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Medscape
3 hours ago
- Health
- Medscape
Gen Z Women Have Their Own Ideas About Contraception
Often citing concerns about side effects, Gen Z women (born between 1997 and 2012), increasingly are shunning evidence-based family planning and reproductive health counsel, turning instead to advice from social media influencers and fertility tracking apps — with mixed results — according to experts. Federal data published in 2020, the most recent data currently available, reported that only about 14% of women in the United States used oral contraception. That was down by half from data collected in the United States in 2010. One expert views the sea change as an emerging power struggle between women and medicine at large, the institution that has control over their fertility and body literacy. Others are less worried about the dangers posed by social media and more about health data being stolen or subpoenaed, compromising their patients' safety. Influencers in the Mix Among the many social media platforms, TikTok in particular attracts the most women in Gen Z, according to a recent Pew Research Center report. It found nearly 45% of platform users were women, the highest rate among any platform studied. Last year, the Kaiser Family Foundation reported that 53% of Gen Z people surveyed in the United States reported they trust health information they consumed on TikTok. Nearly 60% of this cohort reported watching information about abortion on the platform, while 52% reported they had watched TikTok videos about birth control. Zoe Pleasure, MPH, a doctoral candidate at the University of Washington, Seattle, and her colleagues are just beginning to analyze data from their study of how TikTok is used to discuss what she called the 'perceived and experienced' side effects of hormonal contraceptive methods. The study is sponsored by the Society of Family Planning. Among the investigators' goals, Pleasure said in an interview, is to determine how side effects from hormonal contraceptive methods affect a woman's decision-making about family planning. They also seek to learn what in social media might be useful in clinical practice, said Pleasure. Evidence-Based vs First-Person Anecdotal Evidence Over the past decade or so, there has been a raft of studies associating oral contraceptives, in particular, with higher rates of depression among women, as well as other poor health outcomes. However, in 2022, JAMA Network Open published an umbrella review of meta-analyses that concluded the majority of these studies were not based on high-quality evidence. A meta-analysis on the mental health effects of oral contraception, also published in 2022, similarly found weak evidence, although investigators noted that the risk for depressive symptoms in adolescents using oral contraception should be kept in mind. However, numerous TikTok influencers such as @broganperry and @amanda_pac contravene these studies. They report to their fans, numbering in the 10s of thousands or more, that they had a range of side effects that ended once they quit taking oral contraceptives. This kind of social support should not be discounted, and not all sharing is misinformation, according to Pleasure. 'There are potential benefits to people sharing their contraceptive experiences online, such as supplementing what individuals might hear from their providers,' Pleasure said. Unplanned Pregnancy Uptick Results from another recent study suggest there is a knowledge gap for physicians to fill when it comes to properly using any kind of contraception. Earlier this year, researchers in the United Kingdom found that across a 5-year span, there was an uptick in women seeking an abortion who reported they did not use any contraception. The study was published in BMJ Sexual & Reproductive Health . The UK researchers also found an increase in the number of women who reported using fertility awareness methods and a decrease in use of prescription contraception. The study compared data between 33,495 women who presented for an abortion in England and Wales from January to June 2018 and 55,055 women who presented for an abortion from January to June 2023. Investigators found that the use of hormonal contraception prescriptions fell from nearly 19% in 2018 to just over 11% in 2023. Use of long-acting reversible contraceptive implants fell from 3% to 0.6% in the period studied. The investigators also found that the use of fertility awareness methods around the time of conception had increased from 0.4% in 2018 to 2.5% in 2023. The age of women using these methods fell from nearly 30 years to 27 years. Most salient was that the number of women who reported not using any form of contraception when they conceived rose from 56% in 2018 to 70% in 2023. The study's lead author, National Health Service researcher Rosie McNee, public health registrar, suggested the results point to a zeitgeist. 'Access to contraception during and following the pandemic is one aspect but also attitudes toward contraception are changing,' she said in an interview. The study is relevant to clinical practice, according to McNee, in that it highlights the need to remove barriers to sexual and reproductive healthcare. This is 'so that women can access timely, supportive, and evidenced-based reproductive healthcare,' she said. 'All the Options' One expert on family planning, Marguerite Duane, MD, does not believe all evidence-based options are in fact being presented to women of reproductive age. That's because doctors don't know enough about them, she said. 'Even though fertility awareness is basic reproductive physiology, I didn't learn it in medical school,' Duane told Medscape Medical News in an interview. 'We learn aboutthe femalehormones, but we don't learn that [a woman] can learn to observe external biomarkers that reflect the daily internal hormonal changes that are happening in her body, and that can serve as a fifth vital sign.' The American College of Obstetricians and Gynecologists (ACOG) issued a committee opinion in 2015 endorsing tracking the menstrual cycle as a vital sign, but only in adolescence. ACOG reaffirmed their stance in 2020. Duane is a family medicine physician who created and teaches a fertility awareness class at Georgetown University School of Medicine in Washington, DC. She salutes Gen Z. 'They are absolutely pushing this. And I think doctors are going to feel the demand from the Gen Z women who want this information because they are tired of being gaslit,' Duane said. Duane believes the current generation of women is demanding respect for themselves and their bodies, not control over them. 'Fertility is seen as a disease, right?' asked Duane. 'For more than 50 years, women have been told that our reproductive system — which is biologically designed to allow us to reproduce — is a problem, and that it needs to be controlled with a drug, the Pill. No. We don't need to suppress it. We need to understand it.' 'A woman can learn from a trained instructor how to chart her cycles, but the reality is the birth control industry is a billion dollar one,' she said. Rhythm Method Is Outdated Duane is the executive director and cofounder of FACTS about Fertility, an organization aimed at educating healthcare professionals about evidence-based fertility awareness methods. FACTS advisory council members have come from both Planned Parenthood and the Catholic Medical Association, according to Duane. 'Our goal is to work with anyone interested in educating medical professionals about the science supporting these methods,' she said. One of FACTS's primary areas of study is the standardization and refinement of fertility awareness–based methods (FABMs). A recent survey by the organization found that most physicians surveyed are uninformed about what Duane called 'modern, evidence-based natural methods' such as the Billings method, which monitors cervical mucus. Some in the survey knew about the rhythm method, but Duane said that as revolutionary as it was when it was developed in the 1930s, things have advanced. FABM Mania Failure rates of FABMs, even when used correctly, can be up to 12%, according to the Guttmacher Institute. Used incorrectly, failure rates can be as high as 34%, they assert. By comparison, oral contraceptives have about a 0.3% failure rate when used correctly and an 8% failure rate when used incorrectly, all according to the Institute. This failure rate has not deterred hundreds of millions of women around the globe from using it, as one study suggests. The researchers at Oxford University in the United Kingdom claimed that from April to December of 2021, fertility tracking apps such as Flo and Clue were downloaded around the world more than 200 million times and in 112 countries. 'Our findings reinforce emerging evidence that menstrual tracking apps are more popular in areas with limited access to reproductive health services and contraception,' the authors wrote. In the United States, however, the American Medical Association is advocating for tougher standards around these apps. That's thanks to a case prosecuted by the Biden administration in which a fertility tracking app developer lied to customers and disclosed their data to multiple third parties, including those in China. App Users 'Unconcerned' Despite Risks In May of last year, the Federal Trade Commission (FTC) released a study, performed by Duke University faculty, on the dangers of fertility apps. The authors warned that data collected by the apps could be sold without their knowledge or, in a post-Roe world, either seized by the government or turned over by app developers for use against women who terminate a pregnancy. 'The stakeholders who have access to the period-tracking apps' collected data have the most impact on participants' perceived privacy concerns, with government and law enforcement being the most concerning stakeholders,' the study authors wrote. Data published in Contraception earlier this year found women are not as concerned about their privacy as the FTC suggests they should be. The study's authors found that the use of fertility tracking apps by women in five states increased by half after the Dobbs decision. 'It doesn't seem like people heeded the advice to stop using fertility trackers,' Emily Neiman, a clinical nursing instructor at The Ohio State University, Columbus, Ohio, and the study's lead author, said in a media release. Neiman said she believes some women use the apps not to track the best time to conceive but when they think it will be the best time for them to have unprotected sex. 'As providers and public health professionals, we could be doing a better job of educating around the reliability of the information they're getting from these technologies to help people who are trying to prevent unwanted pregnancies,' Neiman said in the release. Neiman suggested the rising popularity of these apps in a post-Roe world is a paradox. 'In a time when people should have very reliable contraception if they don't want to be pregnant because of abortion restrictions, the push on social media seems to be for methods that are not as reliable because of the lack of understanding around what information the tech provides,' she said. For Duane, the answer is less complicated. 'I tell women, 'You're smart, smarter than your smartphone. Don't let your phone tell you when you're fertile,'' Duane said. 'Learn to observe your signs and learn how to interpret them with a trained instructor.'
Yahoo
a day ago
- Business
- Yahoo
Joe Scarborough: I served in Congress. Joni Ernst's mock apology would have been unimaginable back then.
This is an adapted excerpt from the June 2 episode of 'Morning Joe.' Republican Sen. Joni Ernst of Iowa is doubling down on her controversial comments on Medicaid cuts. On Friday, while defending the GOP's sprawling megabill to carry out Donald Trump's agenda, Ernst dismissed concerns from her constituents that the proposed cuts could cause people to lose eligibility and possibly die, telling the crowd at a town hall: 'Well, we all are going to die.' On Saturday, the senator posted a sarcastic apology video to social media. Speaking from what appears to be a cemetery, Ernst referenced her comments from the previous day and said she 'made an incorrect assumption that everyone in the auditorium understood that, yes, we are all going to perish from this earth.' 'So I apologize, and I'm really, really glad that I did not have to bring up the subject of the tooth fairy as well,' she continued. 'But for those that would like to see eternal and everlasting life, I encourage you to embrace my Lord and savior, Jesus Christ.' In Iowa, 40% of the people who are enrolled in Medicaid are children and 42% live in a rural area, according to the Kaiser Family Foundation. The program also covers 50% of nursing home residents in the state. And when Ernst is asked what she's going to do about the fact that these vulnerable people will be impacted by the Republicans' proposal, her response is to say, 'Well, we all are going to die anyway.' Ernst is mocking the people in her state, talking about the tooth fairy while planning to vote for a bill that's going to savage health care in Iowa. The question is not whether we're all going to die or not. The question is whether you're going to give tax cuts to billionaires and take health care from the poorest Americans. Talk to anybody in rural health care, they'll tell you how devastating this bill would be. Talk to pediatricians, and they will all tell you that cutting Medicaid is going to have a substantial impact. During my time in Congress, we would have really tough fights on important issues, but it was unimaginable that a United States senator on either side would behave in this way. Republican senators are now so afraid of Trump that they're contorting themselves and making jokes about people suffering. If Webster's Dictionary wants to use the senator's video in the future, they can put it right next to the word 'clueless,' because that's what Ernst and her fellow Republicans are right now. This article was originally published on
San Francisco Chronicle
3 days ago
- Politics
- San Francisco Chronicle
These Bay Area communities are most vulnerable to Trump's immigration crackdowns
With the Trump administration clamping down on immigration, experts say some Bay Area immigrants may pursue one of the surest ways to protect their ability to remain in the country: becoming a citizen. That is, if they want to — or even can. Just 25% of Bay Area residents born in Guatemala, excluding children of American parents, are citizens. The same was true for 35% of Mexico-born residents. Meanwhile, nearly 60% of residents born in China and Nicaragua are naturalized. Still, overall more than half of the Bay Area's foreign-born population has already won citizenship, 2023 data from the U.S. Census Bureau's American Community Survey shows, similar to the national figure. That means many of the region's immigrants are likely protected from deportation and scrutiny from border officials, said Bill Hing, a professor of law and migration studies at the University of San Francisco — though there have been some exceptions. As President Donald Trump continues to restrict immigration, more people who are eligible for naturalization will likely pursue that option, Hing said. It might not be the first time — naturalizations rose during Trump's first term. Naturalized citizens are less likely than lawfully present immigrants to report fearing detention or deportation, though about 1 in 4 say they are worried for themselves or a family member, according to a recent Kaiser Family Foundation poll. Hing expects a particularly large surge in people born in Mexico, Central America and South America to seek U.S. citizenship, hoping to avoid getting caught in Trump's mass deportation plans. Many immigrants from those countries who can pursue citizenship often don't, due to a variety of factors. Deportation fears could change that for some immigrants. 'The kind of enforcement that's going on right now is racially profiling those groups,' Hing said. The reasons some groups have relatively low naturalization rates vary, said Eric McGhee, a senior fellow at the Public Policy Institute of California. Many immigrants from Honduras, for example, arrived in the past two decades, meaning they've had less time to seek citizenship. Even among groups for whom naturalization is more common, such as China- and India-born immigrants, few of those who came to the U.S. in the past two decades are citizens. Indian immigrants in particular can face long wait times for permanent legal status — the longest of any nationality, according to some research. Naturalization applicants must have a green card for at least five years or be married to a U.S. citizen or permanent resident for at least three years, with exceptions for members of the military. Even with those hurdles cleared, there are often others, including language barriers. And undocumented immigrants are, of course, completely ineligible to become citizens. That likely explains why so few people among certain foreign-born groups, such as those born in Guatemala, are naturalized, McGhee said. While the Trump administration has targeted immigrants who are in the U.S. lawfully, such as by targeting international students, the crackdown will undoubtedly affect undocumented immigrants the most. 'There's a lot in flux and in play, but there's no question that the flexibility and range of options for the Trump administration are greater on the undocumented side,' McGhee said. There are additional reasons immigrants from some countries might be more likely to be citizens than others. Bay Area nonprofits previously encouraged Chinese-born residents to become citizens so they could gain the right to vote and become a political force, Hing said. The effort, made possible by the repeal of the Chinese Exclusion Acts in 1943, was a success. More than 90% of Bay Area Chinese-born residents who immigrated to the U.S. from 1970 to 1990 are citizens. Whether immigrants seek to become citizens also depends on the situation in their home country, Hing said. For example, Taiwan's political upheaval in the 20th century, and now its tensions with China, may give immigrants born there more of an incentive to seek naturalization. But those factors may matter less for immigrants from wealthy, stable countries like Japan, Singapore and Australia, especially for those who plan to travel often (or ultimately return) to their birth country. But anti-immigrant sentiment can also lead to an increase in naturalization, as Hing predicts will happen again. After California Proposition 187 was passed in 1994, cutting undocumented immigrants' access to social services, the state saw a surge in naturalization applications.
Yahoo
25-05-2025
- Politics
- Yahoo
Mike Johnson Insists It's ‘Moral' to Throw People Off Medicaid
Speaker Mike Johnson defended Donald Trump's 'one big, beautiful bill' that the House passed last week in the middle of the night, claiming the newly added Medicaid work requirements are 'moral.' Meanwhile, the legislation will hand the rich a gigantic tax cut. 'We looked at your home state, and the projection is that nearly 200,000 Louisianans will lose their Medicaid coverage… How do you defend that to your constituents?' Face the Nation host Margaret Brennan asked Johnson on Sunday. 'We have not cut Medicaid, and we have not cut SNAP. What we're doing, Margaret, is working on fraud, waste and abuse, and everyone in Louisiana and around the country understands that that's a responsibility of Congress,' Johnson said. But the bill will ultimately kick beneficiaries off Medicaid coverage and SNAP benefits, according to multiple estimates. He went on to claim that it is 'moral' to 'make young men work.' According to the Kaiser Family Foundation, the vast majority of Medicaid recipients (92 percent) are either already working (64 percent) or may be eligible for an exemption because they are caregivers, in school, or disabled. That leaves just eight percent of Medicaid recipients who say they are retired, cannot find work, or are unemployed for another reason. 'You've got about 4.8 million people on Medicaid right now nationwide who are able-bodied workers, young men, for example, who are not working, who are taking advantage of the system,' Johnson claimed. 'If you are able to work and you refuse to do so, you are defrauding the system. You're cheating the system. And no one in the country believes that that's right. So there's a moral component to what we're doing. And when you make young men work, it's good for them, it's good for their dignity, it's good for their self worth, and it's good for the community that they live in.' Johnson cited approximately $11 billion in improper SNAP payments to justify his argument, but that total (actually $10.5 billion) includes overpayments as well as underpayments and instances where payments did not comply with regulations — not just fraud. Trump has also alleged the bill will not cut Medicaid, saying, 'We're not doing any cutting of anything meaningful,' Trump said last week. 'The only thing we're cutting is waste, fraud and abuse. … We're not changing Medicaid and we're not changing Medicare and we're not changing Social Security.' Analysis by the independent Congressional Budget Office (CBO) projected that approximately 15 million people would lose health coverage by 2034 if all provisions in the House bill are enacted, thanks to Medicaid cuts, not extending tax credits on Affordable Care Act (ACA) marketplace premiums, and other devastating changes to the ACA marketplace. That number includes almost 8 million Americans who would stand to lose Medicaid coverage. Sweeping changes to Medicaid in the bill would push states to stop using their own funds to cover undocumented immigrants (14 states plus D.C. cover documented and undocumented immigrant children, and seven states plus D.C. cover some undocumented adults, according to PolitiFact). The legislation also bars non-profits like Planned Parenthood, which provide comprehensive reproductive care, from accepting Medicaid funds. And, there are the much-discussed work requirements. Adding a work requirement for Medicaid coverage would likely drown both states and recipients in administrative red tape while not moving the needle on employment. States would need to set up ways to verify recipients are working or searching for work, which could increase administrative costs. Further, it seems unlikely these requirements would actually help accomplish the GOP's stated goal to increase the workforce. A study on the implementation of Medicaid work requirements in the state of Arkansas found that it did not increase employment. The study also concluded that people who lost their Medicaid coverage experienced negative consequences in the following year, with half encountering problems paying off medical debt and more than half having delayed care or delayed taking prescribed medications due to cost concerns. 'Work requirements are not about waste, fraud, and abuse — they are fundamentally changing the rules of who is eligible for the program, and they are adding an immense set of bureaucratic obstacles and red tape for eligible people to keep coverage,' Benjamin D. Sommers, a professor of health care economics and medicine at Harvard University's T. H. Chan School of Public Health and Harvard Medical School, told PolitiFact. Studies have found that hospitals may close or reduce services amid Medicaid cuts, which total $700 billion in the Republican bill. 'Hospitals will be forced to make difficult decisions about whether they will have to reduce services, reduce staff, and potentially consider closing their doors,' said Colleen Kincaid, vice president of media relations and strategy at the American Hospital Association. Another part of the bill would remove Medicaid coverage from people who are also on Medicare — the majority of those people are seniors or disabled individuals. New eligibility requirements mandating recipients prove their eligibility twice a year can also kick people off Medicaid because either they don't get or submit required paperwork or because the state doesn't process their paperwork, the left-leaning Center on Budget and Policy Priorities says. 'Relatively little of the bill is clearly related to trying to reduce fraud or error,' Leighton Ku, director of George Washington University's Center for Health Policy Research, told PolitiFact. 'There are some minor provisions about things like looking for dead people who are enrolled or checking addresses. But the major provisions are not fraud, waste or error by any means. They're things that reflect policy preferences of the Republican architects.' The bill now heads for the Senate where it faces opposition not just from Democrats but also Republicans. Sen. Josh Hawley has publicly come out against the proposed cuts, and an anonymous GOP senator told The Hill there is a contingency of five to seven Senate Republicans who oppose cuts. 'There's probably five, six, seven of us who, if you do anything that cuts into benefits, you're going to have a real problem. The leader is aware of that,' the senator said last week. 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Yahoo
22-05-2025
- Health
- Yahoo
250k Tennesseans could lose TennCare, private insurance under Congressional spending bill
U.S. Capitol building in Washington, D.C. (Photo: Jennifer Shutt/States Newsroom) Proposed cuts in federal healthcare spending on Medicaid and the Affordable Care Act could force more than 250,000 Tennesseans to join the ranks of the uninsured, an analysis by the Kaiser Family Foundation found. Healthcare advocates are closely following House debate over a legislative package that would make significant changes to Medicaid and the Affordable Care Act (ACA) marketplaces. The reconciliation bill would cut Medicaid spending nationwide by at least $716 billion, representing the single largest cut in the program's history, a separate analysis by the Congressional Budget Office found. The bill would achieve those cuts in a variety of ways, including by introducing stricter enrollment and work requirements for the low-income and disabled Tennesseans who rely on TennCare, Tennessee's Medicaid program. The bill would also eliminate so-called premium tax credits that have helped individuals purchase their own health insurance on the Affordable Care Act marketplace. Together, the two provisions could cost between 190,000 – 310,000 Tennesseans access to TennCare or private insurance through the healthcare marketplace, according to Kaiser Family Foundation. Much, however, remains in flux about the final language of the omnibus federal spending bill as it heads to a vote on the House floor. The bill includes a significant increase in spending on immigration enforcement and an extension of tax cuts created during President Donald Trump's first administration. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
