Women’s Health on the Back Burner
New York City
Sheryl McCarthy, in “Behind the Abortion Color Line” [April 27], is correct that women who cannot get effective, affordable birth control are more likely to have unintended pregnancies and abortions. Most women will spend about thirty years trying to prevent pregnancy, making contraception a critical component of healthcare. In my practice, women tell me every day that they cannot afford birth control; nor can they afford to miss work to wait all day for free supplies. Is it so surprising that nearly half of US pregnancies are unplanned, with little change over decades?
We physicians need to do our part: medical education must improve to enable honest conversations between doctors and patients. Few physicians receive comprehensive training about birth control–as little as one lecture in medical school. Medical schools and residency programs should increase evidence-based training about the range of contraceptives available and how to discuss sexuality with patients.
The wider public also needs to learn about the benefits and risks of contraception. The benefits of contraception far outweigh the risks, especially compared with the risks of pregnancy and childbirth. McCarthy highlights the side effects of hormonal contraception; women should also know that hormonal contraception prevents ovarian and uterine cancer, and improves acne and menstrual cramping. Some women have trouble with one contraceptive but are able to use another. I’ve helped hundreds of women find birth control that works for them, whether IUD, pill, patch, ring, injection, implant or tubal ligation.
Of course, education alone won’t prevent unintended pregnancies–economic factors and lack of health insurance also contribute to the problem. But widespread knowledge about contraceptive options–among patients and physicians–would be a step in the right direction.
ANNE DAVIS, MD, MPH, medical director
Physicians for Reproductive Choice & Health
Healthcare: Radical Reform Needed
I was a member of the Health Care Reform Task Force in the Clinton White House, and I have difficulty accepting that the reform proposal failed because it was too radical, as Lester Feder claims in “Fighting for Our Health” [April 27]. In my book The Politics of Health Policy, I present a long list of reasons the reform failed. Feder’s reason is not on that list. Far from being too radical, the proposal was much too accommodating to the health insurance industry; it did not dare to confront it. Grassroots Democrats, already disappointed and angry about President Clinton’s approval of NAFTA, could not be mobilized to support the reform proposal.
Without a clear mobilization in the country, such as we saw in the civil rights era, we are not going to see true healthcare reform. Feder’s recommendations to give more money for technology and research (to investigate how doctors can practice better and more cheaply) and to subsidize premiums for those who cannot pay are exceedingly unambitious. They don’t even come close to the root of the problem: the enormous power of the insurance-medical-industrial complex.