This month’s featured editorial
Nurse practitioner education: keeping the academic pipeline open to meet family planning needs in the United States
Geraldine Bednash, Sandy Worthington, Susan Wysocki
According to the Centers for Disease Control and Prevention, family planning is one of the greatest public health achievements of the 20th century. Ample research shows that family planning helps women and men maintain reproductive health, allows women to avoid unintended pregnancies and assists families in determining the number, timing and spacing of their children — all of which contribute to the well-being of individuals, families and the broader society as well.
There are 66.4 million women in the United States of reproductive age (13–44 years). More than half (36.2 million) of these women are sexually active, not seeking pregnancies and in need of contraceptive services and supplies. Due primarily to poverty or young age, over 17.5 million of these women do not have insurance or financial resources and need publicly funded contraceptive care.
Nurse practitioners (NPs) provide the majority of family planning services in public health departments, community health centers and Planned Parenthood affiliates in the United States. For example, 75% of the 1780 clinicians employed nationally by Planned Parenthood affiliates are NPs.
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This month’s commentary
Fourteen million women with limited options: HIV/AIDS and highly effective reversible contraception in sub-Saharan Africa
Gretchen S. Stuart
pages 412-416
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Controversies in Reproductive Health
An evidence-based approach to hormonal contraception and headaches
Marissa Harris, Bliss Kaneshiro
pages 417-421
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Original research articles
The association between use of spermicides or male condoms and major structural birth defects
M. Shayne Gallaway, D. Kim Waller, Mark A. Canfield, Angela Scheuerle, the National Birth Defects Prevention Study
pages 422-429
Background: Women may become pregnant while using contraceptives. Commonly used contraceptives containing spermicides may or may not be associated with an increased occurrence of structural birth defects.
Conclusions: The increased occurrence of perimembranous ventricular septal defects among spermicide users may be real or may be a chance finding. Overall, the findings are consistent with those of most previous studies that observed no increased risk for birth defects among spermicide users.
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Extended regimens of the vaginal contraceptive ring: cycle control
Cristina Aparecida Falbo Guazzelli, Fernando Augusto Barreiros, Ricardo Barbosa, Fábio Fernando de Araújo, Antonio Fernandes Moron
pages 430-435
Background: Oral contraceptives used for extended periods of time have been extensively studied because of their potential benefits; however, there have been few publications on extended regimen of vaginal rings. The aim of this study was to compare the bleeding patterns of women using extended regimens of the vaginal ring or oral contraceptives.
Conclusion: Vaginal ring used on an extended regimen is a contraceptive method that offers good cycle control.
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Bleeding pattern and cycle control with an estradiol-based oral contraceptive: a seven-cycle, randomized comparative trial of estradiol valerate/dienogest and ethinyl estradiol/levonorgestrel
Hans-Joachim Ahrendt, Dagmar Makalová, Susanne Parke, Uwe Mellinger, Diana Mansour
pages 436-444
Background: This study compared the bleeding pattern, cycle control and safety of an oral contraceptive (OC) comprising estradiol valerate/dienogest (E2V/DNG; administered using a dynamic dosing regimen) with a monophasic OC containing ethinyl estradiol 20 mcg/levonorgestrel 100 mcg (EE/LNG). E2V releases estradiol (E2), which is identical to endogenously produced 17β-estradiol.
Conclusions: A novel OC composed of E2V/DNG is associated with an acceptable bleeding profile that is comparable to that of an EE-containing OC.
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Bleeding pattern with drospirenone 3 mg+ethinyl estradiol 20 mcg 24/4 combined oral contraceptive compared with desogestrel 150 mcg+ethinyl estradiol 20 mcg 21/7 combined oral contraceptive
Leena Anttila, Michael Kunz, Joachim Marr
pages 445-451
Background: The study was conducted to compare cycle control, bleeding pattern and efficacy of two low-dose combined oral contraceptives. Conclusion: Drsp 3 mg/EE 20 mcg 24/4 achieved an acceptable bleeding profile with reliable cycle control, comparable with an established formulation.
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Implanon users are less likely to be satisfied with their contraception after 6 months than IUD users
Renee C. Wong, Robin J. Bell, Kalyani Thunuguntla, Kathleen McNamee, Beverley Vollenhoven
pages 452-456
Background: The study was conducted to perform a direct comparison of the satisfaction of intrauterine device (IUD) users and Implanon users after 6 months.
Conclusions: IUD users reported a higher level of satisfaction than did Implanon users at 6 months. Side effects in women using IUDs and Implanon are common. The range of likely side effects should be included in counseling women about long-term reversible contraception.
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Insertion and 3-year follow-up experience of 372 etonogestrel subdermal contraceptive implants by family physicians in Granada, Spain
Lorenzo Arribas-Mir, Dolores Rueda-Lozano, María Agrela-Cardona, Tania Cedeño-Benavides, Carmen Olvera-Porcel, Aurora Bueno-Cavanillas
pages 457-462
Background: User profile, continuation rate, reasons for discontinuation, problems during insertion and removal, and effectiveness of an etonogestrel subdermal contraceptive implant (ESCI) were assessed.
Conclusions: Family physicians can achieve excellent results with the ESCI. It should be included in the range of contraceptives offered by primary care physicians.
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Contraceptive use by obese women 1 year postpartum
Jeanette R. Chin, Geeta K. Swamy, Truls Østbye, Lori A. Bastian
pages 463-468
Background: Obese women have higher rates of pregnancy complications, making the prevention of unintended pregnancies in this group of particular importance.
Conclusion: At 12 months postpartum, obese women were less likely to use effective contraceptive methods than overweight women. Although certain contraceptive methods may be preferred over others in this population, providers should reinforce the importance of effective contraception to avoid unintended pregnancies in obese women.
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Temporal and regional trends in IUD insertion: a population-based study in Ontario, Canada
Sheila Dunn, Geoffrey M. Anderson, Arlene S. Bierman, for the POWER Study
pages 469-473
Background: Intrauterine device (IUD) use is low in Canada and declined between 1985 and 1995. This study examines temporal and regional trends in IUD insertion in Ontario, Canada, from 1996 to 2006.
Conclusions: IUD insertion rates began to increase in 2001, the year of introduction of the levonorgestrel-releasing intrauterine system. Regional variation in rates suggests that access is not equal across the province and that strategies to support FPs to insert IUDs may be important to ensure adequate access.
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Contraceptive usage among Jamaican women with sickle cell disease
Jennifer Knight-Madden, Antoinette Barton-Gooden
pages 474-478
Background: The usage of contraceptive methods in young women with sickle cell disease (SCD) and the factors affecting usage are unknown.
Conclusions: This study demonstrates that 92% of these women with SCD were using contraceptive methods or had reason not to do so. Subjects had been educated about contraceptive methods and appeared to be uninfluenced by local myths regarding contraceptive usage.
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Efficacy, acceptability and safety of medication abortion in low-income, urban Latina women
Stephanie B. Teal, Tabetha Harken, Jeanelle Sheeder, Carolyn Westhoff
pages 479-483
Background: Health care providers may be reluctant to offer medication abortion to low-income, non-English-speaking populations. Concerns include lack of patient interest, incorrect use of misoprostol at home, missing mandatory follow-up visits and inappropriate use of emergency services. We describe the appeal, acceptability, safety and follow-up rates of medication abortion in a low-income Latina population in New York City.
Conclusion: Medication abortion can be a very appealing, safe and effective option in low-income, non-English-speaking populations.
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A randomized, double-blind, placebo-controlled safety and acceptability study of two Invisible Condom® formulations in women from Cameroon
Francois-Xavier Mbopi-Keou, Sylvie Trottier, Rabeea F. Omar, Ngoh N. Nkele, Séraphin Fokoua, Enow R. Mbu, Jean-Francois Giguere, Marc-Christian Domingo, Jocelyne Piret, Landry Tsague, Leopold Zekeng, Anthony Mwatha, Benoît Mâsse, Michel G. Bergeron
pages 484-492
Background: The objectives of this clinical trial were to evaluate the safety, tolerance and acceptability of two gel formulations of the Invisible Condom®: (i) the polymer alone and (ii) the polymer-containing sodium lauryl sulfate (SLS) compared to placebo when applied intravaginally with our unique applicator in sexually abstinent and active woman volunteers.
Conclusion: The Invisible Condom® formulations and applicator were found to be comfortable, well tolerated and acceptable when applied intravaginally once, twice or thrice daily for 14 days. Thus, expanded safety evaluation is warranted.
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Letters to the Editor
"On-demand" oral contraception
Elizabeth Raymond, Vera Halpern, Delphine Levy
page 493
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Abortion laws may compromise transparency and accountability
Dhrubajyoti Bhattacharya
pages 493-494
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