All physicians involved in reproductive health are automatic advocates, even if they don’t consider themselves political or likely to speak up, according to this year’s presenter of The Benson and Pamela Harer Seminar on History.
Advocacy involves transforming society, and that societal transformation always takes time, said Anne Davis, MD, MPH, Wyeth-Ayerst Associate Professor of Ob-Gyn and Family Planning Fellowship Director, Columbia University Medical Center, who presented “YOUR Reproductive Decision? There’s a Law for That” on Tuesday morning.
“When there’s a lot of controversy around a subject that has to do with medical care, that’s the time where we really need to speak up because controversy is very loud, and patients’ voices get drowned out,” she said.
Dr. Davis, who also works as a physician advocate and the consulting medical director for Physicians for Reproductive Health, a non-profit advocacy and education organization that works for comprehensive reproductive health care for all, discussed how both recent and historical legal and legislative decisions about contraceptives shape medical practice.
Her presentation included a review of recent events, included the benefits to reproductive health that the Affordable Care Act brought. The results have been real — lower or no cost for contraceptive coverage for many women, more planned pregnancies, fewer abortions and better overall outcomes for women and babies because birth control saves money.
Dr. Davis also highlighted the Colorado Department of Health’s initiative to address unintended pregnancy. In 2009, the state increased funding to clinics that provided services to the poor, including funding for long-acting reversible contraception (LARC).
LARC use in the program grew from 4.5 percent to 19 percent by 2012. The birth rate decreased 39 percent for women ages 15-19 and 22 percent for women ages 20-24 involved in the initiative. Half of teen mothers used LARC post-delivery, leading to a 53 percent decrease in repeat births between 2009 and 2013, and the abortion rate fell by 42 percent.
The initiative saves between $50 million and $100 million in costs related to Medicaid births, Dr. Davis said.
But with progress comes pushback, she said.
Cases such as Burwell v. Hobby Lobby, Inc., where the Supreme Court decided that closely held, for-profit corporations do not have to cover all contraceptives, and ongoing misguided and medically misinformed efforts in Colorado to have IUDs classified at abortifacients and, therefore, ineligible for state funding, show that the work of advocacy and education are ongoing.
Colorado legislators voted to stop funding the Colorado unintended pregnancy program, an example of how legal interference causes problems for the practice of medicine.
“We should be in the game,” Dr. Davis said. “We need to be there and be in these conversations and help make these decisions.”
Physicians make the ideal advocates, Dr. Davis said, particularly because of their role in putting patients first. A Gallup poll for honesty and ethical standards ranked physicians third after nurses and pharmacists, much higher than journalists, lawyers, and especially legislators. Public trust in physicians has increased since 1976.
“The successes we’ve seen, with the uptick of LARC and what LARC can do to really help us with unintended pregnancy shows how putting resources toward projects related to contraception can really move the needle in a major way,” Dr. Davis said.
The fight has been going on for decades. Tuesday’’s lecture began with a look at ancient contraception attempts and how contraception in the United States has changed from the Comstock Law of 1873 that made it illegal to send, sell, or possess contraceptives along with erotica, sex toys, and abortifacients.
Dr. Davis went on to describe many of the advances, including the work of William and Margaret Sanger creating a birth control clinic during the World War I era and the 1936 appeals court ruling that the federal government could not interfere with doctors providing contraception. She also mentioned Girswold v. Connecticut in 1965 and Eisenstadt v. Baird in 1972 that struck down the remaining Comstock laws for both the married and unmarried.