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Why Coverage of Prescription Contraception Matters for Men As Well As Women

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Though the federal Affordable Care Act requires health insurers to cover many types of contraception, a vasectomy is not one of them.

Contraception – who should be able to use it, and the role of government in its provision – has become a contentious issue, in part due to disagreements over the Affordable Care Act mandate positing that all private insurance plans must cover prescription contraception for women. The issue is not trivial, because nationally representative surveys show that more than 10 million women in the United States use the pill as their current method to prevent pregnancy. The pill is the most popular form of reversible birth control.

Across the political spectrum, both citizens and public officials tend to understand birth control as a “women’s issue” rather than as a healthcare or social policy issue. Usually, birth control is discussed as a matter of reproductive health and rights or treated as an aspect of women’s personal responsibility for managing their own sexuality.

But where do men fit? How do they benefit from the availability and use of prescription birth control coverage? Could a better understanding of the ways prescription birth control coverage benefits heterosexual couples improve bipartisan discussions about coverage for contraception? My research provides insight into both of these questions.

Women’s Contraceptive Use and Couples’ Protection from Pregnancy

Contraception presumes the sexual involvement of couples, but surveys typically ask individual people about what method(s) they as individuals use to prevent pregnancy. By default, a woman who uses the pill for contraception also provides her partner with protection from pregnancy; and if her partner wears a condom, then both participants benefit. Contraception and condoms can be used together, but research shows that, in practice, couples in long-term relationships often move from using condoms to relying solely on prescription contraception.

Notably, interviews I conducted revealed that women who use prescription contraception for long periods of time rarely receive financial help from partners in purchasing it. Thus, although women’s birth control covers men, too, the men do not have to pay for this coverage and its benefits.

Men reap the positive effects of women’s use of prescription contraception in at least three ways: they gain protection from pregnancy without much effort; they avoid using condoms when couples transition to solely using prescription contraception, and they can spend money they might have spent on contraception on other items and pursuits.

There is also another way that men benefit from female contraceptive use that is not often mentioned. Women must deal with the downsides of whatever type of prescription birth control they use – including downsides such as physical side effects like nausea or depression and hassles like having to repeatedly refill prescriptions at the pharmacy. Their male partners are freed from such issues.

Contraceptive Use and the Unequal Burdens of Dissatisfaction

Preventing pregnancy is generally not something that couples enjoy, because it can be stressful, costly, and bothersome. Although public attention focuses on men’s dissatisfaction with condoms, much less attention is paid to women’s dissatisfaction with prescription birth control methods. My research using survey data finds that nearly 40% of women ages 23 to 44 who had ever used hormonal contraception had stopped using it at some point because they were dissatisfied.

Yet even though many women stop using a particular type of prescription contraception, they rarely stop contraception use altogether. They try various methods – different pills, or long-acting reversible contraception devices like implants and intrauterine devices – until they find something that feels right for them. As my in-depth interviews show, although many women experience dissatisfaction with side effects of particular birth control methods, they still believe that they should continue using some kind of prescription method.

Discussions that focus only on the benefits that prescription contraceptive coverage provides to women hide the ways that prescription birth control is very much like other medications – it can cause unpleasant and consequential side effects. By persisting despite dissatisfactions in their search for effective ways to prevent pregnancy, women provide tangible benefits for their partners, who get to avoid pregnancy without sharing such costs.

Even when women find it difficult or unpleasant to use certain methods, they cannot always count on getting male partners to wear condoms – or otherwise take responsibility for the couple’s contraception. This may explain why data from nationally representative surveys show that women who experience dissatisfaction with contraception are at higher risk of unintended pregnancy. When the burden of responsibility for birth control is too great, male partners cannot be counted on to pick up the slack.

What Does the Full Picture Mean for Debates about Contraception Coverage?

Recognizing that men as well as women benefit from prescription birth control coverage is crucial for appropriately evaluating the costs of rolling back the Affordable Care Act mandate for prescription contraception coverage. A nationally representative survey shows that only a very small percentage of people recognize that married women are the most likely to use prescription birth control. This may be because many of us are conditioned to see birth control as something affecting women rather than couples.

Public debates might very well change if more Americans understood all the ways that women, men, and society at large benefit from women’s access to prescription birth control – and their willingness to use it despite dissatisfaction. Too often, pundits and partisan debates treat contractive coverage as simply a women’s issue or benefit.

But if women, especially married women or women in long-term relationships, lose access to the most popular form of reversible contraception, so will men. Both men and women will experience new frustrations and costs.

Krystale Littlejohn is an Assistant Professor of Sociology at Occidental College. Her research examines how culture shapes reproductive health outcomes in contraception and abortion. Her work lies at the intersection of health and medicine, race and gender, and social inequality. Two of her current projects investigate gender and women’s experiences using birth control across relationships and how medical providers talk about birth control in contraception counseling visits (with Katrina Kimport).

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Health

Self Help Tips and Advice For Social Workers

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There is no denying the positive impact social workers have on hundreds of families and individuals throughout their career. They will tell you about the rewarding experiences they have helping others in need. Unfortunately, for every success, there is at least one case in which they could not help. Social workers see the best and the worst of society every day, and even the strongest among us can crack under the pressure. That is why self-care is so important. Being mindfully aware of your needs as well as the needs of those around you can keep you healthy and able to be there when you’re needed.

What is Self Care and How Can You Do It Every day?

Self-care is a practice that becomes a lifestyle. Understand and commit to the idea that it is not something you do once, it is something you do every day. The key is to be mindful and aware.

It is important to be mindful of where you are and what you are doing as you go about your day. Whether you are in a meeting or at the grocery store, notice how you are feeling in the moment. This can range from listening to your body and noticing your state of health to recognizing an emotional situation in your life.

Become aware of your breathing. When we are feeling stressed, emotional, or run down, we forget how to breathe. Our breath can become fast and shallow which deprives our bodies of the oxygen it needs. Pay attention to your breathing and focus on slowing it down. Allow the air to fill your abdomen, not just your lungs. You will find that mindful breathing exercises calms your thoughts, allows for greater clarity, and lessens your anxiety.

Now That You Are Aware, How Do You Improve?

It’s one thing to be mindful and aware of how you are feeling, but doing something about it is another matter. Improving your physical and emotional state requires some life changes as well.

Many social workers have the stress relieving habit of smoking or grabbing an unhealthy snack from the vending machine. It makes us feel like we’re taking a moment for ourselves. Instead of grabbing a cigarette or a bag of chips, try an e-cigarette starter kit or grab a granola bar. This gives you a moment away while making healthier choices through controlling the nicotine and sugar you intake. The idea is not to deprive yourself but to make small changes that will make you feel better over time.

Changing the way you approach daily tasks is another life change that will give you some added peace of mind. For decades we have been taught to multitask but all we’ve learned is how to start tasks but not finish them in a timely manner. By focusing on one task at a time you’ll allow yourself to finish a job before moving onto something else. This creates a sense of accomplishment and boosts your confidence at the job you are doing.

Maintaining Your New Found Awareness

Creating a support system is important when attempting to care for yourself. By relying on your friends and family you are willingly accepting love and nurturing that you simply cannot give to yourself. When meditating on an issue in your life doesn’t result in answers, one of the best things we can do is turn to our support system for help. It’s not necessary to face every challenge alone and often times, they can see from a perspective that you cannot. You may also find that the more willing you are to receive care from others, the easier it becomes for you to provide care for the people you’re working to help.

Self-care is difficult for those who spend their lives taking care of others. By allowing yourself the care you need you will find that it not only feeds your soul but it will improve your ability to care for the people around you.

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SNAP Benefits Aren’t Enough to Afford a Healthy Diet

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A new study from North Carolina State University and the Union of Concerned Scientists finds that the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, only covers 43-60 percent of what it costs to consume a diet consistent with federal dietary guidelines for what constitutes a healthy diet. The study highlights the challenges lower-income households face in trying to eat a healthy diet.

“The federal government has defined what constitutes a healthy diet, and we wanted to know how financially feasible it was for low-income households, who qualify for SNAP benefits, to follow these guidelines,” says Lindsey Haynes-Maslow, co-author of a paper on the study and an assistant professor of agricultural and human sciences at NC State.

This can be a tricky question to answer, as federal dietary guidelines vary based on age and gender. SNAP benefits also vary, based on household income and the number of adults and children living in the household. For the purposes of this study, the researchers used average monthly SNAP benefits for 2015.

To address their research question, the researchers looked at the cost to follow federal dietary guidelines based on the U.S. Department of Agriculture’s monthly retail price data from 2015 for fruits, vegetables, grains, protein, and dairy. They calculated costs under a variety of scenarios. For example, what would it cost to comply with dietary guidelines if one only ate produce that was fresh, not frozen? What if one only consumed fruits and vegetables that were frozen? What if a household followed a vegetarian diet? The researchers also included labor costs associated with shopping and preparing meals, based on 2010 estimates produced by other economics researchers.

“We found significant variability in the costs associated with following federal dietary guidelines,” Haynes-Maslow says. “For example, it was most expensive to consume only fresh produce, and it was least expensive to consume a vegetarian diet.”

To place this in context, consider a four-person household that has one adult male, one adult female, one child aged 8-11 and one child aged 12-17 – all of whom qualify for SNAP benefits. They would need to spend $626.95 per month in addition to their SNAP benefits if they ate only fresh produce as part of their diet. That same household would need to spend $487.39, in addition, to SNAP benefits if they ate a vegetarian diet.

“Many low-income households simply don’t have an additional $500 or $600 to spend on food in their monthly budget,” Haynes-Maslow says.

The researchers did find that SNAP is sufficient to meet the healthy dietary needs of two groups: children under the age of 8 and women over the age of 51. However, SNAP was insufficient to meet the needs of older children, younger women, or men of any age.

“Even though SNAP is not designed to cover all of the cost of food – it’s meant to be a supplemental food program – this study makes it clear that there would be many low-income households that would not be able to cover the gap needed to eat a diet consistent with federal dietary guidelines,” Haynes Maslow says. “Even without including labor costs, a household of four would need to spend approximately $200-$300 in addition to their SNAP benefits to follow the dietary guidelines.”

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12 Years After Fleeing Katrina, Family Displaced by Harvey Seeks New Life in Dallas

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Ashley Aples, left, speaks with his 8-year-old son Zion at an evacuee shelter at Kay Baily Hutchison Convention Center. Mr. Aples fled to Dallas with his family as flood waters from Hurricane Harvey rose around their apartment in Houston.

Flooded homes. People stranded on roofs. Rescue boats patrolling neighborhoods.

Ashley Aples saw the chaos and panic engulf Houston in just a few days, and he knew from experience it was time to flee. He did so 12 years ago when Hurricane Katrina ravaged his hometown of New Orleans and forced him to rebuild his life in Texas.

Now he and his family are rebuilding their lives again – this time in Dallas, with no plans to return to an area facing years of painful recovery from Hurricane Harvey’s historic wrath.

“We’ve seen it before; we know what this means,” Mr. Aples said from the Dallas Mega-Shelter at the Kay Bailey Hutchison Convention Center, where UT Southwestern faculty are coordinating and providing medical care to Harvey evacuees.

By Friday, the medical unit there had treated nearly 200 people like the Aples family, while still awaiting a potential influx of evacuees struggling to escape the floods.

The 35-year-old forklift operator sat on a green cot next to his wife and 8-year-old son, who along with other relatives packed into two cars as floodwaters began to rise around their apartment. They headed north, not sure what they would find.

“My family got what they needed,” Mr. Aples said with a smile, looking across the multitude of volunteer groups spread across the sprawling shelter.

“Some of the worst times bring out the best in us and show us who we really are,” Mr. Aples said of the physicians and volunteers helping at the shelter. “We have individuals here of different faiths and races, all helping their fellow man.”

The Aples family was among the first of a few thousand evacuees expected to seek refuge at the shelter this week after torrential rains from Harvey left much of the Texas Gulf Coast submerged, destroying thousands of homes and killing more than three dozen people.

Inside the medical unit

UT Southwestern faculty, fellows, residents, and students from UT Southwestern Medical School who are spearheading the medical response at the shelter include a wide range of specialties from Emergency Medicine, Pediatrics, and Psychiatry. Caregivers are checking on blood-pressure levels, helping control potential issues such as diabetes, and ensuring evacuees are able to acquire the medications they may have left behind.

Dr. Raymond Fowler, who is directing the medical response at the convention center, said the team has plenty of experience dealing with such situations. He has overseen several similar medical responses to major disasters, including Hurricane Katrina, though he notes this operation is twice as large.

“We’ve gotten pretty good at this,” said Dr. Fowler, Division Chief for Emergency Medical Services at UT Southwestern, who holds the James M. Atkins, M.D. Professorship in Emergency Medical Services. “As soon as we can get them here, we’re ready for our friends in the South.”

The shelter has about 5,000 beds available if needed, and the initial evacuees seeking shelter in Dallas provided an opportunity to test the processes and ready the medical unit, said Dr. Raymond Swienton, Professor of Emergency Medicine, Chief of the Emergency and Disaster Global Health Program at UT Southwestern, and long-standing senior adviser to the state of Texas.

“We are now gaining access to large numbers of people who have been stranded for days in this unprecedented disaster impacting our entire Texas coastal area,” Dr. Swienton said. “We stand ready to provide shelter and medical care to our fellow Texans who arrive in Dallas.”

The medical wing has been bustling this week with volunteers and emergency response crews unpacking food and going over final plans. A pediatrics section decorated with walls of colorful birds and clouds was stocked with formula, diapers, and a box of stuffed animals. One mother sat on a cot in a corner, bouncing a laughing toddler on her knee.

UT Southwestern Pediatrics faculty physicians are staffing and providing support to the pediatric clinic daily to help treat the evacuated children.

“We will provide services as long as they are needed,” said Dr. Maeve Sheehan, Associate Professor of Pediatrics who is overseeing the shelter’s pediatric care with Dr. Halim Hennes, Professor of Pediatrics and Chief of Pediatric Emergency Medicine. “We will also be providing telehealth services throughout the night in conjunction with Children’s Health.”

UT Southwestern pediatric neonatologists aided with the evacuation of neonatal patients as the flooding began, and UT Southwestern pediatric nephrologists are providing dialysis to several displaced children.

Next steps

Outside the medical wing, Mr. Aples sat with his wife and son, listing his next steps: getting a job, finding a home, enrolling his son in school.

“Kids don’t have the same coping mechanisms as adults,” he said, noting one reason why he won’t bring his son back to Houston for anything beyond gathering belongings from their apartment.

“Every time we went back to New Orleans, we saw places from our childhood destroyed. Your mind is fighting itself, looking at the devastation. You have to fight your way out of that box, because that box will put you in a depression.”

Mr. Aples said he has explained the situation to his son but is trying to keep the mood lighthearted.

Mental health experts at UT Southwestern’s Peter O’Donnell Jr. Brain Institute say that’s generally a good approach to take with children dealing with such traumatic events.

In addition, they recommend showing a calm demeanor around the children. Parents should offer but not force them to talk about the incident. They should also filter some of the news updates children may receive from television or social media.

“This can be overwhelming and scary for kids,” said Dr. James Norcross, Professor of Psychiatry. “But the good news is that kids are remarkably resilient. If you can reassure them, keep them in a routine as much as possible, they will be able to overcome and manage this.”

Mr. Aples is keeping his family’s thoughts positive. He is hoping to get a job as soon as he can and perhaps have the family out of the center in the next few days.

Until then, he wants to spread his message of hope to anyone who needs it.

“I want everyone to really, really just love on their families and be optimistic about the change,” he said, glancing over his shoulder at his son. “We’re going to figure out what we have to do, and the whole family will come together.”

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