Grossman: Reducing the barriers to family planning

Friday, Dec. 22, 2017 4:23 PM
Richard Grossman, MD

There is no good news about male contraceptives yet, but there is much progress in the field of family planning for women.

Perhaps the best news is that, globally, more women who want to avoid pregnancy are using an effective contraceptive method. The number who weren’t using modern contraception was estimated to be 225 million in 2014 but is 214 million now. The decrease is partly because of huge efforts from Family Planning 2020 to make better family planning available in developing countries. With local support, as well as funding from rich countries and foundations, FP2020 has provided over 30 million women with effective contraception.

The goal of FP2020 is to reach 120 million previously unserved women with effective family planning by the year 2020. In many places, couples only had access to one or two methods, such as condoms or tubal ligation. FP2020’s strategy includes avoiding coercion and offering a choice of several methods.

Please remember that it is not just developing countries that wrestle with unintended fertility. In 2008 in the USA, 51 percent of pregnancies were unintended. There is good news here, too; it is now just 45 percent. This decrease, and the significant decrease in abortions, is thought to be because of Long Acting Reversible Contraception also known as LARCs. These methods include intrauterine devices, implants and the three-month shot. One in seven women in the U.S. is now using these most reliable types of birth control.

LARCs have two shortcomings, however. In general, they are expensive – but remember that dollar-for-dollar, contraception saves more than any other health intervention!

The other problem with LARCs is convenience because most require a health care professional. An exception is the three-month shot, “Depo” or DMPA. This has been in use for birth control for almost 50 years, but requires a clinic visit four times a year.

Sayana Press is an innovative solution that is accepted very well. It is a small, plastic bubble filled with the medication and a short attached needle. The woman just punctures her skin, squeezes the bulb and she is protected against pregnancy for 90 days.

Malawi, a small East African country with large families, compared women who went to the clinic to get their shots with women who injected the medicine themselves. They found that women who were given the first shot at the clinic then took home three Sayana Presses were much more likely to use the medication for a full year.

Birth control pills are available without prescription in many countries, and the U.S. will be following suit if Daniel Grossman has any say. Grossman and I may be distantly related, and we are very close in our belief that “the pill” is amazingly safe and there should be minimal barriers to its access. Grossman has started the “Free the Pill” campaign. This would follow the way Emergency Contraceptive pills have gone over the counter; now sells EC pills!

Another physician named Grossman – Jessica – heads up Medicines 360. This organization has as its mission “... to expand access to medicines for women regardless of their socioeconomic status, insurance coverage or geographic location.” Their first product is a big success! Liletta is an IUD that releases a hormone over four years, is safe and very effective and decreases menstrual bleeding and cramping. It is primarily sold to clinics and is significantly less expensive than similar IUDs. Recently, there is good news about all IUDs; they reduce the risk of a woman getting cervical cancer.

When President Donald Trump reinstated and expanded the Global Gag Rule, the Dutch started “SheDecides” to replace essential funding for reproductive health. More countries, foundations and individuals have stepped up to pledge $200 million. This amazing organization’s goal is to make it possible for “... girls and women to decide freely and for themselves about their sexual lives, including whether, when, with whom and how many children they have.”

Most couples in the U.S. use contraception at some time in their lives, even if their religion opposes birth control. In much of the global south, however, this is not the case. There, the Roman Catholic hierarchy turns most women away from birth control. This might change, however. The Pontifical Gregorian University in Rome is holding a series of talks to commemorate the 50th anniversary of Humanae Vitae, according to the National Catholic Register.

Despite political forces in this country that are trying to erect barriers around access to family planning, there is a lot of good news about contraception for women.

Richard Grossman practiced obstetrics and gynecology in Durango. Reach him at © Richard Grossman MD, 2017