Contraception Highlights November 2014

Announcement Daniel R. Mishell Jr., MD, Outstanding Article Award 2014 Read announcement Editorial Global fee prohibits postpartum provision of the most effective reversible contraceptives Abigail R.A. Aiken, Mitchell D. Creinin, Andrew M. Kaunitz, Anita L. Nelson, …


Daniel R. Mishell Jr., MD, Outstanding Article Award 2014

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Global fee prohibits postpartum provision of the most effective reversible contraceptives
Abigail R.A. Aiken, Mitchell D. Creinin, Andrew M. Kaunitz, Anita L. Nelson, James Trussell
Early postpartum access to highly effective reversible contraceptives [intrauterine contraceptives (IUCs) and the implant] and sterilization is key to helping women prevent unintended pregnancy [1]. However, most current hospital reimbursement policies deny postpartum women access to IUCs and implants prior to hospital discharge. For women whose deliveries are covered by private insurance or Medicaid, hospitals receive a global fee based on the diagnosis-related group (DRG) for all delivery-related care.
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Advocating for immediate postpartum LARC: increasing access, improving outcomes, and decreasing cost
Maria I. Rodriguez, Megan Evans, Eve Espey
Unintended pregnancy, endemic in the United States (US), carries significant health and economic consequences and disproportionately affects poor women and women of color. Rapid repeat pregnancy—defined as a pregnancy within 12 to 18 months after delivery—can occur if women are unsuccessful at initiating contraception. Improving postpartum initiation of effective contraception including long-acting reversible contraception (LARC), the intrauterine device (IUD) and contraceptive implant, is a key strategy to reduce unintended pregnancy and health inequities.
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Global family planning metrics — time for new definitions?
Willard Cates, John Stanback, Baker Maggwa
In 2012, the groundbreaking London Summit on Family Planning galvanized support for the far-reaching benefits of contraception. Funders, government leaders and other global partners made commitments to expanding access to rights-based family planning services for an additional 120 million women and girls by 2020. This ambitious goal has been branded as FP2020, and a formal secretariat was established under the UN Foundation to facilitate the implementation and coordinate contributions from key stakeholders.
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Review Articles

Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States
Elizabeth G. Raymond, Daniel Grossman, Mark A. Weaver, Stephanie Toti, Beverly Winikoff
Objective: The recent surge of new legislation regulating induced abortion in the United States is ostensibly motivated by the desire to protect women’s health. To provide context for interpreting the risk of abortion, we compared abortion-related mortality to mortality associated with other outpatient surgical procedures and selected nonmedical activities.
Conclusions: The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. The new legislation restricting abortion is unnecessary; indeed, by reducing the geographic distribution of abortion providers and requiring women to travel farther for the procedure, these laws are potentially detrimental to women’s health.
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The accuracy of using last menstrual period to determine gestational age for first trimester medication abortion: a systematic review
Dana Schonberg, Lin-Fan Wang, Ariana H. Bennett, Marji Gold, Emily Jackson
Objective: We sought to evaluate the accuracy of assessing gestational age (GA) prior to first trimester medication abortion using last menstrual period (LMP) compared to ultrasound (U/S).
Conclusion: Our results support that LMP can be used to assess GA prior to medication abortion at GA <63 days. Further research looking at patient outcomes and identifying women eligible for medication abortion by LMP but ineligible by U/S is needed to confirm the safety and effectiveness of providing medication abortion using LMP alone to determine GA.
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Original Research Articles

Unmet demand for highly effective postpartum contraception in Texas
Joseph E. Potter, Kristine Hopkins, Abigail R.A. Aiken, Celia Hubert, Amanda J. Stevenson, Kari White, Daniel Grossman
Objectives: We aimed to assess women’s contraceptive preferences and use in the first 6 months after delivery. The postpartum period represents a key opportunity for women to learn about and obtain effective contraception, especially since 50% of unintended pregnancies to parous women occur within 2 years of a previous birth.
Implications: In two Texas cities, many more women preferred long-acting and permanent contraceptive methods (LAPM) than were able to access these methods at 6 months postpartum. Women’s contraceptive needs could be better met by counseling about all methods, by reducing cost barriers and by making LAPM available at more sites.
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Change in abortion services after implementation of a restrictive law in Texas
Daniel Grossman, Sarah Baum, Liza Fuentes, Kari White, Kristine Hopkins, Amanda Stevenson, Joseph E. Potter
Objectives: In 2013, Texas passed omnibus legislation restricting abortion services. Provisions restricting medical abortion, banning most procedures after 20 weeks and requiring physicians to have hospital-admitting privileges were enforced in November 2013; by September 2014, abortion facilities must meet the requirements of ambulatory surgical centers (ASCs). We aimed to rapidly assess the change in abortion services after the first three provisions went into effect.
Implications: Supply-side restrictions on abortion — especially restrictions on medical abortion — can have a profound impact on access to services. Access to abortion care will become even further restricted in Texas when the ASC requirement goes into effect in 2014.
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Finding the Twitter users who stood with Wendy
Amanda Jean Stevenson
Objective: I examine Twitter discussion regarding the Texas omnibus abortion restriction bill before, during and after Wendy Davis’ filibuster in summer 2013. This critical moment precipitated wide public discussion of abortion. Digital records allow me to characterize the spatial distribution of participants in Texas and the United States and estimate the proportion of participants who were Texans.
Implications: The Twitter discussion surrounding Wendy Davis’ filibuster revealed a geographically diverse population of individuals who strongly oppose abortion restrictions. Texans from across the state were among those who actively voiced opposition. Identifying rights supporters through online behavior may present a new way of classifying individuals’ orientations regarding abortion rights.
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Developing future leaders in reproductive health through a scholarly concentration for medical students
Melissa Nothnagle, Heidi Radlinski, Susanna R. Magee, Rebecca H. Allen
Objectives: To evaluate the impact of a scholarly concentration for medical students, which aims to develop students’ research, clinical and advocacy skills to promote women’s reproductive health.
Conclusions: A scholarly concentration for medical students provides a unique platform to support the development of talented students as future leaders in women’s reproductive health.
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Acceptability of the nestorone®/ethinyl estradiol contraceptive vaginal ring: development of a model; implications for introduction
Ruth B. Merkatz, Marlena Plagianos, Elena Hoskin, Michael Cooney, Paul C. Hewett, Barbara S. Mensch
Objectives: Develop and test a theoretical acceptability model for the Nestorone®/ethinyl estradiol contraceptive vaginal ring (CVR); explore whether domains of use within the model predict satisfaction, method adherence and CVR continuation.
Implications Statement: Acceptability research is important when introducing a new method of contraception and determining whether it can be a successful option in meeting the reproductive health needs of women and men. This study was designed to test a conceptual model of acceptability and identify factors associated with successful use of a new contraceptive delivery modality. Original research was conducted for this publication.
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IUDs as EC? Limited awareness and high reported acceptability: evidence from Argentina
Margaret Pichardo, Lia Arribas, Elina Coccio, Graciela Heredia, Sherani Jagroep, Tia Palermo
Background: We explored knowledge and attitudes regarding the copper intrauterine device (IUD) as emergency contraception (EC) among women in Buenos Aires, Argentina.
Implications: After given information about the IUD as a method of EC, women interviewed said they would be willing to use the IUD EC despite their limited prior knowledge of this method. With more widespread information and availability of the IUD as EC, more women may opt for this highly effective method, which can provide additional protection against unwanted pregnancy for up to 10 years.
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Prospective measurement of blood pressure and heart rate over 24 h in women using combined oral contraceptives with estradiol
Giovanni Grandi, Anjeza Xholli, Antonella Napolitano, Ilaria Piacenti, Manuela Bellafronte, Angelo Cagnacci
Objective: Combined oral contraceptives (COCs) containing ethinyl-estradiol are known to increase blood pressure (BP). We evaluated whether COCs containing estradiol (E2) influence 24-h ambulatory BP and heart rate (HR) in normotensive and normal-weight women.
Conclusions: These data suggest a neutral effect of estradiol-based COCs on independent risk factors for cardiovascular diseases such as BP or HR.ImplicationsBP and HR of normotensive women are not increased by E2-based COCs.
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A comparison of multiphasic oral contraceptives containing norgestimate or desogestrel in acne treatment: a randomized trial
Unnop Jaisamrarn, Somsak Chaovisitsaree, Surasak Angsuwathana, Osot Nerapusee
Objective: This study aimed to compare the effectiveness and safety of triphasic combined oral contraceptives (OCs) containing ethinyl estradiol (EE) and norgestimate (NGM) and biphasic combined OCs containing EE and desogestrel (DSG) in the treatment of mild to moderate acne.
Implications: EE/NGM and EE/DSG are multiphasic OCs, which were shown to be clinically equally effective for mild to moderate facial acne, and the multiphasic combined OC with NGM was more effective for women with facial seborrhea. Clinicians may apply the results of this study when considering treatment options for facial acne and seborrhea.
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A systematic approach to improving intrauterine device services in family planning clinics
Melissa L. Gilliam, Stephanie Q. Mistretta, Summer L. Martins, Jane L. Holl
Objectives: To improve the quality of intrauterine device (IUD) services at Title X clinics.
Conclusions: This process revealed that the failures most in need of improvement and redesign were the scheduling and intake processes and the lack of time for counseling during certain types of visits.ImplicationsA systematic assessment of the underlying problems in IUD-care revealed three important issues across three clinics: (1) client does not show up for appointment or cancels appointment; (2) client recently had unprotected intercourse; and (3) limited time for counseling, informing, and placing IUDs.
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Impact of a revised appointment scheduling script on IUD service delivery in three Title X family planning clinics
Melissa L. Gilliam, Stephanie Q. Mistretta, Summer L. Martins, Jane L. Holl
Objective: The objective was to study a redesigned call script for intrauterine device (IUD) appointment scheduling.
Implications: Revising an appointment scheduling call script is a simple and scalable intervention to decrease administrative and clinical barriers to family planning services. As many clinics in the United States move toward computerized and centralized call centers, improving patient communication during the scheduling process may have a broad impact on clinical efficiency.
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Correcting oral contraceptive pharmacokinetic alterations due to obesity: a randomized controlled trial
Alison B. Edelman, Ganesh Cherala, Myrna Y. Munar, Martha McInnis, Frank Z. Stanczyk, Jeffrey T. Jensen
Objective: To determine if increasing the hormone dose or eliminating the hormone-free interval improves key pharmacokinetic (PK) alterations caused by obesity during oral contraceptive (OC) use.
Conclusion: Both increasing the OC dose and continuous dosing appear to counteract the impact of obesity on key OC PK parameters.ImplicationsObesity adversely affects the pharmacokinetics of very low dose OC pills. Although the impact of these changes on OC efficacy is still under debate, PK parameters can be normalized in obese users by continuous dosing or increasing to a low-dose pill.
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Letters to the Editor

Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization
Douwe A. Verkuylemail
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Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization: in reply
Aileen M. Gariepy
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Drug Integrity Associate Audrey Amos is a pharmacist with experience in health communication and has a passion for making health information accessible. She received her Doctor of Pharmacy degree from Butler University. As a Drug Integrity Associate, she audits drug content, addresses drug-related queries

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