Down with Traditional Birth Control (from the secular media)

Recently, there have been rumblings in several cultural magazines of female dissatisfaction with available birth control methods.  This sentiment is not all that surprising to me.  During my years in medical school, patient clinic appointments were commonly devoted to women’s concerns about their contraceptive method and their desires to try something different.  But despite all the complaints I heard about condoms and contraceptives behind closed clinic doors, many colleagues and friends (and perhaps even some family members?) looked at me in shocked disbelief when I admitted that my husband and I don’t use hormonal contraceptives or condoms.  So, I was amazed to read Ann Friedman’s piece in the New York Magazine (note: the headlining picture and article may be explicit for some readers) last month.  Friedman openly acknowledged complaints and frustrations that I have heard so many times with patients.  She also offered a no doubt inflammatory admonition: “Though we all want safe, accessible, reliable contraceptive options, the pill is no longer synonymous with sexual liberation.” (NYMag 9/5/13, Ann Friedman)

 

I read with even greater interest Katie Gilbert’s piece in The Atlantic a few weeks ago, proposing Fertility Awareness Methods (FAMs) as a solution to the plaguing hormonal milieu.  She acknowledges that a rare 1 to 3 percent of U.S women use FAMs as their family planning method of choice (which includes all nine of the Builders here).  But, she sites Journal of Family Practice survey suggesting that far more women consider FAM when the methods are fully described.  Ms. Gilbert concludes that FAMs are effective, based on several recent scientific reviews, while acknowledging that they require more detailed training than hormonal contraceptive methods.

 

What I found most interesting were Ms. Gilbert’s assessments regarding the reasons why FAMs have failed to gain wider acceptance.  She cites as a limiting factor the religious, specifically Catholic, ties that people assume about FAMs (given that NFP methods and instructors have been lead the field for so long) and seems to bemoan that secular versions of NFP teaching and support groups don’t really exist.  She also notes that there is a lack of knowledge and information about FAMs among our country’s physicians, as well as a lack of economic motivation for companies to promote it.  Gilbert quotes Mihira Karra, an official with USAID’s office of population and reproductive health:  “With the natural methods, we have clients eager to use them, but our big barriers are sitting at the higher medical levels.”

 

During medical school, I was discouraged that fertility awareness methods weren’t taught in any meaningful way.  This felt especially affronting during my family practice and OB/gyn rotations, when NFP and other FAMs were dismissed as ineffective rhythm methods without any serious explanation.  Within the fields of OB/gyn and Family Practice, providing and promoting contraceptives among women of childbearing age is considered a cornerstone clinician obligation.  Yet, most physicians don’t realize that without a knowledge base rounded out by fertility awareness techniques, the promotion is terribly one-sided and does a disservice to many women.

 

In my opinion, most of the medical community is totally unconvinced that any reasonable, rational, educated women desire natural forms of family planning.  As a training clinician, I never had a patient tell me that she would prefer a non-hormonal method of birth control.   As patient myself, I had to weather the uncomfortable, amazed expression on the face of my OB when I turned down her offer of post-partum contraception.  “No thanks, we’ll use NFP,” I said, shyly.  “So, how about spermicide and condoms?” was her confused reply.  Discussing dissatisfactions or oppositions to hormonal or barrier contraceptives with your physician can be uncomfortable and discouraging.  But in my experience, the vast majority of physicians want to find ways to respond to the preferences and desires of their patients.  So, such discussions are a valuable opportunity to encourage some change or broaden the scope of care that is offered.  We all can play a role in improving this area of health care.   Any other ideas?

  • Kathleen

    This is a great post. I try to encourage my OBGYNs and GPs (some catholic, some not) to learn NFP so they can market themselves to a rather fertile demographic. Let’s face it, Catholics are good for the OBGYN business. Some OBGYNs have scoffed, but others have really taken to heart my explanation of why I don’t want to put myself on Artificial Birth Control. I’ve put one Doctor in touch with Paul the VI institute because she has to help women with fertility issues and obviously, the knowledge you gain from NFP can help navigate those issues.

    I have to admit that one of the reasons one doctor took me so seriously is because NFP was effective when after a serious miscarriage, she asked that I give myself a few months. Perhaps, if I had “messed up” she might not have taken me seriously. Who knows. But I would say that the more moms who speak confidently and intelligently with their Doctors about NFP, the more they might start listening!

    • Queen B

      Awesome that you shared the Paul the VI Institute with a physician, Kathleen. I knew residents who attended during residency and learned a very practical skill set about how to help their patients with all kinds of issues. I hope more programs like that are offered to practicing and training physicians.

  • Juris Mater

    On one hand, it’s extremely encouraging and impressive that women are saying no to polluting their bodies w/contraceptives, realizing that women deserve better. But it’s hard to imagine really practicing FAMs without some spirit/understanding of self-sacrifice that is also required, and I’m not getting the idea that these authors grasp that.

    BTW, our moms were the Pill generation, and we’re the withdrawal generation!? Gross.

    • Queen B

      Agreed, JM. Long term NFP, or any practice of NFP, requires a serious self-sacrificial commitment, which can certainly be a blessing in disguise but doesn’t always feel that way at the time.

  • http://www.buildingcathedrals.com/ Kellie

    I agree that women need to be educated and able to discuss FAM with their OB’s. It shouldn’t be our job to teach our doctor, but sadly that is often the case. The more women can speak intelligently on these issues, the more likely doctors will learn about FAMs and be able to advise us.

    Second, I have often talked to my doctors about why they advocate pharmaceuticals over more natural methods. We are a society obsessed with organic food, but we give women hormones on a daily basis to alter their body’s natural cycles? That makes absolutely no sense. I bring this up pretty regularly, and hammer the point when they ask me about what contraceptive method I am using (and often roll their eyes when I say NFP).

    Finally, I think we should reward good doctors with positive word of mouth and also our business. If you have an OB that rolls their eyes at you when you say NFP, or knows nothing about NFP and isn’t willing to admit that it works, go elsewhere. I realize sometimes geography and insurance make this impossible, but sometimes not switching is just the result of us being lazy (myself included here!). We need to give our business to doctors who are open minded and honest about women’s health.

    From a Church Leadership standpoint, I think all Bishops should have a Catholic Medical Society in their diocese, and EVERY Catholic OB (and those delivering at Catholic hospitals) should be required to meet with the Bishop and take a basic NFP course for doctors. It is inexcusable that our Bishops are not doing a better job ensuring that Catholic OB’s are aware of Church teaching and doing their job to protect women. And if a diocese doesn’t have any Catholic OB’s the Bishop should recruit one! The Bishops have done very little to demand that trained professionals help in this area. Instead, this is largely a lay movement, with great people involved, but very little practical guidance from Church leadership.

    I also think all couples getting married in the Church should be required to take an NFP class.

    • Queen B

      Kellie,
      True that physicians need more encouragement and reinforcement to offer NFP services. I have known physicians with NFP-only practices that have had to give up the OB part of their practice because they didn’t have enough patients interested in their NFP-only OB services. OB insurance is excruciatingly expensive, and if doctors don’t have enough OB patients to cover the costs of the insurance, they will abandon that part of their practice for areas that actually do cover costs.

  • Sarah Johnson

    Great post and questions! I happen to be involved with an effort to bring prolife healthcare to our area. The national Gianna center (http://www.saintpetershcs.com/GiannaCenter/) is trying to establish new and connect many existing NFP only or pro life practices around the country. They primarily focus on creighton model and napro technology, but support all kinds of NFP. There are many reasons why this is exciting, but here are three relevant to this thread:
    - the “Gianna center” will be a national brand, so once they get bigger and in more places you will more easily be able to find supportive healthcare by one name. And the name too is not too obviously religious (though it is named for St. Gianna Beretta Molla). Based on their success rates, I think that they will attract a wider secular audience too if a couple is struggling to conceive or cannot afford other methods.
    - The first center is part of a pretty powerful hospital in NJ, and they are now going to start pushing insurers to cover the way they do their procedures. Once insurers figure out that these methods are cheaper in the short and long term, it will be another force pushing for change!
    - These centers would be able to offer rotations to doctors who have moral issues with contraception and IVF who struggle to find supportive environments in medical school.

    • Queen B

      Sarah, this is so exciting, and will be a welcome opportunity for physicians. The Pope Paul VI Institute in Omaha offers courses to for residents that are able to get away for a few weeks, but I wasn’t aware of the Gianna Center’s wider work in this area. Exciting!

    • Mary Alice

      I see the doctor at the Gianna Center! I got great help there for post partum depression and related mood disorders, which is another women’s hormonal issue that traditional OBs do not do a great job understanding or explaining. I highly recommend it.

  • Bethany

    Queen B, I love having your insider perspective on what it’s like to be a pro-FAM, pro-life practitioner. It gives me hope to hear about women who are unhappy with current methods of contraception. I have had many friends and family members switch off hormonal birth control in pursuit of more natural/organic options. They were tired of their bodies/emotions feeling so out of whack due to artificial hormones! Now to find doctors who will support their choices and give them appropriate alternatives!! I have been so grateful to find a Catholic OB who goes to my church and supports our family planning choices. I just wish more women had the trust of their OB and could avoid the eye rolls/scrutiny when admitting to using FAM methods.

  • Jennifer

    So true! And so nice to hear this from a doctor! Up until my second pregnancy, I went to an OB that rolled her eyes whenever she asked if I wanted a prescription for the pill and I said that we use NFP. It used to drive me crazy. I switched practices when I got pregnant with my second (mainly because of location) and by chance my new OB is Catholic and when he asked about contraceptives and I said we use NFP, he said that is what he and his wife did! It was such a relief not to have to argue about contraceptives with my doctor.
    As some people have mentioned, this also makes a difference when someone is trying to get pregnant. We struggled to get pregnant both times, even though we knew my cycles well. My first OB was not interested in looking at my charts and not able to offer anything other than a referral to a fertility doctor that would want to start right in with things like IUI and IVF. That is not a path we are willing to go down. I’ve talked to my new OB about this and he seems a lot more interesting in determining if there more natural tweaks that can/should be made when we try for #3.

  • Becky M

    You guys might try the relatively new FEMM institute, which is marketing FAM in a totally secular way. I think they’ve opened a clinic at Ohio State University. The method they’re teaching is based on Billings, but without the “stigma” of Catholicism to go with it. FAM is just plain good healthcare for women. Here’s the link: http://femmhealth.org/

    • Queen B

      Great recommendation, Becky. Thanks for sharing, as I had not heard of FEMM.


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