Science and Babies Private Decisions, Public Dilemmas (1990) / Chapter Skim
Currently Skimming:
3. Contraception: Having a Healthy Baby at the Right Time
3. Contraception: Having a Healthy Baby at the Right Time
Pages 41-68
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 41... ...
women got under way with Margaret Sanger's first birth control clinics. The synthesis of two orally active progestogens in 1951, followed by the successful testing of these steroids as oral contraceptives, began a campaign for widespread access to birth control in the 1960s described by some observers as a "contraceptive revolution." The development of the birth control pill, plus a renewed interest in the IUD, came at a time when rapid population growth was being perceived as a threat to the global environment and to the economic and social health of many countries, particularly those in the Third World.
|
From page 42... ...
Stirred by these concerns, governments for the first time began to fund research on population and contraceptive development. The success of the pill encouraged the pharmaceutical industry to become vigorously involved in developing new contraceptives.
|
From page 43... ...
In fact, the opposite has occurred. Writing in Family Planning Perspectives in early 1988, Richard Lincoln and Lisa Kaeser of the Alan Guttmacher Institute observed: If in the 1960s we saw the birth of a contraceptive revolution, then in the 1980s we are witnessing the failure of that revolution and the reversal of many of its hard-won gains.
|
From page 44... ...
Certain developments have accelerated the decline of contraceptive research, particularly research on entirely new contraceptive methods. The most harmful developments have been the proliferation of product liability suits and the sharp rise in liability insurance premiums.
|
From page 45... ...
Currently, two IUDs are available in the United States: the Progestasert, made by Alza Corporation, and the copper-wrapped ParaGard, distributed by GynoPharma, Inc., under license from the Population Council. Carl Djerassi, a contraceptive expert at Stanford University, described other negative effects of liability litigation when he wrote: In 1980, several pharmaceutical companies claimed to have had more product liability claims for oral contraceptives than for all other drugs combined, notwithstanding that probably no group of currently used prescription drugs has been tested clinically as thoroughly as these steroids.
|
From page 46... ...
A study by the Institute of Civil Justice at the Rand Corporation revealed that between 1982 and 1985 there was a 15 percent annual increase in the cost of defending both malpractice claims and product liability suits. The cost for defending more routine automobile claims rose only 6.3 percent annually.
|
From page 47... ...
Many providers of medical care and products find themselves caught between the two. For example, FDA rules can be used as a basis for making judgments in tort liability suits while in the same lawsuits FDA rules are not allowed as a defense.
|
From page 48... ...
Some observers feel that the paradox is tied instead to interest rates and profitability: Liability claims rose at a time when interest rates on invested premiums declined, reducing the insurer's profit margin. When interest rates were high, critics say, insurers were interested in writing product liability insurance; when the rates dropped, insurers compensated by canceling policies held by contraceptive developers.
|
From page 49... ...
Congress are considering a range of bills that would reform both the tort system and liability insurance laws. Whether these reforms are passed and whether contraceptives will be covered by such legislation seems unlikely in the near future.
|
From page 50... ...
C Wayne Bardin, vice president of the Population Council, observes that, "In retrospect, the toxicity testing in animals correctly predicted that steroidal contraceptives were relatively free of risk compared to other drugs." But such testing, he said, "was not successful at predicting many of the rare but serious adverse effects of hormonal contraceptives, such as thromboembolism and hypertension." Not surprisingly, the very high doses used in the animal studies produced diseases in dogs that had not been observed in humans.
|
From page 51... ...
Under the original FDA approval process, contraceptive development in the United States took a long time, sometimes almost the entire life of the patent. With little opportunity to recoup their costs, pharmaceutical companies have had little incentive to develop new contraceptives.
|
From page 52... ...
In industrialized countries that maintain data on unplanned pregnancies and abortions, it is clear that abortion rates mirror the number of unintended pregnancies. The number of unplanned pregnancies and, subsequently, the number of abortions are lower in countries where effective contraceptive methods are widely used.
|
From page 53... ...
U.S. support boosted family planning programs in many of the most populous developing countries during the 1970s; the programs were just beginning to demonstrate an impact when the effort was weakened in the l980s by changes in U.S.
|
From page 54... ...
This index measures such essential human needs as income, inflation, demand for new jobs, urban population pressures, infant mortality, nutrition, clean water, energy use, adult literacy, and personal freedom. To Improve Maternal and Child Health Contraceptive methods do more than avert the dangers posed by undesired population growth.
|
From page 55... ...
Family planning influences the health and lives of women and children in important ways: It averts the need for abortion. It permits young women to avoid pregnancy until they are more emotionally and economically prepared to take care of a child.
|
From page 56... ...
Oral contraceptives also reduce the risk of endometrial cancer, cysts and cancer of the ovaries, benign breast tumors, pelvic inflammatory disease, and ectopic pregnancies. The benefits of the pill in cancer protection equal or outweigh the cardiovascular risks.
|
From page 57... ...
By that time, too, more women, 17 percent, had discovered and were using other methods of contraception. Researchers in family planning emphasize that many variablesdemographic, psychosocial, and community—affect the use of contraceptives in the early days of sexual activity.
|
From page 58... ...
~-r ~ -- A In addition to the inherent attributes, a set of"perceived" attributes tend to grow around each contraceptive method.
|
From page 59... ...
In its study of unintended pregnancy, contraceptive practice, and family planning services in
|
From page 60... ...
· In many countries where the use of effective methods is high and pregnancy and abortion rates are low, contraceptive care is delivered chiefly by family physicians rather than by specialists. The family physicians are especially likely to prescribe oral contraceptives.
|
From page 61... ...
Better dissemination of information would help eliminate the barrier to contraceptive use caused by negative attitudes toward the pill and the IUD, according to the Gallup poll and a 1987 Guttmacher study of women at risk for unintended pregnancy. Those surveys found that women avoid using the pill and IUD, the most effective methods, because they fear potential health risks.
|
From page 62... ...
Contraceptive development is markedly hindered by a lack of funds, the proliferation of lawsuits, exorbitant jury awards, and an absence of liability insurance for contraceptive manufacturers. Many men and women in this country are badly informed about birth control and about the true effectiveness and health risks of the methods that are available.
|
From page 63... ...
Although oral contraceptives may have undesirable side effects for some individuals, they protect against cancers of the ovaries and uterus and against excessive menstrual bleeding. Intrauterine devices are 98 to 99 percent effective.
|
From page 64... ...
If used consistently, however, experts believe the diaphragm is highly effective. In addition, it offers some protection against sexually transmitted diseases.
|
From page 65... ...
Two types of vaginal rings that release steroids into the bloodstream via the vaginal epithelium are being studied by the Population Council and the World Health Organization. One releases a combination of estrogen and progestogen and is worn for 3 weeks; the other, which releases the progestogen levonorgestrel, is worn continuously for 3 months and is designed for women who are breastfeeding.
|
From page 66... ...
Family Planning Perspectives.
|
From page 67... ...
1988. Unintended pregnancy, contraceptive practice and family planning services in developed countries.
|
From page 68... ...
Family Planning Perspectives.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.