09/18/15
New research from the UCSF Bixby Center is answering important questions about how to make pregnancy safer for women worldwide. In two new studies, UCSF Bixby researchers examine novel approaches to make childbirth and abortion, two common pregnancy outcomes, safer — particularly for women without easy access to care.
The first study examined a novel approach to treat postpartum hemorrhage (PPH) – or heavy bleeding after giving birth — which is the leading cause of maternal death. The current approach to treat PPH, called universal prophylaxis, gives misoprostol or oxytocin to all women after birth. It is unclear if universal prophylaxis saves women's lives, as some women still bleed heavily despite the treatment. Cost and supply-chain issues also make it difficult to offer this treatment to all women. Given these issues, the researchers compared this approach with a novel approach — giving misoprostol to only the small proportion of women who bleed more than average after birth.
They found that this novel approach resulted in substantially fewer women receiving medication (4.7 percent versus 99.7 percent). There was no difference in the rate of PPH, or the rate of transfer to other health facilities to treat complicated cases of PPH. The researchers concluded that this novel approach is a feasible alternative to universally medicating all women who give birth, and that it may be more acceptable, cost-effective and sustainable at the community level.
The second study investigated how to make abortion safer for women around the world. In countries where abortion is illegal or performed outside the health system, women may have complications such as prolonged bleeding. If women are concerned about seeking care for post-abortion bleeding, or if there is a delay in receiving care, they are at risk of death. UCSF Bixby researchers have previously demonstrated that the non-pneumatic anti-shock garment (NASG), a low-technology first-aid device, decreases blood loss and deaths from PPH. In a new study, they confirmed that the NASG also decreases bleeding and death after an abortion.
With data collected in Egypt, Nigeria, Zambia, and Zimbabwe, they found that blood loss significantly decreased when providers used the NASG to manage bleeding post-abortion. Women treated with the NASG were half as likely to die. Adding the NASG to post-abortion care among women experiencing severe bleeding and shock has the potential to save the lives of tens of thousands of women each year.
09/14/15
Around the world, millions of women are at risk of unplanned pregnancy, HIV and other sexually transmitted infections (STIs). Recent developments in the emerging field of multipurpose prevention technologies (MPTs) are poised to deliver a new generation of safe and effective prevention methods that better meet women’s needs. At an upcoming conference, researchers from the UCSF Bixby Center and partners will announce new discoveries and recent developments in the field of MPTs that will soon enable women to simultaneously prevent unplanned pregnancy, HIV and other STIs.
At the upcoming World STI & HIV 2015 Congress in Australia, the UCSF Bixby Center is co-hosting a panel on MPTs with the World Health Organization (WHO), Initiative for Multipurpose Prevention Technologies (IMPT) and the Australasian Sexual Health Alliance (ASHA). The panel will focus on:
“The growing field of MPTs is in an exciting phase of scientific advancement,” said Dr. Craig Cohen from the UCSF Bixby Center. “We are on the cusp of breakthroughs that will transform the health of women and families globally. Delivering HIV and STI prevention in combination with contraception has great potential to impact women’s health around the world. It is a promising moment for research and investment in this important field in order to make more effective prevention a reality.” More information about the panel and the conference can be found online.
09/03/15
The UCSF Bixby Center is the new home of the Bridging Interdisciplinary Research Careers in Women’s Health (BIRCWH) program. The BIRCWH program is a joint initiative of UCSF and the Kaiser Permanente Division of Research<. It aims to foster the next generation of women’s health scholars through financial support, mentorship and research training. BIRWCH includes mentors and advisors from 11 of UCSF's departments and centers, as well as Kaiser.
BIRCWH emphasizes novel, interdisciplinary approaches to a wide range of women’s health issues, with a particular focus on translation into policy impact. The Bixby Center welcomes BIRCWH scholars to its family of fellows, including members of the Fellowship in Family Planning and GloCal Health Fellowship.
08/24/15
Nearly 40 percent of women in developing countries seek birth control from the private sector. However, the reasons that women choose private or public providers are not well understood. In a new study, UCSF Bixby Center researchers examined women’s expectations and experiences when seeking family planning care from private and public facilities in Nairobi, Kenya. Through interviews and group discussions, the researchers explored women's decision-making about contraceptive use after giving birth. They found that women:
As an increasing number of women in urban areas worldwide rely on private sector health providers, these private facilities can continue to attract clients with respectful care and efficient of service. However, private providers may need assistance with technical standards of care. Public facilities, on the other hand, can improve patient care by enhancing interpersonal relationships and efficiency. These findings are also relevant to the Family Planning 2020 goal of enabling 120 million more women and girls to use contraceptives by 2020.
08/13/15
A group of federal lawmakers recently sent a letter to the Department of Health & Human Services (HHS) urging the agency to require health insurance plans to cover a 12-month supply of birth control without out-of-pocket costs. The letter cites a UCSF Bixby Center study that found a 12-month supply of birth control decreased unplanned pregnancies by 30 percent, compared with a supply of just one or three months. The study also found that giving women a one-year supply of birth control reduced the odds of an abortion by 46 percent.
Many insurance plans limit birth control prescriptions to one or three months. “If a woman is unable to refill her prescription at the time her insurance company requires, she may have a gap in her birth control use and her chanes of unintended pregnancy will increase,” the lawmakers wrote in the letter. "This is of particular concern for low- and middle-income women who may have unpredictable work hours, difficulty accessing transportation, or other barriers preventing them from getting to a pharmacy.”
The Centers for Disease Control and Prevention (CDC) and Office of Population Affairs (OPA) both advise health care providers to give women multiple cycles of birth control, ideally a year, to help reduce such gaps. Both Oregon and the District of Columbia recently passed laws ensuring residents have access to a one-year supply of birth control.
08/05/15
Preterm birth--or birth before 37 weeks’ gestation--is a significant cause of newborn illness and death around the world. Each year, more than one million infants die from complications of preterm birth, and those who survive often face long-term health effects. There are many causes of preterm birth, and preventing it is a major public health challenge.
UCSF Bixby Center researchers examined if contraceptive services can help reduce rates of preterm birth for women's subsequent pregnancies. They looked at public health records in California to see whether women received contraceptive services within 18 months after giving birth. Contraceptive services were provided by publicly funded programs, such as Medi-Cal and Family PACT. The researchers found that:
Providing women with access to contraceptive services reduces rates of preterm birth. Publicly funded contraceptive programs are key to improving maternal and newborn health. To help reduce preterm birth worldwide, increasing access to high-quality contraceptive services would be an effective primary prevention strategy.
07/31/15
UCSF Bixby Center has launched a free online training, An Update on Long-Acting Reversible Contraception. The training is a primer on IUDs and the contraceptive implant, and is suitable for all types of healthcare providers and support staff. This one-hour course is self-paced with videos, case studies and interactive quizzes.
The training features real world providers who guide learners through all steps of offering IUD and implant services, from the first phone call to follow-up. The course helps all clinic staff to integrate IUDs and implants into routine contraceptive care, and provides resources for many facets of this integration. Clinicians taking the course will receive continuing medical education credit from the the University of California, San Francisco.
Here is what people are saying about the course:
“I loved this training. We train health educators and this is an excellent resource for them.”
— Peer health education training coordinator, FL
“Very good overview and the information was accurate. I liked the approach of hearing from multiple health care providers.”
— Registered nurse, Washington, DC
To access the course, register at bixbycenter.digitalchalk.com, then go to the Catalog tab in the upper right. Select "An update on long-acting reversible contraception" and add it to your cart. Then click on the checkout icon at the top of the screen. Please contact the Online Training Coordinator with any questions.
07/24/15
When a woman needs to request medical leave or a change in her job duties due to a pregnancy, her obstetrician or other prenatal care provider can help her by writing a letter to her employer. Yet there is little guidance for healthcare providers to write such notes, and some notes have been used to fire pregnant women. In a new commentary, a UCSF Bixby Center and UC Hastings working group offers guidance to help providers write work accommodation letters. The commentary also provides an overview of current federal and state laws meant to protect pregnant workers.
They note that a correctly written letter will help pregnant women protect their rights, keeping their jobs while maintaining a healthy pregnancy. “Writing a precise, informed and thoughtful note can help a patient continue to work during pregnancy as well as keep her job and health benefits after delivery.” Healthcare providers can also “advocate for more comprehensive laws that protect pregnant workers such as the Pregnant Worker's Fairness Act to ensure [women's] ability to both support their families and have healthy pregnancies.”
06/16/15
Better counseling about women’s birth control options can dramatically reduce unintended pregnancies, according to new research from the University of California, San Francisco’s Bixby Center for Global and Reproductive Health. The study, published today in The Lancet, shows that health care providers can play a critical role in supporting women’s contraceptive decision-making and preventing unintended pregnancies.
Bixby Center researchers conducted a randomized trial with Planned Parenthood Federation of America at 40 health centers nationwide to evaluate an accredited training curriculum for health care providers. Through a half-day session for all clinic staff, the curriculum provided the most up-to-date information on intrauterine devices (IUDs) and implants, which are far more effective than the pill or condoms at preventing pregnancy.
The training resulted in a striking reduction in the number of unintended pregnancies among family planning clients by almost half. It also dramatically increased providers’ counseling and women’s awareness of IUDs and implants. However, women receiving contraception post-abortion did not benefit from the intervention, as less than half who chose IUDs and implants at the time of an abortion actually obtained them. Researchers noted that there are many cost barriers to contraceptives at the time of abortion in the U.S.
The study was conducted by the UCSF Bixby Center's Beyond the Pill Program in partnership with the Planned Parenthood Federation of America.
For more information, please see:
05/28/15
Advancing New Standards in Reproductive Health (ANSIRH), a program at the UCSF Bixby Center, recently announced that Dr. Dan Grossman will become its new director on September 1, 2015. “Dr. Grossman brings to ANSIRH a perfect combination of rigorous research, high-impact policy work, global health expertise and a powerful media presence,” said Dr. Rebecca Jackson, chief of Bixby’s division in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences. Dr. Diana Greene Foster, ANSIRH interim director, added, “We are overjoyed to have him lead our organization.”
Dr. Grossman is currently vice president for research at Ibis Reproductive Health. He is a respected researcher with an extensive research portfolio and over 100 peer-reviewed journal articles. In recent years, Dr. Grossman has emerged as a leading spokesperson on cutting-edge topics such as over-the-counter oral contraceptives, restrictions on access to abortion care and telemedicine. Dr. Grossman is an abortion provider and will continue his clinical practice at UCSF.
“I feel very honored to have been chosen to lead such a distinguished group of researchers, and I look forward to helping ensure that ANSIRH’s work has the greatest possible impact on practice and policy,” Dr. Grossman said.
04/20/15
The UCSF Bixby Center has released a new guide to help health providers offer women the full range of contraceptive options. The guide, Intrauterine Devices and Implants: A Guide to Reimbursement, provides information to navigate patient coverage, stocking and reimbursement of these highly effective contraceptive methods. The guide is a joint project of the Bixby Center and the:
Intrauterine devices (IUDs) and implants are safe and highly effective forms of contraception, but their high cost often creates obstacles for providers to offer these methods to women. This new guide aims to decrease the cost barriers for providers and patients alike.
04/13/15
The UCSF Bixby Center and partners have reached new agreement to reduce the cost of a tool that helps save women’s lives during childbirth. The agreement reduces the cost per use of the non-pneumatic anti-shock garment known as Lifewrap™, which has been shown to safely and effectively reduce deaths due to postpartum hemorrhage. Under the agreement, the cost per use of Lifewrap™ will be reduced from $1.30 to below $0.30 for public sector purchasers in 51 countries.
The agreement represents a partnership between the Bixby Center’s Safe Motherhood Program and the
Postpartum hemorrhage is the leading cause of maternal death worldwide. The Lifewrap™ can be applied by anyone after a short, simple training and has been used to help over 9,000 women in 20 countries to date.
03/25/15
Some previous research has found higher levels of alcohol use among women who have received abortions, and these findings are often used to discourage women from accessing abortion care. However, new research from the UCSF Bixby Center challenges the notion that abortion is related to increased alcohol use. Using data from the Turnaway Study, researchers found that women who had a child from an unwanted pregnancy reduced alcohol consumption over a two-year period, while women who had abortions resumed their typical pre-pregnancy alcohol consumption. This new study shows that the difference in alcohol consumption for these two groups is due primarily to reductions among women continuing pregnancies rather than increases among women having abortions.
There was no evidence that having an abortion lead to risky or problematic drinking over time, or that it caused women to start binge drinking. These new findings join others showing that abortion care is medically safe and does not have negative consequences for women.
03/17/15
In 2014, Louisiana passed a law requiring abortion providers to have hospital admitting privileges. The law is temporarily on hold while a court case challenging it continues. According to new research from the UCSF Bixby Center, this law would close all of the state’s abortion facilities, forcing three-quarters of Louisiana women to travel 150 miles or more each way for services.
Using
data from three of the five Louisiana abortion care facilities in the year
before the law was scheduled to take effect, Bixby Center researchers aimed to
describe who would be affected if the law went into effect. They found that:
The study may actually underestimate the distance women would have to travel, since three of Louisiana’s neighboring states—Texas, Mississippi and Alabama—have also passed admitting privilege laws and other restrictions that could close their abortion care facilities. Forcing women to travel further would likely contribute to delays in care and put an additional financial burden on women. The researchers concluded that Louisiana’s law would put a considerable burden on many Louisiana women, particularly those who are already financially vulnerable.
03/16/15
About half of pregnancies in the U.S. are accidental, with inconsistent use and non-use of birth control being the leading causes. For some women, going to a healthcare provider to obtain a prescription stands in the way of using birth control. Making oral contraceptives available without a prescription has the potential to increase the number of women using this method and reduce gaps in use.
New research from the UCSF Bixby Center examines how non-prescription oral contraceptives might impact women's access, use and pregnancies, as well as public health costs. Using national and state data, the researchers found that if women were able to obtain oral contraceptives without a prescription as a covered health insurance benefit, there would be an 11 to 21 percent increase in the number of women using the Pill. As a result, the rate of accidental pregnancies in the U.S. would decrease by 7 to 25 percent.
The researchers also considered the public sector costs of providing oral contraceptives without a prescription and of providing medical care for unintended pregnancy. They found that the combined costs would be reduced for public health plans that chose to cover oral contraceptives without a prescription. Despite these cost savings, it is relatively uncommon for public health insurance to cover non-prescription methods of birth control.
“In the era of no-co-pay contraception, there is still a need for over-the-counter birth control to fill the gap when women run out of pills while traveling, for example, or for those who find it inconvenient to get to a clinic," study co-author Dan Grossman said. "But to reach the largest number of women most in need, it's critical that a future [non-prescription] pill be covered by insurance.
02/25/15
Cervical cancer, caused by human papilloma virus (HPV), is a leading cause of cancer-related death among women in low-resource settings. Some areas with the high cervical cancer prevalence, such as sub-Saharan Africa, also have high HIV prevalence. Among HIV-positive women, a weakened immune system and inability to clear HPV may lead to an increased risk of cervical cancer; studies have found a 2- to 22-fold increase in the incidence of invasive cervical cancer among women living with HIV compared with the general population.
The high risk of cervical cancer among HIV-positive women underscores the urgent need for effective cervical cancer prevention programs tailored to their needs. To help develop such programs, researchers with the UCSF Bixby Center worked with a group of HIV-positive women with cervical cancer in Western Kenya. The researchers saw the women six and twelve months following a treatment to clear abnormal cervical cells. The treatment effectively reduced the risk of cancer for up to one year, with only 13% of women experiencing a return of cervical cancer. However, among the women who did experience a return of the disease, the researchers observed a high proportion of invasive cancer.
Because of the risk of developing invasive cancer after treatment, HIV-positive women should receive continued and close follow-up care for cervical cancer. However, the standard of care in low-resource settings means that many cases of invasive cervical cancer could be missed. For instance, without collecting specimen samples of cervical tissue, cases of invasive disease may be missed, especially among HIV-positive women. The researchers call for a continued investigation of the most cost-effective and feasible programs to prevent and treat cervical cancer worldwide.
02/03/15
Although the relationship between abortion and mental health has been a topic of scientific debate and public interest for the past three decades, few studies have been designed to examine this relationship specifically. Researchers with the UCSF Bixby Center conducted a study to examine this relationship and fill this gap in the scientific literature.
Using data from the Turnaway Study, the researchers found that anxiety and depression were not more common among women having an abortion. Specifically:
These findings show that relative to unwanted childbearing, abortion does not lead to an increased risk of mental health problems among women. Opponents of legalized abortion have suggested that abortion is a traumatic event with severe consequences for women’s mental health, but this study and others indicate definitively that abortion does not cause mental health issues. Policymakers should take this into account when legislating women’s access to safe and high-quality abortion care.
01/16/15
There is growing evidence that increased use of highly effective contraception is associated with reductions in unintended pregnancies and abortion. New research from the UCSF Bixby Center examines whether increased access to intrauterine devices (IUDs) and implants in Iowa contributed to a decline in abortions in the state.
Between 2006 and 2008, access to family planning services increased in Iowa through a state Medicaid program and a privately funded initiative. During the same time, access to abortion expanded in Iowa through telemedicine provision of medical abortion. Even with this increased access to abortion services, the number of abortions in Iowa declined. Using data from more than 500,000 medical records, Bixby researchers found a strong connection between increases in IUD and implant use and the subsequent decline in abortions across Iowa. The researchers found that:
"To our knowledge, this is the first study to explore the relationship between IUD and implant use and reduction in abortion that was able to control for other factors, such as population density, poverty levels and the number of abortion clinics in a region,” Bixby Center researcher and lead study author Antonia Biggs said. “Our research adds to the growing body of evidence that an investment in highly effective family planning is money well spent.”
Given the increase in abortion access and lack of legal restrictions placed on abortion in Iowa from 2005 to 2012, the researchers concluded that reductions in abortions were not a result of laws restricting abortion access. These findings support the need to continuously provide women with access to safe and high-quality abortion and contraceptive services, which together help women plan for their and their families’ wellbeing.
01/05/15
Too many women around the world face the risk of death or disability from childbirth, and the UCSF Bixby Center is conducting groundbreaking research to make childbirth safer. Bixby Center researcher Suellen Miller recently discussed how the Safe Motherhood Program, which she founded in 2003, pioneered use of the Non-pneumatic Anti-shock Garment (NASG). The NASG is a first-aid device to stabilize women suffering from obstetric hemorrhage and shock, the leading cause of maternal death during which a woman bleeds heavily after giving birth.
In a new interview with WBAI Pacifica Radio’s “Healthstyles,” Miller discusses how the NASG helps reduce maternal mortality by 50 percent. The NASG can be applied by anyone after a short, simple training, and has been used by over 9,000 women in 20 countries. Miller also talks about how the SafeMotherhood Program partners with nongovernmental organizations, health ministries and other decision-makers to expand access to the NASG around the world. “Almost always now, people are saying, ‘We cannot let mothers die.’” Miller said. “And that has made the introduction of this device much easier… You can say ‘Ok, if you’re interested in saving lives, here’s a device that can help.’”
12/11/14
In the most comprehensive look yet at the safety of abortion, researchers at the UCSF Bixby Center found that the procedure is incredibly safe for women. In a new study published this week, Bixby Center researchers found that major complications from abortion are rare, occurring less than a quarter of one percent of procedures. This is:
Although these new data are similar to what has been found in previous studies, this is the first study to examine complete data on all of the health care used by women who have received abortions. Since some women must travel long distances to find abortion providers, they tend to receive any needed follow-up care at facilities closer to where they live. For many women, this means their local emergency department. But, up until now, no study has systematically examined emergency department use for post-abortion care.
The researchers said they expect the study to contribute to the national debate over abortion safety. Many state legislatures have recently passed laws increasing various requirements for providers and clinics, purportedly to increase patient safety. But the researchers said that these laws were likely to make women travel further to get abortions or induce them on their own using unsafe methods, both of which may increase the risks for women. The policy debate over abortion restrictions in the United States will be better informed by weighing any theoretical and small reduction in patient risk against the increased risk to women’s health that occurs with reduced access to abortion care.
11/25/14
Violence against women and girls is a global public health problem of epidemic proportions, with an estimated 35% of women and girls experiencing some form of physical or sexual violence in their lifetimes. The United Nations marks November 25 as the International Day for the Elimination of Violence Against Women, and advocates around the world are calling for a series of social, policy and legal changes to help curb such violence. The UCSF Bixby Center has examined the issue of sexual violence and reproductive coercion from multiple angles, generating rigorous evidence that can help inform needed policy changes.
The Bixby Center helped broaden access to emergency contraception (EC), a critical health tool for women following sexual assault. An estimated 7% of women will be sexually assaulted by a stranger, and many more (23%-36%, depending on the region) will experience unwanted sex from an intimate partner. Victims of sexual violence risk unwanted pregnancy and exposure to sexually transmitted infections, making EC access a health imperative and human right for sexual assault survivors. Bixby Center research has increased women’s access by helping to make EC available without a prescription and expanding the range of EC options.
Currently, the Bixby Center is studying sexual and reproductive empowerment, exploring how women’s agency affects their ability to control contraceptive use and pregnancy. Our investigators have created a tool to measure women’s reproductive autonomy. Separate research is looking at the effect of male coercion on women’s reproductive and sexual health decisions. For example, research from the Bixby Center provides an in-depth look at the ways women describe their partners’ influence in their decisions regarding abortion and women’s risk of violence from their male partners following an abortion. While violence against women and girls continues to be a pandemic, improved prevention and treatment measures are possible and essential. The UCSF Bixby Center supports the efforts of our researchers and partners to provide sexual assault survivors with the care they need. Photo credit: Cindy Chew
11/19/14
The UCSF Bixby Center for Global Reproductive Health has partnered with the California Family Health Council to spread the word about long-acting reversible contraception (LARC)—intrauterine devices (IUDs) and the implant. During LARC Awareness Week, the UCSF Bixby Center is sharing its ongoing and comprehensive research about LARC methods, which are over 99% effective at preventing pregnancy. About half of pregnancies in the US are accidental, and this hasn’t changed in the last two decades. As more US women learn about and use IUDs and the implant, the rate of accidental pregnancy has declined.
The UCSF Bixby Center has explored different factors that influence LARC use. Many young women and health care providers have misinformation about IUDs and implants. Providers with recent training about LARC are more likely to counsel their clients about the methods. Women’s social networks also influence IUD use. Health care providers can encourage IUD users to share their personal experiences with their friends and family to spread the word about these methods.
To participate in LARC Awareness Week, spread the word about LARC on Twitter and Facebook @CalFamHealth and @Bedsider with the hashtag #LoveMyLARC.
10/07/14
The UCSF Bixby Center's Innovating Education in Reproductive Health program is excited to announce the upcoming launch of the first ever online course about abortion. Abortion is a common experience for women around the world, yet is often excluded from the curricula of health professionals. The free six-week course, Abortion: Quality Care and Public Health Implications, is hosted by Coursera, an education platform for massive, open, online courses (MOOCs). It will address abortion care from both clinical and social perspectives.
Dr. Jody Steinauer, Associate Professor of Obstetrics, Gynecology & Reproductive Sciences at UCSF, will facilitate the course, which features over twenty faculty from multiple disciplines. The class will address abortion in the U.S. and around the world, framing the issue in a public health context. The aim of the course is to fill in the gaps left by the exclusion of abortion from mainstream curricula.
The course will run from October 13 through November 24, 2014. This course is geared toward clinicians, health care workers, and students. However, there are no prerequisites, and anyone is welcome to take the course. To enroll, go to coursera.org/course/abortion.
10/01/14
A long-term study among women seeking abortion in the U.S. showed that 8% of women sought an abortion because they had abusive partners. New research from this UCSF Bixby Center team shows that, compared to women who were able to end an unwanted pregnancy, those who could not access abortion care and ultimately gave birth were more likely to remain in physically abusive relationships over the next two and half years. Physical abuse included being pushed, hit, slapped, kicked, or choked. They concluded that “having a baby with an abusive man, compared to terminating the unwanted pregnancy, makes it harder to leave the abusive relationship.”
Read more in Salon.com.
07/10/14
In new guidelines, the American College of Physicians recommends that doctors stop performing routine pelvic exams for most women. There is no evidence that pelvic exams are effective at detecting diseases like cervical cancer and plenty to suggest that the procedure provokes fear, anxiety and pain in many women, according to the new practice guideline. In an editorial accompanying the new guidelines, UCSF researchers discuss the efficacy of routine pelvic exams and possible reaction among women's health care providers to the new guidelines. The guidelines build on the Bixby Center's longstanding and rigorous research on pelvic exams, cervical cancer and birth control.
The pelvic exam has “held a prominent place in women’s health for many decades and has come to be more of a ritual than an evidence-based practice.” The new recommendations may be “controversial” since the exam has “long been considered a fundamental component” of women’s health visits. For instance, 2012 guidelines from the American College of Obstetricians and Gynecologists continued to recommend annual pelvic exams for all women ages 21 and older, and a recent survey revealed that US Ob-Gyns conduct the exam for the vast majority of patients. “Ending such a prevalent practice with widespread support among women’s health providers will be met with formidable challenges,” according to the authors.
Even if the new recommendations do not change why and how often doctors perform pelvic exams, they should “prompt champions of this examination to clarify its goals and quantify its benefits and harms.” Given current evidence, providers who continue to offer the exam should at least be aware of the “uncertainty of its benefits and its potential to cause harm through false-positive testing and the cascade of events it prompts.
06/26/14
Although contraception is an important preventive health care tool for all women, many women face barriers when trying to access birth control. In particular, HIV-positive women face unique challenges, such as misconceptions among health care providers about what methods are safe. In fact, there are no medical reasons to restrict contraceptive access to women at risk of HIV, and only one class of HIV medications—known as protease inhibitors—may interfere with hormonal contraception.
In order to better understand this issue, researchers with the UCSF Bixby Center surveyed doctors and nurses working in HIV-prevalent areas of South Africa and Zimbabwe. They found that most providers (85%) offered women oral contraceptive pills, but only about a quarter considered the pill appropriate for women with HIV or at risk of HIV. A higher proportion of providers considered injectable contraceptives appropriate for HIV-positive women (46%) or women at risk of HIV (42%). Few providers considered emergency contraception appropriate for women with HIV (13%) or at risk of HIV (16%).
These findings emphasize the urgent need to improve health care providers' knowledge about contraceptive safety, especially among providers caring for HIV-positive women. Integrating family planning and HIV care has already been shown to improve the quality of contraceptive care. Having access to a wide range of birth control options can help women protect their health and wellbeing, and make important decisions about their lives and families.
06/12/14
The UCSF Bixby Center's partnership with the University of Zimbabwe (UZ) recently joined a global research effort to develop a safe and effective vaccine to prevent HIV. The program's research site in Chitungwiza, Zimbabwe, is joining the HIV Vaccine Trials Network (HVTN), the world's largest publicly funded international collaboration facilitating the development of HIV vaccines. The U.S. National Institute of Allergy and Infectious Diseases is the network's main sponsor.
The UZ-UCSF site in Chitungwiza will expand to support its growth in HIV vaccine research. This infrastructure development will be complete by 2015, with the first study expected to start in spring 2015. These will be the first ever HIV-related vaccine clinical trials conducted in Zimbabwe.
The UZ-UCSF team is excited to join HVTN's network of clinical research sites at leading research institutions on five continents.
Photo credit: Beth Novey
06/11/14
Unintended pregnancy remains a persistent public health issue in the United States. Increased use of effective contraceptives, like intrauterine devices (IUDs), has the potential to reduce unintended pregnancies. Although IUDs are highly effective and rapidly reversible, less than 4% of U.S. women ages 15-44 used this method between 2006 and 2010. Although popular media has described "IUD evangelism" among women using this method, little is known about how women's social networks may influence contraceptive attitudes.
To fill this gap, researchers with the UCSF Bixby Center investigated how information about contraceptives, particularly IUDs, is spread through social networks and how this information influences women's attitudes. They found that:
Women frequently discuss contraception in social settings, and these conversations may influence decisions regarding IUDs. Interventions supporting and encouraging positive and accurate social communication about IUDs may be a promising approach to increase interest in this highly effective method.
05/21/14
Since Nepal legalized abortion in 2002, safe abortion services have helped reduce high pregnancy-related complications and deaths. This policy change also created new opportunities to offer women contraception, as women presenting for abortion may also have an unmet need for contraception. Despite these new opportunities, contraceptive use in Nepal has plateaued since 2006, with 43% of married women using modern methods of contraception. On average, women have nearly one child more than desired.
Researchers with the UCSF Bixby Center recently examined the contraceptive information and services Nepalese women receive at an abortion visit. They found that:
Although considerable progress has been made to provide comprehensive family planning services after abortion, challenges remain. Expanding the range of contraceptive methods discussed would allow more women to obtain an acceptable method. Addressing barriers to immediate post-abortion LARC provision would prevent gaps in protection. Legalization of abortion in Nepal presented an unprecedented opportunity to expand contraceptive access—ongoing efforts to improve contraceptive services will continue to reduce the number of women at risk of unintended pregnancy.
05/05/14
Publicly funded family planning clinics serve more than seven million women in the United States, meeting 41% of country's need for family planning. But while publicly funded clinics are a key source of care, many states struggle to provide access to high quality reproductive health services in a cost-effective manner.
A new report from the UCSF Bixby Center provides key insights from Family PACT—California’s publicly funded family planning program—that could prove useful to other states nationwide. Researchers explore the impact of Title X funding among Family PACT providers on access to and quality of reproductive health services for low-income populations. They found that Title X funding in California provides resources that enhance clinic efficiency and services, including:
These enhancements provide better access to services and contribute to a higher quality of care. Although more people in the U.S. are gaining access to health insurance under the Affordable Care Act, public funding for reproductive health care services will remain a critical safety net and help maintain high-quality healthcare services.
04/28/14
Half of the 6.6 million pregnancies in the United States each year are unintended, with disparities among adolescents and women of color. Compared with older women, sexually active teens are less likely to use contraception and more likely to take breaks or stop. Compared with white women, Black and Hispanic women are less likely to use contraception and more likely to use methods with higher risk of failure.
To address disparities in unintended pregnancy, we need more information about the relationships between women's contraceptive knowledge, method use, race/ethnicity and age. Investigators with the UCSF Bixby Center explored racial/ethnic and age group differences in women's knowledge and attitudes about contraception.
The researchers found that Hispanic women and teenagers had lower contraceptive awareness:
Lower contraceptive knowledge among teenagers and Hispanics, particularly immigrants, suggests the importance of disseminating family planning information to these women as one way of addressing disparities in unintended pregnancy. Clinicians, public health advocates and policymakers should also address other potential causes of contraceptive disparities, including limited access to family planning care and low quality care.
04/18/14
The idea that abortion is emotionally traumatic for women has gained traction in recent years, and the notion that the procedure lowers self-esteem has spurred legislation that increasingly restricts abortion access. Data on whether abortion is related to self-esteem and life satisfaction are limited and mostly come from retrospective studies.
To fill this gap, researchers with the UCSF Bixby Center examined the effects of obtaining an abortion versus being denied an abortion on self-esteem and life satisfaction in the Turnaway Study. Using data from more than 900 women who sought an abortion from 30 facilities across the United States, the researchers found that:
While an abortion may be an emotionally significant event in a woman's life, there is no evidence that it causes harm to self-esteem or life satisfaction in the short or long term. In fact, these findings suggest that being denied an abortion is more harmful to women's feelings of self-worth and well-being in the short term. Other factors associated with low self-esteem are also related to having an abortion, such as having an unintended pregnancy or life circumstances that lead women to decide to terminate the pregnancy. Efforts to support women’s emotional well-being should focus on these and other factors known to impact self-esteem and life satisfaction.
04/11/14
This year marks the 20th anniversary of the Bixby Center's partnership with the University of Zimbabwe (UZ) in HIV/AIDS research. The collaborative research program has released a new report and website to commemorate this anniversary and highlight some of its noteworthy findings and accomplishments.
Since its launch in 1994, UZ-UCSF studies have helped shape national and global responses to the HIV/AIDS pandemic, and defined policies and standards regarding HIV acquisition, prevention, treatment and care. Examples include:
Over the past 20 years, UZ-UCSF researchers have led 63 research studies with more than 15,000 participants. Additionally, the program has mentored the next generation of Zimbabwean and global researchers, supporting more than 200 upper-level students and postgraduates to date. The partnership is leading 22 ongoing studies, continuing to develop capacity to identify and respond to emerging scientific priorities.
04/09/14
Under the Affordable Care Act, millions of women in the United States will have increased access to public and private health insurance. However, any potential gains in women’s access to health insurance will be limited by federal and state restrictions on coverage for abortion care. Even though an estimated 30% of U.S. women will have an abortion by age 45, longstanding restrictions limit the use of federal Medicaid funds for the procedure, and new restrictions limit private insurance coverage for abortion care.
New research from the UCSF Bixby Center reveals that due to these restrictions, many women pay substantial out-of-pocket costs for abortion care. Based on interviews with women visiting 30 abortion clinics nationwide, the researchers found that:
There are significant gaps in the system for providing financial assistance, insurance and Medicaid coverage for abortion care. New state-level laws further restricting insurance coverage for abortion will only exacerbate existing challenges. The researchers call for studies to examine how new restrictions on private insurance coverage for abortion burden women seeking safe reproductive health care.
03/17/14
Researchers are increasingly recognizing the importance of women’s reproductive autonomy for their health and well-being. Reproductive autonomy is having the power to decide and control contraceptive use, pregnancy, and childbearing. For example, women with reproductive autonomy can control whether and when to become pregnant, whether and when to use contraception, which method to use, and whether and when to continue a pregnancy.
Despite the importance of such decisions for women’s health, few studies have assessed reproductive autonomy using a validated measure or examined how autonomy affects contraceptive use. Researchers from the UCSF Bixby Center sought to address this issue by creating a validated instrument to measure women's reproductive autonomy. The measure:
Researchers hope this tool will help addresses the significant void in studies of women's empowerment and health. Over time, the tool may show that sexual and reproductive health interventions that explicitly address women's reproductive autonomy are more effective at helping women realize their reproductive goals.
03/14/14
Unintended pregnancy is a significant public health issue in the United States, accounting for half of all pregnancies. One significant contributing factor is that many women have problems accessing contraceptives. Additionally, women who have abortions are at high risk for future unintended pregnancy, and are therefore an important population to include when examining barriers to contraceptive access.
Making oral contraceptive pills accessible over-the-counter (OTC) may improve the availability of this effective method. OTC access could also be attractive to women who have difficulty obtaining prescriptions, including some women seeking abortion. Researchers with the UCSF Bixby Center surveyed women seeking abortions across the United States to gauge their interest in obtaining the pill OTC.
The researchers found a high level of interest in OTC access:
Oral contraceptive use among women at high risk of unintended pregnancy may increase if the pill were available without prescription. Women consider OTC access convenient and timesaving compared to clinic visits. The pill is already formally or informally available without a prescription in many countries.
03/07/14
Medical residents training to become Obstetrician-Gynecologists in the United States can opt out of training on abortion for religious or moral reasons. Some data suggests that most residents who opt out of abortion training do go on to gain skills in other aspects of family planning, but we know little about their experiences.
Researchers from the UCSF Bixby Center conducted interviews with current and former residents who opted out of some or all of the family planning training at ob-gyn residency programs. The programs were affiliated with the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning. They found that residents who opted out of abortion training valued the ability to participate in family planning training. These residents identified specific knowledge and skills that they thought would impact how they care for patients:
Given these findings, the researchers recommend that all residency programs offer students the opportunity to participate in family planning and abortion care training regardless of their attitude about abortion. Such training should go beyond procedural skills to include in-depth contraceptive training and exposure to abortion counseling.
02/28/14
Previous research on migration and HIV in sub-Saharan Africa has primarily focused on male migrants' risk of HIV, despite the fact that equal or greater numbers of women are migrating in the region. And while studies that have examined the issue found higher risks and HIV prevalence among migrant compared to non-migrant women, little is known about how migration places women at increased risk of HIV.
Researchers from the UCSF Bixby Center aimed to bridge this gap by studying the factors that place migrant women in Kenya at a higher risk of HIV infection. They found that:
The researchers stress that HIV prevention and treatment interventions tailored to migrant women are urgently needed. Such interventions should aim to preserve the positive aspects of mobility, such as women’s independence and improved socioeconomic status, while also reducing the high HIV risks among female migrants. Photo credit: Beth Novey
02/26/14
In 2009, the American College of Obstetricians and Gynecologists recommended long-acting reversible contraception (LARC) as contraceptive options safe for nearly all women. LARC, which includes intrauterine devices and implants, are the most effective reversible contraceptive methods. However, many health care providers do not offer LARC to eligible women, due to factors such as a lack of awareness or training, misconceptions about LARC safety and financial obstacles.
New research from the UCSF Bixby Center provides insights into how family planning providers' beliefs and practices affect women's access to LARC. The researchers surveyed clinicians from 1,000 sites participating in California's family planning Medicaid program, Family PACT. They found that:
Although there has been significant progress in expanding understanding about LARC, these results show that many clinicians unnecessarily limit LARC access. Targeted trainings are needed to inform clinicians of current LARC eligibility criteria. Such efforts will help ensure that women are informed about all the contraceptive choices available to them.
02/19/14
Nearly half of all pregnancies in the United State are unintended, with marked racial and ethnic differences in unintended pregnancy rates even after accounting for income levels. Black and Hispanic women have significantly higher rates of unintended pregnancies compared with white women—a trend that may be related to differences in the contraceptives women use.
New research from the UCSF Bixby Center examined racial and ethnic differences in contraceptive use and how methods varied according to women’s age and reproductive experiences. Using national survey data, the researchers found that:
These findings could stem from several factors, including differences in women's knowledge and higher levels of concern about birth control. Black and Hispanic women also may have lower access to quality medical care and family planning services, as well as different experiences interacting with the medical system. For instance, previous research found that women of color experience more pressure to use birth control from medical providers, which may result in frustration or distrust.
These findings have significant implications for public health programs and interventions. Providers should ensure that all young women have information about highly effective contraceptive methods, and should consider communicating information outside of clinical settings. Reproductive healthcare should also be sensitive to communities that have experienced reproductive coercion, and help women maintain control over their contraceptive use. Ensuring that all women have information about and access to effective methods can help reduce widening reproductive health disparities.
02/14/14
Healthcare providers are increasingly recognizing that male partners have considerable influence on women’s reproductive health decisions and outcomes. For instance, previous research showed that male partners can affect women’s choices regarding contraceptive use and pregnancy. However, one area that remains less explored is male partners’ influence on women’s decisions regarding abortion. In an effort to shed light on this issue, new research from the UCSF Bixby Center provides an in-depth look at the ways women describe their partners influence in their decisions regarding abortion.
Using data from a long-term study among women seeking abortion in the U.S., the researchers found that nearly one-third of women cited their partners as a factor in their decision to have an abortion. The three most common partner-related reasons were:
Additionally, 8% of women sought an abortion because they had abusive partners. Abuse included being hit, threatened, mentally harassed or raped. Healthcare providers should be aware of the possibility of violence among women seeking abortion. Reproductive healthcare visits are an important time to identify women experiencing partner violence and offer information about safety, referrals to counseling and other support services.
These findings illustrate that women are clearly reflecting on whether their relationships would support or undermine their goals for rearing a child. They also bolster previous research showing that women's reasons for seeking abortion are complex and interrelated, and provide key recommendations for healthcare providers to support women when making reproductive decisions.
02/07/14
In the United States, adolescent pregnancy has long been a concern because of disproportionate negative consequences for teenage mothers and their children. Despite overall declines in teenage pregnancies and births over the past 20 years, the US rates remain significantly higher compared with other developed countries – underscoring the need for effective strategies to prevent teen pregnancy.
Researchers with the UCSF Bixby Center recently examined such an effort in California, in which publicly funded family planning services were available to adolescents through the Medicaid and its family planning expansion program, Family PACT. By accessing information from a range of state health surveys, claims data and statistical files, researchers were able to examine the association between adolescent births and access to these family planning services.
They found that increased access to family planning services was significantly associated with a lower adolescent birth rate. Efforts to reduce adolescent births, specifically in counties that had persistently high rates, will be critical to achieving a healthy future for California and the nation overall. The publicly funded family planning program in California plays a crucial role in helping adolescents avoid accidental pregnancies, and continued funding for this program is important for the state. Family PACT has already served as a model for other states in designing their family planning programs; its innovative services for adolescents are another key aspect of its success.
02/06/14
High-quality family planning services provide clients with access to a wide range of contraceptive options, allowing them to choose methods that best fit their needs and preferences. In a new publication in the Journal of Women's Health, Heike Thiel de Bocanegra and colleagues with the UCSF Bixby Center explored whether public funding for family planning programs helped providers offer a broader range of contraceptives, including those requiring specialized skills such as intrauterine contraceptives, implants, vasectomies and fertility-awareness methods.
The researchers looked at programs in California that provide public funding for family planning services, including the federal Title X Family Planning program. Title X provides reproductive healthcare to low-income women and men.
Researchers found that significantly more Title X-funded providers offered methods that require special training compared to providers without Title X funding. These findings show that public funding for contraceptive care is associated with higher quality care that reduces barriers to access by offering a variety of methods onsite. Having to go elsewhere to obtain a preferred method can lead to lack of follow-through or the receipt of a less appropriate method. Extra funding for programs such as Title X can help improve onsite access to a full range of contraceptive services.
01/31/14
Countries in Sub-Saharan Africa have some of the lowest family planning use rates in the developing world. Approximately 30% of women in the region have an unmet need for family planning services and methods, which is even higher among women living with HIV. A large cluster randomized trial conducted by the UCSF Bixby Center examined if integrating family planning with HIV/AIDS services can help bridge this gap and increase the use of contraception among HIV-positive women and men. The study was a collaboration with the Kenya Medical Research Institute, and took place in Kenya's Nyanza Province.
The main study found that women who visited health sited that integrated HIV and family planning services were significantly more likely to use more effective contraceptive methods at the end of the study, compared with women who visited clinics where clients desiring contraception were referred to family planning clinics at the same facility.
In a second, study, researchers surveyed HIV-positive men and women currently in HIV care but not using highly effective methods of contraception. Over 70% thought that they or their partner would be more likely to use family planning if it were offered at the HIV clinic. The authors stress that integrating family planning into HIV care would likely have a large impact on the majority of women and men accessing HIV care and treatment. Integrating these services also would present the opportunity to involve men more actively in the contraceptive decision-making process, potentially addressing two major barriers to family planning: access to contraception and partner uncertainty or opposition.
In a third study, researchers aimed to determine if community clinic health workers in rural Kenya talking with HIV-positive patients about family planning would improve contraceptive knowledge and attitudes. Following 15-minute health talks with almost 50 HIV-positive men and women, there was a significant increase in knowledge about contraceptives. Additionally, 45% of women and 33% of men intended to try a new contraceptive, suggesting that providing family planning education to patients as they wait for HIV services can increase both knowledge and intention to use contraception.
These collaborative studies reveal that integrating family planning into HIV care result in increased use of effective contraceptive methods among HIV-infected women and men. Researchers also stressed that integrating family planning and HIV services will require leadership at the community, regional, national and international levels.
01/23/14
Every year 1.2 million women have elective abortions in the United States. While previous studies have provided data about abortion rates, investigators have been unable to track the incidence of complications following abortions. This gap is due to lack of follow up and because women often seek care from sources other than the original provider. To help fill this knowledge gap, researchers with the UCSF Bixby Center examined records for more than 50,000 abortions covered by California's Medicaid program to determine the rate of complications associated with procedure.
Ushma Upadhyay, PhD, MPH and colleagues from the Bixby Center's partner program ANSIRH (Advancing New Standards in Reproductive Health) looked at reported complications and emergency department visits following abortion procedures. They considered a major complication one that required hospitalization, blood transfusion or surgery. The rate of major complications following an abortion was 0.25%—meaning that complications are rare and abortion is medically safe for women.
The study was the first ever to analyze abortion complications at a population level in the United States and with such a large number of women. Dr. Upadhyay presented the team's findings at the 2013 North American Forum on Family Planning. At the Forum, she stressed that because abortion is already a medically safe procedure, legislation enacting strict requirements for surgical centers and hospital admitting privileges are unlikely to increase safety for women. Also at the Forum, this research won the award for best scientific presentation.
01/15/14
New research from the UCSF Bixby Center sheds light on the critical role of contraceptive access to help achieve the ideal amount of time between pregnancies. Heike Thiel de Bocanegra and colleagues from the UCSF Bixby Center examined data from women who received services through California's Medicaid or family planning expansion program. The Bixby Center provides ongoing program support and evaluation for this program, which aims to promote optimal reproductive health and reduce unintended pregnancy by increasing access to comprehensive family planning services for low-income Californians.
Previous research has shown that pregnancies less than 18 months apart place mothers and infants at an increased risk of poor health outcomes, including preterm birth and low birth weight. This new study examined the effect of contraceptive type and length of coverage on the timing between pregnancies. Women who used long-acting reversible methods after birth, including intrauterine devices or implants, were almost four times more likely to wait 18 or more months between pregnancies compared with women who used condoms or other barrier methods. Additionally, women who used hormonal methods — such as the pill, patch, injectable or ring — were almost twice as likely to wait 18 or more months between pregnancies compared with women who used a barrier method alone.
In a related study, Bixby Center researchers found that receiving a contraceptive method within 90 days after birth was significantly associated with better timing between pregnancies. Despite this, only 41% of women in the study had a claim for contraception in their medical records within those 90 days.
Both of these studies reveal that public programs can improve on the contraceptive services they provide to women who have recently given birth. Doing so has the potential to improve the timing between pregnancies, along with women and infants’ health outcomes. The researchers identified opportunities to improve contraceptive access in the postpartum period:
01/02/14
A UCSF Bixby Center program in Zimbabwe recently received a seven-year grant for $70 million to further its groundbreaking HIV/AIDS treatment and prevention research efforts. The University of Zimbabwe-University of California, San Francisco, Collaborative Research Program (UZ-UCSF) received this new funding through National Institutes of Health initiative that aims to improve collaboration and coordination of HIV/AIDS-related clinical trials.
UZ-UCSF, led by Dr. Zvavahera (Mike) Chirenje, was established in 1994 to implement high quality science addressing HIV prevention and treatment. Its areas of focus include:
During its 20 years of advancing HIV/AIDS science, UZ-UCSF has supported several noteworthy research efforts. For instance, the program has conducted many studies that have advanced the understanding of women's sexual health and HIV. Among its current research efforts, the program is investigating:
10/10/13
Women in California will now have greater access to safe and comprehensive reproductive health care, thanks in large part to research conducted by the UCSF Bixby Center. California Gov. Jerry Brown recently signed into law a bill (AB 154) that removes barriers to abortion access by allowing nurse practitioners, certified nurse midwives, and physician assistants to utilize their education and training to perform early abortion care. The law aims to increase access to high-quality abortion care in areas where few, if any, doctors perform such services. Notably, this was the only state legislation enacted in 2013 that expanded – rather than restricted – abortion access for women.
The bill is based on long-term research conducted by the Bixby Center’s Diana Taylor, professor emerita of the UCSF School of Nursing, and Tracy Weitz, formerly an associate professor in the Department of Obstetrics, Gynecology & Reproductive Services at UCSF. Their six-year study, called the Health Workforce Pilot Project #171, found that nurse practitioners, certified nurse midwives, and physician assistants with special training provide safe aspiration abortions on par with physician providers. Their research also has found that women appreciate receiving care in their own communities from providers they know and trust, rather than having to travel to geographically distant physicians.
In addition to the Bixby Center, many other partners were involved in the effort to expand women’s access to safe abortion care in California through the bill. Key partners include:
The Bixby Center supported this research through its partner program ANSIRH (Advancing New Standards in Reproductive Health), a collaborative research group that aims to ensure reproductive health care and policy are grounded in evidence through multi-disciplinary research, training and advocacy.
10/04/13
The UCSF Bixby Center’s Safe Motherhood Program is honored to announce that the Non-pneumatic Anti-Shock Garment (NASG/Lifewrap) has been selected as one of UNICEF/USAID/Every Mother Counts/PATH’s Ten Breakthrough Innovations to Save Mother’s Lives in 2015.
In the report, UN Secretary-General Ban Ki-moon noted that these ten innovations are “game-changing practices and advances… that will have an immediate impact on the leading killers of women and children”. According to Rajiv Shah, Administrator of the US Agency for International Development (USAID), the NASG and the other nine lifesaving innovations on the list “could end preventable maternal and child deaths within a generation”. The effective scaling up of these innovations in low-resource countries could save 1.2 million mothers and children by the end of 2015.
Learn more about the NASG at the Safe Motherhood Program website, www.lifewraps.org. You can also read the full list of innovations (PDF).
09/05/13
The Guttmacher Institute announced Cynthia C. Harper, PhD, Bixby Principal Investigator and Associate Professor in UCSF's Department of Obstetrics, Gynecology and Reproductive Sciences, as the 2013 recipient of the Darroch Award for Excellence in Sexual and Reproductive Health Research.
"Through her high-impact research designed to inform public policy and improve clinical practice in reproductive health, Dr. Harper exemplifies the goals of the Darroch award," says Dr. Susheela Singh, Guttmacher vice president for research. "At a time when evidence-based policy is more important than ever, Dr. Harper's work has been instrumental in guiding and shaping some of the major policy advances of this decade."
The Darroch Award was established in 2005 to recognize excellence among sexual and reproductive health researchers who are in the early or middle years of their careers. It is named for Jacqueline E. Darroch, Ph.D., formerly senior vice president for science at Guttmacher and currently a senior fellow at the Institute, whose three decades at Guttmacher have exemplified rigorous and innovative work on sexual and reproductive health issues and a commitment to the practical application of research to policy and programs. The award is presented biennially.
For the full text of this announcement, click here.
08/20/13
The UCSF Safe Motherhood Program and Pathfinder International have completed an evaluation of the real-life use of the Life Wrap non-pneumatic anti-shock garment (NASG) in Nigeria. The Life Wrap is a first aid device that helps women with bleeding during childbirth survive until they can reach a health care facility equipped to offer full obstetric care. From 2007-2012, over 1,100 women who were in shock due to obstetric hemorrhage received treatment with a Life Wrap at 50 facilities across Nigeria. Among women who received the Life Wrap, 17.5% died. Women were more likely to die if they had other complications in addition to bleeding, such as anemia, preeclampsia or eclampsia, sepsis, or stillbirth. They were also more likely to die if they did not receive a blood transfusion.
This report is the first on use of the Life Wrap outside a clinical trial, and the findings suggest that use of the device could reduce death from obstetric hemorrhage. This evaluation used a simple system to collect information about the women's outcomes in non-research facilities which could be replicated in other settings. Wile the Life Wrap is effective, this evaluation underscores the need for a comprehensive approach to the management of pregnancy complications.
This evaluation was made possible by Pathfinder International’s Clinical and Community Action to Address Postpartum Hemorrhage Project in Nigeria. To learn more, see Comorbidities and Lack of Blood Transfusion May Negatively Affect Maternal Outcomes of Women with Obstetric Hemorrhage Treated with NASG, co-authored by UCSF Bixby Center members Alison El-Ayadi, Elizabeth Butrick, and Suellen Miller.
07/10/13
The UCSF Bixby Center has been selected by the National Institute of Child Health and Human Development (NICHD) as a member of the Contraceptive Clinical Trials Network (CCTN). In this role, the Center will help the NICHD evaluate new methods of contraception for safety, effectiveness, and acceptability. Center faculty have a long history of conducting contraceptive clinical trials, and look forward to continuing to rigorously evaluate new and improved methods of family planning. The leaders of this initiative are Bixby Center co-Director, Dr. Philip Darney, and the Kaiser Permanente Northern California Women's Health Research Institute Director, Dr. Tina Raine-Bennett.
04/30/13
Performing routine pelvic exams
may be medically unnecessary for healthy women with no symptoms. So why do physicians continue to perform such
exams with no clear evidence that they provide preventive benefit? Research at
the UCSF Bixby Center, sought to answer this question. The
national study, led by Drs. Jillian Henderson and George Sawaya, gathered and analyzed
clinician perspectives via a mailed survey on the bimanual pelvic examination
for asymptomatic women across the lifespan.
The survey
asked a representative sample of over 500 providers whether they would perform
a pelvic exam in varying clinical scenarios. Nearly all obstetrician
gynecologists would perform pelvic exams in asymptomatic women in part because
women expect it and normal results reassure patients that they are healthy.
Nearly half of physicians surveyed incorrectly believe the exam is important
for detecting ovarian cancer despite longstanding evidence that it isn’t effective
for this purpose.
This study shows a need to further evaluate the appropriateness of the routine
use of the pelvic exam for healthy women, as it takes up clinical time that
could be devoted to other concerns and can impede women’s access to birth
control. Drs. Henderson and Sawaya’s work has already made its mark in the
public – Jane Brody’s article “Questioning the Pelvic Exam” was featured in the
New York Times blog, Well, this
Monday.
04/08/13
On April 5th, 2013 a federal district judge ruled that levonorgestrel emergency contraception must be available without a prescription for women of all ages within the next 30 days. Until pharmacies implement this change, women aged 16 and younger will still need a prescription to buy levonorgestrel emergency contraception.
It has been over a year since the U.S. Department of Health and Human Services (HHS) blocked a Food and Drug Administration decision to make Plan B One Step emergency contraception available without prescription for all ages. Today’s court ruling cited this HHS action as “politically motivated, scientifically unjustified, and contrary to agency precedent.”
Research conducted by UCSF Bixby Center members provided evidence for the FDA that women aged 12-17 are able to safely and correctly use levonorgestrel emergency contraception by following instructions on the package and showed that HHS’s cited concerns about a lack of evidence for safe EC use by girls under age 12 was not prompted by scientific concerns.
UPDATE: On Tuesday, April 30, the U.S. FDA announced that it has approved the availability of Plan B One-Step for women aged 15 and older without a prescription.
02/11/13
At the American Public Health Association (APHA) annual meeting in October 2012, UCSF Bixby Center researchers shared the first findings from the Turnaway Study. This study examines the effects of access to abortion services on women’s lives, comparing women who received an abortion to those who were denied care because they presented past the gestational limit of the clinic. The study’s Principal Investigator, Diana Greene Foster, reported that “there is no evidence of a post-abortion trauma syndrome, receiving an abortion does not increase the incidence of mental health disorders compared to having an unwanted birth.” Another important finding was that the socioeconomic consequences for women denied abortions are substantial. “Women denied abortion were more likely to be receiving public assistance (76% vs. 44%) and have household income below the federal poverty level (67% vs. 56%) than women who received an abortion,” said Dr. Foster. Since these initial findings were announced at APHA, the Turnaway Study has received significant media attention, including Dr. Foster’s appearance on the Melissa Harris-Perry Show.
The Turnaway Study’s research team will continue to collect data and report findings in the coming years. The team is also expanding its investigation internationally with a Global Turnaway Study, which studies access to legal abortion and the consequences of illegal abortion and childbirth in Cambodia, Colombia, India, Nepal, South Africa and Tunisia. The global research effort will replicate the domestic study’s design in a range of different cultural and legal environments in where the rates of maternal mortality and morbidity are higher than they are in the US.
01/10/13
There is increasing evidence that exposure to environmental chemicals at levels encountered in daily life can have negative effects on women’s reproductive and children’s developmental health. Research from the UCSF Bixby Center’s Program on Reproductive Health and the Environment (PRHE) shows that nearly every pregnant woman in the US has measureable levels of multiple such chemicals in her body.
Exposure to certain environmental chemicals has been linked to birth defects; premature deliveries, stillbirths, and infants with low birth weight; and problems with nervous system development. New evidence also suggests that some environmental chemicals in men’s and women’s bodies are linked with reduced fertility.
Yet a recent PRHE survey shows that most Obstetrician-Gynecologists do not talk to their prenatal patients about environmental chemicals. Nearly all Ob-Gyns in the survey routinely talked to pregnant patients about alcohol, smoking, and weight gain. Most (86%) also discussed how to limit workplace hazards, and some (44%) talked about the risks of certain types of fish containing high levels of mercury. But few (5-19%) physicians discussed common sources of environmental chemicals like pesticides, air pollution, processed and canned foods, cosmetics, and the fumes from gas and other solvents.
With so many sources of environmental chemicals and increasing evidence of their harm during pregnancy, women need specific information about how to reduce their exposure. Most of the Ob-Gyns in the survey (86%) believed that could help their patients reduce their exposure, but they were concerned that this is not their area of expertise. Ob-Gyns noted the need for clear-cut practice guidelines on environmental chemicals and reproductive health, and that they trust information from the American College of Obstetricians and Gynecologists.
Reducing or preventing preconception and prenatal exposure to environmental chemicals can have multiple benefits lasting a lifetime. PRHE has developed free resources that clinicians and families can use to learn about and discuss the issue of environmental chemicals and reproductive health.
09/26/12
On World Contraception Day 2012, the UCSF Bixby Center celebrates the positive impact of contraception around the globe. Voluntary use of contraceptives allows women to decide if and when to have a child—and empowers them to raise healthier and more prosperous families. Use of contraceptives in developing countries already prevents 218 million unintended pregnancies, 118,000 maternal deaths, and 1.8 million infant deaths each year.
We also see room for improvement: research shows
that not all women’s needs are met by the current contraceptive
options. Women’s experiences with side effects and low effectiveness in
real world conditions are major flaws of many methods. The most
effective reversible methods, the implant and intrauterine device,
require a highly skilled healthcare provider for placement and removal,
and they can be prohibitively expensive. We must invest now
in an array of new contraceptives that enhance user control, have added
health benefits like the prevention of HIV, and that meet women’s
needs.
08/15/12
Our 2012 Symposium is focused on the many international projects coordinated by the UCSF Bixby Center. Dr. Jaime Sepulveda will deliver a keynote address on global health research at UCSF. Panels will include:
UCSF Bixby Center Co-Directors, Drs. Claire Brindis, Philip Darney, and Joseph Speidel will provide remarks. The Symposium will be followed by a wine and cheese reception.
05/09/12
There is little scientific evidence about best practices in patient education and counseling related to abortion care. Yet many recently enacted state laws mandate specific counseling and education practices for abortion patients. A new study from UCSF Bixby Center researchers sheds light on the counseling practices and patient needs at one U.S. clinic providing abortion care. The study used data drawn from patient medical records and a counseling needs assessment form, which patients complete when they arrive at the clinic.
The study found that nearly nine out of ten women seeking abortion care had high confidence in their decision to terminate the pregnancy. Nearly all patients in the study had told someone about their decision, and the large majority of people they had told were supportive of the decision—whether it was a male partner, mother, or friend. Taking into account women’s demographics, social support, and decision-making characteristics, women were less likely to feel highly confident of their decision if they were under 20 years old, had not completed high school, were Black, had a history of depression, or had spiritual concerns about abortion.
The study concludes women’s attitudes and decisions about abortion are complex and require “individualized approaches to patient education and counseling.” Patient-centered care in the context of abortion can be a challenge due to constantly changing laws and mandated counseling that is not based on evidence. Future research should address how different counseling approaches affect women’s well-being following an abortion so that all health care providers offering this basic service can meet their patient’s needs.
04/20/12
A few strains of human papillomavirus (HPV) are the major cause of cervical cancer (16 and 18) and the cause of most genital warts (6 and 11). In the U.S., some young women started using a vaccine—Gardasil—that protects against all four of these HPV strains in 2006. Clinical trials showed that the vaccine conferred high levels of protection from HPV to an individual woman, but we are still awaiting evidence regarding a population-level effect of the vaccine. Because cervical cancer usually develops many years after a woman first contracts a high-risk strain of HPV, it will be at least a decade before we can assess the vaccine's impact on cancer incidence and mortality rates.
Genital warts are usually on a much faster timeline than cervical cancer—they develop within a few weeks or months after exposure to the HPV strains that cause them. A new study from the California Department of Public Health's (CADPH) Sexually Transmitted Disease Control Branch assessed the incidence of genital warts in California Family PACT clients over four years, 2007-2010. UCSF Bixby Center members and study authors Drs. Heidi Bauer and Joan Chow showed a significant decline in the number of genital warts diagnoses for women and men under age 26. The ecological study used billing data from over 8 million Family PACT clients, and further found no change or slight increases in the number of genital warts diagnoses for clients age 26 and over. An ecological study cannot assess a causal relationship between the observed declines in genital warts and use of the quadrivalent vaccine, but it does provide interesting insight to the dynamics of HPV infection in a large population.
03/23/12
Unintended pregnancy is elevated among teens in the United States and is far more common than in other developed countries. Emergency contraceptive pills, like Plan B One-Step, provide effective pregnancy prevention but females under age 17 must have a prescription to purchase them. The pills are most effective when taken promptly, so waiting for a clinic to open after the weekend can mean higher failure rates. The U.S. Food and Drug administration recently considered several studies on levonorgestrel emergency contraception among females under 17, and decided that adolescents could safely use the product without a prescription.
One of the studies the FDA considered was from UCSF Bixby Center researchers, Drs. Tina Raine and Cynthia Harper, and has now been published in Obstetrics & Gynecology. The study shows that females younger than 17 can read Plan B One-Step’s label and understand whether or not to use it, and then use it correctly, in over-the-counter conditions. The study included females aged 13-17, and found no differences in their ability to choose or use Plan B by age.
In an unprecedented move, the U.S. Department of Health and Human Services Secretary Kathleen Sebelius overturned the FDA decision. Secretary Sebelius objected to the fact that there are no data on whether 11 and 12-year olds can safely use the product. There are no data about such young girls because their need for emergency contraception is exceedingly rare. Secretary Sebelius’ decision, however, means that 15 and 16 year olds, who may be sexually active and need access to emergency contraception, may not get it in time to prevent pregnancy. Adult women as well must still wait for pharmacy hours to obtain the product when needed since it will remain behind the counter. In response to the situation, Dr. Harper commented, “We need to direct our policy efforts toward reducing unintended pregnancy, so that teens and young women in this country have the opportunity to complete their education, to contribute to the labor force and to take proper care of the children they do have.”
03/22/12
Congratulations to Uta Landy and Philip Darney, UCSF Bixby Center members recognized by Planned Parenthood with their highest honor, the Margaret Sanger Award.
The award recognizes “leadership, excellence, and outstanding contributions to the reproductive health and rights movement.” Drs. Landy and Darney have devoted their careers to training the next generation of women’s health care providers. Dr. Landy directs the Ryan Residency Training Program and the Fellowship in Family Planning. Dr. Darney is a professor in the department of UCSF Obstetrics, Gynecology & Reproductive Sciences, former chief of Obstetrics and Gynecology at the San Francisco General Hospital, and co-founder of the UCSF Bixby Center.
The Margaret Sanger Award is given annually, and past recipients have included the Reverend Martin Luther King (1966), Alan Guttmacher, Sr. (1972), Katherine Hepburn (1983), Bella Abzug (1991), Justice Harry Blackmun (1996), Delores Huerta (2007), Kenneth Edelin (2008), Secretary of State Hillary Rodham Clinton (2009) and Anthony Romero (2011).
03/07/12
Placing a copper IUD within 5 days of unprotected sex offers 100%
effective emergency contraception (EC). Yet copper IUDs are rarely
recommended by health care providers when women request EC. A new study in Obstetrics & Gynecology by
UCSF Bixby Center researchers examines why providers recommend this
highly effective form of EC so infrequently. The study found that
providers were more likely to recommend the copper IUD as EC when their
views about who could IUDs were in line with updated patient eligibility
criteria. Other recent
research has shown that when women know they can use a copper IUD as EC,
some prefer it over emergency contraceptive pills.
It’s not just health care providers’ attitudes about IUDs that affect use; women’s views are another part of the equation. According to new research from UCSF Bixby Center, some women like the idea of being able to remove their own IUD—so much so that they might be more willing to try using an IUD in the first place. Women who liked the idea of removing their own IUD said it was because they would feel more in control, and it would save them the hassle of a doctor's appointment. Health care providers don't have enough information to offer the option of self-removal yet. More research is needed to learn what information is important for women interested in this option, and confirm that removing one's own IUD is safe. The researchers plan to conduct a study addressing these questions in the coming years.
02/03/12
The United States has one of the highest rates of unintended pregnancy among the world's developed nations. A series of articles in the Journal of Obstetric, Gynecologic and Neonatal Nursing addresses this issue. The articles - authored by ANSIRH researchers Diana Taylor and Amy Levi, and UCSF School of Nursing students Kim Dau and Evelyn Angel James - offer information on current pregnancy prevention strategies and a blueprint for a coordinated public health model of unintended pregnancy prevention. Primary care and women's health nurses are already important for women's contraceptive access, and will become increasingly crucial as U.S. healthcare evolves toward preventive care.
Reducing unintended pregnancies has been a goal for the U.S. Department of Health and Human Services since 2002, but to date, the rate has not changed. In fact, the rate of unintended pregnancy has increased for young and low-income women. The authors point out that unintended pregnancy is a preventable occurrence, but one that requires a coordinated effort of health care providers with basic knowledge on evidence-based and effective care. The clinical skills required to offer the full range of contraceptive methods may not have been offered to nurses and primary care clinicians during their training. The authors offer resources that will help clinicians better prepare to promote preconception care and the overall reproductive health of women at risk of an unintended pregnancy.
12/26/11
Former Ellertson Fellow and sociologist Dr. Amy Schalet spoke about American and Dutch attitudes toward teen sex on CNN’s American Morning show. Dr. Schalet’s research shows that Dutch parents allow older teens to have sleepovers in their homes. The parents discussed how this allowed them to keep a conversation about relationships, birth control and sexual health open with the teens. The Dutch approach to teen sex is related to their low rate of teen pregnancy (5 per 1,000 15-19 year olds). In comparison, the US rate of teen pregnancy is high (41 per 1,000 15-19 year olds). Dr. Schalet proposes that the take home message for US parents is to discuss sex with their children in the broader context of relationship and health—a conclusion supported by the American Pediatric Association and the American College of Obstetricians and Gynecologists. More information about her research is in her new book, Not Under My Roof: Parents, teens, the culture of sex.
12/07/11
Emergency contraception (EC), a safe and effective method of preventing pregnancy, has been subject to
Previous research conducted by members of UCSF Bixby Center showed that use of EC by women under age 17 is safe. Easier access to EC did not change teens’ sexual behavior, including their rates of sexual activity, unprotected intercourse, sexually transmitted infections, or number of partners. Additional research has since shown that women as young as 12 and 13 understand the instructions on Plan B packaging and take the medication according to instructions.
Levonorgestrel-based EC works by preventing a pregnancy, and it is most effective when taken within 72 hours of unprotected sex. This decision means that women under 17 will continue to face the hurdles of getting a clinic appointment and prescription for EC within a few short days. Additionally, this decision will not contribute to our national goal of reducing the high rates of unintended teen pregnancy. EC is the only form of contraception that has any type of age restriction.
12/06/11
New research from the UCSF Bixby Center shows that—although California’s public schools have made great progress in the quality and scope of sexuality education and HIV/AIDS prevention since the passage of Senate Bill 71 in 2003—improvement is inconsistent among schools. Many districts omit required information or teach inaccurate information, failing to give students critical health knowledge and violating state law. The report, “Uneven Progress: Sex Education in California Schools,” was released this week by UCSF and the American Civil Liberties Union of Northern California (ACLU).
Co-authors Dr. Claire Brindis and Sarah Schwartz Combellick surveyed a random sample of 100 unified school districts and sex education instructors. The surveys asked about the state of sexuality education in California public schools. Key findings include:
The ACLU will to use the report as evidence of the need to continue improving sex education in California.
11/04/11
New research from the UCSF Bixby Center shows that the California state and federally funded Medicaid family planning expansion program, Family PACT, helped couples to prevent an estimated 286,700 unintended pregnancies in 2007. The study used billing data from Family PACT and information about what methods new clients had used before enrolling in the program to estimate how many pregnancies would have occurred without the program. Using national data about the outcome of unintended pregnancies, the authors estimate that the program prevented “122,000 abortions, 133,000 unintended births and over 40,000 births among teens.”
Since the last estimate made in 2005, the program has expanded its reach and provided highly effective contraceptive methods to more clients, helping to prevent about 80,000 additional unintended pregnancies. Other studies have confirmed the cost-effectiveness of Family PACT for the state and federal government; this study provides an estimate of the number of couples who may have experienced economic, health and social benefits thanks to the program.
Another study from the UCSF Bixby Center shows that the use of highly effective intrauterine contraception (IUC) is increasing in California. The study used 10 years of data from the California Women's Health Survey to examine who used IUC in California from 1997 to 2007. Over the study period, IUC use almost doubled from 4% to over 7%. Compared to women using other methods of birth control, IUC users were more likely to be born outside the US, and they were substantially more likely to have children. Some things changed about women using IUC over 10 years of the study: young women, women born in the US, women without a college degree, and Asian women all showed significant increases in IUC use. However, use among women without children remained disproportionately low. Given the national trend of increasing IUC use and the medical consensus that most women are good candidates for IUC use, it is both timely and important to educate family planning clients about IUC's high effectiveness and safety, and train health care providers in the necessary counseling and clinical skills.
10/31/11
The United Nations (UN) Population Fund estimates that the world’s human population reached 7 billion today. An editorial in The Lancet connects this momentous event with the urgent need for improved access to family planning, especially in parts of South Asia and Sub-Saharan Africa where unmet need is greatest. The UN projects that 90% of population growth in the coming century will occur in the least developed countries, leading to heighted competition for already restricted resources, increased poverty and nutritional uncertainty. Drs. J. Joseph Speidel of the UCSF Bixby Center and Richard Grossman of the University of Colorado propose in a green journal commentary that—now more than ever—“reproductive health professionals play a critical role in making family planning universally available by shaping policy, advocating for funding, conducting research, and implementing training and service programs.” It will take renewed commitment and interdisciplinary work to make family planning access a development priority.
10/28/11
New research from ANSIRH and the Harvard School of Public Health explores how healthcare providers offering abortion services experience and cope with the stigma associated with this aspect of their work. For this study, researchers conducted interviews with 14 physicians, nurses, and nurse-midwives who provide abortion care services, and found that stigma can negatively affect those who deliver abortion care. But providers also actively resisted being stigmatized by focusing on the ways that abortion care helps their patients. The researchers conclude that: “while stigma exacts a price on individuals within the abortion-providing community, it also taxes the integrity of the healthcare system… [by calling] into question any institution, payer, or entity that facilitates abortion services.” Stigma marginalizes abortion care, keeping it separate from other aspects of healthcare, despite the fact that abortion is one of the most common healthcare procedures in the US.
09/02/11
Two new studies from UCSF Bixby Center members explore the role of contraceptive use in racial and ethnic disparities in unintended pregnancy rates. They find that Californian women of differing race and ethnicity have distinct contraceptive use patterns that are not explained by the cost of the methods, nor women’s socioeconomic situation.
In one study led by Dr. Christine Dehlendorf, researchers examined the relationships between race, ethnicity and contraceptive method use by Family PACT clients from 2001-2007. Family PACT is California’s Medicaid family planning program, which makes contraception free to women with no insurance and women under 200% of the federal poverty limit. The program served over a million women in 2007. The authors found that “the contraceptive methods women received differed substantially by race and ethnicity.” Taking into account age and the number of children women had, “white women were more likely than Latina, black or Asian women to receive the pill, ring or IUD, while Latina and black women were more likely than whites to receive the injectable, patch or barrier methods.” While the use of less effective contraceptives may be one factor in racial and ethnic disparities in unintended pregnancy rates, the authors point out that it is not the whole picture.
The second study, led by Dr. Grace Shih, examined whether income and education were related to contraceptive use by women of varying race and ethnicity. Using data from the 2006-2008 California Women’s Health Survey, the authors found similar disparate use of birth control by race and ethnicity. They also found that differences in educational level did not explain these disparities. Income levels were related to the use of hormonal contraceptives, with women below 200% of the federal poverty level 30-40% less likely to use these methods. Women’s knowledge about contraception, their preferences for various methods, and health care providers’ recommendations may all vary by race and ethnicity and contribute to these disparities. Both studies point to the need for an improved understanding of contraceptive knowledge, choices and use among women of different race and ethnicity.
09/01/11
Dr. George Tiller and the staff of the former Wichita Women’s Health Care Services clinic offered compassionate care for women with wanted pregnancies that went terribly wrong late in gestation. After the murder of Dr. Tiller in May 2009 and closure of the clinic shortly thereafter, Bixby Center sociologist Dr. Carole Joffe began exploring how the staff of the unique clinic coped with working in an environment attacked by antiabortion activists on a daily basis.
In her special report, Dr. Joffe also documents the services developed for the clinic’s patients, who travelled from all over the country. In interviews with seven former staff members, the sustained protests of the clinic emerged as a paradoxical galvanizing force for the work of the late Dr. Tiller and his staff. Gratitude from patients was another source of sustenance; one staff member said, “I have never worked for any physician where there was that kind of love and appreciation from patients… they really felt like they had their lives back, that this was a place of healing for them.” The availability of abortion for women who need one late in pregnancy remains extremely limited, but the services pioneered in Wichita are being replicated in other centers around the US.
07/19/11
A centerpiece of the Patient Protection and Affordable Care Act of 2010 (ACA) is coverage of preventive health care services—an important shift from treatment for existing illnesses. The ACA will remove cost-sharing requirements for patients from a list of preventive services, making those screenings, counseling and procedures free. This new emphasis on preventive care is intended to foster health and well-being, and save money that would otherwise be spent on costly acute care treatments. Women stand to benefit from this shift, particularly due to their higher burden of chronic disease and disability.
Three independent bodies recommended preventive services in the ACA (the US Preventive Services Task Force, the American Academy of Pediatrics’ Bright Futures, and the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices), but there were critical gaps in preventive services for women’s health. The US Department of Health and Human Services (HHS) requested that the Institute of Medicine (IOM) convene a group of experts to recommend additional evidence-based preventive measures to ensure women's health and well-being.
The IOM committee, which included the UCSF Bixby Center co-founder Dr. Claire Brindis, has eight recommendations:
If adopted by HHS, these recommendations would expand the scope of screening for cervical cancer, STI counseling, and HIV counseling and screening. They recommend that contraceptive counseling, methods and provision be included as key preventive services, echoing 27 states that have already made contraceptive coverage mandatory for private insurers. They also recommend expansion of preventive services available to pregnant women to include screening for increasingly common gestational diabetes and support for breastfeeding. Finally, they recommend culturally competent screening and counseling for interpersonal and domestic violence.
Dr. Brindis noted that these recommendations were crafted by “carefully reviewing existing evidence,” allowing the committee to “identify those clinical areas especially relevant to women’s health and ways to decrease traditional barriers women encounter in accessing preventive care.”
Read more
- IOM’s Preventive Clinical Services for Women:
Closing the Gaps Report,
Brief, and Press
release
- UCSF News Center UCSF Health Experts Shape Historic Blueprint for Women’s Health Care
07/18/11
HIV-positive women with bacterial vaginosis (BV) are more likely to transmit HIV to their male partners than women without BV. Taking into account women’s age, pregnancy status, incidents of unprotected sex, other partners, viral load, and other sexually transmitted infections, men whose partners had BV were 3 times more likely to acquire HIV compared to men whose partners had normal vaginal flora. This finding from the Partners in Prevention Study was presented today by Dr. Craig Cohen at the International AIDS Society Conference in Rome.
BV is a very common condition, affecting 30-50% of women in Sub-Saharan Africa, in which the normal bacteria living in the vagina are out of balance. Research had shown previously that women with BV had a 60% increase in male-to-female HIV transmission.
The mechanism through which BV increases HIV transmission is not known, but Dr. Cohen’s team suggests two possibilities. Normal vaginal bacterial flora may be protective against HIV, killing some of the virus and reducing the proportion capable of causing an infection in a partner. In the case of female-to male transmission, BV may also indirectly increase a male partner’s susceptibility by activating his Langerhans and CD4 cells.
This study confirms that there is a critical need for improved BV treatments. The current treatment options are inadequate, with BV recurring in up to 70% of women treated with antibiotics within 3 months.
Read more
- NAM AIDSMap blog Bacterial vaginosis raises women's risk of transmitting HIV
03/02/11
When health care providers give women a one-year supply of birth control pills, rates of unintended pregnancies and abortions decline. New research from Bixby Center members Diana Greene Foster, PhD, Philip Darney, MD, MSc, and Michael Policar, MD, MPH, shows that women given one or three packs of pills at a time had a significantly higher risk of unintended pregnancy and abortion compared to women given a year's supply. The authors estimate that giving all women in the study a year of pill packs would have averted about 1,300 pregnancies and 300 abortions. Providing a year of pills is not only good medical practice - it can save taxpayer dollars.
The study linked data on 84,401 women who received birth control pills in January, 2006, via California's family planning Medicaid expansion program (Family PACT) to hospital records from Medi-Cal showing pregnancies and births in 2006. About 19,000 women received 12 months of pills from Family PACT providers. Compared to the 65,000 women in the study who received either one or three packs of pills at a time, their odds of pregnancy decreased by 30% and odds of abortion decreased by 46%.
This study's findings are particularly significant now, as the US House of Representatives has voted to "de-fund Planned Parenthood," and eliminate Title X, a safety-net federal family planning program.
Read More
- Time Magazine, "To Slash Abortion Rate, Dole Out Birth-Control Pills a Year at a Time"
- Original research article in Obstetrics & Gynecology, "Number of Oral Contraceptive Pill Packages Dispensed and Subsequent Unintended Pregnancies"
02/09/11
Philanthropedia has honored the Bixby Center as a Top Nonprofit working in women’s reproductive health, rights, and justice.
Philanthropedia is a nonprofit organization that helps donors make smarter grants and gifts by connecting them with the highest impact nonprofits working on the causes they care about. Our award was based on Philanthropedia’s survey of 192 experts.
Visit Philanthropedia’s website to read the experts’ reviews of the Bixby Center.
01/07/11
Craig Cohen, MD, MPH, a professor of obstetrics, gynecology and reproductive sciences at UCSF, and Bethany Holt Young of the Coalition Advancing Multipurpose Innovations (CAMI) are exploring new solutions to improve sexual and reproductive health.
Coalition Advancing Multipurpose Technologies (CAMI ) from STV Productions on Vimeo.
CAMI explains the recent advances in “multipurpose prevention technologies” —technologies to address different reproductive health needs simultaneously. Condoms are an example of a multipurpose prevention technology, protecting against both unplanned pregnancy and sexually transmitted infections (STIs), including HIV. Dr. Cohen’s vision for a better technology is a vaginal ring that slowly releases “a chemical which would essentially reduce the risk of HIV acquisition” and simultaneously protect against pregnancy.
Learn more about the work of CAMI.
12/15/10
The Bixby Center Ellertson Fellow, Julia R. Steinberg, PhD, and the Guttmacher Institute’s Lawrence B. Finer, PhD, have shown that there is no significant relationship between having an abortion and subsequent mood or anxiety disorders or substance abuse. Steinberg and Finer published “Examining the association of abortion history and current mental health: A reanalysis of the National Comorbidity Survey using a common-risk-factors model” in Social Science & Medicine. Their work is a response to Dr. Priscilla Coleman et al. “Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the effects of abortion in the national comorbidity survey” (2009), which argues that, compared to women who have not had abortions, women with an abortion history are more likely to develop substance abuse, mood and anxietydisorders.
Both teams analyzed data from the US National Comorbidity study. Steinberg and Finer “were unable to reproduce the most basic tabulations of Coleman and colleagues,” calling into question the validity of their results. Steinberg and Finer’s analysis provides compelling evidence that abortion does not endanger women’s mental health; rather, a history of mental health disorders is the strongest predictor of poor mental health after an abortion.
The national media paid attention: see some of the coverage in the Washington Post and CBS News.
11/22/10
New research shows that nearly one-third of women’s health care providers require a pelvic exam before they will provide a prescription for birth control pills. There is no medical need for a pelvic exam before using oral contraception, but it remains common practice to link them. This may create an unnecessary hurdle for women who want birth control pills. One of the study authors, Dr. George Sawaya, said, "In my view, we should have as few barriers as possible to women trying to get effective birth control."
Clinicians were more likely to require pelvic exams if they were older or served a higher proportion of Medicaid patients. Those working in private practice were two times more likely than those working in family planning or community clinics to require a pelvic exam. The researchers noted that “in the absence of adequate financial incentives for contraceptive counseling as an important clinical activity in its own right, providers are incentivized to conduct a physical exam with a well-reimbursed billing code,” such as a pelvic exam. In addition to creating unnecessary costs, conducting unneeded pelvic exams and pap smears may lead to false positive results that require further investigation. “Any (test) we do with an asymptomatic person has a chance of resulting in a false-positive,” Dr. Sawaya noted.
Read more
- Reuters Health news article, “Women seeking birth control get unneeded pelvic exams”
- Obstetrics & Gynecology original research article, ”Pelvic Examinations and Access to Oral Hormonal Contraception”
- American College of Obstetrician and Gynecologists Practice Bulletin, “ Cervical cytology screening"
10/25/10
Family AIDS Care and Education Services (FACES), was founded in Kenya in 2004. It is a joint clinical and research program, co-directed by Craig Cohen, MD, MPH, professor of obstetrics, gynecology and reproductive sciences at UCSF, and Elizabeth Bukusi, MBChB, MD, PhD of the Kenya Medical Research Institute (KEMRI).
FACES clinics offer HIV testing, counseling and treatment services, and to date, have served more than 75,000 Kenyans. For those in need, the program provides free antiretroviral medicines. The health and well-being of people living in the Kenyan communities served by FACES has measurably improved.
While the program has been a tremendous success, its growth poses new challenges. One example is “loss to follow-up”—patients who have been diagnosed with HIV but do not come back for antiretroviral medicine. At FACES, the loss to follow-up rate is around 30 percent. Clinic workers have been making special efforts to track down the patients and, if possible, get them back into treatment.
New research led by Dr. Cohen suggests that malaria infection might increase women's susceptibility to HIV and AIDS. This could be part of the explanation for sub-Saharan Africa’s higher rate of HIV, and suggests a new avenue for FACES clinical care.
10/05/10
Craig Cohen MD, MPH provides commentary to allAfrica.com about his recent research, which suggests that Malaria infection might increase women's susceptibility to HIV and AIDS.
09/08/10
Dan Grossman, MD, FACOG, along with colleague Joseph E. Potter, PhD published "Potter, Grossman: Make birth control available to immigrants" (9/3/2010) in Statesman, an Austin, TX newspaper.
08/30/10
In the San Francisco Chronicle editorial "End practice of shackling pregnant inmates," (8/26/2010) Dr. Carolyn Sufrin writes in support of California AB1900; if passed, this legislation would mandate that pregnant inmates incur the least restrictive forms of restraint as possible. You can also read Lois Kazakoff's response to Dr. Sufrin's editorial, here.
07/30/10
ANSIRH’s Lori Freedman, PhD, has found a gap between physician willingness to provide abortion care and their ability to offer these services. In Willing and Unable: Doctors’ Constraints in Abortion Care, Dr. Freedman explores this gap. Freedman interviewed 30 obstetrician-gynecologists who received abortion training in their residency programs; of those 30 physicians, 18 wanted to provide abortion care, but only three were able to do so. Freedman found that these doctors encountered a variety of structural barriers, including senior members of a group practice who disallowed abortion care. Intimidated by “the stigma and contention surrounding abortion” (RealityCast), many group practices are unwilling to provide abortion, sending patients to free-standing clinics such as Planned Parenthood, instead. Although abortion is the most common medical procedure for women of reproductive age, refusal to offer abortion care within the context of routine medical care reinforces this stigma and contention.
Freedman’s book is an important addition to the many voices of the abortion debate. Her work steps above the oft-quoted ethical and religious tropes and highlights the systematic barriers—both objective and subjective—that preclude obstetrician gynecologists from providing abortion care.
Read more:
- Slate Magazine review
- Our Bodies Ourselves blog
07/06/10
Craig Cohen, MD, MPH and Elizabeth Bukusi, MBChB, MD, MPH, PhD, Co-Directors of FACES
(Family AIDS Care and Educational Services), which is a collaboration between the Kenya Medical Research Institute (KEMRI) and UCSF, were featured on the front page of the San Francisco Chronicle in "UCSF-Kenyan team helps guide country out of HIV" (Sovern, 7/5/10) as well as in a KCBS radio news story titled "AIDS in Africa: Faces of Hope". FACES has been in operation in Kenya since September of 2004 and its treatment and prevention efforts have drastically improved the health and well-being of people living in numerous Kenyan communities.
06/30/10
Several Bixby Center investigators have received 2010 Society of Family Planning grant awards. Congratulations to Cynthia Harper, PhD, Tracy Weitz, PhD, MPA, Carole Joffe, PhD, Jillian Henderson, PhD, MPH, Jody Steinauer, MD, MAS, and Julia Steinberg, PhD!
06/01/10
05/21/10
Janet Turan, PhD, MPH, is the 2010 recipient of the Pathways to Discovery Mentor Award. The Pathways to Discovery Program helps motivated students from the School of Medicine, School of Nursing, School of Dentistry, and School of Pharmacy develop knowledge, skills, and experiences that will help them contribute to the health community beyond individual patient care.
05/09/10
05/07/10
In the face of oral contraception's 50-year history, Dan Grossman, MD, advocates for an over-the-counter future in USA Today's article "The pill: 50 years of birth control changed women's lives" (Rubin, 5/7/10).
Dr. Grossman, along with colleagues at the University of Texas, are studying oral contraceptive use along the US-Mexico border, where American women have the option of obtaining pills over the counter in Mexican pharmacies. For more information, see Dr. Grossman's recent article "Clinic Versus Over-the-Counter Access to Oral Contraception: Choices Women Make Along the US-Mexico Border" (American Journal of Public Health, 4/15/10).
04/28/10
04/14/10
04/09/10
03/22/10
03/17/10
Prof. Tracy Weitz, PhD, MPA, Director of ANSIRH, responds to Rep. Bart Stupak's effort to prohibit federal funding of abortion services within the Affordable Health Care for America Act on the Rachel Maddow Show (clip here) (MSNBC, 3/17/10).
03/03/10
01/13/10
12/28/09
For more about the multi-campus UC Global Health Institute and the three 'Centers of Expertise' see "New Center Focuses on Women’s Health and Empowerment on Global Scale" (UCSF Today, 12/28/09)
12/07/09
11/20/09
The American College of Obstetricians and Gynecologists (ACOG) has issued new guidelines for cervical cancer screening. Dr. George Sawaya's studies on the benefits and risks of cervical cancer screening were instrumental in these new recommendations.
For more information, see Dr. Sawaya's editorial "Cervical Cancer Screening — New Guidelines and the Balance between Benefits and Harms" (The New England Journal of Medicine, 11/25/09), the Department of Obstetrics, Gynecology & Reproductive Sciences news page, which includes links to additional media coverage, and "New Guidelines on Pap Tests Draw from UCSF Expert’s Findings" (UCSF Science Cafe, 12/2/09).
11/18/09
09/23/09
Claire Brindis, DrPH, MPH, discusses the nuances of health care policy and reform in "Policy Expert Brindis Takes the Pulse of Health Care Reform Efforts" (UCSF Today, 9/23/09).
08/18/09
07/07/09
Dr. J. Joseph Speidel will be awarded the Allan Rosenfield Award for Lifetime Contributions to International Family Planning. The Society of Family Planning gives this annual award to individuals who have made invaluable contributions to the health of women worldwide. Dr. Speidel will receive this award at Reproductive Health 2009 in September.
06/10/09
05/21/09
05/09/09
"Former Marin midwife saving the lives of mothers in Africa" (Halstead, 5/9/09) discusses the LifeWrap and the international work of Suellen Miller, PhD, RN, CNM, MHA.
05/07/09
Suellen Miller, PhD, RN, CNM, MHA's work with the LifeWrap for obstetric hemorrhage is featured in "Science for Us, but Also for the World" (Berkley, 5/7/09) and Dying to Give Life (Abrams, 5/26/09).
05/06/09
05/01/09
George F. Sawaya, MD, and co-authors Chirenje MZ, Magure MT, Tuveson JL, Ma Y, Shiboski SC, Da Costa MM, Palefsky JM, Moscicki AB, Mutasa RM, Chipato T, Smith-McCune KK, were awarded the 2008 Roy M. Pitkin Award for their paper, “Effect of diaphragm and lubricant gel provision on human papillomavirus infection among women provided with condoms: a randomized control trial” (Obstetrics & Gynecology 2008; 112: 990-997).
According to Obstetrics and Gynecology, “the Roy M. Pitkin Award was established in 1998 to honor departments of obstetrics and gynecology that promote and demonstrate excellence in research. The award consists of a $5,000 unrestricted grant presented to each department whose faculty, fellows, or residents published 1 of the 4 most outstanding manuscripts in Obstetrics & Gynecology during the past year. We recognize both the authors and the departments for the quality of the research and publication of the results.”
04/22/09
03/11/09
02/10/09
12/12/08
The New Generation Health Center and its collaborative project, Glass to Diamonds, are featured in "UCSF Partners with Community to Inform Teens About Reproductive Health" (12/12/08). The Glass to Diamonds project seeks to highlight issues of access to reproductive health care for young women.
10/07/08
09/20/08
08/14/08
Dr. Maternowska's book, Reproducing Inequities: Poverty and the Politics of Population in Haiti (Rutgers University Press), reviewed in "The Strange History of Birth Control" (Epstein, 8/14/08).
05/22/08
Dr. Darney participates on a panel addressing teen pregnancy and birthrates in California and the nation. Radio program achrived here: "Teen Birthrate" (KQED Forum, 5/22/08).
12/19/07
A CDC study published in the Journal of Adolescent Health concluded that sex education increased the likelihood that teens would delay sex. Dr. Claire Brindis explains to Science Daily that sex education is needed to counter the "mythology" around sex; teach anatomy, physiology and contraception; and give teens ways of dealing wisely with sexually risky situations.
12/07/07
The UCSF News Office reports that the Bill & Melinda Gates Foundation has given UCSF researchers nearly $1.4 million to expand African research trials on the non-pneumatic anti-shock garment (NASG). The director of Safe Motherhood Programs, Dr. Suellen Miller, hopes the NASG will help to reduce maternal mortality worldwide.
12/05/07
Dr. Claire Brindis discusses the factors that lead to the 19 million STD infections diagnosed each year in the United States in "Breaking the silence" (CNN, 12/5/07).
11/05/07
Claire Brindis, DrPH, and Douglas Kirby, PhD, of ETR Associates, describe California's family planning program for low income men and women, Family PACT, which also provides contraceptives to low income teens. California teaches comprehensive sex education in schools in contrast to Texas, which promotes an abstinence-only curriculum. Dr. Brindis's research shows that, from 1991-2004, California's teen birth rate fell by 47 percent, while the United States' teen birth rate fell by one third. During the same period Texas's teen birth rate fell by 19 percent.
Related links:
Decline in Unintended Pregnancies in California: California Congressional Districts
Decline in Unintended Pregnancies in California: California State Senate and Assembly Districts
Family PACT Fact Sheet on Adolescent Services
11/02/07
This October, UCSF faculty members associated with the Bixby Center participated in both an evidence-based medicine and problem-based learning training course and a high-level policy seminar with medical educators in Vietnam. The group, led by Uta Landy, PhD, included Drs. Eugene Washington, Lee Learman, Philip Darney, Rebecca Jackson, and George Sawaya. The training course was a follow up to an earlier course held in June by faculty members Drs. Sawaya and Jody Steinauer. The final course in this series is scheduled for spring 2008 in Ho Chi Minh City. Dr. Landy hopes this program will serve as a model program for improving medical education in other countries.
10/29/07
Nancy Padian, PhD, director of the Women's Global Health Imperative (WGHI), congratulated the Women's Global Health Scholars for concluding the program's first year with the determination and know-how to carve out leadership positions in health care around the world and for exceeding the goals they had set at the start of the year. The first class of Women's Global Health Scholars hailed from Africa (Kenya, Malawi, Tanzania, South Africa, Uganda, Zimbabwe, Botswana), Asia (China, India, Vietnam), Eastern Europe (Turkey, Georgia), and Latin America (Brazil, Argentina, Peru). The program consists of two one-week courses at UCSF, monthly virtual meetings, and ongoing mentorship.
10/19/07
Suellen Miller, PhD, RN, CNM, MHA, speaks about using the low-tech NASG to reduce maternal mortality and save women's lives on The World report, "Maternal health focus of MacArthur grant." See additional coverage of this radio event on UCSF Today. For more information about the grant, see "MacArthur Grant Funds Innovative UCSF Project to Reduce Maternal Mortaility" (Synapse, 11/8/07) and "Providing Nigerian Hospitals with Equipment and Supplies to Save Mothers' Lives" (UNFPA News, 10/11/07).
08/10/07
San Francisco General Hospital does not use digoxin or potassium chloride injections to ensure fetal demise in late-term abortions because, "We do not believe that our patients should take a risk for which the only clear benefit is a legal one to the physician," wrote Dr. Philip Darney, San Francisco General Hospital’s Chief of Obstetrics & Gynecology, in an e-mailed response to the reporter's inquiry. "Shots assist in aborting fetuses" (Goldberg, 8/10/07) focused on doctors' reactions to the U.S. Supreme Court's April decision to uphold the Partial-Birth Abortion Ban Act. The Act imposes the possibility of a two-year prison sentence for abortions in which the fetus is partially delivered while alive.
07/30/07
Dr. Darney weighs in on the re-released contraceptive, the Today Sponge, in The New York Times article, "Good News, Elaine: The Sponge Is Back, With a More Modern Approach" (Levere, 7/30/07).
07/25/07
Dr. Nancy Padian reviewed methods for preventing transmission of HIV in the context of her recent study of diaphragms as a barrier method of HIV prevention and made recommendations for future research during a plenary session of the 4th International AIDS Society Conference in Sydney, Australia. Dr. Padian's speech, "Synthesizing Our Options: Biomedical Prevention Technologies in the Context of Behavioural Interventions," was covered by:
07/23/07
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Dr. Suellen Miller discusses preventing maternal death during childbirth with the non-pneumatic anti-shock garment (NASG) on Mother Jones Radio.
06/06/06
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02/27/06
"First aid for obstetric haemorrhage: the pilot study of the non-pneumatic anti-shock garment in Egypt" (British Journal of Obstetrics and Gynaecology, 2006;113(4):424-9) finds that the NASG — a reusable neoprene suit — shows promise for management of obstetric haemorrhage, particularly in lower resource settings. Haemorrhaging is a leading cause of maternal deaths worldwide. See news coverage in"Reusable Suit Could Save Lives During Childbirth" (Los Angeles Times, 3/4/06)
11/09/05
10/07/05
"Plan B: A Collision of Science and Politics" (Couzin, 10/7/05) highlights the emergency contraception research of Cynthia Harper, PhD, and Tina Raine, MD, MPH.
09/15/05
Dr. Claire Brindis was quoted in several news articles discussing the CDC's National Center for Health Statistics's recent report "Sexual Behavior and Selected Health Measures: Men and Women 15-44 Years of Age, United States, 2002" (9/15/05).
See coverage in The Washington Post (Stepp, 9/16/05), Los Angeles Times (Maugh, 9/16/05), and TIME Magazine (Lemonick, 9/19/05).
08/24/05
"Fetal Pain: A Systematic Multidisciplinary Review of the Evidence," which appeared in the August issue of the Journal of the American Medical Association, examines whether a fetus feels pain and whether safe and effective techniques exist for providing direct fetal anesthesia. The review finds that fetal perception of pain is unlikely before 29 or 30 weeks. The article also finds that there is little data addressing the effectiveness of direct fetal anesthesia or the safety of such techniques on pregnant women.
See news coverage of the study in:
New York Times (Grady, 8/24/05)
Washington Post (8/24/05)
Los Angeles Times (Maugh, 8/24/05)
San Francisco Chronicle (Hall, 8/24/05)
08/15/05
Philip Darney, MD, MSc, interviewed in "Abortion Pill Investigated in Four California Deaths" (La Ganga, 8/15/05).
08/12/05
07/24/05
In the powerful "Lives" feature "Haiti Eyes" (7/24/05), Dr. Maternowska describes her life-threatening experience in Haiti, where she has done public health work for 22 years.
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