Better Statistics: Connecting the Community to Research

Abstract 

The department of Homeland Security is mandated by the Constitution to safeguard the lives and properties of Americans. Therefore, the Department works by adopting contingency measures to buffer harm that could otherwise result from terrorist acts or caused human error and natural disasters. Notably, the Affordable Act provided for the inclusion of citizens with low income and limited resources in the enrollment of Medicaid Health insurance cover. Medicaid allows women of reproductive age to receive birth control services, of their choosing and at their convenience. Providentially, Homeland Security could capitalize on the realization that the process initiated through the enactment of the Affordable Act supplied rich information that could be sorted to reveal insightful trends. Accordingly, this study submits a proposal to Homeland Security to enforce mandatory follow-ups every 6 months for women with a full birth control cover. Hopefully, the process will yield information that will enable the department to deliberate on key concerns that impact women's reproductive health in the country. In recommendation, the study recommends for full partnership and total cooperation from all key stakeholders. 

Keyword : homeland security, health, Medicaid, reproductive health, birth control 

Better Statistics 

This document is a proposal to the Department of Homeland Security to be implemented in the health sector allowing for mandatory follow-ups by Medicaid, to women with full coverage for birth control. A working hypothesis for the foregoing recommendation will lead to a better understanding of the impacts of reliance on contraceptives for family planning. Ultimately, the findings will influence the best course of action, through recommendations to all parties on the precautions to undertake when exercising their rights and freedom. 

Background of the Study 

There is a myriad of options for family planning for women, including hormonal and non-hormonal, but there are many variables that come into play when deciding which route to take. The only types of birth control men use are either a condom or abstinence, that is why this doesn’t really affect them. There are no hormones entering their body. On the other hand, there are about a dozens of different types of birth control and several different ways they can enter the woman’s body. Planned parenthood has all the different types of birth control listed on their website. A couple that are out there are the implant—which goes on your arm (Nexplanon), and the Intrauterine Device—it is placed in the women’s uterus, these two don’t have to be changed until about 2 years or more. There are others that are more high maintenance, for example, the pill, the vaginal ring, patch, internal condom, and many more. All these different types of birth control either have estrogen and progestin (female hormones), are progestin only. or they contain no hormones at all. The side effects vary for each one and for each woman. 

The use of contraceptives is widespread as global statistics reveal that about 1.1 billion Women of the Reproductive Age group need family planning, representing about 60 percent of women of the reproductive age group in the world ( Böttcher et al., 2012 ). Notably, about 842 million women in the world are using contraceptive methods, whereas about 270 million others have unmet needs for contraception (WHO, 2020). Data published by the CDC on current contraceptive status among women in America, aged 15-49 for 2015 to 2017 shows a significant increase in the number of women currently using contraception. In particular, about 72 million women in America, accounting for about 65 percent of women aged 15-49 are using contraception that range from oral contraceptives pills to female sterilization, long-acting reversible contraceptives (LARCs), and male condoms. However, a majority, about 90 percent of women using contraception in America opt for procedures that involve scientific alteration of hormones that control fertility ( Böttcher et al., 2012 ). Unfortunately, numerous studies associate the use of hormones with hormonal imbalances, characterized by negative physical, emotional, and mental conditions. WHO (2020) summarizes the negative effects of birth control pills, noting that they cause nausea, intermenstrual spotting, breast tenderness, weight gain, missed periods, mood changes, vaginal discharge, decreased libido, and vision problems, to list but few. 

In addition to the common side effects caused by contraceptives that alter hormones in the body to prevent pregnancy, birth control pills also render one vulnerable to long-term health problems. An empirical study conducted by Wigginton et al. (2016) underscores that women with a history of prolonged exposure to contraceptives are at risk of contracting cancer, suffering from cardiovascular arrest, and developing equally-fatal noncancerous ovarian cysts. Additionally, the use of birth control pills results in mood swings, which can metamorphose to clinical depression- accompanied by suicidal tendencies. For instance, a Canadian-based study posted in the American Journal of Psychiatry supposes that 95 percent of women with a history of contraceptives’ use have a relatively high risk of committing suicide, with a 24 percent success rate ( Skovlund et al., 2018 ). The study took 13 years to complete and featured over a million women both on hormonal and nonhormonal birth control showing tendencies of depressive behavior. A total of 71 suicides were recorded before the completion of the study. Simply put, the study accepts the hypothesis that contraceptives will cause 12 additional suicides to the 1400 plus cases already established for each year, among a million mentally healthy women. The foregoing realization highlights the severity of using birth control pills, necessitating for measures to mitigate the impending threats following exposure to hormonal-based contraceptives, hence the need for facilitation of full coverage for birth control through Medicaid with guaranteed follow-ups every 6 months to learn about developing dynamics. 

Medicaid and Medicare 

Eligibility and Birth Control Cover for Women 

Medicaid and Medicare represent two distinct programs run by the government in the U.S., enjoying autonomy and operated by different parts of the government. Notably, Medicare and Medicaid serve different groups, as the former provides health coverage for seniors above 65 years and individuals with disabilities of all ages regardless of one’s income, whereas the latter provides health coverage for citizens with relatively low income ( Piatak, 2017 ). The terms of the 2010 Affordable Act apply to health insurance plans that are otherwise not “grandfathered” ( Piatak, 2017, p. 1168 ). Also, Piatak highlights that short-term health plans for 12 months or less do not provide free birth control, whereas some private employers object to offering birth control cover for religious or personal selfish reasons. Fortunately, Medicaid programs cover family planning and offer several birth control methods, even to citizens not eligible for Medicaid and those with low income. However, the plan secured by the Affordable Act is limited to ten procedures including birth control patch, ring, pills, and shots, diaphragm, cervical cap, IUD, emergency contraception, and permanent contraception methods ( Piatak, 2017 ). Medicaid birth control cover only protects women, making it easier for the government to track patterns and forms of usage. The data drawn from such an experience will inform the department of Homeland Security on better approaches to deploy when mitigating the health risks posed to American women using contraceptives. Therefore, Medicaid should follow through Homeland Security’s recommendation of effecting mandatory follow-up after every six months to monitor progress and discover new patterns that require action. 

Statistics and Facts 

Mikulic (2020) confirms Medicaid as the largest source of medical and health-related services in the country, especially for Americans with low income and limited resources. Accordingly, Medicaid accounts for a significant percentage of U.S. health care spending. Empirical evidence suggests that only 17 percent of the American population has an active enrollment with Medicaid (Milkulic, 2020). Additional evidence by Statista depicts that 21 percent of women in the country have insurance coverage through Medicaid, representing over 200 million women in the country (Milkulic, 2020). Demographically, the American women of African descent represent a majority with 23 percent representation, Latinas account for 11 percent, followed closely by the White with a 7 percent representation (Milikulic, 2020). The foregoing evidence suggests that the government can learn more from women’s reproductive health, based on factual data, to inform implementations of strategies that align with the needs to be achieved. By allowing for mandatory follow-ups after every six months for women with full birth control cover, the health department of Homeland Security will be able to monitor the patterns and forms of contraceptive use by women and resultant development. 

Important Patterns for Observation by the Department of Homeland 

Homeland Security strives to safeguard the lives of Americans and properties within the Homeland and therefore mitigate against threats that could frustrate its efforts to protect Americans. Remarkably, Homeland Security applies Strategic Risk Management tools in identifying, assessing, and deterring threats, as well as, in managing consequences realized after a failed/missed opportunity to thwart threat (Schanczer et al., 2009). Consequently, Homeland Security monitors systems that inform their decision when implementing strategies to safeguard the nation’s critical infrastructure. Critical assets and infrastructure describe items and aspects that the government considers critical that their incapacitation could immobilize the country rendering it defenseless against possible attacks (Battaglia et al., 2019). Therefore, critical assets support the continuity of the country by ensuring that all systems remain active and reactive to current trends and patterns. The department of homeland security, through the health sector, need to understand health systems and patterns to identify appropriate and effective strategies that could be used as intervention measures to further motivate improved health care conditions. 

The Health Sector in response to the Presidential Policy Directive 21 (PPD-21) assesses important infrastructure that supports the health system to identify possible channels for threats. Therefore, the Department of Homeland Security is keen to monitor critical aspects of health care that include prevalent diseases, causes, and management strategies, and patterns to inform on developmental progress such as birth rate, mortality rate, and aspects influence overall life expectancies in the country (Battaglia et al., 2019). Information drawn from such efforts allow the department to protect the country against threats that could deteriorate health standards in the country. The health sector can, therefore, evaluate the country’s family planning programs to understand aspects that affect reproductive health in the country. 

It is irrefutable that family planning has undergone major developments over the past half-century and issues of fertility and reproductive health should inform the policies that need to be enacted to enhance continuity. Whereas global fertility rates seem to be on the decline, further insights on the impacts of interactions with birth control pills can be drawn through calculated observation of patterns and trends of women ( Stadler et al., 2019 ). Particularly, the government can learn about family planning, important aspects of adolescent sexual and reproductive health, unsafe abortions, and the impacts of contraceptives on the overall health of women in the country. The mandatory regular follow-up by Medicaid for women with full birth control cover will supply the information needed to enact policies that guarantee improved results. 

The Rationale of Family Planning and Homeland Security’s Role in Influencing Change 

It is established that family planning offers a range of potential benefits to individuals and the nation on important aspects that encompass economic and social development, maternal and child health, and general concerns that address aspects of women’s empowerment ( Kavanaugh & Jerman, 2018 ). Additionally, the United Nations estimates that families can save up to $2 from expenditures on voluntary family planning by, accessing other affordable services such as education, sanitation, and immunizations ( Kavanaugh & Jerman, 2018 ). A better understanding of the demographic aspects of women’s reproductive health will also inform the government on strategies to adopt to ensure equality and equitable access of services by women from all ethnicities, regardless of their income ( Kavanaugh & Jerman, 2018 ). Most importantly, the initiative by the government would lead to overall improved conditions for both mother and child health, enhanced through the informed use of contraception (Ahmed et al. 2012). Notwithstanding, the department will have access to data that will influence their actions when managing the risks associated with the use of contraception. Prolonged use of contraceptives is associated with mental instability and poses a direct threat to the life of the majority of women in the country, given their susceptibility to suicidal tendencies. 

Depression is a mood disorder associated with a persistent feeling of sadness, aloofness, and general loss of interest. Without disregarding the other side effects caused by the contraception, women on birth control pills are at a high risk of developing depression, caused by the hormone imbalance in the body ( Smith et al., 2018 ). An article published by the U.S National Library of Medicine National Institutes of Health links altered mood swings to large dosages of synthetic estrogens and progestogens (Smith et al., 2018). Evidence followed experiments that were conducted in Denmark and documented in the American Psychology Journal involving the periodic injection of hormones to observe effects on mood. The findings of the study concurred in fact with the assertions of the U.S. Department of Health & Human Services, that categorizes women on contraception as potentially volatile and unstable (Smith et al., 2018). It is, therefore, safe to posit that women on contraception are at a high risk of committing suicide, as foregoing evidence suggests. Equally, opposing studies preclude the severity of suicide tendencies among women on contraception, necessitating a thorough examination of available data to inform the best course of action. 

A study conducted by Royal College of General Practitioners in 2010 featuring American women with a mean age of 40 with a prolonged history of birth control pills uses, revealing a higher mortality rate among those with a history ( Skovlund et al., 2018 ). Unfortunately, the study did not outline the motivation behind the increased suicide rate. Therefore, further research should be commissioned to supply information on the realized suicidal tendencies among women on contraceptives. 

Numerous empirical studies focus on suicides linked to prolonged use of birth control and associated vulnerabilities to depression. Nonetheless, several studies explain how women using contraceptives become depressed and opt for suicide. According to, an article written by Annette McDermott the studies over 12 million women suffer from depression each year ( Stadler et al., 2019 ). The rate of infection is quite alarming and begs for questions regarding the role of contraception in causing depression and suicides. In a study that was completed in 2010, after about 20 years of observation examining the lives of 20,000 adolescents on contraception reveal four interesting patterns. The first two patterns are resultant of the initial years of the study between 1994 and 2003. Even though the initial number of participants dropped to 6,654, men were eliminated from the study, together with those that were sexually inactive and already pregnant. The groups were then clustered into 2 classes featuring those using hormonal contraception, non-hormonal contraception, and no contraception. Additionally, the subject for observation was divided into two more groups to include those that used progesterone and progesterone free contraception. Additional important matters considered by the researchers of these two studies include external factors such as levels of education, participants’ race, age, number of sex partners, any sports, history of depression, smokers/nonsmokers and even religion ( Skovlund et al., 2018 ). Assumedly, all of these factors could have been the cause of depression qualifying them as an important subject of study. Unlike with the Denmark study, other studies highlight the benefits of using birth control, further qualifying the validity of the suggestion made to allow for mandatory follow-ups on women with full birth control cover. it shows that there might not be a link between birth control and suicide rates. 

Researchers link the use of birth control pills to depression basing on the biological mechanisms. For oral contraceptives only it has been shown that there are reduced levels of serotonin and norepinephrine, which depression is associated with low levels of these exact hormones. Also not only do they reduce those hormones, but they change folate and B12 levels which have also been linked to depression, especially when they get too low. Since depression is the only link that there is according to the research, focusing on things that birth control has that causes depression is very important. Although as mentioned previously the evidence is contradicting in this same study, they mention that “The estrogens in oral contraceptives increase tryptophan available for the brain to convert to serotonin and tryptamine.” ( Skovlund et al., 2018, p. 18 ). Notwithstanding, there is enough evidence to support that government intervention could address the issues already outlined in the study. 

The Effectiveness of Governmental Intervention in Managing Deaths Associated with Birth Control Use 

Boonstra’s (2008), evaluation of the impact of government programs on reproductive health disparities, chronicles interesting facts that should provide the ministry with a benchmark value on the need to adopt the proposed strategy. Despite the enactment of the Affordable Act, contradicting evidence suggests a decrease in the use of contraceptives among women of reproductive age ( Böttcher et al., 2012 ). Unfortunately, the newest data explains the increased levels of unwanted pregnancies, as well as, the recent government position on safe abortions. The effort to legalize abortion was a necessary move to curb the increasing number of deaths resulting from unsafe abortions. Also, issues of racism and disfranchisement were already propping up, disadvantaging the minority groups with whom the act was considered criminal. 

The enactment of the Pregnancy Discrimination Act of 1978 mandates employers with the obligation of providing their expectant employees with health plans to cover pregnancy-related care. The Medicaid eligibility expansion transformed the provisions to govern pregnancy-related care ( Piatak, 2017 ). Currently, 44 states and the District of Columbia underscore the minimum requirements for enrollment of pregnant women under Medicaid to include those with low earning and limited resources. Notably, this development was realized following a similar undertaking as proposed herein involving the health sector and health care providers ( Piatak, 2017 ). Therefore, the proposed strategy that full birth control coverage through Medicaid ought to be complemented with mandatory follow-ups every six months will allow the government to understand where much efforts ought to be directed and will equally influence the Homeland security in safeguarding American live. 

Conclusion and Recommendations 

In summary, the Department of Homeland Security works together with the Federal Health Sector, together with other governmental and non-governmental organizations to safeguard the lives of Americans and crucial assets that enhance continuity of the health systems. Consequently, the Department of Homeland Security through the health sector should adopt measures to analyze infrastructure for possible vulnerabilities, upon which appropriate preventive measures can be made. Additionally, the Department of Homeland Security aids other sectors in preparing for and responding to health-related emergencies, to minimize the consequences, should threats materialize. Finally, the agency conducts its operations in collaboration with a team of diverse players to ensure that the security levels of the country are heightened and that the health sector enjoys resilience, as threats can be easily identified and appropriate strategies employed to manage the consequences. The use of strategic risk management by the Department of Homeland Security should allow for heightened security in the country. Therefore, the Department of Homeland Security should continue to cooperate with the state, territorial, local, tribal, non-governmental, and private sectors, as cohesion will allow for a better understanding of threats that may be facing the country. Finally, the application of strategic risk management at the tactical, operational, and strategic levels by the DHS is commendable, as it provides opportunities for cross-agency deliberation on priorities, eventually combatting security threats in the country. Additionally, the agency should continue evaluating the cost of security to illuminate further the need for heightened awareness on the issues of individual policing on matters of health. Correspondingly, resources, and appropriate arrangements should be made to facilitate the implementation of the proposed programs. 

Recommendations 

The recommendations outlined with this paper are based on the findings of the study and are meant to help the government increase awareness of the potential benefit of birth control use, as well as, the possible disadvantages- to further shed light on the need for regular monitoring of trends and patterns that influence patterns and forms of contraception use among American women. Therefore, the following recommendations suffice: 

The Department of Homeland Security should enhance cohesiveness and collaboration of its 16 sectors to enhance performance and address issues that threaten the security of Americans and their properties. 

Women should be involved at all levels when examined and informed of the potential consequence of their involvement in the program, to further win their trust and encourage them to share more. 

An approach to facilitate mandatory follow-ups on patients with full birth control coverage should be welcome to further understand the nature and forms of reproductive health in America. 

References 

Battaglia, T. A., Pamphile, J., Bak, S., Spencer, N., & Gunn, C. (2019). Connecting the community to research: A training program to increase community engagement in research. Progress in Community Health Partnerships: Research, Education, and Action , 13 (2), 209. 

Böttcher, B., Radenbach, K., Wildt, L., & Hinney, B. (2012). Hormonal contraception and depression: a survey of the present state of knowledge.  Archives of Gynecology and Obstetrics ,  286 (1), 231-236. https://doi.org/10.1007/s00404-012-2298-2/. 

Boonstra, H. D. (2008, August 6). The impact of government programs on reproductive health disparities: Three case studies . https://www.guttmacher.org/gpr/2008/08/impact-government-programs-reproductive-health-disparities-three-case-studies#. 

Kavanaugh, M. L., & Jerman, J. (2018). Contraceptive method use in the United States: Trends and characteristics between 2008, 2012, and 2014.  Contraception ,  97 (1), 14-21. https://dx.doi.org/10.1016%2Fj.contraception.2017.10.003 

Mikulic, M. (2020, May 4). Medicaid- statistics & facts . https://www.statista.com/topics/1091/medicaid/. 

Piatak, J. S. (2017). Understanding the implementation of Medicaid and Medicare: Social construction and historical context.  Administration & Society ,  49 (8), 1165-1190. https://journals.sagepub.com/doi/abs/10.1177/0095399715581030. 

Schanczer, D. H., Eyerman, J., & Dirugue, V. (2009). Strategic risk management in government: A look at Homeland Security . http://www.businessofgovernment.org/sites/default/files/StrategicRiskManagement_0.pdf 

Skovlund, C. W., Mørch, L. S., Kessing, L. V., Lange, T., & Lidegaard, Ø. (2018). Association of hormonal contraception with suicide attempts and suicides.  American Journal of Psychiatry ,  175 (4), 336-342. doi/10.1176/appi.ajp.2017.17060616. 

Smith, K., Nayyar, S., Rana, T., Archibong, A. E., Looney, K. R., & Nayyar, T. (2018). Do progestin-only contraceptives contribute to the risk of developing depression as implied by beta-arrestin 1 levels in leukocytes? A pilot study.  International Journal of Environmental Research and Public Health ,  15 (9), 1966. 

Stadler, A., Weidlinger, S., & Stute, P. (2019). Impact of endogenous and exogenous progesterone exposure on stress biomarkers: A systematic review.  Climacteric ,  22 (5), 435-441. 

Wigginton, B., Harris, M. L., Loxton, D., & Lucke, J. C. (2016). A qualitative analysis of women's explanations for changing contraception: the importance of non-contraceptive effects.  Journal of Family Planning and Reproductive Health Care ,  42 (4), 256-262. Retrieved from https://srh.bmj.com/content/42/4/256?papetoc=. 

WHO. (2020, January 3). Family planning/contraception methods . https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception.