This article originally appeared in The Pacific Standard on Feb. 28, 2014.
By Jessica Kiley
If you take the control of birth control away from the legislators and the United States Supreme Court, diminish the politically charged conversations on women’s health, and put in perspective sensational stories on contraception complications, what remains is the common sense fact that birth control is a good thing.
Recently, a federal appeals court refused to allow the University of Notre Dame to deny insurance coverage for contraceptives to its students and employees. Claiming it countered the notion of religious freedom, a large retailer for airplane model kits and silk flowers filed a Supreme Court brief seeking exemption from the contraception mandate from the Department of Health and Human Services included in the Affordable Care Act. Hobby Lobby Stores, Inc. does not want employees in its 500 stores nationwide to have free access to 20 contraceptive options. And Catholic institutions such as The Little Sisters of the Poor Home for The Aged have also objected to the mandate and will have their day in court.
But none of these legal moves addresses the well-being of all women who want to maintain control of their reproductive health and experience the benefits of the good side effects of birth control.
Women who have planned pregnancies receive more prenatal care, and they have healthier pregnancies and healthier babies. Birth control allows women to achieve education and career goals, benefiting their families and society.
As 2014 marks the 20th anniversary of the United Nations’ International Conference on Population and Development (the famous “Cairo conference”), it is time for America to lead by example with the best access to information on contraception for women. Too often, media attention turns to politics and the uncommon complications associated with birth-control medications or devices, including a recent story on Essure, a call out from lawyers to prompt litigation on users of Yaz, and a release from the United Kingdom’s National Health Services about birth-control pills and blood clots.
These scare tactics are dangerous.
As a practicing obstetrician-gynecologist, I worry about the women who read these stories and shy away from using much-needed contraception. For more than 10 years I’ve taken care of women who safely use birth control.
These women have not only enjoyed protection from unplanned pregnancy, but they’ve also had the added benefit of something you rarely hear about—non-contraceptive benefits. These benefits are the “good side effects,” which occur much more frequently than the bad ones that commonly make headlines.
A recent report from the Guttmacher Institute shows that abortion rates are the lowest in the United States since 1973. One contributing factor might be better access to birth control.
Pills are the most popular contraceptive in the United States, chosen by 27.5 percent of women who use some form of birth control. Oral contraceptives help regulate menstrual periods; women on standard birth-control pills have predictable periods every 28 days. The positive side effects are lighter periods as well as less cramping and pain during menses.
Oral contraceptives are also commonly prescribed, specifically for relief of endometriosis and in controlling premenstrual dysphoric disorder. In addition, oral contraceptives have positive effects on skin and are effective for the treatment of acne.
Benefits are also seen in cancer prevention; women using birth-control pills are at lower risk of developing cancers of the ovaries and endometrium. Since they are made of similar hormones and work much like birth-control pills, contraceptive rings and patches are believed to deliver similar benefits.
More long-term contraception includes intrauterine devices, or IUDs, highly effective contraceptives that can last either five or 10 years, depending on the type. The five-year type, called the levonorgestrel intrauterine system (PDF), contains a hormone medication called a progestin, which is secreted directly into the uterus. Similar to birth-control pills, this system provides relief of symptoms related to uterine fibroids and endometriosis. It can be a component of hormone replacement therapy for menopausal women.
Estrogen therapy in these women controls hot flushes, and the levonorgestrel IUD protects the uterus from overgrowing and possibly risking cancer. Furthermore, in certain women with pre-cancers or cancers of the endometrium, the levonorgestrel IUD is an option for treatment of these conditions, and it is likely as effective as the standard oral medications used for decades.
The 10-year IUD contains a copper coil and no hormones. The lack of hormones alone is a major benefit to many women, who simply prefer an effective, hormone-free birth-control option. Interestingly, some research shows that the copper IUD is associated with lower rates of endometrial cancer.
Other birth-control methods containing progestins, such as the three-month shot and the three-year implant, also cause decreased menstrual bleeding. Women using the shot are very likely to stop having periods, a side effect they typically enjoy.
Critics will try to emphasize the severity of the bad outcomes, such as blood clots on pills or ring, or they may bring up bad events from decades ago, like pelvic infections with old IUDs no longer marketed. While this information is important, it should not guide the headlines or the discussions. Rare is rare, and history is history.
Non-contraceptive health benefits are clearly recognized by professional societies, such as the American Congress of Obstetricians and Gynecologists and the American Society for Reproductive Medicine, and these benefits must be threaded into our public conversations.
On a societal level, contraceptives need to be readily available for that primary reason—contraception. But we spend a lot of time talking about sensationally adverse events that don’t happen to most women. And we spend a lot of time listening to political debate about reproductive rights.
In turn, women may view contraception as optional, or they may choose to not use birth control out of fear. Knowing that most adverse events are rare, we must focus on the positives—first, family planning is good for women and families, and second, birth-control methods provide many added benefits.
Knowledge is power, and in this case, knowledge is also good health.
- Jessica Kiley is an assistant professor of obstetrics and gynecology at Northwestern University.