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)