My father was eight years old when his mother died. Black and white photographs of my paternal grandmother from 1940s India hang in my parents’ living room. Growing up, I had always noticed a sad expression on her face. Today, I understand why. She died during childbirth – her 7th child (a baby body who died a month later). My grandma was 28. How different her life might have been had she had access to contraception. The erosion of women’s rights to make decisions about their bodies is prompting people from all sectors to speak up including the entertainment industry. Celebrities like Schitt’s Creek star, Annie Murphy, is on a mission to ensure that girls and women everywhere are able to make informed decisions about their birth control options. Options that my grandmother never had.
I recently interviewed the Emmy-winning actress on my YouTube health show about her promotion of an FDA-approved non-hormonal contraceptive, Phexxi©, in partnership with Evofem Biosciences whose CEO, Saundra Pelletier, also joined the conversation. Both women are fierce champions of bodily autonomy and a woman’s right to choose, particularly when it comes to reproductive health including choice of contraception.
“I feel that it’s so, so incredibly important for everybody to have bodily autonomy, and that’s been taken away from almost half of the U.S. population,” the Canadian actress declared. “And that, to me, is beyond disturbing. The more we talk about it, the more we educate ourselves, the more we are actively supporting one another. That’s the only way to get out of this real hell that a lot of people are living in right now.”
Like many women, Murphy experienced several side effects related to hormonal contraceptives. “I was on the pill at 16 and had super huge mood swings,” described the ambassador for the global relief agency, Care Canada. “I was feeling very sad and very low at the time.” Murphy is mindful of the motto that one size does not fit all. “While Phexxi works for me, it might not work for everybody.”
The health and social impacts of contraception cannot be overstated. The CDC lists family planning and contraceptive services as one of the ten greatest public health achievements in the 20th century. Research from the Guttmacher Institute shows that benefits of birth control include reduced global maternal mortality, increased female engagement in the workforce and improved economic self-sufficiency for women.
Efficacy of birth control depends on the method used. According to the American College of Obstetrics and Gynecology (ACOG), implants and intrauterine devices (IUDs; hormonal and copper) are the most effective, resulting in less than 1 pregnancy per 100 women per year. Sterilization is equally effective but is considered permanent. Next effective are hormonal methods like an injection, the pill, patch or vaginal ring, or the diaphragm (non-hormonal), all of which are associated with 6 to 12 pregnancies per 100 women in a year. Least effective methods include condoms (male and female), cervical caps, sponges, “natural” means such as the rhythm method and non-hormonal gels (e.g. spermicides, Phexxi), associated with 18 to 27 pregnancies per 100 women per year.
Evofem officials point out in-house studies showing that Phexxi “prevented 99% of pregnancies per act of intercourse.”
Some OBGYN physicians like Mishka Terplan, MD, MPH, FACOG, find the use of non-hormonal contraception like Phexxi – which contains lactic acid, citric acid and potassium bitartrate – interesting and quite elegant. But he believes that Evofem’s data should be clarified. “It might be ‘99% effective at preventing pregnancy per act of intercourse,’ but [the reality is] that most intercourse won’t result in pregnancy, and the likelihood of pregnancy differs by time of cycle.” Dr. Terplan added: “The likelihood of pregnancy is at best 10% per act of intercourse when timed to ovulation.”
Somya Gupta, MBBS, MD agrees. “Contraceptive efficacy is tested over long-term studies and is not just based on total number of acts of intercourse,” explains Dr. Gupta, an OBGYN physician from Cloudnine Group of Hospitals in India. “The chances of pregnancy vary according to the timing of intercourse with respect to a woman’s cycle. It would be more interesting to know over what period of time these 24,289 acts of intercourse in women were followed up.”
As a doctor, I believe in giving patients options and helping them make informed decisions. A patient should be presented with all options for preventing pregnancy. Some options include medications in the form of pills, gels and a patch; others are physical barriers like a condom or diaphragm. Among medications, some contain hormones like estrogen and progesterone. Like ALL treatments in the field of medicine such as albuterol for asthma and ibuprofen for pain, contraceptives also have trade-offs or pros and cons. Phexxi would be the preferred option for women who cannot tolerate or choose not take hormones; it can also be taken on-demand, i.e. in the moment as opposed to daily use like the pill. Ultimately, women and all birthing individuals should be educated and empowered to make family planning decisions that work best for them.
Murphy feels “very, very lucky” for her fame and believes that she would not be doing her “due diligence as a human if I didn’t use my platform to help educate women about all the choices they have.” The Golden Globe nominee is also aware of the current political climate: “We’re in a time where women have taken a massive, massive hit over [many] weeks and deserve all of the education they can get their hands on. So I’m just happy to talk about it.”
Women’s healthcare trailblazer, Pelletier, could not agree more.
“Now more than ever, with the SCOTUS decision, access to contraception is critical,” shares the single mother and breast cancer survivor. “We know contraception is lifesaving, and the idea that women should have this taken away from them is archaic and draconian.” Pelletier added that every woman should have autonomy over her body and be able to choose when, if and how often she has children. For Pelletier, Phexxi is a way for her and Evofem to make a contribution to a woman’s right to make personal health decisions.
While access to birth control has improved significantly over the past several decades, the reality is that we’re living in a precarious time; a time where some conservative U.S. politicians are attempting to restrict access to birth control. A few weeks ago, Senate Republicans blocked a Democratic attempt to create a federal right to birth control. In addition, Justice Clarence Thomas wrote a concurring opinion (with the ruling overturning Roe vs Wade) that the Supreme Court should reconsider past precedents such as Griswold vs Connecticut and Eisenstadt vs Baird which both guaranteed birth control access. We also know that access to contraception is more challenging for Black women dues to decades of stigma, discrimination and systemic barriers in the healthcare system.
Thankfully, the U.S. House of Representatives has taken measures to protect access to contraception. But Pelletier has a message for our elected officials.
“When you look at the economic impact of unintended pregnancy versus the cost of contraception, lawmakers need to know that many healthcare plans are still denying women access to contraception,” explains the entrepreneur. “The ACA [Affordable Care Act] clearly states that an FDA-approved product should be provided for women at zero out-of-pocket pay.” The long-time women’s rights advocate added, “If you’re going to take away the right to a safe abortion, at least give women access to contraception for God’s sake, right?” Pelletier pointed out that sildenafil (Viagra) is covered by insurance.
As a physician to marginalized populations, a woman of color and daughter of Indian immigrants, I’m angered by the persistent eradication of women’s rights by lawmakers whose agendas perpetuate the oppression of girls and women. We need to come together – activists, students, teachers, medical and legal professionals, business leaders like Saundra Pelletier and entertainers like Annie Murphy – to advocate for bodily autonomy and a woman’s right to make decisions about her own body. A right that my grandmother never had, but that every woman worldwide must.
Source: https://www.forbes.com/sites/lipiroy/2022/08/15/birth-control-and-bodily-autonomy-schitts-creek-star-annie-murphy-speaks-out/