Where “Family Planning” Is Deadly

India’s controversial population control policies are in the news again now that a dozen women have died and many others have fallen ill after undergoing surgical sterilization at a government-run camp:

The women were paid 600 rupees apiece, or almost $10, said Dr. Amar Singh Thakur, joint director of health services in the central Indian district of Bilaspur. One surgeon performed surgery on 83 women in the space of six hours on Saturday — meaning he could have spent only a few minutes on each patient, Dr. Thakur said. The women began to fall ill around five hours after being discharged, Dr. Thakur said, experiencing giddiness, vomiting and low blood pressure. Sixty-seven women are being treated for septic shock in hospitals, and four are in serious condition and on ventilators, he said.

India’s sterilization drives began as part of a national population control policy under Indira Gandhi in the 1970s and continue today on a state-by-state basis. David Whelan emphasizes just how creepy this is:

In India’s pursuit of the dream birth rate, human beings are reduced to whole numbers, children to fractions and fallopian tubes to mobile phones. It’s become a weird meta-game for states, where their total fertility rate (TFR) is ​calculated, aggregated, and ranked. Rajasthan declared it would it would ​sterilize 1 percent of its pop​ulation during 2011 in exchange for mobile phones and lottery tickets for cars, like the monstrous Santa Claus of eugenics.

Basic human rights go out the window. In 2012, a single surgeon, Dr. Rajendra Prasad, conducted 53 sterilizations in Bihar without the aid of, oh, ​such trifles as running water or sterilizing equipment. One woman was apparently three months pregnant and miscarried 19 days later. In Uttar Pradesh ​you can trade getting snipped for guns, which is perhaps the most cynical population control ever conceived: Prevent people from reproducing and assist them in killing each other. Give whoever came up with that one the fucking Nobel Peace Prize.

On top of the obvious moral issues at hand, Dhiraj Nayyar questions whether such programs are even effective:

In fact, India’s fertility rates have been declining sharply for reasons that have nothing to do with sterilization programs. In 1971, the Indian average was 5.1 children per woman. That figure declined to 4.5 in 1981 and 3.6 in 1991; it now stands at 2.4, just above the level (2.1) at which a population stabilizes. Over that period, there has been no marked increase in sterilization programs; the government has focused more on building awareness about family planning and disseminating contraception. What has changed, especially after economic liberalization in 1991, are the living standards, rates of urbanization and education levels of the population.

Filipa Ioannou touches on the class dimension of sterilization-based family planning programs, both in India and elsewhere in the developing world:

This sadly probably goes without saying, but: India’s sterilization initiatives are disproportionately pushed upon the relatively powerless rural poor. In 2012, 53 women were sterilized in a single two-hour period in the state of Bihar; the operations took place in a middle school without access to running water or sterilizing equipment. Bihar has the lowest per-capita income in India; as of the 2011 census, it also had the lowest literacy rate. In 2013, the state said it planned to open 13,000 sterilization camps—temporary field hospitals where procedures are performed en masse. And last year in West Bengal, the fifth poorest of India’s 29 states, more than 100 women were dumped unconscious in a field after a mass sterilization gone wrong at a hospital that could not accommodate their numbers. When questioned in parliament, health officials said that in the period from 2009 to 2012, the government paid compensation to families due to 568 sterilization-related deaths.

The Pill’s Guinea Pigs

Ann Friedman reviews Jonathan Eig’s The Birth of the Pill. The book doesn’t shy away from the ethically dubious parts of the pill’s development:

Initially, [fertility expert John Rock and researcher Goody Pincus] sought out healthy American women for the hormone trials but didn’t tell them they were testing a possible contraceptive, or what the risks were. (At the time, there were no rules governing medical testing.) Nurses at the city hospital refused to participate. Inmates at a women’s prison refused.

Rock and Pincus finally found a couple of takerswomen who hoped their participation would contribute to fertility researchbut due to side effects like nausea, dizziness, and breast tenderness, as well as a demanding schedule of invasive checkups, most of those women dropped out of the study. And so Pincus and Rock decided to take their trials to Puerto Rico, where contraception was entirely legal and abortion readily available (wealthy American women with unwanted pregnancies would fly there for a “San Juan weekend”), due in large part to concerns about overpopulation on the island. McCormick worried that Puerto Ricans couldn’t be trusted to follow the testing regimen, and Rock was concerned he wouldn’t find “ovulating intelligent” women there. But, the researchers assumed, women there would be more compliant test subjects.

Their racist paternalism had real consequences, arguably hindering the development of the pill. Women in Puerto Rico dropped out of the study, too, and so they started looking for women they could force to participate, both at home and in Puerto Rico. Women locked up at a Massachusetts mental asylum were signed up. Women enrolled in medical school in San Juan were told they had to take part in the medical test or face expulsion. Many dropped out rather than comply.

Eig explains how the researchers got FDA approval:

This is the first pill ever created for healthy women to take every day. There’s never been anything like this and the idea of seeking FDA approval for something women are going to take every day without studying it for years and years and checking out the long-term side effects, this is scary stuff! But Pincus also feels like he’s racing the clock, that if the word gets out about this and the Catholic Church and the federal government realize what they’re doing, the opposition will mount and he’ll have no chance of getting it through. …

In 1955, when they’ve really only tested the pill on maybe 60 women for more than say, six months or a year, Pincus goes to a conference and declares victory. He declares that we’ve invented the pill. The media picks up on this and it becomes this huge story. … Thousands of women are writing to their doctors and writing directly to [Pincus and Rock] saying, “I’ve heard about this pill and I need it, I need it now!” … There was this huge outpouring and it had a huge effect on Pincus and on the other scientist working on this because they began to see there was an enormous demand for this and they began to see they had to push harder, they had to go fast.

Rand Paul Stands Up For Emergency Contraception

 has details:

While on a college tour in South Carolina [last] week, a red-headed woman in a baseball cap asked Paul if drugs that prevent conception, like Plan B, should be legal. Paul, leaning gracelessly on the side of the podium, stated matter-of-factly: “I’m not opposed to birth control.” He paused and shrugged. “That’s basically what Plan B is. Plan B is taking two birth control pills in the morning and two in the evening. I’m not opposed to that, or don’t think there should be any laws opposing that.”

As reported by The Daily Beast, Paul’s statement resulted in the prominent social conservative Tony Perkins, president of the Family Research Council, attacking him on Twitter — which left Team Paul “fuming.”

Suderman puts Paul’s remarks in context:

The GOP probably won’t come out as the party of gay rights and the pill in time for the 2016 election, but those issues won’t be front and center. If anything, judging by the Summit, most Republican politicians are likely to try to avoid talking about gay marriage whenever possible. And when it comes to contraception, many will emphasize support for greater access by making it available over-the-counter.

The causes behind the Republican party’s shift are complex—changing social norms, the shifting demographics of the electorate, and the decline of religiosity in American life are all factors. But rather than trace the reasons for the transformation, I think it’s worth dwelling briefly on how rapid and drastic the shift on these issues, especially gay marriage, has been, and what that shift suggests about the stability of internal power dynamics in political parties.

But Ryan Lizza has a hard time squaring Paul’s comments with his support of the Life at Conception Act:

In my recent Profile of Senator Rand Paul, Dr. John Downing, the Senator’s friend and former medical partner, expressed his worries about Paul’s sponsorship of the Life at Conception Act, also known as the personhood law. The bill would ban abortion and grant the unborn all the legal protections of the Fourteenth Amendment, beginning at “the moment of fertilization.” To Downing, who is an ardent Paul supporter, this seemed like political madness. Downing said that he believed Paul’s personhood law would make some common forms of birth control illegal, and thus doom Paul’s Presidential hopes. “He’s going to lose half or more of women immediately once they find out what that would do to birth control,” Downing told me. …

As with so many other issues—the Middle East, civil rights—Paul has placed himself in a political vise on the question of when life begins. His views on personhood will be savaged by Democrats if he runs for President; and his casual endorsement of Plan B has antagonized leading social conservatives who were already highly skeptical of his pro-life bona fides.

The Most Reliable Birth Control We’re Not Using, Ctd

Rebecca Leber flags some new medical advice for teens: “The American Academy of Pediatrics has just revised its official position on birth control: The academy’s new guidance advises members to recommend intrauterine devices (IUDs) and progestin implants as the most effective birth control methods available”:

The announcement, which appears in the flagship journal Pediatrics, is important for its own sake because it’s likely to change patterns of medical practiceand reduce the incidence of pregnancy. It’s also important for what it says about the ongoing controversy over who should pay for contraception. …

IUD usage in the U.S. is still fairly rare in the United States, especially among teens (just 3 percent of teens rely on IUDs). But that is finally changing, rising from just 2 percent to 8.5 percent between 2002-2009. One likely reason that may continue to change is, under the Affordable Care Act, all insurance policies must cover birth control fully, without extra out-of-pocket costs. Implanting an IUD is expensiveit can run several hundred dollars, without insuranceso the coverage makes a difference.

Some conservatives might bristle at the idea of pediatricians counseling teens about sex. But the new guidelines make clear that “Adolescents should be encouraged to delay sexual onset until they are ready.” The problem, the article explains, is that “existing data suggest that, over time, perfect adherence to abstinence is low (i.e., many adolescents planning on abstinence do not remain abstinent).”

Julia Lurie explains why this is such a big change:

It’s no secret that a lot of teens have sex; according to the report, nearly half of US high school students report having had sexual intercourse. Each year, 750,000 teenagers become pregnant, with over 80 percent of the pregnancies unplanned. But the recommended AAP guidelines are a huge step away from the current practices of the 3.2 million teenage women using contraceptives; in fact, it seems that the frequencies with which teens use contraceptives are inversely related to their efficacy.

Lurie notes that “male condoms are by far the most frequent choice of contraception, with over half of teenage women reporting condom use the last time they had sex. According to the Centers for Disease Control, condoms have an 18 percent failure rate.” IUDs, on the other hand, “can prevent pregnancy for up to 10 years with a failure rate of less than 1 percent.” Meanwhile, James Hamblin homes in on the economic impact:

The United States has more teenage pregnancies than any other wealthy country, and the cost of that is around $11 billion every year─in the form of public assistance, care for infants more likely to suffer health problems, and income lost as a result of lower educational attainment and reduced earnings among children born to teenage mothers. So it’s especially interesting that only about 4.5 percent of women 15 to 19-years-old currently use LARC [IUDs].

Previous Dish on the devices herehere, here, and, more recently, here.

“Uber For My Uterus”

That’s what Kat Stoeffel calls a new program from Planned Parenthood. Marcotte explains:

Now, patients in Minnesota and Washington will be able to talk to a nurse online and even get their birth control medication mailed to them at home in an unmarked package. In October, the program will be expanded to STI consultation, and even mail-order medications for chlamydia. There’s even a phone app!

“The service is expected to be especially appealing to clients living in rural areas who don’t have ready access to a clinic,” writes Dan Browning at the Minneapolis Star Tribune. But it’s not just access that’s likely appealing to those people. The Planned Parenthood website highlights that the service is “discreet.” This is great for those who would rather not be seen going into a family planning clinic or picking up a package with the iconic round birth control pill dispenser at the pharmacy. Discretion can also be critical for young people living at home who don’t want their parents to know that they’re sexually active. (For STI services, the promise of discretion is likely an even bigger draw.)

Tara Culp-Ressler cites an example:

Right now, since women need to visit a doctor’s office in person to obtain a prescription for birth control, they can end up in a tight spot if they can’t get an appointment in time, especially if they live in a rural area. [Sarah Stoesz, the president and CEO of Planned Parenthood in MN, ND, and SD] told the Tribune that the first woman to take advantage of Planned Parenthood Care ran out of birth control pills and couldn’t see her regular physician soon enough; fortunately, she discovered this new option online.