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.