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Saturday, April 06, 2013

Plan A: Pay Attention

Headlines of news on the Reproductive Justice front screamed across two continents yesterday, which was enough to rouse my brain to full attention, foggy as it was with medications helping me recover from this bout of bronchial pneumonia.

There are actually three bits of news I've been considering.

The first news item is that the Bill & Melinda Gates Foundation is putting up $100,000 to the best proposal for a more fun and pleasurable condom. The competition is part of its Grand Exploration Challenges, which has already doled out nearly $50 million for quirky but effective solutions to global health problems, like microwaves to treat malaria and an electronic nose to detect tuberculosis.

Okay, before you dismiss this as very rich people having way too much fun with money, let me rush to point out one thing about about condoms: They're cheap, discreet and can actually help prevent sexually transmitted diseases, including HIV, as well as pregnancy.

They've been used effectively for centuries. The problem is that they are not used consistently because men say they interrupt the pleasure of sex. ("Like taking a shower with your clothes on." Or, so I've heard.). So the Gates Foundation is calling for new shapes, materials and packaging that "significantly preserve or enhance pleasure, in order to improve uptake and regular use."

I'm actually quite taken by the Origami Condom. Shaped like miniature accordions, the company's website claims that "these silicone rubbers fit loosely and aim to simulate the feeling of sex without a condom".

They also boast a 2.8 seconds "application time," says the website, which presumably means they go on easily.

Yes, well, right. Of course. That would be important. Of course.

Moving on in the news.......

In France, women are now entitled to a full reimbursement for the cost of their abortion and girls aged 15-18 are also guaranteed free birth control (both for the contraceptive pill and the implant).

This is major news - on both sides of the issue.

For those on the Religious Right, this is not an issue of public health, it is a major issue of morality and ethics. These Good Christian Folk bemoan that the government is not only playing "executioner" to the "unborn," but now also allowing their daughters to have sex whenever they wish, without having to consider the consequences and be the "moral barometers" of society to hold young men under some "restraint".

I am not making that up. That's the argument. Really.

For feminists and liberals, this is a major victory, giving women of childbearing age control of her own reproductive health. This is important on many, many levels, but especially because of the socio-political recognition that women still struggle to attain financial equality with men. As long as that playing field is not level, all others - including the freedom to have access to contraception and abortion - are not equal. When you live in a country like France where there is Socialized Medicine, allowing reimbursement for abortion care makes sense.

Since increasing access to birth control has consistently been shown to reduce abortion rates, French authorities are expecting to see a drop in the amount of women requiring abortions now that the law is effective.

Of course, others are predicting that, now that abortions are "free", everyone will want them - even those who hadn't considered it before. Or, if you've had one before, you'll want another.

You know, like free refills for your coffee or soda at fast food restaurants. You can hardly finish the cup you're drinking, just thinking about the fact that that next cup will be FREE!

Which is no doubt why, when the bill passed in October, the Minister of Health, Marisol Touraine, explained that it was a "public health choice" and she took the opportunity to remind people that abortion is "never a trivial act" for women.

Because, apparently, some people do need to be reminded of that.

Finally came the news on Friday that a US Federal Judge from the Eastern District of New York ordered that the most common morning-after pill be made available over the counter for all ages, instead of requiring a prescription for girls 16 and younger.

Not only that, Judge Edward R. Korman poked his finger right into the middle of the hornet's nest and accused the Obama administration of putting politics ahead of science. He concluded that the administration had not made its decisions based on scientific guidelines, and that its refusal to lift restrictions on access to the pill, Plan B One-Step, was “arbitrary, capricious and unreasonable.” 

He is right, of course. It was politics, unpure and complicated as politics always is. Or, in the judge's words, "arbitrary, capricious and unreasonable."

At the time of the decision, Mr. Obama was campaigning for reelection. Health and Human Services Secretary Kathleen Sebelius said that the manufacturer had failed to provide clinical evidence that the drug was safe for children under age 11, about 10% of whom are physically able to bear children.

A weak argument, to be sure, which might have been convincing if she and the FDA had not approved the large scale administration of the HPV vaccine to 10-11 year old girls, even though the vaccine manufacturer conducted exactly ZERO studies on the negative effects of the HPV vaccine on that young age group.

The folks from the Religious Right are predictably hysterical. You may remember Michele Bachmann's breathless report of the story told to her by the mother of "the poor little girl" who "felt forced" to allow her child to have the HPV vaccine and "now she has mental retardation".

These folks will stop at absolutely nothing. Not perpetuating ignorance. Not pandering to pseudoscience. Not fanning the flames of anxiety and fear.


The folks on the Religious Right have always called "Plan B" the "abortion pill". It is not.

RU-486, sold as Mifeprex, is a prescription drug for medical abortion. Mifeprex is used after a woman is already pregnant. Plan B is an emergency contraceptive. It is used to prevent pregnancy.

It does not "abort" a fetus because, 72 hours after unprotected, unplanned sexual intercourse, there is yet no fetus to abort.  Plan B prevents pregnancy from happening in much the same way that other oral contraceptives do.

Plan B acts primarily by stopping the release of an egg from the ovary. It may prevent a sperm from fertilizing the egg. If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb. If a fertilized egg is implanted prior to taking Plan B, Plan B will not work and pregnancy proceeds normally.

It's not rocket science. It's biology. It's the way the reproductive system has worked since the beginning. Nothing has changed except we now have a deeper understanding of how the human body works - including our ability to reproduce. 

Again, the issues surrounding this decision are fraught with overlays of religion and morality and conversations about parental control and responsibility. 

Which brings me to a point I want to make about all of this.

None of these things - Condoms, Government subsidized abortion and contraception, and emergency Plan B contraception available without prescription to anyone young woman who needs it - will ever replace Plan A: Education and Awareness. For parents and their children.

Yes, "boys will be boys" - and "girls will be girls". Adolescence will always be a dangerous time of pushing and testing boundaries and exploring identity and experimentation.  Even parents and kids with the best, open relationship will have difficulty discussing issues of human sexuality in general and sex in particular.

Here's the thing: The best parental responsibility is to teach our children responsibility by modeling that behavior. And, that includes allowing them a "Plan B" to which they have free access when they make a mistake - just as adults sometimes do.

Boys and men must take responsibility for their own behavior, just as girls and women. But, it's not women who are responsible for the morality of men, much less the whole of society. We all are. That includes providing medical prophylactic alternatives for reproductive choices for women and men - including condoms which men might actually use consistently as well as a medicine like Plan B which women can use when that is deemed necessary or imperative.

I'm sure of one thing: The personal will always be political, and there ain't nothing more personal than a woman's reproductive system.  Which is why it will always be political.

And, it's why news like this will always catch my attention, no matter where I am or how good or bad I'm feeling.  The progress in Reproductive Rights has always been the most difficult to achieve and the most tenuous to maintain.

Vigilance and persistence are key to preventing further erosion of the progress we've been able to make over the last 50 years since the Birth Control Pill was made widely available.

Which is why my personal "Plan A" is to pay attention. Always. And, everywhere.


Chilebnr said...

Thank you!

Elizabeth Kaeton said...

You are very welcome.

Sextant said...

Excellent post Elizabeth.

I applaud the Gates Foundation efforts to create a new condom, although 100 grand is probably a drop in the bucket for development costs. I gathered that this was more of a prize for ideas rather than seed money for development.

Unfortunately, I predict that they will fail. They may win the battle of creating an improved condom, but I predict that they will lose the war of universal acceptance and willingness to use condoms. At best, I believe that they will benefit only those people that already routinely use them. Those who don't use them will most likely still not be inclined to use them.

I hate to be such a pessimist.

While I have little in the way evidence, I have contemplated this problem mostly from my own experience. My wife and I were forced to use condoms for various periods in between birth control pill prescriptions lasting for a year or two. Neither of us liked them, but we could never quite state why. They are not that bad. The only thing about them that I can say I genuinely did dislike is the need for immediate withdrawal. Yet there was something inherently wrong with using condoms that seemed to be a far deeper issue than the mechanical realities of their usage. It was like we didn't really make love.

In my opinion it is worse than taking a shower with a rain coat on, it is like masturbating on opposite sides of a sheet of latex. More precisely I believe it is like having a conversation on a dead phone line and somehow convincing yourself that you did indeed have the conversation. Again I have little or no evidence but I feel condoms are a poor choice of birth control for loving MONOGAMOUS couples that are 100% faithful.

Sex in human beings has a multitude of purposes with reproduction being pretty far down the list. Sex of course is ancient, human intellect and consciousness is rather a recent evolutionary development. Much of what goes on in our bodies and minds are below the level of consciousness, for instance most people can not will themselves to have an orgasm--it is rather automatic.

Ooopps too long continued below.

Sextant said...

Continued from above.

So why do I think condoms are a problem. I think sex is a form of biochemical communication between partners. I believe that lovers exude and absorb through the genitals a host of coital and post coital biochemicals from each other and possibly some rather intimate concoctions that are formed during the mix of fluids. So when a couple has coitus without a condom, I believe the primitive elements of their brains are flooded with some powerful love potion #9s (obviously I am not a bio-chemist). Repeat the same process using a condom and the biochemistry is blocked. While our intellect is aware of the fact that we just had sex, the ancient swamp beings in our brains with the biochemical receptors are saying "what sex?"

Again this is my theory and I have little evidence for it. Gordon Gallup of SUNY did some research that found women that don't use condoms but are sexually active in heterosexual relationships suffer less depression, leading to the hypothesis that semen has somer sort of anti-depressants qualities. This is something of an accumulated effect. But I believe that empty feeling after coitus with condoms is that a good bit of our brains did not experience the sex because of the immediate blocking of fluid contact during coitus.

Hence my pessimism regarding the development of a new improved condom that will have universal acceptance. If the fear of HIV and a host of other STDs or pregnancy is insufficient to promote condom use, I doubt that making improvements in them will either. The property that makes condoms effective, blocking fluid contact, I believe ultimately dooms them. As such I have two beliefs regarding condom use.

1) If you or your partner are not absolutely monogamous with 100% fidelity, you are totally crazy not to use condoms or dental dams during sexual activity.

2) If you and your partner are absolutely monogamous with 100% fidelity, condoms and dental dams may be ultimately harmful to your relationship.

To be honest, I would much rather see the Gates Foundation fund research in to what happens during coitus, monitoring blood levels of the biochemistry and brain electro-chemical changes during and after coitus with and without condoms.

Regarding the other two items you mentioned in your post, I am in complete agreement with you...these are welcome and needed changes. I also agree with about education and everyone recognizing their moral obligation to conduct their sex lives responsibly. Contraception and prevention of STDs are everyone's problem, not just one gender or the other.

Again excellent post, Elizabeth.

Elizabeth Kaeton said...

Thanks, Sextant. You've given me much to consider. For example, I wonder about the biochemical communication between sex partners of the same sex. I wonder, too, about the undercurrent of metaphorical communication in sexual intimacy and how it might inform biology.

I've also found myself sitting with this random curiosity regarding this conversation about sexual communication might not somehow inform those folks who believe that, when a woman's body is being violated - raped - the "body has a way of shutting the whole thing down". Not that this diminishes, in any way, what you're saying. It was just a random curious thought.

The Gates Foundation is deeply committed to empowering women in the so-called 3rd World. Melinda Gates, an active RC, has addressed the US Conference of Catholic Bishops and said that condoms can save lives in Africa by allowing women control over her own family and her own body.

I suspect that their intention to create a "fun, innovative" condom is to reduce the risk of disease and unwanted pregnancy that men would actually use world wide. And, if it can do some good with some people in America, even better.

That's my hunch. But, I hear what you're saying, Sextant. And, if I hear you correctly, there is no need for condoms in 100% faithful relationships as long as there are other contraceptive methods available to the fertile couple.

Isn't it interesting, however, that condoms are so commonly available we have to think of ways to make them more attractive for use by men, but we still have to regulate the availability of contraceptive devices for women?

I envision a day when young women can put a few coins in a machine in the women's room and purchase a Plan B pill just the way young men can put a few coins in a machine in the men's room and purchase a condom.

Sextant said...


The one thing I meant to mention last night, it was late, is that there could be simply a psychological barrier to men. I don't think it is as simple as that. I think there is a definite problem with condoms that is beyond the physical reality of their use and to design ever better condoms without fully understanding the reluctance to their use is short sighted. I think some imaginative research is needed and not simply write it off as irresponsibility. The phenomena is very pervasive and it survives in the face of extreme danger. So I think there is something far deeper than loss of sensitivity, or stopping the passion to install the condom. BTW that process can actually be a lot of fun, one thing that I do miss about condoms.

Regarding rape, remember one must qualify between "legitimate rape" and otherwise. Idiots!

Please note that I am not against condom distribution, indeed, Melinda Gates should be commended for her work in Africa and attempts at increasing understanding within her church. What I am saying is that I think they are trying to build a time machine without having an understanding of how time travel works. So yes I think a better condom can be made, and I also think that it will have only an incremental improvement in usage rates.

Also note that I am not recommending against the use of condoms, except for those who are in monogamous (completely and absolutely) relationships which as you note do require other forms of contraception. I am not against contraception, I just think there are better methods than condoms. BTW there are monogamous couples that still may have to use condoms, semen allergies, those with a propensity for infections, BV, and so forth. But I would recommend against them except as a last resort in monogamous couples.

Regarding monogamous same sex couples, without getting into details, I would recommend an introduction of fluids to each others genitals. It would be an interesting and fun experiment. I think that the same effect happens with oral sex as well, although I am not sure to what degree of efficacy compared to genital to genital sex. But I would certainly think that the same principles would hold true, just with similar chemistries.

Another interesting question is how deleterious are condoms for couples that are trying to fall in love and build a loving relationships...both hetero and same sex? I really feel that a couple trying to establish a long term loving relationship should at some point declare themselves faithful to each other and quit using condoms for the express purpose of building intimacy. If contraception is an issue find another form. How many couples may find sex disconcertingly empty?

Elizabeth I hear what you are saying about contraceptives being widely available for women and I agree. However I hope in a bar's restrooms, there is a condom dispenser in both restrooms, dispensing units for both genders. Unfortunately female condoms remain tricky and comparatively expensive. Actually I was more interested in the Origami condom for women than the mens style.

But here is the thing, a condom may be worn by a man but it affords protection to both. Women should carry their own and insist that the man wears them for non-monogamous relations. Plan B may be a good contraceptive, but it will do nothing for STDs.

I think everyone has the obligation to express their sexuality with responsibility. Contraception and the prevention of STDs are both partners concerns.

Thank you for posting this.

Matthew said...

I hope you are feeling better. RE: plan B, part of the issues in the legal decision is that the govt. used delay tactics for 12 years. 12 years this litigation has gone on. You would think in 12 years they could have identified the health risks if there were any, or done the studies, but that's not the real reason.

Elizabeth Kaeton said...

Sextant - You have summed up my point precisely with this: Having the freedom to express one's sexuality with responsibility. That's it - whether one lives in America or Africa or Asia or is male or female, gay or straight, young or old.

Somehow, we have to change the culture to make the use of condoms "cool". I have been in some lady's room's that have condom machines next to the tampon machine, but many women are easily intimidated by male strength to not use them.

It's been an interesting discussion.

Elizabeth Kaeton said...

Matthew - 12 year delay? Really? So, Obama's delay was on top of the previous delays? I would have thought the science moved faster than that.

Matthew said...

Yes exactly. What has been so infuriating about this whole litigation is that is started eons under the Bush administration which tried to appease far right forces and the frustrating part has been just how seamless this litigation happened between a far right wing president and a so called progressive president who we thought supported contraceptive rights but the litigation just kept on truckin along. No one halted it or dropped the case. There never was any science and still isn't. Its not that science take a long time. The Bush strategy was to post pone in hopes of dragging it out because they knew the science wasn't there and the admin lawyers just kept doing the same thing when Obama came to power. Perhaps Obama did not want a reversal because it would have inflamed the passions of the far right and maybe he hoped if they kept litigating it it will fall under the radar for another 8 years as litigation in process (ya know, wait for the process to conclude -- where have we heard that arguement before)? But the judge called their bluff and now the Obama admin looks stupid for having continued the litigation for 5 years in hopes of ginning up some sham science. Its as bad as the continuation of the Afghanistan war and also lives are at stake.

Chelsea Edgell said...

It's worth noting that the present consensus amongst reproductive and pharmaceutical scientists is that emergency contraceptives prevent ovulation and thicken cervical mucus, but have no provable effect on implantation. This myth was originally included in FDA labelling due largely to scientific speculation about how the morning after pill works. Today, most agree that emergency contraceptives do not provably interfere with implantation, and in the case of Plan B, provably do not interfere. :) While scientists mostly agree that implantation should not be included in labels or information with emergency contraceptives, The New York Times covered the political machinations influencing the uptake of this advice.

Elizabeth Kaeton said...

Matthew - I agree with you. This is one political strategy that backfired and makes smart people look pretty stupid.

Elizabeth Kaeton said...

Thanks, Chelsea. My guess is that there's a conservative or two on the FDA who, as long as there's a remote chance of Plan B interfering with implantation, that information should be included in the pamphlet.