Download Exhibit N

March 6th, 2017
Senator Patricia Spearman
Chair, Health and Human Services Committee
Nevada Senate
Re: S.B. 233
Chair Spearman and members of the committee:
I am here today in support of SB 233. I am an ObGyn and practice in Carson City,
NV. Over my 27 years here, I have delivered thousands of Nevadans and have
spent my life working to protect women and their families. It’s my strong belief
that an ounce of prevention is worth a pound of cure. By supporting this bill you
will be joining with me to protect and care for Nevada’s women and their
families.
This bill includes provisions that remove barriers for women to obtain
preventative services, prenatal care, assistance with smoking cessation, checks for
sexually transmitted diseases, vaccinations and contraception. In each of these
situations science clearly shows that the cost of screening/ prevention is far less
than the cost of treating the consequences of failure.
The clearest example is with unintended pregnancy. Births resulting from
unintended or closely spaced pregnancies are associated with adverse maternal
and child health outcomes, such as delayed prenatal care, premature birth, and
negative physical and mental health effects for children. In 2010 52% of all
pregnancies in Nevada were unintended and the majority were teen pregnancies.
We can all agree that that number is too high. Over the past 5 years we have seen
a steady drop in both unplanned pregnancy and in teen pregnancy. Those of us in
healthcare firmly believe that much of this is due to removing the barriers to
effective, reliable and affordable contraception.
Poor and low income women are much more likely to be effected by unintended
pregnancy. Women with a family income below the federal poverty level are 5
times more likely to have an unintended pregnancy. These women are much
more sensitive to barriers for services that allow them to prevent pregnancy.
Most unintended pregnancies are in the one third of women not using
EXHIBIT N Senate Committee on Health
And Human Services
Date: 3-6-2017
Total pages: 4
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contraception. These pregnancies are expensive. In Nevada in 2010, 102.9
million dollars of public money was spent on unintended pregnancy.
Most women spend several decades during their reproductive years trying to
prevent pregnancy. I have submitted a list of contraceptive choices. Some types
of birth control are within the couple’s control, for example condoms,
diaphragms, rhythm method, withdrawal, oral contraception, rings and patches.
These have the highest failure rates since use may not be consistent for many
reasons. Birth control pills are especially susceptible to error in use caused by
lack of availability. For this reason this bill mandates that this contraception
should be dispensed with up to one year of supplies. This may be a surprise to
you, (and it has certainly surprised many of my patients over the years), but
missing the very first pill in the package places women at the highest risk of
unplanned pregnancy. For years the answering service has been putting calls
through on weekends from desperate women who find themselves without their
next package of pills. This is the most common reason for accidental pregnancy in
birth control pills users and is very easily addressed. Passing access to 12
packages of birth control pills with one visit will solve this problem.
The second, and more effective class of contraceptives, are called LARCs, (Long
Acting Reversible Contraceptives). They include IUDs, implants and shots. They
have very low failure rates and user error is less common. Some people have
expressed concern that IUDs cause abortion. The progesterone IUDs work in the
same way that the shot and the implants work; they prevent the sperm from
getting through the cervix. The copper IUD creates a sterile inflammation, copper
is toxic to sperm, causing the sperm to be engulfed upon entering the uterus.
The third type is permanent sterilization. Vasectomy and tubal ligation are both
popular methods of pregnancy prevention. They are the most effective and their
use should be encouraged for couples that have decided their families are
complete. Since vasectomy is a minor surgery, performed in the office setting it is
especially important that we remove barriers to this option.
Access to the morning after pill as an emergency resource is also important. I
prescribe this to my patients that use barrier methods for contraception. Plan B
is over the counter; however there is a more effective drug called Ella that
requires a prescription. It’s much more effective for women who are overweight
and unfortunately this includes much of our population. Both drugs work by
delaying ovulation. Neither of them will cause abortion.
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There are many reasons why couples choose one contraceptive method over
another. Sometimes it is personal chose and other times there are reasons why
certain methods can’t be used safely. An example is migraines with aura.
Women with this diagnosis have an increased risk of stroke if they use birth
control pills, rings or patches. This is why it’s important for couples to be able to
obtain without barrier every method approved by the FDA.
Thank you for taking the time to give serious consideration to these concerns.
Your vote for this bill is a vote to protect the health and welfare of women in
Nevada. The benefit to our society and our budget is tremendous.
Sincerely,
Sandra Koch, M.D.
Carson Medical Group
Carson City, Nevada
[email protected]
PDF on contraception
http://www.reproductiveaccess.org/wpcontent/uploads/2014/06/contra_choices.pdf
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