Green Birth Control?? What About Green Hamburgers?

Jennifer Rogers

Green seems to be the color on everyone’s mind, and lately that has come to include birth control. A green contraceptive is something we should work toward but it won’t prevent the growing number of gender bending fish in our waterways.

Green seems to be the color on everyone’s mind, and lately that has come to include birth control. A green contraceptive is something we should work toward but it won’t prevent the growing number of gender bending fish in our waterways.

Synthetic estrogen used in oral contraceptives contributes only 1% to the total amount of estrogens excreted by humans.  Additionally, almost half of this synthetic estrogen is filtered out during our wastewater treatment processes. Of all the estrogen sent into our water supply through human biology, only a very minute fraction is synthetic. Clearly, there are other sources contributing to gender confusion in fish.

If we really care about our environment and our water supply, I’d like to suggest an alternative culprit: hamburgers. It turns out cows, chickens and pigs contribute an estimated 90% of estrogens to the environment. Yes, 90%. So if we really want to green our water supply, we need to start by greening our dinner. How? Well, first we’d stop pumping our livestock full of hormones or, at the very least, we would treat agriculture manure. Studies have shown that hormones from animal manure reach both surface and ground water and that livestock pumped full of hormones increase their excretion of these hormones up to six fold.[1]

If we are going to be concerned about synthetic human estrogen in our water, we also need to pay attention to other likely culprits, and both industrial and agricultural sources need to be considered.

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I find it troubling that we have dramatized the contribution of estrogens in our environment to women on the pill. I’m not suggesting we should ignore the impact of estrogens in our environment. In fact, quite the opposite. Clearly, the types and sources of estrogens in the environment are diverse and cumulative. Natural estrogens (agriculture and natural human excretion) as well as synthetic estrogens and estrogen-mimicking compounds (other pharmaceutical uses, industrial chemicals, pesticides, plastics, etc) are present in our waterways and cannot be discounted as sources of the observed phenomena in fish, even at trace levels. What I am suggesting is that we stop the knee-jerk response that reducing estrogens is as simple as reducing women’s use of birth control pills. It is estimated that unregulated agricultural run off annually contributes 13 tons of hormones to our water sources. Clearly, we need to broaden the conversation.

What else can we do? First, we need to reform our chemical policy in the United States so that harmful estrogen-mimicking compounds found in our everyday products stay off the shelves. The burden cannot and should not be on individuals and communities to protect the health of their families. Instead, we need reform that requires pre-market safety testing of all our consumer goods and personal care products. Second, as the 50th anniversary of the pill is on the horizon, I’d like to ask my friends and allies to take some time to appreciate and even celebrate contraception. Modern contraception enables women to choose the number and timing of their children, which is central to our health and economic well-being. And, where all women have access to affordable contraception, birthrates decline and population growth slows. Slower population growth is not a panacea for today’s environmental problems, but it can ease pressure on natural systems that are reeling from stress. So, contraception is good for women—and for the planet.

In the meantime, we might think about forgoing that next hormone-riddled bacon cheeseburger. 

References: Callantine MR, et al. "Fecal elimination of estrogens by cattle treated with diethylstilbestrol and hexestrol." Am J Vet Res. (1961) 22:462-465.

Commentary Maternity and Birthing

What My First Pregnancy Taught Me About Birth Justice

Ruth Jeannoel

The medical community needs to do more to support women of color, particularly Black women, who must confront a number of hurdles in order to have a vaginal birth after cesarean.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

After discovering I was pregnant for a second time, I had concerns that my previous cesarean section would keep me from having a vaginal birth. But what I learned after speaking with medical professionals and reading up on vaginal birth after cesarean (VBAC) is that it is possible, with the appropriate resources. I also came to realize that the medical community needs to do more to support women of color, particularly Black women, who must confront a number of hurdles in order to have a VBAC.

All across the country there has been an injection of #BlackLivesMatter in our decades-long Black liberation movement, and reproductive justice, including birth justice, is a critical part of those efforts. Birth justice includes making sure Black moms have full control of their own health and birth process through proper childbirth education and community resources.

It was around 9:30 p.m. on October 22, 2008, when I began to have contractions and I went to the hospital. I was about 32 weeks into my first pregnancy, which was well before my “safe period” of 37 weeks, which in 2008 was described as the stage when the fetus has fully developed. (The “safe period” has since changed to 39 weeks.) Within six hours of labor I developed preeclampsia, which is a pregnancy condition affecting as many as 8 percent of all pregnancies and can be deadly for Black women.

At about 10:30 p.m., the doctors explained I would need an emergency cesarean or else I could lose the little one I had been carrying.

I was scared: At the age of 21, I had to have major surgery.

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The nurses quickly changed my gown, gave me an epidural, and moved me from my hospital room to surgery. I kept thinking about how I didn’t want any of this, because I wanted to give birth naturally and without any pain relief medication, but it sounded so urgent. It sounded like I needed to really have a cesarean for both my safety and the health of my baby. And so on October 22 at 11:59 p.m. I had a c-section.

C-section rates are declining in the United States, but Black women continue to have them more frequently than their white counterparts. According to 2014 data from the Centers for Disease Control and Prevention, the cesarean delivery rate “declined for non-Hispanic white women for the fifth consecutive year, down 2% from 32.0% in 2013 to 31.4% in 2014 and 4% from the 2009 peak. Rates declined 1% for both non-Hispanic black (from 35.8% to 35.6%) and Hispanic women (32.3% to 31.9%). For the second year in a row, non-Hispanic white women had the lowest cesarean delivery rate; non-Hispanic black women continued to have the highest rate.”

Throughout my pregnancy I saw a midwife at a birth center, who ultimately was not with me when I developed preeclampsia and had to go under the knife. I felt disempowered because everything happened so fast and it seemed as if all of the decisions were made for me.

After the surgery, my family and close friends were glad that the baby and I were both safe. But beneath their concern for our safety I could see there was an underlying stigma around having a cesarean birth. Even though the c-section was not planned, I would get looked down on as if I wasn’t “woman enough” because I didn’t have a vaginal birth. I felt ashamed and didn’t know how to share my birth story because in a way I had lost decision-making control over it. I was unprepared to deal with the stigma that was attached with having a c-section.

A couple years after having my first child, I began to have a different understanding of what reproductive justice is and began to reflect more on what it would look like in my own life. SisterSong Women of Color Reproductive Justice Collective describes reproductive justice as, “the human right to have children, not have children, and parent the children we have in safe and healthy environments.”

During that period between my two pregnancies, after having more conversations with other mothers and hearing different birth stories, I began to understand that what I was attempting to deal with wasn’t about vaginal birth vs. cesarean birth; it was about women having the bodily autonomy to make their own decisions. I told myself that if I ever got pregnant again, I would make sure that I had all the necessary information to ultimately decide how my birth went: I would do everything in my power to have a vaginal birth. For example, had I known in advance that I may be susceptible to preeclampsia, I would have looked into methods to lower the risks of complications.

While telling everyone who asked (or didn’t) that I would have a vaginal birth, I ran into several myths. The main one was that you can’t have a vaginal birth after c-section. It just didn’t make sense to me because I knew that birthing was a natural process, meaning that I needed to trust my body and know that every pregnancy was different and that my body could handle a vaginal birth.

At that point I had a lot more questions than answers.

I began reading and asking my OB-GYN about vaginal births and she described the risks and benefits of having a VBAC and emphasized that it was very possible. And she, of course, was right.

As research from the National Institutes of Health explains, “VBAC is a reasonable and safe choice for the majority of women with prior cesarean.” The American College of Obstetricians & Gynecologists (ACOG) agrees, adding that “most” women with one prior cesarean and “some” women with two prior cesareans are candidates for VBAC.

The main problem a woman seeking to have a VBAC might encounter, I found during my research, was a potential uterine rupture. However, a report published in the Obstetrics & Gynecology medical journal found:

Despite increased rates of VBAC attempt and VBAC failure among black women as compared with other racial groups, black women are significantly less likely to experience a uterine rupture. It is unclear whether this discrepancy in magnitudes of risks and benefits across race associated with VBAC trials is attributable to selection bias or inherent racial differences.

My research helped me to better understand that the risks associated with a VBAC weren’t as high as I thought.

When I found out that I was pregnant five years later, I moved forward with my plan to have a VBAC. By that time I had moved to another state, and VBACs were not as common or accessible in Florida as they were in Massachusetts.

I quickly learned that not every OB-GYN I encountered performs VBACs. In South Florida, I had only three doctors to choose from. With help from my doula, I was able to find the right one and a hospital where VBAC was an option.

Unfortunately, in Black communities, not everyone may have access to doctors who do VBAC. Because of the higher risk of uterine rupture, many hospitals, especially in low-income communities of color, are not able to make this accommodation. Also, I found that doctors often do not promote VBACs; therefore, many women who may want to have one may not know that such an option exists.

In 2014, at 37 weeks, I was able to have a successful VBAC and give birth to my second born. I was proud of myself that I was able to have a vaginal birth under my own terms in a hospital room with an amazing team of doctors.

It’s important to dispel the myth that you can’t have a vaginal birth after a previous c-section. Doctors and the medical community have a responsibility to make sure that all women have the appropriate information to make an informed decision over their body. It will always be a woman’s right to choose how she wants to have her child, and where she wants to have her child if her local hospital doesn’t offer the services she requires.

Analysis Law and Policy

Will the Supreme Court Listen to Students About What the Birth Control Benefit Means to Them?

Jessica Mason Pieklo

A brief filed on behalf of individuals affected by efforts to block the contraception benefit in the Affordable Care Act details what's at stake should the Supreme Court rule against the Obama administration's religious accommodation.

The case against the Affordable Care Act’s (ACA) birth control benefit, Zubik v. Burwellis the fourth challenge to the ACA the Supreme Court has heard so far. But for the first time, individuals who depend on the insurance protections in conservatives’ cross-hairs will be able to have their stories heard by the Court directly, during oral arguments in late March. Their testimonies make it clear that stripping the benefit would make accessing care even more precarious—especially for students who become pregnant and find themselves without any accommodations at their institutions.

Zubik is actually a group of cases, each challenging the accommodation available for those religiously affiliated employers who want to opt out of providing their workers insurance coverage for birth control.

Americans United for the Separation of Church and State (AU), a nonprofit legal advocacy organization, successfully intervened as a third party in the contraception challenges on behalf of a University of Notre Dame student in January 2014. The organization recently filed a brief to the Roberts Court on behalf of 240 students, faculty, and staff at religiously affiliated universities—the first of its kind to cite the personal stories of those whose benefits are in danger.

“The voices of affected women have been conspicuously absent from most of the lawsuits seeking to block contraceptive coverage,” said AU’s Senior Litigation Counsel Gregory M. Lipper in a statement following the filing of the brief. “As our brief makes clear, women will suffer concrete and profound harms if religious objectors succeed in blocking their access to vital healthcare.”

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The religiously affiliated institutions challenging the contraception benefit argue that the task of filling out the form to opt out of providing coverage themselves “triggers” or “facilitates” the ability of their employees to get coverage elsewhere. This self-certification process, they claim, makes them “complicit” in the “sin” of facilitating contraception access, in violation of their religious beliefs. But according to the attorneys representing affected students and faculty, the plaintiffs are really arguing for the Court to rule that their religious rights trump the nondiscrimination guarantee built into the contraception benefit.

In other words, the plaintiffs are looking for the Court to grant them the right to exercise their religious beliefs in such a way as to actively and directly harm the rights of third parties like the students, faculty, and employees represented in the amicus brief.

“Whatever views petitioners or others may hold about contraception, they have no right to veto the government’s provision of benefits and thereby to strip these students, faculty, and staff of access to coverage for critical preventive care,” the brief states. “This Court has never before recognized a free-exercise right, under RFRA or otherwise, to so thoroughly undermine the rights of third parties. It should not do so now.”

The brief details the specific challenges already faced by students, employees, and faculty members at religiously affiliated institutions in accessing contraception coverage without discrimination and explains how a ruling against the contraception accommodation would exacerbate those challenges. This is especially true, it says, for students who face unplanned pregnancies. Insurance coverage for abortion services is almost nonexistent. But for those students who decide to continue their pregnancies, the brief says, religious institutions have a long history of refusing to accommodate single, pregnant students.

“Although Title IX of the Education Amendments of 1972 … protects access to educational opportunities for women who are pregnant or have children, compliance is uneven,” the brief states. “Schools often allow professors to set policies for their classes; and some professors refuse to accommodate students who miss deadlines because of pregnancy-related absences.”

“Universities may compound these problems by failing to offer health services and suitable housing for students who are pregnant or have children.”

The brief continues:

And in the last three years, the U.S. Department of Education’s Office for Civil Rights has resolved complaints alleging that colleges have denied pregnant students financial aid, required pregnant students to restart their degree programs after returning from maternity leave, and forced pregnant students to resign or face expulsion.

The combined effect of reduced access to contraception and noncompliance with Title IX’s protections may be especially severe for women at religiously affiliated colleges and universities. That is because Title IX exempts from its requirements “any educational institution which is controlled by a religious organization if the [requirements’] application * * * would not be consistent with the religious tenets of such organization.”

Eligible institutions have received waivers allowing them to expel unmarried students who become pregnant.

That’s right. As AU’s brief makes clear, religious institutions are arguing for the right to deny contraception access to all students, then kick the unmarried ones out of school should they become pregnant.

That’s why AU’s brief and intervention in these cases on behalf of affected students, employees, and faculty is so important. Reproductive rights jurisprudence is dripping with examples of attorneys and judges speaking for patients rather than to patients. Like the personal abortion stories shared in amicus briefs with the Supreme Court in Whole Woman’s Health v. Hellerstedt, hearing directly from those with the most to lose in these cases pushes against hyper-intellectualized narratives that leave real people out of the conversation. Federal judges—almost always men—agonize in opinions about the “difficult choices” women face in terminating a pregnancy. They wax poetic about nonexistent “abortion regret syndrome” and invoke the loftiest of rhetoric to explain why the courts and conservative lawmakers are better equipped to make reproductive health-care choices than women, who just can’t be trusted to negotiate these questions on their own.

Religious conservatives have tried to copy-and-paste those examples from abortion rights cases into the contraception challenges. Instead of pearl-clutching over “potential fetal life,” the religious objectors in these cases are stoking fears of the Obama administration forcing birth control on nuns. But as AU’s brief makes clear, in both the abortion and contraception cases, it really does boil down to the question of trusting women to make medical decisions that are best for them.

“In short, even a single unintended pregnancy may hinder or derail a woman’s opportunity to get an education, advance professionally, and have a career,” the brief states. “While many women will decide to make those sacrifices, contraceptive coverage enables them to decide for themselves whether and when to take on the added burdens.”

But like the never-ending conservative war on abortion rights, the contraception challenges make clear that conservatives will never trust women, as AU puts it, “to decide for themselves whether and when to take on the added burdens” of an unplanned pregnancy. If they did, these institutions would support pregnant and parenting students.

“By allowing women to control the timing and frequency of their pregnancies, reliable contraception has revolutionized women’s ability to make long-term plans about school, work, and marriage, allowing them to achieve personal, educational, and professional goals,” AU’s brief notes.

This truth—that reliable contraception makes women independent of our patriarchal institutions—is at the crux of conservatives’ fears and at the heart of their legal challenges to the ACA.