Contraception

Editorial Board

2010-08-01

Joseph W. Goldzieher and the birth of hormonal contraception

Giuseppe Benagiano — 2010-04-14

Gregory Pincus has been rightly celebrated as the “father of the Pill” for his pioneering work on the inhibition of ovulation through the administration of progestins, energizing the entire field of contraception and setting the stage for all the developments that followed (see Refs. ). This, however, should not result in a lack of acknowledgment of the many pioneers who transformed an idea into dozen of products used by tens of million of women.

Introduction to Controversies in Family Planning

Courtney A. Schreiber — 2010-04-05

It is with great pleasure that we introduce to you a new periodic addition to Contraception called “Controversies in Family Planning.” Through this medium, we will present edited versions of interesting cases and commentaries that were chosen from the Fellowship in Family Planning listserv, a valuable mode of communication for family planning experts of all levels of training in the United States and Canada. Our hope is to share these controversies, and the wisdom from the listserv conversations with the Contraception community. Even with the vast amount of scientific research that helps guide the delivery of care in family planning, we believe this series will highlight the questions that still lack definitive answers. We want to thank both the inquirers and the experts who commented on these cases for their time and insights, and we look forward to the response from the Contraception readership. We are grateful to the Fellowship in Family Planning for allowing us to share this information with the readers of Contraception.

The missing IUD

Peter Vasquez, Courtney A. Schreiber — 2010-04-05

Case 1: I was referred a patient by a colleague because he could not locate her levonorgestrel-releasing intrauterine contraceptive on physical exam or by pelvic ultrasound. The patient desired a pregnancy, and conception would require removal of the device. When it was not visualized on examination or by ultrasound, my colleague performed a laparoscopy, but it was not seen in the pelvis. I obtained a pelvic X-ray that showed the IUD outside the uterus on the left side of the pelvis. I wonder, could the IUD have been in the broad ligament all along and that is why my colleague did not see it on laparoscopy or ultrasound? Or might it have migrated further since her laparoscopy and if I bring her back to surgery might I be able to retrieve it? Would an MRI help?

Bringing evidence to the debate on abortion coverage in health reform legislation: findings from a national survey in the United States

Kathryn A. Phillips, Daniel Grossman, Tracy A. Weitz, James Trussell — 2010-04-01

Divisions over abortion are a major obstacle for health reform legislation in the United States . We use nationally representative data from a government survey to examine how much uninsured individuals, who will be covered under health reform, currently pay out-of-pocket for health care and how this compares to costs of abortion care.

Endocrinological, metabolic and clinical features of treatment with oral contraceptive formulation containing ethinylestradiol plus chlormadinone acetate in nonobese women with polycystic ovary syndrome

2010-03-02

Abstract: Background: Chlormadinone acetate (CMA) is a progestin compound similar to progesterone, with antiandrogenic properties. In healthy eumenorrheic women, it was demonstrated that the monophasic estroprogestin formulation containing CMA (2 mg) plus ethinyl estradiol (EE) (30 mcg) (EE30+CMA) is efficacious both in reducing hyperandrogenic symptoms, fat mass and in improving lipoprotein panel, without changes in insulin-glucose metabolism. These metabolic properties are important for women affected by polycystic ovary syndrome (PCOS) in whom there is a predisposition to insulin resistance.Study Design: We studied whether in young nonobese women with PCOS (15 subjects, EE30+CMA-PCOS group) a six-cycle treatment with EE30+CMA can reduce androgen levels, androgen bioavailability and the score of hirsutism and acne, and modify glucose-insulin metabolism evaluated by the oral glucose tolerance test and the body composition evaluated by bio-impedenziometry. These parameters were evaluated before (first visit) and during the sixth cycle of EE30+CMA (second visit). All the results were compared with those of a matched-age-group of nonobese PCOS women (15 subjects, no OC-PCOS group) evaluated before (first visit) and after six menstrual cycles in which they did not use any drug or oral contraceptive (second visit).Results: In the EE30+CMA-PCOS group women, androgen levels and bioavailability, hirsutism and acne score were significantly lower at the second than at the first visit, whereas they did not change in no OC-PCOS group. At the second visit, in both groups, glucose-insulin metabolism and body composition parameters were not affected.Conclusions: A six-cycle treatment with EE30+CMA is efficacious in nonobese PCOS women to improve hyperandrogenic symptoms, without negative interferences both on body composition and on insulin-glucose metabolism.

Effect of oral contraceptive containing ethinyl estradiol combined with drospirenone vs. desogestrel on clinical and biochemical parameters in patients with polycystic ovary syndrome

2010-05-26

Abstract: Background: A prospective randomized trial was conducted to compare efficacy of a drospirenone-containing combined oral contraceptives (COC) with desogestrel-containing COC in women with polycystic ovary-syndrome (PCOS) not desirous of child-bearing.Study Design: Sixty women were randomized into study group [ethinylestradiol (EE) 30 mcg+drospirenone 3 mg] and control group (EE 30 mcg+desogestrel 150 mcg), treated for 6 months and followed up at 1 month, 3 months, 6 months, during treatment and 3 and 6 months post-treatment. Acne and hirsutism scoring, bodyweight, body mass index (BMI), blood pressure (BP), ultrasound parameters, lipid profile, glycemic profile and hormonal profile were compared.Results: Cycles were regular in both groups during treatment. Effect of regular cycles persisted in 44.83% (13/30) vs. 17.24% (5/30) in study vs. control group at 6 months post-treatment with 33.3% decreased hirsutism score in the study group (versus no change in control group) even at 6 months after stopping treatment. With treatment, BMI fell by 0.52 kg/m2 in the study group; systolic and diastolic BP fell in the study group while it rose in the control group. Low-density lipoprotein significantly decreased and high-density lipoprotein was elevated in the study group (p<.05). The study group showed a significant fall in fasting/postprandial blood sugar and insulin and total testosterone against a rise in the control group.Conclusion: In women with PCOS, a drospirenone containing COC has better outcome in terms of persistent regular cycles, antiandrogenic effect, fall in BMI and BP, better lipid profile, favorable glycemic and hormonal profile than desogestrel-containing COC.

Effects of two combined hormonal contraceptives with the same composition and different doses on female sexual function and plasma androgen levels

2010-04-01

Abstract: Background: This study was conducted to compare the effects of two contraceptive pills with different doses of the same components, on plasma androgen levels and female sexual function among women without previous sexual dysfunction.Study Design: The participants were randomized into two groups, to receive pills containing ethynylestradiol (EE) 30 mcg and levonorgestrel (LNG) 150 mcg or EE 20 mcg and LNG 100 mcg, for six cycles. Sexual function was assessed using a standardized questionnaire [Female Sexual Function Index (FSFI)]. Hormone assays were performed at baseline and after the sixth cycle.Results: Forty-nine women were included in the EE30/LNG150 group and 48 in the EE20/LNG100 group. EE30/LNG150 group presented 54% and 67% decreases of total testosterone and free androgen index, respectively, with statistical significance. EE20/LNG100 presented reductions of 20% and 42%, respectively, but without statistical significance. Both groups showed improvements in the FSFI “desire” score, but with statistical significance only for EE20/LNG100 group.Conclusions: EE30/LNG150 decreased plasma androgen levels, but there was no impairment in sexual desire, on the other hand, sexual desire score increased with EE20/LNG100 formulation.

Effects of sex hormones in oral contraceptives on the female sexual function score: a study in German female medical students

2010-02-11

Abstract: Background: The survey was conducted to compare the influence of sex hormones in oral contraceptives (OCs) on female sexual function.Methods: One thousand eighty-six female German medical students completed an online-based questionnaire incorporating the Female Sexual Function Index (FSFI). Oral contraceptives used were classified into those containing androgenic or antiandrogenic progestins and by ethinylestradiol (EE) dosage (20 mcg, 30 mcg and >30 mcg). Female Sexual Function Index scores in women using OCs were compared to those in nonusers.Results: Seven hundred fifty-two of 1086 participating women used OCs. No statistically significant differences in FSFI scores were found among women using OCs containing androgenic or antiandrogenic progestins, nor were any seen between different EE dosages. In general, OC users had lower FSFI scores than nonusers.Conclusion: Female Sexual Function Index scores were negatively influenced by the use of OCs. However, the impact of an androgenic or antiandrogenic progestin content or different dosages of EE as modulating factors of female sexual function seems negligible.

Pharmacist-administered subcutaneous depot medroxyprogesterone acetate: a pilot randomized controlled trial

Carla Picardo, Stefanie Ferreri — 2010-02-22

Abstract: Background: The objectives of this study were to assess the feasibility of administering subcutaneous depot medroxyprogesterone acetate (DMPA-SC) in a pharmacy setting and assess patient satisfaction.Study Design: Fifty women, at least 18 years of age, presenting to a family planning clinic to initiate, continue or restart any form of DMPA were randomized to receive two subsequent injections at a nearby pharmacy by trained pharmacists or at the clinic. Women completed two follow-up surveys to rate their satisfaction with DMPA-SC and their clinic/pharmacy experiences.Results: The relative risk of returning and receiving a second DMPA-SC injection of women randomized to the pharmacy compared with those randomized to the clinic was 0.73 (95% CI 0.42–1.27). The relative risk of returning and receiving a third DMPA-SC injection was 0.75 (95% CI 0.39–1.46). Most women found the pharmacy setting convenient (70%), private (100%), the providers respectful (100%) and were satisfied with DMPA-SC and the pharmacy as a clinical site (≥89%). No significant difference in patient satisfaction with location, convenience, privacy, and respect from providers was found between study groups (p>.05), nor were there significant differences in attitudes or satisfaction among women between their two follow-up injections.Conclusion: Administration of DMPA-SC by pharmacists in a pharmacy setting is feasible. Continuation rates and patient satisfaction with DMPA-SC and the pharmacy setting were comparable to those who received DMPA-SC in a family planning clinic.

Postexposure prophylaxis for victims of sexual assault: treatments and attitudes of emergency department physicians

Arvind Bakhru, Julie B. Mallinger, Michelle C. Fox — 2010-02-11

Abstract: Background: Emergency departments (EDs) are the primary source of care for victims of sexual assault (SA). Provision of emergency contraception (EC) to these women has previously been noted to be sporadic. Completeness of care for victims of SA and the barriers to complete care are further investigated in this study.Study Design: All ED attending physicians in Maryland, Virginia and the District of Columbia were identified and contacted for participation; 35% completed the survey. Practice patterns were analyzed for the 67% of physicians who do not refer SA victims to other hospitals.Results: We found that 83% of physicians “always” or “usually” offer EC, but only half prescribe EC more than 48 h postassault. While most (89%) typically offer prophylaxis for STDs other than HIV, only 45% offer or counsel on HIV prophylaxis. Physician attitudes and hospital protocols were significant modifiers.Conclusion: Sexual assault victims are often not offered comprehensive care including prophylaxis against pregnancy and all STDs including HIV. Additional research is warranted to determine why physicians do not routinely offer HIV prophylaxis after SA.

Effect of depot medroxyprogesterone acetate on postpartum depression

Rita Tsai, Jonathan Schaffir — 2010-04-14

Abstract: Background: Depot medroxyprogesterone acetate (DMPA) is commonly prescribed to women immediately postpartum due to its efficacy, convenience and lack of estrogen. It is unclear whether administering a progestin injection can affect the course of postpartum depression (PPD), which some suspect to be influenced by hormonal changes. In this retrospective study, the objective was to determine whether DMPA administered immediately postpartum influences the development of PPD.Study Design: A retrospective review of a total of 404 charts was conducted of clinic patients who were scheduled for 6-week postpartum visits at a major medical center, where all patients are routinely asked to complete the Edinburgh Postnatal Depression Scale (EPDS). The average scores on the EPDS at these visits were compared between patients who had received DMPA prior to postpartum discharge from the hospital and patients who had not received any hormonal contraception by using an unpaired t test. In addition, the proportions of women diagnosed with PPD via the scale were compared via contingency tables.Results: Fifty-five women who had received immediate DMPA were compared with 192 women with no hormonal contraception after delivery. The groups were similar in parity, race, mode of delivery and weight, but women receiving DMPA were significantly younger (24.2 vs. 26.2 years, p=.03). Mean EPDS scores at 6 weeks postpartum were not statistically significant between the groups (5.02 vs. 6.17, p=.16). Six patients (10.9%) who received immediate DMPA were diagnosed with PPD based on EPDS scores greater than or equal to 13, while 27 (14.1%) in the comparison group had PPD (p=.88).Conclusion: Administration of DMPA in the immediate postpartum period does not appear to predispose women to PPD.

Attitudes and beliefs about the intrauterine device among teenagers and young women

Kendra L. Fleming, Abby Sokoloff, Tina R. Raine — 2010-04-14

Abstract: Background: Little is known about attitudes and beliefs among teenagers and young women about the intrauterine device (IUD).Study Design: We surveyed 252 women, ages 14–27 years, presenting for appointments at an urban family planning clinic about demographics, sexual and birth control history, and opinions about the IUD.Results: Fifty-five percent had not heard of the IUD. Participants who were parous were 4.4 times more likely to be interested in the IUD than nulliparous participants. Independent of parity, participants who had heard of the IUD from a health care provider were 2.7 times more likely to be interested in using the method. The study population was at high risk for sexually transmitted infections (STIs); however, 82% of participants predicted that they would increase or experience no change in their condom use with an IUD in place.Conclusions: Health care providers should be encouraged to talk to teenagers and young women who are at high risk for unintended pregnancy, both parous and nulliparous, about using the IUD.

Reproductive Health 2010 Scientific Abstracts Atlanta, GA, September 22–25, 2010

2010-06-04

These scientific abstracts are scheduled for presentation at Reproductive Health 2010, the combined annual meeting of the Association of Reproductive Health Professionals (ARHP), the Society of Family Planning (SFP) and the Planned Parenthood Federation of America National Medical Committee®. This year, 202 abstracts were submitted for consideration, of which 21 were selected for oral presentation and 102 were selected for poster presentation. SFP functioned as the lead partner in the scientific abstract review, and the reviews were completed by a sub-committee of volunteers, which was cochaired by Melissa Gilliam, M.D., M.P.H., chair of SFP's Scientific Committee, and Eve Espey, M.D., M.P.H., chair of ARHP's Education Committee. Lastly, the Reproductive Health 2010 Executive Planning Committee would like to thank the following reviewers and staff for their hard work:

The utility of sonographic assessment of intrauterine device placement following immediate vs. delayed insertion following uterine aspiration

M.F. Reeves, C Cwiak, E Espey, MD Creinin, M Nichols, PH Bednarek — 2010-08-01

To assess whether the distance from the intrauterine device (IUD) to the uterine fundus by transvaginal sonography can predict expulsion. Women requesting suction aspiration at 5–12 weeks and desiring IUDs were randomized to insertion immediately following aspiration (immediate) or 2–6 weeks later (delayed). As a planned substudy, we used transvaginal sonography to measure the IUD-fundal distance (IFD) from the fundal-most tip of the IUD to the fundal uterine serosa. The IFD was assessed immediately after insertion and 1 month later. Expulsions were identified through 6 months.

Contraceptive and pregnancy outcomes: a randomized controlled trial of immediate vs. delayed post-abortal copper T 380A IUD insertion after second trimester abortions

M. Cremer, K. Bullard, R. McDonald-Mosley, C. Weiselberg, T. Alonzo, M. Molaei — 2010-08-01

The IUD is a safe, effective, well-tolerated form of contraception. Placing an IUD immediately after a second trimester abortion could potentially increase high tier contraception use and decrease subsequent unplanned pregnancies.

The safety of digoxin as a feticidal agent

R. Steward, M. Gatter, D. Nucatola — 2010-08-01

Since the 2008 Partial-Birth Abortion Ban, many use digoxin as feticide before dilation and evacuation. Our clinic has used digoxin since 2000. We conducted this study to add to the growing evidence supporting digoxin's safety. Our primary objective was to examine the incidence of chorioamnionitis and extramural delivery.

Music as an auxiliary analgesic during first trimester surgical abortion: a randomized control trial

J. Guerrero, P. Castaño, L. Rosario, C.L. Westhoff — 2010-08-01

To study the impact of intraoperative music added to routine pain control measures during first trimester surgical abortion. We randomized 101 women presenting for first trimester manual or electric vacuum aspiration to undergo the procedure with routine pain control measures only (ibuprofen and paracervical block) or with the addition of intraoperative, self-selected music via a digital music player with headphones. The primary outcome was the change in preoperative and postoperative patient-reported pain scores on a 100-mm visual analog scale (0=no pain, 100 mm=worst pain). Secondary outcomes included anxiety, vital sign change and satisfaction.

Introducing medical abortion in Nepal with minimal technology

2010-08-01

Nepal legalized abortion in 2002, but access to services remains poor in many areas. In May 2008, the Ministry of Health approved a pilot to (1) determine the feasibility of introducing medical abortion in Nepal and (2) demonstrate that medical abortion can be provided without routine use of ultrasound or laboratory tests.

A double-blinded randomized trial of same-day Dilapan-S vs. overnight laminaria for cervical preparation before surgical abortion between 14 and 18 weeks' gestation

2010-08-01

To determine whether same-day Dilapan-S is inferior to overnight laminaria for cervical preparation before early second-trimester dilation and evacuation (D&E). We enrolled women between 14 and 18 weeks' gestation and randomized them to Dilapan-S on the day of their abortion or overnight laminaria for cervical preparation. Study participants and clinicians were blinded to group assignment. The primary outcome was procedure time. The trial was powered to assess noninferiority of Dilapan-S within a margin of 10 min and a mean point difference of 5.25 min.

Early weight gain and its relationship to later weight gain in adolescents on DMPA

A. Bonny, M. Secic, B. Cromer — 2010-08-01

To examine whether early weight gain in adolescents on DMPA predicts continued excessive weight gain and identify risk factors of early weight gain. Adolescents (age: 12–19 years) initiating DMPA were eligible to participate. Height and weight were assessed at baseline, 6, 12 and 18 months. Early weight gain was defined as >5% baseline weight gain after 6 months of DMPA use. Mean weight gain at 6-month intervals was estimated based on early weight gain status (≤5% gain vs. >5% gain).

The impact of pack supply on oral contraceptive continuation: a randomized controlled trial

K. O'Connell White, C. Roca, C.L. Westhoff — 2010-08-01

Oral contraceptives (OC) have high discontinuation rates. The small number of packs frequently provided at initiation may be a barrier to continuation. We examined the impact of increased initial OC supply on 6-month continuation rates.

Do depressed mood, psychological stress and eating disordered symptoms increase the risk for oral contraceptive discontinuation in young minority women?

K. Stidham Hall, K. O'Connell White, V. Rickert, N. Reame, C.L. Westhoff — 2010-08-01

Depression, stress and eating disorders (ED) contribute to high-risk sexual behavior and medication misuse, yet how they impact oral contraception (OC) discontinuation is unknown. We examined the relationships between these psychological conditions and OC continuation in inner-city multi-ethnic family planning patients.

Does convenience matter? Oral contraceptive continuation along the US–Mexico border

2010-08-01

It has been argued that making contraception more convenient could increase use and continuation. Suggestions for making oral contraceptives (OCs) more convenient include (1) removing the prescription requirement and (2) providing users with more pill packs. We test the association of both of these measures with OC continuation in a setting where low-income women can obtain OCs without a prescription by crossing the border into Mexico.

Comparison of the incidence of pelvic inflammatory disease in intrauterine devices users by gonorrhea and chlamydia screening strategies

C. Sufrin, D. Postlethwaite, M.A. Armstrong, M. Merchant, J. Wendt, J. Steinauer — 2010-08-01

There are no uniformly accepted strategies for the timing and need for gonorrhea/chlamydia (GC/CT) screening in intrauterine device (IUD) users. The incidence of pelvic inflammatory disease (PID) in IUD users by different GC/CT screening strategies is not known. We compared the incidence of PID within 90 days after IUD insertion in women who were and were not screened for GC/CT. The hypothesis was that there were no differences in PID rates among GC/CT screening groups.

Randomized trial of home vs. clinic-based screening for sexually transmitted infections in long-acting reversible contraceptive users

A. Graseck, G. Secura, J. Allsworth, T. Madden, J. Peipert — 2010-08-01

To determine whether home-based screening for sexually transmitted infections (STIs) results in a greater number of tests received compared to clinic-based screening in participants using long-acting reversible contraception (LARC).

Pregnancy intentions and family planning preferences among HIV-infected women in Nyanza Province, Kenya

2010-08-01

To explore pregnancy intentions and family planning (FP) needs among HIV-infected women in Nyanza Province, Kenya. Thirty semi-structured interviews were conducted with women aged 18–45 accessing HIV care at government health facilities. Interview transcripts were translated into English and analyzed using qualitative methods with a grounded theory approach.

Can parents teach their teens to have safe sex? Results of an educational intervention for parents in Mexico

L. Campero, D. Walker, E. Atienzo, J.P. Gutierrez — 2010-08-01

To evaluate the effectiveness of an educational intervention for parents of first year high school students in the State of Morelos, Mexico. The intervention's aim was to impact adolescents' sexual behavior, knowledge of contraceptive methods and access.

Rates of continuation and expulsion of intrauterine contraception at 12 months in nulliparous and adolescent women

T. Madden, C. McNicholas, G. Secura, J. Allsworth, Q. Zhao, J. Peipert — 2010-08-01

To compare the 12-month intrauterine contraception (IUC) expulsion and continuation rates between nulliparous and multiparous women, and between adolescent women and older women.

Revitalizing long-acting reversible contraceptives in settings with high unmet need: a multi-country experience matching demand creation and service delivery

P. Blumenthal, M. Eber, T. Cooley, A. Saunders, C. Bixiones, C. Clemente — 2010-08-01

Due to problems with contraceptive security and high discontinuation rates, revitalizing long-acting reversible contraceptives (LARC) has long been a goal of family planning programs in developing countries. In countries with high unmet need, LARC have had a low share of the contraceptive method mix. To increase the prevalence of LARC and reduce unmet need, Population Services International (PSI) began a multi-country initiative with a focus on the copper IUD and implants.

Prophylactic misoprostol prior to IUD insertion in nulliparous women

E. Schaefer, L. Van Houten, A. Olson, C. Leclair, P.H. Bednarek, A. Edelman — 2010-08-01

To study the effects of prophylactic misoprostol on patient pain with intrauterine device (IUD) placement in nulliparous women. A randomized, double blind, placebo-controlled trial of nulliparous women, 18–45 years old, desiring an IUD, received 400 mcg of misoprostol or placebo buccally 90 min prior to insertion. Women completed a series of 100-mm visual analogue scales (VAS; anchors: 0=none, 100 mm=worst imaginable) to measure their perceived pain at different time points. Secondary outcomes included provider ease of placement (100-mm VAS; anchors: 0=easy, 100 mm=extremely difficult), side effects and retention of the IUD after 1 month (self-report or clinic visit). The study had 80% power (α=0.05, one-sided) to detect a difference of 20 mm in the VAS score (total sample needed 34).

Resumption of sexual activity after first trimester suction aspiration

M.D. Creinin, P.H. Bednarek, M.F. Reeves, C. Cwiak, E. Espey — 2010-08-01

To evaluate resumption of sexual activity among US women following suction aspiration. This substudy was nested within a multicenter, randomized trial of women undergoing IUD insertion immediately after suction aspiration (immediate) or 2–6 weeks later (delayed). Immediate insertion subjects returned at 30 days for follow-up. Subjects were instructed to avoid intercourse for 7 or 14 days after the aspiration, depending on the study site. At the first follow-up after the aspiration procedure, women were asked about contraceptive use and sexual activity.

Structured contraceptive counseling: a randomized controlled trial

A.M. Langston, L.Y. Rosario, C.L. Westhoff — 2010-08-01

Contraceptive counseling is widely used, but little evaluated. We hypothesize that structured counseling preceding first trimester abortion will lead more women to choose very effective methods.

Txt Now 2 Decrease Pregnancies L8r: a randomized control trial to evaluate the effect of daily educational text messages on oral contraceptive continuation in young urban women

P. Castaño, R.A. Martínez, M. Lara, C.L. Westhoff — 2010-08-01

To determine whether daily educational text messages affect oral contraceptive (OC) continuation at 6 months. We randomized women ages 13 to 24 years electing OC at an urban family planning clinic to routine care or routine care and 180 daily educational text messages. The primary outcome was OC continuation at 6 months. We performed intention-to-treat analyses.

STI/Pregnancy prevention using technology-based education

M. Howard, J.A. Davis — 2010-08-01

Utilizing technology in health care sites offers great promise for more teen-friendly and effective sexual education. The study purpose was to demonstrate that, during clinic waiting room time, use of computer-based interventions linked to the Internet can influence the knowledge, attitudes, skills and behaviors of teen girls regarding condom use.

A randomized trial of immediate versus delayed insertion of the Copper T 380Q following medication abortion

N. Shimoni, A. Davis, C.L. Westhoff, M.E. Ramos, L. Rosario — 2010-08-01

Medication abortion follow-up visits provide an excellent opportunity for initiation of highly-effective contraception such as the intrauterine device (IUD). The timing of IUD insertion after medication abortion might impact expulsion or requests for removal. Immediate versus delayed IUD insertion remains unstudied in this setting. The objective of this study was to compare IUD use at six months in women randomized to receive the CuT 380A 1 week versus 1 month after medication abortion. Secondary objectives included comparing expulsions, removals, and bleeding profiles.

Pain Following Post-Aspiration IUD Insertion

M.D Creinin, P.H. Bednarek, M.F. Reeves, C. Cwiak, E. Espey — 2010-08-01

To assess women's impressions of pain with IUD insertion immediately after a first trimester aspiration procedure. Women requesting suction aspiration at 5–12 weeks and desiring intrauterine contraception (levonorgestrel or copper) were randomized at four centers to insertion immediately following aspiration or 2–6 weeks later. Subjects were asked to complete a 100 mm visual analogue scale (VAS) to measure their pain level. Women in the immediate group completed a VAS after the aspiration procedure was completed and before the uterus was sounded. A separate VAS was completed immediately after the IUD was inserted. Pain was measured as the difference in VAS scores. A change of more than 10 mm was considered a significant increase or decrease in pain.

Using qualitative methods to explore EC Users willingness to accept the copper IUD

C.J. Frost, Wright Altamirano R., D. Turok — 2010-08-01

US women continue to have the highest rate of unintended pregnancy and abortion in the developed world. When initiated as, emergency contraception (EC), the copper intrauterine device (IUD) has the potential to decrease these rates due to provision of continuing highly effective contraception. In this study, qualitative research methods were employed to develop a deeper and nuanced understanding about how individuals perceive EC use and why they would consider the copper IUD as a method of EC.

Transcesarean IUD insertion: a prospective cohort study

E. Levi, E. Cantillo, V. Ades, A. Murthy — 2010-08-01

Transcesarean insertion of intrauterine devices (TCIUD) could reduce a substantial barrier to access to long term effective contraception by eliminating a 6-week postpartum waiting period and additional office visit. The aim of the study was to assess IUD expulsion rates and secondarily, acceptability of TCIUD.

Rates of expulsion at 6 months in women undergoing immediate postabortion intrauterine contraception insertion

S. Norman, T. Madden, G. Secura, J. Allsworth, J. Peipert — 2010-08-01

To compare the 6-month expulsion rates between women undergoing immediate postabortion (postAB) and interval intrauterine contraception (IUC) insertion. The Contraceptive CHOICE Project is a prospective cohort study designed to promote the use of long-acting, reversible methods of contraception and evaluate continuation and satisfaction for all reversible methods. We identified 341 women who underwent immediate postAB insertion of IUC after a first or second trimester surgical abortion. We determined the 6-month expulsion rate and compared it to 705 women undergoing interval IUC insertion. We performed univariate and multivariable analysis to assess if participant characteristics were associated with observed expulsion rates.

Estimated cost savings with providing universal contraception in the state of Oregon

S. Burlone, A. Edelman, S. Dantas, J. Trussell — 2010-08-01

To compare the costs of contraceptive provision between an all-payer system (current standard) and a universal coverage plan for the state of Oregon. Total current costs of contraceptive use/failures were compared to projected total costs of providing universal contraception in Oregon. Publicly available data from the 2002 National Survey of Family Growth and California Family PACT program were used to calculate the current and projected use of contraception by type in Oregon. Total costs for each contraceptive method (including cost of product, failure rate with subsequent pregnancy outcomes, and adverse events) were obtained from the literature.

Predictors of patient use of highly effective post-partum contraception

A. Lance, Jamie McGuire J., V. Dalton — 2010-08-01

To identify patient and health service factors associated with using highly effective contraception post-partum. Women delivering at a university hospital were recruited for participation. We used a combination of a patient survey and medical record review to identify predictors of highly effective contraception use post-partum. Bivariate relationships were examined using t-tests and chi-square. Logistic regression will be used to identify predictors of highly effective contraception use at 3 months post-partum.

Effects of St. John's Wort on the pharmacokinetics of levonorgestrel in emergency contraceptive (EC) dosing

P. Murphy, B. Bellows, S. Kern — 2010-08-01

St. John's Wort (SJW) induces P450 liver enzymes. Women are advised to increase EC dosing to 2.25 mg levonorgestrel from 1.5 mg if taking the herb. This preliminary study evaluated pharmacokinetic interactions between SJW and levonorgestrel.

Evaluation of oral contraceptive effectiveness in a large cohort study — is elevated BMI associated with reduced oral contraceptive effectiveness?

N. Buttmann — 2010-08-01

The influence of obesity on oral contraceptive (OC) efficacy has triggered considerable discussion. As primary objective, we attempt to assess the effectiveness of oral contraceptives and to estimate the association with obesity.

Comparing the contraceptive decision-making of women who choose an intrauterine device versus a less effective method: a qualitative analysis

B. Harwood, N. Peacock, K. McRae, A. Schwartz, S. Geller — 2010-08-01

We compared factors that played a role in contraceptive decisions among women who decided to use an intrauterine device (IUD) and women who decided to use a less effective, or no method of contraception. We categorized these factors using an evidence-based conceptual framework for decisional conflict, the Ottawa Decision Support Framework (ODSF).

Comparing outcomes following immediate or delayed levonorgestrel-IUD insertion after dilation and curettage, dilation and evacuation and vaginal delivery

B.A. Chen, M.F. Reeves, H.L. Hohmann, M.D. Creinin — 2010-08-01

To compare outcomes in women undergoing immediate or delayed levonorgestrel-intrauterine device (IUD) insertion following first-trimester dilation and curettage (D and C), second-trimester dilation and evacuation (D and E) and vaginal delivery at term.

Contraceptive use among women obtaining abortions in 2008

R. Jones — 2010-08-01

Understanding the extent to which abortions are due to nonuse of contraception and the extent to which they are due to contraceptive failure can help in the development of strategies to reduce unintended pregnancies.

Couples-based family planning services: is there a need?

M. Zolna, M. Kavanaugh, L. Lindberg, J. Frost — 2010-08-01

Reducing the alarmingly high US unintended pregnancy rate is an important national reproductive health goal. While publicly funded family planning centers have played a key role in increasing contraceptive use, little significant progress in decreasing unintended pregnancy has been made nationally. Research suggests that involving males in family planning can improve contraceptive use. In this paper, we explore a promising and relatively new programmatic strategy: couples-based family planning services, designed to foster joint decision-making around contraceptive use.

Levonorgestrel release rates with LNG20, a new levonorgestrel intrauterine system, and Mirena

F. Wijzen, V. Gordenne, J. Foidart, M.D. Creinin, F. Frankenne — 2010-08-01

To compare the in vitro release rates of LNG20, a new levonorgestrel intrauterine system (LNG-IUS) and a marketed LNG-IUS Mirena®. The release rate performance of seven LNG20 and seven Mirena IUS products, each with a reservoir length of 20 mm surrounded by a release rate controlling membrane, were assessed in an in vitro diffusion test in sink conditions for approximately 3 years (1100 days). An early prototype of this LNG releasing system using exactly the same technology as the LNG20 but with a slightly thicker membrane was also compared to Mirena (n=3 and 5, respectively) over approximately 5 years (1850 days) using the same diffusion testing.

Knowledge of contraceptive effectiveness among a cohort of St. Louis women choosing reversible contraception

D. Eisenberg, G. Secura, T. Madden, J. Allsworth, Q. Zhao, J. Peipert — 2010-08-01

Determine whether women enrolled in the Contraceptive CHOICE Project (CHOICE) have prior understanding of the effectiveness of their chosen contraceptive method. CHOICE is an ongoing prospective cohort study of 10,000 women 14–45 years old. Among the first 2500 enrolled, 1557 women completed a contraceptive knowledge questionnaire prior to receiving contraceptive counseling and choosing their method. For each contraceptive method, women were asked “what percentage would get pregnant in a year: <1%, 1–5%, >6–10%, >10% and don't know.”

Plasma levonorgestrel levels in women using LNG20, a new levonorgestrel intrauterine system, and Mirena

V. Gordenne, F. Wijzen, J.-M. Foidart, T. Marmon, M.D. Creinin, F. Frankenne — 2010-08-01

Plasma levonorgestrel levels were evaluated for equivalence in women with menorrhagia using LNG20, a new levonorgestrel intrauterine system (LNG-IUS), and a marketed LNG-IUS Mirena® over 6 months.

Continuation and satisfaction of reversible contraception: A preliminary analysis from the Contraceptive CHOICE project

J. Peipert, T. Madden, J. Allsworth, Q. Zhao, D. Eisenberg, G. Secura — 2010-08-01

The primary objectives of the Contraceptive CHOICE Project are to promote the use of long-acting reversible methods of contraception (LARC) and to determine continuation rates and levels of satisfaction with all reversible methods.

Understanding the attitudes of black, Latino, and white couples towards sterilization

G. Shih, C. Dehlendorf — 2010-08-01

To explore the factors which shape black, Latino and white women's and men's decisions regarding sterilization. To generate hypotheses about the relationship of race/ethnicity to the sterilization decision-making process.

Carbamazepine coadministration with an oral contraceptive: Effects on steroid pharmacokinetics, ovulation and bleeding

A. Davis, C.L Westhoff, F. Stanzyck — 2010-08-01

Anti-epileptic drugs (AEDs) are widely used in reproductive-age women. The AED carbamazepine (CBZ) induces the hepatic cytochrome p450 system accelerating hormone metabolism. We sought to assess the pharmacodynamic effects of CBZ on breakthrough bleeding and ovulation during oral contraceptive (OC) use.

What do women want? Women's experiences and preferences about contraceptive counseling: a qualitative study

K Levy, J Steinauer, A Kelley, C Dehlendorf — 2010-08-01

With 50% of pregnancies in the United States being unintended, the role that health care providers play in how women choose contraception is of great importance. Little is known about how providers communicate with patients or about what women value in their interactions with providers about contraception. This question is of particular interest in minority and low-income populations, who experience disproportionately high rates of unintended pregnancy.

Pain with IUD insertion following prophylactic ibuprofen: a randomized trial

P.H. Bednarek, M.D. Creinin, M.F. Reeves, C. Cwiak, E. Espey, J. Mayo, J. Jensen — 2010-08-01

To evaluate if ibuprofen 800 mg reduces pain with intrauterine device (IUD) insertion among US women. We conducted a randomized, double-blind, placebo-controlled trial of women undergoing IUD insertion approximately 2–6 weeks following first trimester suction aspiration. IUD type (levonorgestrel or copper) was based on subject preference. Subjects were randomized to receive ibuprofen 800 mg or placebo 30–45 min prior to IUD insertion. A 100-mm visual analog scale (VAS) was administered to measure pain after speculum insertion (baseline) and immediately following IUD insertion.

US adolescent experience with intrauterine device insertion and use: a retrospective study

L. Bayer, J. Jensen, M. Nichols, P.H. Bednarek — 2010-08-01

To evaluate the experience of US adolescents with intrauterine device (IUD) insertion and utilization. We searched our electronic clinic database to identify females ≤19 years who underwent IUD insertion between January 2007 and June 2009, and performed chart review to evaluate sociodemographics, contraceptive/sexual history, and experience with IUD insertion and post-insertion.

Emergency contraception knowledge and likelihood of use by women with recent poor perinatal outcomes

E. Godfrey, C. Lind, S. Townsell, M. Issel, N. Peacock, A. Handler — 2010-08-01

To determine knowledge and predictors of emergency contraceptive use among women who experienced recent poor perinatal outcomes. Baseline survey data from the Chicago Healthy Births for Healthy Communities Interconceptional Care Project were used to describe and measure the relationship between demographic characteristics, behavioral characteristics, reproductive history, and reproductive knowledge and the likelihood of the use of Plan B, emergency contraception. Study participants included women from two low-income Chicago communities who had recently experienced a birth identified as high-risk (low birth weight, prematurity, fetal loss). Both bivariate and multivariable analyses were conducted; multivariable models were adjusted for age, education, income and insurance status.

Contraceptive choices in patients with low literacy skills

M. Schaefer, D. James, T. Barrett — 2010-08-01

Health literacy is the ability to apply reading skills to health-related materials such as prescriptions, appointment cards and medicine labels. The aim of the current study is to identify what contraceptive method patients with low health literacy are choosing and if they are attending the postpartum visit.

What factors influence women's contraceptive decisions?

L. Selitsky, L. MacIsaac, P. Freedman — 2010-08-01

Women's contraceptive decisions are affected by many factors which are poorly understood. Our study aimed at understanding both clinical factors and systems barriers that influence the contraceptive choices of women in our obstetric/gynecology practice.

Family planning provider attitudes and practices related to provision of contraceptive methods among women with various characteristics and medical conditions

C. Tyler, L. Zapata, M. Whiteman, P. Marchbanks, K. Curtis — 2010-08-01

To characterize family planning provider attitudes of safety and practices regarding contraceptive methods for women with specific characteristics and medical conditions included in the 2010 US Medical Eligibility Criteria for Contraceptive Use.

Medical student intrauterine contraception knowledge and attitudes: evaluation of obstetric and gynecology clerkship training

D. Bartz, J. Tang, R. Maurer — 2010-08-01

Modern intrauterine contraception (IUC) is safe and highly-reliable. However, studies demonstrate that many clinician populations surveyed have incorrect knowledge about the safety of IUC and often harbor negative attitudes towards IUC. Here we set out to determine whether this misinformation and poor acceptance of IUC is being propagated to medical students in training.

Association of age and LARC method choice in the contraceptive choice project

R. Mestad, G. Secura, J. Allsworth, T. Madden, Q. Zhao, J. Peipert — 2010-08-01

To determine if age is associated with long acting reversible contraceptive (LARC) method choice among adolescents and young women. The Contraceptive CHOICE Project is a longitudinal study of 10,000 women promoting the use of long-acting, reversible methods of contraception and evaluating user continuation and satisfaction with reversible methods of contraception. Using data obtained from the baseline questionnaire of the first 2500 participants, we assessed whether age was associated with LARC vs. non-LARC method choice between women 25 years and younger and those older than 25 years. We then assessed whether age was associated with specific LARC method choice among our adolescent participants, and whether the contraceptive implant has a higher acceptance rate than intrauterine contraception (IUC) in participants aged 14–17 vs. 18–20 years.

Unmet need for publicly funded family planning in region IV

K. Luchok — 2010-08-01

Unmet need for family planning results in higher rates of unintended pregnancies, shorter birth spacing intervals, higher abortion rates, and a greater number of pregnancies. Unmet need may be caused by lack of services, fewer contraceptive options offered, high out-of-pocket costs of methods, low understanding of options and proper use and low use of effective long-acting methods. By examining trend data in the southeast compared to national data, program decision-makers can monitor unmet need and take steps to improve service delivery that will reduce unintended pregnancies and lead ultimately to better health outcomes for women and the children they eventually may bear.

Prevalence of Chlamydia trichomatis and Neisseria gonorrhoea in patients requesting IUD as post abortion contraception in a publicly funded pregnancy termination clinic

R. Scott-Ram, A. Patel, V. Bhogireddy — 2010-08-01

Intrauterine devices are safe, effective, long-acting, reversible forms of contraception that are underutilized in the United States. The screening strategies for Chlamydia trachomatis (CT) and Neisseria gonorrhoea (GC) in high-risk patients prior to IUD insertion after an abortion are debated. It is unclear if patients are the best judge of their own risk of CT and GC. The objective of this study is to determine if patients who chose an IUD post abortion are self-selecting and have lower rates of GC and CT.

Giving young women in Kenya an opportunity to use implants instead of short-acting methods: prospective study to measure acceptability and benefits

D. Hubacher, A. Olawo, C. Manduku, J. Kiarie — 2010-08-01

This study has three main objectives: (1) to offer implants and measure uptake in a young population, (2) to measure/compare 12-month continuation rates of implants and short-acting methods and (3) to tally pregnancies in the two cohorts over time.

Factors associated with choosing a long acting reversible contraceptive method amongst postpartum women in an urban teaching hospital

M. Kottke, P. Goedken, M. Gidvani, C. Cwiak — 2010-08-01

Long acting reversible contraceptive (LARC) methods are highly effective, safe with breastfeeding, and permit child-spacing. Therefore, they may be ideal in the postpartum setting. We investigated factors associated with selection of LARC methods (intrauterine device or implant) among postpartum women at an urban hospital.

Effect of subcutaneous depot-medroxyprogesterone acetate on serum androgenic markers in normal weight, obese and extremely obese women

J. Du, P. Segall-Gutierrez, X. Liu, C. Niu, A. Xiang, D. Taylor, F. Stanczyk — 2010-08-01

The purpose of this study was to examine changes of androgenic markers in obese women after injection of subcutaneous depo-medroxyprogesterone acetate (DMPA-SC). Five normal weight women [body mass index (BMI)=18.5–24.9 kg/m2], five with Class 1–2 obesity (BMI=30–39.9 kg/m2), and five with Class 3 obesity (BMI ³ 40 kg/m2) women received injections of 104 mg DMPA-SC at baseline and 12 weeks later. Serum levels of androstenedione (A), testosterone (T), dehydroepiandrosterone sulfate (DHEA-S), sex hormone-binding globulin, and 3a-androstanediol glucuronide (3a-diol G) were quantified by immunoassay methods at baseline and 13 and 26 weeks following the first injection; free testosterone (FT) was calculated. Androgen markers were classified as ovarian (A, T), adrenal (DHEA-S) and peripheral (3adiol-G). Kruskall–Wallis test, Fisher's Exact test and Wilcoxon's signed rank test were used for statistical analysis with p≤.05 considered significant.

Barriers to contraceptive use in TASBA-PRI, Nicaragua

M. Dickinson, J. Daniels, J. Horney, R.J. Pena Garcia, D. Morgan — 2010-08-01

Contraceptive use in developing countries is limited by obstacles related to access, including travel time to a health facility. This study examines the potential association between travel time to a health center and contraception use in Tasba Pri, Nicaragua, a remote region located on the Atlantic coast.

Community-based provision of DMPA in Tigray, Ethiopia: Task shifting to reach women

N. Prata, A. Gessessew, A. Cartwright, D. Karasek, M. Potts — 2010-08-01

To demonstrate that Community-Based Reproductive Health Agents (CBRHAs), low-level community health volunteers, can provide DMPA injections with the same efficacy, acceptability, and satisfaction as the lowest level government health workers, Health Extension Workers (HEWs), and increase access to DMPA, the most popular modern family planning method in rural Ethiopia.

IUD removals in the emergency department setting

J. Pawasarat, K Gibson, J. Jacobson, D. Turok — 2010-08-01

Intrauterine device (IUD) removal occasionally occurs in the emergency department (ED) setting. This case series will quantify the number of IUDs removed in the EDs of a private hospital system and determine the reasons for removal.

Rates of intrauterine device discontinuation after abortion vs. Interval placement

E. Woodhams, L. Owens, R. Kumar, M. Rosche, L. Borgatta — 2010-08-01

Early discontinuation of IUD use is a concern in terms of cost as well as patient satisfaction. There is limited data regarding IUD continuation rates after post-abortion placement.

Method satisfaction among users of post partum IUD in El Salvador

L. Orellana, C. Castaneda, J.C. Lovo, A.M. Henríquez, C. Bixiones, P. Blumenthal — 2010-08-01

Population Services International (PSI), through its local affiliate in El Salvador, PASMO, initiated the Women's Health Project to increase access to and utilization of long acting and reversible contraception. Use of post-partum intrauterine devices (PPIUD) was identified as an under-utilized approach. In April 2009, PSI-PASMO introduced PPIUD at the National Maternity Hospital. This method was not previously available in public facilities.

Ovarian suppression in normal-weight and obese women using a contraceptive vaginal ring

A.H. Torgal, E.R. Mayeda, M.V. Dragoman, D. Linker, C.L. Westhoff — 2010-08-01

To compare ovarian suppression between normal-weight and obese women during contraceptive vaginal ring (15 mcg ethinyl estradiol/120 mcg etonogestrel) use. Secondary aims included comparisons of endometrial thickness and bleeding patterns.

Ovarian follicular development during six week extended use of a single contraceptive vaginal ring

A.H. Torgal, E.R. Mayeda, M.V. Dragoman, D. Linker, C.L. Westhoff — 2010-08-01

To assess ovarian follicular development among women using a single contraceptive vaginal ring (15 mcg ethinyl estradiol/120 mcg etonogestrel) for 6 weeks continuously. Secondary aims included comparisons of endometrial thickness and bleeding patterns during the 6-week regimen.

Continuation and acceptability of the levonorgestrel intrauterine system and depo-medroxyprogesterone acetate among adolescents and young women

T.R. Harken, D. Grossman, A. Sokoloff, B. Brown, A. Foster-Rosales, T.R. Raine — 2010-08-01

Given the high rate of unintended pregnancy and abortion in teens and young women in the United States, finding more effective and acceptable forms of contraception is a priority. Evidence suggests that the levonorgestrel intrauterine system (LNG-IUS) is a safe and effective method for teens and young women; however, little is known about the acceptability of and continuation with this method.

The effect of parity on reasons for removal of a levonorgestrel IUS

T. Behringer, M. Reeves, B. Rossiter, B.A. Chen, E.B. Schwarz — 2010-08-01

To examine reasons for discontinuation of a levonorgestrel intrauterine system (IUS) among nulliparous and parous women served by an urban academic clinic. We reviewed all follow-up visits made prior to February 2010 by 399 women who had a levonorgestrel-releasing IUS placed between July 2005 and June 2008. Reasons for IUS discontinuation were categorized and examined by parity.

Self-administration of subcutaneous depot Medroxyprogesterone acetate by adolescent women

R.L. Williams, D.J. Hensel, D. Fortenberry — 2010-08-01

The intramuscular contraceptive depot medroxyprogesterone acetate (DMPA-IM) is now available in subcutaneous (SC) formulation, potentially allowing for home-based self-administration. We conducted the first examination of adolescent women's interest in and proficiency at DMPA-SC self-administration.

Provision of postpartum contraception in women with chronic medical conditions

A. Gerhardt, J. Chor, A. Cowett — 2010-08-01

Because chronic medical conditions can worsen in pregnancy and adversely affect maternal and fetal health, family planning in this population is important. Prenatal care provides an opportunity for contraceptive counseling. In women with medical diseases, contraceptive counseling may be overshadowed by management of their conditions and by the complexity of counseling. We sought to compare postpartum contraception methods prescribed to women with and without chronic medical conditions.

Use of a self-administered computer module providing personalized contraceptive recommendations in a clinical setting

M. Kottke, P. Goedken, S. Nash, C. Cwiak, R. Hatcher — 2010-08-01

Barriers exist to comprehensive contraceptive counseling. New technologies may assist in streamlining the process. This study evaluated the use of a computer-based survey providing personalized contraceptive information in a clinical setting.

Cost analysis of hysteroscopic sterilization versus the intrauterine device as long-term contraception

M. Zapata, A. Chen, R. Rible, R. Parvataneni — 2010-08-01

The intrauterine device (IUD) is effective as laparoscopic tubal sterilization (LS), reversible and more cost effective in a 5 year model. Hysteroscopic sterilization (HS) is less invasive, as or more effective than LS. Published HS cost data addresses short term costs rather than the long term societal perspective. We compared the cost of HS with IUD for long-term contraception using decision analysis modeling incorporating clinical outcomes

Ibuprofen prophylaxis for levonorgestrel-releasing intrauterine system insertion: a randomized controlled trial

J. Chor, B. Harwood, A. Cowett — 2010-08-01

Our objective was to determine whether prophylactic ibuprofen reduces pain during insertion of the levonorgestrel-releasing intrauterine system (LNG-IUS). We conducted a double-blind placebo controlled trial, randomizing women to 800 mg ibuprofen or placebo 30 minutes prior to LNG-IUS insertion. Women completed a questionnaire regarding gynecologic history and recorded the level of pain anticipated during the LNG-IUS insertion on a 100 mm Visual Analog Scale (VAS). Women then recorded the level of pain at the time of tenaculum placement and IUD insertion on a VAS. Thirty-seven women in each group were required to detect a 15% difference in pain at insertion with 80% power, an alpha of .05, and a standard deviation of 23 mm.

Provider opinions about expanding access to hormonal contraception

S. Rafie, S. Ghaffarian, E. Gray, M. Haycock, S. Yen, C. Harper — 2010-08-01

To gain a better understanding of healthcare providers' opinions on expanding access to hormonal contraception (oral, transdermal patch, vaginal ring and injectable) and the role of pharmacists as direct providers of these and other reproductive health services in the United States.

Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies

D. Foster, D. Hulett, M. Bradsberry, P. Darney, M. Policar — 2010-08-01

Recent studies have shown that dispensing a greater supply of oral contraceptives (OCPs) at a clinical visit is associated with fewer repeat visits and greater contraceptive continuation at 15 months after initial supply. Our current objective is to determine whether a year's supply of OCPs is associated with a reduction in unintended pregnancy compared to dispensing one ore three packs at a visit.

Length of time after insertion for the levonorgestrel-releasing intrauterine system for it to significantly alter cervical mucus quality and sperm penetrability

2010-08-01

The primary objectives are to compare cervical mucus quality and sperm penetrability prior to insertion of levonorgestrel intrauterine system (LNG-IUS) and at 1, 3 and 5 days after insertion.

Contraceptive choices of adolescents in a LARC-oriented adolescent Title X clinic

J. Sheeder, K. Gant, L. Hess, L. Romer — 2010-08-01

A Title X, adolescent-only, family planning clinic was redesigned to improve access to and acceptability of highly effective contraceptive methods. Barriers to obtaining excellent contraception were identified. After the clinic was restructured to overcome these barriers, we evaluated contraceptive choice among female adolescents initiating contraception.

Barriers to post-partum IUC use: Implications for patient contraceptive preferences and satisfaction with health services

J. McGuire, A. Lance, V. Dalton — 2010-08-01

To identify barriers to postpartum intrauterine contraception (IUC) placement and to explore patient preferences and satisfaction with contraceptive health services. Women delivering at a university hospital were recruited to participate in a survey addressing decision-making about post-partum contraception use. Additional information about health service utilization was gathered from a chart review. Women who reported an antenatal plan to use IUC post-partum were identified and followed to determine what proportion actually had IUC placed. Along with a chart review, a written survey is being administered at 6 months post-partum to identify reasons for not having it placed, patient contraception preferences and satisfaction with health services.

The impact of insurance coverage on IUD utilization

A. Gariepy, E. Simon — 2010-08-01

To evaluate the impact of insurance coverage on intrauterine device (IUD) utilization in an urban population in a state without mandatory contraceptive insurance coverage. We reviewed the records of all women with private insurance that requested an IUD for contraception in an urban academic faculty practice from May 2007 until May 2008. We determined the extent of insurance coverage, including the out-of-pocket expense to the patient, and whether she had an IUD inserted.

Characteristics of women who fail to return for delayed IUD insertion for post-abortion contraception

2010-08-01

To determine characteristics of women who choose an intrauterine device (IUD) for post-abortion contraception, but fail to return for a scheduled delayed insertion. Women requesting uterine aspiration between 5 and 12 weeks and desiring IUDs were randomized to immediate or delayed (2-6 weeks) IUD insertion. At enrollment, a detailed questionnaire was administered. Topics included demographics; obstetric, social, and contraceptive history; reproductive goals; influences and motivations for contraceptive choice.

Use of effective contraceptive methods among women taking teratogenic medications for systemic lupus erythematosus

C. Bradley, P. Segall-Gutierrez, D. Arkfeld — 2010-08-01

Women with systemic lupus erythematosus (SLE) are advised to plan their pregnancies for periods of disease quiescence and minimized teratogen exposure. Most are candidates for extremely effective contraceptive methods (EECM) (typical use failure rate ≤3%) including depomedroxyprogesterone acetate, implants, intrauterine contraceptive devices or permanent sterilization. However, these methods are often underutilized. This study aims to assess whether women with SLE who are at risk for pregnancy and using specific teratogenic medications (methotrexate, mycophenolate mofetil, cyclophosphamide, alendronate sodium or leflunomide) are also using EECM.

Are there differences? SHBG levels, free testosterone and sexual pain in women using combined hormonal contraception: a retrospective study in vulvodynia patients

Y. She, A. Bhattacharya, S. Kellogg-Spadt, P. O'Hare, L. Ekbladh, K. Whitmore — 2010-08-01

It is estimated that more than 2.4 million women in the United States have vulvodynia. Many of these women use contraception containing both estrogen and progestin. Hormonal contraception has been shown to affect serum level of sex hormone-binding globulin (SHBG), a protein binds free testosterone. The goal of this study is to explore the differences and relationships among SHBG levels, serum testosterone and sexual pain in vulvodynia patients using various hormonal contraception regimens.

Partnership characteristics as predictors for choosing a very effective contraceptive method

A.M. Langston, L.Y. Rosario, C.L. Westhoff — 2010-08-01

To describe partnership characteristics as predictors for choosing a very effective contraceptive method immediately after a first trimester uterine evacuation procedure. This was a planned secondary analysis of data from a randomized controlled trial. Women seeking a first trimester evacuation procedure at an academic family planning practice in New York City enrolled in the study. Participants reported partnership characteristics at enrollment.

Unmet demand for sterilization among Latinas

2010-08-01

Surgical sterilization is the most commonly used method of contraception in the United States, yet there have been indications that access to this method is limited for some segments of the population. We interviewed low-income oral contraceptive users in El Paso, Texas to assess frustrated demand for sterilization among oral contraceptive users who wanted no more children.

Examining the influence of maternal characteristics on the use of contraception after abortion in the United States using the 2002 National Survey of Family Growth

M. Ivankovich — 2010-08-01

In the United States, nearly half of all pregnancies are unintended and almost half of these end in abortion; 47% of all induced abortions are repeat procedures. Contraception, especially post-abortion contraception, may be the most effective way to prevent unintended pregnancies and repeat abortions. This is the first attempt to characterize post-abortion contraceptive use in the United States at a national level.

Medical versus surgical abortion: The importance of women's choice

C. Moreau, J. Trussell, J. Desfreres, N. Bajos — 2010-08-01

Using a large national sample of women undergoing an abortion in France, we explore the factors associated with the choice of abortion technique. We draw particular attention to the influence of women's preferences in the decision making process.

Women's attitudes and behaviors toward unplanned pregnancy: A prospective study

P. Castaño, L. Polen, E. Jackson, P. Namerow, C.L. Westhoff — 2010-08-01

To identify factors associated with women's attitude toward their unintended pregnancies and with their decision to continue or terminate that pregnancy. From a cross sectional study of 1539 reproductive-age women seeking pregnancy testing in an inner city family planning clinic, we performed a secondary analysis of data from 497 women with a positive pregnancy test, who reported the pregnancy was unintended, were in a relationship and with known pregnancy outcome. Using multivariate analyses, we assessed associations between demographic, relationship, and reproductive history variables; women's attitude toward their pregnancy and their pregnancy outcome.

Changes in service delivery patterns after launching telemedicine provision of medication abortion in Iowa

D. Grossman, K. Grindlay, T. Buchacker, J.E. Potter, C. Schmertmann — 2010-08-01

Planned Parenthood of the Heartland in Iowa developed an innovative model to provide medication abortion (MA) via telemedicine in outlying clinics without on-site physicians. The purpose of this study was to describe the changes in service delivery patterns after initiating telemedicine in June 2008.

Has mifepristone medical abortion expanded abortion access in New Mexico? A survey of Ob/Gyn and family medicine physicians

E. Espey, C. Eyman, L. Leeman, T. Ogburn, M. North — 2010-08-01

To examine the impact of mifepristone medication abortion availability on abortion access in New Mexico, we conducted two surveys of attitudes, barriers and provision of medication abortion among New Mexico Ob/Gyn and family medicine (FM) physicians in the years 2001 and 2008.

Reproductive health program: outcomes of a unique abortion training program

M. Greenberg, C. Herbitter, B. Gawinski, J. Fletcher, M. Gold — 2010-08-01

In the US, 88% of counties have no abortion provider. Despite the need for more clinicians to provide safe abortion care, few primary care clinicians receive training. From 1999 to 2005, the Reproductive Health Program (RHP) at the University of Rochester Medical Center (URMC) offered elective abortion training to medical students, residents, and practicing clinicians, most of whom were primary care physicians and APCs. To our knowledge, this is the first study assessing primary care abortion trainees who have become abortion providers.

“Are we even speaking the same language?”: contested definitions of rape, incest and life endangerment under the Hyde Amendment

A. Dennis, K. Blanchard — 2010-08-01

In 1976, Congress passed the Hyde Amendment which is now routinely passed as part of the annual appropriations process and prohibits federal Medicaid funding for abortions except in the cases of rape, incest or life endangerment of the woman. Few guidelines exist on how determine whether a specific case qualifies for federal Medicaid funding. We aimed to document how abortion providers' interpret the Hyde Amendment and investigate their experiences seeking Medicaid funding.

Standardizing early abortion complication definitions and tracking: testing an evidence-based framework

D. Taylor, E.A. Drey, D. Fischer, M. Gatter, K. Sheehan, J. Waldman, T.A. Weitz — 2010-08-01

Existing abortion complication tracking methods do not follow the federal patient safety tracking methods for identifying procedural complications, which define adverse events by diagnoses (ICD codes), treatments (CPT codes) and outcomes. Due to the lack of consensus on abortion-related complication definitions or estimates of post-abortion complications, we evaluated a minimum dataset and standardized coding methods as part of a larger study of early abortion provision outcomes.

Ovulation resumption after medical abortion with mifepristone and misoprostol

S. Sober, S. Ratcliffe, M.D. Creinin, C. Schreiber — 2010-08-01

To measure the time to ovulation in women who received mifepristone 200 mg orally and misoprostol 800 mcg vaginally for abortion up to 63 days of gestation. This planned substudy was part of a multicenter randomized trial of mifepristone 200 mg followed immediately or 24 h later by misoprostol 800 mcg vaginally. Women who had successful expulsion of the gestational sac based on ultrasound examination one week after mifepristone treatment were enrolled. All subjects agreed to use non-hormonal contraception until substudy completion. Baseline serum progesterone (P) levels were drawn on day 8±1 after mifepristone administration and then twice weekly until the P level was>3 ng/ml, consistent with ovulation. The mean time-to-ovulation was calculated using interval censored regression to address the censoring due to participant discontinuation.

Preliminary results of the role of semiquantitative pregnancy tests in medical abortion provision

2010-08-01

Standard medical abortion practice involves in-clinic follow-up to confirm abortion completion. Alternatively, negative results on a validated pregnancy test, with high predictive value, taken at home one to two weeks after medical abortion could reduce the number of follow-up visits, thus simplifying clinical practice worldwide. This study employs a semiquantitative urine pregnancy test that estimates hCG levels to assess its feasibility and acceptability for determining abortion status in lieu of clinic-based follow-up after medical abortion.

Preventing repeat abortion: is the immediate insertion of intrauterine devices post-abortion associated with fewer repeat abortions in a Canadian population?

C.M. Ames, W.V. Norman — 2010-08-01

Ninety-seven thousand two hundred fifty-four abortions were performed in Canada in 2005, 38% of which were repeat abortions. This study aims to determine whether the provision of free intrauterine devices (IUDs) post-abortion is associated with a reduction in the rate of repeat abortion in a Canadian population.

Dilation and evacuation vs. labor induction for fetal indications: a retrospective cohort study

A. Bryant, G. Stuart, D.A. Grimes — 2010-08-01

Little is known about the optimal method of uterine evacuation in case of fetal anomalies or fetal death in the second trimester. Most published reports only compare methods of labor induction. We performed this retrospective cohort study to examine the safety of dilation and evacuation vs. labor induction for these indications at a tertiary care hospital.

Abortion practice and need for training in Mexico: Results from a survey of Mexican providers at the 2009 annual obstetrics and gynecology specialty conference

D. Walker, I. Dayananda, E. Atienzo, S. Haider — 2010-08-01

Abortion training has not been evaluated among providers in Mexico. This is especially important given the depenalization of abortion in Mexico City (DF) in 2007. We surveyed 418 Mexican providers at the 60th Colegio Mexicano de Especialistas en Ginecologia y Obstetricia meeting in 2009, using an anonymous audio computer-assisted self-interviewing (ACASI) survey.

Contraceptive choices of overweight and obese women in a publicly funded hospital: Clinical implications

R. Scott-Ram, A. Patel, L. Keith, V. Bhogireddy — 2010-08-01

Obese women have the same risk of pregnancy as normal weight women, but this population has been understudied despite the growing obesity epidemic. The aim of this study is to outline the contraception preferences of obese women as compared to normal weight women.

Impact of gestational age on pain perception during first trimester surgical abortion

R.-M. Renner, A. Edelman, M. Nichols, J. Jensen — 2010-08-01

To study the effect of gestational age (GA) on patient pain perception in women undergoing first trimester surgical abortion. A post hoc analysis of two randomized double-blind, placebo-controlled trials that assessed the effect of 5 ml of 1% and 4% intrauterine lidocaine respectively, in addition to a standard paracervical block (n=160). Women reported their perceived pain (anticipated pain, after speculum insertion, after intrauterine infusion, after cervical dilation, after suction aspiration, and 30 minutes post-procedure) on a series of 100-mm visual analog scales (anchors: 0=none, 100 mm=worst imaginable). Our data analysis tested for association between pain score and GA ≤76/7 weeks and ≥80/7 weeks (determined by ultrasound).

Impact of a specialty rotation in family planning on obstetrics and gynecology residents' self-assessment of competency and intentions to provide abortion services after graduation

L. MacIsaac, Z. Vickery, P. Friedmann — 2010-08-01

The availability of abortion in the US remains threatened by many factors, including the declining numbers of physicians trained to provide them. Lack of training during residency has been cited by obstetrician/gynecologists as a reason for not including abortion services in their practice.

The extended gestational age medical abortion study: the effectiveness of medical abortion with mifepristone and misoprostol at 57–63 days versus 64–70 days gestation

2010-08-01

Medical abortion with in-patient regimens is safe and effective through late first trimester, yet women who narrowly pass the 63-day LMP limit are denied out-patient medical abortion because data on out-patient regimens are lacking. We compared the effectiveness and acceptability of early medical abortion protocols with home administration of misoprostol in pregnancies 64–70 and 57–63 days of gestation.

Music in surgical abortion care: a randomized controlled pilot study

J. Wu, W. Chaplin, J. Amico, M.J. Ojie, D. Hennedy, M. Butle, L. Clemow — 2010-08-01

To investigate the effect of music therapy as an adjunct to local analgesia on pain and anxiety during first trimester surgical (aspiration) abortion. We conducted a randomized controlled pilot study comparing: (1) music therapy via headphones in addition to local analgesia (pre-procedural oral ibuprofen and a paracervical block) versus (2) local analgesia only. Primary outcomes included pain and anxiety assessed with 11-point verbal analogue scales (VAS) at five time points. Secondary outcomes included patient satisfaction (four-point Likert scale) and self-perceived coping ability (11-point VAS, 0=did not cope well at all; 10=coped extremely well). We conducted mixed effects regression analyses to compare trends in pain and anxiety as well as scores at individual time points.

Can the prospect of infertility motivate young women's intentions to seek preventive healthcare? Findings from CDC concept testing focus Groups

A. Friedman, B. Bloodgood, J. Bender, E. Levine — 2010-08-01

Chlamydia is a leading cause of pelvic inflammatory disease, which can lead to infertility, ectopic pregnancy, and chronic pelvic pain. The Centers for Disease Control and Prevention (CDC) reported >1.2 million cases of Chlamydia in 2008, with the highest rates among 15–24 year-old females. To inform a national infertility prevention campaign, CDC sought to test three approaches to promoting Chlamydia screening. Concepts were designed to (1) diminish identified barriers to screening, (2) emphasize female empowerment and (3) emphasize women's health and infertility in relation to their life aspirations.

High-risk sexual behaviour in a random sample of >22,000 men from the general population in Denmark

N. Buttmann, A. Nielsen, C. Munk, K.-L. Liaw, S.K. Kjaer — 2010-08-01

Sexual intercourse is the primary route of transmission of human papillomavirus (HPV). As sexual habits of men play a vital role in the transmission of HPV, we aim to provide estimates and correlations on sexual risk behaviour defined as ≥10 lifetime sex partners, ≥2 new sexual partners in the last 6 months and sexual contact to commercial sex workers.

Experiences of discrimination and STI testing in white and black women

J. Allsworth, A. Graseck, G. Secura, T. Madden, J. Peipert — 2010-08-01

To test whether prior experiences of race-, gender-or economic-based discrimination impacts sexually transmitted infection (STI) testing rates in a randomized trial of home- vs. clinic-based testing.

Missed opportunities for Chlamydia retesting at limited service visits in California family planning clinics

H. Howard, J. Chow, H. Bauer, G. Wright, M. Menz, R. Zerne, G. Bolan — 2010-08-01

Chlamydia reinfection in women is common and associated with adverse reproductive complications. National guidelines recommend retesting for Chlamydia 3 months post-treatment for initial infection, yet retesting rates remain low in family planning settings. The aim of this study was to describe clinic return and retesting patterns by visit type and propose structural interventions for improved opportunistic retesting.

The baboon (Papio anubis) as a novel model of Chlamydia trachomatis pelvic inflammatory disease for testing intrauterine contraception

2010-08-01

Pelvic inflammatory disease (PID) is a major source of morbidity and infertility. The influence of intrauterine contraception (IUC) on the pathogenesis of PID is unknown. To better understand the biology of PID, and eventually study its relationship to IUC use, we sought to develop a baboon PID model.

Imiquimod 2.5% and 3.75% applied daily for up to 8 weeks to treat external genital warts

D. Baker, D. Ferris, S. Tyring, K. Ault, S. Levy, T. Liu, G. Barry, J. Wu — 2010-08-01

Evaluate imiquimod 2.5% and 3.75% applied daily for up to 8 weeks to treat external genital warts. In two phase 3 randomized studies, subjects ≥12 years of age with 2–30 external genital warts and total wart area ≥10 mm2 applied placebo, imiquimod 2.5–3.75% (1:2:2) cream once daily to warts until complete clearance of all (baseline and new) warts or up to 8 weeks. Clearance assessment was up to 8 weeks post-treatment. Subjects with complete clearance were also assessed for 12-week sustained complete clearance.

Elderly person's reproductive health challenges and involvement in risky sexual activities in Ikorodu, Nigeria

O. Adebola — 2010-08-01

Most studies on sexual behaviour in Nigeria focus on young people, limited attention is paid to the elderly. There is a dearth of information about elderly persons' RH challenges and involvement in risky sexual activities. This study examined the perceptions of sexual practices and RH problems among the elderly in Ikorodu, Nigeria.

Predictors of sexual satisfaction among young adults in the United States

J. Higgins, M. Mullinax, J. Trussell, J.K. Davidson, M. Nelwyn — 2010-08-01

The WHO defines sexual health as “a state of physical, emotional, mental, and social well-being, not merely the absence of disease or dysfunction.” Yet, virtually no reproductive health research examines factors associated with sexual well-being. This study intended to assess correlates of sexual satisfaction among young adults.

Reproductive and sexual health in mentally ill

N.R. Matevosyan — 2010-08-01

To explore perceived sexual and reproductive health in cross-section of forty four outpatient women with DSM-IV Axis-I disorders. An institutional review board-approved mixed-method study explored perceived sexual and reproductive health in cross-section of 44 women with serious mental illnesses (SMI). Candidate factors (history of sexual abuse, provisional psychiatric diagnoses, length of treatment, numbers and combinations of prescribed medications,) confounders (age, education, hormone replacement therapy, age at menopause), intervening variables [body mass index (BMI), behavior and symptom identifications subscales-BASIS 24], and measurable outcomes (sexual activity scores, gynecological problems, STD counts, abortions) were modeled for Pearson correlations and Poisson regression for inferences and causality.

Sexual intimate partner violence, sexual risk behaviors, and contraceptive practices among women of African descent

J. Stockman, J. Campbell, D. Campbell, P. Sharps, G. Callwood — 2010-08-01

Sexual intimate partner violence (IPV) and HIV/AIDS have been shown to be linked through sexual risk taking behaviors. We studied the prevalence of sexual IPV and associations with sexual risk behaviors and contraceptive practices among predominantly low-income women of African descent.

Reproductive healthcare needs of HIV-positive women

M. Badell, E. Lathrop, P. Goedken, S. Nash, M. Nguyen, C. Cwiak — 2010-08-01

To determine current rates of contraception and sterilization, and future contraceptive and fertility desires of HIV-positive women. HIV-positive women at an infectious disease clinic completed a self-administered, paper survey on their contraceptive and reproductive history, and future contraceptive and fertility desires. Descriptive analyses were performed.

Contraceptive knowledge, attitudes, and practices among HIV-infected women and men receiving HIV care and treatment in Nyanza Province, Kenya

2010-08-01

To describe contraceptive knowledge, attitudes, and practices among HIV-infected women and men attending HIV clinics in Nyanza Province, Kenya. Face-to-face surveys were conducted among 489 women and 489 men at 18 government-run HIV care and treatment clinics in Nyanza.

High contraception use and low pregnancy rate among HIV positive women attending a postnatal program in Lilongwe, Malawi

2010-08-01

To assess contraception use and pregnancy rate among HIV+ women attending a postnatal program in Lilongwe, Malawi. From December 2008, HIV+ women approximately 6 months post-delivery enrolled in a program providing water purification and nutrition products and counselling (contraceptive, weaning, hygiene) at monthly visits through 18 months. From August 2009, enrollees were asked current contraceptive method and pregnancy status at each visit. We described reported methods at initial inquiry and compared demographic and clinical factors according to contraceptive use status. Among those with >1 visit, we determined modifications in contraception over time.

Intrauterine lidocaine infusion for pain management during outpatient transcervical tubal sterilization

M. Isley, J. Jensen, M. Nichols, P.H. Bednarek, A. Lehman, A. Edelman — 2010-08-01

To study the effects of a 4% intrauterine lidocaine infusion prior to hysteroscopy on patient perceived pain during transcervical sterilization (Essure®). A randomized, double-blind, placebo-controlled trial in which all subjects received standard premedication with 800 mg of ibuprofen, a 10-ml 1% lidocaine paracervical block, and transcervical instillation of 5 ml of either 4% lidocaine or saline 5 minutes prior to insertion of the hysteroscope. Subjects completed a series of 100-mm visual analogue scales (anchors, 0 mm=none, 100 mm=worst imaginable) to measure their perceived pain at a variety of time points during and after the procedure. Serum lidocaine levels were obtained. The study was designed to detect a minimum difference of 20 mm in the VAS score between groups with 80% power.

Risk factors for and consequences of unintended pregnancy among Latina and white populations in Utah, 2004-2007

M. Flores, E.B. Schwarz, T.A. Manuck, J. Jacobson, S.E. Simonsen, D.K. Turok — 2010-08-01

To examine differences in pregnancy intentions and perinatal outcomes among US-born Latinas (USBLs), foreign-born Latinas (FBLs), and non-Latina whites. Cross-sectional study of data from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey linked to Utah birth certificates. Complex survey design and weighting methods were used to analyze data from 190,948 mothers delivering a singleton, live birth ≥20 weeks gestation, from 2004 to 2007.

Comparison of LNG20, a new levonorgestrel intrauterine system, and Mirena for treatment for menorrhagia

V. Gordenne, F. Wijzen, J.-M. Foidart, T. Marmon, M.D. Creinin, F. Frankenne — 2010-08-01

To compare the safety and efficacy of LNG20, a new levonorgestrel intrauterine system (LNG-IUS), and a marketed LNG-IUS, Mirena®, over 12 months for treatment of menorrhagia. A total of 280 women with menorrhagia were recruited at 15 sites in 3 European countries. Women with a mean blood loss per cycle of at least 80 ml over three baseline cycles were randomized in a 1:1 ratio to LNG20 or Mirena. Subjects were seen at weeks 1, 2, 4, 13, 24, 38 and 52. Blood loss was assessed using a validated modified Wyatt pictogram. Women who completed ≥ 360 days of IUS use without protocol violations were included in this analysis. Noninferiority, using a one-sided ratio test procedure, was defined as a ratio of mean changes in blood loss (LNG20/Mirena) >0.75.

Presumptive treatment of abnormal early pregnancy of unknown Location

C. Cooksey — 2010-08-01

Early pregnancies with inappropriately increasing serum hCG may be intrauterine or ectopic. When ultrasound is unable to localize the gestation, suction curettage can exclude an intrauterine gestation before methotrexate administration. Whether suction curettage is necessary in this setting is unclear. We performed a decision analysis to evaluate whether abnormal pregnancy of unknown location may be treated primarily with intramuscular methotrexate regardless of location, thus avoiding curettage.

Vaginal and rectal clostridial colonization among women of reproductive age in the United States

2010-08-01

The primary objective of this pilot study was to establish the baseline prevalence for vaginal and rectal colonization with C. sordellii and C. perfringens among women of reproductive age in the United States.

Two-stage cluster sampling with referral: improving the efficiency of estimating unmet needs among pregnant and postpartum women after flooding in northwest Georgia, September 2009

J. Jennifer Horney, M. Dickinson, J. Hsai, A. Williams, M. Zotti — 2010-08-01

Women of reproductive age (WRA) are uniquely vulnerable to disasters, which create stressors for caregivers, limit access to pre-natal/post-partum care or interrupt contraception. Traditional approaches (e.g., newborn records, community surveys) to survey WRA about unmet needs may not be practical after a disaster. Finding WRA who are pregnant/post-partum is challenging as<5% of WRA are pregnant/post-partum at any time. We piloted a sampling strategy to increase the proportion of WRA who were pregnant/post-partum women in Cobb/Douglas Counties (GA) after flooding in September 2009.

Rural reproductive health: barriers and facilitators experienced by low-income rural women in obtaining reproductive health care services

E. Ladoceour, J.N. Curtis — 2010-08-01

Although it has been well documented that women living in rural areas of the United States receive less and poorer quality reproductive healthcare than urban and suburban women, the reasons behind this disparity have received little research attention and are poorly understood. This study explores the issues experienced by low-income rural women in their attempts to access reproductive health care and their perceptions about barriers and facilitators to care.

Effect of a "contraceptive vital sign" in primary care: a randomized controlled trial

E.B. Schwarz, S. Parisi, G. Fischer, S. Handler, R. Hess — 2010-08-01

To evaluate the feasibility and effect of routine assessment of women's pregnancy intentions and contraceptive use on primary care physician (PCP) prescription practices. Fifty-five PCPs in an academic general internal medicine practice were randomly assigned to an intervention or control group. The intervention group received a “contraceptive vital sign” (information about their patients' pregnancy intentions and recent contraceptive use) prior to all visits. Control PCPs continued their usual practice. We reviewed medical records for 1256 pre-intervention clinic visits and 2291 visits that occurred in the 10 months post-intervention.

Association between Economic Vulnerability and Women's Pregnancy Intentions

T. Wolfe, A. Vahratian, X. Xu, L. Harris — 2010-08-01

To examine the association between indicators of economic vulnerability and pregnancy intentions using multiple waves of the National Survey of Family Growth data. We performed cross sectional analysis of four nationally representative samples of women aged 15–44 years who participated in 1982, 1988, 1995 and 2002 National Survey of Family Growth. For each dataset, we conducted bivariate analysis and multivariable logistic regressions to examine the association between economic vulnerability and pregnancy intentions.

Impact of length of formal family planning training on self-assessed competence and procedure volume of abortion procedures

J. Turk, M. Hawkins, M. Gonzalez, U. Landy, J. Steinauer — 2010-08-01

The purpose of this study was to assess the impact of rotation length on clinical exposure and competence in abortion procedures among residents in formal family planning training.

Impact of formal family planning training on ob-gyn residents' skills and exposure in contraception provision

J. Turk, M. Fulton, G. Patel, U. Landy, J. Steinauer — 2010-08-01

The purpose of this study was to assess the impact of formal, opt-out family planning training on clinical exposure and competence in contraception skills and procedures among ob-gyn residents.

Innovation in emergency obstetric training, PRONTO2: an in situ multi-disciplinary, low-tech, high-fidelity simulation-based curriculum for Mexico, Results of a pilot implementation study

D. Walker, S. Cohen, F. Estrada — 2010-08-01

Suboptimal response to obstetric emergencies is responsible for maternal deaths worldwide. We aimed to develop, pilot and evaluate an innovative training approach in four rural Mexican hospitals where emergency response suffers from knowledge, resource, and infrastructure limitations. High-fidelity simulation learning and team training addresses these barriers by focusing on mobilization of resources, leadership, communication and coordination of care.

Contraception Use After An Unplanned Pregnancy

S. Pentlicky, C. Williams — 2010-08-01

In recent years, approximately half of pregnancies were unplanned. With unplanned pregnancies, women and neonates experience poorer outcomes. We hypothesized that women who have an unplanned pregnancy are more likely to use contraception postpartum than women who have a planned pregnancy due to greater motivation to prevent a repeat unplanned pregnancy.

Erratum to “Two medical abortion regimens for late first-trimester termination of pregnancy: a prospective randomized trial” [Contraception 2010;81:323–7]

2010-05-31

In the above article, the authors' names were transposed and printed incorrectly. They now appear correct. The authors regret any confusion this error may have caused.

Contraception

Editorial Board

Contents

Joseph W. Goldzieher and the birth of hormonal contraception

Introduction to Controversies in Family Planning

The missing IUD

Bringing evidence to the debate on abortion coverage in health reform legislation: findings from a national survey in the United States

Endocrinological, metabolic and clinical features of treatment with oral contraceptive formulation containing ethinylestradiol plus chlormadinone acetate in nonobese women with polycystic ovary syndrome

Effect of oral contraceptive containing ethinyl estradiol combined with drospirenone vs. desogestrel on clinical and biochemical parameters in patients with polycystic ovary syndrome

Effects of two combined hormonal contraceptives with the same composition and different doses on female sexual function and plasma androgen levels

Effects of sex hormones in oral contraceptives on the female sexual function score: a study in German female medical students

Pharmacist-administered subcutaneous depot medroxyprogesterone acetate: a pilot randomized controlled trial

Postexposure prophylaxis for victims of sexual assault: treatments and attitudes of emergency department physicians

Effect of depot medroxyprogesterone acetate on postpartum depression

Attitudes and beliefs about the intrauterine device among teenagers and young women

Reproductive Health 2010 Scientific Abstracts Atlanta, GA, September 22–25, 2010

The utility of sonographic assessment of intrauterine device placement following immediate vs. delayed insertion following uterine aspiration

Contraceptive and pregnancy outcomes: a randomized controlled trial of immediate vs. delayed post-abortal copper T 380A IUD insertion after second trimester abortions

The safety of digoxin as a feticidal agent

Music as an auxiliary analgesic during first trimester surgical abortion: a randomized control trial

Introducing medical abortion in Nepal with minimal technology

A double-blinded randomized trial of same-day Dilapan-S vs. overnight laminaria for cervical preparation before surgical abortion between 14 and 18 weeks' gestation

Early weight gain and its relationship to later weight gain in adolescents on DMPA

The impact of pack supply on oral contraceptive continuation: a randomized controlled trial

Do depressed mood, psychological stress and eating disordered symptoms increase the risk for oral contraceptive discontinuation in young minority women?

Does convenience matter? Oral contraceptive continuation along the US–Mexico border

Comparison of the incidence of pelvic inflammatory disease in intrauterine devices users by gonorrhea and chlamydia screening strategies

Randomized trial of home vs. clinic-based screening for sexually transmitted infections in long-acting reversible contraceptive users

Pregnancy intentions and family planning preferences among HIV-infected women in Nyanza Province, Kenya

Can parents teach their teens to have safe sex? Results of an educational intervention for parents in Mexico

Rates of continuation and expulsion of intrauterine contraception at 12 months in nulliparous and adolescent women

Revitalizing long-acting reversible contraceptives in settings with high unmet need: a multi-country experience matching demand creation and service delivery

Prophylactic misoprostol prior to IUD insertion in nulliparous women

Resumption of sexual activity after first trimester suction aspiration

Structured contraceptive counseling: a randomized controlled trial

Txt Now 2 Decrease Pregnancies L8r: a randomized control trial to evaluate the effect of daily educational text messages on oral contraceptive continuation in young urban women

STI/Pregnancy prevention using technology-based education

A randomized trial of immediate versus delayed insertion of the Copper T 380Q following medication abortion

Pain Following Post-Aspiration IUD Insertion

Using qualitative methods to explore EC Users willingness to accept the copper IUD

Transcesarean IUD insertion: a prospective cohort study

Rates of expulsion at 6 months in women undergoing immediate postabortion intrauterine contraception insertion

Estimated cost savings with providing universal contraception in the state of Oregon

Predictors of patient use of highly effective post-partum contraception

Effects of St. John's Wort on the pharmacokinetics of levonorgestrel in emergency contraceptive (EC) dosing

Evaluation of oral contraceptive effectiveness in a large cohort study — is elevated BMI associated with reduced oral contraceptive effectiveness?

Comparing the contraceptive decision-making of women who choose an intrauterine device versus a less effective method: a qualitative analysis

Comparing outcomes following immediate or delayed levonorgestrel-IUD insertion after dilation and curettage, dilation and evacuation and vaginal delivery

Contraceptive use among women obtaining abortions in 2008

Couples-based family planning services: is there a need?

Levonorgestrel release rates with LNG20, a new levonorgestrel intrauterine system, and Mirena

Knowledge of contraceptive effectiveness among a cohort of St. Louis women choosing reversible contraception

Plasma levonorgestrel levels in women using LNG20, a new levonorgestrel intrauterine system, and Mirena

Continuation and satisfaction of reversible contraception: A preliminary analysis from the Contraceptive CHOICE project

Understanding the attitudes of black, Latino, and white couples towards sterilization

Carbamazepine coadministration with an oral contraceptive: Effects on steroid pharmacokinetics, ovulation and bleeding

What do women want? Women's experiences and preferences about contraceptive counseling: a qualitative study

Pain with IUD insertion following prophylactic ibuprofen: a randomized trial

US adolescent experience with intrauterine device insertion and use: a retrospective study

Emergency contraception knowledge and likelihood of use by women with recent poor perinatal outcomes

Contraceptive choices in patients with low literacy skills

What factors influence women's contraceptive decisions?

Family planning provider attitudes and practices related to provision of contraceptive methods among women with various characteristics and medical conditions

Medical student intrauterine contraception knowledge and attitudes: evaluation of obstetric and gynecology clerkship training

Association of age and LARC method choice in the contraceptive choice project

Unmet need for publicly funded family planning in region IV

Prevalence of Chlamydia trichomatis and Neisseria gonorrhoea in patients requesting IUD as post abortion contraception in a publicly funded pregnancy termination clinic

Giving young women in Kenya an opportunity to use implants instead of short-acting methods: prospective study to measure acceptability and benefits

Factors associated with choosing a long acting reversible contraceptive method amongst postpartum women in an urban teaching hospital

Effect of subcutaneous depot-medroxyprogesterone acetate on serum androgenic markers in normal weight, obese and extremely obese women

Barriers to contraceptive use in TASBA-PRI, Nicaragua

Community-based provision of DMPA in Tigray, Ethiopia: Task shifting to reach women

IUD removals in the emergency department setting

Rates of intrauterine device discontinuation after abortion vs. Interval placement

Method satisfaction among users of post partum IUD in El Salvador

Ovarian suppression in normal-weight and obese women using a contraceptive vaginal ring

Ovarian follicular development during six week extended use of a single contraceptive vaginal ring

Continuation and acceptability of the levonorgestrel intrauterine system and depo-medroxyprogesterone acetate among adolescents and young women

The effect of parity on reasons for removal of a levonorgestrel IUS

Self-administration of subcutaneous depot Medroxyprogesterone acetate by adolescent women