This month’s featured editorial
International Reproductive Health Still Worth The Investment
Suzanne Petroni, PhD, Wayne C. Shields
pages 491-494
The United States has been a global leader in the international population arena for nearly 50 years. United States investments in maternal, reproductive and sexual health programs have been a tremendous success, saving and improving many millions of lives. But many challenges remain, and the collective education and advocacy efforts of the sexual and reproductive health community can help overcome them. read more >
Review Articles
Provision of DMPA by community health workers: what the evidence shows
Shawn Malarcher, Olav Meirik, Elena Lebetkin, Iqbal Shah, Jeff Spieler, John Stanback
pages 495-503
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Alternatives to ultrasound for follow-up after medication abortion: a systematic review
Daniel Grossman, Kate Grindlay
pages 504-510
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Original research articles
Cervical preparation for surgical abortion between 12 and 18 weeks of gestation using vaginal misoprostol and Dilapan-S
Leah C. Wilson, Leslie A. Meyn, Mitchell D. Creinin
pages 511-516
Background: We investigated the safety and efficacy of using misoprostol and Dilapan-S™ hygroscopic cervical dilators to prepare the cervix for surgical abortion from 12 to 18 weeks of gestation in an outpatient office setting.
Conclusions: Early experience for same-day surgical abortion from 12 to 18 weeks of gestation in an outpatient setting using misoprostol and Dilapan-S for cervical preparation is positive in regard to efficacy and safety.
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Intrauterine device insertion after medical abortion
Sarah J. Betstadt, David K. Turok, Nathalie Kapp, Kui-Tzu Feng, Lynn Borgatta
pages 517-521
Background: Studies comparing immediate intrauterine device (IUD) insertion after first-trimester surgical abortion with interval insertion show similar efficacy and expulsion rates. However, women randomized to interval insertion of an IUD are less likely to return for device placement. An ideal time to insert intrauterine contraception may be the day a woman presents for verification of a completed medical abortion. We examined immediate insertion of IUDs after completed first-trimester medical abortion.
Conclusion: Intrauterine devices inserted at the time of completed, confirmed first-trimester medical abortion have low rates of expulsion.
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Immediate vs. delayed post-abortal copper T 380A IUD insertion in cases over 12 weeks of gestation
Miriam Cremer, Kimberley A. Bullard, Raegan McDonald Mosley, Christine Weiselberg, Michael Molaei, Veronica Lerner, Todd A. Alonzo
pages 522-527
Background: The intrauterine device (IUD) is a safe, effective, well-tolerated form of contraception. Immediate placement after second-trimester abortion could increase high-tier contraception use in women who are at high risk for unintended pregnancy.
Conclusions: Placing the IUD immediately after the procedure significantly increases the likelihood of use of effective contraception following a second-trimester procedure. Women who have an IUD placed immediately after their procedure may also be less likely to have a subsequent unplanned pregnancy.
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Women's out-of-pocket expenditures and dispensing patterns for oral contraceptive pills between 1996 and 2006
Su-Ying Liang, Daniel Grossman, Kathryn A. Phillips
pages 528-536
Background: Little is known about the out-of-pocket expenditures and dispensing patterns for oral contraceptive pills (OCPs), factors associated with these outcomes and whether they change over time.
Conclusion: Women paid a substantial amount out-of-pocket for OCPs and dispensing limits remained, although these improved over time. Better insurance coverage of contraception and policies targeting younger women and the uninsured in particular would help overcome barriers to OCP access.
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Financial effect of instituting Deficit Reduction Act documentation requirements in family planning clinics in Oregon
Maria Isabel Rodriguez, Lisa Angus, Emily Elman, Philip D. Darney, Aaron B. Caughey
pages 537-541
Background: The study was conducted to estimate the long-term costs for implementing citizenship documentation requirements in a Medicaid expansion program for family planning services in Oregon.
Conclusions: Screening for citizenship status in publicly funded family planning clinics leads to financial losses for the state and society.
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Discontinuation of oral contraceptives and depot medroxyprogesterone acetate among women with and without HIV in Uganda, Zimbabwe and Thailand
Kavita Nanda, Charles S. Morrison, Cynthia Kwok, Josaphat Byamugisha, LaShawn Jones, Somchai Sriplienchan, Thulani Magwali
pages 542-548
Background: We examined hormonal contraceptive (HC) discontinuation and factors associated with discontinuation among HIV-uninfected women and the effect of HIV diagnosis on subsequent contraceptive use.
Conclusion: Contraceptive continuation for OCs and DMPA was relatively high over 2 years. Young women, those reporting side effects, and those using condoms are more likely to discontinue and need ongoing contraceptive counseling. Many women receiving HIV-positive diagnoses desire effective contraception.
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Trends and correlates of hormonal contraceptive use among HIV-infected women in Rakai, Uganda, 1994–2006
Chelsea B. Polis, Ronald H. Gray, Tom Lutalo, Fred Nalugoda, Joseph Kagaayi, Godfrey Kigozi, Noah Kiwanuka, David Serwadda, Maria J. Wawer
pages 549-555
Background: Little is known about what factors correlate with hormonal contraceptive (HC) use in HIV-infected women in sub-Saharan Africa.
Conclusions: Although contraceptive use by HIV-infected women has increased three-fold in this rural population, unintended pregnancies persist, placing women and their children at risk of adverse consequences.
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Contraception use and effectiveness among women in a trial of the diaphragm for HIV prevention
Kelly Blanchard, Alan Bostrom, Elizabeth Montgomery, Ariane van der Straten, Naomi Lince, Guy de Bruyn, Dan Grossman, Tsungai Chipato, Gita Ramjee, Nancy Padian
pages 556-563
Background: There is little data on contraceptive effectiveness or use patterns from sub-Saharan Africa.
Conclusions: Long-acting methods of contraception should be made available in HIV prevention trials and to women in Southern Africa.
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Low-dose combined oral contraceptive and cervicovaginal shedding of human immunodeficiency virus
Marianna Roccio, Barbara Gardella, Renato Maserati, Francesca Zara, Daniela Iacobone, Arsenio Spinillo
pages 564-570
Background: Previous studies indicate that the sexual beliefs and mores of students in medical professions may influence their capacity to care for patients' sexuality and contraception issues. Students also represent a large sample of reproductive-age individuals. In this study, we examined contraceptive usage patterns in North American medical students.
Conclusions There are significant differences in contraceptive use based on demographics, even at the highest education levels. The personal contraception choices of medical students may influence their ability to accurately convey information about contraception to their patients. In addition, medical students may personally benefit from improved knowledge of effective contraceptive practices.
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Evaluation of estrogenic receptors in the nasal mucosa of women taking oral contraceptives
Ieda Millas, Bianca Maria Liquidato, Hudson de Sousa Buck, Mirna Duarte Barros, Roberto Antonio Pinto Paes, José Eduardo Lutaif Dolci
pages 571-577
Background: There is evidence that the nasal mucosa is affected by estrogen influence. Some authors have already detected estrogen receptors (ER) in the nasal mucosa. However, there doesn't seem to be a consensus about the concentration and distribution of the ER or the possible influence of hormonal contraceptives in the nasal mucosa.
Conclusions: Women who took oral contraceptives showed a decrease of beta-receptors in some cells of the lamina propria. These findings show us the possibility of effects of contraceptive pills on the cells such as fibroblasts, mast cells, plasmocytes, and other inflammatory cells.
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Comparison of uterine artery blood flow with levonorgestrel intrauterine system and copper intrauterine device
Berna Haliloglu, Aygen Celik, Erdin Ilter, Serpil Bozkurt, Umit Ozekici
pages 578-581
Background: As a contraceptive method, we investigated whether the levonorgestrel-releasing intrauterine system (LNG-IUS) has any effect on uterine artery blood flow when compared with copper intrauterine device (IUD).
Conclusion: The significant increase in uterine artery RI in LNG-IUS users 1 year after insertion might be due to its local progestational effects. It might also indicate the mechanism of the LNG-IUS in reducing menstrual blood flow.
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Serum anti-müllerian hormone level is not altered in women using hormonal contraceptives
Hang Wun Raymond Li, Ching Yin Grace Wong, William Shu Biu Yeung, Pak Chung Ho, Ernest Hung Yu Ng
pages 582-585
Background: Anti-müllerian hormone (AMH) is secreted from granulosa cells of antral follicles into the circulation of adult women and hence could serve as an ovarian function test. This would be of value to hormonal contraceptive users if its serum level is unaffected by the use of hormonal contraceptives.
Conclusion: Being unaffected by hormonal contraceptives, serum AMH measurement is potentially a useful clinical test in hormonal contraceptive users for the differential diagnosis of anovulatory disorders and determination of menopause.
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