Tuesday Open Thread

It’s Tuesday!

Could you use some good news? Here’s a tidbit: the Department of Health and Human Services has signed off on recommendations to include contraceptives in preventative care. Translation: goodbye, copays!

Via Jezebel:

This means, quite simply, that starting next August, all private insurance must fully cover contraception, including emergency contraception, alongside well-woman exams, STI testing, and so on. This is a recognition that being able to control your fertility is a major part of staying healthy — not to mention less expensive to the system and yourself than the alternative.

What are you feeling good about today? Chat away!


CDC birth control guidelines could reduce breastfeeding

cross-posted at Bleeding Heartland

The Academy of Breastfeeding Medicine warns that recently updated “birth control guidelines released by the U.S. Centers for Disease Control and Prevention (CDC) could undermine mothers who want to breastfeed,” I learned from the ByMomsForMoms blog, sponsored by Lansinoh.

From the Academy of Breastfeeding Medicine’s news release:

“The new guidelines ignore basic facts about how breastfeeding works,” says Dr. Gerald Calnen, President of the Academy of Breastfeeding Medicine (ABM). “Mothers start making milk due to the natural fall in progesterone after birth. An injection of artificial progesterone could completely derail this process.”

The CDC report, “U.S. Medical Eligibility Criteria for Contraceptive Use, 2010,” released in the May 28 issue of Morbidity & Mortality Weekly Report (MMWR), contains important changes in what constitutes acceptable contraceptive use by breastfeeding women. The criteria advise that by 1 month postpartum the benefits of progesterone contraception (in the form of progestin-only pills, depot medroxyprogesterone acetate (DPMA) injection, or implants), as well as the use of combined (progestin-estrogen) oral contraceptives outweigh the risk of reducing breastfeeding rates. Previously, progesterone birth control was not recommended for nursing mothers until at least 6 weeks after giving birth, and combined hormonal methods were not recommended before 6 months.

Based on clinical experience, breastfeeding support providers report a negative impact on breastfeeding when contraceptive methods are introduced too early. One preliminary study demonstrated dramatically lower breastfeeding rates at 6 months among mothers who underwent early insertion of progesterone-containing IUDs, compared with breastfeeding rates of mothers who underwent insertion at 6-8 weeks postpartum.

I have met women whose milk supply collapsed after they received a progesterone shot. One acquaintance had successfully nursed previous babies and was never informed by her health care provider that a birth control shot could impede her ability to produce enough milk for her infant.

It’s illogical for the CDC to give its blessing to early postpartum use of hormonal birth control when the federal government has supposedly been trying to promote breastfeeding for more than a decade. Earlier this year, the White House Task Force on Childhood Obesity set a goal of having half of U.S. babies breastfed for at least nine months by 2015, and recommended a number of specific policies to help reach that goal. But breastfeeding without a full milk supply is quite difficult no matter how educated the mother is or how supportive her environment. I hope the CDC will revise its guidelines and recommend non-hormonal forms of birth control for women in the early months of breastfeeding.


The Pill is Crap

Okay, maybe not crap. There’s that whole “freed 50% of the population from the tyranny of forced reproduction” thing.  And the whole “shorter periods” and “better skin” thing, too.  When I was 19, the pill was a gift from heaven.  When I was 29? There’s still me with the whole “lovin’ the oral contraceptive” thing.  35?  Still there.

Today?  Today the pill sucks.  It is the suckiest suck in all of suckdom.

I have, in the 5 years since Molly was born, been on 7 different pills.  I think I wrote once about the cancer scare that turned out to be nothing but (to quote the sketchy doc) my “old uterus” which apparently couldn’t tolerate the lovely Seasonale with its associated 4- count ’em 4- periods a year.  Okay, I figured something like this would happen eventually.  I momentarily forgot that I was on that pill because of the gut-wrenching cramps and migraines that had arisen with the previous versions of the pill.  The next two pills didn’t help with whole 30-day-period which was the crux of the initial complaint.  So today I complete my first month (with no unscheduled periods, thank you very much) on the new pill.  I took inventory tonight, comparing the relative merits of my experiences and here’s what I’ve come up with:

I’m 10 pounds heavier (in spite of a killer work out schedule and nearly no enjoyable food in my diet anymore)
My head is going to explode
My uterus is trying to crawl through my navel
My skin is worse than it was when I was 14
My hair is falling out by the handfuls
I’m a cranky pants

The only upside?  I didn’t spot.  Oh- and I had a little blip in my libido (for the good, which was a surprise considering that I’m fat and cranky and pimply and balding).  I’m at my wit’s end.  DH actually considered a vasectomy but his doc talked him out of if (“What if you get a divorce?  What if something happens to your wife?  What if one of the kids gets sick and you need a bone marrow donor?  What if you change your mind?”  Prick.  The doc, I mean.  Not DH.  He’s just a chicken.)

I need an option.  I was actually considering Mirena before the whole missing IUD diary, but I’m really not considering that anymore.  I need suggestions and, lucky for me, I have rock star insurance that covers this stuff.  I don’t want to get knocked up again right now- or ever, maybe- and it won’t be long until it’s not an issue anymore, but I want to leave the door open…

What do you use?  Is it worth it?  Should I just buy a chastity belt and tell DH to get used to it?  


Where Do the Candidates Stand on Sex Education?

If you need anymore reason to fear a John McCain presidency, check out his response to a sex education inquiry by the New York Times. (Thanks Salon for the tip!):

Q: What about grants for sex education in the United States? Should they include instructions about using contraceptives? Or should it be Bush’s policy, which is just abstinence?

McCain: (Long pause) Ahhh. I think I support the president’s policy.

Q: So no contraception, no counseling on contraception. Just abstinence. Do you think contraceptives help stop the spread of HIV?

McCain: (Long pause) You’ve stumped me.

As Salon’s Rahul K. Parikh, M.D., pointed out, McCain’s continuation of Bush’s policy of abstinence-only education is not only disturbing, it is ineffective. Almost two-thirds of female adolescents have had sex by their senior year of high school, according to the Centers for Disease Control and Prevention. Most recently, the CDC found that one in four teen girls has a sexually transmitted disease.

McCain does support Bush’s ideologically based policies. He has voted against legislation to ensure that sex education be scientifically accurate instead of just abstinence based, has voted to impose parental consent for teens seeking birth control, and has opposed legislation that birth control be covered by insurance. He has also voted against programs to increase awareness about emergency contraception.

How do Sen. Hillary Clinton and Sen. Barack Obama stack up? In Dr. Parikh’s view a heck of a lot better. They both have received a 100 percent rating from pro-choice groups and favor sex education that is based on science, including information on contraception. Clinton, however, has a longer record and has received the endorsement of all the women’s rights groups, including NOW and NARAL.

Like many issues in this campaign, it’s not easy to separate where Hillary Clinton and Barack Obama stand on sex education. Both have been solid supporters of reproductive rights, although Obama’s time in the Senate doesn’t give him as deep a congressional record as his rival…

In the face of a war in Iraq and a staggering economy, sex education for teens may not loom large on voters’ minds. But with so many young Americans deeply engaged in this election, they deserve to know the facts about where their candidates stand on an issue that affects them this personally. As a doctor and a parent, I want those issues upfront as well. The last thing I want to see is my time with teens restricted by views or laws that force me to bury my head in the sand. Restricting access to reproductive education and choices is not good for any young person’s health.

And the politics surrounding this important topic don’t end in the classroom. The balance of the Supreme Court — and protection of laws like Roe v. Wade — are at stake. Teens and their parents have much reason to worry.


Back Up Your Birth Control Day

Today is Back Up Your Birth Control Day, and organizers are encouraging people to blog about it. A coalition of more than 100 women’s health and medical organizations established the event as part of an ongoing campaign “to help make emergency contraception (EC) more effective by making sure women know about it – and can get it in time.” According to them, “Widespread knowledge and use of this safe and effective back-up birth control method could prevent as many as half of the 3 million unintended pregnancies that occur each year in the U.S.”

Wait, you say. Isn’t Dana one of the lesbian writers here at MT? What is she doing talking about birth control?

EC is in fact an issue worthy of all women’s attention, straight, bisexual, or lesbian. Some lesbians may choose to have sex with men on occasion; some may be victims of rape. Many of us have daughters, or nieces, or friends, for whom EC is a needed option.

The Back Up Your Birth Control Day activities are largely targeted at educating teens. The organizers state, “In the fall of 2006, the FDA approved over-the-counter (OTC) sales of EC for adult women, but kept the prescription requirement for teens younger than 18. The FDA’s decision is an incomplete victory for all Americans. Many women, due to the age restriction, are excluded from timely OTC access as a result of the FDA’s decision.”

While I’m on the topic of choice, however, I’ll note that anti-abortion legislators in Florida are pushing for a bill (yet to be referred to a committee) that would require pediatricians, school nurses or other health providers who find out that a girl under 16 is pregnant to tell the police. “The confidentiality privilege that normally exists between doctor and patient would not apply in cases that fall under the bill,” reports the Naples Daily News. Abortion providers would also be required to collect DNA samples from girls under 16 who have abortions. The bill’s supporters say it’s meant to protect girls from sexual abusers, including family members. Veiling anti-choice laws under the guise of protecting women makes me want to beat the legislators about the heads with a copy of The Handmaid’s Tale.

(Crossposted with some variation at Mombian.)