marriage and family: November 2004 Archives

family planning rant

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Dawn Eden notices that the MSM hasn't got a clue how contraception and abortion are linked.
I work in an aggressively secular environment. I stay here because I think that I am able to be a little bit of leaven. Maybe I'm fooling myself. The facility gets a fair amount of funding from Title X federal family planning funds. There is a full file cabinet drawer of info on contraception. When I came here, there was nothing in it on NFP except for a 1970s vintage booklet on fertility awareness that had been photocopied so many times that it was almost unreadable. That drawer now has some basic info, brochures from 3 local teachers, the front and back copied from a non-sectarian NFP book and info on lactational amenorrhea for childspacing.
I make the effort to tell women just how hormonal contraceptives function. (three mechanisms, one of which is abortifacient -may suppress ovulation, but not reliably;usually alter cervical mucous to inhibit sperm transport;render the uterine lining inhospitable to a developing embryo, and slows embryo transport through the tubes to the uterus such that the embryo can not survive the transport time). I remind them that fertility is a state of health and that to make ones self infertile is to create a biologically unhealthy state. They listen and then usually go on using their pills or their depo.
I keep hearing news stories about how we are increasingly the most obese nation around, especially our women. I wait in vain for some one to link the prevalence of hormonal contraception (especially depo and until it was off the market, norplant) to this problem. I wince thinking about the women now in their 30s who will have osteoporosis in their 50s from prolonged use of depoprovera. Yes, the obesity from the depo might partially offset the calcium depletion, but still.....
I still need to do my research, but I am convinced that there is a double standard about the approval of unsafe drugs - my impression is that the death risk (heart attack et al) from Vioxx, the muscle wasting risk from Baycol are actually much lower than the risks of serious consequences from hormonal contraceptives. The Pill kills 0.3 to 1.9 women annually in every 100,000 users ages 15 to 29. (If you click on this link, you will notice it is info on the patch, but scroll hafway down to find the mortality table (table 3) for contraceptives of all kinds). This table is a little deceptive - for those methods that have a direct risk of death, they list the actual deaths occuring during the usage period - but for other methods they list the death risk from the theoretical pregnancies that would occur if the method did not succeed at preventing conception/implantation. There is also no consideration of possible excess mortality and morbidity related to increased risk of obesity, hyperlipidemias, hypertension, delayed childbearing, or breast cancer. To be fair, there is some good research that taking combination OCPs for more than 5 years does reduce the risk of ovarian cancer - but so does pregnancy followed by breastfeeding such that there is a prolonged natural amenorrhea.

Yes, pregnancy can also be a cause of mortality and morbidity. I won't deny that. Abortion can also kill the pregnant or recently pregnant woman. Maternal mortality in women aged 21 - 29 was 7.4 to 7.9 deaths per 100,000 live births. If the choice was strictly between hormonal contraception and pregnancy/birth, it would seem that the risks are higher with pregnancy - but there is a flaw here - the flaw is in an assumption that one women using a contraceptive for one year equals one pregnancy, and the other logical flaw is to assume that the only way to prevent pregnancy is to use hormonal contraception. NFP properly used can be as effective (as hormones) at preventing conception if that is the desire of the users. NFP is more effective than barrier methods and spermicides. As I see it, the major health risk of NFP is that the users may decide to have relations on a fertile day, and then have a pregnancy. That is why communications and joint decision making are key to effective practice of NFP if the intent is to delay or avoid pregnancy. It is not a good method of family planning for women who are in abusive relationships, for example. If a woman has no power to say NO and have it respected, then NFP will probably not help her to delay or prevent childbearing. But that is not the fault of the method, it is the fault of a culture that denies women the right to say no, a culture that has so separated sexuality from procreation that women are literally surprised that they got pregnant without planning to.

comments on theology of the body


and a Jewish wedding
from dawn
Oh how I wish I could get this across to some of my patients!

thought provoking thoughts

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A married couple post about the meaning of the sexual union and what our cultural misunderstandings have done to us all.
He speaks here and here
She speaks here and here
Thanks to Happy Catholic for the links

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This page is a archive of entries in the marriage and family category from November 2004.

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