catapult magazine

catapult magazine

Vol 7, Num 17 :: 2008.09.26 — 2008.10.10


Considering contraception

I have always been challenged and inspired by the depth and inclusiveness that catapult has brought to the table on Kingdom living here and now in the culture in which we abide.  As a women’s health nurse practitioner (not practicing at this time), I worked for a Title X Family Planning Program, which was ironically closed for what I believe was a true lack of understanding of the long term benefits of preventative health care in the area of reproductive health.  Out of that experience, I think that the topic of family planning may warrant another issue to round out the discussion.

Where do I begin?  The term “family planning” is indeed an odd phrase.  I do not know who came up with the nomenclature, but I believe it was a way of using fancy language to mask anything involving sex, which we do too often.   Many times clients would call for services and be put off when they heard the receptionist answer the phone, “Family planning clinic, may I help you?”  The client would respond, “I want to have my exam” or, “I want birth control” (another equally odd phrase).

Both terms, family planning and birth control, imply that in the areas of procreation, we can manipulate the outcome—that is to have a child when desired and not to have a child when not desired.  And I would argue that thoughtful planning and action is part of the discernment that should happen in all areas of our lives as those created in God’s image.  As in many of the best laid plans, we have surprises (some call these grace moments).

All birth control methods have their limitations and failure rates including abstinence.  Yes, abstinence is only 100% effective if used 100% of the time.  And thus the statistics in communities with abstinence-only programs which show higher teen pregnancy rates.

Natural Family Planning (NFP) is a good option for couples who are dedicated to working together to manage the gift of fertility.  Like other options, it is not for everyone.  In a world where many people travel for business (although the energy crisis may impact on this), the ability of couples to sustain a body, mind, spirit connection may be strained.  Also many women have extremely erratic cycles and this can be especially true of shift workers, so even nurses may have difficulty in consistently using NFP.

While hormonal contraception is not for everyone, I am concerned about the sort of blatant write-off of it as a good option for many women.  Yes, hormonal contraception became available in the 1960s and well we all know what happened in the 60s with free love, etc.  Too often the argument continues that if we get rid of the pill and other hormonal methods of contraception, then we can go back to the good old days.  Nothing happens in a vacuum and the decade of the 60s was a reaction to the very restrictive 50s, when women were thrust back in to being wives and mothers after being the strong “Rosie the Riveters” of the 40s.  On a side note, one of the nurses I worked with in family planning had five children in six years before the advent of the pill, which one article in this issue of catapult points out is not healthy for mothers or babies (or fathers who care for them).  Incidentally, 1959 was the year with the highest incidence of teen births, as many women were married in their teens and had their first babies shortly after.

In reference to the good old days, I must also note that in colonial America, 40 percent of women were pregnant when they married.  This is known from tracing marriage dates and birth dates.  So while a discussion of the long term dualism in our puritanical origins is perhaps beyond the scope of this treatise, it bears consideration.

Back to hormonal contraception, two articles mention the level of hormones found in fish assumed to be from women on the pill.  We should be concerned about how our actions affect all of creation.  There is a growing recognition of drugs of all kinds found in wastewater and we should not target hormones from the pill alone as the evil culprit.  Remember: animals are given hormones, too.  The oral contraceptives that women are prescribed contain far less hormone than the original pills of the 60s and consequently have fewer side effects.  Interestingly enough, pills in Europe have even less hormones with equal efficacy.  Why not do that in the U.S., you ask?  Because lower amounts of hormone mean that women might experience break-through bleeding, which is not harmful in the least but which freaks out American women—or at least that is what the pharmaceutical reps tell us and my experience with women does bear this out.

While I respect all women to choose what is best for them in the reality of their lives, I am concerned about educated women not addressing the very real political climate in which we find ourselves at this moment.  As I write this, the current administration is attempting to restrict access to reproductive health options including oral contraceptives.  The argument is that health care workers should not have to provide services that they morally question.  While that seems only just, there are now pharmacists who refuse to fill oral contraceptive prescriptions.  This can happen for a variety of reasons, like a woman is not married or contraception is not approved by his or her faith community or the belief that pills are an abortifacient.

I do wish to respect the beliefs of those who differ from me.  What helps me is to look at some glimpses of other people in other places and how they choose to live, in this case with the gift of fertility.  In Saudi Arabia, women can purchase oral contraceptives over the counter.  The restriction is that they must be married.  In some parts of Africa, the intra-uterine device (IUD) is very regularly used and women like the convenience of having one inserted after the birth of a child and then having it removed when they wish to conceive again.

By the way, the IUD really works like a barrier method in that the IUD interferes with the sperm making it to the fallopian tube and meeting up with the egg.  Too often the IUD is looked upon as interfering with implantation which it undoubtedly can do, but conception does not occur, as realized in the statistics that show that women with IUD’s have less tubal pregnancies than women without IUD’s (in other words, they don’t conceive).  All of this leads to me recommending the use of the word “contraception” instead of “birth control,” as technically abortion is birth control, and that opens up a whole new issue.  Suffice it to say, that wise use of contraception lessens the need for abortion to be considered at all.

Of course there is always the question of what is “natural” with the underlying thought being that “natural” is best when we look at anything from food to contraception.  Certainly it is not natural for us to live in houses that are air conditioned or that have central heating or to drive cars.  Is it “unnatural” for a person with diabetes to take hormones (insulin) to regulate his or her blood sugar?  Is it “unnatural” for a depressed person to take anti-depressants when depression has definite biological components?  Is it “unnatural” for a woman to take oral contraceptives to regulate her fertility?  One could rightfully argue that fertility is not a disease, but the timing of a pregnancy might not be best or healthy for a woman and/or her family.  I do not advocate the notion that there is a pill for everything and we just need to find the right pill at the right time.   A person with diabetes will have improved overall health with diet and exercise and insulin and a person with depression will be helped with therapy in addition to medication.  A woman in her childbearing years may be able to improve her overall health before a pregnancy, like quitting smoking or dealing with a myriad of other issues, by using effective contraception, including hormonal options. 

My basic nursing education was received at a denominational university and I was trained in the concept of high level wellness.  This concept looks at the whole person and system to strive for optimal health.  So while we live in an imperfect world and often have imperfect health, our creator has worked through the years to assist us in finding ways to be whole.  He shows us through the death of his son that true wholeness does not come from perfect physical health, but comes from the hole in the soul being filled with the healing spirit. 

While I could continue with my thoughts regarding family planning, I will close thanking you for the opening to discuss something about which I am obviously passionate. 

I would like to mention in passing some general philosophy about procreation.  Our creator blessed us with the ability to procreate and in such a wonderful way (SEX).  We would do well to honor this gift. 

Having said that, I believe that gift of sexuality in its fullest expression of mind, body, spirit connectedness is ultimately procreative, whether contraception is used or not and whether biological conception ever occurs.  What I mean by procreative in the nonbiological sense, is the connectedness and intimacy and healing that occurs in healthy sexual relationships.  I would be remiss if I did not caution that if we see procreation in a clearly biological sense only, that we negate healthy sexual relationships between infertile couples no matter what age and what genders.

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