Analysis Abortion

Is Better Access to Sex Ed and Contraceptive Methods Behind the Latest Significant Decline in Abortion Rates?

Yvonne Hamby

Does the decline in abortion rates indicate better reproductive health choices and outcomes for women? And if so, how do we continue to build on this success?

The latest Centers for Disease Control and Prevention (CDC) figures indicate not only the lowest current rate of abortion in the United States, but also the largest drop in the rate in 10 years. It will be difficult to determine the precise reason for this trend. As with most public health issues, but especially those that relate to sexual and reproductive health, there are myriad of potential explanations for the decline. The most important questions we need to ask now are: Does the decline in abortion rates indicate better reproductive health choices and outcomes for women? And if so, how do we continue to build on this success?

Researchers have shared several theories behind the decline. Some believe the economic recession has affected reproductive decision-making. A Washington Post report suggests that women are making decisions to continue their pregnancy rather than terminating.

CDC says the decline is due to more effective contraception and increased access and use by women. A study from the journal Fertility and Sterility supports the CDC view with the finding that the use of long-acting contraceptives such as intrauterine devices had tripled between 2002 and 2009, with most of this increase happening within the last two years. These data suggest that our efforts in primary prevention are paying off, which is, to me, perhaps the most hopeful explanation.

It is interesting to note that trends in abortion rates match the current trends in teen pregnancy rates. The teen pregnancy rate and the teen birth rate have declined by more than 40 percent since the early nineties, according to The National Campaign to Prevent Teen and Unplanned Pregnancy. The decline, says National Campaign Chief Program Officer Bill Albert, is due to the “magic combination of less sex and more contraception.”

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There is a way to keep the trend going. Research tells us that information has a protective effect, and information plus the availability of contraception reduces teenage pregnancy, STDs, and abortions. The data leads to some inescapable conclusions: repressed sexual culture equals earlier sex, less ability to refuse sex, more unwanted pregnancies and thus more abortions. Effective sex education programs have been shown to decrease sexual activity and to increase contraceptive use among those already sexually active.

So young people need information, that much is clear. Who do they get it from? John Snow, Inc. has conducted two studies which explored issues and factors associated with choosing birth control methods and unintended pregnancy in two Colorado counties. Two key messages came out of these studies. The first is that young women (and men) want information about making healthy choices if they decide to become sexually active; and secondly their parents and health care providers are their most trusted sources of information. These results are similar to National Campaign findings.

Participants in the JSI study underscored the value of providers. Here is one participant’s comment:

“I think doctors should spend more time talking about birth control. Even if it’s just 15 minutes, like this is what it is, this is what it’s going to do to you, this is what it may cause for you. Because for them, what’s that? What’s five minutes to them for a lifetime to someone else? That right there could change someone’s life. They’re getting paid good money, why don’t they sit there for another 10 minutes? It’s not going to hurt.”

The information imparted during a contraceptive method visit is very important, as it enables women to choose and employ contraception with satisfaction and technical competence. A long-running quality improvement project with Title X Family Planning clinics found that a lack of information is a reason for discontinuing method use, and belief in rumors may be a deterrent to use altogether. The common response in this study was that women would like more information about the method that they are going to use so that they can make sure that it will fit into their lifestyle, among other considerations.

Reducing unintended pregnancies, particularly among adolescents, would improve educational and employment opportunities for women which would, in turn, contribute to improving the status of women, increasing family savings, reducing poverty and spurring economic growth. We have to end our taboo on open, honest conversations about sex because the stakes are too high.

Commentary Contraception

Zika Threat Shows Urgent Need for Better Contraceptive Access

Julie Rabinovitz

As summer approaches and global officials continue to issue warnings about Zika, U.S. federal and state officials can allocate funds and expand insurance coverage to ensure contraceptive access.

Pressure is mounting on Congress to send President Obama a sufficient spending bill to combat the Zika virus’ spread.

The House and Senate recently passed their own measures, both proposing less than the $1.9 billion the president requested. But now they must work out their differences for the sake of our public health. Currently, none of these proposals include funding for Title X, the federal program that provides low-income people with family planning services, birth control, and other preventive reproductive health services. With the potentially life-changing outcomes that can result from contracting Zika, federal and state action is urgently needed to support prevention efforts and increase access to the full range of contraception available nationwide.

There’s no time to waste. More than 600 people in the continental United States, including at least 150 pregnant women, have already been infected with Zika. This month, a New Jersey infant exposed to Zika was born with the birth defect microcephaly, where a baby’s head is smaller than expected. Many more Americans have been affected in Puerto Rico and other U.S. territories. Local transmission is expected to spike as warmer weather approaches and climate conditions become more favorable to the virus’s primary vector, the Aedes aegypti mosquito.

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The Centers for Disease Control and Prevention (CDC) have reported significant evidence showing links between Zika and adverse pregnancy and birth outcomes, including miscarriage, stillbirth, and fetal abnormalities. Brain damage in Zika-infected babies is proving to be far worse than doctors initially thought. Zika has been found to attack lobes of the fetal brain that control thought, vision, and movement. Exposure to Zika was first considered to be a threat for women in the first trimester only, but there is growing concern about the possibility of maternal-fetal transmission throughout pregnancy.

It has also been discovered that men infected with Zika can transmit the virus to their sexual partners through semen, where the virus is stored much longer than in the blood.

As more individuals learn about the potential health risks linked to the virus, many will want and need services and information to help them effectively avoid or postpone pregnancy. Extensive research already shows the public health value and taxpayer savings associated with preventing unintended pregnancy.

Now with Zika, the stakes are even higher.

Congressional leaders must act without delay to pass a comprehensive Zika funding and preparedness package that includes additional resources for Title X to expand access to reliable birth control, related services, and counseling to low-income and uninsured people. Increased funding for these essential services is needed on the ground now, especially in regions expected to be disproportionately affected by the virus. The threat is particularly worrisome in areas that experience the warmer weather that’s conducive to Zika-carrying mosquitoes.

On the state level, elected leaders across the country should require public and commercial health plans to cover all—not just some—FDA-approved birth control. After the passage of the Affordable Care Act (ACA), California was one of the first states to approve a contraceptive-coverage equity law that codified the spirit of the ACA’s contraceptive mandate, also known as the birth control benefit, by requiring health plans to cover all methods of contraception without cost sharing or restrictions. Maryland recently enacted a similar measure that also requires coverage for vasectomies, and several other states are considering legislation with the same intent. The Zika threat makes passage of these kinds of laws across the country time-sensitive. State Medicaid programs must also adopt reimbursement and coverage policies that break down barriers enrollees may face in accessing the full range of effective contraceptive methods.

Patients must be able to get the method they can use safely and consistently. That means health-care professionals across the country, including those in primary-care settings, must offer all forms of available birth control. Providers need training to support their patients in accessing the contraceptive method that is best suited for their health and reproductive life goals. Even some OB-GYNs can use training on newer methods and updated best practices.

Many unknowns remain regarding the Zika virus, which has quickly become one of the world’s greatest public health challenges. But a concerted and proactive response—that includes improved access to contraception—must be implemented before Zika becomes a national public health crisis here in the United States.

Roundups Sexual Health

Sexual Health Roundup: Chlamydia Rates Up, Kindergarten Sex Ed, and Sex for Your Headache

Martha Kempner

A look at how chlamydia rates are up, especially in women, how Chicago Public Schools may start sex education in kindergarten, and why "not tonight, honey, I have a headache" may not be a wise excuse for some.

Chlamydia Rates Up for Women

On Monday, the Centers for Disease Control and Prevention (CDC) released 2011 data on chlamydia rates, and the news is not good, especially for women. The chlamydia rate for women has gone up 51 percent this decade, from 430 cases per 100,000 women in 2001 to 649 cases per 100,000 women in 2011. In some states (Alaska, Louisiana, and Mississippi), the chlamydia rate rose to more than 1,000 per 100,000 women. And even in states with lower chlamydia rates, the rates doubled or more over the last decade. Maine has the lowest chlamydia rate, with 316.8 cases per 100,000 women, but that is more than double its 2001 rate of 157.7 cases per 100,000 women. In New York, chlamydia rates rose even more (82 percent), from 388 cases per 100,000 women in 2001 to 705 cases per 100,000 women in 2011.

These increases are partly due to more widespread screening and better reporting; chlamydia is one of the few sexually-transmitted infections (STIs) that is reportable to the CDC. However, they also reflect a higher incidence of the infection itself.

Chlamydia is a bacterial infection that can be cured with antibiotics. If left untreated, however, it can cause pelvic inflammatory disease, scarring of the fallopian tubes, and infertility. The good news is that research shows latex condoms are highly effective in preventing the spread of chlamydia. The new rates suggest it may be time for some more education on preventing this common infection.  

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Chicago Public Schools May Start Sex Education in Kindergarten

Chicago has the third largest school district in the United States. Currently, students in the city’s public schools start learning about sexuality in the fifth grade, but the school board is reviewing a proposal to start age-appropriate sexuality education in kindergarten. The move is in response to high rates of sexual activity among students as well as high rates of STIs and teen pregnancy in Cook County. 

Chicago Public Schools (CPS) CEO Barbara Byrd-Bennett supports the change, saying in a statement, “It is important that we provide students of all ages with accurate and appropriate information so they can make healthy choices in regards to their social interactions, behaviors, and relationships.”

If the changes go through, students in kindergarten through third grade will learn about their anatomy and appropriate and inappropriate touching and that all living things reproduce. Fourth graders will focus on puberty, HIV, and AIDS. Conversations about human reproduction, contraception, and abstinence will still not take place until after fifth grade.  

According to the local Fox affiliate, some parents are not happy about the change. “I don’t think it’s age appropriate. They have no concept of anything like that at that stage in life,” said one parent. “CPS shouldn’t take control of someone else’s children like that with our sex education. That’s how I feel,” said another.

Like in most school districts, parents will be able to opt out if they do not want their child to participate in sexuality education classes.

Debra Hauser, president of Advocates for Youth, which promotes sexuality education, said in a statement, “Advocates for Youth applauds the Chicago school district for recognizing the importance of providing young people with sequential, age-appropriate, and honest sex education. Thirty years of public health research shows that young people who receive this type of sex education are more likely to delay sexual initiation and to use contraception when they do have sex.”

The school board is set to vote this week. If the plan is approved, it will be go into effect in 2016. 

Yes Honey, Tonight: I Have a Headache

New research from neurologists in Germany suggests that having a headache may actually be a reason to have sex. Researchers sent an anonymous questionnaire to 800 individuals who had suffered from migraines and an additional 200 individuals who suffered from cluster headaches, a type of recurrent headache that is experienced on only one side of the head. They asked participants if they had ever had sex during a headache attack and what the result of that experience was.

The survey revealed that more than one-third of migraine sufferers had had sex during an attack. Of those, nearly two-thirds said they experienced some relief, and some reported complete relief as a result of sex. One-third of the individuals who had sex during a migraine, however, said it made symptoms worse.

Similarly, one-third of individuals suffering from cluster headaches said they had had sex during an attack. Among those, 37 percent said their symptoms improved, but 50 percent said they got worse. 

The researchers concluded that “sexual activity in the presence of headache is not an unusual behavior” and that “sex can abort migraine and cluster headache attacks, and sexual activity is used by some patients as acute headache treatment.”

So the next time you think of using your headache as a reason not to have sex, think again; maybe the sex can help.

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