Family Planning Forum, 2016

Advocates for women’s health hold a vigil in Nov. of 2015 in Muskegon

“It’s so great to be around friends. The work we do is so hard.”

                                — Participant, 2016 Society of Family Planning’s North American Forum

In November of 2016, I had the honor of attending to the Society of Family Planning’s North American Forum, a life-changing experience, not so much because of what I learned, but because of what it made me feel. I knew this conference was going to be different from any other I had attended when I went to register and realized that I needed two personal references to even complete the online form.

This was heavy. It’s heavy because healthcare providers are risking their lives every day to provide comprehensive reproductive healthcare services to women. It’s heavy because by being in the presence of so many abortion doctors at one time, I was myself at risk for being murdered. Every conference attendee received a name badge, with a photograph that had to be scanned every time we entered the conference area. We were to turn off the location-finders on our electronic devices. We were to take off our name badges if we left the conference area. We were not to take photographs with other attendees and share them.

I’ve been to a lot of conferences before, but nothing with this level of security. One might think that I would be afraid for my own safety, but the measures taken were reassuring. A lot of people don’t understand the sacrifice people make to perform abortions. Often, it is the only work a doctor can do, due to stigma. This can result in social isolation. Going into the work is not taken lightly and is often the consequence of life-changing experiences, some of which were shared with tears and great conviction at the microphone. Sharing space with such brave people opened my heart to a small taste of what they experience daily. I can read about statistics and danger, but this experience brought me closer to a more personal understanding.

Doctors weren’t the only ones in attendance, though. There were also attorneys, researchers, academics, students, and advocates, but I think I was the only doula and childbirth educator present. I’ve shared a lot of the resources I gathered, but I haven’t written about some of the things that I learned that may be useful in my work. Here are some highlights:

  • Catholic Healthcare:
    • Although there are over 600 Catholic hospitals in the US, over 1/3 of women surveyed did not correctly identify the hospital where they sought care in terms of religious affiliation.
    • Most women believe that hospitals should never be able to restrict care.
    • Residents who graduate from programs at Catholic institutions report dissatisfaction with their training. Although they may not be able to provide abortions, they can still be taught how to do them, through online modules and off-site collaborations.
  • Zika Virus:
    • Many of the countries affected by Zika also have some of the most restrictive abortion laws in the world.
    • Zika is not transmitted through breastmilk
    • Men should wait 6 months after potential exposure before trying to conceive. Women should wait 8 weeks.
    • We don’t yet know what the outcomes will be for infants who were exposed, but are “normal” at birth.
    • Vertical (mother-to-fetus) transmission is less likely in the first trimester, due to the impermeability of the placenta, but if contracted, outcomes are worse. Later in the pregnancy, the fetus has a more mature immune system and the mother has transmitting immunity, so the outcomes are better.
    • Affected countries are advising that women avoid pregnancy, without giving them access to contraception and abortion, which is an unfair and unreasonable expectation.
  • Immediate Postpartum Long-Acting Reversible Contraception (LARC)
    • LARCs can be inserted immediately postpartum.
    • 50% of women ovulate and 60% resume sex before their 6-week postpartum visit
    • Up to 35% of women never attend their postpartum visit
    • Subdermal implants inserted 1 to 3 days postpartum have shown no negative impact on infant health or breastfeeding.
  • Male Contraception
    • There are 3 options for male contraception:
      • Injectables
      • Pills
      • Gel
    • Acceptability determines if men will use available options.
      • Surveys show 44 – 83% of men would use, if available.
      • Lowest acceptability is in Indonesia; highest is in Spain.
    • Women play a role in acceptability – men are more likely to participate in studies when encouraged by their spouses.
    • A barrier is that men don’t have a designated healthcare provider for birth control, but family planning clinics may be the most logical place for them to go.
    • Methods exist, but are not yet labeled for use as male birth control.
    • LARC methods exist for men, but are hindered by lack of precision and research.
    • There is likely to be less of an environmental impact with male hormonal contraception methods than female methods because those are excreted into the waste-water and impact fish reproduction.
    • There are potentially non-contraceptive benefits to male hormonal contraception, such as an increase in lean mass, decrease in fat mass and decrease in bone loss.

Overall, I left the conference feeling that the training of most doulas in family planning is inadequate. Doulas and childbirth educators play a role in reducing infant mortality, poor birth outcomes and perinatal mood disorders when we have knowledge of family planning to decrease unplanned pregnancies and increase interpregnancy intervals. We can also help educate clients about the wide range of birth control options and their potential impact on breastfeeding and future fertility. As a full-spectrum doula, it’s important to provide information and support that is respectful of the values of the families I serve, across the wide-range of reproductive health decisions they face.

Opioid Addiction in Pregnancy: Ending the Stigma

On Friday, May 8th 2015, I attended Pine Rest’s Annual Perinatal Mood Disorders Conference in Grand Rapids. The topic was “Perinatal Substance Use and the Journey to Wellness.” I learned so much and want to share some reflections on a subject so near and dear to my heart.

The first time I taught childbirth education classes was to the pregnant inmates at the Rose M. Singer Center, A.K.A. Rosie’s, on Riker’s Island, the largest penal colony in the world. There were so many pregnant and postpartum inmates at Rosie’s that they had their own unit. There were two reasons for their high numbers. First of all, New York State, unlike Michigan, has laws that require correctional facilities to accommodate newborns. So long as the mom doesn’t have a conviction that involves harming a child, she can apply to keep her infant with her for one year (or 18 mo., if she will be released within that time) or bring her breastfeeding infant with her during her incarceration. Studies done at Bedford Hills Correctional Facility, which houses one of the oldest prison nurseries in the country, show that there are no harmful effects on the children. Many of the women at Rosie’s are either already participating in or planning to be a part of their on-site nursery.

The second reason has to do with opiate addiction. Riker’s, a jail, housed a methadone treatment program. Withdrawing from opiates during pregnancy can be deadly for both the mother and the fetus, so opiate-dependent women who would otherwise be transferred to a prison to serve a longer sentence remained at Riker’s during their pregnancy to receive methadone maintenance. (At the time I taught there, methadone was the drug of choice for the treatment of opioid addiction during pregnancy. Since other treatments are now available, this may no longer be the case).

There is so much stigma surrounding moms who use during pregnancy, making it even less likely that these women will seek help. Many people believe that a mom who is addicted to an opiate should stop using during pregnancy. Discontinuing opiates during pregnancy is not the standard of care. One of the speakers at the conference, Dr. James Nocon who is both an obstetrician and an attorney, had this to say about providers who encourage women to withdraw during pregnancy, “In my retirement, I want to sue doctors whose patients suffer negative outcomes because they receive improper treatment during pregnancy.” He can be contacted at

My heart breaks every time I hear someone say an infant is “born addicted.” Addiction, by definition, is continuing to use a substance (or repeat a process) despite negative consequences. An infant can be born dependent, but cannot be an addict. I know that many people have personal experiences caring for the children of parents who could not themselves care for them due to substance abuse disorders, resulting in strong emotions. However, vilifying parents with addictions will not help these children. As a Certified Substance Abuse Prevention Specialist, I know that if we want to help infants and children, we need to look at the underlying causes of why women use. The vast majority of women who use during pregnancy are self-medicating due to the effects of trauma and abuse. This is true whether the substance is cigarettes, alcohol, crack or heroin.

If we are truly dedicated to helping children prenatally exposed to substances, we should focus not just on treatment, but prevention. Gender-based violence is the result of oppression, which stems from inequality. When we fight for gender equality (e.g. pay equity, paid parental leave, paid sick time, LGBTQ rights, etc.), we are working to elevate the status of women and end the trauma of abuse.

Developed by Larry Cohen, based on the work of Dr. Marshall Swift. Available at:

Developed by Larry Cohen, based on the work of Dr. Marshall Swift. Available at: