[0:10]Hi everyone. My name is Grace Cook. I am the program associate here at our bodies ourselves. and I am here with Dr. Kristin Brandy, if you'd like to go ahead and introduce yourself.
[0:21]Sure, thanks so much for having me. So I'm Dr. Kristen Brandy, pronounced she her Aya. I'm an OBGYN, a complex planning sub specialist. I work in New Jersey.
[0:31]Um, I trained to got my medical school and residency in Rucker's New Jersey Medical School, where I also worked as an assistant professor.
[0:39]Um, I then went on to be a family planning, um, specialist. I got my fellowship completed in Boston University, where I also got my masters in public health.
[0:49]Um, with a concentration of health rights, bioethics, or health law, bioethics and human rights.
[0:55]Um, my research is on reproductive decision making, contraceptive coercion, autonomy, um, and also racism and reproductive healthcare.
[1:04]I've been lucky to be involved with several different organizations. I was previously the board chair for physicians for reproductive health.
[1:10]I've worked on committees for society for family planning, and I'm a founding member of a group called centering equity, racial and cultural literacy and family planning or circle FP.
[1:19]And I consider myself a strong advocate for reproductive justice and autonomy, particularly in marginalized communities.
[1:26]Right. That's great. That is a whole list of things that are all.
[1:30]Many hats. Yes.
[1:33]Wear a lot of hats. And I love how specialized you are in this complex family planning. Can you talk about what you do as an OB, um, and in this specific context or your specialty?
[1:45]Sure. I think when people think about OBGYN, they think about reproductive health, women's health, um, and a lot of that's stuff that I still do.
[1:54]Um, but as a complex family planning sub specialist, I've had to narrow down my focus and I focus mostly on contraception and abortion care.
[2:01]Um, it also includes things like miscarriage management, managing things like ectopic pregnancies.
[2:07]Um, but I really love it that I get to talk to patients every day about sometimes really personal, really awkward things.
[2:16]Um, but help them figure out kind of what's best for them and help them meet whatever goals they have for um, for their family size.
[2:22]That's great. Um, before we jump into like the impacts of contraception and all this fertility planning and family planning.
[2:32]Um, could you in whatever context you would like, cover what kinds of contraception there is available to people and maybe how that changes over, um, like as we age?
[2:44]Sure. So there are really lots of options for birth control or contraception. Um, and there's no real age limits or things that, um, impact kind of things from a health perspective.
[2:56]Most birth control, um, is safe and effective for the majority of people, regardless if you have health conditions.
[3:04]Um, there are certain circumstances where there's some, um, complexity to that, and that's why I have the sub specialty is that if people have medical complexity in their lives are managing multiple medical conditions, we can talk about the risks and benefits of certain types of birth control.
[3:19]Um, as far as in general, um, there's a lot of methods that can be tailored based on what your needs and preferences are.
[3:26]So, just to review, um, there's things that you, that, uh, patients, people have to do more actively, things like the birth control pill, which is what most people kind of think of when they think about birth control, um, which is the pill you have to take every day.
[3:38]There's different versions of that, so there's the patch, which can work every week.
[3:44]Um, there is a vaginal ring that can be placed every month, same medicines, um, but just kind of a different way your body absorbs it.
[3:51]There's also the Depo provera shot, which is an injection, um, that someone takes every three months.
[3:58]And that can be done either in a clinic, in an office setting, or people can actually self inject if they feel comfortable doing that.
[4:02]And then there's longer term options, things like the IUDs, both hormonal versions and non-hormonal versions and the implant, which is our most effective form of birth control that's reversible.
[4:13]Um, and then we also have more permanent methods like, um, tying your tubes classically, um, or, um, getting a vasectomy.
[4:22]So there's a lot of different options, and usually it's a conversation I have with patients about kind of what are your goals, what are the things that you want to experience, kind of how engaged you want to be in your, um, birth control use, and then we talk about the pros and cons and kind of figure out what works best for them.
[4:38]Yeah, that is, there's a whole, um, world out there of contraception and choices that we can make, um, I think that's great, and it can be kind of overwhelming if you don't know, and you're just starting out.
[4:47]Um, so like,
[4:50]Absolutely. Resources and, and just exploring a bit beforehand and then talking to someone like you seems like a great start.
[5:00]Yeah, and I think it's important for people to know their options. I think a lot of healthcare providers don't know a lot about birth control.
[5:06]It's something that is something if you happen to be like specialized in it, you know a lot about it, but otherwise most even like general healthcare providers don't know much about the options.
[5:17]They know about the pill and they know about tying your tubes.
[5:21]But there's a lot of stuff in between. Um, and there's a lot of great resources out there. Um, your site has a lot of resources.
[5:27]I'll also name Bed Sider, I think is one that I send to my patients a lot, um, which I like because it has pictures of everything and has videos of people's experiences and people can kind of look through that web page, kind of think through things and then then the like we can have a deeper conversation about like what does that mean for them as an individual and figure out what works best.
[5:46]Yeah, I'm glad you said that. I was going to bring this up later, but I'll bring it up now.
[5:51]Um, the idea or I'm from the rural Midwest and sometimes there's not information available to people.
[6:00]Um, and I've heard so many times like I was just told to get on the pill and now my friends are, you know, we're in our mid twenties and we're like, whoa, we didn't realize there was all of these options.
[6:10]So I'm wondering, um, if you have any advice for how to advocate for yourself at appointments, especially like right off the bat or even if a method isn't working for you.
[6:24]Um, to find like a contraceptive contraceptive option that is actually going to fit your needs.
[6:27]Sure. I mean, I think the first thing we've kind of already talked about is like doing your research at home before you go into the office.
[6:33]Um, thinking through kind of what you want the experience to be like.
[6:37]Some people are fine to take a pill every day, some people find that super annoying and they don't want to do that.
[6:43]Um, some people want something long term, but some people are worried about something in their body.
[6:47]There's a lot of different aspects to making that decision for yourself, so I think first some self-reflection is helpful.
[6:53]And then going to an office and hopefully finding a provider that's open to having a dialogue about it.
[6:59]I agree. Me as a patient as well have had many providers that been like, oh yeah, just take this or do this.
[7:05]Um, so I think one thing is just asking a lot of questions. If you have questions that are going to inform your decision, you have a right to know those answers.
[7:14]So whatever it is, whether it's like side effects or cost, asking those questions up front, or just saying like, you know, I've heard about the pill, but what are my other options?
[7:20]And see what that person says. Um, and if they, you know, shut that down or you feel like they're not giving you the full amount of options or not acknowledging, you know, your research and thinking through like what do you, what do you want, then that's not the right provider for you.
[7:38]Um, so trying to find people that are opening to open to listening, to answering your questions and helping you figure out what's right for you.
[7:46]Um, that's what you're looking for. And if you're not finding that, find someone else.
[7:51]Exactly. I think that's good, that's sound advice for all health issues similar to this.
[7:58]Um, yeah, if, if your provider's not listening, like you know your body the best.
[8:03]So Yeah. The way I usually frame it is that like I am the expert in like the medicine and the science piece of it, and the person that I'm taking care of is the person that's the expert in their lived experience.
[8:16]And between the two of us, we are going to come to a consensus of like, this is all of our expertise, how can we match all of that and like come to the best outcome for that person.
[8:51]Absolutely, yeah. I think birth control, one of the reasons why I like to be able to provide this care, is that it seems like it's something that's like optional.
[8:58]It's like this elective thing that people can choose to do or not.
[9:02]And I don't see it that way. I think contraception is incredibly important for folks and helps them be able to live out whatever their reproductive life goals are, whatever that is for them.
[9:14]Um, and being able to have a deeper conversation about people's preferences, like choosing with them kind of what works, what doesn't work, is a really powerful experience and it's really personal and it dives deeper into that person's life and who they are.
[9:31]Um, but I think it's really important because this is going to have a long lasting impact for people.
[9:36]Um, we know that folks that have access to contraception are able to build the families that they want.
[9:42]Um, and that's not just like a nice thing for people to have. It is, it is, it is really important for people to live out their own autonomy.
[9:48]It also helps with things like if pregnancy is dangerous for somebody, it helps them be able to go on with their lives safely and not having to worry about a pregnancy, which I think many people don't recognize that being pregnant is always more dangerous than not being pregnant.
[10:04]Um, and so being able to help make sure people's healths can be optimized is really important.
[10:09]It also impacts a lot of other things. Um, we know that people that have more children than what they want, are higher, more likely to end up in poverty or more likely to end up with other socioeconomic difficulties, um, like food insecurity, housing insecurity.
[10:25]Um, and so we're also helping people not just live out their autonomy around what family size they want, but kind of what life do they want to live?
[10:32]What resources do they want available to themselves? Um, and how to, um, create an environment to be able to parent the children they have and with dignity and respect.
[10:43]I think about it from a reproductive justice perspective, where all people should have the human right to be able to decide if and when to become pregnant and to parent in safe and sustainable communities.
[10:54]And so I think being able to talk about birth control, as like, little as that seems, it actually is such big consequences for the people that I serve.
[11:06]I was hoping we could dive into inequities that you see in your field of like access to contraception, um, maybe related to like social determinants of health and intersectional inequalities and how does that present to your patients and in the broader field?
[11:24]Sure. Oh, there's so much we could talk about. Let's see.
[18:31]I mean, it's something that I think about both from a clinical perspective as well as a research perspective.
[18:37]Um, so contraceptive coercion is a a type of coercion that kind of exists under a big umbrella, and kind of like stepping back even farther.
[18:44]Um, there's this concept of reproductive autonomy, that people should be able to make decisions about if and when to become pregnant.
[18:52]Um, and there's a lot of things that people have to use to do that, like you have to be able to advocate for yourself, um, have self-efficacy, be able to communicate your needs to whoever to obtain whatever healthcare you need to do that.
[19:03]Um, have to be able to engage in consent with partners. Um, but there's this opposite effect of autonomy called coercion, when people or outside forces pressure you to do something that you may not want to do.
[19:27]Um, a classic example I feel like I see on TV all the time is like a parent or a partner feeding someone birth control pills to prevent them from getting pregnant.
[19:53]Um, or stories of partners pulling out people's IUDs to cause them to get pregnant or putting holes in condoms, things like that.
[20:04]That's contraceptive coercion. And we know that there are adverse health outcomes to when that happens, particularly when we've seen it in in in partner violence relationships.
[20:14]That those folks, if they have experienced contraceptive coercion, also have higher rates of all the other things that happen with that, unintended pregnancy rates, um, domestic violence, all these things.
[20:25]Um, I also think about it and we've talked a lot about autonomy and helping center patients.
[20:30]I think about it from a provider perspective that for example that example you said about we're not giving patients all the options you're saying, here, just take a pill.
[20:39]That's contraceptive coercion to me. That's saying like I know better than you do about what you need.
[20:44]Do this or don't do this, um, because often as healthcare providers, we're the gatekeepers of whether or not people have access to something.
[20:51]And so sometimes we may be coercing people and not be giving them their full options or allowing them to live out that autonomy that they deserve.
[21:00]Thank you for explaining that. That's one of the first times I've heard that term actually.
[26:09]Uh, I just really wanted to end on a positive note and ask if you have any, I don't know, inspiring stories or messages of hope to women and um, gender expansive people that might be listening and watching.
[26:23]Um, a message of hope. Well, I would echo that like I think it's important to not get overwhelmed.
[26:31]that there's a lot of things going on right now, and it's easy to kind of just say that like things aren't working and I'm just going to be my little bubble and that's it.
[26:40]Um, but I think we do need to keep talking about these things more and think about what we can do to share stories and share, um, whatever we can, kind of, do whatever things that we can do in our little spaces.
[26:53]Um, I'll share, I guess one story about there's a lot of concern in the past couple weeks that the CDC took down their like contraceptive guidelines.
[27:01]And so it's not like, you know, doctors just kind of sat around and like, oh no, we have no guidelines now.
[27:07]We all kind of like gathered our resources, tried to figure out where we could find links to people that were still posting this information, because we know that stuff is critically important to our patients.
[27:18]And so we don't, you know, we don't know what that means, um, and we're trying our best in this moment to make sure that science prevails and that patients get the care that they need with whatever, whatever resources that we have.
[27:31]Um, so even if it feels like healthcare may be damaged or, um, struggling in this moment, we're still fighting for our patients.
[27:38]And so we're going to be here as best we can for as long as we can.
[27:44]Thank you. Thank you for doing that and and sharing that.
[27:48]Um, it's also it's so important to our bodies ourselves too, to be just a trusted source amongst so much happening right now.
[27:56]So we really appreciate you talking and sharing your wealth of knowledge and I I hope that this is really helpful to someone out there.
[28:07]Hopefully. Thanks so much.
