Last Friday the New York Times published an article focusing on the potential health concerns of using two popular oral contraceptives, Yaz and Yasmin. While this information is certainly important and the risks of serious side effects including blood clots and stroke should absolutely be considered when thinking about what type of contraception to use, the article failed to discuss the risk of health issues during pregnancy. Studies have found that 4 to 5 per 100,000 reproductive age women who are not taking birth control pills will develop thrombosis. Among women taking low-dose birth control pills that risk increases to 12 to 20 per 100,000. Among pregnant women the risk is even higher--48 to 60 per 100,000. So when we hear about the increased risks of serious side effects such as blood clots and strokes we need to ask ourselves: "Compared to what?"

In addition to providing us with the scary news, I wish there were more articles about the women, men and families who are thankful for reliable birth control methods such as the pill. A recent report from the Guttmacher Institute found that nearly half of women reported that they wanted to reduce or delay their childbearing because of economic concerns--clearly family planning is as important as ever.

There are lots of other great methods of birth control available, but like anything in life there are trade-offs for each one, and we all have to find the one that fits us best (check out our Birth Control 101 page for more information). While most methods have side effects (and these should be discussed with your doctor), consider the potential alternative--an unplanned pregnancy.

Why do we expect so much more from our birth control pills than from other medications we take?

What if I told you there was a birth control out there that was 99% effective, didn't require daily maintenance, and wouldn't have the hormonal side effects that you're used to in the Pill?  Yeah.  I'd laugh in my face, too.  Because if such a magical thing existed, we'd be all beating a path to the doctor for a prescription, right?

Wrong.

Meet the IUD (intrauterine device), the simple to use, long-lasting, reversible, hormone-free, economical birth control that's only used by about 2% of American women, despite huge popularity with our European cousins. 

So why are American women missing the boat on this?

Scientists are making progress in developing a vaginal ring to protect against not only unintended pregnancy but also HIV transmission. As noted by the Global Campaign for Microbicides, "Today's prevention options --condoms, mutual monogamy, and STI treatment-- are not feasible for millions of people around the world, especially women. Many women do not have the social or economic power necessary to insist on condom use and fidelity or to abandon partnerships that put them at risk. Because microbicides would not require a partner's cooperation, they would put the power to protect into women's hands."

Given that women now account for more than one quarter of all new HIV/AIDS diagnoses, that contraception is never one-size-fits-all, and that safe sex means protection from STIs (sexually transmitted infections) as well as unintended pregnancy, safe, microbicidal birth control could be a big step in the right direction.

 

The 2009 NFPRHA Conference wrapped up with several excellent workshops and presentations yesterday. In a particularly impassioned workshop presentation, Linda Dominguez reminded us that no decision is more important than helping a couple plan when they want to have children, and that making a contraceptive choice can be one of the most important decisions women (and their partners) make. She went on to point out that whatever kind of contraception that a woman chooses at a particular point in time should fit in with her reproductive life plan (do you have a reproductive life plan: how many kids do you want to have? When do you want to have them? With whom? Has a provider ever asked about your plan?).

The goal is to have women and men embrace their contraceptive method, and help them to be satisfied with the method they have selected (or help them find another method that might work better for them).

• How can we work to dispel the myths around contraceptive methods and talk more about the fantastic health benefits that are associated with some methods?

• More than one-third of women report that they are using a method of contraception that they don't like - how can we reach these women and help them find a method that they do like?

• The next question is, how can we help women and men use the method they have selected as effectively as possible?

A presentation by Hieke Thiel de Bocanegra of UCSF's Bixby Center for Global Reproductive Health offered one innovative way to tackle this second question. A pilot project she is leading (full disclosure: funded by the National Campaign) uses text messaging to remind women that it's time to fill their prescription (e.g., if on the NuvaRing) or visit the clinic for a follow-up appointment (e.g., if they need a Depo shot). The project aims include determining 1) the feasibility of this type of reminder system; 2) the acceptability and usage of this system by providers and clients; and 3) the system's effectiveness. More on this to come as the project progresses...