How a medication abortion, also known as an ‘abortion pill,’ works | CNN



CNN
 — 

While legal battles over access to mifepristone, one of two drugs used for medication abortions, play out in court, the drug continues to be available in states which consider abortion legal.

“While many women obtain medication abortion from a clinic or their OB-GYN, others obtain the pills on their own to self-induce or self-manage their abortion,” said Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

“A growing body of research indicates that self-managed abortion is safe and effective,” he said.

Mifepristone blocks the hormone progesterone, which is needed for a pregnancy to continue. The drug is approved to end a pregnancy through 10 weeks’ gestation, which is “70 days or less since the first day of the last menstrual period,” according to the FDA.

In a medication abortion, a second drug, misoprostol, is taken within the next 24 to 48 hours. Misoprostol causes the uterus to contract, creating cramping and bleeding. Approved for use in other conditions, such as preventing stomach ulcers, the drug has been available at pharmacies for decades.

Together, the two drugs are commonly known as the “abortion pill,” which is now used in more than half of the abortions in the United States, according to the Guttmacher Institute, a research group that supports abortion rights.

“Some people do this because they cannot access a clinic — particularly in states with legal restrictions on abortion — or because they have a preference for self-care,” said Grossman, who is also the director of Advancing New Standards in Reproductive Health, a research group that evaluates the pros and cons of reproductive health policies and publishes studies on how abortion affects a woman’s health.

What happens during a medication abortion? To find out, CNN spoke with Grossman. The conversation has been edited for clarity.

CNN: What is the difference between a first-trimester medication abortion and a vacuum aspiration in terms of what a woman experiences?

Dr. Daniel Grossman: A vacuum aspiration is most commonly performed under a combination of local anesthetic and oral pain medications or local anesthetic together with intravenous sedation, or what is called conscious sedation.

An injection of local anesthetic is given to the area around the cervix, and the cervix is gently dilated or opened up. Once the cervix is opened, a small straw-like tube is inserted into the uterus, and a gentle vacuum is used to remove the pregnancy tissue. Contrary to what some say, if the procedure is done before nine weeks or so, there’s nothing in the tissue that would be recognizable as a part of an embryo.

The aspiration procedure takes just a couple of minutes; then the person is observed for one to two hours until any sedation has worn off. We also monitor each patient for very rare complications, such as heavy bleeding.

Grossman: A medication abortion is a more prolonged process. After taking the pills, bleeding and cramping can occur over a period of days. Bleeding is typically heaviest when the actual pregnancy is expelled, but that bleeding usually eases within a few hours. On average people continue to have some mild bleeding for about two weeks or so, which is a bit longer than after a vacuum aspiration.

Nausea, vomiting, fever, chills, diarrhea and headache can occur after using the abortion pill, and everyone who has a successful medication abortion usually reports some pain.

In fact, the pain of medication abortion can be quite intense. In the studies that have looked at it, the average maximum level of pain that people report is about a seven to eight out of 10, with 10 being the highest. However, people also say that the pain can be brief, peaking just as the pregnancy is being expelled.

The level of cramping and pain can depend on the length of the pregnancy as well as whether or not someone has given birth before. For example, a medical abortion at six weeks or less gestation typically has less pain and cramping than one performed at nine weeks. People who have given birth generally have less pain.

CNN: What can be done to help with the pain of a medication abortion?

Grossman: There are definitely things that can be used to help with the pain. Research has shown that ibuprofen is better than acetaminophen for treating the pain of medication abortion. We typically advise people to take 600 milligrams every six hours or so as needed.

Some people take tramadol, a narcotic analgesic, or Vicodin, which is a combination of acetaminophen and hydrocodone. Recent research I was involved in found medications like tramadol can be helpful if taken prophylactically before the pain starts.

Another successful regimen that we studied combined ibuprofen with a nausea medicine called metoclopramide that also helped with pain. Other than ibuprofen, these medications require a prescription.

Another study found that a TENS device, which stands for transcutaneous electrical nerve stimulator, helps with the pain of medication abortion. It works through pads put on the abdomen that stimulate the nerves through mild electrical shocks, thus interfering with the pain signals. That’s something people could get without a prescription.

Pain can be an overlooked issue with medication abortion because, quite honestly, as clinicians, we’re not there with patients when they are in their homes going through this. But as we’ve been doing more research on people’s experiences with medication abortion, it’s become quite clear that pain control is really important. I think we need to do a better job of treating the pain and making these options available to patients.

CNN: Are there health conditions that make the use of a medication abortion unwise?

Grossman: Undergoing a medication abortion can be dangerous if the pregnancy is ectopic, meaning the embryo is developing outside of the uterus. It’s rare, happening in about two out of every 100 pregnancies — and it appears to be even rarer among people seeking medication abortion.

People who have undergone previous pelvic, fallopian tube or abdominal surgery are at higher risk of an ectopic pregnancy, as are those with a history of pelvic inflammatory disease. Certain sexually transmitted infections can raise risk, as does smoking, a history of infertility and use of infertility treatments such as in vitro fertilization (IVF).

If a person is on anticoagulant or blood thinning drugs or has a bleeding disorder, a medication abortion is not advised. The long-term use of steroids is another contraindication for using the abortion pill.

Anyone using an intrauterine device, or IUD, must have it removed before taking mifepristone because it may be partially expelled during the process, which can be painful.

People with chronic adrenal failure or who have inherited a rare disorder called porphyria are not good candidates.

CNN: Are there any signs of trouble a woman should watch for after undergoing a medication abortion?

Grossman: It can be common to have a low-grade fever in the first few hours after taking misoprostol, the second drug in a medication abortion. If someone has a low-grade fever — 100.4 degrees to 101 degrees Fahrenheit — that lasts more than four hours, or has a high fever of over 101 degrees Fahrenheit after taking the medications, they do need to be evaluated by a health care provider.

Heavy bleeding, which would be soaking two or more thick full-size pads an hour for two consecutive hours, or a foul-smelling vaginal discharge should be evaluated as well.

One of the warning signs of an ectopic pregnancy is severe pelvic pain, particularly on one side of the abdomen. The pain can also radiate to the back. Another sign is getting dizzy or fainting, which could indicate internal bleeding. These are all very rare complications, but it’s wise to be on the lookout.

We usually recommend that someone having a medication abortion have someone with them during the first 24 hours after taking misoprostol or until the pregnancy has passed. Many people specifically choose to have a medication abortion because they can be surrounded by a partner, family or friends.

Most people know that the abortion is complete because they stop feeling pregnant, and symptoms such as nausea and breast tenderness disappear, usually within a week of passing the pregnancy. A home urine pregnancy test may remain positive even four to five weeks after a successful medication abortion, just because it takes that long for the pregnancy hormone to disappear from the bloodstream.

If someone still feels pregnant, isn’t sure if the pregnancy fully passed or has a positive pregnancy test five weeks after taking mifepristone, they need to be evaluated by a clinician.

People should know that they can ovulate as soon as two weeks after a medication abortion. Most birth control options can be started immediately after a medication abortion.

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FDA advisers vote unanimously in support of over-the-counter birth-control pill | CNN



CNN
 — 

Advisers for the US Food and Drug Administration voted unanimously on Wednesday in support of making the birth-control pill Opill available over-the-counter, saying the benefits outweigh the risks.

Two FDA advisory panels agreed that people would use Opill safely and effectively and said groups such as adolescents and those with limited literacy would be able to take the pill at the same time every day without help from a health care worker.

The advisers were asked to vote on whether people were likely to use the tablet properly so that the benefits would exceed the risks. Seventeen voted yes. Zero voted no or abstained.

Opill manufacturer Perrigo hailed the vote as a “groundbreaking” move for women’s health.

“Perrigo is proud to lead the way in making contraception more accessible to women in the U.S.,” Murray Kessler, Perrigo’s president and CEO, said in a statement. “We are motivated by the millions of people who need easy access to safe and effective contraception.”

The FDA doesn’t have to follow its advisers’ advice, but it often does. It is expected to decide whether to approve the over-the-counter pill this summer.

If it’s approved, this will be the first birth-control pill available over the counter in the United States. Opill is a “mini-pill” that uses only the hormone progestin.

At Wednesday’s meeting, Dr. Margery Gass of the University of Cincinnati College of Medicine thanked the FDA for its consideration of switching Opill to an over-the-counter product.

“I think this represents a landmark in our history of women’s health. Unwanted pregnancies can really derail a woman’s life, and especially an adolescent’s life,” she said.

The FDA has faced pressure to allow Opill to go over-the-counter from lawmakers as well as health care providers.

Unwanted pregnancies are a public health issue in the US, where almost half of all pregnancies are unintended, and rates are especially high among lower-income women, Black women and those who haven’t completed high school.

In March 2022, 59 members of Congress wrote a letter to FDA Commissioner Dr. Robert Califf about OTC contraception.

“This is a critical issue for reproductive health, rights, and justice. Despite decades of proven safety and effectiveness, people still face immense barriers to getting birth control due to systemic inequities in our healthcare system,” the lawmakers wrote.

A recent study showed that it’s become harder for women to access reproductive health care services more broadly – such as routine screenings and birth control – in recent years.

About 45% of women experienced at least one barrier to reproductive health care services in 2021, up 10% from 2017. Nearly 19% reported at least three barriers in 2021, up from 16% in 2017.

Increasing reproductive access for women and adolescents was a resounding theme among the FDA advisers.

“We can take this opportunity to increase access, reduce disparities and, most importantly, increase the reproductive autonomy of the women of our nation,” said Dr. Jolie Haun of the James A. Haley Veterans’ Hospital and the University of Utah.

Dr. Karen Murray, deputy director of the FDA’s Office of Nonprescription Drugs, said the agency understands the importance of “increased access to effective contraception” but hinted that the FDA would need more data from the manufacturer.

Some of the advisers and FDA scientists expressed concern that some of Perrigo’s data was unreliable due to overreporting of “improbable dosing.”

Murray said the lack of sufficient information from the study poses challenges for approval.

“It would have been a much easier time for the agency if the applicant had submitted a development program and an actual use study that was very easy to interpret and did not have so many challenges. But that was not what happened for us. And so the FDA has been put in a very difficult position of trying to determine whether it is likely that women will use this product safely and effectively in the nonprescription setting,” she said. “But I wanted to again emphasize that FDA does realize how very important women’s health is and how important it is to try to increase access to effective contraception for US women.”

Ultimately, the advisers said, they don’t want further studies of Opill to delay the availability of the product in an over-the-counter setting.

“I just wanted to say that the improbable dosing issue is important, and I don’t think it’s been adequately addressed and certainly leads to some uncertainty in the findings. But despite this, I would not recommend another actual use study this time, and I think we can make a decision on the totality of the evidence,” said Kate Curtis of the US Centers for Disease Control and Prevention.

Curtis said she voted yes because “Opill has the potential to have a huge positive public health impact.”

Earlier in the discussion, Dr. Leslie Walker-Harding of the University of Washington and Seattle Children’s Hospital said the pill is just as safe as many other medications available on store shelves.

“The safety profile is so good that we would need to take every other medicine off the market like Benadryl, ibuprofen, Tylenol, which causes deaths and people can get any amount of that without any oversight. And this is extremely safe, much safer than all three of those medications, and incorrect use still doesn’t appear to have problematic issues,” she said.

Dr. Katalin Roth of the George Washington University School of Medicine and Health Sciences also emphasized the safety of the pill over the 50 years it has been approved as a prescription drug in the US.

“The risks to women of an unintended pregnancy are much greater than any of the things we were discussing as risks of putting this pill out out over-the-counter,” she said. “The history of women’s contraception is a struggle for women’s control over their reproduction, and we need to trust women.”

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Spotlight on family planning as India surpasses China as world’s most populous country

India is set to become the world’s most populous country on April 14, a title China has held for decades. Faced with a large – and growing ­– population of more than 1.4 billion, India’s family planning service is under pressure to maintain a decreasing fertility rate.

A UN forecast predicts that on April 14 the Indian population will reach 1,425,775,850 – a number that dethrones China from its long-held position as the world’s most populous country.  

The exact population of India today is unknown ­(a 2021 update on the decade-old census was indefinitely delayed by the pandemic) but all signs point to exponential growth. While China’s formerly steep rate of population increase is starting to plateau, India’s curve is still forging upwards. 

It is estimated that India has added 210 million – almost the number of people in Brazil – to its population since the last census 12 years ago. As of 2020, it has gained roughly 1 million inhabitants each month.

>> Read more: China faces demographic crisis as population shrinks for first time in 60 years

The population of India – and China – is now equivalent to the entire continent of Africa, and dwarfs that of Europe and the Americas. 

 

How India’s population compares globally © Worldometer

 

But over the same decades that population growth in India has soared, fertility rates have been falling. In 1964 Indian women had six children on average, today they have closer to two, in part, due to the state family planning service, which India claims it was the first country to provide when it launched in 1952.

“The primary goal was to slow population growth as a means of supporting the economic development of the country, which was only a few years old at that point,” says Anita Raj, Professor of Global Public Health, Director of the Center on Gender Equity and Health, University of California at San Diego.

The scheme has had some successes: India’s 2022 family heath survey found that almost 100% of married women and men aged 15-49 are aware of at least one method of contraception. The public health sector is the provider for 68% of people who use modern contraceptives (products or medical procedures used to prevent pregnancy such as condoms, the pill and IUDs, as opposed to traditional methods such as the withdrawal or rhythm methods or abstinence).

Yet, faced with a soaring population there is work to do. “Total fertility rates have declined for years,” says Raj. “However, if the goal was truly reproductive choice and women’s reproductive autonomy, then more should be done.”

Sterilisation

The most used form of pregnancy prevention in India is female sterilisation, which accounts for 38% of all contraception used. “The emphasis of the national family planning programme historically was on family size, and consequently, sterilisation was the focus,” says Raj.

Yet, male sterilisation rates account for just 0.3% of all contraception methods. This is partly due to a patriarchal society – the family heath survey found more than a third of men regard contraception as “women’s business”.

Contraceptive methods used by married women in India
Contraceptive methods used by married women in India © NFHS India Report, 2021

But there is also resistance to male vasectomy due to lingering “stigma and taboos”, says Debanjana Choudhuri, a gender rights specialist based in India.

In the 1970s, economic and social stagnation led the Indian government to launch a mass drive to sterilise men as a population control method. Heavy-handed enforcement saw men pressured into having vasectomies on pain of having their salaries docked or losing their jobs. Poor men risked being picked up by police from railway and bus stations before being sent for sterilisation.

The result in modern India is that “no scalpel vasectomies have a very poor uptake”, Choudhuri says. “Men aren’t doing enough.”

State efforts still shy away from diversifying contraceptive methods. Sterilisation for men and women is incentivised with payment, and some states have introduced a two-child policy with penalties such as bans on holding government jobs for those who do not comply. The private health sector is the main provider of contraceptive of pills, injectables and condoms.

Recent public health provision of UDIs could be a “game changer in achieving method mix”, says Choudhuri, “but it will take 5-10 years to become popular. There is an immediate need for a healthier method mix, sensitisation, and awareness of long-acting reversible contraception and other short-term methods.”

Contraceptive control

Aside from placing the burden on women, reliance on female sterilisation limits women’s options. “Sterilisation does not support birth spacing, which is important for maternal and infant health and survival. It also is not a solution to ensure women’s control of timing of pregnancies, only limiting of them,” says Raj.

“If sterilisation is the women’s choice and supports women’s health, then that is fine; but too often these decisions are built on family and community expectations.”

Socio-economic conditions also define many women’s choices around family planning. The 2022 family health survey found poorer, less educated women living in rural areas are likely to have more children at younger ages and have less exposure to family planning messages than their wealthier, educated and urban counterparts.

Geography also plays a role, with women in the poorest parts of east India less likely to use any contraceptive methods at all, and especially less likely to use modern contraceptive methods.

“Evidence from all over the world shows when women are given the choice to control their fertility and the opportunities around it [such as education and economic opportunity] you’re always going to see family sizes coming down,” says Alistair Currie, campaign manager from Population Matters, a UK-based charity that addresses population size.

Lowering the fertility rate

Forecasts predict that India’s population will continue to increase for decades to come. The UN’s “medium variant” projection puts the peak of growth at 1.7 billion people in 2064. “Low variant” projections would see the growth curve start to flatten in 2047.

As they are, efforts from the Indian government are slowing population growth at an increasingly rapid rate, but data indicates family planning has a greater role to play. There remains a significant gap between the wanted fertility rate (number of children women want to have) of 1.6, and the actual fertility rate of 2.

“We would hope to see a situation in which all pregnancies are wanted and that people have the capacity to make a choice [to get pregnant],” Currie says. “If that were the case, then we would see a lower fertility rate in India.”

In addition, a population growth spurt looms: nearly half of the Indian population is below the age of 25, likely to have children of their own in coming years.

At the moment, many of this demographic lacking vital information about contraceptives, Choudhuri says. “There’s a prejudice that comes with the family planning programme – because it’s called family planning many people feel that it is not aimed at them. The adolescent population needs to be brought into the contraception conversation. Right now, they are excluded, and that’s alarming.”

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Judge Snot Boogie Steals Obamacare Preventive Medicine Rules, At Least For Now

A federal judge in Texas yesterday blocked the part of the Affordable Care Act that requires insurers to provide free preventive services to policyholders. Stuff like cancer screenings and screenings for high blood pressure and depression, plus some pregnancy-related care, as well as “pre-exposure prophylaxis” against HIV (PrEP), medicines that prevent people from getting the AIDS virus. US District Judge Reed O’Connor is the same dipshit who back in 2018 ruled that the ACA itself was unconstitutional, which was generally considered one of the stupidest, flimsiest legal decisions ever. (The Supreme Court eventually knocked down that ruling, as you may have noticed since Obamacare is still very much a going thing.)

O’Connor may be an idiot, but he’s a popular idiot with rightwing activists: He rules on flimsy grounds in favor of nutty ideas, his rulings get overturned on appeal, and then more wingnuts bring him more crap ideas to rule on. He’s a bit like poor Snot Boogie, the dead guy in the foreground of the first scene of The Wire. Snot Boogie joined every craps game he could, and at some point during the game, he’d always try to steal the pot, leading to an inevitable beatdown. Everyone knew he was going to do it, and he knew he’d never get away with it. Baltimore PD Detective Jimmy McNulty asks one of the witnesses — who saw nothing, of course —why everyone put up with Snot doing that, and we get the answer that frames the entire series: “You got to. This America, man.”

That’s basically what’s up with Judge O’Connor, too, only as gross political farce, not police drama.


O’Connor already ruled last fall that companies wouldn’t have to cover PrEP treatments if they had “religious” objections, and that the federal task force that recommends preventive services to be covered by Obamacare was illegal because its members were supposedly appointed in violation of the Appointments Clause of the Constitution. Yesterday’s ruling blocks the government from enforcing those parts of the ACA.

The lawsuit had challenged some other parts of the ACA involving other federal panels, but O’Connor let those stand, meaning that the ACA mandate for free contraception will remain in place — at least until someone in Texas comes up with a different creative challenge and shops the case to O’Connor.

As Reuters explains, the lawsuit challenging preventive care was

brought by eight individuals and two businesses, all from Texas. They argued that the free PrEP requirement requires business owners and consumers to pay for services that “encourage homosexual behavior, prostitution, sexual promiscuity and intravenous drug use” despite their religious beliefs.

They also said that the advisory body that recommends what preventive care should be covered, the Preventive Services Task Force, is illegal because its members are not directly appointed by the president, which they argue is required by the U.S. Constitution. The task force’s recommendations automatically become mandatory under the Affordable Care Act.

As the Washington Post points out, the ruling “applies nationwide immediately,” but there’s a big but there, because the Department of Health and Human Services, which administers the ACA and is the defendant in the case, is nearly certain to “ask the court for a stay preventing the ruling from taking effect while the Biden administration appeals the ruling.”

For the moment, the Post explains, insurers and employers will have to decide what to do about the popular coverage for free services. Some may continue it, assuming it’ll be restored eventually on appeal, but some may decide to stick employees for some or all of the cost.

Ironing that out, and quickly, will be a priority for the Biden administration, because HHS estimates roughly 150 million Americans with private insurance, plus another 80 million on Medicare or Medicaid, have been helped by the ACA’s preventive services.

The Health Affairs blog explains that the lawsuit involves a cast of characters already familiar to those who follow rightwing legal fuckery (our word, not theirs):

In the Houston suburbs, a right-wing megadonor and conservative activist named Dr. Steven Hotze owns a wellness center that employs about 70 people. Dr. Hotze is a Christian and is unhappy that the Affordable Care Act requires the insurance that he offers to his employees to cover pre-exposure prophylaxis (PrEP) drugs that prevent transmission of HIV. In his view, the drugs “facilitate behaviors such as homosexual sodomy, prostitution, and intravenous drug use,” which conflicts with his religious beliefs.

Dr. Hotze has a checkered history. In addition to opposing equal rights for gay people, he called on the Texas governor to “shoot to kill” if Black Lives Matter protesters “start rioting” in the wake of George Floyd’s murder. And in 2021, Dr. Hotze was indicted for his role in a bizarre “citizen’s arrest” in which he allegedly paid a private investigator more than $250,000 to run an air conditioning repairman off the road. Dr. Hotze apparently believed that the repairman’s van held 750,000 fraudulent ballots for the 2020 presidential election. (It did not.)

Before he was indicted, Dr. Hotze filed suit before Judge O’Connor in the name of the management company, Braidwood, that employs his workers. (That’s why the case is captioned Braidwood v. U.S. Department of Health and Human Services.) Hoetz’s lawyer is Jonathan Mitchell, the legal mastermind behind S.B. 8, the Texas law that effectively banned abortion in Texas even before the U.S. Supreme Court overruled Roe v. Wade.

If you ask us, Hotze and Mitchell and Judge Snot Boogie should all be remanded to a satire about health insurance where they can’t do any harm in the real world.

But what comes next? If O’Connor’s ruling isn’t stayed, Health Affairs says many insurers and employers will continue not charging, since most preventive care is inexpensive, and, as the name suggests, prevents more costly illnesses later. But there’s no guarantee of that. The appeals process could take as long as a year, and then likely another year to get to the Supremes.

We have to go through all this, because that’s how the game works. Congress could simply clarify the law and fix the little glitches that rightwing law firms pick at, but that’s easier said than done. Eventually, and no doubt after some people have died who didn’t have to, maybe it’ll get fixed. Or not. This America, man.

[Reuters / Lawdork / WaPo / Health Affairs]

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Florida Bill Doing Best To Out-Worst All Other Bans On Gender-Affirming Care

As Yr Wonkette covered yesterday, and as brought to our attention by the invaluable Erin in the Morning, the state of Florida (Motto: “America’s Useless Appendage”) is considering a whole swath of terrible legislation that if passed, would make life even more miserable for LGBTQ+ people there. It’s understandable, really — there are so many Republicans in the state Legislature, and they all want a turn at proving that they can hate LGBTQ+ folks as much or more than their peers.

Read More:

Florida LGBTQ Hate Bills Want Some Bigot To Have ‘Parental Rights’ Over Everybody Else’s Children

Red States About Five Minutes Away From Legalized Lynching Of Trans People

What IS Gender Affirming Health Care For Kids Anyway, Because Texas Is Super F*cking Lying About It Right?

Today, we’ll take a closer look (again, thanks to Erin Reed) at just one of those very bad ideas, Florida HB 1421, which drunkenly tells other states’ bans on gender affirming care for trans youth, “Hold my beer” before jumping on a skateboard and launching itself into the abyss. A Florida House subcommittee yesterday voted to move HB 1421 out of committee. After hearings in a second committee, the bill is likely to be sent to the full House, where it’s likely to pass. It’s Florida, and Republicans have an 85-35 majority of seats.

It’s not only an extremist bill, it’s also so broadly written that in attempting to outlaw gender-affirming care for minors, it also may make mastectomies for breast cancer illegal and ban hormone treatments for menopause. We can’t entirely guarantee that’s a mistake. The bill doesn’t simply ban gender-affirming treatment going forward: It would force detransition on trans youth. All minors currently receiving puberty blockers or hormone replacement therapy would have to end treatment by December 31 of this year. Such forced detransitioning is almost certain to lead to suicides, not that the psycho bigots supporting the bill care.

As ever: If you’re having thoughts of harming yourself, call the national suicide and crisis lifeline at 988.

This being Florida, the bill keeps getting worse. One provision would allow the state to take trans kids from their parents to “protect” them from getting gender-affirming care in another state.

As with several similar bills around the country, the law also forbids insurance plans from covering gender-affirming care for adults, because the bill’s sponsor, the dubiously named Rep. Randy Fine — a former gambling industry executive, not a doctor — says he believes all medical care for trans people is merely “a cosmetic-type procedure, and not necessarily a procedure that would improve their health.” Yes, of course he’s ignoring the consensus among medical organizations that transition is the treatment for gender dysphoria, and that, yes, it saves lives.

Because the bill bans the state from paying for any gender-affirming care, it would also result in forcible detransition for incarcerated trans people. The bill’s sponsor was very clear on that when another state representative asked. Further, the blanket prohibition on puberty blockers and hormone therapy would probably prohibit some treatments for stunted growth in children. Another legislator said that, as she read the bill, it may ban contraception for minors, although Fine said he didn’t think it would.

HB 1421 also prohibits any changes to birth certificates to reflect an adult’s gender identity. State Rep. Kelly Skidmore (D) had questions about why a bill supposedly aimed at “protecting” children would do that; Fine (again, not a doctor) explained that “your biology cannot be changed,” to which Skidmore replied, “Doctors would disagree. […] You can change your biology. That’s the point of gender-affirming care and surgery.”

Fine then muttered something about chromosomes, which kind of ignores the fact that hormone therapy very definitely changes a person’s biology, what with the differences in hair growth, body chemistry, and so on. But not chromosomes!

Fine went on to explain that gender-affirming care for minors is “child abuse,” although he acknowledged that’s his personal opinion, not actually a law. But co-sponsor Rep. Ralph Massullo — who somehow is a doctor — insisted it was just like “If you chop your sons arm off it’s child abuse,” so there’s a doctor who knows his stuff. Massullo also explained, contrary to the medical consensus, that since gender dysphoria is all in trans people’s heads, they should see a therapist and get cured through good old conversion therapy, which doesn’t work.

The most glaringly insane part of the bill is the former gambling executive’s medically muddy definition of “gender clinical interventions,” a term that isn’t actually from medicine. HB 1421 defines such interventions as

procedures or therapies that alter internal or external physical traits.

The term includes, but is not limited to:

1. Sex reassignment surgeries or any other surgical procedures that alter primary or secondary sexual characteristics.

2. Puberty blocking, hormone, and hormone antagonistic therapies.

The bill allows a few exceptions, such as for treatment of infants born with ambiguous genitalia, and of course for treatments to reverse gender-affirming care, but that’s about it; as House Democrats pointed out, the broad prohibitions on altering “primary or secondary sexual characteristics” appears to ban mastectomies, breast reduction or enhancement, maybe prostate surgery, and who knows, maybe even penile implants for treatment of erectile dysfunction.

But wait! Since it only applies to minors, Fine figured that wouldn’t be a problem. During questioning by state Rep. Christine Hunschofsky (D), Fine was surprised to hear that minors can even have breast cancer, though he remained skeptical of that anyway, and mocked what he said was the “pervasive problem of youth breast cancer.” Probably just an excuse to get top surgery, right sir?

Oh yes, and because it’s so sloppily written, the bill would also ban insurance from covering breast cancer mastectomies — for adults too, since the insurance ban is for all “gender clinical interventions,” regardless of the patient’s age.

Will Larkins, an 18-year-old high school student, testified against the bill, telling the committee members that his transgender friends would be directly harmed by the bill, not “protected.” He begged the lawmakers to at least agree to a Democratic amendment that would allow youth who have already begun treatment to continue it.

“That health care has saved their lives. You will kill them. I am telling you right now — look me in the eyes — you will kill them if you pass this bill and you don’t pass this amendment. […] You will kill them if you force them to detransition.”

The committee rejected the amendment, because there are no trans people in Florida, just punching bags to beat up on for the cameras.

This is where we wish we could tell you that HB 1421 is so obviously unconstitutional that there’s no chance it will pass and be signed into law, but you’ve been here for a while and you wouldn’t ever fall for a hopeful lie like that. We don’t even think they’d listen to our new hero, Grace Linn, that wonderful centenarian wonder woman. But who knows? Bet she’d make a trans lives matter quilt if she thought it would help.

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Contraception in Europe, why is it only free in some EU countries?

Contraception is known to prevent unwanted pregnancies and, in the case of condoms, protect against sexually transmitted infections (STIs). When it comes to contraceptives, male and female condoms are the most effective barriers to STIs including HIV, according to the WHO and the European Centre for Disease Prevention and Control. 

So, on International Condom Day, 2023, why is there still such disparity in access to contraception around Europe? 

The European Parliament encourages safeguarding access to contraception. As recently as 2021, a parliamentary report on sexual and reproductive health stressed that all member states are encouraged to provide universal access to contraceptive methods and address any barriers.

Yet government policies across the European Union continue to vary.

Financial inequality between western and eastern member states is believed to be part of the problem. Neil Datta, Executive Director of the European Parliamentary Forum for Sexual and Reproductive Rights told Euronews: “In east European countries, up until the early 1990s, contraception was not very well known, it was not very accessible so, we are still dealing with the legacy of that even today.”

Recommendations

The AIDS Healthcare Foundation has designated 13 February as International Condom Day. It says the event was created to encourage safer sexual practices on an international scale and promote the use of contraception to prevent unintended pregnancies and STIs.

The EU mirrors this message and has also called on public authorities to ensure students in schools are given a rounded education on sexual health. It calls for professional counselling to be provided on a range of contraceptive methods in line with standards set by the World Health Organization.

But, these are recommendations and the 27 Member States are not obliged to act on them.

“Governments have not been very proactive in thinking about their policies in relation to contraception,” said Datta. He went on to explain that some countries are also against wider contraception policies, based on the idea that encouraging the use of contraception will have a negative impact on fertility rates.

‘Best accessibility’

The Contraception Policy Atlas, designed by the European Parliamentary Forum for Sexual and Reproductive Rights, breaks down contraception policies in 46 countries across Europe. Its findings suggest that France has the best access to contraception, counselling and the highest availability of online information services out of all EU Member States. Accessibility was rated at 93.2%. 

France announced its pharmacies would provide free condoms to people aged 18-25 from January 2023 after health authorities discovered that the number of STIs in France increased by 30% in both 2020 and 2021. A programme providing free STI testing and the emergency contraceptive pill has also been rolled out.

In Ireland, free condoms are available to people of all ages through sexual health clinics and some third-level colleges. In addition, from 1 September 2023, free contraception will be given to 16-year-old girls and to women between the ages of 26 and 30 as part of the national budget. The national health service has also announced it will spend €500,000 on condoms and lubricants as part of an ongoing campaign against “crisis pregnancies” and STIs – amounting to 1.5 million free condoms every year.

Germany also announced that it wants to follow France’s lead and finance condoms through its national health insurance. For now, though, contraception comes at a cost through the national health scheme, although special provisions cover birth control pills and emergency contraception for adolescents up to the age of 22.

‘Lowest accessibility’

The Contraception Policy Atlas puts Poland at the opposite end of the scale, with a rating of just 33.5% in terms of public access to contraception. Emergency contraceptive pills need to be prescribed by a doctor and are not available over the counter in pharmacies.

Meanwhile, in Hungary, there is no publicly-funded website for contraception services and a prescription is needed for all contraceptive supplies except condoms and emergency contraception.

Role of politics and religion

“Policies on contraception influence people’s behaviours in accessing contraception. One aspect is whether it is covered by the respective national health system. If it is not covered by the national health systems then it creates financial barriers for individuals who want to use it” said Datta.

Religion is also an important factor, “most religions, Christian religions specifically, do discourage the use of contraception, particularly in the world of Catholicism. 

“So where those religions are very strong, the narratives out there which do discourage the use of contraceptives and religious actors can have influence over public policies” he added.

The right kind of sex education

Yet, in Europe as a whole, the unintended pregnancy rate has declined by 53% over the past 30 years, according to the Guttmacher Institute.

Some experts argue that one of the factors behind declining unintended pregnancy rates is the promotion of sex education in schools, which is widely encouraged by the European Parliament and the World Health Organization. 

“Comprehensive sexuality education teaches young people both about contraception and about respect and consent within relationships including sexual relationships. This has a very positive knock-on effect on people understanding how to prevent unintended pregnancies and how to protect their own health by being able to empower themselves to avoid sexually transmitted infections” said Datta.

Sex education remains a topical issue. In some countries, such as Ireland and France, it is a compulsory part of school education, but in Italy, for example, sex ed is optional.

Where available, education is often delivered through a variety of school subjects as part of a cross-curricular programme. Various aspects are taught through biology, home economics and social sciences.

Yet sex education does not necessarily provide students with information on contraception methods.

Natalie Picken, an analyst for the RAND Corporation, a non-profit specialising in improving policy and decision-making through research, told Euronews that education on contraception is only included in the sex education curriculum in some EU countries.

“It is likely that the content, nature and extent of these programmes varied considerably between regions, schools, and classes” she added.

Picken’s research found that most EU members have limited teacher training opportunities in sex education, despite its benefits. 

“There is strong evidence that sexuality education can lead to reduced risk-taking, delayed initiation of sexual intercourse, and more use of contraception and condoms and generally improves young people’s knowledge and attitudes around sexual health,” she said.

How can EU countries bridge the gap?

Implementing better access to contraception can be costly but there are ways authorities can get up to speed. 

“One easy quick fix that is accessible to any government would be to provide government supported information for example via a website which provides authentic, authoritative information… that is within the capacity of each government no matter how strapped it may be”, concluded Datta.

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