Contraception – Population Matters-USA

The really bad news is that we have elected a misogynistic felon with a narcissistic personality disorder. Even worse news is that people have fallen for Trump’s lies.

There’s some good news, despite lots of disappointments. In my state, Colorado, almost 2/3rds of voters chose to amend our constitution to guarantee the right to safe abortion care. In addition, the state will start paying for abortions for women who are state and local government employees, and for those on Medicaid.

The state to our north, Wyoming, had abortion laws preventing almost all abortions. In November, a Wyoming judge ruled that the laws were against that state’s constitution. She wrote: “The abortion statutes suspend a woman’s right to make her own health care decisions during the entire term of a pregnancy and are not reasonable or necessary to protect the health and general welfare of the people.” Although the state will probably appeal this decision, for now women can obtain safe, legal abortion care in Wyoming.

Public health scientists have identified several causes why young children don’t flourish. Children may not do well if pregnancies are too close together. We also know that if a mother really, really doesn’t want to carry a pregnancy, but is forced to give birth, that the child may not fare well. Do children who result from unintended pregnancies also suffer?

“Yes” is the sad answer. Researchers looked at Demographic and Health Surveys from developing countries. Surveyed mothers rated their births as being desired, mistimed or unwanted. The endpoint of the research was infant mortality—the death of the child before age one year of age. What they found is that children whose pregnancies were described as unwanted or mistimed were more likely to die. This finding held for 41 of the 60 countries studied. Moreover, the effect was stronger in poorer, less educated places.

Unfortunately, there are over 120 million unintended pregnancies globally each year. These findings are the bad news. The good news is that now there is proof that contraception decreases infant mortality in impoverished areas.

Unfortunately, there is concerning news about two of the Long-Acting Reversible Contraceptive (LARC) methods. DepoProvera, has been associated with an increased risk of users developing meningiomas. These are benign tumors of the membranes covering the brain. Meningiomas are more common in women, and have been found to have receptors that respond to female hormones. However, the risk of developing a meningioma is very, very small, and it is still very small for users of Depo.

There are four IUDs containing a hormone. In addition to providing excellent contraception, they make periods less painful and lighter. Fortunately, they don’t seem to increase the risk of meningioma, but the latest information is that they may increase the risk of breast cancer.

It will take more studies to confirm (or refute) these concerns about LARCs causing tumors. In the meantime, it is the right of women to know of these possibilities. However, the risks of morbidity or mortality from pregnancy exceed by far the likelihood of a problem caused by any contraceptive method, if used properly. For women who desire long-term reversible birth control, the ParagardÒ IUD is a hormone-free LARC. It can provide excellent protection for 10 years—or possibly even longer.

Since the Dobbs decision, many states have made it very difficult to access safe abortion care. Furthermore, unintended pregnancies cause problems if the mother is forced to carry to term. Taken together, these facts make it all the more important to increase the availability of contraception.

©Richard Grossman MD, 2024

There are three pieces of good news about birth control methods. One is very old, but never really studied, one is brand new and one futuristic.

I spent some time in Paris studying French when I was in college. I also learned about a male method of birth control from a research assistant for Dr. John Rock. Rock is best known for his work in developing “The Pill”, but he was also interested in other means of limiting fertility. He tested an idea based on the fact that testicles work best if they are cooler than core body temperature. His idea, which was never marketed, was an insulated athletic supporter. It was nicknamed the “Rock Strap”, of course.

Fast forward 60 years and researchers are still working on this idea. The physiology is clearly effective, but the long-term safety of heating testicles hasn’t been studied. Furthermore, persuading men to wear a warming codpiece doesn’t seem too practical.

Many governments have recognized that it is safer for women to take “The Pill” than to not use contraception. The relative safety is especially true in places with high maternal mortality—because preventing pregnancy also prevents maternal mortality. Oral contraceptives are available without prescription in over 100 countries—and, thanks to OPill®, now the USA is one of them! The FDA has finally recognized the safety of oral contraceptives.

The manufacturer and nonprofits that worked to make birth control pills available over the counter had several wishes that went along with the approval. The pill should be available to teens, it should not be too expensive, and that insurance should cover the medication even though it is available over-the-counter. After 20 years of work, they finally got their wishes! The FDA has very strict requirements. One of them is that the pills come with instructions on their proper usage that almost anyone can understand.

OPill® is a Progestin-Only Pill (POP). Unlike the majority of hormonal contraceptives, it does not have any estrogen. Blood clots, the most serious problems caused by birth control pills, are caused by estrogen; that is one reason the FDA finally gave their approval. There are minor problems with POPs, however, such spotting and needing to take OPill® at the same time of day, every day. Also, the unintended pregnancy rate may be a little higher than pills with estrogen.

Although I knew that sperm didn’t like heat, I didn’t know that they don’t like iron. An innovative contraceptive that is now the subject of research makes use of that fact. Ovaprene® is a diaphragm-like vaginal insert with a central mesh that is impregnated with an iron compound. Because it is a mesh, it is permeable to blood and cervical mucus, but the iron makes it lethal to sperm. The woman places it in her vagina as her period ends, being careful that her cervix is covered. The insert is left in place until her next period starts. It has the theoretical advantage of being nonhormonal, and providing month-long protection against pregnancy.

Ovaprene® appears to be ready for human testing. However, it is still years away from commercial availability, so don’t expect to find it in your pharmacy any time soon.

This brings up the challenges of developing a new family planning method. There are many contraceptive ideas that seem great at the start, but wind up in the trash. I know from personal experience. My idea for a rip-stop condom earned a patent (#4,881,553), but lost me a lot of money since no company was interested in buying the idea. This winnowing process explains, in part, why new methods are usually expensive.