Courtesy of Annika Bjerke ’19

April 15, 2019

GROSKAUFMANIS | What to Expect When You Don’t Want to Be Expecting

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It took Cornell senior Maddie* three doctor’s visits to find a birth control option that worked for her. While trying to find the right contraception, Maddie worried about how different forms might affect her recovery process from eating disorders. Weight gain and mood changes were among her concerns, but her main focus was which option would allow her to keep a regular, monthly menstrual cycle — something that can be an important indicator of appropriate weight and overall health for those in recovery.

Although her medical records indicate a history of anorexia, Maddie said her experience with it didn’t come up in visits until she finally brought it up herself during her third appointment. After reading a study on how different forms of birth control can be better suited for those with anorexia, she felt compelled to raise the issue. “I knew what to ask for on my own because luckily medicine, and specifically women’s health, is what I study. But this isn’t the norm and it’s concerning to think how many girls approach birth control consultations with less information.”

Maddie’s story is just one of many that illustrates the often unspoken complexities of women’s reproductive health. I talked to other women between the ages of 18 and 25, many of whom were Cornell students, who felt that their experiences seeking out prescriptions were similarly complicated by different elements of their health profiles. Concerns related to mental health and hormonal side effects were among the most common.

It should be noted early on that the vast majority of birth control side effects are negligible compared to the side effects of a pregnancy. And birth control — despite the precarious future of its accessibility — has changed the world by facilitating family planning. The rate of unplanned pregnancies in the United States has reached a record low, as have the rates of abortion and teen pregnancy. In all of these developments, access to contraception has been instrumental.

Birth control, by and large, is a great thing. But that doesn’t mean that our information on it and access to it couldn’t be better.

When we think about birth control, we need to think about accessibility: what are the barriers — be it cost, age or social stigma — preventing women from getting birth control and how can those barriers be alleviated? But beyond the baseline of access, we should also be pushing for more quality information on contraception, including the pros and cons of different types.

Each of the physicians I spoke with for this column flagged a myriad of misconceptions that patients come with when seeking out prescriptions. While medical providers are an obvious source of immediate and accurate information, they alone can’t necessarily shoulder the burden of educating the public on every option, under every condition, for every person.

One might think that sex education in schools would be a logical place to begin combatting misconceptions, but limited curricula have rendered many initiatives counterproductive.  In 18 states, for instance, educators are required to teach that sex is only acceptable in marriage. And only 10 states expressly mention “consent” in their curricula.

The average age at which teens in the U.S. become sexually active is 17, but only 18 states and the District of Columbia require that information on contraception be provided during in-school sex education. While each of these specificities in curriculum may sound tedious, there is reason to believe that they are consequential.

For instance, in the states that are the most adamant proponents of abstinence only sex education, we see the highest rates of teen pregnancy. While some states are more progressive than others, we are failing on a national level to provide students with important information right at the time when they need it. And the information deficits we create at age 16 don’t necessarily self-correct in adulthood.

“Getting into the schools is really difficult,” said Dr. Sareeta Bjerke ’89, OBGYN, on her experience trying to contribute to the sex education initiatives of her school district in Connecticut. “For 20 years I have tried to discuss birth control in public schools but it’s too politically charged and there are too many parents who think that that is not the school’s responsibility.”

While New York State is relatively progressive on the birth control front — from allowing teens to seek out confidential services to its passage of the recent Comprehensive Contraception Act — there is still a ways to go. “In most places, our youth in the state are not receiving comprehensive, inclusive, age-appropriate information through sex education,” said Ashley McGuire from Planned Parenthood of the Southern Finger Lakes, noting that even within a state there can be sizable variation from school district to school district.

And just as there’s variation from school to school, there’s variation from doctor’s office to doctor’s office.

Elizabeth Marshall M.D., a chief resident of family medicine at the University of Michigan Medical School, said that conversations about birth control generally don’t take too long. “Let’s say someone came to my office for a cold but somehow birth control came up in the course of the conversation — I can go my through my general spiel in seven minutes.” This comprehensive spiel, Marshall said, includes everything from a presentation of different options to an assessment of a patient’s lifestyle factors that could make one option better than another.

Keeping it short and simple, for most patients, is ideal: with a straightforward medical record, there’s no need to make the process of prescribing birth control more complicated or less efficient than it needs to be. But the brevity of standard prescription processes only makes me more convinced of a need for more external information. Doctors can’t read patients’ minds, so it’s important for patients to come knowing what to ask.

In my conversations with Cornell students, I found a surprising gap in the information held from person to person. Some students who went to public school in progressive states or whose parents were physicians could give contraception spiels of their own. Others were more in the dark, including more than one who said they didn’t know IUDs existed until well into their college years. The onus is generally on women to handle contraception, assuming financial costs, inconvenience and any potential side effects. But in a country where our sex education is largely insufficient and access to health care is scattered, many women also are confronted with the additional burden of educating themselves on the issue.

*The subject’s name was changed to ensure their anonymity.

Jacqueline Groskaufmanis is a senior in the College of Arts and Sciences. She can be reached at [email protected]. The Dissent runs every other Tuesday this semester.