Giving RH Reality Check a Reality Check on Alternative Contraception


This response to an article published yesterday by Jaz was originally published by hmprescott at her blog, and linked in an RH Reality Check diary. We feel it is important to profile it here.

Note to readers: The Editors agree with concerns about the scientific viability/efficacy of the method described in the article critiqued here. In this case, however, we provided leeway for the original author to make her case, anticipating that it would spark a healthy and respectful discussion about efficacy and methods.  We encourage others to weigh in.

In an article entitled “A Natural Alternative to the Pill?” a “social media professional/Twitter lover” who goes by the name “jaz” expresses some healthy skepticism about the outpouring of praise surrounding the 50th anniversary of the Pill.

Unfortunately, the article contains a lot of misinformation as well.  So, here’s a reality check.

First, Jaz claims that  “With the Pill off the table, we are left with very few options besides condoms (or diaphragms and cervical caps which are essentially out of existence and have lower effectiveness rates), or more permanent solutions like the IUD and sterilization which do not make sense for younger women or women who want to have children in the next few years.”

According to this table, male condoms have a 2 percent failure rate if used “perfectly” — i.e. every time a couple has intercourse, and the condom doesn’t break or fall off.  Diaphragms have a 6 percent failure rate.  IUDS are not the same as sterilization either.

Second, the article tries to suggest that herbal contraceptives are effective. Jaz discusses an herb called wild carrot (aka Queen Anne’s Lace) and mentions the work of Robin Rose Bennett which “has been surrounded by controversy and naysayers in her efforts to bring this to American women.”  Well, count me in as one of the naysayers.  Even Bennett says that her study was unscientific, i.e. was not a controlled clinical trial.  Her sample was also very small — only 13 women — and three of them became pregnant.  So far, not a good alternative to barrier methods.

Jaz implies that this natural remedy is safer than oral contraceptives.  According to Bennett, wild carrot is an estrogenic herb — in other words, it contains the same chemical as many birth control pills.  So, the same contraindications for use of oral contraceptives would apply to wild carrot.

The underlying assumption of the article is that natural remedies are safe because, hey, they’re natural.  Well, those who are looking to try this method on their own better be sure they can tell the difference between wild carrot and poison hemlock.  Even jaz says she’s “a little wary of making my own contraception, since it’s more serious than making a smoothie or a mojito, though I do want to experiment with my inner alchemist and my green thumb!”

She should be just as wary of herbal treatments prepared by so-called experts.  Since herbal remedies are considered dietary supplements,  they not regulated by the FDA as are drugs.  This means no one is checking to make sure the health claims are valid.  Also, there is no national system of licensure or certification for herbalists.  This means that anyone can hang out a shingle and call her/himself an herbalist.

[NB: if you take St. John's Wort be aware that it can interfere with the effectiveness of oral contraceptives].

So, while I agree with jaz that “women deserve to have a wide range of options readily available to make the ideal decisions for their bodies and sexual health,” they also need accurate and reliable health information.  RH Reality Check usually does this and gives guides on how to detect inaccurate information.  In their section, “Fact v. Fiction,” the editors write:

“One trademark of the far right is misinformation. They make ideology sound like fact, belief sound like scientific data. We bring you the most widely circulated fictions about reproductive health, and the facts and resources to dispute them. If you are confused about how to determine if a study is real, this primer provides you with a great framework to evaluate any research study you read.”

Too bad the editors of the site didn’t apply these same criteria to misinformation from the left.  Women deserve better.

Disclosure: My research is funded by the National Library of Medicine and the Connecticut State University American Association of University Professors Research Grant.  I have no financial ties to pharmaceutical companies of any kind.

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  • hmprescott

    Thanks for posting this.  I look forward to having a discussion about this.

  • nycprochoicemd

    I think there’s some element of wanting something that seems natural behind this, but I also think women really like the idea of having everything within their control: no need for a doctor’s appointment (or “permission”), no need to worry about what a pharmacist might think about the prescription, no need to worry about paying for it.  This makes it a personal decision that only she makes, either on her own or with her partner.

     

    As others on this site have noted, there is a very patriarchal element to contraception.  Its use is controlled by doctors, and many women are not presented with all of their options but rather presented with what the doctor thinks is best for them given their age and life circumstances (ie, all teens get depo-provera, college students get nuvaring, older women or those who have had many children get sterilized or an IUD).  Women who turn to long-acting methods must even see a doctor to *stop* using the method. 

     

    I suspect this is part of the reason more women have not chosen long-acting methods (such as Implanon, Paragard IUD, or Mirena IUD).  We in the medical profession are trying to get everyone to use these methods because they are long-lasting, not subject to fluctuations in insurance, and do not require ongoing appointments with physicians.  Women have been slow to follow us in our enthusiasm.

     

    I hope that physicians will get better at contraceptive counseling and women will feel more in control.  I also hope we can get approval some day to offer oral contraceptive pills over the counter, without a prescription.  I doubt we will be able to get them available on the regular pharmacy shelf, but there might be hope of getting them behind the counter (must ask for it from the pharmacist).

  • crowepps

    That failure rate is 23%, higher than ‘ovulation monitoring’ which to me seem to make it unacceptably risky for someone who is serious about not wanting to get pregnant. In addition, is there any information about the effect on the fetus of use in the grey area between conceiving and being awate one has done so?

     

    I think there is a unmet demand for a woman controlled birth control method that is non-prescription, non-physician, and PRIVATE, but that is more because girls and women don’t want to risk being subject to the harsh judgmentalism that SOME physicians and pharmacists loudly announce as their ‘conscience right’.

     

    I absolutely agree everyone has a right to do only what comports with their conscience, but I also think professional ethics requires such persons to disclose their position up front instead of individually embarassing and shaming women who express their (legal) need.

  • jaz

    As I wrote in the comments section of my post, my hope is to stimulate discussion and critical thought. I’d like to reiterate, even though I say this throughout the post, that wild carrot is something that has worked for ME. I do not say anywhere that it is a cure-all and should replace the pill. I also mention that the effectiveness is questionable, controversial and something that is currently being studied. I am not telling anyone to drop their current methods and run towards wild carrot but for women who have experienced issues with hormonal contraception, it may be a viable option. It has been for me, and I clearly speak for myself. 

    I appreciate this post because the research is important but I am not blind to the condescending language. I stand by my words. The FDA doesn’t approve many natural remedies that are effective because of Big Pharma, but that doesn’t discredit the knowledge and work of many trained and well-educated herbalists who actually heal people. I am well aware of the controversy around the studies and why women may not be comfortable with this method. I am just as uncomfortable with hormonal and chemical methods. This is something that I have been questioning and looking into for years because the bottom line is that a significant amount of women are unhappy with the current contraceptive options. Women having access to contraception that is both effective and works with (and not against) their bodies, no matter where it comes from, is the goal and I believe we can agree on that. 

  • hmprescott

    In response to NYProchoiceMD — I’m working on a book chapter for an edited volume on the history of the prescription on the history of discussions about making oral contraceptives available over-the-counter (see my blog for a preview).  This was first raised in the early 1990s by reproductive health professionals and officials at FDA at the prompting of oral contraceptive manufacturers.  There were objections from religious conservatives, but also from feminist health activists such as Judy Norsigian who were concerned that women who were at risk for complications would not be adequately screened.  Others made the argument that contraceptive screening at Title X clinics was a poor woman’s ticket to health care.

    In response to jaz’s comments about the FDA — the agency only approves methods that have been proven to be safe and effective through controlled clinical studies.  The study you mention is based on anecdotal evidence. The NIH has a center for alternative and complimentary medicine that funds scientific studies of alternative medicine.  So, the herbalist conducting this study could apply for funding through this agency.  As it is, her research  does not meet the scientific standards required by NIH or FDA.  For example, she has no controls, and her approach to human subjects research appears haphazard.  Researchers funded by NIH are supposed to recruit diverse populations (including members of minority groups and children/adolesents) and have to provide complete information about the risks and benefits of a particular treatment.  Based on the information on her website, she doesn’t appear to be doing that.

  • crowepps

    The FDA doesn’t approve many natural remedies that are effective because of Big Pharma,

    I beg to differ with you here – the FDA does not proactively go out and LOOK for remedies – instead persons who wish to have remedies approved as safe and effective APPLY for review.  People who are promoting natural remedies, almost all of which are NOT legally classified as ‘medicines’ but insteadl, like vitamins, as ‘dietary supplements’, can be scrupulous researchers using well constructed double-blind studies that lead to convincing evidence OR they can be snake-oil salesmen selling expensive bottles of swamp water, but very, very rarely do they ever apply for FDA review.

     

    As a matter of fact, 2010 is the year in which the new regulations finally effect everyone where the FDA can inspect whether supplements are “free of contamination and contain exactly what the label says”.  Regulations which were passed by Congress in 1994 in the face of vehement protests from many ‘natural remedy’ manufacturers who said ‘trust us’.

     

    http://www.nytimes.com/2007/06/23/washington/23fda.html

  • deb-r

    You make some good points. there are a couple things that are of course part of the bigger problem of health care in this country: insurance companies deciding health care instead of Drs and patients and Drs who refuse to listen to their patients (as if they don’t know their own bodies!) I know a young woman(college student) who was doing fine on BC pill for 2 years–her moms insurance changed and new company refused to pay for her prescription–she had to try a generic or another cheaper brand(I don’t remember which) she started having depression, headaches, etc–told her Dr, he said it could not be from the new pill. She quit taking it and symptoms went away. Luckily her mom had the financial resources to be able to help her daughter pay for the pill that worked for her and was a mom who was more concerned with her daughter making it through college than to judge her for being sexually active! This is just one example of many that I know of. I could not do any kind of hormonal bc and am allergic to latex and spermicide–that did not leave me with a whole lot of options. I wanted to get a tubal ligation after my 3rd kid but could not afford it–assistance for that would be helpful too for those who are done with kids! One of the things that was brought up in another post on acupuncture for infertility is how so few women know how their bodies work. Alternative practitioners are often much more helpful in educating women. I did great for many years with using a combination of NFP and herbal medicine and learning to enjoy sex without intercourse–another area that is sadly lacking in education young people! I would not say any woman should use the herbal route unless they are willing to deal with a possible unwanted pregnancy but I also believe women need to know that their is traditional knowledge out there to help with preventing (or achieving) pregnancy. There is a lot of blatant cultural bias against health care that comes from any but western culture.