The Federalist just published an anti-science, misogynistic screed on contraception. While this fact is not surprising it is shocking that this piece of propaganda was written by a physician.
The articles makes quick work of belittling women:
I wonder if the women using the #Fight4BirthControl hashtag understand how the contraception mandate works. Or how insurance works. Or birth control itself, for that matter.
I find the unsubstantiated assertion that women might not grasp concepts of insurance or the mechanism of birth control offensive. Does Dr. Duane really mean a large number of American women are too stupid or too lazy or too uninformed to understand how insurance or contraception work?
The article starts off promoting the falsehood that contraception is “embryocidal” so it clear that it is Dr. Duane who needs a lesson in the mechanisms of action of contraception. IUDs create hostile environments for sperm, they don’t prevent implantation. There is no data supporting the concept that birth control prevents implantation.
Dr. Duane argues that eliminating mandatory coverage for birth control mandate is fine because it won’t prevent many women from accessing contraception because most insurers covered contraception before the ACA. What isn’t mentioned is that before the ACA the IUD often had a significant out of pocket cost and so was often unaffordable for many, however post ACA the cost dropped to $0 for most women. We know from the CHOICE study and the Colorado Family Planning Initiative that accessing birth control without financial barriers, especially long acting reversible contraception or LARC, reduces unplanned pregnancies.
Poor women and adolescents will be affected the most when employers start dropping contraception coverage. With the Colorado Family Planning Initiative LARC use increased from 5% to 19% among low-income teenagers and young women (aged 20–24 years) with a 29% decrease in birth rates and a 34% decrease in abortion rates among teenagers. Physicians, like Dr. Duane, will likely be able to continue to afford birth control without insurance but many women will not. The most effective forms of contraception, LARC, will once again be out of the price range for many.
Following Dr. Duane’s line of thinking it should be fine to do away with any treatment if it only affects a relatively small number of poor people. Does Dr. Duane really mean we should stop covering surgery for conjoined twins or choriocarcinoma because they are uncommon? The idea that it is acceptable for a treatment to be unaffordable if it only affects a minority is an anathema to me.
The statement “birth control doesn’t treat reproductive problems well” is false. The World Health Organization (WHO) states “contraception has clear health benefits, since the prevention of unintended pregnancies results in a subsequent decrease in maternal and infant mortality and morbidity.” This is the best kind preventative health care we have. The WHO also states that contraception contributes to “individuals being able to take control over their sexuality, health and reproduction, thus helping them to achieve a satisfying sexual life.” A sexual life seems like a rather important reproductive issue.
The medical benefits of surviving pregnancy and spacing pregnancies not withstanding hormonal contraception has been proven to offer a multitude of other non pregnancy related medical benefits. A review of 18 studies of the levonorgestrel IUD finds it highly effective for treating heavy menstrual bleeding (it reduces menstrual blood loss by 79–97%) and estrogen containing birth control pills reduce menstrual blood loss by 40-50%. Hormonal contraception can also treat acne, hirsutism, polycystic ovarian syndrome, painful periods, menstrual migraines, the pain of endometriosis, and reduce the risk of cancer. None of this data is particularly new so it is astounding to me that it appears to be unknown to Dr. Duane who is an adjunct associate professor at Georgetown.
Dr. Duane mentions she had hair loss on the birth control pill, but she did not follow that up with the likely diagnosis of telogen effluvium. This is a condition where more hair follicles than usual go into a resting state and so there is increased hair loss. The hair follicles recover and so this is temporary. It is seen far more commonly after a pregnancy than with birth control pills. Of course if people have a distressing side effect then the risk benefit ratio may not favor them taking a medication, however, side effects experienced by one person are not reason to deny a therapy to everyone else. I had a disastrous complication with assisted reproduction but that doesn’t mean other people shouldn’t benefit from the technology.
Dr. Duane dismisses women who require hormonal contraception for dysmenorrhea ( severe menstrual cramps) because she tracked her menstrual cycle and was able to time ibuprofen to treat her pain. There is no mention of what women like me with kidney disease can do as we can’t take ibuprofen, or women for whom ibuprofen is ineffective, or those who have irregular cycles, or women who have difficulty tracking their cycles. Doctors should not assume because they, in their position of societal privilege, were able to do something that everyone else can simply follow suit.
Dr. Duane is wrong that the hormonal birth control pill only “suppresses symptoms” although even if they did that would be fine. Treating symptoms is what doctors do. In fact as a chronic pain doctor that is pretty much all I do. If we confined medicine to cures we’d all be sitting around our offices with very little to do as most things are treated not cured.
It’s going to be a real shock for Dr. Duane when someone shows her this article and she finally finds out that hormonal birth control works in exactly the same way as ibuprofen for dysmenorrhea, by reducing prostaglandins. If the birth control pill temporarily suppresses symptoms then so does the ibuprofen.
Dr. Duane also tells us about her asthma attack. She is incensed there is no mandate to cover asthma medications. Why should birth control get priority she asks? Well, every dollar invested in contraception saves $4 in health dollars. By investing in birth control we can afford to cover more asthma medications. Isn’t that great math!?
I believe that therapies for all conditions as well preventative health care should be affordable. My medical condition should not prevent yours from being treated. As for Dr. Duane’s asthma? Well, I have a dead baby from prematurity and I’m not telling women to give up their birth control to divert funds to prematurity research or care. I look at the science and I think what makes the most sense for society? As contraception gives the greatest return on the investment it seems to me to be a no brainer.
I’m an OB/GYN so let me summarize the facts:
Contraception is not abortion.
For women to be equal they must have reproductive health parity with men. They can only achieve this by controlling when and if they get pregnant. To say otherwise is misogyny.
Affordable, accessible contraception reduces unplanned pregnancies, saves money and is the best kind of preventative care.
Hormonal contraception is valid medical care for a variety of medical conditions.
Investing in contraception makes financial sense.
I understand Dr. Duane is a proponent of natural family planning. I welcome all contraception research as women should have choices, however, her claim that there is no science to support birth control as necessary or beneficial for women’s health is false. The benefits of birth control are well-reserached and undeniable. It is no wonder Dr. Duane did not provide any supporting data for her arguments.
Dr. Jen Gunter 
I didn’t know you had kidney disease! I have a kidney transplant myself. I don’t want children which is lucky because I would have had to choose between keeping the kidney or having a child. Contraception is essential for me and in one respect, lets me keep my kidney.
Another reason we really need birth control to be covered on all plans, without a copay: because not all women get to make free financial decisions. Recently I needed it and my Catholic husband disapproved. I agonized for ages on how I could pay for it, given that we have a joint account and if I spent the money, he’d know. If we’d had insurance, I could have just gone and gotten it. Without insurance, even the cheapest pill required me to have a physical, which was $85 even at the cheap clinic — hardly an amount I could easily conceal from my husband, with our budget as tight as it is.
In the end he agreed that, even though he is the one who works, joint money is joint money and he wasn’t going to try to police what I did with it. But not all women are so lucky. Abuse victims need to be able to just walk into their doctors’ offices, ask for birth control, and get it, without worrying about how to pay for it and hide the cost from their abusers.
I’m stunned by this last sentence (which is not to say that I was OK with any of the rest of it!):
‘Why do we “fight for birth control,” but not drugs that allow people to breathe?’
SINCE WHEN are people not fighting for better insurance to cover life-threatening conditions? Has it completely escaped Dr Duane that only a few months ago the Republicans were trying to gut existing health insurance and that the reason they failed was because people across the USA were up in arms about this and actively protesting against it, using, in very many cases, their own examples of how reducing health insurance would disastrously effect them? Surely, by her own beliefs, Dr Duane should have been one of those passionately fighting to stop the damage that the proposed changes would cause? But if she was taking that interest and fighting against the proposed changes, how could she ever be oblivious to all the other people fighting for the same cause?
Dr Duane is “a board-certified family physician” according to her bio in The Federalist: one should not assume expertise in women’s reproductive health issues from her. Judging by her article, one would not get it.
Dr Gunter, on the other hand, has training and experience in the field. I join other commenters in thanking her for sharing it.
FP MDs know “a little about a lot”. THis is a valuable skill. Specialists know “a lot about a little” which is also a valuable skill. The real nuance is to know to when “a little” is enough and “a lot” is too much”. Clearly, Dr Duane needs in this circumstance to defer to the knowledge of the expert as her posted information (I read her website) is impressively incorrect and terribly biased
Basic reproductive health is well within the purview of family medicine. She’s being incompetent on her own ground.
If health insurance shouldn’t cover birth control because a religion objects to it, then health insurance also shouldn’t cover blood transfusions because a religion objects to it. We should not be favoring one religion over another.
I am not an oby/gyn and even I knew all of these things. I think that EITHER she intentionally ignores these facts, which she knows… or she doesn’t know them, which scares the living fuck out of me, if she is allowed access to actual patients.
The Federalist has been closely associated with Opus Dei, the ultraconservative secret Catholic society of which crackpot Catholic Antonin Scalia was a member. This poorly trained doctor is using standard ultra-Catholic talking points. I suspect she is either funded or supported in some way by a Catholic organization, since there are dozens of them and they have centuries of experience in hiding their true agenda and missions. Last year I met a physician, an Ob-Gyn, who was found to be a member of an extremist fundamentalist group and got in some trouble for it. This Duane person should be investigated, as Georgetown receives federal funds and thus is precluded from advocating viewpoints that advance any particular religious agenda. She can go to a Catholic institution for that. Also, she is obviously just a crummy, ill-informed, and poorly trained doc who does not seem to know what her job is in serving the public in an academic institution that receives mucho federal funding.
See my above post for how I feel about this infusion of religious dogma and politics to subvert science… but Georgetown is a Catholic (Jesuit) university which explains her position (from their website: Established in 1789, Georgetown is the nation’s oldest Catholic and Jesuit university. Drawing upon the 450-year-old legacy of Jesuit education, we provide students with a world-class learning experience focused on educating the whole person through exposure to different faiths, cultures and beliefs.)
And in the meantime, this is happening, unfortunately:
http://news.groopspeak.com/texas-house-passes-bill-to-make-women-buy-rape-insurance-2/
What a stupid headline from an alarmist screed. This is not about “rape insurance”, it is about insurance to fund abortions and who pays for it. Rape represents only 1% of all reasons for having an abortion so calling this rape insurance is a grotesque misrepresentation. BTW I am a fan of universal health care and funded abortion being available to every woman who needs one. I just hate this kind of idiotic polarization and politicking around women’s bodies. “Rape insurance.” How preposterous!
What Dr. Duane somehow failed to mention is that she herself has four young children. While we don’t know the circumstances of those births, she is not exactly a walking example of the efficacy of the methods she’s trying to force on the rest of us. Thank your for taking her to task.
This is a sad commentary on the modern political situation which has its roots in Electoral College — designed by the Founding Fathers to increase the voting power of small states and rural voters such that their wishes for government would not be overrun by the “citified” elite. And what this block of voters (aka the red states) wants in regards to this situation is two fold — they want “government out of health care” and they want a return to “Christian Values”…e.g. sex only in the confines of marriage primarily for procreation, the nuclear family etc. Now we could all spend hours discussing the hypocrisy and irrationality of this when it comes to birth control and many other issues (I mean seriously, if you want to end abortion make contraception widely available, free and encourage its use….wanted pregnancies are, with very limited exceptions related to health and genetics, not aborted. Plus, why should I live by the “dictums” of their God if my beliefs are different). Unfortunately, many (well at least some) of these “Red State Voters” are not uneducated and ignorant … they are smart and successful and truly believe and feel the facts justify what they preach despite that science supports the opposite. Its maddening and dangerous and I wish I could see a solution.
I find your characterization of “red state voters” divisive and offensive. Even though you qualified it saying “many (well at least some)” it still came across as a broad and sweeping generalization. Nor do I see why you had to bring up the electoral college. Trump won. Get over it and kindly leave red/blue politics out of the discussion. A whole lot of people who voted for Trump do not support what people like Dr. Duane is saying.
Of course it is a generalization–not all people who live in “Red States” support this level of idiocy . But, Trump won despite not winning the popular vote and his base (fanatically?) supports on principle “govt out of health care” (at least in the sense of ending “ObamaCare” with its contraception mandate) and “family values”. I say “idiocy” because anyone who is fiscally conservative would understand in a heartbeat that ubiquitous contraception saves money (lots and lots of money) and lives and anyone who reads and lives by the Constitution would understand that separation of church and state means that I have the right to not be governed by your religion. And Dr Duane is a tool of this base to justify less access to contraception and more govt regulation based upon Catholic doctrine. So yes Ms Tumbleweed, this post bespeaks of the heart of the problem
I am Canadian and I think universal healthcare is a right not a privilege. I also entirely and completely support full access to all forms of contraceptives and I support choice. My husband agrees with me on this. He is an American and he voted for Trump. He did so because we spend our winters in the USA. We know many American families in what you so disparagingly call the red states. We met families who had good health and doctors they liked up until Obamacare. They voted for Trump because their good health plans were gone and the doctors they liked were gone. The new health plans cost them 4-8 times as much after Obama care and they now had to function with deductibles of $5000 to $20,000 for policies they were paying $1200 and more a month for. These people voted for Trump not out of a fanatic’s belief that they need to control women’s bodies but because Obama care had failed them. My husband voted for Trump not because he liked Trump but because he was convinced Hillary was a crook who bought her Democratic nomination from a corruptible party (all of which which has turned out to be true) and she was unfit for the job. Your election system runs on the electoral college vote system and Hillary knew that when she set her campaign and made decisions to not visit certain states based on the electoral college. Do you honestly think if Trump had won the popular vote and Hillary had won the electoral vote she would have graciously announced “oh of course only the popular vote counts, I concede to Trump.” Of course not! Sit in your little bubble of angry intolerance, whining about how Hillary should have won if you prefer, but I think what you really need is a long drive on limited funds through the fly over states, eating in their restaurants and talking to these “fanatic” red state Americans. Some broader sources for your information is also in order. These people you are dismissing as fanatics are your fellow Americans, not some caricatures, and they deserve respect and consideration from you, not stupid labels because you think everyone who voted for Trump did so only because they are fanatical religious bigots.
Oh Ms Tumbleweed…how you assume things! I did not vote for Hillary, I am a devoted fiscal conservative, I grew up and did all my schooling in a very,very Red state and I am not a super big fan of Obamacare (a good idea and maybe even a good start but it cost way too much in its current iteration for the benefits; however, it did do 2 things that made moral and moral / fiscal sense respectively….eliminate the clause for pre-existing conditions and mandate contraception coverage). The point is that Trump, however you feel about him and whatever you thought about the election, has the support of a base that does not view the issues outlined in this blog post with objectivity. For example, 37% of people in the USA believe in literal creationism (e.g. a literal Adam and Eve and the earth is 10K years old). 37%!!!!! This group of people are concentrated in “Red” states (Gallup poll 2015) and, while I do not have data to support this, most likely voted for Trump (or if you prefer– the Republican candidate). So, how do you explain the scientific rationale of the benefits of access to contraception to this group of people who lens everything thru literal biblical beliefs? I do not know this answer, but the solution is important for a whole variety of issues, especially this one. This is not “liberal elitism”…this is simple, factual, apolitical science. And, I hate to say this, but whether or not your husband and his friends / family believed they did not vote “out of a fanatic’s belief that they need to control women’s bodies “….that is exactly what they ended up doing because that is exactly what the current administration is doing and this appeals greatly to the aforementioned base.
Oh so you give us subtlety and nuance. In case you hadn’t noticed I was protesting your sweeping generalizations about red states. Thank you for clarifying you don’t think all red state people are fanatics. I wouldn’t have guessed it form your previous posts.
There is no such thing as “obama care” . The law is called the Affordable Care Act. Insurance companies raised the rates, not President Obama. If you followed the creation of the law you would know that many of the provisions were put in there by the Republican party which opposed the necessary funding that would have made coverage truly affordable.
“This is a sad commentary on the modern political situation which has its roots in Electoral College — designed by the Founding Fathers to increase the voting power of small states and rural voters such that their wishes for government would not be overrun by the “citified” elite.”
Look, the population of the USA was simply overwhelmingly rural before the 20th century. The Founding Fathers did not worry about the urban population outvoting the rural population because the rural population was about 20 times larger than the urban population in the 18th century.
Click to access table-4.pdf
Their goal was to make sure that small population states (like Rhode Island) wouldn’t have their interests overlooked by the Federal government being controlled by large population states (like Virginia). No one at the time foresaw that agricultural technology was going to change so massively and no longer require so much human labor to produce food.
Which is not to say that the Electoral College hasn’t outlived its purpose, but it’s purpose was not to protect rural voters.
Sort of….it was to protect low population centers (e.g. small states) from, high population centers (large states). The intent was as you describe but the effect was to protect the interests of rural voters as the population of cities expanded….which it has done very effectively especially in modern times
If I wanted to be callous, I’d suggest the author of that screed should have tried lifestyle changes to get to the root of her asthma and stop complaining about access to quick fixes – it worked for me, you see! It would be like suggesting that anti-inflammatories or repeated surgery are the ultimate solution. Of course, I realize that not everyone can actually get rid of their asthma by controlling their allergies better.
I’m also bemused by the author’s apparent claim that NSAIDs address the root cause of the pain. The root of one of my problems is an inherited tendency to get a raging migraine when my estrogen levels fluctuate, such as around ovulation or menstruation. So far, I seem to have eliminated this problem with an extended cycle pill. Why choose the NSAID that does nothing to prevent the estrogen withdrawal if the contraceptive works? The ibuprofen I used to take to knock out any incoming migraines often failed to stop the pain. It was also not that great at reducing the bleeding to an acceptable level, so I also needed a prescription for tranexamic acid to be able to carry on with normal activities (my uterus is fine; there’s a possibility I have a bleeding disorder). I was on two drugs, not doing anything “wrong” in terms of lifestyle, and my symptoms still weren’t adequately controlled. The obvious solution was to try something else, i.e. contraceptives.
Fantastic article. Thank you for speaking out using science and reason.
Good morning!
My partner and I are launching Girl Groove (signup.girlgroove.com) this weekend. As the teaser page says, Girl Groove naughty, saucy, cheeky, sophisticated online magazine + boutique with a curated selection of luxury toys, VR, lingerie, books…A destination for women, men + their partners to discover everything to make intimacy even better…
We are the polar opposite to goop.com woo-woo “health” recommendations. I am a big fan of yours and admire your ‘take no prisoners’ position toward the craziness that Gwyneth recommends.
It would be great if we could republish your blog posts on Girl Groove with appropriate attribution.
It would be great to have you as a regular contributor, but I understand how busy you must be. And, we’re bootstrapped right now and can’t compensate in real dollars. However, we are experienced marketing technologists and know how to drive traffic. We want to give you and medical advice grounded in fact a louder voice.
May we go back into your archive and publish one of your previous posts? We’ll include your name, blog address, social media links.
Sincerely,
Lydia _______________________________________ Lydia Sugarman, CEO http://www.Venntive.com Ph: 917.445.8637
Markets are conversations. Make them yours. Venntive – A Full-Stack Marketing-Sales Solution
Thank you but I am not interested. I do not allow my content to be reposted except in very specific circumstances. Best of luck with your endeavors.
Dr. Gunter–Thanks for taking a firm stand about not reposting your content. That’s how informative blogs get taken over by marketers looking for free content, and then it usually quickly goes south from there.
For women to be equal they must have reproductive health parity with men. They can only achieve this by controlling when and if they get pregnant. To say otherwise is misogyny.
This sentence, why is this sentence so hard for people to grasp! Even women fight this sentence. HOW!
Madeleine Albright had something to say about women like this doctor.
Her organization does not support birth control of any kind other than “rhythm”. Which is lovely for her personally but certainly not an actual effective method of birth control. taken properly, the Pill is effective 98% of the time – the fact that she either don’t know or deny that medical fact makes me wonder how she got your degree. Her sneering insulation that women are too stupid to understand their needs and choices is obnoxious. Her medical emergencies story is confusing. Did she actually have insurance or is she complaining because she couldn’t get free asthma medicine? Seems like good insurance would cover ALL of the drugs and medical care – birth control as well as asthmatic treatments. And lastly, everything she spouts is diametrically opposed to DO NO HARM. She wishes to do a great deal of harm – shame on her.
“Dr. Duane dismisses women who require hormonal contraception for dysmenorrhea ( severe menstrual cramps) because she tracked her menstrual cycle and was able to time ibuprofen to treat her pain.”
Oh my effen God!
I am lucky enough that 9 periods out of 10 I can “pregame” my cramps so that they’re somewhere from barely noticeable to nonexistent. But that 10th one, it either starts in the middle of the night, so I’m not prepared or it just so bad on their own that Ibuprofen won’t cut through the pain.
In either case, I KNOW I’M LUCKY! While suffering through my worst cramps, I always remind myself that the cramps are rarely this bad, never last more than 8 hours and that there are many women who would love to have my easy periods. My step daughter-in-law has horrible periods and needs hormonal birthcontrol just to get her period into the heavy/bad range!
The idea that having an easy period gives women license to think other women are faking their horrendous periods pisses me off! As a “doctor” Duane should be grateful for what she has and should do everything in her power to help women suffer less!
The Federalist is nothing but alt-right propaganda. That this is how they go about achieving “kinder, kuche, kirche” is disgusting.
I think you’ve missed the (hidden) point, Dr. Gunter. Dr. Duane isn’t saying we should stop paying for things which affect the poor, or which are rare. It’s right in her first sentence – we should stop paying for things which trigger her sense of moral outrage. Which, as always in this debate, brings us around to the ultimate question – why should ANYONE’S particular sense of moral outrage outweigh anyone else’s lack of said outrage? Especially when that outrage is rooted in ancient, tribal, misogynistic religious beliefs which are not shared universally, and which are mired in unscientific – no, actually, ANTI-science – thought?
I agree with your comment! It is my opinion that underlying this whole crappy article is a self righteous approach based on the idea that women should not be having sex unless they want to be making a baby anyway. Sex for pleasure, for bonding with your partner, or any other reason than to make a baby is immoral and babies are a natural consequence of sex and an unwanted pregnancy is your (and all womens) punishment for being immoral. When dealing with attitudes like that, there is no debate. It is just really a shame that a personal hang up with women enjoying sex is being allowed to influence her professionally state opinions.
This, I think, is what the entire debate, across the whole country, has always been about. It’s really sad. And unfortunate that it still exists in this day and age.
Very well done. Thank you for such an excellent explanation of what is going on and the links to the other article I found helpful as well. Bravo
The apparent lack of concern for women’s health, but particularly poor women, young women, women of colour, queer women (etc. etc.) is staggering. And this from an academic – that’s just personally offensive!
(Jen Gunter, so sorry to hear of your premmie baby)
I read the first sentence of your post and jumped to read the referenced article. While I do not always 100% agree with your point of view (and that is a good thing), the Federalist article made my blood boil. I am not a Doctor, but I am a women that once used Planned Parenthood and I am a mother of two girls, One with an immune disorder that impacts her life daily. The ability to control their reproduction is critical to management of their lives. The blah blah bull of straw horses of alternate natural management and the callousness and cluelessness of ignoring those without financial or logistical means to procure birth control is just shortsighted and naive. Maybe the writer needs to spend a bit of time with the women who have suffered and continue to suffer because of dismissive attitudes like hers.
It’s sad when a woman is anti woman.
This makes me so angry and sad. It’s unbelievable.