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

Family Planning Global Climate Change Population

Cool Off the Planet

“The ultimate test of a moral society is the kind of world that it leaves to its children.”
Pastor Dietrich Bonhoeffer

Writing last month’s article depressed me. The article predicted run-away global warming within this century.
This series on global warming is long overdue. The vast subject is crucial because climate change will affect our progeny so severely. The ultimate cause of global warming is our outsized population and extravagant use of fossil fuels.
The first article defined positive feedback loops—which have very negative effects. The second was about the problem itself, and this one offers suggestions to slow greenhouse gas emissions—the problem’s cause.
Certain common gases in the atmosphere (especially carbon dioxide and methane) hold in the sun’s heat. Global warming is caused by unprecedented rises in the concentrations of these gases.
This article is easier to write because of a book that contains much more information than I could put in 750 words. You Can Prevent Global Warming (and Save Money): 51 Easy Ways is brief and to the point. Not all 51 ways will apply to every reader, of course, but this $11 investment will pay for itself many times over. The authors claim one can save over $2000 the first year by just following the easy tips!
You can buy a copy from Maria’s Bookshop, 960 Main, Durango. The Durango, Bayfield and Ignacio public libraries also have copies.
Unfortunately, the book has two shortcomings. I’ll criticize them at this article’s end.
The book starts with my favorite way to save electricity (and thus decrease CO2 emissions). Compact fluorescent bulbs use only a quarter of the energy of the more common incandescent bulbs, and last many times longer. That also saves money, of course. Since CO2 is released when most electricity is generated, CFs prevent huge quantities of the greenhouse gas CO2 from being added to the atmosphere. These bulbs are smaller and cheaper than just three years ago when the book was written. There is almost no reason not to use them to replace the old-fashioned energy hogs.
It also soundly trounces my pet peeve—oversized, inefficient vehicles needed to bolster an undersized ego, rather than required for utility. To accentuate the positive, however, this book includes the advantages of high-mileage vehicles, public transportation, biking (including information about electric bikes) and walking.
In addition to the 51 tips, the book includes basic information about greenhouse gases and global climate change. There are also Internet references for those who want more information.
The two shortcomings of You Can Prevent Global Warming are major. The book includes 51 ways to decrease emissions of CO2 and methane. However, it does not compare the end result (even if you followed all the tips) with the goal—actually stopping global warming. It does state that the aim of the Kyoto Accord would be reached if just a third of all people in the USA followed the 51 tips.
The other obvious failing of this book is that it never looks at the effects of human numbers. We could live our accustomed profligate lives with much less effect on the environment, and little risk of changing the climate, if the population of the USA were just 100 million rather than 300 million. Choosing to have a small family, or no children at all, is still the most important step we can take to slow climate change.
If you haven’t seen “An Inconvenient Truth”, you must. It is an amazingly persuasive and accurate film, seeking to convince unbelieving U.S. citizens that global warming is a titanic problem. Stay to the end, because the closing lists some of the steps that an individual can take to slow greenhouse emissions. It also refers you to its website
We are in for a hell of a future if global warming is as bad as scientists forecast. The planet will be hotter, drier and less productive. For every degree Celsius the temperature increases, grain output on the planet will decrease 10%, leading to massive famines. Moreover, the fossil fuels that have been our virtual slaves for the past two centuries will become scarce. Their byproducts (carbon dioxide, mercury and others) will linger for centuries, thus changing the world that we leave our grandchildren.
Watch Al Gore’s movie and read You Can Prevent Global Warming to learn actions you can take to minimize the problem—and save money. Next month’s article will focus on ways some communities are already using to combat global warming.

© Richard Grossman MD, 2006