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Contraception Journal
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Contraception Highlights November 2011

This month’s featured editorials

Publicly funded contraceptive care: a proven investment
Rachel Benson Gold, Adam Sonfield
pages 437-439
This year has been a difficult one for the nation's publicly funded family planning programs, which have faced unprecedented threats. Some of these threats appear driven primarily by policy makers struggling to close budget deficits, many of whom have set their sights on Medicaid. During FY 2011, 43 states attempted to reduce Medicaid costs through such steps as cutting provider reimbursement, lowering drug costs or reducing benefits; nearly all governors have proposed additional cuts for FY 2012. And with Medicaid the dominant source of public support for family planning services, proposals to restructure the program and curtail its public costs would have an enormous impact on family planning providers and clients read more >

Difficult feat: conducting high-quality research in challenging areas
Melissa Gilliam
pages 440-441
The death of University of Chicago Professor Emeritus Paul Meier makes us stop and appreciate his tremendous contribution to human health. An early champion of randomized controlled trials, he helped to save millions of people from pharmacologic and other interventions that were well intentioned but not well proven. The eponymous Kaplan–Meier curves have become a mainstay of statistical methodology and his seminal article on understanding survival is one of the most commonly cited articles. His work focused on bringing scientific integrity to complex problems of human health. It highlights the need for rigorous research in all areas of science especially on difficult topics. read more >

Controversies in Family Planning

Ophthalmic migraines and combined hormonal contraceptives
Misa Perron-Burdick, Courtney Schreiber, Pratima Gupta
pages 442-444
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Office device to aid in Implanon insertion
Irvin J. Reiner, V. Daniel Castracane
pages 445-446
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Review Articles

Intrauterine contraceptive insertion postabortion: a systematic review
Maria W. Steenland, Naomi K. Tepper, Kathryn M. Curtis, Nathalie Kapp
pages 447-464
This review was conducted to evaluate the evidence regarding the safety and effectiveness of intrauterine device (IUD) insertion immediately following spontaneous or induced abortion.
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Fertility after discontinuation of contraception: a comprehensive review of the literature
Mags Beksinska, Jenni Smit, Carol Joanis, Margaret Usher-Patel, William Potter
pages 316-321
Fear of adverse effects on subsequent fertility following reversible contraceptive use is an important concern for some women.
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Original research articles

Unintended pregnancy in the United States: incidence and disparities, 2006
Lawrence B. Finer, Mia R. Zolna
pages 478-485
Background: The incidence of unintended pregnancy is among the most essential health status indicators in the field of reproductive health. One ongoing goal of the US Department of Health and Human Services is to reduce unintended pregnancy, but the national rate has not been estimated since 2001.
Conclusions: Since 2001, the United States has not made progress in reducing unintended pregnancy. Rates increased for nearly all groups and remain high overall. Efforts to help women and couples plan their pregnancies, such as increasing access to effective contraceptives, should focus on groups at greatest risk for unintended pregnancy, particularly poor and cohabiting women.
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Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation
Gabriela Noé, Horacio B. Croxatto, Ana María Salvatierra, Verónica Reyes
pages 486-492
Background: The contraceptive efficacy of emergency contraceptive pills containing levonorgestrel (LNG-EC) has been estimated in most previous studies by judging the day of ovulation from presumptive menstrual cycle data, thus providing poorly reliable estimates.
Conclusion: The efficacy of LNG-EC has been overestimated in studies using presumptive menstrual cycle data. Our results confirm previous similar studies and demonstrate that LNG-EC does not prevent embryo implantation and therefore cannot be labeled as abortifacient.
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Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project
Renee Mestad, Gina Secura, Jenifer E. Allsworth, Tessa Madden
pages 340-345
Background: Adolescent women have a high risk of unintended pregnancy. Currently, there are little data about their choice to initiate long-acting reversible contraception (LARC).
Conclusions: Long-acting reversible contraception use is clearly acceptable and common among adolescents enrolled in the Contraceptive CHOICE Project, with the younger group being most interested in the implant.
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Postplacental or delayed levonorgestrel intrauterine device insertion and breast-feeding duration
Beatrice A. Chen, Matthew F. Reeves, Mitchell D. Creinin, E. Bimla Schwarz
pages 499-504
Background: The objective of this study was to assess the effect of timing of postpartum levonorgestrel-releasing intrauterine device (IUD) insertion on breast-feeding continuation.
Conclusion: Immediate postplacental insertion of the levonorgestrel IUD is associated with shorter duration of breast-feeding and less exclusive breast-feeding. Further studies on the effects of early initiation of progestin-only methods on women's lactation experience are needed.
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Outcomes of medical abortion through 63 days in women with twin gestations
Jennifer L. Hayes, Sharon L. Achilles, Mitchell D. Creinin, Matthew F. Reeves
pages 505-507
Background: Twin gestation is not considered a contraindication to medical abortion with mifepristone and misoprostol. However, data comparing the efficacy of medical abortion for singleton gestations as compared with multiple gestations are limited. We examined medical abortion outcomes for twin gestations through 63 days.
Conclusions: Treatment success of medical abortion for twins is not significantly different than for singletons, although small differences cannot be excluded due to the limited number of twins.
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A prospective randomized trial comparing low-dose ethinyl estradiol and drospirenone 24/4 combined oral contraceptive vs. ethinyl estradiol and drospirenone 21/7 combined oral contraceptive in the treatment of hirsutism
Gokalp Oner, Iptisam Ipek Muderris
pages 508-511
Background: A prospective randomized trial was conducted to compare the clinical efficacy of two oral contraceptives containing drospirenone in the treatment of hirsutism in women.
Conclusion: The treatment of hirsutism with both combined oral contraceptives (COCs) containing drospirenone offered comparable effects and was well tolerated.
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Hormonal contraception and area of cervical ectopy: a longitudinal assessment
Patricia L. Bright, Abigail Norris Turner, Charles S. Morrison, Emelita L. Wong
pages 512-519
Background: The effect of combined oral contraceptives (COCs) and depot-medroxyprogesterone acetate (DMPA) on the area of cervical ectopy is not well understood.
Conclusions: Use of COCs, but not DMPA, was associated with large area of cervical ectopy. Area of ectopy at baseline was the strongest predictor of area of ectopy at follow-up.
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Perceptions of family planning and abortion education at a faith-based medical school
Maryam Guiahi, Karla Maguire, Zachary T. Ripp, Rachel W. Goodman
pages 520-524
Background: Because of religious beliefs against contraception and abortion, family planning education is limited at faith-based institutions. The purpose of this study was to assess medical students' satisfaction with family planning education at a faith-based medical school.
Conclusions: The majority of students enrolled at a faith-based medical school rated their current family planning education as inadequate and desired additional opportunities.
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Mucosal integrity and inflammatory markers in the female lower genital tract as potential screening tools for vaginal microbicides
H. Irene Su, Courtney A. Schreiber, Courtney Fay, Sam Parry
pages 525-532
Background: In the female genital tract, vaginal colposcopy, endometrial mucosal integrity and inflammatory mediators are potential in vivo biomarkers of microbicide and contraceptive safety.
Conclusions: Gynol II and HEC may modulate inflammatory markers in the vagina and endometrium. How these changes relate to infection susceptibility warrants further study.
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Development and evaluation of matrix type transdermal patch of ethinylestradiol and medroxyprogesterone acetate for anti-implantation activity in female Wistar rats
Shyam Sunder Agrawal, Jatin Kumar Pruthi
pages 533-538
Background: Medroxyprogesterone acetate (MPA), which increases high-density lipoprotein level, has not been used as a progestin in combination with estrogen in a transdermal patch to date. The aim of the research was to develop and evaluate a matrix-type transdermal drug delivery (TDD) system of a combination of ethinylestradiol (EE) and MPA for interception.
Conclusions: These findings suggested that TDD formulation aimed for postcoital antifertility activity has been successfully developed in female Wistar rats.
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