Statement to Office of Research on Women’s Health & National Institute of Health

September 21, 2009
Providence, RI

ORWH/NIH/DHHS, and the Northwestern University, Feinberg School of Medicine, and Northwestern Memorial Hospital co-hosted the fourth in a series of four public hearings and scientific workshops to update the Women’s Health Research Agenda at the NIH for the coming decade.

Good afternoon. My name is Dr. Rebecca Allen. I am a member of the Association of Reproductive Health Professionals (ARHP) and serve as assistant professor of Obstetrics and Gynecology at the Warren Alpert Medical School at Brown University. I also work here at Women and Infants’ Hospital in the Division of Ambulatory Care. I am presenting comments on behalf of ARHP.

ARHP was founded in 1963, and is a multidisciplinary professional association with over 12,000 reproductive health professional members who provide direct services, conduct reproductive research, and influence public policy. ARHP is offering comments today because we value evidence-based science and serve as a trusted resource for reproductive and sexual health education and information. We meet our educational mission through a variety of educational programs, meetings, publications, and web-based activities. Through professional education, ARHP helps translate cutting-edge science for reproductive health care providers to improve patient care.

On behalf of ARHP and its members, I thank the Office of Research on Women’s Health and the National Institute of Health for holding these meetings on new dimensions and strategies for women’s health research, and for the opportunity to offer comments this afternoon.

ARHP would like to take this opportunity to focus on several key issues that present opportunities for the ORWH and NIH—

1. Identifying research gaps that need immediate attention
2. Translating evidence-based science into continuing education for health care providers to improve clinical practices and patient care with federal funding support
3. Promoting regular cross-agency and intra-departmental collaboration on reproductive and sexual health topics to develop innovative strategies

Of the many key aspects of reproductive and sexual health these two are of particular importance:

1. The effective translation of the latest clinical recommendations into the best clinical practice, and
2. The development of additional safe and effective forms of long-acting reversible contraception, or LARC

For efficiency and potential impact, more research is needed on effective translation of reproductive health-related science into practice. Unless research findings are converted into practice change, the intention of conducting research to inform clinical practice and patient care is lost. To truly improve patient care, it is important to identify professional education platforms that work. This can be accomplished through the development of comprehensive evidence-based guidelines, well-designed continuing education and training programs, and tools to evaluate their implementation.

For the development of innovative strategies and solutions, cross-agency and intra-departmental collaboration should be encouraged in order to develop better and more innovative strategies. Currently, different health topics are housed in different agencies or departments, and collaboration seems very challenging. This means, for example, that logically linked topics such as maternal and child health and reproductive health are studied independently by separate agencies or departments. By including a focus on maternal child health in a discussion of reproductive health, for example, important life-saving, health promoting aspects of family planning emerge to improve maternal child health. By working within and across departments and agencies, redundancies can be reduced, efficiency improved, and costs cut.

As the Obama administration investigates ways to reduce abortion and unintended pregnancy rates, the CDC and NIH have collaborated on issues related to pre-term birth and unintended pregnancy. The discussion and research occurring between these two agencies has the potential to make a dramatic impact on both pre-term birth and unintended pregnancy rates. Further cooperation and communication between departments and agencies can only enhance and strengthen programs already proven to work.

The work currently being done around pre-term birth highlights the need not only for continuing education to implement practice change, but also the need for federal funding to be available to ensure evidence-based scientific findings are incorporated into clinical practice. Unlike the many mechanisms now in place to support scientific research, there is no federally-funded system designed to fund the translation of that research into practice. Now is the time to establish clear federal funding mechanisms for the development of continuing education and health professions training curricula in reproductive health. This is a “fast track” solution to reducing health disparities and improving patient care.

For the sexual and reproductive health field, this would mean addressing the linked issues of contraception, sexuality, abortion, HIV and sexually transmitted infections, pregnancy, and maternal and child health, as well as increasing provider knowledge, skills, and understanding of these areas. Through adequate education and training of all clinicians, evidence-based, comprehensive sexual and reproductive health care can be brought directly to the patients, which is the primary goal of conducting meaningful research.

Recently, the National Institute of Health and industry research have moved away from developing female contraceptive methods to a new focus on developing contraceptives for men. This research is important and should continue, but NIH should also maintain a focus on researching new safe, effective contraceptive methods for women, especially new LARC methods. ARHP advocates for the availability of as many safe and effective contraceptive methods as possible to meet the wide variety of needs of American women and men.

ARHP is encouraged by NIH’s collaborative work with the CDC and hopes that cross-agency and intra-departmental collaboration continues to develop in order to improve efficiency, reduce redundancies and cut costs. An investment of federal funding to develop and expand sexual and reproductive health continuing education for all providers throughout their careers would aid in the achievement of these goals.

Thank you again for the opportunity to present these comments. I welcome any questions you may have.