Those working in obstetrics often use the scenario of women who don't have control over their bodies as the reason to provide hormonal
contraception.  However, while there are certainly women who don't have control (internal or external) this is false logic and does not hold up. First, giving one injection does not last a lifetime.  Second, many many many more women with control over their bodies are given/strongly encouraged to use these contraceptives without adequate consent. Third, many women (especially teens and those from lower socio-economic classes) are coerced by the medical establishment to accept contraceptives (reinforcing inner beliefs that they do not have control).  Fourth, this rationalization does not change the fact that women lose their milk supply from birth control.  Fifthly, this is very paternalistic toward women and does nothing to empower them. Sixthly, there are some very effective forms of non-hormonal contraception available. 


For these reasons, do not accept this rationalization from any provider.  What happened to "Do no Harm" and "evidenced-based practice"?  Does the end justify the means?  Has it been proven that a 3 month injection ends unwanted pregnancy?  (NO)  IS it only evidence when we want it to be?  Is Level II-2 poor evidence really evidence?  (The bulk of the Kapp article in Contraception sponsored by the CDC was level II-2 poor).  Would we use the same level of evidence to do heart surgery or to treat diabetes? 


I knew these recommendations were coming despite the evidence.  I have spoken out about them many times.  I quite a job over being publicly reprimanded for telling an exclusively-breastfeeding teen they could lower her supply.  I have written a paper and submitted it for publication. 
IT shows that when supplementation rates are low, population losses are low, normal control groups are used, exclusivity is defined and non-commercial funds are used and accurate modes of measurement are used that studies meeting at least 5 of these criteria consistently found 
evidence of milk supply decreases.  


While I did this research I found redundant publications stating their were increases in supply sponsored by Upjohn.  I found level-II poor evidence being use to assert progestin increase supply while level-II fair evidence finding decreases were ignored.  I found that studies that found evidence of increases consistently inferior for these quality criteria while those with equivocal evidence were slightly better.  The level of bias in the studies showing increases were astounding i.e. comparing any duration of breastfeeding to exclusive durations or studies with mothers being instructed to feed every 3 hours with a night-time interval from BIRTH.  Most mothers averaged 7 feeds in the first few months of that study.  This study is/was used to defend that stance that progestins increase supply. Studies' had abnormal infant growth patterns or gains and mothers with very low supply.  I found in a Jeliffe and Jeliffe book from 1978 that the progestin-only (micronor) pill was referred to as the "milk-pill" with "galactopoetic" properties BEFORE it was even available.  The pharmaceutical companies have been extremely effective haven't they?  IS there any other interpretation of this statement?  Upjohn states in its (depot-medroxyprogesterone) DMPA product literature that, it will not affect milk supply, but under side effects "prevention of lactation" is provided.  In its  oral medroxyprogesterone (Provera) it state do not use in breastfeeding women.  It is excreted in milk.  Same company, same medication although via different routes (oral vs injection) very different instructions.  Can you explain that?  I can–its called money not evidence- based practice. 


I am worried that my paper will not be accepted given social agendas and deep-seated biases. I appreciate any good thoughts or prayers sent my way. I am also grateful to the ABM for their statement and I am hopeful that it may improve my chances of the paper being accepted.  So kudo's to the ABM. I can't wait to see the study they refer to!!! 


Christine Betzold NP CLC MSN
www.theBFclinic.com
714-269-9879

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