This month’s featured editorials
Medical Students for Choice: Creating Tomorrow's Abortion Providers
Megan L. Evans, Lois V. Backus
pages 391-393
In the spring of 1993, tens of thousands of US medical students received an offensive pamphlet in their mailboxes with the following “joke”: “Q: What would you do if you were in a room with Hitler, Mussolini and an abortionist and you had a gun with only two bullets? A: Shoot the abortionist twice.” Ironically, this mailing was the single most influential factor leading to the creation of Medical Students for Choice (MSFC). At the time, there were few residencies training their residents to provide abortions and even fever medical schools educating their students on comprehensive women's reproductive health care. Additionally, abortion providers were on the decline, and fewer women had access to comprehensive reproductive health care. read more >
Controversies in Family Planning: Are All Oral Contraceptive Formulations Created Equal?
Stephanie P. Sober, Courtney A. Schreiber
pages 394-396
Over 75 million women worldwide utilize oral contraceptive pills (OCPs) for contraception. In the United States, over 80% of women born after 1945 have used OCPs at some time in their lives. Thus, OCPs are one of the most commonly prescribed medications and are, in fact, the most extensively studied medications in the history of medicine. And yet, misconceptions about OCPs are common among patients as well as providers. The 50th anniversary of the OCP's approval by the US Food and Drug Administration (FDA) provides an opportune time for clarifying one common misconception surrounding this well-utilized and effective contraceptive method — are generic OCPs as effective as their brand-name counterparts? read more >
Review Articles
Contraceptive failure in the United States
James Trussell
pages 397-404
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New strategies for providing hormonal contraception in developing countries
John W. Townsend, Regine Sitruk-Ware, Katherine Williams, Ian Askew, Klaus Brill
pages 405-409
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Original research articles
Comparing two early medical abortion regimens: mifepristone+misoprostol vs. misoprostol alone
Nguyen Thi Nhu Ngoc, Jennifer Blum, Sheila Raghavan, Nguyen Thi Bach Nga, Rasha Dabash, Ayisha Diop, Beverly Winikoff
pages 410-417
Background: Nonsurgical abortion methods have the potential to improve access to high-quality abortion care. Until recently, availability and utilization of mifepristone medical abortion in low-resource countries were restricted due to the limited availability and perceived high cost of mifepristone, leading some providers and policymakers to support use of misoprostol-only regimens. Yet, this may not be desirable if misoprostol-only regimens are considerably less effective and ultimately more costly for health care systems. This study sought to document the differences in efficacy between two nonsurgical abortion regimens.
Conclusions: Mifepristone+misoprostol is significantly more effective than use of misoprostol-alone for early medical abortion. The number of ongoing pregnancies documented with misoprostol-only warranted an early end of the trial after unblinding of the study at interim analysis. Policymakers should advocate for greater access to mifepristone. Future research should prioritize misoprostol-only regimens with shorter dosing intervals.
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Antibiotics and oral contraceptive failure — a case-crossover study
Sengwee Toh, Allen A. Mitchell, Marlene Anderka, Lolkje T.W. de Jong-van den Berg, Sonia Hernández-Díaz, National Birth Defects Prevention Study
pages 418-425
Background: Evidence on the association between antibiotic use and combined oral contraceptive (COC) failure is controversial. We examined the effect of concomitant antibiotic treatment on the risk of breakthrough pregnancy among COC users.
Conclusion: We did not find an association between concomitant antibiotic use and the risk of breakthrough pregnancy among COC users. However, due to limited power and potential carryover effects, findings from this study cannot rule out an elevated risk of COC failure among antibiotic users.
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Bleeding related to etonogestrel subdermal implant in a US population
Petra M. Casey, Margaret E. Long, Mary L. Marnach, Jessica E. Bury
pages 426-430
Background: The etonogestrel subdermal implant received US Food and Drug Administration approval in 2006. Menstrual changes represent a common reason why recipients of this implant request early implant removal.
Conclusions: Age, race, BMI, parity, prior contraception method, and postpartum and breastfeeding status did not predict bleeding or removal for bleeding risk. Removal rates were higher for amenorrhea, occasional spotting or bleeding, and regular menses than for prolonged or continuous bleeding.
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Blood loss at the time of first-trimester surgical abortion in anticoagulated women
Bliss Kaneshiro, Paula Bednarek, Michelle Isley, Jeffrey Jensen, Mark Nichols, Alison Edelman
pages 431-435
Background: The objective of this study was to compare blood loss resulting from surgical termination of pregnancy up to 12 weeks of gestation between women receiving anticoagulation therapy and healthy controls.
Conclusion: Anticoagulated women appear to have an increase in blood loss during and immediately following first trimester surgical abortion as compared to healthy controls. However, this increase does not appear to be clinically significant.
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Predictors of pregnancy in microbicide trials
Vera Halpern, Che-Chin Lie, Paul Feldblum, Lut Van Damme, Microbicide Research Group
pages 436-440
Background: High pregnancy rates undermine the conduct and interpretation of HIV prevention trials. We performed this analysis to identify baseline participant characteristics associated with increased risk of pregnancy in recent vaginal microbicide trials.
Conclusions: Our data suggest that current use or acceptance of intrauterine contraception, implants, sterilization or injectables is the most effective approach to reduce pregnancy rates and might be a useful eligibility criterion in future HIV prevention trials.
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A survey of women obtaining emergency contraception: are they interested in using the copper IUD?
David K. Turok, Shawn E. Gurtcheff, Erin Handley, Sara E. Simonsen, Christina Sok, Riana North, Caren Frost, Patricia A. Murphy
pages 441-446
Background: This study aims to determine if women presenting for emergency contraception (EC) at family planning clinics may be interested in using the copper intrauterine device (IUD) for EC.
Conclusion: While one third of EC users surveyed at family planning clinics were interested in a long-term, highly effective method of contraception, only a small portion of all EC users may be interested in the copper IUD for EC. Cost is a potential barrier.
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Dedicated providers of long-acting reversible contraception: new approach in Zambia
Josselyn Neukom, Jully Chilambwe, Joseph Mkandawire, Reuben Kamoto Mbewe, David Hubacher
pages 447-452
Background: Long-acting reversible contraception (LARC) is underused in many countries in sub-Saharan Africa. Many previous attempts to increase uptake of this important class of contraception have not been successful.
Conclusions: By having the necessary time, skills and materials — as well as a mandate to both generate informed demand and provide quality services — dedicated providers of LARC can expand contraceptive choice. This new approach shows what can be achieved in a short period and in a region of the world where uptake of LARC is limited.
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Breaking the barrier: the Health Belief Model and patient perceptions regarding contraception
Wendy Brown, Anne Ottney, Sammie Nguyen
pages 453-458
Background: The study was conducted to determine the discrepancy between unintended pregnancies and use of contraception is attributed to imperfect use, misconceptions and an inability to adjust therapy to lifestyle.
Conclusions: A positive correlation between perceived benefit regarding ease of use as educational level increased and perceived barriers due to side effects as income level decreased immerged. Special counseling by practitioners to improve patient's self-efficacy, ultimately enhancing contraceptive adherence, are warranted
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Contraceptive usage patterns in North American medical students
Tami S. Rowen, James F. Smith, Michael L. Eisenberg, Benjamin N. Breyer, Eleanor A. Drey, Alan W. Shindel
pages 459-465
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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Reddy female condom: functional performance of a 90-mm shaft length in two clinical studies
Christine Mauck, Smita Joshi, Jill Schwartz, Marianne Callahan, Terri Walsh
pages 466-471
Background: We report on the functional performance, safety and acceptability of the 90-mm Reddy female condom in two clinical trials, one in Los Angeles, CA, and one in Pune, Maharashtra, India.
Conclusions: Two clinical studies of the 90-mm Reddy female condom suggest that its functional performance is inferior to other female condoms.
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Determinants of intrauterine contraception provision among US family physicians: a national survey of knowledge, attitudes and practice
Susan E. Rubin, Jason Fletcher, Tara Stein, Penina Segall-Gutierrez, Marji Gold
pages 472-478
Background: Poor contraception adherence contributes to unintended pregnancy. Intrauterine contraception (IUC) is user-independent thus adherence is not an issue, yet few US women use IUC. We compared family physicians (FPs) who do and do not insert IUC in order to ascertain determinants of inserting IUC.
Conclusion: US FPs have training and knowledge gaps, as well as attitudes, that result in missed opportunities to discuss and provide IUC for all eligible patients.
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Comparison of contraceptive use between the Contraceptive CHOICE Project and state and national data
Nupur D. Kittur, Gina M. Secura, Jeffrey F. Peipert, Tessa Madden, Lawrence B. Finer, Jenifer E. Allsworth
pages 479-485
Background: We compared contraceptive prevalence reported in the Contraceptive CHOICE Project (CHOICE) at time of enrollment with estimates from representative surveys, the 2006–2008 National Survey of Family Growth (NSFG) and 2006 Missouri Behavioral Risk Factor Surveillance System (BRFSS).
Conclusion: Despite differences in sampling strategies between CHOICE and state and national surveys, the contraceptive prevalence estimates were largely similar. This information combined with the high rates of long-acting reversible contraception (LARC) use after enrollment by CHOICE particiants that have been previously reported by study participants may imply that cost and restricted access to LARC could be essential factors in the low rates of LARC use in the United States.
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Provider determinants of emergency contraceptive counseling and provision in Kenya and Ethiopia
Shana Judge, Amber Peterman, Jill Keesbury
pages 486-490
Background: In a majority of sub-Saharan African countries, counseling and provision of emergency contraception (EC) lag behind that of developed countries. As policymakers expand EC programs in the region, an understanding of provider knowledge and bias regarding EC is critical.
Conclusion: Training on EC can increase provider knowledge and lower bias, leading to improved access for clients.
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