Beyond the Pill

Beyond the PillBirth control options for women over 40

Audio: Welcome to the Beyond the Pill Health Communication Campaign Presentation. The purpose of this campaign is to bring awareness of birth control options to women 40 and older.

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30% of the pregnancies in women aged 35 and over are unintended (Godfrey, Chin, Fielding, Fiscella, & Dozier, 2011).Changes in bodies as we ageThe average age of a menopausal woman in the United States is 51 (NIH, 2013).

Prevalence of the Health Problem

Birth control for 40 year old women? Some may think this is an unnecessary topic due to prevailing stereotypes surrounding this age group. Were either already married, have had children, and about to start menopause. Or are biological clocks are about to explode and were all looking to be with child at the first chance. Or, once we hit the big 4-0, we no longer care about sex and only wish to sit around watching the Real Housewives of Insert the Big City here. - The truth is 30% of pregnancies in women aged 35 and over are unintended. - The average age of a menopausal woman in the United States is 51 (NIH, 2013). - That means a womans potential to get pregnant as an end result of sex doesnt end because she has reached 40. Women in this age group still need to look for ways to protect themselves from unintended pregnancies.

References:Godfrey,E.M., Chin,N.P., Fielding,S.L., Fiscella,K., & Dozier,A. (2011). Contraceptive methods and use by women aged 35 and over: A qualitative study of perspectives. BMC Women's Health, 11(5), 1-9. doi:10.1186/1472-6874-11-5

NIH-National Institute on Aging. (2013, December). Menopause. RetrievedAugust1, 2015, from https://www.nia.nih.gov/health/publication/menopause

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Parenthood should be a choice; not the end result of unprotected sexual activity.Reduction in fertility is insufficient protection against pregnancy (Human Reproduction Update, 2009).Desire doesnt cease once we hit forty

Why this topic?

- Just because weve hit a certain age bracket does not mean our sexual desires cease. Additionally, in an ideal world parenthood would be a conscious decision and not the end result of sexual activity. - For many women, as our bodies age and change, the birth control options we used in our teens and twenties may not work the same as in our 40s. They in fact may cause more harm than help. Older women are susceptible to higher risk pregnancies than their younger counterparts; making birth control just as important now as it was in the younger years. Our risks for obesity, high blood pressure, heart disease increase with age. These diseases, subsequently, make oral contraception less effective and sometimes dangerous choice for older women.

References:Human Reproduction Update. (2009). Female contraception over 40. Human Reproduction Update, 15(6), 599-612. doi: 10.1093/humupd/dmp020 3

Goal: Increase usage of long-activing reversible contraception (LARCs) among American women 40 and over to 27% within 5 years.First 6 months: increase awareness to 10% among women in Alameda & Contra Costa counties.Expand campaign to 9 remaining counties within one year; increasing usage to 15%Become on par with Europe (27% usage rate) among American women with in 5 years (Oatman, 2012).Initial Audience:Alameda & Contra Costa counties (first 6 months)Roll out to the rest of the Bay Area counties after the 6 monthsNationwide after 1 year initial roll out.

Target Audience: Goals & Objectives

Among women, ages 35-44, in the United States approximately 5.3% use some form of LARC as their means of protection against unintended pregnancy (National Center for Health Statistics, 2015). While in European countries such as Norway usage is 27%; in China up to 41% of women use some form of long acting reversible contraception (Oatman, 2012). Our initial target audience will be women in Alameda and Contra Costa Counties of the San Francisco Bay Area. With 1.2 million women in both counties, the audience is widely diverse in racial identity, economic class, and education. They are comfortable with technology and new media. Social media, smartphones, are all part of their everyday lives; Google is the best friend. They are quick to research health information online as well as speaking with their healthcare providers. The first 6 months of the campaign will focus on the 2 Bay Area counties, and then expand to the remaining 9 Bay Area counties. After the first year, the campaign will go nationwide.

References:National Center for Health Statistics. (2015, February 24). Trends in long-acting reversible contraception use among U.S. women aged 15-44. RetrievedAugust14, 2015, from http://nchstats.com/2015/02/24/trends-in-long-acting-reversible-contraception-use-among-u-s-women-aged-15-44

Oatman,M. (2012, September 26). Why don't more American women use IUDs? RetrievedAugust15, 2015, from http://www.motherjones.com/blue-marble/2012/09/why-are-iuds-unpopular

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Technologically proficient audience, they dont want information now, they want it 5 minutes ago.Mobile app for smart phones and tablets.

Optimized for Mobile Design

- As technology savvy individuals, the campaign must embrace technology in order to gain awareness and survival. Working with media strategies that also have experience in the health/medical field, we will create not only an optimized for mobile website, but also a mobile app with detail information women can download to their phones or tablets. This app and the information will serve has a handy brochure women can reference at any time.

References:Image: https://thegrio.files.wordpress.com/2012/06/techwoman16x9.jpg?w=6505

1 year markWomen most likely to remove LARC3 year markReplacement time for some of the options5 year markReplacement time for some of the options

Evaluation Process

- The evaluation process to determine if the campaign is working will occur at the 1 year, 3 year, and 5 year marks. * The 1 year mark has given the campaign time to settle into the minds of the targeted audience. Its also within the first 1 year of using a woman will decided whether or not to have the LARC removed. Additionally, it is typically within the first 3 months of usage where the worst of the negative side effects occur. * The 3 year mark is to interview the women who chose the LARC options which need to be replaced after 3 years. * The 5 year mark is to interview the women who chose the LARC option which needs to be replaced after 5 years.

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99% effectiveSits directly inside the uterus

Intrauterine Devices (IUD)

Beyond the Pill will focus on bringing awareness of the IUD and the Implant.

The Intrauterine Device also known as the IUD is a small t-shaped device that is placed directly into the uterus to prevent pregnancy. The IUD is one of the most effective forms of birth control available; with 99% effectiveness (CDC, 2015). There are two options for an IUD; hormonal or non-hormonal. Hormonal IUDs are Mirena which is lasts up to 5 years before it needs to be replaced and Skyla, which is good for up to 3 years before needing to be replaced. Both work by slowly releasing a steady stream of the hormone progestin directly into the uterus, thinning the uterine lining, making it difficult for sperm to attach.

The non-hormonal method is Paraguard. It is copper based and can last up to 10 years. The copper acts as repellent to sperm making it difficult for implantation to take place. Many women who are not interested in adding hormones to their body opt for the Paraguard.

References:Center for Disease Control (CDC). (2015, June 1). CDC-contraception. RetrievedJuly31, 2015, from

Image: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm#Intrauterine-Contraception-IUD-IUS

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Hormonal IUDS:Skyla (3 years)Mirena (5 years)

Non-HormonalParaguard (10 years) Options for IUDs

There are two options for an IUD; hormonal or non-hormonal. Hormonal IUDs are Mirena which is lasts up to 5 years before it needs to be replaced and Skyla, which is good for up to 3 years before needing to be replaced. Both work by slowly releasing a steady stream of the hormone progestin directly into the uterus, thinning the uterine lining, making it difficult for sperm to attach.The non-hormonal method is Paraguard. It is copper based and can last up to 10 years. The copper acts as repellent to sperm making it difficult for implantation to take place. Many women who are not interested in adding hormones to their body opt for the Paraguard.

References:Image: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm#Intrauterine-Contraception-IUD-IUSImage: http://www.drgangemi.com/wp-content/uploads/2014/02/paraguard.jpg

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Dalkon ShieldMyths still persistCaused pelvic infections and 6 reported deaths (Case Western Reserve Univ, 2010).Clearing up Misconceptions

If the IUD is 99% effective why is it not more readily used in the United States? Well, in the 1970s, the Dalkon shield, a distant cousin of todays IUDs, caused many woman to become infertile due to pelvic infections and perforations; 6 women even died as a direct result of using the Dalkon Shield (Case Western Reserve University, 2010). Despite all new evidence and research showing todays IUDs to be safer than the Dalkon shield the myths about IUDs causing death and infertility still exist. Of the two forms of LARC, the Beyond the Pill campaign will need to work extra hard to shatter the urban legends that haunt the IUD and show women that this little device, which is slightly larger than a pair of earbud, is a safe and effective form of birth control.

References:Image: http://www.case.edu/affil/skuyhistcontraception/online-2012/dalkon-sheild.jpg

Case Western Reserve University. (2010). History of contraception- IUD. RetrievedSeptember20, 2015, from http://www.case.edu/affil/skuyhistcontraception/online-2012/IUDs.html9

NexplanonLasts up to 3 years Under the skin99% effective (CDC, 2015)The Implant (Nexplanon)

The contraceptive implant, known under the brand name of Nexaplon, is a tiny device (approximately the size of a matchstick) which is placed in the skin of the upper arm of the users non-dominant hand. Like the IUD, the Implant is also 99% effective in preventing pregnancies (CDS, 2015). It too releases low levels of hormone progestin into the womans body; preventing pregnancy. It is discreet and, other than having to replace it after three years, requires no maintenance on the users part.

Center for Disease Control (CDC). (2015, June 1). CDC-contraception. RetrievedJuly31, 2015, from http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm#Intrauterine-Contraception-IUD-IUS

Image: http://www.unidocs.co.uk/img/top/nexplanon.jpg

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Pain levels may varySome women report the insertion of the IUD to be one of the worst pains; giving birth in reverseSide effects may include:Acne, weight gain, hair growthsHeavier periods; intense cramps (copper IUD)5% of IUD users report device expelling from body in first year of use (ACOG, 2014)Amenorrhea-absence of a period (hormonal methods)Some women may find not having a monthly period stress inducing as a period is typically a sign that pregnancy has not occurred.

Pros and Cons of the LARC

As with all forms of birth control, there are pros and cons. Beyond the Pill will need to highlight benefits of using an IUD or Implant; showing the negatives are minimal in comparison to the benefits of not having to worry about getting pregnant.For many women, depending on their tolerance for pain, may find the IUD insertion (which takes approximately 30 seconds) to be the worse pain of their lives. The Implant is inserted by making a small incision into the arm; for some women the thought of being cut into is enough to make them decided against using the Implant. Side effects, if using a hormonal option, may include: acne; weight gain; facial hair growth, reduction in libido. Additionally, there is the possibility of inconsistency with ones period. One month a womans period may not arrive, the next month it may arriveand stay for weeks.Side effects, if using non-hormonal options, may include: heavier periods with extremely intense cramping.Another side effect, which may or may not be viewed as a negative, of using a LARC is amenorrhea; the absence of a period. For many women a period = equals no pregnancy occurring.The worst of the side effects typically occur within the first 3 months of using LARC.

References:American Congress of Obstetricians and Gynecologists (ACOG). (2014, July). Long-acting reversible contraception (LARC): IUD and implant. RetrievedSeptember20, 2015, from http://www.acog.org/Patients/FAQs/Long-Acting-Reversible-Contraception-LARC-IUD-and-Implant#possible

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Upfront cost higher than other birth control options$300-$700Scholarship assistance for women needing aid.Cost of LARCs

Even with changes in the U.S. Healthcare laws the upfront cost of LARCs may be a serious deterrent for some women. Depending on their insurance (or lack of insurance), currently, out of pocket expenses for an IUD or Implant may run between $300-$700 (Planned Parenthood, 2014). The Beyond the Pill campaign will seek to budget in minimal scholarship assistance for those women demonstrating financial need to cover the costs

ReferencesImage: http://www.chicoparty.com/images/products/detail/z889220dollar20symbol20green.jpg

Planned Parenthood. (2014). Birth control methods: Birth control options. RetrievedSeptember19, 2015, from http://www.plannedparenthood.org/learn/birth-control/12

Partnering large health organizationsPartnering with local womens health centersOpportunity to get the message on the minds of as many women as possibleIn person presentationsOne on one consultations.Working with Healthcare Providers

To obtain maximum exposure, the Beyond the Pill campaign will need to partner with large health organizations such as Sutter Health and smaller local womens health centers. These partnerships will allow the campaign to reach women of varying socio-economic levels. This will also give the campaign opportunities to hold in person presentations and one on one consultation with women interested in learning more about using LARCs.13

Reproductive freedom & sexual health are ongoing lifetime discussions.Parenthood should be a conscious decision.

Conclusion

The primary goal of the Beyond the Pill campaign is to get women 40 and older talking about birth control and letting them know they have options; safe and effective options. Reproductive freedom and sexual health are ongoing discussions throughout the entirety of our lives and not just while were young. Just because a womans fertility may be decreasing as her body ages does not mean she is out of the woods when it comes to naturally conceiving a child. Being aware of her body, the changes that are taking place, and knowing she has options allows a woman to fully embrace her sexual independence and control over her body. In a perfect world, the decision to become or not become a parenthood is just that; a decision, a conscious decision.

References:Image source: https://www.pinterest.com/pin/90635011225232055/

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American Congress of Obstetricians and Gynecologists (ACOG). (2014, July). Long- acting reversible contraception (LARC): IUD and implant. RetrievedSeptember20, 2015, http://www.acog.org/Patients/FAQs/Long-Acting-Reversible-Contraception-LARC-IUD-and-Implant#possibleCase Western Reserve University. (2010). History of contraception- IUD.RetrievedSeptember20, 2015, from http://www.case.edu/affil/skuyhistcontraception/online-2012/IUDs.html Center for Disease Control (CDC). (2015, June 1). CDC-contraception. RetrievedJuly31, 2015, http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm#Intrauterine-Contraception-IUD-IUSNational Center for Health Statistics. (2015, February 24). Trends in long-acting reversible contraception use among U.S. women aged 15-44. RetrievedAugust14, 2015, from http://nchstats.com/2015/02/24/trends-in-long-acting-reversible-contraception-use-among-u-s-women-aged-15-44/Oatman,M. (2012, September 26). Why don't more American women use IUDs? RetrievedAugust15, 2015, from http://www.motherjones.com/blue-marble/2012/09/why-are-iuds-unpopularPlanned Parenthood. (2014). Birth control methods: Birth control options. RetrievedSeptember19, 2015, from http://www.plannedparenthood.org/learn/birth-control/

References

https://thegrio.files.wordpress.com/2012/06/techwoman16x9.jpg?w=650 http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm#Intrauterine-Contraception-IUD-IUS http://www.drgangemi.com/wp-content/uploads/2014/02/paraguard.jpghttp://www.case.edu/affil/skuyhistcontraception/online-2012/dalkon-sheild.jpg http://www.unidocs.co.uk/img/top/nexplanon.jpghttp://www.chicoparty.com/images/products/detail/z889220dollar20symbol20green.jpg https://www.pinterest.com/pin/90635011225232055/

References (Images)

Introduction: Beyond the PillWelcome to the Beyond the Pill Health Communication Campaign Presentation. The purpose of this campaign is to bring awareness of birth control options to women 40 and older.Section 1-Prevalence of the Health ProblemBirth control for 40 year old women? Some may think this is an unnecessary topic due to prevailing stereotypes surrounding this age group. Were either already married, have had children, and about to start menopause. Or our biological clocks are about to explode and were all looking to be with child at the first chance. Or, once we hit the big 4-0, we no longer care about sex and only wish to sit around watching the Real Housewives of Insert the Big City here.The truth is 30% of pregnancies in women aged 35 and over are unintended.The average age of a menopausal woman in the United States is 51 (NIH, 2013).That means a womans potential to get pregnant as an end result of sex doesnt end because she has reached 40. Women in this age group still need to look for ways to protect themselves from unintended pregnancies.

Script Notes

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Just because weve hit a certain age bracket does not mean our sexual desires cease. Additionally, in an ideal world parenthood would be a conscious decision and not the end result of sexual activity. For many women, as our bodies age and change, the birth control options we used in our teens and twenties may not work the same as in our 40s. They in fact may cause more harm than help. Older women are susceptible to higher risk pregnancies than their younger counterparts; making birth control just as important now as it was in the younger years. Our risks for obesity, high blood pressure, heart disease increase with age. These diseases, subsequently, make oral contraception less effective and sometimes dangerous choice for older women.

Script Notes cont

Section 2- Target AudienceAmong women, ages 35-44, in the United States approximately 5.3% use some form of LARC as their means of protection against unintended pregnancy (National Center for Health Statistics, 2015). While in European countries such as Norway usage is 27%; in China up to 41% of women use some form of long acting reversible contraception (Oatman, 2012).Our initial target audience will be women in Alameda and Contra Costa Counties of the San Francisco Bay Area. With 1.2 million women in both counties, the audience is widely diverse in racial identity, economic class, and education. They are comfortable with technology and new media. Social media, smartphones, are all part of their everyday lives; Google is the best friend. They are quick to research health information online as well as speaking with their healthcare providers. The first 6 months of the campaign will focus on the 2 Bay Area counties, and then expand to the remaining 9 Bay Area counties. After the first year, the campaign will go nationwide.

Script Notes cont

Section 3-eHealth Technology/MobilizationAs technology savvy individuals, the campaign must embrace technology in order to gain awareness and survival. Working with media strategies that also have experience in the health/medical field, we will create not only an optimized for mobile website, but also a mobile app with detail information women can download to their phones or tablets. This app and the information will serve has a handy brochure women can reference at any time. Section 4- Evaluation ProcessThe evaluation process to determine if the campaign is working will occur at the 1 year, 3 year, and 5 year marks.The 1 year mark has given the campaign time to settle into the minds of the targeted audience. Its also within the first 1 year of using a woman will decided whether or not to have the LARC removed. Additionally, it is typically within the first 3 months of usage where the worst of the negative side effects occur.The 3 year mark is to interview the women who chose the LARC options which need to be replaced after 3 years.The 5 year mark is to interview the women who chose the LARC option which needs to be replaced after 5 years.

Script Notes cont

Section 5- IUD & ImplantBeyond the Pill will focus on bringing awareness of the IUD and the Implant.The Intrauterine Device also known as the IUD is a small t-shaped device that is placed directly into the uterus to prevent pregnancy. The IUD is one of the most effective forms of birth control available; with 99% effectiveness (CDC, 2015). There are two options for an IUD; hormonal or non-hormonal. Hormonal IUDs are Mirena which is lasts up to 5 years before it needs to be replaced and Skyla, which is good for up to 3 years before needing to be replaced. Both work by slowly releasing a steady stream of the hormone progestin directly into the uterus, thinning the uterine lining, making it difficult for sperm to attach.The non-hormonal method is Paraguard. It is copper based and can last up to 10 years. The copper acts as repellent to sperm making it difficult for implantation to take place. Many women who are not interested in adding hormones to their body opt for the ParaguardScript Notes cont

If the IUD is 99% effective why is it not more readily used in the United States? Well, in the 1970s, the Dalkon shield, a distant cousin of todays IUDs, caused many woman to become infertile due to pelvic infections and perforations; 6 women even died as a direct result of using the Dalkon Shield (Case Western Reserve University, 2010). Despite all new evidence and research showing todays IUDs to be safer than the Dalkon shield the myths about IUDs causing death and infertility still exist. Of the two forms of LARC, the Beyond the Pill campaign will need to work extra hard to shatter the urban legends that haunt the IUD and show women that this little device, which is slightly larger than a pair of earbud, is a safe and effective form of birth control.The contraceptive implant, known under the brand name of Nexaplon, is a tiny device (approximately the size of a matchstick) which is placed in the skin of the upper arm of the users non-dominant hand. Like the IUD, the Implant is also 99% effective in preventing pregnancies (CDS, 2015). It too releases low levels of hormone progestin into the womans body; preventing pregnancy. It is discreet and, other than having to replace it after three years, requires no maintenance on the users part.Script Notes cont

Section 6-Pros & Cons of LARCAs with all forms of birth control, there are pros and cons. Beyond the Pill will need to highlight benefits of using an IUD or Implant; showing the negatives are minimal in comparison to the benefits of not having to worry about getting pregnant.For many women, depending on their tolerance for pain, may find the IUD insertion (which takes approximately 30 seconds) to be the worse pain of their lives. The Implant is inserted by making a small incision into the arm; for some women the thought of being cut into is enough to make them decided against using the Implant.

Script Notes cont

Side effects, if using a hormonal option, may include: acne; weight gain; facial hair growth, reduction in libido. Additionally, there is the possibility of inconsistency with ones period. One month a womans period may not arrive, the next month it may arriveand stay for weeks.Side effects, if using non-hormonal options, may include: heavier periods with extremely intense cramping.Another side effect, which may or may not be viewed as a negative, of using a LARC is amenorrhea; the absence of a period. For many women a period = equals no pregnancy occurring.The worst of the side effects typically occur within the first 3 months of using LARC.

Script Notes cont

Section 7-Cost of LARCsEven with changes in the U.S. Healthcare laws the upfront cost of LARCs may be a serious deterrent for some women. Depending on their insurance (or lack of insurance), currently, out of pocket expenses for an IUD or Implant may run between $300-$700 (Planned Parenthood, 2014). The Beyond the Pill campaign will seek to budget in minimal scholarship assistance for those women demonstrating financial need to cover the costsSection 8-Working with Healthcare ProvidersTo obtain maximum exposure, the Beyond the Pill campaign will need to partner with large health organizations such as Sutter Health and smaller local womens health centers. These partnerships will allow the campaign to reach women of varying socio-economic levels. This will also give the campaign opportunities to hold in person presentations and one on one consultation with women interested in learning more about using LARCs.

ConclusionThe primary goal of the Beyond the Pill campaign is to get women 40 and older talking about birth control and letting them know they have options; safe and effective options. Reproductive freedom and sexual health are ongoing discussions throughout the entirety of our lives and not just while were young. Just because a womans fertility may be decreasing as her body ages does not mean she is out of the woods when it comes to naturally conceiving a child. Being aware of her body, the changes that are taking place, and knowing she has options allows a woman to fully embrace her sexual independence and control over her body. In a perfect world, the decision to become or not become a parenthood is just that; a decision, a conscious decision.

Script Notes cont