Birth Control “Options”: Just Like Tex-Mex?

Amanda Marcotte

Women seeking a contraceptive method that's effective, reversible, and doesn't require you to fiddle with devices in the middle of a sexual encounter seem to have a myriad of options. But the majority of those options are variations on the Pill.

Recently, a public interest
group with no anti-choice agenda that I’m aware of filed a petition
with the FDA requesting that the contraceptive patch be pulled from the
saying that the
patch’s uneven distribution of hormones that varies from woman to woman
made it too dangerous for use.
Without getting into the debate over whether or not the group, Public
Citizen, successfully made the case in their complaint, I can say that the whole situation
has highlighted a situation in contraception development that I’d
like to call the "Tex-Mex Factor". In Texas, we make cracks about
how the diversity of the cuisine called Tex-Mex is an illusion: it’s
all rice, beans, cheese, meat, tortillas and chilis, and you just call
it different names depending upon how you roll it. That’s fine if you like
those ingredients, but if you don’t like tortillas, for instance,
you won’t find much to eat in Tex-Mex.

Women seeking a contraceptive
method that’s effective, reversible, and doesn’t require you to
fiddle with devices in the middle of a sexual encounter seem to have
a myriad of options: the pill, the patch, shots, implanted devices,
cervical rings. But like with Tex-Mex, it’s all the same thing,
just called different names depending upon how you roll it. All these methods
are variations on the original earth-shaking and still controversial birth control pill.
It’s great if you’re good with hormones, but like a person who wants
Tex-Mex but doesn’t like tortillas, you’re out of luck if hormones
don’t work well with your body (IUDs have filled in the gap for some women, but they are uncomfortable to insert and still
have a bad reputation, despite huge improvements in the technology.)

Most adaptations on the hormone
theme are driven by the question of how to conquer the problem of inconsistent
use, which is no small problem. As a recent Guttmacher report
shows, half of women who
intend to avoid pregnancy put themselves at risk every year through
inconsistent contraception use.

And the pill, for all that it beats the shot and the patch for dosing
women just right, also lends itself to inconsistent use. Taking
a pill every day at the same time can be hard to remember to do, and as the report shows, big life changes that mess up your daily
schedule–moving, a job change, or a personal crisis–makes it even more difficult to keep a consistent dosage routine. The beginning or
end of relationships also present an opportunity for inconsistent
use. When transitioning from "coupled" to "single" in either direction and the frequency of your sexual contact changes, a daily pill can seem like a mismatch for your needs.
I can attest
that when you’re single and not getting laid a whole lot, you begin to wonder why you’re bothering to swallow a pill every day.
If you remember it, you do it for the same reason you get dressed every
day even when you work at home–a combination of optimism and propriety.
(Read the whole report and the PDF as well,
because there are many more reasons for inconsistent use I don’t delve into

So clearly, getting women to
use their contraception more consistently is a major priority.
The fact that drug companies try to address the problem by developing variations on the
pill geared towards giving you less opportunities to
screw it up is a good thing. Still, I can understand why some women who
can’t use hormones get annoyed when faced with this illusion of diversity.
Why can’t we have something that’s like the pill in terms of ease of use
and effectiveness but that works differently than fiddling with hormones?

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The short answer is, not to
be facetious, that we’re lucky to have the pill. We live in
an era of so many earth-shattering inventions that we sometimes forget
you can’t just snap your fingers and get a new one. At the time
of its invention, the birth control pill was, like the vaccine, a godsend invention, and, like the vaccine, it relies on the body’s innate biological tendencies to work (vaccines depend on the immune system’s learning capacities, and the
birth control pill relies on the hormone levels which signal to the body not to

The invention of the birth
control pill was such a unique and momentous event that this pill ended
up earning the moniker of "The Pill." You know, out of all
the pills in the world. Even the Bible rarely gets called The Book, and
needs the clarifying adjective "good." Erectile dysfunction
drugs have contended for the Most Famous Pill Ever throne (I’m detecting
a theme), but still not a one has laid
down a real challenge to dethrone that pill which we call The Pill.
If lightning hasn’t struck again to create a non-hormonal version
of hormonal contraception, should we attribute that to laziness or sexism on the
part of researchers, or the fact that coming up with something
even better might require a lot more knowledge and time than we’ve
had up until this point?

Of course, the entire discussion
around improving women’s ability to control unwanted pregnancy neglects
to include STD protection. This brings up a related question
about how hard it is to improve upon the already marvelous invention
of the humble latex condom. As with the pill, most condom
failure is user error, but unlike with the pill, you can’t fiddle with
dosage schedules in hopes of reducing the opportunities for inconsistent
users to screw it up. Next week’s column will be "all about condoms"
and what sex educators, condom sellers, and activists can do to encourage
people to use them right every time.

Roundups Sexual Health

This Week in Sex: A Reason to Celebrate on Tax Day?

Martha Kempner

Same-sex married couples get a long-awaited policy change (but maybe not a tax break), there’s encouraging news about the development of a male contraceptive method, and the month of April brings some much-needed attention to sexually transmitted diseases.

This Week in Sex is a summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Tax Day 2016: A Reason to Celebrate for Same-Sex Couples

Many in the United States dread this time of year because it means dealing with the Internal Revenue Service (IRS). But there is something to celebrate this time around: 2016 is the first year that every married same-sex couple can file both federal and state taxes together.

After the U.S. Supreme Court ruling striking down part of the Defense of Marriage Act in 2013, the IRS changed its rules to allow legally married same-sex couples to be treated as married for federal tax purposes. While this was a step forward for equality, it actually made tax filing far more complicated for some couples, as NPR explains. Those who lived in a state where same-sex marriage was not recognized would have to file federal taxes as a married couple, but state taxes as individuals. To make matters trickier, state taxes are often based on your federal tax return; some couples had to create mock individual federal returns just to figure out what they owed their state.

This all changed in June 2015, when the Supreme Court ruled in Obergefell v. Hodges that no state can prevent same-sex couples from marrying and all must recognize their unions, effectively legalizing marriage equality nationwide. So this makes Tax Day 2016 the first day that all married couples—regardless of gender—will be treated equally.

While many are celebrating the symbolic victory, some couples may be shocked to find out that they actually owe more taxes as a married couple.

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Another Step Toward Male Contraception

Over the last few decades, researchers have developed numerous ways to prevent pregnancy, from hormonal pills that block ovulation to IUDs that slow the movement of sperm through the reproductive tract. Up until now, male contraception has been limited to one barrier method, condoms, and one permanent one, vasectomies. Now, a new study lends some proof of concept for possible reversible male contraception methods.

As Rewire has reported, one method in development, known as Vasalgel, is intended to be injected into the vas deferens and create a physical barrier preventing sperm from leaving the testicles. Scientists behind Vasalgel say they intend for it to be reversible with another injection. This could be on the market as soon as 2018. But scientists are still looking for other ways to temporarily render males infertile—possibly ones that do not involve an injection into the testicles.

A new study suggests new chances for one such method. University of Virginia researchers are focused on an enzyme known as TSSK2, which helps make sperm motile. They think this enzyme could be the key to a contraceptive method because it is only found in the testicles and only involved in the very last state of sperm production. In theory, this means that blocking this enzyme could produce nonswimming sperm without causing side effects in the rest of the body. They have found a way to mass produce this enzyme in a laboratory, and their next step is to test existing drugs to see if any can bond only to TSSK2 in the testicles without affecting the rest of the body.

Clearly, they are years away from an actual male birth control pill based on this concept. But this is not the only idea for a male birth control pill under development. As Rewire reported last year, other scientists are working with existing drugs to block a protein called calcineurin and have successfully rendered mice infertile by doing so.

While men wait—though it’s still unclear if many are really interested in their own pill—we should all remember that between condoms, pills, patches, rings, and IUDs, there are many methods couple can rely on for preventing pregnancy.

April is STD Awareness Month

With so many months and even weeks dedicated to disease, causes, or remembrances, it can be easy to let them pass unrecognized. But we here at Rewire thought it was important to remind our readers that April is STD Awareness Month, because the epidemic in this country is growing out of control. For the first time in a decade, cases of chlamydia, gonorrhea, and syphilis are all on the rise.

Syphilis—a disease that not long ago, we thought could be eradicated—has increased by 40 percent between 2010 and 2014. While much of this increase is seen in men who have sex with men, rates among women are increasing as well. There has also been an increase in cases of ocular syphilis, which infects the eyes and can cause permanent blindness.

Along with this, we have seen a rise in the rate of congenital syphilis, which occurs when an infected woman passes the bacteria to her infant. As Rewire reported, the rate of congenital syphilis increased 38 percent between 2012 and 2014. Congenital syphilis can cause miscarriage, stillbirth, severe illness in the infant, and even early infant death. There were 438 nationwide cases of congenital syphilis in 2014, which led to 25 stillbirths and eight deaths within 30 days of birth.

Rewire has also been reporting on the possibility of antibiotic-resistant strains of gonorrhea that could turn a once easy-to-treat bacterial infection into a very dangerous disease.

We really do need to be aware of STDs and take steps to prevent them in ourselves and our communities. The CDC has given us all three easy tasks for this month—Talk, Test, Treat. So, for April, let’s talk openly about STDs with our friends, relatives, and partners; get tested if we’ve been exposed to any risk; and of course, seek treatment if necessary.

News Contraception

Two States Could Soon Bolster Birth Control Access

Nicole Knight

Lifting birth control restrictions has been shown to reduce the number of unplanned pregnancies.

Women in California and Washington state could receive up to a year’s supply of birth control at a time under measures advancing in both state legislatures.

Washington’s Democratic-led house on Thursday voted 91 to 6 in favor of HB 2465, which requires private insurers to cover up to a 12-month supply of birth control, while a California bill introduced Wednesday would extend the same coverage. Both HB 2465 and SB 999 cover hormonal pills, patches, and rings approved by the Food and Drug Administration (FDA).

Lifting birth control restrictions has been shown to reduce the number of unplanned pregnancies.

“We all know that birth control is only effective when taken regularly,” Rep. June Robinson (D-Everett), sponsor of the Washington bill, said in a statement. “Studies show that when women need to visit a pharmacy every month or every three months, they are more likely to miss doses.”

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Forty-eight percent of pregnancies in California and Washington were unintended in 2010, while the national rate stands at 51 percent, according to the most recent data from the Guttmacher Institute.

Requiring private insurers in Washington state to cover up to 12 months of contraceptives could prevent up to 26 percent of unintended pregnancies in the state, saving an estimated $4 million over two years, according to a legislative analysis.

A 2011 University of California, San Francisco study of more than 84,000 California women found a 30 percent drop in unplanned pregnancies in women with a yearlong supply of birth control, compared to those with the typical one- to three-month refills most insurers cover.

“Women who are responsibly managing their reproductive health should not risk an unintended pregnancy simply because a prescription ran out,” state Sen. Fran Pavley (D-Calabasas), who introduced the California bill, said in a statement.

Oregon and Washington, D.C., last year required private health-care plans to provide up to 12 months of contraception at a time.

Publicly funded health-care programs in California and Washington already cover a yearlong supply of contraception.

“Passage of SB 999 would provide for all California women the same common-sense access to continuous and effective birth control that is already available to women in publicly funded health programs,” Pavley noted in her statement.

The Washington bill now heads to the state senate, where Republicans hold a narrow majority. The California bill, which is sponsored by the Planned Parenthood Affiliates of California, the California Family Health Council, and NARAL Pro-Choice California, will be heard in committee this spring. Democrats control both chambers in California.


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