There has been a lot of talk about the side effects of the pill and other hormonal contraceptives that can come about and be detrimental to a woman’s health. Aside from side effects, another cause for concern are certain health conditions or diseases already present in a woman that make her ineligible to use a certain birth control method. This is what medical parlance calls contraindications for a certain birth control method. In fact, the World Health Organization has already issued a document that addresses this entitled “Medical Eligibility Criteria for Contraceptive Use”. A tabulated, easy-to-use summary is also provided by the Reproductive Health Access Project as an easy reference. The U.S. government through the Center for Disease Control has also issued its own guidelines. Though the WHO document is dated 2010, two years on, I have yet to hear of our own Department of Health implementing this set of guidelines.
When a method is absolutely contraindicated, the method of contraception or birth control should not be given to a woman in the first place. If one looks at the Reproductive Health Access Project Chart for instance, a current history of breast cancer is an absolute contraindication (
Risk Level 4: Method NOT to be used) for all methods which have a hormonal component from the oral contraceptive pill (OCP) down to the progestin IUD. If one wants to implement good medical practice in advocating OCP’s for instance, one would have to screen out this condition in a woman if a medical practitioner would want to prescribe the contraceptive pill for her.
The gold standard for screening women for breast cancer is a screening mammography. For a woman to have a screening mammography taken and read by a specialist, the following are required:
- A dedicated x-ray mammography unit with a generator able to provide 24-32 kVp, 5-300 mAs, with usually a Molybdenum/Molybdenum anode-filter combination, also equiped with a compression plate an image receptor (Not the typical x-ray unit that takes your annual chest PA is not used in this regard)
- Screen film cassettes with a spatial resolution of of 20 lp/mm or greater
- A mammographer (radiologic technologist who ideally has had additional months of training in taking mammograms aside from taking a 4 year BS Radiologic Technology course and passing the board examinations)
- A breast imaging specialist (a licensed medical doctor who has had additional 4 years training in diagnostic radiology, passed the required diplomate exams and has had an additional 1- 1 1/2 years of training in breast imaging and has passed the required subspecialty examinations)
- Adequate film viewing conditions (including hot lights, a magnifying lens, view boxes that can mask unexposed areas)
All these is required just to screen out women that have breast malignancies who may be thinking of using a hormonal method of contraception. Arguably, government may be able to provide for the equipment needed, but the manpower needed is hard to come by.
There were only 514 new radiologic technologists who passed the PCR licensure examination in June 2012. Only 71 new radiologists were added in our country this year. Only a fraction (probably less than a quarter) of these will probably go on to train to become mammographers and breast imaging specialists as there may be other fields that would interest the radiologic technologist or radiologist. The manpower required is definitely not enough to serve the entire country.
The above illustrated is just for screening for breast cancer as a contraindication. There are also other requirements for screening for all the other conditions contraindicated for each of the contraceptive methods one is planning for a woman to use. If a country wants to implement certain family planning methods, the government has to be ready to implement mass screening for everyone who wants to use a contraceptive method as part of good medical practice to make sure a woman with absolute contraindications is not going to be using a contraceptive method she should not have started to use in the first place. Contraceptive pills cannot just be given out like candy to every Juana when one has not taken a thorough medical history, examined the woman and ordered the requisite screening procedures. We don’t want to shortchange the Filipina and endanger her health in the process, do we?