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Working for zero barriers to sexual and reproductive health care

Every week, a different guest tweeter takes charge of Croakey’s rotated, curated Twitter account, @WePublicHealth, and uses the account to cover specific health issues or events.

Last week Brenna Bernardino  (@brennabernardin) covered wide-ranging information, issues and evidence on contraception, including access and education, in Australia in the lead up to World Contraception Day 2020 on September 26 #WCD2020.

This post features a broad selection of her tweets and links below.


Brenna Bernardino tweets:

This week I will tweet primarily on contraception education and access in Australia in the lead up to World Contraception Day 2020 on September 26 #WCD2020

My name is Brenna Bernardino and I am Timorese, Portuguese and Torres Strait Islander. I have lived between Brisbane and the USA, but I’m currently in Okinawa, Japan!

This week I’ll be tweeting from Okinawa, Japan where I’ll be for the next 2 years due to my husband’s job in the military. I feel very lucky to be here. It’s so beautiful! Here is a recent sunrise in Okinawa

Now I’m currently working as a secretary on a military base. I’m also consulting for an FASD program with an urban Native community in the USA, and for a model of care program in NSW. Soon I’ll also be an RA at UQ looking at success factors for Indigenous undergrads!

But my REAL passion is sexual and reproductive health! I moderate @ReproJusticeAus and plan on pursuing a PhD, becoming a sex educator (or both!).

I believe there should be ZERO barriers to access to SRH healthcare, and we must use a human rights/justice framework to provide equitable care.

DISCLAIMER: I (Brenna Bernardino) am NOT a medical professional. All my info this week on contraception is sourced online from medical services in Australia. Please check out the resources, talk to your doctor or other trusted health professional for guidance on what YOU want.

This week I will tweet primarily on contraception education and access in Australia in the lead up to World Contraception Day 2020 on September 26 #WCD2020

World Contraception Day on Sep 26 also sits in the month of September which includes World Sexual Health Day (4th) and International Safe Abortion Day (28th) #WCD2020

World Contraception Day was launched in 2007 to improve awareness of contraception and to enable young people to make informed choices on their sexual and reproductive health. Find more info here: https://your-life.com/wcd #WCD2020

Talking history of contraception

Let’s discuss HISTORY of contraception in Aus. Assoc. Prof Lisa Featherstone from @UQ_News (who) wrote on Australian condemnation of contraception, with “population control…seen as a direct threat to…the Australian nation” http://auswhn.org.au/blog/contraception-dont-try/ #WCD2020

In 1961, the oral contraceptive pill was introduced and finally gave women greater reproductive autonomy. But did you know it was initially only for MARRIED women and had a 25.% tax?? https://nma.gov.au/defining-moments/resources/the-pill #WCD2020

In 1988, the intrauterine device (IUD) became available, followed by the Mirena which came onto the PBS in 2000 https://1800myoptions.org.au/information/resources #WCD2020

For more history, @WHVictoria created a fantastic ‘zine with a summary of “contraception through the ages” such as the ancient yet common practice of withdrawal, honey soaked cotton, animal intestine condoms & even using citrus fruits down there… https://1800myoptions.org.au/information/resources #WCD2020

Short and long acting contraception

Now let’s explore different types of contraception. What is short acting contraception? It refers to contraception that is used at short time intervals e.g. single use, daily or 3 month use https://your-life.com/en/contraception-methods/short-acting-contraception/ #WCD2020

Short acting includes: the pill, contraceptive patch, contraceptive ring, male condom, contraceptive injection, female condom, diaphragm, sponge, spermicides and cervical cap https://your-life.com/en/contraception-methods/short-acting-contraception/ #WCD2020

Short acting can also include fertility awareness methods or no PIV activity @TrueOrgAu http://truechoicecontraceptivechoice.com.au #WCD2020

Here’s also a great 7 part series which covers broader topics on “the pill” e.g. history, side effects and how to choose the right contraceptive pill for you https://theconversation.com/au/topics/pill-series-52834 #WCD2020

Let’s dive into short acting contraceptives. #1 “the pill” otherwise known as the “daily combined hormonal contraceptive pill”. It releases small amounts of progestogen and oestrogen. 91% effective. Daily use. http://truechoicecontraceptivechoice.com.au/contraceptive-methods/daily-combined-hormone-contraceptive-pill #WCD2020

There is also the “mini pill” which releases a small amount of progestogen. 91% effective. Daily use. What’s the difference? Besides the hormones, the “pill” stops the ovaries releasing an egg/month & the “mini pill” thickens cervical mucus https://thewomens.org.au/health-information/contraception/contraceptive-pills #WCD2020

#2 Condoms! Both internal (79%) and external condoms (82%) are both short term contraceptives. Both can prevent against sexually transmitted infections (STIs) and do not contain hormones. https://truechoicecontraceptivechoice.com.au/contraceptive-methods/external-condom #WCD2020

What’s cooler than wearing condoms as an accessory? Being a whole condom SUPERHERO. Shoutout to Aunty Gracelyn Smallwood and the Townsville mob for creating the culturally appropriate empowering figure for sexual health promo in the ’80s. https://condoman.com.au #WCD2020

#3 Contraceptive Injection. “Depo”. 96-99.5% effective. No STI protection. Lasts 12-14wks. In between short and long term contraceptive. Can also be used during breast feeding! https://fpv.org.au/for-you/contraception/contraceptive-injection-depo #WCD2020

#4 Diaphragm. “cervical cap”. 82-86% effective. No STI protection. Lasts for 1 sexual activity. Needs gel inside otherwise it won’t work. https://fpv.org.au/for-you/contraception/barriers-you-will-need-to-use-every-time-you-have-sex/diaphragms #WCD2020

#5 The vaginal ring. “the ring”, “NuvaRing” (brand). 93-99% effective. No STI protection. Has 2 hormones, similar to “the pill”. Needs 2 be changed every 4 wks. Once inside, usually can’t feel it! https://fpv.org.au/for-you/contraception/other-methods/nuvaring-vaginal-ring

#6 Fertility awareness methods. “natural planning” or “rhythm method”. 75-99.6% effective. No STI protection. Plan to avoid having sex when at risk of pregnancy due to menstrual cycle fluctuations (egg may not have been released by ovary). https://truechoicecontraceptivechoice.com.au/contraceptive-methods/fertility-awareness-methods #WCD2020

#7 No PIV. Basically, this means no touching between a naked penis or vulva, thereby preventing pregnancy. This includes kissing, masturbating, using toys and sex other than PIV (oral/anal). But, there may still be a risk of STIs! https://truechoicecontraceptivechoice.com.au/contraceptive-methods/no-piv-activity #WCD2020

What’s missing from today’s short term contraceptives? EMERGENCY contraception! These include the “morning after pill” (2 versions, diff hormones) and even the copper IUD can be used up to 5 days after sex! https://truechoicecontraceptivechoice.com.au/contraceptive-methods/emergency-contraceptive-pill-UPA #WCD2020

Long acting contraceptives include: the implant, IUD, injection, breastfeeding methods, vasectomy and tubal litigation @TrueOrgAu https://truechoicecontraceptivechoice.com.au

Also, why are long acting contraceptives my favourite? Well I’m biased because I’m currently on my THIRD round of the contraceptive implant, otherwise known as the rod or bar. It works great for me! https://truechoicecontraceptivechoice.com.au/contraceptive-methods/contraceptive-implant #WCD2020

I UD #1 is the hormonal IUD. 99.8% effective with perfect use. No STI protection. Lasts 5 years. Works by releasing progestrogen, thickening the cervical mucous and thins the uterus lining https://contraception.org.au/methods/hormonal-iud/ #WCD2020

IUD # 2 is the copper IUD. 99.4% effective w/ perfect use. No STI protection. Lasts 5-10 years. Works by releasing low amounts of copper (reducing sperm mobility) and stops eggs from implanting in the uterine wall. Super cool! https://contraception.org.au/methods/copper-iud/ #WCD2020

Have you heard of the breastfeeding method as a form of contraception?? @TrueOrgAu details how for 6 months after child birth + breast feeding=hormones prevent ovulation thus preventing pregnancy! https://truechoicecontraceptivechoice.com.au/contraceptive-methods/breastfeeding #WCD2020

What about sterilization? While not 100% effective, a vasectomy has a failure rate less than 0.1%. By closing off the vas deferens, sperm in the testicles can no longer travel to mix w/ semen. Can take 30 mins to complete! @mariestopesaus https://mariestopes.org.au/contraception/vasectomy/

Here’s an article exploring in more detail how it works and if it can be reversed… https://theconversation.com/explainer-how-does-a-vasectomy-work-and-can-it-be-reversed-110780 #WCD2020

Then there’s also tubal litigation! “Getting ya tubes tied”. 99.5% effective. This occurs when the fallopian tubes are cut. If they are removed, it’s an salpingectomy (word of the day)! https://truechoicecontraceptivechoice.com.au/contraceptive-methods/tubal-ligation #WCD2020

Although LARCs have higher efficacy, they are still under utilized. @doughendrie wrote an article with @Danielle_Mazza explaining that there is low GP & consumer knowledge, as well as system barriers (cost, training, access). https://www1.racgp.org.au/newsgp/clinical/the-pill-remains-the-default-female-contraceptive #WCD2020

While I’ve been tweeting about diff types of contraception this week, I wanted to highlight a fantastic organisation @DecoloniseContr who has also been sharing info on contraception Check them out: https://decolonisingcontraception.com #WCD2020

While I’ll share more research on contraception later this week, here’s a study on contraceptive practices among Australian women in general https://pubmed.ncbi.nlm.nih.gov/27373543/ #WCD2020

Reproductive and sexual health services

Today I will share links and resources to large organisations across Australia that focus on different types of contraceptives #WCD2020

SHINE SA began as the Family Planning Assoc of Australia, but now offers more such as primary care services and workforce development. This year they celebrate 50 years of service! https://shinesa.org.au #WCD2020

Family Planning NT offers all people safe and confidential access to reproductive and sexual health services, education and information. PLUS they have free condoms ay! http://fpwnt.com.au #WCD2020

Rounding out state/territory SRH services is Family Planning Tasmania! They are even hiring for a couple positions right now! http://fpt.asn.au #WCD2020

Besides our state/territory services, there are many fantastic organizations getting amongst it. @childrenXchoice in QLD provides info on all unplanned pregnancy options, counselling & referrals, plus training for students & health care workers. https://childrenbychoice.org.au

One of my fave campaigns is @young_deadly which aims to raise awareness of STIs for Aboriginal youth in regional/remote areas. They have great flyers on their website too: https://youngdeadlyfree.org.au Let’s knockout STI’s!

Many of you have probably heard of @mariestopesaus – did you know they are the only national, independently accredited safe abortion, vasectomy and contraception provider? Check out the training deets on their site—>https://mariestopes.org.au #WCD2020

Back to the archives

Relevant contraception findings from the 1st Australian Study of Health and Relationships (ASHR) include #1 Sex in Australia: contraceptive practices among a representative sample of women. The most used contraceptive was oral.

ASHR Study #2: On condom use, condoms were more likely to be used with casual partners and less likely to be used with regular co-habiting partners (no surprise there!) https://pubmed.ncbi.nlm.nih.gov/14696715/ #WCD2020

The 3rd ASHR is currently underway! You’ll have to watch this space to see how SRH and contraceptive use has again changed over time. Fascinating stuff! https://findanexpert.unimelb.edu.au/project/104633-the-third-australian-study-of-health-and-relationships-(ashr3)–a-nationally-representative-sexual-health-survey #WCD2020

Now we’ll explore the explosion of studies out there! Check out Unintended and unwanted pregnancy in Australia: a cross-sectional, national random telephone survey of prevalence and outcomes in @theMJA https://mja.com.au/journal/2018/209/9/unintended-and-unwanted-pregnancy-australia-cross-sectional-national-random #WCD2020

Enhancing use of emergency contraceptive pills: A systematic review of women’s attitudes, beliefs, knowledge, and e… https://pubmed.ncbi.nlm.nih.gov/30475681/ #WCD2020

Doctors’ experience of the contraceptive consultation: a qualitative study in Australia https://pubmed.ncbi.nlm.nih.gov/27172879/ #WCD2020

Women’s access to emergency contraception ‘critical’ https://www1.racgp.org.au/newsgp/clinical/women-s-access-to-emergency-contraception-critical #WCD2020

Check out these @ashm reports on sexual health care and services during COVID-19. https://ashm.org.au/covid-19/clinical-care/ashm-covid-19-taskforce-report-on-sexual-health-services/ #WCD2020

The impact of COVID-19 on contraception and abortion care policy and practice: experiences from selected countries https://srh.bmj.com/content/early/2020/08/10/bmjsrh-2020-200709 #WCD2020

Interconception care @Danielle_Mazza https://www1.racgp.org.au/ajgp/2020/june/interconception-care#.X22ZIBlCvoQ.twitter #WCD2020

What do young Australian women want (when talking to doctors about contraception)? https://ncbi.nlm.nih.gov/pmc/articles/PMC5353872/ #WCD2020

Uptake of long‐acting, reversible contraception in three remote Aboriginal communities: a population‐based study https://www.mja.com.au/journal/2016/205/1/uptake-long-acting-reversible-contraception-three-remote-aboriginal-communities

Money and motivation: the obstacles behind male hormonal contraceptives https://sbs.com.au/news/the-feed/money-and-motivation-the-obstacles-behind-male-hormonal-contraceptives?cid=news:socialshare:twitter via @TheFeedSBS

Prevalence rates of sexual behaviors, condom use, and contraception among Australian heterosexual adolescents https://sciencedirect.com/science/article/pii/S1743609520308791 #WCD2020

The impact of COVID-19 on the reproductive health of people living in Australia: findings from an online survey https://medrxiv.org/content/10.1101/2020.08.10.20172163v1 #WCD2020

Contraception provision in the postpartum period: Knowledge, views and and practices of midwives https://sciencedirect.com/science/article/pii/S1871519220303115 #WCD2020

For further info on COVID-19 and Women’s SRH, check out the consensus statements from the Women’s Sexual and Reproductive Health COVID-19 Coalition here:

As I wind down this week of tweeting on World Contraception Day, I wanted to highlight @SPHERE_CRE which has produced fantastic research on all things contraception + access in Aus. https://spherecre.org

I can be found at @brennabernardin and at @ReproJusticeAus if anyone would like to stay in touch!

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