Friday Musing: Something To Think About Edition

When I went to urgent care after stepping on a sharp metal object in the driveway (thanks dear!), I was told I should take a round of antibiotics.  The doctor was nice enough, informing me that the antibiotics would interfere with my contraceptive method, and therefore I should use a backup method for the next month.

It was nothing I didn't already know, and yet I left thinking, "That's not the way I would have phrased that."  Okay, I say that a lot.  Obviously I'm the kind of person with certain ideas about how health care should and should not be.  But I really mean that here... that is not the way I would have phrased that.

Last week, the Affordable Care Act went into effect, giving women specifically increased access to health care and support.  While the health care bill has obvious short-comings, women's health advocates celebrated the accomplishment, primarily the new contraception without copay rule that will benefit many (but not all) women using birth control.

Don't get me wrong... increasing economic access to a range of birth control methods is awesome.  It absolutely should be lauded as a great accomplishment for sexual health.  But what's left to battle over are the other barriers.  Social stigma, attacks by religious institutions, and a lack of access to education all shape our society's relationship with birth control, not to mention a common issue that is very often overlooked completely: lack of partner support.

Because it's so hidden, it's difficult to gauge how many women are in relationships that impede their ability to use consistently effective birth control.  Birth control sabotage is particularly common in abusive relationships, the idea being that a person is less able to leave the relationship if she is kept in what amounts to reproductive slavery. Abusers don't always covertly sabotage contraception to force pregnancies on their partners; intimidation, threats, or simple unwillingness to use a condom all create significant obstacles that mere co-pay free contraception is not about to remedy.

Given its potential to go unreported, health care providers need to be able to create a plan of care that can work with or around a patient whose partner is unwilling (or just refuses) to play an active role in safer sex practices.  Today many reproductive health clinics (such as Planned Parenthood) staff providers who are able to do this, helping patients choose a method that cannot be sabotaged or, in some cases, even detected by an intimate partner.  But many general health practitioners - particularly those from "the old school" - fall short of even recognizing this as a potential issue.

So back to my doctor's health counseling.  "You should use a backup method for the next cycle" isn't at all inaccurate.  It's actually good information, clearly stated and with little room for confusion.  However, his counseling in no way acknowledged the fact that using a backup method might be out of the question for me. 

What if he phrased it, "You should use a backup method for the next cycle, is that going to be a problem?"  To be sure, the majority of his patients would have said, "No, that's not going to be a problem," and maybe wondered why he thought it might be.  No harm done.  And the ones who would potentially have a problem would be given the opportunity to say so, possibly receiving advice to prevent pregnancy or even some resources to help them change their situations. 

Health care providers need to be at the forefront of these conversations.  We entrust them with our confidential information, knowing our intimate details are protected by law and by their oaths.  They need to be able to first see if they can help patients get out of abusive situations, but they also need to know that getting out is not always possible, and therefore working within those situations to reduce harm may be the best conceivable option.