Madison Diocese and birth control

Wisconsin CycleBeads

WOMEN”S RIGHTS
By Kendall McKenzie
August 13, 2010

Wisconsin Catholic Diocese Covers Birth Control, Plans to Fire Employees Who Use it

A Wisconsin state law that took effect Jan. 1 requires any commercial insurance policy with drug benefits to include prescription contraceptives in their coverage. While this is a fair and reasonable piece of legislation, the Catholic Diocese in Madison, Wisconsin, is telling employees they'll be fired if they utilize it.

The idea that a woman might be able to control her own reproductive organs was apparently so offensive to certain Catholic organizations in Wisconsin that they first tried to circumvent the law by becoming self-insured, but the costs ultimately proved to be financially unsustainable. So though the diocese will now be legally obliged to provide contraceptive coverage, they’ve made it clear they’re also going to create consequences for taking advantage of it. Diocesan spokesman Brent King noted that should an employee exercise their right to obtain birth control, they would be subject to counseling and ultimately termination if they “refuse to get in line with Catholic teaching” and abide by the contraception prohibition.

Aside from raising obvious privacy and logistical issues (the diocese has admitted they really have no way to monitor employees’ contraceptive use unless it’s voluntarily revealed), the fight against birth control and its role in sexual “immorality” seems to ignore the pesky reality that many women rely on it for reasons that have nothing to do with preventing pregnancy. In fact, as many as one-third of birth control prescriptions are written for non-contraceptive benefits, which include treating anemia, acne, premenstrual symptoms, and painful and heavy periods. The refusal to allow women access to contraception is nothing new, but it's becoming more and more detrimental and, quite frankly, silly, as additional benefits to using birth control continue to appear.

The bottom line is birth control, whether or not it’s being employed as contraception, is basic health care that 99% of women have used in their lifetime. Mandatory coverage laws recognize this, as well as help alleviate the financial burden of preventing pregnancy that is often placed squarely on the shoulders of women. It’s a damn shame that instead of embracing this common sense legislation, Catholic leaders are using it to threaten their employees.

The diocese’s little “pick one: medicine or work” ultimatum is an excellent example of why "legal" doesn't necessarily mean "accessible." The idea that reproductive health care like contraception and abortions are just ours for the taking whenever we need because the law says so is pervasive and dangerously misleading. Birth control may be our legal right, but that means nothing if it's too expensive, difficult, or fraught with social consequences to obtain. A woman shouldn’t have to choose between her health and her job.

Personal comment: Church officials in the Madison Diocese and elsewhere need to focus on the problem of pedophilic priests and not try to insert themselves into women’s reproductive health care.

Pointe shoe quiz 08-14-2010

What maker’s shoes is this swimmer wearing?

This is an easy one, but I couldn’t resist posting this image

FDA approves ulipristal acetate for EC

ellaOne Emergency contraceptive

FDA OKs new, five-day emergency contraceptive
By MATTHEW PERRONE, AP Business Writer
August 13, 2010

WASHINGTON – Federal health officials on Friday approved a new type of morning-after contraceptive that works longer than the current leading drug on the market.

The pill ella from HRA Pharma reduces the chance of pregnancy up to five days after sex. Plan B, the most widely used emergency contraceptive pill, begins losing its ability to prevent pregnancy within three days of sex.

The Food and Drug Administration approved the drug Friday as a prescription-only birth control option. The ruling clears the way for U.S. sales of the drug, which is already approved in Europe.

Morristown, N.J.-based Watson Pharmaceuticals will market the drug in the U.S. under an agreement with HRA. Watson said it will launch the pill in the fourth quarter.

Studies of ella by its manufacturer showed the drug prevented pregnancies longer and more consistently than Plan B.

In a head-to-head trial between the two drugs, women who took ella had a 1.8 percent chance of becoming pregnant, while women who took Plan B had a 2.6 percent chance. Experts tracked nearly 1,700 women who randomly received one of the two pills within three to five days of having unprotected sex.

Plan B is made by Teva Pharmaceuticals and is also marketed in several generic versions. Unlike ella, Plan B and other generic versions are available without a prescription for women 17 years and older.

HRA Pharma did not request over-the-counter status for its drug.

Ella uses the hormone progesterone to delay ovulation, a key step in the fertilization process.

Despite this, the drug has drawn criticism from anti-abortion groups who say it is closer to an abortion pill than an emergency contraception pill.

Groups including the Family Research Council argue the drug is chemically similar to the abortion drug mifepristone, which can be taken to end a pregnancy up to 50 days into the gestation period. That drug has been associated with severe infections and bleeding after abortion. However, FDA reviewers reported no life-threatening medical side effects with ella.

The most common side effects with the drug included headache, nausea and abdominal pain, according to an FDA release.

Abortion rights groups hailed the approval as an important step for the FDA, which was criticized in 2006 for its handling of Plan B's approval.

Last year a federal judge ruled that the FDA deliberately delayed making a decision on whether to permit over-the-counter sales of Plan B to teenage girls, at the behest of the Bush administration.

"Approval of ella is another indication that the FDA is committed to restoring scientific integrity in its decisions," said Kirsten Moore, president of the advocacy group Reproductive Health Technologies Project.

Privately held HRA Pharma is based in Paris and specializes in women's health products.

Personal comment: because of the way ulipristal acetate works I think it is unlikely to ever be available behind the counter for women 17 y/o and older as Plan B is today. Used for EC an effective dose is 30 mg, but in a far higher dose it could terminate a pregnancy.

Student sexual healthcare and reader’s questions

A Vacusafe aspiration system

Summer Intensive complications: Several weekends ago I was helping out at the clinic and one of the chaperones from the ballet summer intensive being held across town came in with a 14 y/o student who had missed her period and tested positive for pregnancy. The school has a pretty strict dorm policy for students under 16 and she had only been at the SI for a week when her period was late. The fact later emerged that this was the second period she had missed so it’s certain she was impregnated before coming to Vegas for school. Her widowed father had been notified by the school and our Gyn talked with him and had the release forms faxed, signed and faxed back to allow a termination which the student and her father agreed was the best alternative. The Gyn said her father wasn’t mad, just terribly sad and cried wondering how it could have happened because she was on the pill.

The student wanted the fastest possible procedure so she wouldn’t miss any of her classes the following Monday, so it was agreed she would have a vacuum aspiration abortion as the quickest and safest method then be given a course of antibiotics to minimize the likelihood of infection as her uterus repairs itself. Because she was so young her cervix was numbed and dilated to allow easier insertion of the soft cannula. The process of removing her endometrium and the other tissue took about fifteen minutes. The removed uterine contents were examined and the Gyn was satisfied that all the tissue associated with the pregnancy was there (typically an 8 week old fetus is about .5 inches long and weighs about .04oz) so the termination was complete and she spent an hour in post-op recovery to make sure she was ok. I was so proud of how well she handled a difficult situation while away from home and her usual support network.

She was given a pack of pads to wear as she would be spotting for a day or so and two packs of the birth control pill, Yaz, that she is on and condoms and was told not to have intercourse for two weeks and to use condoms while on the antibiotic and until she had taken at least 7 consecutive active pills from a new pack after she had finished the course of antibiotics so she can be sure her hormonal protection is properly reestablished. Fourteen is below the age of consent here so with the schools chaperones I imagine she was safe enough for the rest of the SI.

As to how she could have become preggers while taking her pills consistently, it’s a story we had heard many times before. She had reached menarche only about a year ago and suffered from erratic cycles and painful periods. For the last six months her Gyn had put her on Yaz to stabilize her cycle and lessen the discomfort she was having when menstrual. Then she had been given an antibiotic by her GP to treat a sinus infection. Our Gyn thinks that’s what lessened her protection enough to allow breakthrough ovulation so that taking a partner who wasn’t wearing a condom allowed him to impregnate her. She said he is the only boy she has been intimate with and that she took her pills regularly each morning. Women on hormonal contraceptives do have to be careful about interactions with other meds and some foods as well as vomiting with 4 hours of taking a pill because the hormones may not be fully digested and in the bloodstream until then.

Reader’s questions: A reader asked, “How much do you charge for service?” My reply was: “I teach and am an event planner, I don't charge for personal services. Well, not directly anyway. My fee is distributed over the many services my organization provides.” I’m a brand now and if I were a pharmaceutical the FDA would say my girls are ‘therapeutic equivalents’ of me. I’ve never been for sale so that someone could by a piece of me. Even when I was in school I’ve always been able to choose my partners both male and female and my readers know some of the men as my handsome virile stallions.

During a chat a night or two ago another reader asked if I had ever found someone I wanted to marry. I said I had, but they were married. I said I was confident that I could have seduced him and taken him away from his wife. However, if I did that I would have a man I knew was unfaithful and if he was unfaithful to the woman I took him from he would eventually be unfaithful to me and I don’t need that! I have a wonderful circle of strong talented men for companionship and sexual pleasure and I have plenty of money so I don’t need to be kept; I’m too independent for that anyway. So I’ll be satisfied with the way things are, until Mr. Right comes along.

The copper-T as emergency contraception

The ParaGard IUD

Published on RHRealityCheck.org (http://www.rhrealitycheck.org)
By Amie Newman
Created Aug 9 2010

IUDs: Now for Emergencies?

“According to the results of a study undertaken in China by the National Research Institute for Family Planning, the Copper IUD (sold under the name ParaGard in the United States) can be an excellent emergency contraceptive if inserted within five days of unprotected sex.

Researchers followed 2000 women who came to eighteen different clinics around the country for emergency contraception, within the five day window, and then were implanted with the Copper IUD. Women returned for follow-up visits, according to the study published in BJOG [1](an international journal of obstetrics and gynecology), at 1, 3 and 12 months post-insertion. Prior to or at the first follow-up visit, not one woman (all but 70 women returned) had become pregnant.

Women involved in the study did report some side effects: increased menstrual bleeding and menstrual disturbances (however vague that might be). Twenty-nine women "experienced a difficult IUD insertion process, requiring local anaesthesia or prophylactic antibiotics," notes the study.

It's an interesting find.

The old kid on the block, Plan B, the brand name for the emergency contraceptive (EC) pills sold in the United States, is effective at preventing pregnancy in 1 out of 100 pregnancies. Women have been encouraged to keep them "on hand" or in their medicine cabinet so, if there comes a time when they do need them, they do not need to struggle with finding a pharmacy open and available as soon as possible or finding a pharmacy that won't judge or refuse to sell the pills to you [2]. A recent study concluded that though women who keep EC on hand are not as likely to use the pills as previously thought, it is still an important option for women to have.

But how likely is it that a woman who is in immediate need of emergency contraception would actually choose to undergo insertion of an IUD into her uterus, have access to a health provider in a timely manner or be able to afford the "option," in order to make use of this successful form of emergency contraception?

From a Reuters [3] article on the study:

"...despite the benefits of Copper T, it's not easy to get for many women seeking emergency contraception in the United States. One deterrent is that while women 17 and over can buy Plan B over-the-counter at a pharmacy, Copper T must be inserted by a doctor - an extra step for women who only have a window of time when emergency contraception can work.

"The issue," Godfrey said, "is immediate access. In the U.S. it's easier just to go to a pharmacy."

And while Plan B runs for about $50 off the shelf, Godfrey said that depending on her insurance a woman could pay more than $500 to have Copper T inserted. "Cost could certainly be prohibitive," she said."

There are two different IUDs sold in the United States, currently. The hormonal IUD, sold under the brand name Mirena continually releases hormones into your body for up to five years; and the Copper IUD. Both work to prevent fertilization of an egg or to create an inhospitable environment for a fertilized egg to attach to the uterine wall.

The IUD is a more permanent form of birth control so if you use have one inserted, it's a one-time only occurrence (or at least a one-time every 5-10 years occurrence). While these sorts of studies are important from an efficacy perspective, they don't take into account the reality of women's lives. What are the real benefits of a study such as this one if most women cannot ultimately make use of the results?

Dr. James Trussell, a long-time proponent for emergency contraception, and head of the Office of Population Research at Princeton University was quoted as saying,

"It's too bad it's [Copper IUD] not used more often...If there were many, many more IUD insertions rather than emergency contraception pills (used), it certainly would have an impact on lowering pregnancy rates and abortion."

And while I cannot argue with his logic, it's the realistic implementation in women's lives with which I take issue. It seems to me that if we look at women's lives first and see how we can best address unplanned pregnancy rates given, well, the givens then we can "impact" said rates much more effectively.

I'm sorry if I'm short sighted here but the IUD, while effective at preventing pregnancy, is not the right method of birth control for every woman. Here's a basic run-down, from Planned Parenthood [4], on when you shouldn't use the IUD:

You should not use an IUD if you:
-have had a pelvic infection following either childbirth or an abortion in the past three months
-have or may have a sexually transmitted infection [5] or other pelvic infection
-think you might be pregnant
-have cervical cancer that hasn't been treated
-have cancer of the uterus
-have unexplained bleeding in your vagina
-have pelvic tuberculosis [6]
-have a uterine perforation during IUD insertion

There's a lot of room between thinking "you may have" an STI and finding out for sure. Would a doctor insert an "emergency" IUD in that case? What about not knowing if you have cervical cancer or not? Would a woman be honest about her symptoms if she were so intent on preventing pregnancy and getting an IUD put in place? This is a long list of "ifs" to me. I'm not discounting the IUD as a form of EC but I'm not sure this study would be enough to persuade me that inserting an IUD so swiftly is a bright idea, unless the woman has already done her research and was planning on having one inserted anyway."

Personal Comment: I suppose the copper IUD as an effective method of EC is getting attention right now because of the research findings published in the British journal of obstetrics and gynaecology. However it has been known as effective EC for a long time. I remember at least fifteen years ago when I began researching EC when I was on the pill, Planned Parenthood was even then providing the ParaGard as EC.

I agree with the point this article is making, that while a copper IUD is extremely effective as EC it is not for everyone and it is even more difficult to get in a timely manner than Plan B was before it became OTC.

An ABV hit

A Guardian FFM showing ambient breathing valve

A Suffocation hit: We are puzzled as to why the niece of a casino owner was killed. She was 19 y/o and had been visiting for the summer. Taryn had been at a party with her a week or so back and said she was smart, funny, confident and a delight to be around. Everyone not aware of the details thinks she died from some sort of an undiagnosed medical condition. She was an experienced diver and was out of the water when she died. They found her sitting on a bench on the pool surround of her uncle’s home leaning back against the wall dressed in the same style and color neoprene DUI wetsuit that her aunt wears. She was wearing all her equipment; booties, flippers, gloves, hood and weight belt and was ready to dive. She had suffocated while wearing her new gold silicone Ocean Technologies Guardian FFM similar to the one shown at the top of this entry. Her ambient breathing valve, (ABV) the knurled knob on the right side of the visor, was closed and the valve on her air tank (which was full) was turned off.

When her uncle found her she had been dead at least several hours and there was nothing the EMTs could do. Her uncle who is a sports diver thought she had been adjusting the fit and testing the seal on her new mask, the mask bag was beside the bench, and had some sort of seizure and that’s what he EMTs assumed also, until someone thought of looking at the security video to try and establish her time of death. That showed a woman in a bikini with a pareo around her hips, carrying a tote and wearing a wide brimmed sun-hat coming from the direction of an outside door from the back of the property and walking toward the teen. The teen is seen adjusting the straps on her head harness, closing the ambient breathing valve (ABV) which allows the diver to breathe ambient air while on the surface to save the air in her tank, then tugging on the straps again and opens the ABV to get air. The woman walks up to the girl pulls a squeeze bottle from her tote and sprays fluid onto the ABV. The teen’s hands start rise to her mask then drop back on her lap and her head slumps forward and she starts to topple forward off the bench. Sun-hat steps forward and catches the teen and pushes her back against the wall. As sun-hat turns you can see that she is wearing a cheek filter gasmask that had been hidden by the wide brim of her hat. Sun-hat reaches over and closes the ABV and makes sure the air valve on her tank is turned off so no air can get inside the teens mask. Sun-hat looked at the dive watch on her right wrist and stands there waiting for 7 minutes and 28 seconds before leaving in the direction from which she entered. From a close look at the video sun-hat seemed to be wearing latex surgical gloves, the gasmask may have been an old Czech M10 and was wearing sueded sole well worn white leather ballet slippers that left no prints.

Speculation: The uncle, a friendly competitor of mine, and I have worked some local charity events together and he knows of my interest in women’s violent deaths in Vegas. He wasn’t asking for my help, well not exactly, just for my thoughts about how this sort of thing could have happened to his family. He said after seeing the video the forensics people are testing for anesthetics, but haven’t come up with anything so far. Spraying the anesthetic into the ABV would have concentrated the fumes directly into the masks face cavity where there would have been no escaping the gas. I wondered about the contractor getting the wrong house, but it was daylight and all the homes are plainly marked though well separated so there is a lot of privacy in that neighborhood so hitting the wrong house seems very unlikely and the contractor was prepared to quickly immobilize a woman in dive gear with a minimum of effort. That she spent more than seven minutes watching her target die seems to suggest that she knew she had plenty of time with little fear of being interrupted and the watch on her right wrist indicates she might be left handed.

At this point I think the only reasonable scenario is that it was the right house, but the wrong woman was hit. It has to be that. It’s not like the teen was a high-profile celebrity or had stolen state secrets or something. She was just a pretty girl who would have been a second year student at Princeton this fall and her father is a doctor. The way I see it, everyone knows her aunt and uncle are into SCUBA diving and she was the same size and with probably a better figure (mostly hidden by the neoprene suit) than her aunt and was wearing a wetsuit identical to her Aunt’s. So in a hood and mask sun-hat couldn’t have seen that the teen’s hair color was different from her aunts. If it looks like a duck and acts like a duck it must be a duck, right? Not this time!

But if that’s what happened why would someone want to put out a contract on the aunt? She is 28 y/o with a lot of energy and personality and the 3rd trophy wife of her 52 y/o husband. They have been married less than a year and (rumor has it) she is making him very happy in bed. So happy that he has stopped sleeping around and they are talking about starting a family. She is very athletic and body conscious spending a lot of time at the gym and diving and is the youngest sister of the teen’s mom who lives in New Jersey with her husband. So where’s the motive for offing auntie? Oh, yeah, and auntie (trophy wife #3) has disappeared. Her husband said a small carryon bag and her passport is missing.

Taryn has a copy of the security video, but there is almost no action and certainly no struggle, just sun-hat walking up, the anesthetic sprayed on the ABV, the teen’s raised hands and slumping forward then sun-hat pushing the rubber clad teen back against the wall and closing her ABV. It’s probably too passive an off to be a big seller as a snuff video, but Tanaquil thinks it might appeal to the discriminating rubber fetishist collector who enjoys the subtleties of a female diver assassination, especially if the wrong woman was snuffed!

Fertility Awareness Method of contraception

Every woman should read this book

Fertility Awareness Method (FAM): On my August 6, 2010 post ‘Teens, rhythm and pregnancy’ Eric asked a question about the difference between FAM and the Rhythm Method. Since the two are often confused I thought I’d explain a bit about FAM which is far more reliable than the Rhythm Method if practiced correctly, and post it in an entry where more readers, who might be interested, can read it. An excellent book on FAM is Taking Charge of Your Fertility by Toni Weschler. It’s easy to understand and a very empowering read. I highly recommend every woman reading it regardless of whether she plans on using FAM or not as it gives you an understanding of what’s happening in your body all through your cycle. And guys, it’s worth you reading it too if you are interested in what’s going on in a woman’s body and why we may be cranky at times during our cycles. FAM is super for when you are trying to conceive, because you can tell exactly when you ovulate so you know the best time to go baby dancing. However, what my circle generally uses FAM for is as an aid for contraception and the discussion below is from that viewpoint.

First a caution: Used for contraception FAM is unforgiving of Oopses and just-this-once events like “Just let me stick the red part in for a minute” That’s against the rules when the woman is fertile! Ok?

To use FAM fully (including taking basal body temp) takes discipline and a stable schedule, because the temp readings should be taken at the same time each morning, immediately after awakening after more than 4 hours of uninterrupted sleep. The temps are recorded so the woman can see her temp shift at ovulation. So for any woman with an erratic schedule the temp part is questionable. If you are using FAM for birth control the temperature shift upward by a few tenths of a degree at ovulation is a sort of after-the-fact measurement that tells you when you’ve ovulated. About two weeks later, if you haven’t become pregnant, your progesterone level drops – causing a decrease in temp – that occurs a day before your period starts. No temperature drop about two weeks after ovulation is an indication that progesterone is still high and you may be pregnant.

It’s good to know that you have ovulated and therefore after another 24 hours (O+1) it should be safe to go without protection if you’re sure STIs aren’t a problem. However, if you haven’t been carefully watching up to that point for slippery stretchy cervical fluid and a ripening of the cervix when it softens, opens and rises higher in the vagina - which tells you you’re fertile and should be using a barrier - you may find you’ve been truly fucked in every sense of the word. That’s because when sperm reaches fertile cervical fluid it can live in a woman’s tubes as long as 5 to 7 days waiting for her to release an egg. In the teens and early 20s (19 to 26 years old) a woman has a 50% chance of becoming pregnant from a single act of unprotected IC on her most fertile day. So a woman really needs to be careful using FAM.