Monday, September 17, 2012

The Right Way to Change Contraceptives

You did know that half the pregnancies in the United States fall into the category "unintended" didn't you?  I've read numerous articles trying to explain why that is, but while we are all waiting for an answer, there's a relevant and easily solvable issue - how to change contraceptives without risking a period of unprotected fertility.

Most women and many doctors haven't a clue how to do this.  Sounds simple enough - just stop what you are doing now and start doing something else as soon as possible - but there are some important tricks to know and traps to avoid.

NYT's reliable health column "Well" has the details you are missing along with a thoughtful list of reasons why reproductively-vulnerable women find themselves in a contraceptive gap situation.  It's worth reading the whole thing, but as always, WNL includes a nugget here in case you want it boiled down:
Strategies for Transition
Another factor that puts some women at risk of an unintended pregnancy is the false belief that one must wait until the beginning of a menstrual cycle to start a new method. These gaps in protection should never occur, said Dr. Lesnewski, who was an author of a report on preventing contraceptive gaps in American Family Physician last year.
“Many women get pregnant when they stop one birth control method before starting another,” she said. For example, a woman who has been on the pill should not wait for the start of her next period before she begins a different pill. Rather, she should switch directly from one pill to another without missing a day.
For other kinds of changes — say, from a pill to a contraceptive patch — a two-day overlap is needed to prevent a decline in hormone levels and assure contraceptive protection. When switching from a pill, patch or vaginal ring to a progestin IUD or hormonal implant, an overlap of seven days is needed, but no overlap is required if switching to a copper IUD.
On the other hand, if the switch is made in the opposite direction — from a copper IUD to a pill, patch or ring — a woman should use the new method for seven days before the IUD is removed.
Another option is to rely, religiously, on a barrier method of contraception, like a condom or diaphragm with spermicide, to cover any gap in protection. Use of a barrier method for seven days is essential when changing from a copper IUD to a progestin IUD (or for four days when making a switch in the opposite direction) because a woman can become fertile as soon as an IUD is removed.
The Reproductive Health Access Project has posted a chart that spells out in great detail how to switch contraceptives while minimizing the risk of pregnancy. It can be found at www.reproductiveaccess.org/fact_sheets/switching_bc.htm.
If you don't use contraception and are sexually active, how likely is it you will get pregnant, based on your age?  The measurement here is something called the monthly fecundity rate which is the "likelihood of getting pregnant each month if you're having sex without birth control." 

The younger you are (youngest on this graph being 25 which IMO leaves out some sexually active folks), the greater the possibility that unprotected sex will start a pregnancy sooner rather than later.  So, unless you are 45 or older, having accurate information about how to change contraceptives and a plan to manage gaps in your access to contraception should be on your "to do" list rather than the "maybe later" list.

Sunday, September 9, 2012

Got Eggs? Read Up on the Law

The eggs I am referring to are the ones in your ovaries, not the ones you might have in the fridge.

No matter what your views on who pays for what, when life starts, or how you are balancing work, family, and relationships, those views are going to be irrelevant if you get into a reproductive situation where the laws of your state take over. I'm not going to bother taking a position on right or wrong here.  This post is just a wake-up call to women to find out what the new rules are for themselves for the daughters they are raising .

These new laws are a potpourri of rules, exclusions, prohibitions, and criminal penalties differing in detail from state to state, they all have in common that they concern matters we women are not used to having as anybody's business but our own.

The majority of reproductive age women - between 9 and 55 -  are busy with their lives, and are not tuned into the fine print being churned out by State Legislatures.  This post is an alert and a plea to become aware of that fine print NOW before you are caught in one of the bizarre and life-ruining double binds that new laws around the country are producing.

There are two questions here:  The first is exactly what are the new laws in your state regarding your eggs; The second is how local officials are applying these laws to actual situations.  There are many laws passed in state capitols, usually without funding attached to pay for their implementation, that local law enforcement just ignore.  Others are enthusiastically implemented in strange and unintended ways, depending on the dispositions or beliefs of detectives, prosecutors, and judges.  I'm thinking both need to be part of your education.

Here are some links to get you started.  I have tried to stick to the facts rather than rhetoric with these links, although there is no doubt about how some of the sites feel about the legislation they are reporting.  I have omitted completely sites that push a point of view and mention legislation only in passing.  Once you are tuned into gathering information about your eggs and who is making rules about them, local sources are best.  All these situations nobody wants to be in are local - at least until the national media picks them up.

Center for Reproductive Rights  This group specializes in tracking laws and how they are being implemented.

NARAL Pro-Choice America  Right up front with their point of view, but very heavy on facts with a front page full of links about specific reproductive rights issues, each with a rundown on laws on the subject and a map of where these laws are in effect.  A great place to find out about your state.

Guttmacher Institute  The granddaddy of medical statistics on reproductive issues, this page has statistics on induced abortions in the US over time, who gets them, when, and why.  The site has lots more if you have the time.

RH Reality Check  RH stands for Reproductive Health.  The link here is to an article titled "State Legislative Trends in Reproductive Health Law and Policy: Mid-Year 2012 Analysis", written by Guttmacher Institute researchers.  Overview of the legislative surge.

This is a great news site for reproductive/women's health issues in general.  They will amplify local news items like this one so we can all find out what's going on: "Pregnant? Don't Fall Down the Stairs," is a specific example of how local law enforcement interpreted a new Iowa law.

TheGuardian  UK newspaper covers American items as well.  The linked page gives an overview of some of the pregnancy criminalization issues the new laws are creating.  It is a year old, so there are others if you care to Google the subject.  

WNL:  Once laws are passed, they can be applied, often arbitrarily and with hellish consequences, to our lives.  It would be nice to think that some of these badly written, vague, and intrusive things will be repealed, but that's a long process.  Somebody has to fight years in court to obtain a remedy for other people, while their own lives remained ruined.  Be wise.  Find out the rules and figure out how you are going to deal with the new realities.

(Please contribute your own stories, constructive advice, and comments.  This post is meant to be the beginning of a thread, not the completion of one.)

("Mother Bird" watercolor by Lyn Southworth)

Thursday, August 9, 2012

Women in India Struggle as Opportunities and Oppression Clash


It is so difficult for us out side of India to understand what the experience of being a woman is like there.  Surely it varies depending on economic status, religion, and region, but two intelligent articles have come to my attention that taught me a lot, and I hope you will find them helpful as well.

The headline for both is that reported sexual harassment and assault of women in India is going up while rates for other crimes are going down.  India was also designated "worst" in the TrustLaw Women report assembled by 200+ gender specialists ranking the G20 by their treatment of women (Canada made #1 - Best).

Nilanjana Roy puts real women into the discussion by describing the assaults by mobs of young men which have been filmed and are circulating around India, generating widespread anger, but also the all-too-familiar discussion about what limitations should be placed on women so these regrettable incidents don't happen. 
Rape and sexual assault are among the fastest-growing reported crimes in India, according to the National Crime Records Bureau. Rape also has a plunging conviction rate, with only 26.5 percent of reported rapes successfully prosecuted in 2010. And the response from the authorities across India has been strikingly obtuse. As public anger grew over the Guwahati attack, the police responded by declaring that bars in the city should shut down by 10 p.m. The announcement was widely seen as an attempt to distract attention from their own shortcomings in handling the case.
After a woman was raped in Kolkata this year, the police directed bars to stop serving drinks after 11:30 p.m. After a female journalist was shot and killed some years ago while driving home, Delhi’s police chief suggested that women should not drive late at night without proper escorts. And after the rape of a woman in Gurgaon, a city near Delhi, some months ago, the municipal administration suggested that women should not work after 8 p.m. (Read the full New York Times article.)
WNL would like to hear from women from the subcontinent, whether they still live in India or are living elsewhere.  What is your experience?  What can you tell us about what it's like to be you?

(Graphic above from Thompson Reuters Foundation, reproduced by The Wall Street Journal.  The accompanying article on the same report suggests there were additional rankings, including most dangerous countries pictured above.  Read that article here.)

Saturday, July 28, 2012

Being a Woman at the London Olympic Games

Lenka Hajeckova, Czech Republic, beach volleyball 2012

Betty Grable did the same dance steps as Fred Astaire, and as she famously added, "backwards and in high heels."  The 2012 Olympic Games in London continue the tradition of making life harder for women participants for no discernible reason with the following by-line from The Daily Beast, "Jesse Ellison reports on the IOC's quest to determine whether female athletes are too masculine".

Jesse (who claims to be female, by the way) has written a stunning behind-the-curtain report on the strange and continuing fascination by the International Olympic Committee with the sex, both physical and genetic, of female participants, a fascination that does not apply to male athletes.She reports first on the strange and continuing quest to find some way to disallow South African track star Caster Semenya her medals, then takes us back to the early days of the "sex quest":
Such accusations go back at least half a century. The IOC adopted its first set of gender tests in the 1960s, with “nude parades” that were exactly what they sound like: female competitors made to walk naked before a panel of judges.
But as the IOC later realized, what’s on the outside doesn’t always match what’s on the inside, so the committee moved on to chromosome testing. Once it was shown that women can have a single X chromosome (just as men can have two of them) that was abandoned as well.
Then came SRY gene detection (the gene that triggers male sex determination), but after the Atlanta games, in which 8 women tested positive for it, and all were cleared for competition, this method, too, was deemed insufficient.
A decade ago, the committee decided to chuck the testing altogether. But in the wake of Semenya’s case, and the international scrutiny it prompted, the IOC announced that it would try, once again, to devise a way to decisively determine what makes a woman a woman.
Read the full article here at The Daily Beast to get the full dose of indignity and paternalistic intervention (using drugs to lower naturally-occurring levels of testosterone) for the sake of correctness the IOC is currently forcing on Caster and other female athletes.

Here's a final quote to help raise your blood pressure:
It all highlights a cruel injustice: the policy—and the testing, treatment, and humiliation that can come with it—only applies to female athletes. Men who excel at, say, ice dancing or synchronized swimming, where success has more to do with grace and rhythm than brute strength or speed, simply aren’t questioned in the same way women are. In 2010, after two French-Canadian sports commentators snickered over the flamboyant skating champion Johnny Weir and suggested that he should compete with the women, they were immediately and vociferously condemned for what was widely perceived as homophobic, despicable language. (This was, keep in mind, precisely the moment that Semenya was living in virtual exile after the subject of her gender had made international news.) Similarly, there is no upper—or lower, for that matter—limit to the amount of testosterone their bodies naturally produce.
One more thing - it's not just the IOC making women Olympians' lives more difficult.  Female TV viewers have their piece of the pie as well.   Pacific Standard reports "Female Olympians Sidetracked from Prime Time TV."  The article breaks down coverage percentages over the years and discovers that events where women wear bathing-suit type attire and are performing in "feminine" sports get on TV, while the lady weight-lifters, shooters, fencers, etc don't get the spotlight.
The UNC researchers emphasize they are not arguing that NBC is “intentionally marginalizing any athletes.” Rather, they write, the network—cognizant of the need for high ratings—is responding to the public’s preferences. (The top-rated events of the 2008 summer games were women’s gymnastics, followed by men’s and women’s swimming competitions.)
Don’t assume that means pandering to sexist male sports lovers. Traditionally, the Olympics are the only sporting event that draws a majority female television audience. For NBC’s 2008 coverage, the biggest demographic group was women 18 and over, who made up 49 percent of total viewership. Men ages 18 and older made up only 41 percent.
The Olympics telecasts are a huge ratings draw–214 million people, more than two-thirds of the American population, caught at least some of NBC’s 2008 coverage–so an argument can be made that the programmers know what people want to see. Their decisions suggest we love our women athletes, but only when they’re showing a lot of skin, and/or participating in sports our society considers acceptably feminine.

Wednesday, July 11, 2012

Birth of a Girl - Family Tragedy




This video is part of an article in The Atlantic magazine on gender preference in Pakistan.  It was made by two concerned women who wanted to see for themselves whether the dismal welcome a second girl in a family received as they were growing up was still the norm.

Read the article here.  IMO the video is far more powerful than the article at communicating the awful truth that women are vanishing from our world just as surely as Bengal tigers.  It's not about a country, a culture, the technology of ultrasounds and abortions, religions or laws.  It's about the fundamental devaluing of half the human race by the other half.  When women are worth keeping alive, they will be allowed to live.

Thursday, June 21, 2012

Discoveries about Trauma From the Adverse Childhood Experiences Study


Vincent J. Felitti is co-Principal Investigator of the Adverse Childhood Experiences (ACE) Study, ongoing collaborative research between Kaiser Pemanente and the CDC. Dr. Felitti is Clinical Professor of Medicine, University of California, Fellow, American College of Physicians.
He was invited to speak at an event sponsored by the Office of Violence Prevention in the Chicago [Illinois] Department of Public Health about the ACE Study.  Dr. Felitti’s presentation is in six segments. Click on the "Play video" buttons in sequence to view Dr. Felitti’s presentation.  (The videos are hosted by the Chicago Safe Start website and thus must be linked rather than embedded.)
The study reveals for the first time the direct statistical connection between adverse experiences in childhood and social dysfunction, mental and physical problems, and shortened lifespan.  Bottom line: Things that happened to you as much as sixty years ago are still shaping your life.
Find out all about the study and get a copy of the ACE Score Calculator Quiz so you can take the test.  What's your ACE Score?

Sunday, April 15, 2012

Too Scared to be Afraid



Did you know that the fundamental difference between an intimate relationship and an abusive intimate relationship is that one party is afraid of the other?  That's it, nothing more complicated than that.

That said, what do I mean by "afraid"?  Well, unlike the way we sometimes use the word "afraid" in everyday speech, it's not a synonym for worried or concerned, as in "I'm afraid my partner is going to leave me for somebody younger and richer."  This is the kind of afraid that every child understands and that in its own way represents the turning of one person in a relationship back into a child.  "I'm afraid if I don't get my homework done before watching TV, my parents will ground me".

To be afraid of your partner means that you have learned there are consequences for not doing what you are told or what is expected, even if those orders and expectations change from day to day and minute to minute.  Here are some examples:

  • If the kids toys are not picked up by the time he gets home from work, it's not going to be a pleasant evening.  He might leave, saying "I can't relax in this dump, I'm going out to eat."  He might disappear into the TV room all evening.  He might pick a fight with me or the kids.  I just know everything has to be in its place when he drives in the driveway.
  • If my wife wants something for herself or the house, I've learned to just give her the money, even if we don't have it.  The silent treatment and mean way she treats the kids in front of me just isn't worth it.
  • He inspects my car odometer, my phone, all my shopping receipts.  There better not be anything on there that arouses suspicion....and there's always something.
  • When I get dressed I have a mental checklist of things I don't wear if he's going to be around.  Sometimes he tells me I'm too fat or frumpy, sometimes it's the other way, too sexy or trying to get attention.  Either way, I don't want to get him started.  It's too painful and demeaning.
  • I can go anywhere I want and I always have enough spending money, unlike some of my friends.  But god forbid I disagree with him about anything - politics, where we spend our holidays, what movie or restaurant we go to.
I'd be willing to bet that if you asked the people in the examples above if they are scared of their partner that the answer would be "no."  Maybe that's because when we live in a punitive environment, when our home is a place defined by negative consequences for actions somebody decides are unacceptable, there's no safe place to run to for refuge.  We can't afford to be scared.  We tell ourselves "If I just obey all the rules, I'll be okay."

(Image by Lyn Southworth)