What is Your Method of Family Planning?

Abstract

My editorials usually include a personal anecdote about my practice experience as an NP, but this month I get more personal. I recently read in Melinda Gates’ book, The Moment of Lift, a story about a woman who works to remove the stigma of family planning by speaking openly about it. When she introduces herself at meetings on the topic of family planning, she also discloses her own family planning method. You may not be comfortable sharing this information with others, but that discomfort is actually part of the problem. We don’t talk about it enough. So, allow me. The family planning methods I have used, in chronological order: luck, diaphragm, breastfeeding, implants, IUD and menopause. Yes, like many, many adolescents, my first method of family planning was luck, and I was lucky because I was able to go to college and access student health services where family planning education and care were provided. From that point on, I was able to consistently access these services, and my husband and I were able to plan when we wanted to have our two wonderful children. Even though there are many available options for family planning in a country as richly resourced as the U.S., we are still fighting battles over funding and access to contraception for family planning for women, ALL women, regardless of class or race or other socioeconomic status. There are still those that fight to deny women the right to be able to plan their families. This lack of access disproportionally affects women of racial and ethnic minorities and is one of the most striking examples of inequality in our healthcare system. Approximately 67% of white women, 64% of Hispanic women and 60% of black women of childbearing age use any type of contraception in the U.S. (NCHS, National Survey of Family Growth, 2015-2017).1Daniels K. Abma J.C. Current contraceptive status among women aged 15-49: United States, 2015-2017. NCHS Data Brief, no. 327. National Center for Health Statistics, Hyattsville, MD2018Google Scholar Therefore, 32-40% of women report using no contraceptive method. Of course, some are actively trying to start a family, but others are depending on luck and for many this won’t work. Lack of family planning leads to unplanned pregnancies. Women who experience unplanned pregnancy often do not receive optimum prenatal care, which is one of the contributors to maternal morbidity rates that should be an embarrassment to everyone in our country. The CDC reports that 17.2 women die per 100,000 live births, but this statistic covers up another huge health disparity. The rate is 42.8 deaths per 100,000 live births for black women and 32.5 for American Indian and Alaskan Native women.2CDCPregnancy Mortality Surveillance System. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion.https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htmGoogle Scholar Many maternal deaths are preventable. Other nations have managed to lower their maternal death rates. Why can’t we? If we believe every system is designed to get the results it gets, then this is not a problem that can be blamed on the patient. Rather, this is a problem with the system of how we provide care to women in our country. There are 2 things that I hope NPs can do more of. 1). As NPs who provide direct patient care I hope we can start the conversation about family planning with every female of child bearing age. (Yes, I know that can be a girl and not a woman. Developmentally appropriate conversations can still be had on the topic.) Once the conversation has been started, it can be continued as the child’s emotional development catches up with her physical development. 2) As we continue to prepare NPs at the doctoral level with improved knowledge in healthcare systems, practice improvement and leadership, I hope solving this complicated system problem will be a high priority. I would love to see NPs lead improvements in our healthcare system to save and improve the lives of ALL women and their families. So, what’s your method of choice?