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.
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.
The role of MPTs in the prevention of infertility.
The need for rectal MPTs to reduce HIV and other STIs, and their potential impact for women and men who have sex with men.
“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.
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.
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:
Preferred private over public facilities due to convenience and faster service. They avoided public facilities due to long wait times./li>
Believed that private facilities treated their customers with care and attention compared with public facilities, where participants experienced verbal harassment, inattention and rudeness.
Reported that they felt more confident about the quality of medical care in public facilities than in private, and believed that private providers prioritized profit over safe medical care.
Reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-making support.
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.
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.”
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:
Of the more than 100,000 women in the study, 9.8% had a subsequent pregnancy with a preterm birth.
For every month a woman used postpartum contraception, her odds of a subsequent preterm birth decreased by 1.1%.
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.
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.
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.”
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 TheLancet, 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.
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.
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:
American College of Obstetricians and Gynecologists
National Family Planning & Reproductive Health Association
National Health Law Program
National Women’s Law Center
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.
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
UN Commission on Life-Saving Commodities for Women and Children
Clinton Health Access Initiative, Inc.
Blue Fuzion Group, which supplies the product
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.
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.
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:
Louisiana women in the study had traveled, on
average, 58 miles each way to have an abortion.
If Louisiana’s abortion facilities closed,
the average distance would more than triple to 208 miles each way, about the distance
from New York to Boston.
Most women who had abortions at the
three Louisiana facilities had no education beyond high school. They were also more
likely to live in areas where average incomes were below the state mean.
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.
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.
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.
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:
Among women who received an abortion, depression
and anxiety symptoms remained steady or decreased over the 2 years after the
procedure.
Levels of anxiety symptoms were initially
higher among those denied an abortion compared with those receiving one, but
the two groups converged over time.
Women who received abortion close to gestational age limits initially had similar levels of depression
and lower levels of anxiety compared to women who were denied abortions and
subsequently carried their pregnancies to term.
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.
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:
A small increase of 1 new IUD or implant user per 100 women was associated with a 4% decline in abortion each year.
The decline happened in conjunction with an increase in the number of facilities offering abortion care to women, particularly in rural and remote areas
"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.
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.’”
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:
About the same frequency of complications as for
colonoscopies.
Less frequent than complications for wisdom
tooth removal and tonsillectomy.
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.
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
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.
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.
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.”
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.
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.
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.
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 reported communication
with female friends and family members was a valued means of obtaining information
about contraceptives.
Negative information—which was
often factually incorrect—was more common and more memorable than positive
information in communication with friends and family.
Social contacts and TV commercials
were the main sources of negative information about IUDs; clinicians were the
main source of positive information.
Most current or former
IUD users had recommended the method to friends or family. Their most common
messages were the method's high efficacy and the advantage of not having to
remember to take a pill every day.
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.
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.
Two-thirds of women reported receiving
information on at least one effective method at their abortion visit, most
commonly injectables (52%) or pills (45%).
Women not currently living with their husband
or partner were less likely to receive contraceptive information than women living
with husbands (57% vs. 68%).
Women who had never given birth were less
likely to receive information than women who had (53% vs. 68%).
Patients at nongovernmental clinics were more
likely to receive contraceptive information than women at public hospitals.
Forty-four percent of women received
effective contraceptive supplies at their abortion visit, most commonly the
injectable (28%) or pills (12%).
However, 48% of women choosing long-acting
reversible contraception (LARC) and 83% of those selecting sterilization left
the abortion visit without an effective method.
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.
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:
Expanded clinic hours.
Increased outreach to vulnerable and
hard-to-reach groups.
Improved language and translation services.
Enhanced technologies, such as electronic
health records and online interactions with clients.
Increased clinical training opportunities for
providers.
Greater onsite provision of highly effective
contraceptive methods, including intrauterine devices and hormonal
implants.
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.
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.
The
researchers found that Hispanic women and teenagers had lower contraceptive
awareness:
Hispanics and teenagers were less likely to
know about the intrauterine device (IUD) compared with white women and young
adults.
Hispanics and teenagers were less likely to
know that a woman experiencing side effects could switch brands of oral
contraceptive pills.
Hispanics born outside the United States had
lower knowledge about contraceptives than U.S.-born Hispanics. For example,
foreign-born Hispanics were less likely than U.S.-born Hispanics to have heard
of the IUD or the vaginal ring.
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.
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:
Women denied an abortion initially reported
lower self-esteem and life satisfaction than women who sought and obtained an
abortion.
Women who obtained first-trimester abortions
reported higher levels of life satisfaction, which remained steady over time,
compared with other women.
The initially lower levels of self-esteem and
life satisfaction among women denied an abortion eventually improved, reaching
similar levels as those obtaining abortions after six months to one year.
Self-esteem and life satisfaction improved
over time for all women, except those who received a first-trimester abortion
since their levels were higher to begin with and remained steady.
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.
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:
Groundbreaking
research in antiretroviral therapy (ART) for HIV prevention, including ART in
patients co-infected with tuberculosis.
ART
for prevention for couples with one HIV-positive and one HIV-negative partner.
Initiation
and monitoring of pediatric ART.
Microbicides
for HIV prevention.
Community
HIV testing strategies.
Prevention
of mother-to-child HIV transmission.
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.
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:
Twenty-nine percent paid the full cost out-of-pocket.
Two-thirds (71%) received some financial
assistance in covering the cost of an abortion, mainly state Medicaid (34%) and
other organizations (29%).
Even with financial assistance, most women
had some out-of- pocket costs for abortion. Out-of-pocket costs for abortion
paid by the woman, family, or friends ranged from $0 to $3,700, with an average
of $474.
For more than half of the study participants,
total out-of-pocket costs (including abortion and travel) were more than
one-third of their monthly income.
More than half of women (54%) reported that
raising money for an abortion delayed obtaining care.
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.
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:
Is applicable to women in any type of sexual
relationship (married or unmarried, cohabitating or not) and to women living in
a variety of gender-equity contexts worldwide.
Captures the influence of other individuals
in addition to women's sexual partners, such as parents, in-laws, and friends.
Is concise, so that it could be easily
inserted into standardized questionnaires, evaluations, or clinical
assessments.
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.
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:
81% of participants supported OTC access to
oral contraceptives.
42% planned to use the pill after their abortion. This increased to 61% if it were available OTC.
33% who planned to use no contraceptive
following abortion said they would use an OTC pill, as did 38% who planned to
use condoms afterward.
Uninsured participants showed greater
interest in OTC access than those with private insurance.
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.
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:
Physicians commonly described contraceptive
counseling and knowledge as particularly useful skills they obtained from the
training.
They appreciated the efforts of the faculty
to allow them to learn up to the level of their comfort.
Physicians gained confidence in caring for
patients facing unintended pregnancies. They also improved their communication
skills, especially in offering options counseling.
Broadly, interviewees described being able to
step back from their personal beliefs about abortion and instead focus on caring
for patients. Many also reported a change in their beliefs about women seeking
abortions and abortion providers.
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.
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 circumstances that trigger migration –
such as widowhood, disinheritance and gender-based violence – can increase women's risk of acquiring the virus.
Migrant women's options to earn a living,
including transactional sex, place them at a high risk of HIV.
Women often migrate to locations with social
contexts that facilitate multiple sexual partners and transactional sex.
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
In 2009, the
American College of Obstetricians and Gynecologists recommendedlong-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:
One-fourth of providers were not routinely discussing
IUDs with contraceptive patients, and nearly half were not routinely discussing
the implant.
Providers were most concerned about offering
and IUD to women with a history of pelvic inflammatory disease, followed by women
who have never given birth, women with a history of ectopic pregnancy, and
teenagers. All of these women can safely use IUDs.
Only around half correctly believed that it
is safe to provide IUDs immediately following an abortion or childbirth.
Also incorrectly, some providers considered
smokers and women with a history of hypertension inappropriate candidates for an
implant.
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.
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:
Both Hispanic and black women were less
likely to use effective methods of contraception, such as hormonal methods and
intrauterine devices, compared with white women.
Black women at risk of unintended pregnancy were
less likely to use any method of contraception.
These trends were concentrated among younger
women.
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.
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:
Poor relationships.
Partners unable or unwilling to support a child.
Undesirable partner characteristics for parenting.
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.
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.
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.
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.
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.
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:
Ensure links between hospital and outpatient records so that contraceptive counseling and provision can be shared across healthcare providers.
Establish clinic protocols that allow any medical visit during the postpartum period to be used for contraceptive counseling and provision, including visits to the pediatrician for the infant.
Add contraceptive counseling to the infant-visit checklist for normal visits in the three months following birth.
Create reminders to review contraception in electronic health records during the postpartum period.
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:
New treatment options for HIV-positive adults, including a cure.
Diseases and conditions that occur frequently among HIV-positive people, such as tuberculosis and hepatitis.
Improving the health of HIV-positive mothers and children.
Microbicides to provide women with improved HIV prevention options.
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:
Effective methods to empower HIV-positive adolescents to ensure their economic success, achieve better access to care, and improve their overall health.
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:
ACCESS: Women’s Health Justice
American Nurses Association-California
American Civil Liberties Union of Northern California
Black Women for Wellness
California Latinas for Reproductive Justice
California Women’s Health Alliance
California Academy of Family Physicians
California Association for Nurse Practitioners
California Academy of Physician Assistants
California Medical Association
California Nurse-Midwives Association
Nation Association of Social Workers-California
NARAL Pro-Choice California
Planned Parenthood Affiliates of California
SEIU-California
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
Late-breaking report on HIV & family planning integration from Nairobi
Accomplishments of the UCSF Bixby Center and University of Zimbabwe collaboration
Changes in Nepal, South Africa and Kenya that allowed safer abortion provision, and how these settings differ.
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.
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.
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.
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.”
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).
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.
The United States has one of the highest rates of unintended pregnancy among the world's developed nations. A series of articles in theJournal of Obstetric, Gynecologic and Neonatal Nursingaddresses 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.
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.
Emergency contraception (EC), a safe and effective method of preventing pregnancy, has been subject to political battles since the introduction of Plan B in the United States in 1999. Certain forms of EC—pills containing levonorgestrel—are available over-the-counter for those over age 17, and with a prescription for those under 17. Today, US Department of Health and Human Services Secretary Kathleen Sebelius announced that it would stay that way. Secretary Sebelius reversed a decision made by the Food and Drug Administration (FDA) Office of Drug Evaluation to remove the age restriction from one EC product (Plan B One-Step). The FDA had considered evidence from multiple rigorous studies and concluded that there is no medical evidence to support an age restriction for access to EC.
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.
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:
over a quarter of districts do not teach about the transmission and prevention of HIV
only 25% of districts discuss the required topic of emergency contraception
less than one‐third of school districts cover sexual orientation as part of sex education
some school districts continue to provide abstinence‐only instruction.
The ACLU will to use the report as evidence of the need to continue improving sex education in California.
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. Otherstudies 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.
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.
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.
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.
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.
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.
yearly well-woman preventive care visits to obtain recommended preventive services
contraceptive methods and counseling to prevent unintended pregnancies
counseling on sexually transmitted infections (STIs)
human papillomavirus (HPV) DNA testing as part of cervical cancer screening for women over 30
counseling and screening for HIV
screening for gestational diabetes
lactation counseling and equipment to promote breast-feeding
screening and counseling to detect and prevent interpersonal and domestic violence
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.”
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
In recognition of her distinguished career dedicated to reproductive health scholarship, teaching, publishing, and activism, Prof. Carole Joffe will be honored with the Irvin M. Cushner Lectureship at Reproductive Health 2010. For more information about the annual meeting awards, click here.
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).
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.
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.”
Dr. Claire Brindis discusses the federal court order for over-the-counter sale of Plan B® emergency contraception to be expanded to 17-year-old women (KGO News Talk 810 AM, 4/22/09). For more information about Plan B®, see the FDA website.
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).
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.
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.
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).
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.
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.
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.
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.
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:
Dr. Claire Brindis speaks about the importance of comprehensive sex education on the WBUR morning news program On Point. See additional coverage of this radio event at UCSF Today.
Dr. Nancy Padian announced that a clinical trial involving 5,045 women in South Africa and Zimbabwe found no statistical difference in the rate of new HIV infections in the two study arms: those who received a diaphragm plus lubricant along with male condoms for their partners and those who only received male condoms. The study, "Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomised controlled trial" (The Lancet, 2007 Jul 21;370(9583):251-61), was widely covered by the following media outlets:
Dr. Claire Brindis discusses the importance of comprehensive sex education in the San Francisco Chronicle article "Abstinence-only sex ed finds few scientific fans" (Weiss, 2/11/07). Even in California — which has seen the second largest decline in teen pregnancy rates in the nation from 1991-2004 (and has not accepted federal aid that would require abstinence-only education programs) — it is important to keep educating our diverse population.
The Society for Medical Anthropology (SMA) awarded the 2006 Steven Polgar Prize to Vincanne Adams and co-authors Suellen Miller, Sienna Craig, Nyima, Sonam, Droyoung, Lhakpen, and Michael Varner for "The Challenge of Cross-Cultural Clinical Trials Research: Case Report from the Tibetan Autonomous Region, People's Republic of China" (Medical Anthropology Quarterly, 2005;19(3):267-289). The Polgar Prize is awarded annually for the best paper published in SMA’s journal Medical Anthropology Quarterly.
Tina Raine, MD, discusses emergency contraception and unintended pregnancy in The New York Times article "F.D.A. Approved Broader Access to Next-Day Pill" (Harris, 8/25/06). The FDA announced its decision today to approve Plan B emergency contraception for over-the-counter access to women aged 18 and over. Please see the FDA webpage for more information about Plan B.
Philip Darney, MD, MSc, was quoted in The Washington Post's article "Period: Full Stop?" (Payne, 6/6/06) which discusses the continuous use of hormonal contraception (e.g., birth control pills, the patch, or the vaginal ring).
Her Majesty Queen Rania Al-Abdullah is hosting the Global Women's Action Network for Children Conference June 11-13, 2006. The conference will be jointly launched by the Jordanian National Council for Family Affairs and the US-based Children's Defense Fund. The conference participants will include prominent political and academic figures, including the Liberian President Ellen Johnson-Sirleaf and Nobel Peace Prize Laureates Shirin Ebadi and Wangari Maathai. Dr. Suellen Miller has been asked to speak on maternal mortality and the Non-pneumatic Anti-Shock Garment (NASG).
Tori Sutherland, a Women's Global Health Imperative (WGHI) Safe Motherhood Program intern, co-authors essay with Dr. Suellen Miller, which is featured in "On The Ground," the blog of The New York Times columnist Nicholas Kristof.The essay details an eye-opening trip to Egypt, Yemen, and Nigeria to observe conditions in maternal health hospitals, where needs are great and the means to help women are stretched thin.
"A new tool in keeping women HIV free" (Graves & Miller, 11/9/05) highlights the importance of microbicide research for HIV prevention, especially in contexts where women lack control over sexual decision-making.
"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.
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.
Dr. Krishnan, director of HIV prevention programs in India for the Women’s Global Health Imperative, was named a recipient of the 2004 Presidential Early Career Awards for Scientists and Engineers. The award, from the Office of Science and Technology Policy, is the nation's highest honor for professionals at the outset of their independent research careers. Dr. Krishnan, is an epidemiologist who works in Southern India. She is conducting two studies that examine the relationship between economic opportunity and HIV prevention among girls and investigate gender-based power dynamics and susceptibility to HIV among married women. She also explores the barriers to treatment adherence and AIDS-related stigma.
Dr. Felicia H. Stewart, Co-Director of the Center and Director of Advancing New Standards In Reproductive Health (ANSIRH), has been named winner of the 2005 Olivia Schieffelin Nordberg Award for excellence in writing and editing in the population sciences. Dr. Stewart writes about both the science and the values of the population field. Without sacrificing rigor, she makes scientific material accessible to nonprofessionals. And as an activist she is uniquely sensitive to the social responsibility of scientists and the need for moral clarity in a field often driven by political factions. The Award will be presented at a Population Council reception in New York in June.
Congratulations to Center Co-Founders Philip Darney, MD, MSc, and Nancy Padian, PhD, MPH, who were elected to the Institute of Medicine. The IOM elected 65 new members, raising the Institute's total active membership to 1,416. Election is considered one of the highest honors in the fields of medicine and health.
Dr. Eleanor Drey, Medical Director of the San Francisco General Hospital's Women's Options Center, was deemed a Local Hero in the San Francisco Bay Guardian's Best of the Bay 2004. As the article so aptly puts it, we are "blessed to have Drey, who's a calm yet impassioned advocate for family planning and the clinic's disadvantaged patients, defending an essential medical service that's perpetually under political attack."
We are pleased to announce that Prof. Carole Joffe has been selected as the 2005 recipient of the Sociologists for Women in Society (SWS) Feminist Activist Award. SWS is honoring Prof. Joffe for her dedication and commitment to the issue of reproductive rights for women. She will be presented with the award at the American Sociological Association summer meeting this August.
Center Co-Founder, Nancy Padian, PhD, MPH, and the Shaping the Health of Adolescents in Zimbabwe (SHAZ) program featured in "Saying No to 'Sugar Daddies'" (Chase, 2/25/04).
