Form Of Birth Control Research Articles

Impact of prior levonorgestrel intrauterine device use at the time of embryo transfer.

Our objective is to investigate whether infertile women with a history of levonorgestrel intrauterine device (LNG IUD) use have impaired endometrial growth and pregnancy rates after embryo transfer. This is a retrospective cohort study at a single academic medical center of infertile women aged 18-44 with a history of LNG IUD use undergoing their first embryo transfer cycle between January 2019 and January 2021 compared to controls with a history of no prior birth control use (NONE) or prior oral contraceptive (OCP) use. The primary outcome is endometrial thickness prior to embryo transfer. Secondary outcomes are embryo transfer results, including implantation, miscarriage and live birth. Demographic, baseline and cycle characteristics were similar among the three groups. Women with a history of LNG IUD use had thinner endometrial stripes than women with a history of NONE (LNG IUD: 8.93 mm, NONE: 10.32 mm (aRR: 0.88, 95% CI: 0.80-0.97)) but not when compared to women with a history of OCP use (OCP: 9.61 mm (aRR: 0.92, 95% CI: 0.84-1.01)). Women with a history of LNG IUD use had slightly higher implantation rates than those with NONE history (LNG IUD: 43.37%, NONE: 24.17% (relative risk (RR): 1.79, 95% CI: 1.21-2.45)), though not when compared to prior OCP users (OCP: 38.72% (RR: 1.12, 95% CI: 0.86-1.47)). The remainder of the embryo transfer outcomes were similar among the three groups. In conclusion, prior LNG IUD users have a reduced endometrial thickness at the time of embryo transfer but do not have worse pregnancy outcomes. LNG IUDs (brand names include Mirena, Liletta and Skyla) are some of the most widely used forms of birth control. While these devices are safe and are generally not believed to impact fertility, a few recent articles have suggested the possibility of a long-term impact of prior intrauterine device use on the uterine lining in some patients. As such, we sought to examine uterine lining growth and outcomes of assisted reproduction in an infertile patient population with a history of LNG IUD use compared to infertile women without a history of LNG IUD use. Ultimately, we found that women with a history of LNG IUD use had less uterine lining growth during assisted reproduction cycles, but that they did not have worse pregnancy outcomes when compared to women without a history of levonorgestrel device use.

A REVIEW STUDY ON ROLE OF CONTRACEPTIVES AND THEIR VARIOUS TYPES.

Contraception is the process used to stop unwanted pregnancy and control birth rate. Contraceptives reduces the chances of pregnancy after sexual intercourse. Contraceptives prevent pregnancies by interfering with the procedure of fertilization. Contraceptives reduces the chances of abortion by preventing unintended pregnancies on their partners, in which 842 million (44%) are modern using modern methods of Contraceptives are accessible in huge varieties and types . Numerous contraceptives are available, 790 million (42%) are traditional method users according the statistical data of 2019. The most common contraceptive techniques that are use of contraceptives are increasing day by day, 922 million of women of reproductive age used worldwide are female sterilization and male condoms, female sterilization are used in 219 million users (24%), male condoms are used in 189 million users (21%) according the data of 2019. The use of traditional methods and IUDs has reduced worldwide since 1994. According to WHO, The only form of birth control is a condom,that can prevent both unintended pregnancies and sexually transmitted diseases. The need of family planning is increased globally up to 77% from 2015 to 2020.. Over the past 20 years, the number of women using family planning methods has grown, rising from 900 million in 2020 to 2000 million. Use of modern contraceptive methods is also increased from 663 million to 851 million with the prevalence rate of 47.7% to 49.0%. Numerous contraceptive methods exist, including hormonal methods like CHC vaginal ring, CHC transdermal patch, and combination hormonal contraceptives. Progestin-only techniques include hormonal male contraceptives, progestin-only pills, DMPA injections, implants, and progestin-only IUDs. The other approach is non-hormonal and consists of vaginal pH modulators, barrier techniques like condoms, and copper IUDs. Traditional methods, such as the LAM method, the fertile cycle method, and the withdrawal approach, comprise the third type of contraception. Herbal contraceptives, which use a variety of herbs and plant preparations, are the fourth technique of birth control.

(109) AS SEEN ON TIKTOK: PERCEPTIONS AND UNDERSTANDINGS OF HORMONAL CONTRACEPTIVES ON SOCIAL MEDIA

Abstract Introduction Contraception plays an integral role in many women’s lives and is essential for family planning and treatment of myriad health conditions. Between 2017-2019, approximately 65% of women aged 15 to 49 in the United States were actively using a form of birth control. Social media has a significant influence over the contraceptive choices of many reproductive-aged women. TikTok, a platform established in 2017, is one of the fastest growing worldwide social media applications. In 2018, it was recognized in top charts as “Most Downloaded”, and by 2023, approximately 150 million Americans became active users. Beyond its entertainment value, TikTok serves as a communication platform to nearly 5 million businesses, and the healthcare sector is no exception. Objective This study assessed the attitudes and information users share about hormonal contraceptives (HC) on TikTok, to elucidate the type of information women are receiving. Additionally, the potential for healthcare providers to use this platform as a means to educate and reach millions of patients was explored. Methods Apify, a free data-scraping tool, was used to automatically extract and compile 593 TikTok videos. Frequently searched hashtags, such as #birthcontrol, #hormonalcontraceptive, and #pregnancyprevention, were utilized to identify videos. Inclusion criteria included videos from US-based content creators and videos with English audio or text. The number of views and shares, length of video, and location of content creator for each TikTok were populated by the online application and imported onto RedCap for data collection. Demographic data such as gender and what type of content creator was providing the information, along with topics being portrayed and characteristics of each video, were also collected on RedCap. Results 150 TikTok videos met our inclusion criteria. The average length of each TikTok was 47.08 seconds. The average number of views and shares were 4,623,942 and 9,952, respectively. The predominant HCs discussed were intrauterine devices (IUDs), depo-provera injections, and contraceptive implants. Prevalent themes included negative personal anecdotes, general health information, and side effects. Additionally, the most common characteristics of the Tiktoks were humor and education. Most of the content creators were female (91%), and non-medical professionals (62%). Of the videos created by medical professionals, 25% were created by physicians, 26% by nurse practitioners, followed by nurse midwives (19%), physician assistants (14%), and registered nurses (5%). Conclusions Through short and engaging videos, TikTok has the ability to reach a wide and diverse audience. Oftentimes, users create TikToks that reveal their concerns, frustrating encounters, and how side effects impact their lives. Further studies may include determining how personal experiences of HC influence TikTok users’ acceptability, adherence, and attitudes. Given its reach, medical professionals should consider using the platform to engage with patients and provide evidence based education regarding HC. Disclosure No.

Long-Acting Reversible Contraception Knowledge Among Female Adolescents Presenting to a Pediatric Emergency Department.

The objective of this study was to assess awareness and use of long-acting reversible contraception (LARC) among female adolescents presenting to a pediatric emergency department (PED). During routine presentation to an urban PED in New Jersey, female adolescents, aged 15-19 years, were asked to voluntarily complete an electronic survey about sexual practices and contraception. The PED is in an urban teaching hospital, treating 35,000 children annually. Patients could schedule a follow-up appointment at the hospital's obstetrics/gynecology clinic. Data were collected over 13 months, and follow-up was monitored to determine if they attended an outpatient appointment, and if so, what the outcome was. Data for 199 participants were analyzed. The median age of participants was 18 years, whereas 79% self-identified as Black, and 17.6% self-identified as Latina. Twenty-one percent of participants used a form of birth control during their first sexual encounter, the largest percentage being condoms (77.8%). Forty percent of participants reported some prior knowledge about contraceptive implants, and 20% had knowledge about intrauterine devices, whereas only 3 (1.5%) intrauterine devices and 2 (1%) arm implants had been previously used. Of the 78 participants that requested a follow-up, 14 (17.9%) completed their appointment. Of those, 2 (14%) were prescribed contraception (Depo-Provera shot and oral contraceptive pills). Knowledge about LARC remains low in our PED, despite it being the most effective method of contraception. Even when interventions were made to link interested respondents to outpatient women's health services, follow-up attendance was poor, and no patients obtained LARC. There is a significant discrepancy between the consensus standard of contraception care across all relevant medical specialties and current utilization by high-risk populations. Future efforts must focus on how to close this gap, and the ED could be pivotal for improving both reproductive health education and intervention among adolescent patients.

Birth control access experiences for members of an Indigenous tribe in the Gulf Coast

The framework of reproductive justice is increasingly being utilized to investigate and understand the experiences of Indigenous women in accessing healthcare. However, the experiences of state-recognized tribes, which do not receive healthcare through the Indian Health Service (IHS), have received less attention. The objective of this study was to explore the birth control access experiences and barriers among Indigenous women belonging to a state-recognized tribe in the Gulf Coast region of the United States. In partnership with a community advisory board, a qualitative descriptive research approach was used to conduct semi-structured life course interviews with 31 Indigenous women. Themes related to birth control included: What Form of Birth Control Used; Lack of Communication With Doctor About Birth Control, with the subtheme: Lack of Communication About Side Effects of Birth Control; Limited Access to Birth Control; and Beliefs and Values About Birth Control. Through exploring the unique ways women who are members of a state-recognized tribe access and use birth control, this research begins to fill an important gap in reproductive justice literature. These findings indicate that important reproductive justice components related to birth control access and holistic, culturally-informed provider-interactions are currently lacking for members in this tribe.

Ectopic Pregnancy in A 28-year-old Woman with CuT IUCD in Situ – A Case Report

Background: There is a 3–4 percent chance of all pregnancies being ectopic in location. The risk of ectopic pregnancy to a woman using an Intrauterine Contraceptive Device (IUCD) is lower than that in a woman using no form of birth control. However if awoman gets pregnant whiles using the IUCD, the chances of having ectopic is more than 4 percent. Data on the occurrence of ectopic gestation with IUCD in situ is scanty, with no report of any such case in Ghana or West Africa. The objective of this report is therefore to contribute to knowledge on the subject with the view to bring it to attention among clinicians.Case: A 28year old woman (G3P1A+1) who has had copper IUCD in situ for over two years, reported to a health facility in Accra after missing her period for two weeks. She had performed a home-based urine pregnancy test on three separate occasions, and theywere all positive. A trans-vaginal ultrasound scan showed a small cystic lesion in the right adnexa with moderate fluid in the pouch of Douglas. A right tubal abortion was found at laparotomy.Conclusion: Ectopic pregnancy in women with an IUCD is an important major potential complication that can be life-threatening.Adequate counselling by clinicians would create awareness among clients for early reporting of amenorhoea and prompt intervention for desirable outcome.

Evaluation of a media literacy education program for sexual health promotion in older adolescents implemented in Southern universities

Objective This study evaluated a media literacy education program designed for sexual health promotion, Media Aware, in southeastern universities. Participants Participants included college students from four universities in the southeastern United States (n = 457). Methods Media Aware was implemented on college campuses either in a group setting, one-on-one setting, at a student event, or online only. Media Aware contains four sections on sexual health promotion including on how media messages influence sexual health, gender stereotypes and representations of romantic relationships, sexual violence, substance use, consent, sexual risk behaviors, contraception, STIs, and partner communication. Results Results indicated significant changes in intention to visit a healthcare provider for sexual health services, intention to use condoms and other forms of birth control, and awareness of Long Acting Reversible Contraceptives after participation in Media Aware. Conclusion Future research should explore how to extend program impacts and use an experimental study design to assess between group differences.

Family planning (KB) practices and the impact on Papuan women reproductive health

ObjectiveThis study aims to describe and analyze KB or family planning practices and their impact on Papuan women. A case study was conducted in Waena Village, one of the Kampung KB in Jayapura City, Papua. MethodsThe research method used is descriptive qualitative using an ethnographic approach. The determination of the informants was done purposively by assigning one of the key informants. Data collection includes in-depth interviews and observation. Data analysis includes data reduction, data description, and interpretation. ResultsThe results showed that women of childbearing age carried out the practice of KB by using various forms of birth control. Some use birth control pills and spiral birth control (intrauterine contraception). In addition, the family planning program has provided education to increase knowledge about reproductive health, types of diseases so that women feel more valued and cared for by men with the existence of KB program. Moreover, the existence of the Kampung KB program also has an impact on community social activities, such as educate adolescents and children to have a clean and healthy lifestyle oriented toward family welfare. ConclusionThe Kampung KB program in Waena Village has educated the public about reproductive health, which significantly affects community order.

Drug-Drug Interaction Studies With Oral Contraceptives: Pharmacokinetic/Pharmacodynamic and Study Design Considerations.

Oral contraceptives (OCs) are the most widely used form of birth control among women of childbearing potential. Knowledge of potential drug-drug interactions (DDIs) with OCs becomes imperative to provide information on the medication to women of childbearing potential and enable their inclusion in clinical trials, especially if the new molecular entity is a teratogen. Although a number of DDI guidance documents are available, they do not provide recommendations for the design and conduct of OC DDI studies. The evaluation of DDI potential of a new molecular entity and OCs is particularly challenging because of the availability of a wide variety of combinations of hormonal contraceptives, different doses of the ethinyl estradiol, and different metabolic profiles of the progestin component. The aim of this review is to comprehensively discuss factors to be considered such as pharmacokinetics (PK), pharmacodynamics (PD), choice of OC, and study population for the conduct of in vivo OC DDI studies. In this context, metabolic pathways of OCs, the effect of enzyme inhibitors and inducers, the role of sex hormone-binding globulin in the PK of progestins, current evidence on OC DDIs, and the interpretation of PD end points are reviewed. With the emergence of new tools like physiologically based PK modeling, the decision to conduct an in vivo study can be made with much more confidence. This review provides a comprehensive overview of various factors that need to be considered in designing OC DDI studies and recommends PK-based DDI studies with PK end points as adequate measures to establish clinical drug interaction and measurement of PD end points when there is basis for PD interaction.

Class Analysis and the Killing of the Newborn Child: Manchester, 1790–1860

Abstract This article explores the practice of neonaticide – the killing of an infant at the moment of birth – in Manchester during the first decades of the industrial revolution. Using a set of previously unexamined pre-trial witness statements, the author makes the case that newborn-killing was practised by working-class women in the town as a known and even accepted form of birth control. There is quite suggestive evidence that women had a language for this practice, shielded other women from having it reported, and in certain circumstances, assisted one another in carrying it out. This finding resonates with similar moral frameworks that have been studied from high-medieval England to early colonial Mexico. Nonetheless, it has also been well established that middle-class people throughout the nineteenth century in Britain abhorred infant killing, associated it strongly with stigmatized stereotypes of working-class maternity, and sought to suppress it using the punitive weight of the law. Period diaries and publications show that this ‘moral panic’ was as potent in Manchester as anywhere else. Taking these contrary patterns together, the author suggests that neonaticide and practices like it allow historians to observe the profound cultural divisions and frictions along class lines which structured life in the early industrial city.

High-Risk Medication Prescriptions in Primary Care for Women Without Documented Contraception.

During pregnancy, women may be exposed to teratogenic medications resulting in a risk of complications and poor maternal-fetal outcomes. The objective of this study was to evaluate the prescription of teratogenic medications in women of childbearing age and the associated prescription of contraception in the primary care setting. The use of high-risk, potentially teratogenic, medications was retrospectively evaluated in women of childbearing age (13 to 45 years old) at 2 family medicine practices. Charts were reviewed for medication use and whether patients received a form of birth control (medication, sterilization, or postmenopausal) with the teratogenic medications. A multivariable logistic regression model was used to estimate the age-adjusted association between receiving a teratogenic medication and contraception. A subgroup analysis excluding ondansetron was also performed. A total of 3,956 nonpregnant women were included with 988 (25%) prescribed at least 1 high-risk medication. The most commonly prescribed high-risk medications were ondansetron (n = 724, 73%) and lisinopril (n = 195, 20%). More than half (55%) of the women prescribed a high-risk medication were without a form of birth control. When ondansetron was excluded, 10% of the population was prescribed at least 1 high-risk medication with 62% also without a form of birth control. Women less than 25 years of age had decreased odds of receiving contraception when prescribed a teratogenic medication (adjusted odds ratio, 0.47; 95% confidence interval, 0.34-0.66). In a family medicine setting, 25% of women of childbearing age were prescribed a high-risk medication with over half not having evidence of contraception management. Interestingly, younger age women had lower odds of receiving contraceptive management when prescribed high-risk medications. Prescribers should be aware of and counsel on the risks of teratogenic medications and regularly evaluate reproductive plans for patients.

Effects of Female Hormone Use and Birth Control Contraceptives on Depression (P11-017-19)

ObjectivesResearch has shown that fluctuation of estrogen and other hormones in the body can enhance the body’s response to stress, which in turn, can lead to both depression and anxiety. The main objectives of this study were to explain the association of the use of female hormones with the likelihood of getting depression and to describe the association of the use of birth control contraceptives with the likelihood of getting depression. The study hypothesized that the uses of female hormones and contraceptive birth control were likely to increase the risk of developing depression or depressive symptoms. The study also looked at how special dietary status was likely to affect the use of either female hormones or contraceptive birth control. MethodsData came from the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2016, and the study included female participants aged 18 years and older who were pregnant or had ever been pregnant. Multivariate regression analyses were used to investigate the effect of the use of female hormones or contraceptive birth control on depression. ResultsResults showed that the use of female hormones was associated with higher risk of depression, so women who used female hormones seem to have increased risk of developing depression. The use of birth control with higher amounts of estrogen were likely to increase the risk of developing depression in women who have ever been pregnant, and those who had longer duration of the use of birth control were also at higher risk of depression. In addition, women with low-fat diet were at higher chance of using either female hormones or contraceptive birth control. ConclusionsWomen are at greater risk for depression than men, and reproductive events such as postpartum and menopausal transition also likely cause the risk of depression. Therefore, women should have better understanding about different forms of birth control and female hormones and about long-term health complications such as increased risk of breast and cervical cancer. Funding SourcesNone.

AyoWahlbergGood Quality: The Routinization of Sperm Banking in ChinaBerkeley, CA: University of California Press, 2018. 248 p. $34.95 (pbk.)

AyoWahlbergGood Quality: The Routinization of Sperm Banking in ChinaBerkeley, CA: University of California Press, 2018. 248 p. $34.95 (pbk.)

TV and internet: a new form of birth control

TV and internet: a new form of birth control

Ovarian penetration by copper intrauterine device: A rare phenomenon

The insertion of a piece of object inside the uterus has been practiced as a form of birth control since antiquity; one of these devices used nowadays is the intrauterine contraceptive devices which have gained a wide range of acceptance because of their safety, efficacy, and cost-effectiveness. There have been cases of migration of intrauterine devices (IUDs) to adjacent peritoneal structures, but ovarian migration has not been widely reported in West Africa. This case report highlights one of the rare complications of IUD migrating to the left ovary of a 24-year-old woman with no complication. It is imperative that insertion should be done timely by well-trained personnel to avoid the incidence of complications.

Effects of Flibanserin on the Pharmacokinetics of a Combined Ethinylestradiol/Levonorgestrel Oral Contraceptive in Healthy Premenopausal Women: A Randomized Crossover Study

PurposeThis study aimed to investigate the effect of steady-state exposure to flibanserin, a 5-HT1A agonist/5-HT2A antagonist approved for the treatment of hypoactive sexual desire disorder in premenopausal women, on the single-dose pharmacokinetics of the contraceptive steroids ethinylestradiol and levonorgestrel in healthy premenopausal women. MethodsHealthy female volunteers (N = 24) received 2 single doses of a combined oral contraceptive containing ethinylestradiol 30 μg and levonorgestrel 150 μg, either alone (reference) or preceded by treatment with flibanserin 100 mg once daily for 14 days (test). The 2 treatments were given in randomized order, with a 4-week washout period following the last administration of the first treatment. Plasma concentrations of ethinylestradiol and levonorgestrel were measured over 48 hours after dosing for the determination of pharmacokinetic parameters; the primary end points were Cmax and AUC0–∞ of ethinylestradiol and levonorgestrel. FindingsOf the 24 women enrolled (mean age, 38.0 years), 23 completed the study. Mean (SD) Cmax and AUC0–∞ values of ethinylestradiol were 66.7 (16.3) pg/mL and 693 (268) pg · h/mL, respectively, following the oral contraceptive alone, and 72.7 (25.5) pg/mL and 740 (235) pg · h/mL, respectively, when the oral contraceptive was preceded by flibanserin. In both cases, the 90% CIs of the reference/test ratios of Cmax and AUC0–∞ were within the range of 80% to 125%, indicating that flibanserin had no significant effect on the pharmacokinetic properties of ethinylestradiol. Similarly, the mean (SD) Cmax and AUC0–∞ values of levonorgestrel were 5.0 (1.6) ng/mL and 52.2 (18.7) ng · h/mL, respectively, with the oral contraceptive alone, and 5.0 (1.6) ng/mL and 53.3 (20.4) ng · h/mL, respectively, following flibanserin; again, in both cases, the 90% CIs of the reference/test ratios were within the range of 80% to 125%, indicating that flibanserin had no significant effect on the pharmacokinetic properties of levonorgestrel. All adverse events were mild to moderate in intensity (incidence: 12.5% and 70.8% with ethinylestradiol/levonorgestrel treatment alone and following administration of flibanserin, respectively). ImplicationsPretreatment with flibanserin 100 mg once daily for 2 weeks did not produce a clinically relevant change in oral contraceptive drug exposure following single-dose administration of ethinylestradiol/levonorgestrel. This finding is relevant to women with hypoactive sexual desire disorder who might prefer oral contraceptives to other forms of birth control. EudraCT No: 2006-006960-46.

A Phenomenological Study on Understanding of Mothers' Knowledge on Breast Feeding Practices in Malaysia

Realizing the importance of children’s nutrition, the World Health Organization strive vast effort to ensure revitalize promotion and protection of infant and young child feeding. Despite its benefits, the breastfeeding rate was still low worldwide including Malaysia. Based upon the findings of the scientific research, it was expected to contribute significant effects on people’s knowledge and perception towards breastfeeding practice. In Malaysia, breastfeeding was found to be dominantly practiced among Malay. The qualitative study design was used to explore Malay mother’s knowledge on the benefits of breastfeeding towards maternal and infant’s health. Fifteen mothers who currently breastfeed their children were recruited by purposive sampling method for this study. Data were collected by in-depth interview using a semi-structured interview guide. Data obtained were analyzed using thematic analysis. Due to study findings, mothers were aware on the nutritional and protective factors contain in breast milk. However, the misperception on colostrum still exists and it was conveyed by influential people in mothers’ life. Mothers perceived breastfeeding could help in maintaining their appearance following child birth. It protects mothers by minimizing the risk of postpartum haemorrhage and incidence of breast cancer. Mothers in this study recognized breastfeeding as a form of birth control. Even so, they doubted on its effectiveness because of lack of understanding on the mechanism of lactation amenorrhea. Social media, health care professionals particularly staff nurses, and breastfeeding support group were the first three most cited source of information by the mothers in this study. According to culture and religious in Malaysia, family greatly support to breast feeding mothers during their breast-feeding period. However, continuing of the breast feeding depends on mother’s knowledge and decision. Therefore, as the health care providers, especially nurses who are closely with mothers keeps on giving health education regarding breast feeding practice to enhance their knowledge and understanding.

A Digital History of Anglophone Demography and Global Population Control, 1915–1984

A Digital History of Anglophone Demography and Global Population Control, 1915–1984

Exploring the relationship between socioeconomic factors, method of contraception and unintended pregnancy.

BackgroundIt is estimated that approximately one-third of pregnancies in Canada are unintended, meaning they were either mistimed (the woman wanted to be pregnant at a different point in time) or undesired (the woman did not want to be pregnant). This study aimed to assess the impact of socioeconomic variables and method of contraception on the decision to either terminate or continue and unintended pregnancy.MethodsData were obtained from two contemporaneous studies in Calgary Canada– a cross-sectional study involving women seeking abortion services (n = 577) and a longitudinal cohort study involving women with continuing pregnancies (n = 3552) between 2008 and 2012. Chi square tests and logistic regression were used to examine the association between socioeconomic variables, use of contraception and pregnancy intention.Results96.5 % of women seeking an abortion and 19.6 % of women with ongoing pregnancies reported having an unintended pregnancy. Women with unintended pregnancies were significantly younger (p < 0.001), less educated (p < 0.001), had a lower household income (p < 0.001), were less likely to be in a stable relationship (p < 0.001), and less likely to speak English in the home (p < 0.002). 20.2 % reported not using any form of birth control despite their desire to not get pregnant. Among women with unintended pregnancies, the only significant demographic predictor of not using any form of contraception was low educational attainment (OR = 1.7, 95 % CI: 1.2–2.4).ConclusionsLow educational attainment was associated with not using any form of contraception among women with unintended pregnancies. However, as unintended pregnancy occurs across all socio-demographic groups, care providers are encouraged to have an open discussion regarding fertility goals and contraception with all patients and refer them to appropriate resource materials.

The Fourth Demand

Copyright © 2016 Michigan State University. Alyssa A. Samek, “The Fourth Demand,” QED: A Journal in GLBTQ Worldmaking 3.1 (2016): 148–156. ISSN 2327-1574. All rights reserved. In her dissent in the Burwell v. Hobby Lobby case, U.S. Supreme Court Justice Ruth Bader Ginsberg wrote, “The Court’s determination that [the Religious Freedom Restoration Act] RFRA extends to forprofit corporations is bound to have untoward effects. . . . The Court, I fear, has ventured into a minefield.”1 Efforts to craft exemptions for religious businesses and organizations to avoid compliance with laws ranging from the Affordable Care Act to employment discrimination have ramped up, increasing concerns about the potential efficacy of antidiscrimination legislation. One of the best examples of this concern is the Employment NonDiscrimination Act (ENDA) legislation, designed to prohibit discrimination in the workplace on the basis of sexual orientation or gender identity. The most recent version of ENDA contained an organizational religious exemption, and in an historic move in the long and winding life of the legislation, major advocacy groups including the American Civil Liberties Union, Gay & Lesbian Advocates and Defenders, the National Center for Lesbian Rights, Lambda Legal, and Transgender Law Center withdrew their support. In a joint letter, they called the provision for religious organizations “discriminatory,” and “unprecedented in federal laws prohibiting employment discrimination,” which “could provide religiously affiliated organizations— including hospitals, nursing homes and universities— a blank check to engage in workplace discrimination against LGBT people.”2 Rea Carey, the executive director of the National LGBTQ Task Force, added that once a company can claim “biblical principles” to ban certain forms of birth control, as in the Hobby Lobby case, “it’s a hop, skip and a jump to an interpretation that a private company could have religious beliefs that LGBT people are not equal or somehow go against their beliefs and therefore fire them.”3