World Contraception Day

world-contraception-day

Today, September 26th, is World Contraception Day (WCD). Now in its ninth year, WCD envisions a world where every pregnancy is wanted and women are empowered with the resources and knowledge to make informed decisions about their sexual and reproductive health. Part of the larger Family Planning 2020 mission, WCD takes a multi-faceted approach to women’s health, encouraging increased sexual education, improved access to health care services, and eliminating challenges to cultural taboos based on myth or misconception.

As women’s health care providers, this mission aligns with our everyday efforts.  We counsel and educate our patients, helping their personal and professional goals align with their sexual and reproductive choices. Empowering women with choice and control over their contraceptive choices and family planning leads to happy and healthy individuals and families. Continue reading

What APHA’s New Standards Mean to Ob-Gyns

Earlier this month at its Annual Meeting and Exposition, the American Public Health Association (APHA) adopted 18 new policy statements ranging from contraception access to preventing prescription painkiller abuse. Although they go beyond the Pap test and pelvic exam, many of the new standards are directly related to ob-gyns as population health is closely linked to our specialty. It’s important for us to pay attention to these related issues so, I’d like to take a moment to review a few of them here. Please note that these are only some of the women’s health focused policy positions.

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Protecting Women’s Access to Birth Control

Ob-gyns know the critical role contraception plays in preventive care for women. When patients need a prescription for contraception, we expect that they will be able to fill it without hassle. Unfortunately for many women, that isn’t the case. All too often, pharmacists insert their own personal beliefs into the health care equation, refusing to fill prescriptions for birth control or emergency contraception. Continue reading

Yes: Contraceptive Care IS Preventive Care

Dr. Jeanne Conry speaks at the #NotMyBossBusiness rally on the Supreme Court steps on March 25, 2014.

Dr. Jeanne Conry speaks at the #NotMyBossBusiness rally on the Supreme Court steps on March 25.

I had the unique opportunity to stand on the Supreme Court steps this morning and share my experience as an ob-gyn, and the experiences of my patients back home in California, as the Court hears arguments in the Hobby Lobby case. My patients are among the millions of women who need and deserve contraceptive coverage.

I have treated thousands of women in my career and have seen firsthand how birth control and contraceptive counseling have helped them. For some, it helped to avoid an unintended pregnancy. For others, it helped to delay pregnancy until the time was right. For others, it has helped other medical conditions. But they all had one thing in common: Their family planning decisions were personal and their boss was not in the exam room. That is the way it should be, for every woman, every time.

Contraception, like all medical decisions, should be based on an individual woman’s needs and health – and nothing else. Contraceptive care IS preventive care. It enhances health and improves quality of life for women and for their families. By covering contraceptive care, we are making women’s health a priority, and we are investing in FUTURE generations.

Dr. Jeanne Conry with Cecile Richards, President of the Planned Parenthood Federation of America and the Planned Parenthood Action Fund, at the #NotMyBossBusiness rally on March 25, 2014.

Dr. Jeanne Conry with Cecile Richards, President of the Planned Parenthood Federation of America and the Planned Parenthood Action Fund, at the #NotMyBossBusiness rally on March 25.

Access to contraceptive care can make a world of difference to each woman. It improves the health of our nation and helps our health care system work better for all of us. Contraceptive coverage puts birth control within reach for more American women.
I’m proud to lend my voice to this important issue through my remarks this morning at the Supreme Court (#NotMyBossBusiness) and also here:

I’d also like to recognize important contraception and women’s health messages from two of my physician colleagues whose voices made a difference today:

New Contraception Counseling Aid Available for Ob-Gyns

As I said in my presidential address at the Annual Clinical Meeting in May, we need to address reproductive health and well-woman care at every single point of contact that women have in our health care system. If we are going to be successful in reducing the high rates of unplanned pregnancies in this country and all of the related maternal and infant health problems that go along with them, then we really only have one option: We must counsel and encourage all of our patients to use effective contraception.

The good news is that more women will have health insurance as the Affordable Care Act continues its roll-out. And under the ACA, more good news: Women now have access to all FDA-approved contraceptives without a co-pay. Coinciding with this, a new ACOG Committee Opinion in the November Obstetrics & Gynecology endorses the CDC’s US Selected Practice Recommendations for Contraceptive Use, 2013 (US SPR). The US SPR helps ob-gyns and other providers counsel our patients about how to use these contraceptives most effectively. This is a companion piece to the US Medical Eligibility Criteria for Contraceptive Use, 2010 (US MEC) that ACOG endorsed in a 2011 Committee Opinion. The US MEC provides guidance for determining which contraceptives are safe for women who have certain medical conditions.

The US SPR is arranged by contraceptive method and is easy to follow. It addresses a host of common as well as complicated issues related to contraceptive use that both doctors and patients may encounter. For instance, it provides guidance on which specific exams and tests we need to provide before prescribing a particular contraceptive method. It helps us advise our patients about exactly what do when they forget to take their daily birth control pill or are late in returning for their next injectable contraceptive. It also explains how to deal with side effects, such as breakthrough bleeding, and when and for how long to use backup contraception.

I think one of the many important points contained in the US SPR is that any contraceptive method can be started at any time during the menstrual cycle, as long as there is reasonable certainty that a woman is not pregnant.

I encourage you to read through and utilize both the US SPR and the US MEC. An eBook for the US SPR will be available soon. As I said at the ACM: Whether it’s a pill, patch, ring, injection, implant, insertable, or a ligation, we can address reproductive health for what it represents—an investment in our future.

Every Woman, Every Time. It’s up to us.

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ADMs, CME, and You: Just What the Doctor Ordered

I have almost completed the “sweep” of our fall Annual District Meetings. Once again, I’m impressed with the dedication of my ob–gyn colleagues across the United States. These meetings are proving to be educational, collegial, and administrative. I say ”administrative” because we discuss the “goings on” of each region, including the political factors impacting each of our states, the public health dilemmas we face, and the effect of changing practice patterns. I look forward to these information exchanges and to sharing insights with my colleagues about the forces influencing our practices and our patients.

For me, the educational component of the ADMs has been most exciting. In a time when physicians are increasingly getting their CME online, the ADM courses provide more than just the course information. They provide perspective and insight from the experts in the field in real time. At the District I, III, and IV ADM in Puerto Rico, Jeffrey F. Peipert, MD, PhD, argued for a paradigm shift in our approach to contraception in his presentation about the St. Louis CHOICE Project. With wider use of LARC (long-acting reversible contraception), we can significantly reduce our nation’s high rate of unplanned pregnancies and abortions and start to see healthier pregnancies. Dr. Peipert provided abundant pearls about how easy LARC is to provide to our patients and how it can improve reproductive health outcomes. We can all use this valuable information in our practices.

At the same ADM, Louis J. Guillette, PhD, gave a rousing talk about the impact of the environment on reproductive health. As it turns out, we both did research at the University of Colorado at almost the same time and even shared members of our thesis teams. Who would guess that our paths would cross 35 years later around shared interests? Dr. Guillette’s message: Increase awareness among our patients—without alarming them—about the vast amount of research implicating environmental factors on our health. And, Deborah A. Driscoll, MD, helped to simplify for us the complex world of genetic testing and familial cancers. Thanks to her, genomic microarray-based technologies are now part of our vocabulary.

Increasingly, physicians are earning more of their CME online. The reality is we are all crunched for time and online CME opportunities are valuable options. But online courses don’t allow for that in-person learning that is so often accompanied by practice pearls. Nor do they provide an opportunity for us to have personal, individual conversations with our colleagues which are so important. I hope that you’ll make plans to attend your next ADM…it’s definitely worth your time.

Remember, registration for the 2014 Annual Clinical Meeting in Chicago opens November 5, just a few weeks away!

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ACOG and ACA: Investing in Women’s Health

As many of you know, I started my ACOG presidency announcing 2013 as “The Year of the Woman” because for the first time we, as a nation, are investing in women’s health care with the Affordable Care Act. It is an investment in our future when we provide all women with preconception care, prenatal care, and contraception.

I spent last week in Washington, DC, discussing the impact of environmental chemicals on our reproductive health with our elected officials. And what a week it was! I saw firsthand the dedication of the furloughed employees who were trying to help everyone. I heard the frustration of many DC residents as they faced reduced work hours and uncertainty about what the next day or week will bring.

Amidst all of this chaos, the ACA’s health insurance exchanges opened for business. Yes, there are going to be some difficulties along the road with implementing health care reform, but there will be fewer of them when we work together to make health care changes a success.

I was in the hair salon recently and found out that the women working there had no health coverage. I opened my iPad and showed them how to enroll in Covered California. In no time, they logged in, found affordable benefits, and were singing its praises. These are working women who had gone without coverage because they could not afford it and their small businesses did not provide health benefits. All of these women—some young, some single moms—all shared one uncertainty: What would they do if they became sick? They had not even considered getting preventive health care.

We need our government to open for business, we need to work on our health care delivery system, and we need to remind everyone that women are finally getting what we said is essential all along: Screening for cervical and breast cancer, screening for intimate partner violence and depression, contraception coverage, and prenatal care. Worrying about not being able to afford or even get health insurance because of a pre-existing condition can now be a thing of the past. Losing your health insurance coverage during the course of a difficult disease when you need it the most can also be a worry of the past. What a wonderful year!

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A Positive Step Toward Preventing Unplanned Pregnancy

The recent US recession did more than make us simply tighten our belts. It’s made many families think long and hard about contraception and when to have children. Research has shown that more women are delaying pregnancy since the start of the recession.

Tough economic times have also led to an increased need for publicly funded family planning services, especially among poor women, who are more likely to have an unintended pregnancy than women of higher socioeconomic status. Today, the Guttmacher Institute released some encouraging statistics—researchers found that publicly funded family planning efforts led to 2.2 million fewer unplanned pregnancies in the US in 2010. Guttmacher estimated that if not prevented these pregnancies would have resulted in more than 1 million unplanned births and more than 760,000 abortions. Additionally, the study showed that every dollar spent on contraceptive services yields $5.68 in public health care cost savings.

These new data underscore what women’s health professionals have known all along: that publicly funded family planning services provide an invaluable safety net for reproductive-age women. It’s great news to see these programs make a real difference in preventing unplanned pregnancy and its consequences.

ACOG has long supported the expansion of the Title X Family Planning program—the nation’s only family planning program dedicated to serving low-income and uninsured individuals regardless of their ability to pay. We will continue to advocate on behalf of the nearly 9 million women who use publicly funded services to ensure that all women—no matter their income—have access to the reproductive health services they need.

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Time Flies When You’re Having Fun

What a ride this past year has been! As I wind down my time as ACOG president, I’m proud of our accomplishments—we remained a strong and vocal supporter of women’s reproductive rights, made strides in standardization of care and patient safety, and moved forward in communication and technology, including the introduction of the new ACOG app for ob-gyns.

Two main themes during my presidential year have been the essentialness of contraceptive access for all women and the importance of having women in leadership roles. For the “grand finale” of my presidency—the President’s Program on May 6 at ACOG’s Annual Clinical Meeting (ACM) in New Orleans—I’ve assembled a roster of phenomenal speakers that will offer their unique spin on these topics.

I’m happy to welcome Malcolm Potts, MD, chair of population and family planning at the University of California Berkeley’s School of Public Health. Dr. Potts has studied extensively the positive societal changes that come when women can make their own reproductive health choices. In a recent speech, Dr. Potts said “If you’re working in cancer or orthopedics or pediatrics, you make people healthier by trying to relieve pain and suffering. What we’ve done in gynecology is change civilization.” His lecture “Sex, Ideology, and Religion: How Family Planning Frees Women and Changes the World” is one not to be missed.

Next, I’ve invited two exceptional leaders, colleagues, and ACOG vice presidents, Sandra A. Carson, MD, and Barbara S. Levy, MD, to present “Your Personal Path to Leadership: The Road Less Traveled.” They’ll discuss their own not-so-traditional journeys to becoming leaders in our field and the need for diversity in leadership.

Rounding out the program, Gary Chapman, PhD, author of The Five Love Languages, will present his speech “The Five Languages of Apology.” His insightful presentation will discuss the importance of apology in developing, maintaining, and repairing relationships.

Though my year as ACOG president is coming to a close, my involvement will continue. I’m looking forward to supporting our new president, Jeanne A. Conry, MD, PhD, in her endeavors and continuing to be an outspoken advocate for women. I’m also looking forward to more time for family and mountain biking in Nevada! Many thanks to ACOG Fellows and staff for your support and friendship throughout this amazing year.

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Guest Blog: Every Reproductive-Age Woman At Risk, Every Time

Frances Casey, MD

Frances Casey, MD

Full implementation of the Affordable Care Act (ACA) will remove many of the financial barriers women face to obtain effective methods of contraception. While making contraception affordable for every woman is a good first step toward improved prevention of unintended pregnancies, it remains the responsibility of health care providers to counsel women about all methods of contraception and help them find the one that may be the most effective.

The CHOICE project demonstrated that removing financial barriers related to the most effective methods of contraception decreases rates of unintended pregnancy and abortion. But the CHOICE project also did something many of us ob-gyns do not. Every reproductive-age woman eligible for the study was read a script about the effectiveness of long-acting reversible contraceptives (LARC), such as intrauterine devices (IUD) and hormonal implants.Instead of discussing LARC with their patients, many providers continue recommending less effective contraceptive methods based on misconceptions that adolescents, women who have never been pregnant, or women they estimate are at high risk for sexually transmitted infections (STIs) are not good candidates for LARCs. However, according to ACOG, LARC is the most effective form of contraception available and safe for use in all of these groups.

Because LARCs don’t require ongoing effort by the user, continuation and correct usage rates are higher. This could significantly reduce unintended pregnancy among teens and women if widely adopted. Additionally, women at high risk of both STIs and unintended pregnancy can be screened, obtain a LARC method the same day, and receive treatment without removing the device. Women with medical conditions and physical and mental disabilities can also benefit from both the pregnancy prevention and the non-contraceptive benefits of LARC.

Other women may also benefit from a longer-acting option. Without strict breastfeeding, postpartum moms are at risk for ovulation and repeat pregnancies even earlier than six weeks after delivery. LARC methods can be inserted immediately following delivery or at four weeks postpartum. Despite slightly higher expulsion rates, the benefits of immediate postpartum insertion of LARC methods may outweigh risks for women who are unlikely to receive postpartum care.

Minimizing financial barriers will make contraceptive methods more accessible for women at risk of unintended pregnancies, but it is up to us, as their partners in prevention, to counsel them on the most effective methods, including LARCs, at every opportunity.

Frances Casey, MD, is a Family Planning Fellow at Washington Hospital Center in DC.

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