Birth control pills over the counter

Ariana · Mar 1, 2006

I was wondering if anyone has the latest news on the issue of Birth control pills being moved over the counter or even with the Plan B.

jonathon · Mar 1, 2006

What is the latest FDA news on this issue anyways?

mustangsally65 · Mar 1, 2006

I haven't heard of this possibility.

I don't mean to insult anyone, but it seems like a lot of the general public is uninformed about the proper use of even the most simple drugs. If birth control were put over the counter who knows what kind of abuse would occur?

In my experience, the many many different varieties of contraception combinations truly do warrant a physician's supervision. Is it really all that hard to go to the local health department and get a prescription?

Girls could be taking hormones as pre-teens to try to enhance their bust sizes, or they could be smoking and not be advised about possible risks (even though they are admittedly small in this age-group) like blood clots. And STDs would probably become even more prevalant than they already are because no one would have to get pap smears or pelvic exams/STD tests.

What if a guy went to the pharmacy and picked up birth control pills and tried to pressure his girlfriend into taking them so they could have sex?

Sorry to rant about this, but I really hope it never happens. I think it could cause much more harm than good. Except maybe in South Dakota.

sdn1977 · Mar 2, 2006

I was just reading about this at work today. A Brooklyn judge ruled 2/28/06 that an FDA official must provide a deposition in a complex case which was brought by Planned Parenthood (I think) & 9 individual defendants in a case claiming the FDA deliberately delayed & missed a deadline which would have allowed easier approval to be considered for OTC status. In addition, there are claims that the FDA hid significant information. So...that is the most recent FDA status.

I really try to educate folks because there is soooo much misinformation. Plan B is the only drug which has its only indication being emergency contraception. To my knowledge, there is no discussion of ever having birth control pills becoming OTC status. The reason is because there are significant risks to using hormonal contraceptives daily and physicians are trained to determine which contraceptive to start with & how to monitor for side effects.

Each state has its own laws on how available Plan B. In CA, Plan B can be prescribed and dispensed by pharmacists who are trained to do so. There are lots of ways to find out how to obtain it: google emergency contraception, pharmacy access.org., plan b, planned parenthood.org., etc. I'm a firm believer in finding out how to obtain it BEFORE you might want it.

bananaface · Mar 2, 2006

I have seen OTC status advocated for BC pills on and off, but it is usually by non-medical persons. Realistically, women don't need a pap smear to be safely prescribed BC pills, but they do need some verbal screening, a BP check, education, and follow-up. BC pills are just not a good choice for OTC status. They can be prescribed by pharmacists on protocol, though.

Shredder · Mar 2, 2006

birth control outposts should be in place to freely distribute pills and contraception to the "underserved" communities. in fact, proof of using them should merit cash or other rewards

over the counter should be done. its better than the inevitable (and more costly?) abortions that would result later. or worse, unplanned births. often to people who cant care for them. i like this thread

mshheaddoc · Mar 2, 2006

Shredder said:
birth control outposts should be in place to freely distribute pills and contraception to the "underserved" communities. in fact, proof of using them should merit cash or other rewards

over the counter should be done. its better than the inevitable (and more costly?) abortions that would result later. or worse, unplanned births. often to people who cant care for them. i like this thread

underserved communities are more likely statistically to not receive proper primary care therefore are more likely to have underlying health issues which need to be addressed prior to starting hormonal medication. Just my opinion though.

I'm against OTC BC's b/c everyone is different and with the different types of options and dosages, I feel they are best in the nature of a PharmD or Doctor/NP care who actually understands the full side effects. You want free BC, go to planned parenthood, get an exam, then pay the $15 a pack. Not bad if you ask me.

Shredder · Mar 2, 2006

mshheaddoc said:
underserved communities are more likely statistically to not receive proper primary care therefore are more likely to have underlying health issues which need to be addressed prior to starting hormonal medication. Just my opinion though.

they do have other problems but they should not have to add to them by throwing unwanted pregnancies and births into the mix. its not right bringing kids into those kinds of lives--unborn kids need to be considered as potential citizens too. i dont know what the cost of birth control is but i suspect its low compared to the repercussions of not using it

among higher SES ppl it may be true that birth control is an incentive to engage in more loose lifestyles. however i think among low SES crowds the presence or absence of birth control makes no difference, so might as well give it to them in the hope that it will curb future problems

maybe youre right about planned parenthood, but since convenience is the main issue here the question is--will the ppl who most need to be using it be willing to go through that "trouble"? anyway i made a thread on it in med biz that deals with the economic implications rather than moral ones

mshheaddoc · Mar 2, 2006

Shredder said:
they do have other problems but they should not have to add to them by throwing unwanted pregnancies and births into the mix. its not right bringing kids into those kinds of lives--unborn kids need to be considered as potential citizens too. i dont know what the cost of birth control is but i suspect its low compared to the repercussions of not using it

among higher SES ppl it may be true that birth control is an incentive to engage in more loose lifestyles. however i think among low SES crowds the presence or absence of birth control makes no difference, so might as well give it to them in the hope that it will curb future problems

maybe youre right about planned parenthood, but since convenience is the main issue here the question is--will the ppl who most need to be using it be willing to go through that "trouble"? anyway i made a thread on it in med biz that deals with the economic implications rather than moral ones

First off, you can't state there are only economic implications to an issue that is ethically (moral/religiously) charged. I understand you can take a business aspect but to blindly ignore one aspect of the problem is self-serving and quite ignorant.

Making birth control available to these people OTC will still not help the issue. Especially with the VAST number of contreceptives available. I find that ridiculous because I don't even know the differences between all the pills/injections/etc but there are differences and some very IMPORTANT differences to the type of birth control you are looking for as well as health aspects.

The main aspect that needs to get out there easy access and education. Then again, some people think its ok for a 17 year old to have 3 separate kids in childbirth because that is what their portion of society knows and its accepted. Additionally, some choose not to use birth control due to religious reasons or the cost. By lowering the cost (which I'm all for) that should not directly mean that you go straight to OTC because you might have cheaper generics available without consulting your doctor/pharmacist.

Most people that know where women's health clinics have either been there for a check up, HIV testing, ECP (emergency contraception) or for an abortion. The majority that I know go for ECP or abortions.

I could argue for hours on why not to make presciption BC's OTC (especially not the injections which would be more appeasible to those who don't want the hassle of taking a pill everyday) but what it comes down to is morals/cost.

Moxxie · Mar 2, 2006

mshheaddoc said:
First off, you can't state there are only economic implications to an issue that is ethically (moral/religiously) charged. I understand you can take a business aspect but to blindly ignore one aspect of the problem is self-serving and quite ignorant.

Making birth control available to these people OTC will still not help the issue. Especially with the VAST number of contreceptives available. I find that ridiculous because I don't even know the differences between all the pills/injections/etc but there are differences and some very IMPORTANT differences to the type of birth control you are looking for as well as health aspects.

The main aspect that needs to get out there easy access and education. Then again, some people think its ok for a 17 year old to have 3 separate kids in childbirth because that is what their portion of society knows and its accepted. Additionally, some choose not to use birth control due to religious reasons or the cost. By lowering the cost (which I'm all for) that should not directly mean that you go straight to OTC because you might have cheaper generics available without consulting your doctor/pharmacist.

Most people that know where women's health clinics have either been there for a check up, HIV testing, ECP (emergency contraception) or for an abortion. The majority that I know go for ECP or abortions.

I could argue for hours on why not to make presciption BC's OTC (especially not the injections which would be more appeasible to those who don't want the hassle of taking a pill everyday) but what it comes down to is morals/cost.

msheaddoc makes some great points. Just because BC (or other medical services) are available for free/reduced cost, it doesn't mean that they will be used. Instead of making BC pills OTC we need to work on better education for the low SES people that Shredder mentions (heck, better sex ed for EVERYONE). The "abstinence only" sex ed courses ignore the fact that many teens WILL have sex, even if god/their parents/society tells them not to. Why not give them the skills and resources to be able to make informed, intelligent decisions. Maybe we wouldn't see as many 16 year olds with two kids and another on the way.

Part of the problem is cultural too. I can't speak for everyone, of course, but I've observed a frightening trend in the Hispanic community in South Texas. Parents don't feel comfortable talking to their kids about sex - many of them completely deny the existence of sex ed. So many girls are left without the knowledge/skills, etc. that I mentioned earlier (I firmly believe that the strongest impressions are those made at home). When they get pregnant, their families do something odd - at first they are disapproving, but when the baby is born they shower it with attention (and the teen in turn gets some of the best positive reinforcement around). I fear that young Hispanic girls are getting the wrong message - it's don't have sex, but if you DO have a baby, we'll be ecstatic!

Maybe someone with a better background than me could give me some insight into the Hispanic ethos?

supersash · Mar 2, 2006

hi everyone. i dont usually read in this forum, but this one caught my eye.

i think otc birth control, or emergency contraceptives are a bad idea. i work in an OB GYN office, and many woman and young ladies only come back for a yearly pap BECAUSE they know we will not renew their pills without a yearly visit. it may sound silly, but it is a big reason why girls see a doctor every year.

if there is no real health concern, many people dont see a doctor all year. i read somewhere (sorry i dont have a source) that a large percentage of americans see their dentists more often than regular physicians.

another problem with OTC's is the health risks. serious risks like blood clots and DVT shouldnt just be an excerpt on a box, they need to be discussed with the patient, and thats where the doctor/np/pharmacist come in to play.

i personally think a big part of "unwanted pregnancies", whether they end in abortion, adoption, or the mother keeps the baby, are rooted in not enough education. i think sex education in the schools need to be kicked up a notch. none of this abstinence only education. abstinence may be the only 100% effective birth control method, but kids are going to have sex. they need to know the best ways to protect themselves.

but anyways, that is just my opinion. moxxie makes some great cultural ethical points. i cant wait to see what other people have to say

Shredder · Mar 3, 2006

education doesnt work, only incentives and disincentives. the underclass doesnt have an understanding of concepts like consequences and long term planning. education operates under those premises. basically the ppl most in need of reproductive planning are largely ineducable. its not within everyones capacity to become educated. but it is within every rational persons capacity to respond to short term incentives. short term is just the key for myopic people.

education is clearly a failed approach not only in the US underclass but also the third world. we are not dealing with a bunch of medical students who will heed educational lessons. i would like to see what kind of results education has produced and over what time frame. im skeptical

sdn1977 · Mar 3, 2006

Shredder said:
education doesnt work, only incentives and disincentives. the underclass doesnt have an understanding of concepts like consequences and long term planning. education operates under those premises. basically the ppl most in need of reproductive planning are largely ineducable. its not within everyones capacity to become educated. but it is within every rational persons capacity to respond to short term incentives. short term is just the key for myopic people.

education is clearly a failed approach not only in the US underclass but also the third world. we are not dealing with a bunch of medical students who will heed educational lessons. i would like to see what kind of results education has produced and over what time frame. im skeptical

gosh!! Am I understanding you saying the socioeconomic less priviledged are unable to be educated? Are you in medical school??? Are you aware there are folks there in your same class who have come from the "underclass" (which is an unnecessarily charged word, IMO)? There were able to be educated & hopefully will go on to educate others as well.

As for education & what it has accomplished...go to the Planned Parenthood site & seek out their statistics to start your search for results. As for third world countries...education is only one factor. Cultural expectations & history is significant as well (why HIV/AIDS education is not as successful in third world countries as it is in this country - another topic).

Most of us who deal with patients daily know many folks don't consider OTC's as "medications" so don't share them w/ their physicians. I've seen this with Vitamin E/bleedings disorders, St John's wort/drug interactions, ibuprofen/gi bleeding, etc..I had a patient 2 years ago who developed dvt @ age 28, suffered a nonfatal pulmonary embolism - all related to oc. She did not have a PCP, but had a gyn who caught her problem & referred her. Most young women do not have PCP's because they are normally healthy. When I consider all the other oc related illnesses I've seen in 30 years as a pharmacist...I must respectfully agree to disagree with you on this.

Shredder · Mar 3, 2006

im a premed. im not a bad person, i just try to see reality as it really is. there are exceptions in the underclass who go on to do all right. far fewer would do so without double standards/AA, this is the truth. but thats not the central issue of the thread. anyway you cannot base policies on exceptions, you must base them on generalizations. i am saying that most of the underclass and the third world is pretty much ineducable for all practical purposes, and using the education approach is futile. as for what education has accomplished--the education approach has been around for decades, yet the problems do not seem to have abated in the underclass or the third world. thus the logical conclusion is that the education approach is faulty and romantic.

but i see what you mean about OTC vs medications, valid assertion. psychological considerations do matter. still, whatever method of reproductive control is being employed in the underclass and the third world appears to be failing miserably. telling ppl to abstain or telling them the real deal about intimate relations makes no difference--were up against human nature here (reproductive urges) and for ppl who are not particularly conscientious, it is going to take more than lectures to generate results. two options are coercion of some sort, or incentives/disincentives. the latter would be more acceptable in the eyes of the american public

incidentally, study after study shows that students in high education from the underclass perform far below peers--lower marks, test scores, and graduation rates. people arent blank slates at birth. they differ in innate tendencies. this must be taken into consideration when trying the education approach with members of the underclass, who again are largely ineducable, at least in the context of family planning

sdn1977 · Mar 3, 2006

Shredder said:
im a premed. im not a bad person, i just try to see reality as it really is. there are exceptions in the underclass who go on to do all right. far fewer would do so without double standards/AA, this is the truth. but thats not the central issue of the thread. anyway you cannot base policies on exceptions, you must base them on generalizations. i am saying that most of the underclass and the third world is pretty much ineducable for all practical purposes, and using the education approach is futile. as for what education has accomplished--the education approach has been around for decades, yet the problems do not seem to have abated in the underclass or the third world. thus the logical conclusion is that the education approach is faulty and romantic.

but i see what you mean about OTC vs medications, valid assertion. psychological considerations do matter. still, whatever method of reproductive control is being employed in the underclass and the third world appears to be failing miserably. telling ppl to abstain or telling them the real deal about intimate relations makes no difference--were up against human nature here and for ppl who are not particularly conscientious, it is going to take more than lectures to generate results. two options are coercion of some sort, or incentives/disincentives. the latter would be more acceptable in the eyes of the american public

incidentally, study after study shows that students in high education from the underclass perform far below peers--lower marks, test scores, and graduation rates. people arent blank slates at birth. they differ in innate tendencies. this must be taken into consideration when trying the education approach with members of the underclass, who again are largely ineducable.

shredder...I'm so sorry, but you sound, in my very small opinion as uneducated!!! You've used the word "ineducable" many times - the word is actually uneducable. un- is a prefix meaning the reverse or negative of a word (verb or noun). in- is a prefix meaning in, on, toward (infer, induct) or no, not, without (illiterate, irresponsible). I'm usually understanding of poor spelling & grammar on message boards, but when you argue education vehemently, I feel the need to point it out. Your argument will sound so much better if you use the correct word.

on to the actual topic....lectures are not what I refer to with regard to education when someone is asking me about Plan B or where to obtain an rx for contraceptives. Those of us in the health professions educate very well when someone comes to seek us out for either one. Yes...it is different education than provided in high schools across the country because as medical professionals we are not constrained by public pressure to not say certain things. I'm asked & will answer EVERYTHING when it comes to reproductive information.

I cannot argue opinion - you have as much right to yours as I do to mine. However, I've got to wonder how many articles you have actually read on the topic of contraception in the US since you are an undergrad. I've been deeply involved in the topic since 1977 - long before you were born and I cannot even begin to know what the studies show in other countries since it is very difficult to keep current on US studies. However, I read primary research. What is reported in newspapers & magazines is not subject to accepted study models & peer reviewed, so is biased. Again...we must agree to disagree and I don't mean to imply you are a bad person. You just sound so arrogant and supercilious to me.

Shredder · Mar 3, 2006

sdn1977 said:
shredder...I'm so sorry, but you sound, in my very small opinion as uneducated!!! You've used the word "ineducable" many times - the word is actually uneducable.

how ironic that you should choose this very word to point out. i specifically looked it up to make sure. i originally put uneducable as my first instinct. a source i consider relatively reliable said otherwise so i went with it. it looks like your opinion on this is very small indeed. im quite careful about my spelling and diction on these forums and elsewhere. if youre going to try picking on me it will have to be on some other front. also, one doesnt sound as uneducated. he sounds uneducated. two can play the spelling/grammar flaming game.

you can call me what names you wish, but apparently you cannot demonstrate that education has had a marked impact on the problem of poor family planning. i will point out to you that a full 70% of black children are born out of wedlock. and this is in the USA. God knows what stats are in the third world, if the institution of marriage is even recognized.

education in the context of this thread doesnt mean disclosing full information about drugs and treatments. as medical professionals thats a given. it means family planning education, in schools and otherwise. name calling/labeling is the last resort of losing debaters. i dont care what anybody sounds like, i care about points. but thats just me. opinion need not be argued, we can argue facts if you cite or call for any.

MarzMD · Mar 3, 2006

Shredder, it seems as though you so quickly dismiss those at a lower socioeconomic status than yourself. Its like you have completely given up on a whole demographic of people simply because its is your opinion that given the resources, most will fail anyway. I know you respect the world of business, and so do I, but when dealing with policies that change lives it is not as clear cut as you make everything out to be. I find it funny that you seem to look down on such people, yet advocate policies that will continue to keep them uneducated. Yes, there is a problem in many communities in America, but the approach you usually suggest only perpetuates the cycle.

jbone · Mar 3, 2006

sdn1977 said:
shredder...I'm so sorry, but you sound, in my very small opinion as uneducated!!!

The shredder is a freakin genius, don't mess.

Moxxie · Mar 3, 2006

Shredder said:
how ironic that you should choose this very word to point out. i specifically looked it up to make sure. i originally put uneducable as my first instinct. a source i consider relatively reliable said otherwise so i went with it. it looks like your opinion on this is very small indeed. im quite careful about my spelling and diction on these forums and elsewhere. if youre going to try picking on me it will have to be on some other front. also, one doesnt sound as uneducated. he sounds uneducated. two can play the spelling/grammar flaming game.

you can call me what names you wish, but apparently you cannot demonstrate that education has had a marked impact on the problem of poor family planning. i will point out to you that a full 70% of black children are born out of wedlock. and this is in the USA. God knows what stats are in the third world, if the institution of marriage is even recognized.

education in the context of this thread doesnt mean disclosing full information about drugs and treatments. as medical professionals thats a given. it means family planning education, in schools and otherwise. name calling/labeling is the last resort of losing debaters. i dont care what anybody sounds like, i care about points. but thats just me. opinion need not be argued, we can argue facts if you cite or call for any.

One quick point: if you're so fanatical about spelling and grammar, why don't you capitalize anything or use apostrophes? But the point here isn't whether or not health care providers are educated (or if we can spell or not, hehe). It's about whether or not it would be safe to allow BC to be OTC, and the resulting issues (cultural/educational/economical) that are associated with this particular problem.

While I agree with you on some points, overall you're coming out pretty classist and just a tad racist here. You point out that 70% of black children are born out of wedlock. Does this mean that all black people are un/ineducable? Of course it doesn't. I'll still argue that a BIG portion of the problem for blacks, hispanics, many minorities is their family culture.

It really IS our job as health care providers to help battle some of these cultural issues and keep our patients, whatever their SES, well-informed with access to the care that they need. If it's true that only incentives/disincentives work for the "underclass," then we need to develop a better system of incentives to get these people (whom you consider to be lower than yourself) to actually use birth control. You're so confident that you know what all the problems are with people of lower income, but do you have any solutions?

aamartin81 · Mar 3, 2006

I didn't read the last few posts (looked a bit long and off topic), so I'm not sure if this has been indicated elsewhere, but Plan B (emergency contraceptive) is available without prescription (OTC) in select pharmacies in Alaska, California, Hawaii, Maine, New Mexico, New Hampshire, and Washington.

A good information site is: http://www.go2planb.com/

Shredder · Mar 3, 2006

Moxxie said:
While I agree with you on some points, overall you're coming out pretty classist and just a tad racist here. You point out that 70% of black children are born out of wedlock.

i see...so pointing out touchy facts has become racist in this day and age. i have friends of all colors, on sdn and off. but i apply the same standards to everyone too. ive always thought ppl like MLK and JFK wanted to move toward that as well. only by directly confronting the problems of the different races and classes can anything be done about them. sidestepping and euphemisms only slow things down or, worse, take steps backward

gtg will revisit later

mshheaddoc · Mar 3, 2006

Shredder said:
i will point out to you that a full 70% of black children are born out of wedlock. and this is in the USA. God knows what stats are in the third world, if the institution of marriage is even recognized.

You need to see where your stats are coming from ...

Once again, African Americans
have experienced the greatest increases, although they have also been responsible for most of the recent decline in both teen births and nonmarital teen births.

From 1950 to 1997, the proportion of births to unmarried white women (non-Hispanic) increased almost twelvefold,
from 2 percent to 22 percent. The African American proportion increased fourfold, from 18 percent to a striking 69 percent. (The African American rate could not have risen much more because it was already so high.)

Similarly, the fertility rate of married African American women fell from 137.3 per thousand in 1950 to 70.7 in 1997 (Fig. 4). Had their fertility rate remained the same, the percentage of African American children born out of wedlock in 1997 would have been 36 percent, not 69 percent.19

Additionally it goes on to say that african american single mothers may have a higher proportion of children but its more along the facts that those children have "less" time as a two-parent household than being born out of wedlock that makes a difference. And latinos have consistently the same thing.

http://www.hoover.org/publications/books/fulltext/colorline/95.pdf

So if you look at the numbers truly alot of the numbers are based off the fertility rate, therefore they are "inflated" compared to actual numbers.

shredder said:
whatever method of reproductive control is being employed in the underclass and the third world appears to be failing miserably.

Where is this failing miserably? I think this statement is a reflection of ignorance as most of the AIDS issue (for example) is spread through prostitutes/rapes and there are organizations to explain that condoms/BC's are for their protection. Its hard when Africa's president comes out and states that there "IS NO SUCH THING AS AIDS" so people feel that they don't need to protect themselves from anything. That doesn't excuse pregnancy though ... but just an example that these women don't always "CHOOSE" to get pregnant.

shredder said:
telling ppl to abstain or telling them the real deal about intimate relations makes no difference--were up against human nature here and for ppl who are not particularly conscientious, it is going to take more than lectures to generate results. two options are coercion of some sort, or incentives/disincentives. the latter would be more acceptable in the eyes of the american public

Here's some information for you ...

#
Birth Control for People with Low Income

Requires incentives or motivation:
# abstinence
# "outside sex"
# delaying marriage

Requires education and incentives or motivation:
# rhythm method

Requires government or agency financial aid and incentives/motivation:
# condoms
# sterilization: vasectomies, tubal ligations, and quinacrine
# pharmaceuticals

Ways to accomplish motivation and incentives:
# Understanding cultural beliefs and attitudes concerning having children Education of women
# Providing women with livelihoods and self-esteem
# Mass Media programs, such as soap operas

Men's Participation Oct 98 from the John Hopkin's Center on Communications: Men are more interested in family planning than assumed, but need services directed specifically to men. Understanding the balancing of power between men and women can improve reproductive health behavior. One billion young men are ages 10-19. Most sexual activity occurs within marriage, but the age of marriage has been rising while the age of sexual initiation has been lowering, putting young people at risk for pregnancy and sexually transmitted disease. Age of puberty for boys has declined over the years to ages 9 to 14.

Surveys in Morocco, Pakistan, Egypt, Bangladesh, and sub-Saharan Africa show that 70% - 90% of men approve of family planning. Recommended strategies:

1. Build on men's approval of family planning.
2. Use the mass media to communicate with men.
3. Reach out to young and unmarried men.
4. Understand the influence of gender.
5. Encourage couple communication.
6. Bring information to where men gather.
7. Inform men about condoms and vasectomy.
8. Counsel men with respect and sensitivity.
9. Offer men a range of health services.

From Family Health International In Kenya, Morocco, Pakistan, Egypt and Bangladesh less than 1/2 to 1/3 of men want to have another child. HIV and other STDs have made men more aware of protection such as condoms.

Rand Issue Paper Reasons for expanding family programs: fertility rates still high, population momentum strong - increases the next 25-50 years, possible weakening of family programs, widespread preference for smaller families in developing countries, access to contraception will reduce abortions. Common barriers to the use of contraception: lack of knowledge about contraceptive methods and availability, and concern about health effects

Colombia's Profamilia founded in 1965 ... a pioneer in many techniques -- the use of radio to promote family planning, a network of trained volunteers offering contraceptives and information door to door, mobile sterilization vans and now special clinics for men. Pills and condoms can be found in the most remote Colombian village. With grants from the Dutch Government and the United Nations, Profamilia is now training others.

Brazil and television. Brazil has a lower birth rate than its richer and better-educated neighbors. The spread of television with the nightly telenovelas (soap operas) has provided the poor, with their first glimpse of small, less authoritarian families and of consumer culture. Women realized they could choose fewer children, and that children had a cost. New York Times, June 13, 1999

Zimbabwe: Battling AIDS in Africa by Empowering Women In Africa, AIDS is mainly heterosexually transmitted and 25 to 30% of the population is infected with H.I.V. Dr. Nancy Padian, an epidemiologist and director of research for the AIDS Research Institute of the University of California at San Francisco, has found that persuading people to use condoms is far easier than originally thought: more than half the uninfected women who come to regular family planning clinics in Harare are able to persuade their male partners to use them. Padian is also trying to encourage them to use female methods of contraception: female condoms, spermicides, diaphragms. Women are taught to negotiate strategies. In role-playing strategies they are presented with obstacles and have to work out ways to overcome them. They are encouraged to talk about sexual activity with their partners, and taught that these discussions are healthy. Factors contributing to the higher susceptibility to AIDS are: the higher prevalence of other sexually transmitted diseases, the lack of male circumcision, (a factor in the man's susceptibility) and poor health due to infection from parasites, poor nutrition, etc. African men often have multiple partners and still have their monogamous partner. Women are generally monogamous with the exception of those in the sex trade. Another factor is the practice of "dry sex," which women believe that men prefer. Micro loans, which are small loans to women to help them start businesses of their own, economically empower women, which helps them negotiate sexual activity. August 22, 2000 New York Times

Group to Pay Addicts to Take Birth Control. A California-based group, Children Requiring A Caring Kommunity (CRACK), will make a provocative offer to Washington's drug addicts: obtain long-term birth control and get $200 in cash. Placards advertising the program will be placed in 500 Metro buses. The Washington DC effort will be headed by Melanie Folstad, who adopted a low birth-weight baby delivered by a drug-addicted D.C. woman who was being held in jail. The campaign started in Anaheim and has spread city by city to Los Angeles, San Francisco, Phoenix, Seattle, Kansas City, Chicago and other cities. The program has been called simplistic, racist and dehumanizing, taking advantage of drug abusers with mental illnesses, making them even more vulnerable to the influence of easy cash. 236 women and one man have collected the reward so far. Barbara Harris, the group's founder, figures the program is trading a small sum to pay to avoid the greater cost of coping with abandoned children. Most of CRACK's board members are black. Harris is married to a black man with whom she raised six biracial children before adopting four African American siblings of the same drug-addicted mother. Folstad's adoptive son and two other children she is now adopting are African American. Planned Parenthood says that "We believe that any program that offers cash as an incentive to take birth control or become sterilized is inherently coercive." Harris wonders how "vulnerable women can make a rational decision to have a free abortion when they are under the influence of drugs?" The program rewarded 237 drug addicts, whose history before treatment revealed 1,501 pregnancies, 527 of which ended in abortion. Of the 966 completed pregnancies, 117 infants were stillborn and 39 died after delivery. Among the 810 children who survived, 537 are in foster care. Of the participants, 101 were white, 102 - black, 25 - Hispanic, 3 - Indian, and 6 - biracial. Under the CRACK program, 117 had a tubal ligation, 67 took Dep-Provera, 23 had an IUD, and the only participating man had a vasectomy. June 26, 2000 The Washington Post

http://www.overpopulation.org/birthcon.html

mshheaddoc · Mar 3, 2006

What it boils down to is this:

1) you are a male, therefore most of these "female" issues it will be hard for you to sympathize with as you do not have to go through what most women go through.

2) You claim you understand and keep preaching about what does and doesn't work in underserved communities ... how much time have you actually spent there? I'd hope with all this talk that you are either from an underserved community or that you have spent a great deal of time there. Because although I may not be from an underserved community, that doesn't mean I haven't spent time in those communities and seeing how they make it day to day. Especially with birth control. Any teenager will tell you ...
1.) Condoms don't feel good
2.) I don't want my parents to find out
3.) He can just pull out and that will solve that issue.

Education is what is needed as well as community involvement to lower (which already is happening) the teen birth rate. Having these clinics available so children can go to get the protection they need from doctors at a price that is reasonable. Most of them don't go because they are lazy, would rather spend their money on their cars and bling-bling and really don't think about the future. Unfortunately, I have witnessed this first hand. So yeah, I can say that I feel I can speak with some authority on this issue. They just don't care, they are kids. All your statistics and logical analysis will not and can not change that. This is where "compassion" comes in and sometimes outweighs the logical and economic aspects that people with one track minds often have. I respect your thoughts and opinions Shredder, but I question your intellectual reasoning skills as too narrow to understand human emotions and just understanding human nature from an economic and logical standpoint.

Life is not and will not be logical.

mshheaddoc · Mar 3, 2006

aamartin81 said:
I didn't read the last few posts (looked a bit long and off topic), so I'm not sure if this has been indicated elsewhere, but Plan B (emergency contraceptive) is available without prescription (OTC) in select pharmacies in Alaska, California, Hawaii, Maine, New Mexico, New Hampshire, and Washington.

A good information site is: http://www.go2planb.com/

And this is something that honestly I'm for because I believe that it would more benefical to have access to this in the first week after sex then an abortion 1-2 months later.

Moxxie · Mar 3, 2006

mshheaddoc said:
And this is something that honestly I'm for because I believe that it would more benefical to have access to this in the first week after sex then an abortion 1-2 months later.

To this and everything else you've said, mshheaddoc -

BRAVO!

Moxxie · Mar 3, 2006

Shredder said:
i see...so pointing out touchy facts has become racist in this day and age. i have friends of all colors, on sdn and off. but i apply the same standards to everyone too. ive always thought ppl like MLK and JFK wanted to move toward that as well. only by directly confronting the problems of the different races and classes can anything be done about them. sidestepping and euphemisms only slow things down or, worse, take steps backward

gtg will revisit later

You missed what I said next...

Does this mean that all black people are un/ineducable? Of course it doesn't.

Yes, I WAS implying that you're being a bit racist here. Why? Because you choose to specifically point out ONLY black statistics, then proceed to bash the "underclass," implicitly grouping blacks with these ignorant, uneducated people that you seem to dislike so much.

And hey, I believe you that you have friends of different races. And it's true that we should apply the same standards to everyone. But this isn't an equal world - we all aren't on equal footing here, and you've GOT to be compassionate about people that haven't had the same advantages that you seem to have had.

Anyways, I'm done arguing race/etc. To address the original question, I think that it's too risky to allow BC pills to be made OTC, but there should be greater access to Plan B. We should give more pharmacists dispensing rights - with the correct education, of course. And not to open a whole other can of worms, but pharmacists should also be able to refuse to fill such prescriptions, IF and only IF they are able to redirect the patient to another pharmacist (that is nearby, not in the next town) that CAN fill the script. (BTW, If you're interested/inflamed by this topic, go to the pharmacy forums - the issue has been talked to death.)

bananaface · Mar 3, 2006

Shredder said:
over the counter should be done. its better than the inevitable (and more costly?) abortions that would result later. or worse, unplanned births. often to people who cant care for them. i like this thread

To go Rx ot OTC, a drug must be able to be used safely by the public, per the FDA. I personally don't believe the public would follow the guidelines that providers currently follow. I don't see all of them refraining from taking estrogen containing BC pills if they are a smoker over the age of 35, etc. Right now, prescribers are the gatekeepers who ensure safe useage. Also, patients aren't going to understand what dose/type of progestin to use to avoid side effects that occured using another BC pill. And, OTC status would result in reduced access for some, when some insurance companies and welfare agencies drop them from their prescription coverage formulary. I think if they were able to obtain them through a pharmacist who did appropriate screening that would be a positive thing. But, I do not want to see them go straight OTC.

I agree that earlier prevention is preferable for all parties involved.

Shredder · Mar 3, 2006

Moxxie said:
If it's true that only incentives/disincentives work for the "underclass," then we need to develop a better system of incentives to get these people (whom you consider to be lower than yourself) to actually use birth control. You're so confident that you know what all the problems are with people of lower income, but do you have any solutions?

i agree, we do need a better incentive scheme. thats my gist. i think "lower" and "higher" is a combo of nature and nurture but mostly nature. thus i altered my signature to incorporate a nice line from spiderman. by most reasonable measures they are lower than SDNers, but the idea is to bring them up. it may not happen within one generation given the nature component. im big on genetics so thats my premise. most children from the underclass will end up in the underclass no matter where they are born. a nobel laureate child born in the ghetto is unlikely to remain there. can clarify if needed but this is where i am coming from

ps im not the one who started the English wars. +i didnt say all blacks are ineducable, thats a straw man. but some are--as are some of all colors--and its hopeless trying to educate such folks. its like trying to force wheelchair bound people to walk. people just have their natural limits and those have to be considered. i pointed out solely the black stat bc its the most glaring and easily remembered. its common to point out the most glaring of a set of stats, and it just so happens that this one invites the all too common racist undertones. if i didnt list mt kilamanjaro as one of the highest mountains in the world i wouldve been called racist just the same. that word is best left out of discussions unless one wants to appear like a loony left winger. its possibly the single most overused word today, shortly after "the" and before "nazi"

Shredder · Mar 3, 2006

mshheaddoc said:
intellectual reasoning skills as too narrow to understand human emotions and just understanding human nature from an economic and logical standpoint.

my EQs no good. i blame it on arnie and making me shy away from the girly man image. but as economists we both know the major underlying assumption in all of econ is rational behavior. if behavior is irrational then you cant apply econ. you cant really apply anything since irrationality is unpredictable and impossible to base theories and models on. so the only option is to assume rationality, or do nothing

anyway why not offer pubescent teens some amount of money in exchange for norplant? it would be cost effective and i dont see any harm in it. i meant to get at this in my med biz thread but its just as well discussed here. i think this is a very reasonable proposition. qualms? it would be voluntary but most would take it up, and society would benefit greatly from it. the only qualm is that it allows for promiscuity and STDs. BUT, historically the problem with promiscuity has not been promiscuity per se, but its consequences such as unplanned births and births out of wedlock. no? as for STDs, theyre occurring anyway. i dont know a way around that but analyzing it gets complicated, for now ill leave it be

as for all the stats, i still cant see how with a 70% out of wedlock birth rate among blacks a claim that education is effective can stand

bananaface · Mar 3, 2006

I am not sure about the idea of incentives for a few reasons.

I'm not sure how the scheme could be made practical, fair, or ethical, or if it is necessary. Would we reward only people in certain income brackets for using BC, or would we reward everyone? Would we reward women, men, or both? It just seems messy. And, if we reward taxpayers for using BC with $$, aren't we just redistributing to the poor, making it a class driven system anyway? We would certainly get some women who don't need BC taking it just for the $$. There are long term risks and benefits associated with use. I wouldn't want to see people go in for money only, without factoring in everything they ought to. From what I have seen in practice, people who don't want to have children (ie: want contraceptive options) will utilize BC methods if they are made accessbile (which may mean making them free). Those who want children will have them anyway. If the problem is those who want contraception not having access, we should address that directly. If the "problem" is that people who want children are having them, well, incentives aren't going to do much. They'll just go off BC pills whenever they feel like having kids and collect rewards during BC years.

bananaface · Mar 3, 2006

Shredder said:
anyway why not offer pubescent teens some amount of money in exchange for norplant?

Because it's no longer on the market.

Shredder · Mar 3, 2006

these are logistical concerns that go along with any social programs. imagine the messiness of social security and welfare programs...quite convoluted but they manage to go along. all of govt is messy. consider taxes. cheating and policing occurs in any incentive schemes, its part of the deal. but as long as the overall benefit outweights the cost, the outcome is positive.

i think most births among the underclass (i refuse to put it on quotes! its a good word to get the concept across) are unplanned. in the early 90s there was concern that welfare policies were in fact an incentive scheme to promote childbearing among the underclass, and consequently it underwent reform to address that in the clinton years--i believe. it was an unusual move for a democrat to reform welfare like that.

if contraception is free most members of the underclass may simply ignore it. usually when they bear children, most of the financial burden of the children is borne by the rest of society anyway. so they dont see the full consequences of childbearing. ill leave it at that for now. there are details to work out, but in theory manipulating incentives is key to enacting social reform

chef_NU · Mar 3, 2006

I think what shredder is trying to say is that from a public policy standpoint, our dollars are most effectively spent on short term incentives. Sure, education and whatever all have their merits, but we're talking about making the biggest impact with the least dollars and administration. The idea, which I agree with, is that government policy needs to play hard and fast with people: no nonsense, direct consequences. Basically we have tough love. Compassion is something that we save for the private sphere.

On another note, the race thing was highly comical. Oh the wonders of living in a PC, super sensitive society!! This generation has been brought up in a highly progressive, civil rights friendly education system. Let's please understand what racism means.

Racism - you believe that, on average, a particular race of human beings is biologically superior to another race of human beings.

The amount of people who believe this today are mind-numbingly small. And the number of people on SDN who are truly racist is probably close to zero. To throw allegations of racism is somewhat ludicrous. What we had here is someone broke a cultural taboo by using the word "underclass" or citing a controversial fact involving race. But guess what! Shredder still isn't racist. I know that, in general, huge numbers of people (including myself) use "racial" slurs or make "racist" jokes, break cultural norms and taboos, and just generally don't give a **** about what other people think. We aren't racist! We just don't care that you're offended by how we speak/behave! So wise up next time your panties get in a bunch.

Shredder · Mar 3, 2006

bananaface said:
Because it's no longer on the market.

yeah i just looked that up...as a premed im not up to speed on the latest drug fads. an extreme option is sterilization, but ppl shudder when they think of that. however if a reversible sterilization is possible, i think it would be great to perform it on perhaps 14 year olds. then undo it later when childbearing is planned for. or have all births done by IVF. anyway this is getting sci fi...but i dont see any reason it couldnt become sci fact

question: why is it so hard to adopt yet so easy to bear ones own children? isnt there something fishy about that?

QuikClot · Mar 3, 2006

chef_NU said:
I think what shredder is trying to say is that from a public policy standpoint, our dollars are most effectively spent on short term incentives. Sure, education and whatever all have their merits, but we're talking about making the biggest impact with the least dollars and administration. The idea, which I agree with, is that government policy needs to play hard and fast with people: no nonsense, direct consequences. Basically we have tough love.

Good idea. My suggestion; you lie to the country as an elected official, we cut your balls off. Your beat or torture someone in government custody, or order it, or fail to report it; you are automatically "rendered" to Iran. All business fraud, including fradualent billing, insider trading, and lying to investors and regulators; all your property is confiscated and you serve ten years.

And those who suggest sterilization for the "underclass" are forcibily sterilized. :laugh:

Racism - you believe that, on average, a particular race of human beings is biologically superior to another race of human beings.

Wrong. That is one, narrow definition of racism, not the universally accepted definition of racism.

From the Arab association of human rights:

Although racism as an anthropological and biological theory emerged primarily during the nineteenth century, it reflects an approach that has existed since the earliest times. From the eighteenth century through the early twentieth century, as Europeans took control of large portions of Africa and Asia, they justified their rule by claiming that it was the duty of the superior White race to civilize the dark-skinned natives of these areas. Although colonialism has virtually been eradicated since the mid-twentieth century, its impact continues to be felt to this day.

Today, however, a broader definition of the concept of racism has become current. This definition does not emphasize the sense of superiority on purely racial grounds, but rather the extrapolations of this sense toward other groups national, linguistic, religious, and so on. While in the past this term was used to refer to superiority in an anthropological, biological and racial sense, it is now used to refer to the superiority of members of one group over those belonging to different groups within the population. As used today, racism refers not only to theories of biological differences between humans, but also to ideas relating to differences between people who belong to different social and cultural groups. In accordance with this definition, racism is present when the argument is made that there is a difference between the members of group and those of group B; and that, due to this difference, the members of group B are to be treated differently from the members of group A.

Thus the term racism has been interpreted as extending to areas that have no direct connection with race per se, and thus grossly contradicts the social needs of a modern democracy.

This broad definition was also adopted in the 1996 International Convention on the Elimination of All Forms of Racial Discrimination, the most important convention relating to the struggle against racism. Article 1 of the convention states:

"In this Convention, the term racial discrimination shall mean any distinction, exclusion, restriction or preference based on race, color, descent, or national or ethnic origin which has the purpose or effect of nullifying or impairing the recognition, enjoyment or exercise, on an equal footing, of human rights and fundamental freedoms in the political, economic, social, cultural or any other field of public life".

The same is true of Israeli law. Article 144A of the Penal Code, 5737-1977, defines racism as follows:

"Racism persecution, humiliation, degradation, manifestation of hatred, hostility or violence, or the harming of a public or of sections of the population, on account of color or affiliation to a race or to a national-ethnic origin".

The Israeli Supreme Court has also addressed the term racism from a broad perspective. In CA 2831/95, Alba v State of Israel, Piskei Din 50(5) 221, Justice Eliahu Matza writes (on pp. 256-257):

"Indeed, in determining the scope of the term racism, far be it for us to adhere to technical, scientific or pseudo-scientific definitions regarding the different origins of the human species. Racism is no longer merely adherence to the infamous theory of racialism. Racism is any pointless hatred of the stranger by virtue of his being a stranger, on the basis of racial or national-ethnic distinction. This hatred is a social ill that is as old as time".

Accordingly, both international and Israeli law adopt the modern, broad and liberal definition of the concept of racism, enabling a more comprehensive and effective struggle against different manifestations of racism.

You go on to admit that you like to make racist jokes, and use racial slurs, but you aren't a racist, presumably because you base your hate on something other than the narrow biological grounds. But as my sources point out, racism existed long before the "biological" argument did, so that cannot be its defining characteristic. Just as racists in the 19th century found the arguments of biology and used them to further their hate, today most racists have found other arguments, without ceasing to be racists.

I know that, in general, huge numbers of people (including myself) use "racial" slurs or make "racist" jokes, break cultural norms and taboos, and just generally don't give a **** about what other people think. We aren't racist! We just don't care that you're offended by how we speak/behave! So wise up next time your panties get in a bunch.

I know a huge number of people like myself, confronted by an oily customer who uses racist slurs, makes bigoted jokes, moans about the "underclass" but claims not to be a racist, will refer to that person as a racist dirtbag, a fascist creep, and an dishonest, cowardly bigot.

But don't get your panties in a bunch. It's just the truth.

chef_NU · Mar 3, 2006

Welll Quickclot, I guess I'm racist.

chef_NU · Mar 3, 2006

and the arab association of human rights can eat my @$$

QuikClot · Mar 3, 2006

My, my, my. And I thought you didn't give a s$it what people thought. :laugh:

I should know better than to engage on a topic like this . . . especially with people who are obviously "ineducatable," preaching sterilization of the poor and racial slurs as expressions of free-thinking. Bye.

bananaface · Mar 4, 2006

Shredder said:
yeah i just looked that up...as a premed im not up to speed on the latest drug fads. an extreme option is sterilization, but ppl shudder when they think of that. however if a reversible sterilization is possible, i think it would be great to perform it on perhaps 14 year olds. then undo it later when childbearing is planned for. or have all births done by IVF. anyway this is getting sci fi...but i dont see any reason it couldnt become sci fact

question: why is it so hard to adopt yet so easy to bear ones own children? isnt there something fishy about that?

That's not fish you smell. It's... oh, nevermind. :laugh:

Paying people not to have babies is not nearly as admirable a social adgenda as making sure that women choose when to and when to not have children. The former is manipulative while the latter is empowering. The difference is not subtle.

You seem to underestimate the appeal of providing services and supplies that people value for free. The bottom line is that if people value contraception, free is good enough. If they don't, they are not going to be compliant.

In my state, alot of women utilize contraceptive services courtesy of the taxpayers. The state does this because it is less expensive than financing births and upbringings. There is a program called "Take Charge" that any woman or man can sign up for and recieve a free pelvic exam, contraceptives of all types, and a few other items such as antibiotics to treat STD infection. There are income parameters, but no verification is performed.

Shredder · Mar 4, 2006

bananaface said:
That's not fish you smell. It's... oh, nevermind.

Paying people not to have babies is not nearly as admirable a social adgenda as making sure that women choose when to and when to not have children. The former is manipulative while the latter is empowering. The difference is not subtle.

You seem to underestimate the appeal of providing services and supplies that people value for free. The bottom line is that if people value contraception, free is good enough. If they don't, they are not going to be compliant.

In my state, alot of women utilize contraceptive services courtesy of the taxpayers. The state does this because it is less expensive than financing births and upbringings. There is a program called "Take Charge" that any woman or man can sign up for and recieve a free pelvic exam, contraceptives of all types, and a few other items such as antibiotics to treat STD infection. There are income parameters, but no verification is performed.

but ppl clearly do not value free contraception. however they would value paid contraception. either way its giving them a free choice. paying them for it is just making the choice a little more favorable for contraception. the same effect is seen in subsidizing abortions, whether that is the stated purpose for subsidizing them or not. by subsidizing something or paying someone to do it, it makes them that much more likely to take that route. but theres nothing forced about it. AA and its associated scholarships are like school subsidies and empowerment, but ppl do not call that manipulative. at the cost of tax money, supposedly its done for minorities' and society's own good, which is the same premise behind paid contraception/abortions or such and such

ppl will value contraception if value is added to it. they would value anything if you externally add enough value to it somehow. the govt would pay ppl to undergo contraceptives, abortions or even sterilizations bc in the same way its cost effective/less expensive than financing this and that; its just taking free measures a step further

too early...

nikibean · Mar 4, 2006

As someone who works daily with an under-served population in distributing birth control, I'd like to join this discussion. For those who don't know, I work at Planned Parenthood.

People do want birth control. Socioeconomic class, from my experience, has *nothing* to do with whether they want it or not, or how well they use it. Most of the young people who come into my clinic have some idea of how things work, and they want an education, they don't want to live in a f*cked up neighborhood. I get pretty personal, especially with teens, and I always ask what future goals are for people - many even want to be physicians! That being said, even the most highly educated people that come into my clinic as "private pay" are incapable of reading the directions in their pills, or they aren't told correctly on how to use something. The patch can cause some women to vomit in the first two days (lovely), so often these women stop using it. If someone's late for a depo shot, they're running a risk. And many times, a woman tries a pill and hates it so she assumes all pills will cause the same side effects. No WAY should OCs be OTC. Plan B - maybe- I'm up in the air on that one. So, let me get into some problems:

1) Teenager - and general - misinformation. Many teens I've spoken to don't get their health class until they're seniors, but guesss what? They're 15 or 16 when they start having sex. Thank goodness for anovulatory cycles early on. I can't even begin to tell you how many pregnancy tests I've done on women who have had their period last week and had unprotected sex last night. The educational value of having them in my clinic is incredible, and I am so happy to have the 20 minutes with them to help them understand what's going on with their bodies. There are groups of people who still think the withdrawal method works, and think that abortions will make you sterile (nope- Chlamydia will, left untreated, and those who are having unprotected sex are not only risking pregnancy but infections, so an STI will do it, not an AB).
And the number 1 reason why teenage girls don't want birth control? "I heard it makes you gain weight."

I quickly point out that pregnancy changes your body forever and the avg weight gain with OCs is about 3 pounds.

2) As to having children early in various populations I see - okay, in Catholic communities, it's okay to get "swept away" by passion/love, but to have pre-meditated sex it's a sin. Therefore, planning to have sex by taking birth control pills is a sin. Children are also highly valued in the hispanic community. Now, are things changing? Yes. Slowly. I'm not trying to make a sweeping generalization, I'm just simply explaining it to you the way it's been explained to me over and over by patients. Many women, however, will come in for depo because there's no evidence to their husbands. Think about the cultural ramifications of birth control, and know that not everyone has the same value systems.

I think OCs should be available and be free (they are in CA, but not everywhere), because certainly it's a woman's right to decide when and how many children she will have. I am a passionate believer in this. If you want to argue the economics of it, as I'm sure Shredder will, yes, it's more cost effective than supporting a woman's Medi-Cal prenatal services or her emergency medi-cal abortion procedure. But I do think that having women come in to speak to knowledgeable personnel is a huge advantage, even with Plan B. When someone comes in for Plan B, I often have the opportunity to ask, "so why aren't you using birth control?" and then I get to answer their questions. We also distribute 48 condoms and offer free STI testing at that point. Do you know how many women we've treated for Chlamydia or Gonorrhea because of that visit? That visit becomes very valuable for the patient at that point- which is why I'm up in the air about Plan B being OTC. I've also had women come in, knowing they're pregnant and ask for Plan B thinking it's mifepristone.

Okay, that's my two cents. Off to drink more caffeine....

bananaface · Mar 4, 2006

Shredder said:
but ppl clearly do not value free contraception. however they would value paid contraception. either way its giving them a free choice. paying them for it is just making the choice a little more favorable for contraception. the same effect is seen in subsidizing abortions, whether that is the stated purpose for subsidizing them or not. by subsidizing something or paying someone to do it, it makes them that much more likely to take that route. but theres nothing forced about it. AA and its associated scholarships are like school subsidies and empowerment, but ppl do not call that manipulative. at the cost of tax money, supposedly its done for minorities' and society's own good, which is the same premise behind paid contraception/abortions or such and such

ppl will value contraception if value is added to it. they would value anything if you externally add enough value to it somehow. the govt would pay ppl to undergo contraceptives, abortions or even sterilizations bc in the same way its cost effective/less expensive than financing this and that; its just taking free measures a step further

too early...

How do you figure that people don't value free contraception? I figure they do because many of my patients utilize the state's program. Cost is their barrier to access, not indifference to contraception. It's the indifferent people you are seeking to reach with the extra bribe.

Giving money doesn't get people to comply if they don't want to. For example, the physicians at one local hospital here often leave money in the Rx bags for their teenage HIV patients, as an incentive for them to come pick up their refills. One of my lab instructors works there. She said it doesn't help much in terms of getting kids to come in and pick up their meds.

Shredder · Mar 4, 2006

nikibean said:
it's a woman's right to decide when and how many children she will have.

its within ppls rights to do what they want, as long as it doesnt infringe on others' rights. there are 2 ways irresponsible childbearing violates this. first of all you have to consider the life that you bring the child into, which is often dismal (in low SES cases and illegitimacy). i guess thats not explicitly violating an unborn childs rights, but its undesirable. secondly, when there is welfare involved for the mother, child or both, then dollars are being stripped from other productive members of society to subsidize that irresponsibility. overall bad situation. key point is that ppl have rights within limits, and if they start stepping over that then action needs to be taken to correct it.

bananaface said:
It's the indifferent people you are seeking to reach with the extra bribe.

i guess thats a way of putting it. however even the unwilling people will at some point become indifferent and then progress to willing, if you adjust the extent of the bribe/incentive. granted, a bribe wouldnt come free--it would come from tax money. but by preventing unintended or undesirable births, those dollars would eventually come around by avoiding welfare, or even crime when dealing with babies from criminals. genetically its been shown that kids of criminals tend to become criminals too, even after accounting for environment

giving enough money to people will get them to comply with nearly anything. its like the saying, everybody has a price tag. its not bribery though, that has a negative connotation. its public policy, for the greater good

anyway planned parenthood was founded on eugenic ideals. sanger, a real pioneer

bananaface · Mar 4, 2006

Shredder said:
i guess thats a way of putting it. however even the unwilling people will at some point become indifferent and then progress to willing, if you adjust the extent of the bribe/incentive. granted, a bribe wouldnt come free--it would come from tax money. but by preventing unintended or undesirable births, those dollars would eventually come around by avoiding welfare, or even crime when dealing with babies from criminals. genetically its been shown that kids of criminals tend to become criminals too, even after accounting for environment

At this point, 40% of births in my state are state financed. That seems like an awful lot of people to bribe and suggests an awful tax burden up front. Alot of people might dismiss it as a program which provides an incentive to remain poor or as a redistribution of the wealth scheme. The latter seems very out of character for you.

Shredder · Mar 4, 2006

bananaface said:
At this point, 40% of births in my state are state financed. That seems like an awful lot of people to bribe and suggests an awful tax burden up front. Alot of people might dismiss it as a program which provides an incentive to remain poor or as a redistribution of the wealth scheme. The latter seems very out of character for you.

the births themselves in addition to pre and postnatal care cost money as well. and all of that would be eliminated under reproductive prevention/disincentive schemes. for those who are unable to pay by their own means, that is. bribing would cost a fair amount of money, but it has to be compared to the costs of: the aforementioned birth+pre and post natal care, possible (if not likely) welfare later, and the same for crime and incarceration. all of these things too impose costs on society, and the idea is to cut down on them.

births shouldnt be subsidized--if a person cannot afford to even bring a child into the world, what does it say about that persons ability (financial and otherwise) to raise the child successfully? but prevention of births should be subsidized. in fact subsidizing births is atrocious, its a blatant incentive to bear children that people are incapable of providing for. the question remains: why is it so difficult to adopt yet so easy to bear ones own offspring? if such high standards are imposed on potential adoptive parents, why do we permit biological parents (is the plural even warranted?) such free reign in undertaking parenthood? imagine a single, impoverished female applying to adopt a child. i think security would have her escorted out and she would be a laughing stock. but if she has her own kid(s), no problem. a little discrepancy here?

am i making sense? i dont see whats unreasonable. also where is the incentive to remain poor? i would never support that. all incentives should be geared toward improving society as a whole and hopefully all of its individual members. clarify the redistribution of wealth scheme if ive left it unaddressed

medhacker · Mar 6, 2006

Moxxie said:
msheaddoc makes some great points. Just because BC (or other medical services) are available for free/reduced cost, it doesn't mean that they will be used. Instead of making BC pills OTC we need to work on better education for the low SES people that Shredder mentions (heck, better sex ed for EVERYONE). The "abstinence only" sex ed courses ignore the fact that many teens WILL have sex, even if god/their parents/society tells them not to. Why not give them the skills and resources to be able to make informed, intelligent decisions. Maybe we wouldn't see as many 16 year olds with two kids and another on the way.

Part of the problem is cultural too. I can't speak for everyone, of course, but I've observed a frightening trend in the Hispanic community in South Texas. Parents don't feel comfortable talking to their kids about sex - many of them completely deny the existence of sex ed. So many girls are left without the knowledge/skills, etc. that I mentioned earlier (I firmly believe that the strongest impressions are those made at home). When they get pregnant, their families do something odd - at first they are disapproving, but when the baby is born they shower it with attention (and the teen in turn gets some of the best positive reinforcement around). I fear that young Hispanic girls are getting the wrong message - it's don't have sex, but if you DO have a baby, we'll be ecstatic!

Maybe someone with a better background than me could give me some insight into the Hispanic ethos?

What you have described does happen often among most hispanic subgroups. There is an initial rejection which is then followed by acceptance. The acceptance follows the normal tendency towards family union which is typical of the hispanic culture.

As others have pointed out, this is a multifactorial dilemma. Focusing on it from a one-sided approach is, to say the least, insensitive.

While low resource populations may be less worried about learning than shor-term needs - they can indeed be educated. I disagree the education must come in the form of "safe-sex education". I believe abstinence if taught as part of a package which involves the entire family, with a religious emphasis can work. I believe it would work if such package becomes the basis of the morals and principles of the person in question. There is no 100% guaranteed for any method. On the other hand, there isn't either a guarantee that someone who has been taught abstinence will have sex before the indicated time for that person.

In short, I do agree education if "holistic" (mind, body Spirit, etc) can make a long-lasting, self-supporting difference in low resource and minority populations.

Beau Geste · Mar 6, 2006

Shredder said:
education doesnt work, only incentives and disincentives. the underclass doesnt have an understanding of concepts like consequences and long term planning. education operates under those premises. basically the ppl most in need of reproductive planning are largely ineducable. its not within everyones capacity to become educated. but it is within every rational persons capacity to respond to short term incentives. short term is just the key for myopic people.

education is clearly a failed approach not only in the US underclass but also the third world. we are not dealing with a bunch of medical students who will heed educational lessons. i would like to see what kind of results education has produced and over what time frame. im skeptical

This sounded REALLY harsh to me, but after I read it again I started to think about the patient population who tend to require reproductive planning. A lot of young and poor. Maybe they don't want to understand or heed the warnings of education because they want to get out there and "do it". Sex education is taught in most of our schools and SHOULD be taught by their parents, so they are supposed to at LEAST get it from somewhere, but still there are teen abortions and lots of STDs. Children don't read warning labels for cigarettes, and how can you miss anti-drug/cigarette TV commercials? Yet a lot of teens smoke - and I don't care about percentages, I know what I see on a Friday and Saturday night, and a lot do drugs, too.

But, if you tell a kid you're going to give them money or a prize for doing something, then they're more likely to listen. (Maybe the same for people who are poor but not necessarily young because it's something they want).

This was a thought I had.

Shredder · Mar 6, 2006

im reading about william shockley, who put forth a proposition long back that ppl should be offered voluntary sterilizations worth $1000 for each IQ point below 100. seems expensive but the money would indirectly come around in leaps and bounds due to the positive aftereffects. the thing is that most of these problems discussed in the thread are tied strongly to IQ, and since IQ is so easily quantifiable (and correlations to it have been demonstrated for a number of useful things) its the best measure to use as the standard.

another proposal ive seen is to give transferable birth licenses to everyone. give each couple 2.2 births and let them trade amongst themselves if they want more. a birth license market. reproduction right now is just out of control in society--the long term outlook is grim. think malthus

Beau Geste · Mar 6, 2006

Shredder said:
im reading about william shockley, who put forth a proposition long back that ppl should be offered voluntary sterilizations worth $1000 for each IQ point below 100. seems expensive but the money would indirectly come around in leaps and bounds due to the positive aftereffects. the thing is that most of these problems discussed in the thread are tied strongly to IQ, and since IQ is so easily quantifiable (and correlations to it have been demonstrated for a number of useful things) its the best measure to use as the standard.

another proposal ive seen is to give transferable birth licenses to everyone. give each couple 2.2 births and let them trade amongst themselves if they want more. a birth license market. reproduction right now is just out of control in society--the long term outlook is grim. think malthus

Considering the SD for the "IQ" range is 15 - I'm not sure how those who have IQ's between 85-100 feel about that, considering they are "normal" too.

I do think high schools should think about having parenting classes for pregnant students and fathers-to-be, and have their parents be included, too.

People would argue for abortion before they argue for birth licenses. Although I've seen some really stupid people procreate (and even had to do several mandatory DCFS reports) and would love for there to be a breeding license, it's a personal thought, not an ethical one, or even constitutional one.

chef_NU · Mar 6, 2006

QuikClot said:
You go on to admit that you like to make racist jokes, and use racial slurs, but you aren't a racist, presumably because you base your hate on something other than the narrow biological grounds. But as my sources point out, racism existed long before the "biological" argument did, so that cannot be its defining characteristic. Just as racists in the 19th century found the arguments of biology and used them to further their hate, today most racists have found other arguments, without ceasing to be racists.

QuikClot you really have taken what your teachers told you to heart. In America, it has become expected that all people adopt a "multiculturalist" attitude. That is, all cultures and ideas should be equally respected. All cultures, behaviors, and idiosyncratic quirks of particular groups should be free from criticism. I flat out reject this notion of multiculturalism. As with any other set of ideas or behaviors, there is a pecking order. For example, a certain method or culture is more effective in attaining certain goals in society (what those goals are is up to you). And furthermore, it is up to you to decide this pecking order using your rationality and your conception of the goals of society. Inevitably, we have differences in how we formulate how certain cultures or groups should behave in order to accomplish what they deem most important.

You claim that I "hate" certain groups. I'm curious why you say this. I hate no groups, I merely think that certain behaviors of groups are logically detrimental to both themselves and society as a whole. I reserve my right to voice my concern over these detrimental behaviors. I reserve my right to offend certain groups. If this qualifies as hate, then continue to call me racist. I don't interpret my feelings in that way, however.

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