Asking Your Doctor about Birth Control

Studies have shown using contraception consistently and correctly reduces rates of unplanned pregnancy.

For many women, that is easier said than done. Complicated lives, medical issues, and safety concerns are important factors to consider when choosing the best birth control method. And what matters in the end is having a birth control method that meets individual needs.

SHAPE Magazine interviewed Section faculty Dr. Julie Chor about “3 Birth Control Questions You Must Ask Your Doctor”. Dr. Chor is an experienced contraceptive counselor, and in the article she advises all women to talk to their doctor about birth control options. She stresses the basics, such as asking how often you need to remember to take a form of contraception and if that realistically fits into your lifestyle.

Earlier this year, FitPregnancy asked Dr. Chor about the best postpartum birth control and she gave her expert advice about how IUDs help attain a healthy pregnancy interval.

Dr. Chor can answer your questions about birth control during her clinic hours at the University of Chicago Hospitals where she provides contraceptive counseling and family planning services. Make an appointment here.

 

Beneath the Drape: The Work of Gynecological Teaching Associates

In honor of International Women’s Week, the Ci3/Section blog is spotlighting the stories of our staff and constituents. Today, research specialist Erin Jaworski shares her past experiences as a gynecological teaching associate.

During graduate school at the University of Minnesota, I fell into an unusual line of work.  At the time, I was underemployed and soaking up as many diverse opportunities that I could balance while working towards a Masters degree in Public Health. If it hadn’t been for this reincarnation as a student in a new field and the resulting openness to novel experience, I probably would not have responded to the enigmatic request for “Patient Educators” hidden at the bottom of the University Women’s Center email and probably never would have begun work as gynecological teaching associate.

Unless you are a medical professional, it is unlikely you’ve heard of gynecological teaching associates or even imagined that such a line of work exists. A comprehensive discussion of the field could easily fill a very interesting book or at least a solid season of a cable television series. In brief, gynecological teaching associates, or GTAs, are laywomen specially trained in leading gynecological workshops for students in medical professions, using their own bodies to teach. Yes, their own bodies.

GTAs were introduced in the early 1970s by Dr. Robert Kretzschmar at the University of Iowa. Prior to the adoption of this instructional model, the medical establishment had a variety of sordid methods for instructing in these exams relying on anesthetized women, cadavers, or plastic pelvic replicas. I hope that time has obviated the need for elaborating on the heinous ethical and legal considerations of exploiting anesthetized women and cadavers. However, the historical use of inanimate pelvic models alone has it’s own unsavory implications, reducing women to not much more than their anatomy. Enter gynecological teaching associates, (consenting) women trained and paid to instruct in the delivery of competent and comfortable, patient-centered gynecological exams.

gta pic

Image courtesy of jezebel.com

Over the years, the gynecological teaching model has become a standard at medical schools across the country and their pedagogical value has been well documented. GTAs receive extensive training in physiology and anatomy, exam technique, and interpersonal communication. During a session, we will lead a group of students through the breast and pelvic exams providing real time feedback and instruction, while maintaining a focus on practicing strong patient-provider communication. The workshop content is broad and may span everything from using appropriate eye contact during the exam to identifying non-verbal indicators of discomfort or pain to navigating how to find and palpate those oh-so-elusive ovaries.

It probably goes without saying, but many of the students practicing the breast and pelvic exams for the first time are tremendously nervous. Beyond their fear of causing injury to another person and their desire to appear competent, they are confronted with the unavoidable reality of nudity, genitalia, and vaginal penetration—all hypersexualized and private domains in our culture. In these workshops, we offer an interactive and non-threatening learning environment that mitigates anxiety and fosters confidence by way of providing technical expertise, verbal feedback, and humor.

Many people are supportive of this work. However, I continue to be the recipient of my share of askew glances when I talk about leading the GTA workshops. Sometimes people perseverate on the awkwardness of being naked and examined by strangers or question the implications of “renting” your body to medicine.

On the contrary, I see this work as a rare opportunity for women to literally lead the study of and conversations about women and women’s bodies in the medical world. The evolution of Gynecological Teaching Associates is a history of female empowerment, from passive anatomies and medical exploitation to the creation of a unique, impactful model where women are the experts of their bodies and experiences. While, sadly, we’ve yet to reach an era where every clinician is sensitive and communicative and every well women visit is free of pain and embarrassment, GTAs are on the job. One exam at a time.

Erin Jaworski is a Research Specialist at Ci3 and the Section of Family Planning and Contraceptive Research.

Pregnant Teens Under Age 15 Have Unique Risk Factors: Study

The following is the text of a Reuters article summarizing a study conducted by Dr. Marcela Smid, a former OB-GYN resident at The University of Chicago Medical Center who conducted a study on pregnant teenagers with the support of The University of Chicago Section of Family Planning. This study was coauthored by Section chief Dr. Melissa Gilliam, Section faculty Dr. Amy Whitaker, and then-Section staff Summer Martins, MPH. The original story can be found here.

Girls who became pregnant before age 15 were more likely to report having sex with much older partners and initially forgoing contraception than their slightly older peers, according to a new study.

Nearly 36 percent of girls who first got pregnant before age 15 had sex for the first time with a partner at least six years older, compared to 17 percent of girls who got pregnant between 15 and 19.

That statistic “is very serious and represents complicated relationships with unequal power,” said lead author and obstetrician Dr. Marcela Smid, from the University of North Carolina at Chapel Hill. She worked on the study while at The University of Chicago.

To make better use of public health awareness and intervention campaigns, Smid and her team (Dr. Gilliam, Dr. Whitaker, and Ms. Martins) wanted to know more about how very young teens were at risk of becoming pregnant.

They used data from the National Survey of Family Growth collected between 2006 and 2010. A total of 3,384 women reported on the survey that they had their first pregnancy before age 20. Within that group, 289 women had become pregnant before age 15 and the rest between 15 and 19.

Girls who became pregnant before age 15 were twice as likely as older girls to be Hispanic or black, the researchers found.

Younger pregnant teens were less likely to have been living with both biological parents at age 14 and less likely to have been brought up within the Catholic or Protestant religions.

Only 25 percent of the youngest teen group reported using contraceptives the first time they had sex, compared to 56 percent of older girls.

While it is “a little bit easier to study live births with national survey and surveillance data,” those statistics don’t tell the complex story of pregnancies, Smid said.

Teen pregnancy study

Image: growingyourbaby.com

Many pregnancies among very young girls end in miscarriage or abortion, she noted.

“We know that their risk of poor pregnancy outcomes is the highest of any age group, even when compared with women who get pregnant at age 45,” Smid said.

In general, U.S. teen pregnancy rates have gradually declined, but, for the youngest teens especially, “any pregnancy rate above zero is too high,” she said.

About one in 1,000 girls under the age of 15 became pregnant in 2008, the researchers write in the journal Obstetrics and Gynecology. That compares with about 68 per 1,000 girls between ages 15 and 19.

The researchers also found that 89 percent of the under-15 group did not want to become pregnant in the first place, compared with 75 percent of teens between ages 15 and 19.

“There are still things we don’t know,” Smid said. “For example, we looked at the first sex experience, but we don’t know the circumstance or the partner involved in the first pregnancy.”

“Measuring pregnancy intention is an extremely complicated thing to do,” said Phillip Levine, an economist at Wellesley College in Massachusetts who has studied teen pregnancy.

“Asking someone years after the fact what was going on in their minds during the act – that’s difficult to untangle,” he said.

Women in the new study were in their early 30s, on average, when asked about past pregnancies.

Levine also noted that for some girls, tough economic and family situations mean there’s not much of an incentive to avoid early pregnancies.

“What we need to consider to fix the problem is think about how these disadvantages contribute to teens becoming pregnant,” Levine, was not involved in the current study, told Reuters Health.

“Teens must want to avoid getting pregnant, or else it doesn’t matter what the intervention is,” whether sex education or better contraceptive access.

If young girls are already on a path that does not include college or a job that leads to a change in socioeconomic status, then having a baby may not seem like such a bad idea, he explained.

“A lot of the problem is about opportunity,” Levine said.

“We live in a society where income inequality is large and growing,” he said. “Teen pregnancy can be seen as a symptom of this broader problem. We need to find ways to allow people to be upwardly mobile.”

SOURCE: bit.ly/1eXPm0Y Obstetrics & Gynecology, online February 4, 2014.