Planning Medical Women's Issues

Wear the Implanon Contraceptive Implant

Did you know that a new contraceptive just became available in Durango? Implanon was approved for use in this country over two years ago, but its manufacturer has been very cautious in making it available.

Almost all women can safely use Implanon. It is effective for up to three years, and can be removed easily when the user wants. Best of all, once it is in place, it requires no action on the woman’s part to provide essentially perfect protection against pregnancy. Compliance is not a problem with this contraceptive method.

The availability of effective contraceptive methods is one of the three most important factors in helping to lower fertility rates in poor countries. (The other two factors are education of girls and lowering child mortality rates. Thanks to almost universal literacy and modern pediatric care in our country, we don’t have to worry about these two factors.) The sad fact is that half of pregnancies conceived in the United States are unplanned. Can a method that is reliable and simple to use help lower this statistic?

Implanon is similar to Norplant in some ways, but has significant differences. You may remember that Norplant consisted of six flexible plastic rods filled with a hormone. Although it was initially well received, a problem forced it off the market a number of years ago.
Many women were keen on Norplant, but doctors weren’t. It had to be inserted properly, so each of the rods was right under the skin of the woman’s arm. Norplant was difficult to remove if it were placed too deep. Bad insertion technique is what got Norplant into trouble. Too many were inserted by people who weren’t properly trained, so doctors attempted removal and ran into difficulties.

The similarities between Implanon and Norplant include the hormonal makeup, which has no estrogen. Both Norplant and Implanon just use a progestin, making them safe—especially for women with blood clotting disorders or migraine headaches. Both systems cause menstrual irregularity; most women using them either have irregular menstrual bleeding. Both offer very reliable contraception, with failure rates of just a fraction of a percent. Both have the hormone in one or more flexible plastic rods that are implanted under the skin of a woman’s arm. Implanon has only one rod, which makes insertion and removal much easier than Norplant’s six.

Learning from the Norplant fiasco, the manufacturer of Implanon has taken precautions to prevent it from getting misused. Implanon will only be available to doctors (and other medical providers) who have completed a comprehensive training program. I attended such a program in Durango in August with a dozen other providers. After practicing the technique on plastic models, we were all impressed with how easy Implanon is to insert and remove. In real people insertion or removal is done with a bit of local anesthesia and takes just a minute or two.

How do women like Implanon? According to the manufacturer, women like it very much. They advised us, however, to warn women before getting this contraceptive method that it will mess up their menstrual cycles. Almost all women will have some spotting or irregular bleeding with Implanon. After a period of adjustment, however, some women will stop bleeding entirely. Skipping periods is entirely safe. Fewer periods helps prevent anemia and PMS, and is the goal of some new birth control pill formulations.

An Implanon wearer should not be aware of its presence. The implant is placed under the skin of a woman’s upper arm. The rod is small and flexible, so an observer cannot see it hidden below her skin. A health care provider (or the woman herself) can find it easily by touching in the correct place.
Implanon works in two different ways. Most important is that the hormone stops ovulation. Without an egg, pregnancy cannot begin. An additional action is that the hormone makes cervical mucus impenetrable to sperm. These two actions make it very reliable, with only one failure per year per thousand women using it.

When a woman wishes to conceive, her fertility should return quickly after Implanon is taken out. Likewise, if a woman doesn’t like the method (for instance, if the irregular bleeding gets to her), the side effects are rapidly reversed as soon as it is removed.

Implanon might not be the contraceptive answer for all couples, but it provides another method that will be safe and effective for some. I am glad that we can now offer it in Durango!

© Richard Grossman MD, 2007

[The article above may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at: richard@population-matters.org.]