My Personal Journey from “Choose Life” to “Choose Control”

I am a pharmacy student at UCSD and if you would have told me one year ago that I would be spending my summer advocating for adolescent reproductive health I probably would have laughed.

My Conservative Background

You see, I was born and raised in the central valley in California, in a conservative community, in a conservative Christian home. I was raised to value human life, including the unborn. You could (and should) call me pro-life. However, during the winter quarter of my first year in pharmacy school, Dr. Sally Rafie, PharmD gave us a lecture about emergency contraception that really impacted me. She shared some staggering statistics. You see, in the United States over 50% of pregnancies are unplanned. Of those unplanned pregnancies, 40% are going to end in abortion. That’s about 20% of all pregnancies in the U.S. But it was her next comment that really struck me and got me interested in this topic, “if we are ever going to decrease the number of abortions, we have to decrease the number of unplanned pregnancies.” That was a lightbulb moment for me.

Courtney Light Bulb Birth Control Sally Rafie

Why I Care About Teens and Family Planning

This summer I have the privilege of doing a project with Dr. Rafie on pharmacists’ growing role in reproductive health services for adolescents. Teen pregnancy in the U.S. is at an all-time low of roughly 26 births per 1000 teens. Now this sounds like a pretty good statistic right?  Less than 3% of teens are actually having babies every year (of course even more are getting pregnant)!  Until you consider the fact that is one of the highest teen birth rates among developed countries and places like the Netherlands have only 5 births per 1000 teens. That means 5 times as many teens are having babies here in the United States. In the central valley where I grew up, our rates are well above the national average and some counties (like Tulare) nearly double it. Obviously what and how we are teaching our teens about and the access that they have to birth control services is not working.

Studies have repeatedly shown that increasing knowledge of and access to birth control methods and services does not increase the number of teens having sex or even how often or with how many people they have sex with. The only statistic that it affects is the number of teens having safe sex and the number of teen pregnancies and teen births. Studies have also revealed that abstinence-only education is ineffective in decreasing the number of teen pregnancies. When we as conservative Christians fight to implement abstinence-only educational programs in schools and limit teens’ access to information and birth control methods, we are contributing to the number of teen pregnancies, the number of abortions, and the number of teen parents and children in the foster system. That is not a statistic that I want to be a part of. Additionally, unless parents know for 100% sure that their child will be living a life of celibacy, family planning education will be valuable to them at some age even if they remain abstinent until marriage. It can also be helpful for teens to share information with their friends who could benefit from accurate knowledge about birth control.

What I’m Doing About It

A new law was passed in California that will allow pharmacists to provide hormonal birth control directly to patients in pharmacies regardless of age. My project this summer is focused on teen girls to see if this is a service that they are interested in and how pharmacies can serve them best. This project will be very important in helping pharmacists prepare to meet the needs of adolescents in their communities as this new program is rolled out.

If you have questions about any of the statistics I discussed or you just want to know more about my research please feel free to contact me. As you might have guessed, this is something that I feel very passionate about and I would love to discuss it with you more.

About the Author:  Courtney Miller just finished her first year of pharmacy school at the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences. She is from the central valley which has the highest rates of teen pregnancy in California so this topic is very close to her heart!

Don’t Blame Birth Control for Population Issues

With more women and men empowered to control their fertility with planning and birth control use, some populations are seeing drops in childbearing.  Some countries are concerned about population declines and are promoting childbearing.  The “baby bonus” programs of Australia and Singapore may ring a bell.

Iran, a country with a population of more than 75 million people, is experiencing a decline in its population.  Supreme leader Ayatollah Khamenei has called for more babies to strengthen national identity.  The ministry of health has offered to help couples pay for fertility treatment.  Now, Iran’s parliament has approved a bill that bans permanent birth control methods and advertising of birth control.  This ban outlaws vasectomies for men and similar procedures for women.  People utilizing these methods of birth control may face up to 5 years in jail.  This comes as a stark change to Iran’s existing family planning policies.

Traditionally, Iran society supported early marriage and parenthood.  As a result, fertility rates were high with 7 births per woman.  However, Iran has been experiencing declines in fertility since the 1960s due to progressive family planning programs and more recent improvements in education.  Iran’s birth rate is currently 1.6 children per woman.  At this rate, the population will slowly decrease and the average age will increase.

Book vs Nuts

If this policy is implemented, men would have no highly effective methods of birth control available to them.  Women would have the intrauterine devices and the subdermal implant available to them.  But the ability to undergo a quick sterilization procedure would be outlawed.  There are serious concerns that this policy could lead to more unsafe abortions. More than half of all abortions in Iran are done illegally since legal abortions are highly restricted and largely inaccessible.  With the lifetime abortion rate estimated to be 1 in 4 women in Iran, there are already too many unsafe procedures.

Others question whether forcing women into the domestic sphere roles may backfire.  Research from Harvard’s sociology department found that declining fertility may not be linked to birth control use, but rather to gender role stereotypes placed on women.  Other countries experiencing similar drops in birth rates are working to improve conditions so that couples want to plan to have children.  An example of improving conditions is more maternity and paternity leave.

The policy does not go into effect until a panel of theologians determine whether it complies with Islam.

We live in an interesting time where most populations are struggling to reduce unintended pregnancies but a few are now working to promote more pregnancies.


  1. Culp-Ressler T. “Iran Bans Some Forms of Birth Control to Encourage More Women to Have More Babies.” (11 Aug 2014) Available from:
  2. Saadat S, et al. Fertility decline in the Islamic Republic of Iran 1980-2006: a case study. 2010. Available from:
  3. Erfani A, McQuillan K. Rates of induced abortion in Iran: the roles of contraceptive use and religiosity. Stud Fam Plann 2008;39:111-22.
  4. Motaghi Z, et al. Induced abortion rate in Iran: a meta-analysis. Arch Iran Med 2013;16:594-8.

Why I Started Choose Control

Image from JakeandLindsay Sherbert via Flickr

Those of you who know me have probably heard me talk about sexual and reproductive health, particularly family planning.  You may be asking, “what exactly is family planning?”  Great question!  Family planning is planning if and/or when to start a family by having children.  You accomplish this by using birth control when you don’t want to have a child, for example.  People who have the opposite goal — to have a child — accomplish this by using preconception care and infertility treatments (however, this is not the focus of Choose Control).

My focus is to help women and men who do not want to start or expand their families right now with their family planning needs.  Seems simple.  But as a nation, we are doing a really bad job of family planning despite a lot of valiant efforts.  Ready to have your mind blown?  Over half of all pregnancies…51% to be exact…are unintended (i.e., mistimed or unwanted).  That’s about 3 million of the 6 million pregnancies in the United States each year.  I hope your mind has been blown by this one statistic (if not, I’ve got lots more where that came from or check out this fact sheet).

Now you’re beginning to understand my passion for this issue.

As a pharmacist specializing in family planning, I know some things worth sharing. Pharmacists have expertise on medications and my expertise is on birth control (i.e., contraception in medical lingo).  I’d like to keep you, my friends and followers, in the know with relevant information and news on research, public policy, and products.  I will make this interactive and fun too.

In closing, I hope you will find Choose Control’s content useful.  I look forward to your comments, suggestions, and questions!