Commentary Contraception

iContraception? Smart Birth Control Should Be As Sexy as Your Smartphone

Kirsten Moore

What if we were as devoted, as critical, as insistent when it came to contraceptive technologies, as we are when it comes to cell phones?

Having recently joined the un”I”verse, I am amazed by the breathless anticipation, the speculation and whispered rumors otherwise known as the run-up to the release of the next generation IPhone.

As a reproductive health advocate, I can’t help wonder: What if we were as devoted, as critical, as insistent when it came to contraceptive technologies, as we are when it comes to cell phones?

Each time a new IPhone is released, reviews and comparisons flood the internet. Is it better than the old version? Does it have enough features? It is the right balance of style and function? Will it do everything I want faster and better than the competition? Consumers and want-to-be consumers chat, Tweet and blog about the features they love, the bugs they hate, and the software or hardware changes they would like to see next time around. Apple pays close attention to this chatter, as do their competitors.

What if every year, Americans pored over academic blogs, FDA approval chatter and leaked corporate press releases for clues about what’s next? What if we, as consumers, demanded new and diverse contraceptive technologies to fit the fast-paced and complex lives we lead? And what if public and private funding sources marshaled the resources to answer that demand with truly innovative products and methods? Okay, maybe birth control isn’t as sexy as a smart phone, but shouldn’t it be? Actually, shouldn’t it be sexier?

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Experts estimate there are 1 million acts of unprotected intercourse every day. That fact may be less of a shock when you learn that most women (71 percent) who use contraception are relying on the rotary dial – methods like birth control pills, tubal sterilization, or male condoms which have been around for 50 years or more. True, newer methods like the birth control patch or ring give women more flexibility by freeing them from the daily task of taking a pill. But when it comes to innovation, contraception seems to have stalled out at the basic flip phone.

Not surprisingly, many consumers are not satisfied with that they’re using. For example, 57 percent of women report being dissatisfied with their pill regimen. Seven percent of women aged 15-44 who are at risk for unintended pregnancy use no method at all. While some women face barriers to access or information, it is equally true that for many women and couples, the right birth control method has yet to be developed.

What else should be on the horizon? Remember when we had digital cameras, phones, and MP3 players crowding our purses? Now we have one multipurpose device that does it all — and fits neatly into the pocket of those skinny jeans. Why not ask for the same from birth control? Multi-purpose prevention technologies would do just that: combining pregnancy prevention with STI or HIV prevention. Like a condom, these innovations would do “double duty” and may come in the form of a vaginal ring, topical cream, or other delivery system.

What about “green” birth control? As more consumers look for ways to limit their ecological footprint, women have begun asking questions about the impact of their birth control method on the environment. A study by the University of California San Francisco has put to rest one myth — that birth control pills are a major contributor to estrogen in waterways. (Good news—they’re not!). Still, more questions remain about the “life cycle” of contraceptives: the energy and materials that go into their production and the waste they create. For some women, an eco-friendly birth control may be just what the doctor ordered.

And of course, men might appreciate having their own Smart Pill. Encouragingly, there are signs that an alternative to the male condom may be inching closer to availability. Moving beyond smartphone devices themselves, there are endlessly customizable combinations of service plans and apps tailored to individual needs, desires, and whims. What if we had that kind of variability for birth control?

Sure, you can get a daily reminder about taking the pill. There’s an app that charts your cycle so you know when you’re most likely to become pregnant if you have unprotected sex. But Consumer Reports has an app that allows you to scan QR tags on appliances and pull up ratings. Imagine if you could do that for birth control methods — walk into a store and get a “read” on different methods — and find out how other consumers have rated it?

Wait, imagine you can walk into a store and get birth control!?! Currently, a woman who wants to purchase birth control over-the-counter can buy male or female condoms or spermicides. These methods provide protection against STIs including HIV, but are less effective at preventing pregnancy than prescription-only methods. Imagine a safe, effective daily birth control pill regimen available on store shelves alongside condoms and cough medicine. What if there was a Sunglass Hut for contraception?

Each of these innovations has promise, and many are in various stages of development right now. But without demand from the marketplace and public and private sector investment, they will not become meaningfully accessible to the women and men who need them.

The opportunities for innovation in products and services are as varied as the women and men who need them. There is no one silver bullet (or pill, or condom) when it comes to contraception: each woman is different and has unique and changing life circumstances. As consumers, we need to talk about what we like, what we don’t like, and what we wish we had when it comes to birth control.

After all, it was the synergy of consumer demand and technological innovation that gave us these incredible little devices. Isn’t it about time we did the same for contraception? Why should our smart phones be sexier than sex?

News Media

Study: Politicians Dominate Nightly News Reports on Birth Control

Nicole Knight Shine

Study co-author Michelle H. Moniz, assistant professor of obstetrics and gynecology at the University of Michigan, noted that news segments largely framed contraception as a political issue, rather than a matter of public health.

When it comes to asking experts to weigh in on birth control, the nation’s three major TV networks favor political figures over doctors, according to a forthcoming paper in the journal Contraception.

Analyzing nightly news segments on contraception on ABC, CBS, and NBC between 2010 to 2014, the authors found that few broadcasts included medical professionals (11 percent) or health researchers (4 percent). Politicians, however, dominated coverage, appearing as sources 40 percent of the time, followed by advocates (25 percent), the general public (25 percent), and Catholic Church leaders (16 percent).

Sixty-nine percent of news segments on birth control included no medical information, the authors found.

Study co-author Michelle H. Moniz, assistant professor of obstetrics and gynecology at the University of Michigan, noted that news segments largely framed contraception as a political issue, rather than a matter of public health.

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“Health professionals are an untapped resource for ensuring that the most up-to-date, scientific information is available to the public watching the news,” Moniz said in an email to Rewire.

An estimated 24 million Americans watch nightly news, making it an “influential information source,” the authors note.

And although nearly half of pregnancies in the United States each year are unplanned, news segments did not emphasize highly effective contraception like IUDs, the researchers found. Instead, emergency contraception, commonly known as the morning-after pill, warranted the most coverage, at 18 percent, followed by the daily oral contraceptive pill, at 16 percent.

The researchers’ analysis of 116 nightly news segments coincided with the rollout of the Affordable Care Act by President Obama and continued through the June 2014 U.S. Supreme Court decision in Burwell v. Hobby Lobby, which carved out the right for private corporations to deny birth control coverage to employees on religious grounds.

“We found that when the network television media covers contraception,” the authors observed, “they do so within a largely political frame and emphasize the controversial aspects of contraception, while paying less attention to health aspects and content experts.”

The paper was authored by five researchers from the University of Michigan, Ann Arbor; the Veterans Affairs Center for Clinical Management and Research in Michigan; and the Pennsylvania Department of Health.

The study builds on earlier work exposing media bias and gender disparities in reproductive health coverage.

In June, an analysis of prime-time news programs on cable networks CNN, Fox News, and MSNBC by media watchdog group Media Matters for America found that 40 percent of guests on all three networks made anti-choice statements or identified as anti-choice, compared with 17 percent of guests who made pro-choice statements or identified as reproductive rights advocates. On Fox, guests made a total of 705 inaccurate statements about abortion care over a 14-month period.

The nightly news study follows a report earlier this year on gender disparities by the Women’s Media Center, a nonprofit advocacy group, indicating that male journalists dominate reproductive health coverage, with bylines on 67 percent of all presidential election stories related to abortion and contraception. Female journalists, in comparison, wrote 37 percent of articles about reproductive issues.

Commentary Sexual Health

Fewer Teens Are Having Sex, But Don’t Pop the Champagne Yet

Martha Kempner

The number of teens having sex may be less important than the number having protected sex. And according to recent data from the Centers for Disease Control and Prevention, condom use is dropping among young people.

Every two years, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC-DASH) surveys high school students to gauge how often they engage in perceived risky behaviors. The national Youth Risk Behavior Surveillance (YRBS) is wide ranging: It asks about violence, guns, alcohol, drugs, seat belts, bicycle safety, and nutrition. It also asks questions about “sexual intercourse” (which it doesn’t define as a specific act) and sexual behaviors.

Started in 1991, this long-running study can provide both a picture of what high school students are doing right now and a historical perspective of how things have changed. But for more than a decade, the story it has told about sexual risk has been the virtually the same. Risk behaviors continually declined between 1991 and 2001, with fewer high school students having sex and more of them using condoms and contraception. But after the first 10 years, there has been little change in youth sexual risk behaviors. And, with each new release of almost unchanging data, I’ve reminded us that no news isn’t necessarily good news.

This year, there is news and it looks good—at least on the surface. The survey showed some significant changes between 2013 and 2015; fewer kids have ever had sex, are currently sexually active, or became sexually active at a young age. More teens are relying on IUDs and implants, which are virtually error-proof in preventing pregnancy.

In 2015, 41 percent of high school students reported ever having had sexual intercourse compared to 47 percent in 2013. The researchers say this is a statistically significant decrease, which adds to the decreases seen since 1991, when 54 percent of teens reported ever having had sexual intercourse.

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Another change is in the percentage of students who had sex for the first time before age 13. In 2015, 4 percent of high school students reported this compared to almost 6 percent in 2013. This is down from a full 10 percent in 1991. As for number of overall partners, that is down as well, with only 12 percent of students reporting four or more partners during their lifetime compared to 15 percent in 2013 and 19 percent in 1991. Finally, the percentage of students who are currently sexually active also decreased significantly between 2013 (34 percent) and 2015 (30 percent).

These are all positive developments. Delaying sex can often help prevent (at least temporarily) the risk of pregnancy or STIs. Having fewer partners, especially fewer concurrent partners, is frequently important for reducing STI risk. And those teens who are not currently having sex are not currently at risk for those things.

While I want to congratulate all teens who took fewer risks this year, I’m not ready to celebrate those statistics alone—because the number of teens having sex is less important to me than the percentage of teens having sex that is protected from both pregnancy and sexually transmitted infections. And that number is lower than it once was.

Among sexually active teens, there were no significant positive changes in measures of safer sex other than an increase in the number of sexually active high school students using the IUD or implant (up to 4 percent from 2 percent in 2013).

Moreover, some results indicate that today’s teens are using less protection than those who were teens a decade ago. The most telling finding might be the percentage of teens who used no method of contraception the last time they had sex. This decreased between 1991 and 2007 (from 17 percent to 12 percent), inched up to 14 percent in 2013, and stayed the same in 2015 (14 percent). There was also little to no change in the percentage of high school students who say that either they or their partner used birth control pills between 2013 (19 percent) and 2015 (18 percent) or those who say they used the contraceptive shot, patch, or ring (5 percent in 2013 and 2015).

For me, however, the most distressing finding is the backward progress we continue to see in condom use. The prevalence of high school students who used a condom at last sex went up from 45 percent in 1991 to 63 percent in 2003. But then it started to drop. In 2015, only 57 percent of sexually active high school students used condoms the last time they had sex, less than in 2013, when 59 percent said they used condoms.

It’s not surprising that teens use condoms less frequently than they did a decade ago. In the 1990s, the HIV epidemic was still front and center, and condoms were heavily promoted as a way to avoid infection. As this threat waned—thanks to treatment advances that now also serve as prevention—discussions of the importance of condoms diminished as well. The rise of abstinence-only-until-marriage programs may have also affected condom use, because these programs often include misinformation suggesting condoms are unreliable at best.

Unfortunately, some of the negative messages about condoms inadvertently came from public health experts themselves, whether they were promoting emergency contraception with ads that said “oops, the condom broke”; encouraging the development of new condoms with articles suggesting that current condoms are no fun; or focusing on teen pregnancy and the use of highly effective contraceptive methods such as long-acting reversible contraceptives (LARC). The end result is that condoms have been undersold to today’s teenagers.

We have to turn these condom trends around, because despite the decreases in sexual activity, young people continue to contract STIs at an alarming rate. In 2014, for example, there were nearly 950,000 reported cases of chlamydia among young people ages 15 to 24. In fact, young people in this age group represented 66 percent of all reported chlamydia cases. Similarly, in 2014, young women ages 15 to 19 had the second-highest rate of gonorrhea infection of any age group (400 cases per 100,000 women in the age group), exceeded only by those 20 to 24 (489 cases per 100,000 women).

While we can be pleased that fewer young people are having sex right now, we can’t fool ourselves into believing that this is enough or that our prevention messages are truly working. We should certainly praise teens for taking fewer risks and use this survey as a reminder that teens can and do make good decisions. But while we’re shaking a young person’s hand, we should be slipping a condom into it. Because someday soon (before high school ends, for more than half of them), that teenager will have sex—and when they do, they need to protect themselves from both pregnancy and STIs.