Saturday, February 14, 2009

Sex ed, birth control, and access to each (part 2)

Sure, we have "comprehensive sex ed." It's written in the Texas legislature.

But the textbooks the Texas State Board of Education has approved for schools to use don't mention birth control methods.

The "teachers" in the classrooms are too embarrassed to talk about it, and don't have time to find out the details of the different methods of contraception available today, in order to give informed answers to students' questions.

So, are we really educating our children about their reproductive systems? About the different methods of contraception available? Are we providing them with the tools they need to make informed decisions about their lives and their bodies?

Women have a legal right to purchase birth control. But can they afford it? Is it covered by insurace -- at least as often as Viagra is? Do insurance companies cover more than just "the pill," since there are many more options out there for women, besides the daily, take-at-the-exact-same-time-every-day pill?

In college, I got my birth control from Planner Parenthood. I got the pill, because that's the only one I knew (besides diaphragms and IUDs, it was pretty much the only choice back then). Then I heard about Depo-Provera, and decided I much preferred to have a shot every three months than to take a pill every day, at the same time (which seldom happened. I'm not a robot, I don't do things at the exact same time every bloody day). When I got a full-time job, I got health insurance -- not only did I no longer qualify for PP's sliding-scale discounted services, but I wanted to use my shiny new insurance. It was so cool!

While the rep went through his whole maternity-coverage spiel, I walked up to the other rep to ask about birth control (since the rep giving the spiel had not mentioned it). Perhaps it was my mistake; I asked if they covered "birth control."

"Oh, yeah, sure. We do."


I got myself a doctor in the network, went for my first appointment. Mind you, this was back when you had to go to your general practitioner to get referred to an ob/gyn, since that was a "specialist." So, I picked a GP from the list, based in his zip code, and went to ask about sending me to a girly doctor. I wanted a female girly doctor, but the man doctor told me he was an ob/gyn as well, so he could just do all that stuff for me.

I wanted a girl girly doctor, but what was I going to say to this guy?

"Uh... okay. If you say so." (Read the previous post, on the ingrained subservient nature of females, if you want to know why I didn't tell him that I preferred a female ob/gyn.)

Since I'd been on the Depo, I continued getting the shots.

The doctor's office said they'd bill the insurance company, so no problems. Every now and then I would get a bill from the doctor's office telling me I owed $60 for the Depo shot, but I called the doctor's office and they said it was probably a mistake. I called the insurance company and they said it must have been a mix-up, they'd take care of it.

Three years later, I got a letter from a collections agency. I owed $360 for medical services.

Because my insurance company covered the pill, but no other forms of birth control.

Funny, nobody bothered to point that detail out to me.

Maybe the insurance rep I talked to (male) didn't know there were other options available for birth control. The pill was it, right? That's the only one people talk about.

How widely-known is it that IUDs are safe even for women who have not been pregnant? Because they didn't use to be, and IUDs got a bad rap from women who became infertile (understandably so). However, the kind of IUD that caused those side effects is no longer available.

This site looks like it's a pharmaceutical in Belgium, but they cite their sources at the bottom of the page so they're credible enough for me:

On a worldwide scale there are nearly 160 million IUD users, most of them (over 100 million) in China. The popularity of intrauterine devices stems for their effectiveness, combined with their long duration of action. Because of their long lifespan, IUDs require fewer visits to doctors, which means high cost-effectiveness. IUDs are implanted and, therefore, cannot be “forgotten”, an asset much appreciated by many women.

IUD use in developed countries, however, varies from as low as 1% in the Netherlands and the USA to about 30% in Scandinavia.

The limited IUD use, particularly in developed countries, can be ascribed to various causes:

  • Pharmaceutical industry : The pill market is of great economic importance. This is the single drug that is taken by the greatest number of healthy women in the world.

  • Medical profession : prescribing oral contraceptives is less time-and energy consuming than insertion an IUD. Moreover not all practitioners have acquired the skills to perform a correct insertion which guarantees the best possible results.

  • Women themselves are often very poorly informed, and fear that inserting an IUD in their uterus has to be painful and may bring an unknown infection and even cancer.

  • The media have never been kind to IUDs and have often neglected their many advantages, but are still repeating the old stories of the ill-fated Dalkon Shield (which has been refuted in post-marketing studies conducted in the UK, See M. Cox J Fam Plann Reprod Health Care 2003;29:8).

Experts conclude that it is due time for the medical profession to realize that contraception does not equal oral contraception. The correctly inserted IUD in correctly evaluated recipients has come of age, has eliminated a great deal of its previous disadvantages, has received a clean bill of health and offers an economically and medically justified choice.

So, are we really educating women about their choices?

Even if they are educated, do they really have access to birth control? To all the different options available?

Do insurance companies pay for birth control? All forms of it? (Or will these women get an angry letter in the mail years later, demanding payment for something they were told was already covered?)

Let's say all the above conditions are met. Let's say the woman received clear, straightforward information about all the different methods of birth control available today, and the pros and cons of each. Let's say her insurance covers all these different methods, so she was able to choose the one that works best for her lifestyle and her body. Let's say she was able to go to the doctor of her choosing and get the necessary prescription.

Then she went to her local pharmacy, and the pharmacists refused to fill her prescription because of his personal moral beliefs.

(Hey, you know what? I am morally opposed to the TAKS test. Can I refuse to administer it? Please get back to me on this soon, we have TAKS test proctor training next week.)

There are several layers of "access." It's kind of like an onion. And, sometimes, stinks about as badly.

Let's say this woman lives in a small town. The kind where everyone is in everyone else's business. What's going to happen when she goes to the one pharmacy in town to get her prescription filled? Because, alas, this woman is unmarried.

Lots of layers.

Money shows up in many of those layers. Let's say this woman has a job, but she's not eligible for health care benefits until she's been with the company for three months. My Nuvaring? $60/month, without insurance. At my last job, it was $40/month (the only thing I'll miss about my current job is its great health insurance: $20/month for the Nuvaring. The first time they rang me up at Walgreens I high-tailed it out of there, sure they'd made a mistake). That can add up.*

Again, birth control is WAY CHEAPER than pre-natal care, childbirth costs, and, well, post-natal care, whether the insurance company is paying for it or the state is. Why do both these entities refuse to take the cheaper option? Someone please explain this to me.

*This is where people say, "Well, she can just keep her legs together for those three months!" or, "Uh, it's called a condom. Duh." These people have not dated much, methinks. They have not come across the men I've come across. I'll address this issue in a future post, since it's too big for a footnote.


  1. The ob-gyn I talked to said that only about 10% of american women use an IUD but 80% of medical professionals do. That said a lot to me right there.

    LOVE the analogy of the TAKS test! Will have to remember that one.

    BTW let's not forget the abstinence-only movement. It's been a little while since I looked into this, but I believe the idea was that federal funding was tied to needing to teach abstinence-only "sex ed." So schools who badly need that funding are forced to teaching non-sex ed, full of its inaccuracies and sometimes outright lies.

  2. depo seemed cool, but when my wife tried it she would go borderline psychotic the final week of the 90 day cycle. after three cycles we'd had enough. so, yes the importance of options can't be overlooked. however, in the past 20 years i've never had insurance that didn't cover most all medical/surgical bc options.

    all i remember about iuds was growing up and as a young man there seemed to be an endless stream of class action lawsuits against them, so if i had a uterus, it would be too scared to try using one. my imaginary uterus isn't very brave.

    i think the repetitive apples-to-oranges comparisons of bc and ed products is the most ridiculous and counterproductive angle to take. you might as well compare bc and, well, actual oranges.

    hey, you are half way there!

  3. @crisatunity: There used to be several different types of IUDs. The ones who were causing those lawsuits when we were growing up are no longer on the market. The ones available now are safe, and years of use have proven them safe.

    I would be in Mirena now, but since Freddy and I plan on having kids in the next 1-2 years, my doctor said it would not be worth it (for that short a period of time).

    Maybe my view of insurance and bc is skewed by working in education, where we generally have very crappy insurance plans. Then again, it may be just a Texas problem; I once met teachers from New Jersey who had an excellent insurance plan.

    However, the point still stands: there are insurance companies out there who do not cover all forms of birth control. And, generally, the people who will have those crappy insurance plans are lower-income people (in crappy jobs); also, there's all the people whose jobs don't even offer insurance. These are the people who need the financial assistance the most, and who can least afford an unplanned child. The problem isn't fixed until we've fixed it for everybody. (Nationwide health care would be nice... but that's just the socialist in me talking.)

    By "ed" you mean education? (As in, my rants against coaches and TAKS testing?) Because that's just me ranting on another one of my favorite topics. I know it's not proper debate protocol, but I like to rant. I'm

  4. I have also been lucky in that I've always had my birth control covered by insurance (the most I've ever paid was $15 for 3 months worth). Yet I also realize that for many many other women out there, they are forced to pay full price ($40-$50+/month).

    BTW crisatunity, thanks for proving Criss's point on why we need better education on birth control options-- so people don't get too scared to try a method that's incredibly effective and safe, based on now-obsolete events and information from 3 decades ago.

    (PS- word verification = "funie")

  5. $15 FOR THREE MONTHS' WORTH??!?!??

    And here I was getting all excited about $20 for ONE month.


    Last month I went to Walgreens on a Friday to refill my bc. I was told to come back that Sunday because I couldn't refill the prescription until Sunday (a full 30 days since the last time I'd bought it).

    Yeah, that's another ridiculous thing about insurance plans. Because, I'm totally going to OD on the Nuvaring if I get more than one every 30 days.

  6. Yeah, both in college and here with Kaiser I've been able to get 3 packs of pills at a time. I was so surprised when I found out most women have to get theirs one at a time. seems SO STUPID to me. Especially when one of the reasons I don't want to go back on the pill is that I don't even trust myself to remember to make it back once every 3 months to pick up my rx.