‘The pill is a badge of honour for some girls, but that still doesn’t make us sluts’

2014-04-09

A US study has found being on the pill doesn’t make girls any more promiscuous – as some critics have suggested. Well, duh, says Daisy Buchanan, as she praises the NHS for always giving out free contraception

By Daisy Buchanan

Abortion: A pregnant woman’s right to choose – free of any pressure

I unreservedly support a woman’s right to terminate her pregnancy, and I have no moral issue with abortion. But it’s precisely because I support a woman’s right to choose that I feel uncomfortable about the way that abortion services are run.

What Women Still Don’t Know About Getting Pregnant Read more: Women confused about fertility and reproductive health

2014-01-29

By Alexandra Sifferlin

As surprising as it seems, about half of women of reproductive age have not talked to their health care provider about their reproductive health, according to a new study.

As a result, the researchers, from the Yale School of Medicine, found that women between ages 18 and 40 weren’t aware of some the important factors that influence fertility and their ability to get pregnant, as well as about basic prenatal practices once they were expecting.

Among the most notable findings, which were published in the journal, Fertility & Sterility :

• 30% of the women reported that they only visited a reproductive health provider less than once a year or not at all.
• 50% of the women did not know that taking multivitamins and folic acid are recommended to avoid birth defects.
• A little over 25% of women did not know that things like STDs, smoking and obesity impact fertility.
• 20% did not know that aging can impact fertility and increase rates of miscarriage
• 50% of the women thought that having sex multiple times in a day increased their likelihood of getting pregnant
• Over 33% of women thought that different sex positions can increase their odds of getting pregnant
• 10% did not know that they should have sex before ovulation to increase the chances of getting pregnant instead of after ovulation

The significant gaps in the women’s knowledge about their fertility may also explain why 40% reported that they had concerns and questions about their ability to get pregnant. The researchers believe that as women put off starting families — the latest CDC report showed women between 25 to 29 years old have the highest pregnancy rates, compared to women aged 20 to 24 in earlier years — doctors, particularly reproductive health specialists, should have more opportunity for improving women’s education about fertility and pregnancy so they know what to expect when they are finally ready to have a child.

Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe Read more: Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe

2014-01-27

By Alexandra Sifferlin

The European Medicines Agency (EMA) — the European version of the U.S. Food and Drug Administration (FDA) — launched a broad review of whether body weight influences the ability of emergency contraceptives to prevent unintended pregnancies.

The agency recently required makers of the European version of Plan B, called Norlevo, to add an alert that the product may be less effective for overweight women. The move was spurred by a 2011 study that found that women with a body mass index (BMI) greater than 25 who used levonorgestrel, which prevents pregnancy by blocking the release of the egg from the ovary, inhibiting fertilization or changing the uterine lining to discourage pregnancy, were four times more likely to get pregnant than women with lower BMIs.

Now, based on that study and other data, the EMA is turning its attention to other emergency contraceptive measures that rely on hormones to prevent pregnancy. These include Norlevo, Levonelle/Postinor and Levodonna which all contain the hormone levonorgestrel. All the medications are available over the counter, and the agency is also studying one prescription-based medication called ellaOne that includes ulipristal acetate.

It’s unclear why emergency contraception could be less effective in overweight women, but the U.S. FDA is also reviewing existing data to determine if any changes in labeling or action is necessary. Calls to the FDA were not immediately returned.

Reproductive health experts say women who are concerned about whether their emergency contraceptive will prevent pregnancy should consider other birth control methods known to be more effective, like the IUD.

Morning-After Pill May Not Work For Women Over 176 Pounds Read more:

2013-11-26

Widespread implications if true

A European company that makes an emergency contraceptive identical to the morning-after Plan B pill is set to warn consumers that the drug is completely ineffective for women over 176 pounds, and begins to lose effectiveness after 165 pounds, Mother Jones reports.

The European drug, Norlevo, will be repackaged to reflect the weight limits, according to the report, which could carry significant implications for American women if true and if also applicable to morning-after pills in the U.S. Norlevo is chemically identical to many of the most popular emergency contraceptive brands used in the U.S., including Plan B One-Step, Next Choice One-Dose, and My Way. American manufacturer of emergency contraceptives didn’t comment to Mother Jones, and the FDA has yet to weigh in on the matter.

According to weight data from the Centers for Disease Control and Prevention, the average American woman weighs 166 pounds, and the average non-Hispanic black woman between 20 and 39 weighs about 186 lbs. If the European manufacturer is correct, morning-after pills could be ineffective for many American women.

Plan B One-Step is the only emergency contraceptive available over-the-counter to women of all ages. Norlevo packages will include a pamphlet summarizing the new discovery.

Why It Takes Teens Equipped With Condoms to Encourage Family Planning in Africa Read more: Why It Takes Teens Equipped With Condoms to Encourage Family Planning in Africa

2013-11-19

By Alexandra Sifferlin

The conference showcases the fact that despite Ethiopia’s high poverty rate and political intrusions on free speech, it has one of the most progressive family planning policies in Africa. And that success is serving as a model, not only for other developing nations such as Rwanda and Malawi, but for developed ones as well.

Economically, family planning is critical for a country’s stability — by protecting women from unwanted pregnancies that can contribute to high maternal and child mortality rates, these programs also allow mothers to enter the work force, and empower them to contribute to their local economy. Family planning is a public health term for essentially means controlling the number of births a woman has, and spacing those births. The Bill and Melinda Gates Foundation estimate that 1 in 4 women’s lives could be saved if there were global access to contraception, for example. And family planning isn’t just focused on mothers. The Foundation found that about 3.2 million children die each year from preventable diseases, many of which could be avoided if families had access to proper medical care, such as immunizations and antibiotics.

Such efforts have translated into measurable changes already. In Ethiopia, public health facilities offer all available contraceptive methods for free, and that has contributed to a rise in contraceptive use among women. The percentage of women of reproductive age using family planning has jumped from 8% in 2000, to 15% in 2005, to 29% in 2011.

For men, the Ethiopian government sends male mentors directly to people’s homes, to educate those who are skeptical or against the idea of their wives planning their births. Family planning is also introduced to boys in primary school. Despite these attempts, however, male involvement in family planning is still considered a challenge for countries in the developing world.

Recognizing that young people are sexually active: While it seems obvious, acknowledging that teens are having sex is a challenge for some administrations, especially conservative ones. A typical 18-year-old Ethiopian woman is already married and likely expecting her first child, and most women have around five. However, community health centers in that country now include youth services and private offices to not only educate teens, but provide them with the protection they need to practice safe sex or delay sexual activity.

Making family planning the law: In Ethiopia’s constitution, access to family planning is cited as a woman’s right. Similarly, Rwanda’s government has legislated strong policies for family planning, and saw uptake of contraceptives jump by 10-fold. In 2000, only 4% of married women of reproductive age were using modern contraceptive methods, but the rate spiked to 45% by 2010, thanks to the country’s National Family Planning Program, which revamped access to contraceptives by stocking up all public health clinics, trained more providers in family planning education, and encouraged more women to give birth in their health facilities rather than at home.

Giving family planning prominence in the country’s constitution is an important step toward acknowledging the critical role that reproductive health plays in a country’s economic stability. “These countries that are having success have really come out front with the recognition that if they were to solve this problem, they would solve so many others in their country. When you don’t have that leadership, it’s really difficult to move forward,” says Beth Fredrick, director of advance family planning for the Bill & Melinda Gates Institute at Johns Hopkins School of Public Health.

Bringing family planning services to the people: In both Ethiopia and Malawi, health extension workers are the key to reaching community members and getting them to clinics, as well as providing them with access to family planning programs. In Ethiopia, every community is allocated a hospital, a smaller health center, and a health post—which is staffed by two health extension workers. To supplement their efforts, the governments of these countries, using funds from the U.S. Agency for International Development (USAID), developed the Women’s Development Army. Members of the army, which include local community mothers who are trained by extension workers, go door to door, educating women about family planning, and hosting small gatherings of five community members to discuss reproductive health and answer questions in an informal setting.

Offering all forms of birth control: Even in the U.S., research shows that when all methods of contraception are offered at low cost, women tend to pick long-acting reversible contraceptives (like implants and IUDs) over condoms and pills. Ethiopia, Rwanda and Malawi all provide contraceptives at no cost in public health clinics, and in line with prior research, women tend to choose the longer-acting, more discreet methods. However, clinics continue to offer the less popular methods in order to give women a full spectrum of choices, so women can decide for themselves which methods are best for them.

Changing cultural norms remains a challenge, but officials in Rwanda rely on community health workers to talk to men about why they should support family planning and about how planning their children can mean having healthier children and potentially fewer children to support. They even encourage male family planning methods such as vasectomies. When men come in with their wives to discuss family planning measures, health workers cite the surgery as an option, and encourage it alongside circumcision to prevent diseases like HIV although it’s still not a popular choice.

In Malawi, public health officials are enlisting the help of respected elders. A campaign headed by community chiefs that promotes family planning for couples, for example, includes the voice and perspective of men. “In the villages, we try to include as many men as possible. Men are very affected. In rural settings in Malawi, the breadwinner is usually the man. So if they cannot control their family, they’re the ones in trouble,” says Gotani Hara.

Public health officials are hopeful that the success of these initiatives in the developing world could spill over to industrialized nations as well — including the U.S. — that still struggle to reduce rates of sexually transmitted diseases, unplanned pregnancies and infant mortality. If there is one lesson to learn from these programs, it’s that the most successful strategies don’t come from doctors or government officials, but from peers — mothers, friends or respected elders –  who, it turns out, have the strongest voice when it comes to talking about sex and families.

Long-term Pill use may double glaucoma risk

Less Is More: One, Instead of Three Doses of HPV Vaccine May Protect Against Cervical Cancer Read more: One Dose of HPV Vaccine May Protect Against Cervical Cancer

2013-11-05

By Alexandra Sifferlin

Public-health officials may not have to worry so much about the low percentage of girls who don’t get all three doses of the human papillomavirus (HPV) vaccine.

The HPV vaccine is one of the best ways to prevent genital warts and infection with the virus that can cause cervical cancer, so since 2007, the Centers for Disease Control and Prevention recommended girls get three doses of the shot when they are 11 or 12 years old, and since 2011, advised that boys of the same age get routinely immunized as well. But about a third of eligible young people in the U.S. start the three-shot regimen, which takes six months to complete, and never complete the schedule; around half of eligible children are fully immunized against HPV.

Cost — all three doses of the immunization cost about $400 — and the lack of follow-up over six months contribute to the low compliance rate, so scientists have been investigating whether fewer doses could protect against infection just as well. A 2011 study reported that people had similar levels of protection at two doses, and now researchers believe even one shot may be enough.

The researchers studied Cervarix, which, like the other HPV vaccine approved by the Food and Drug Administration, Gardasil, protects against HPV subtypes 16 and 18. The researchers measured the immune response to the vaccine in groups of 78, 192 and 120 women who received one, two and three doses of the vaccine, respectively. They then compared the amount of antibodies these women produced against those of a group of 113 women who did not get immunized but had been infected with HPV at some point in their lives.

The vaccinated women in all three groups continued to show HPV antibodies in their blood for up to four years. These levels were similar among women who received two doses and those who were vaccinated with all three doses. But the women who just got one dose also had stable antibody levels, even though they were lower than those found in the other groups. These levels, however, were still 24 times higher than those among women who never received the vaccine but had been infected with the virus. So a single dose of the vaccine, the researchers believe, may be sufficient to provide some protection against infection with HPV.

New Definition of “Full-Term” Pregnancy Presents Other Problems

2013-10-23

By Emily Oster @ProfEmilyOsterOct. 22, 2013

Big news for women who are 38 weeks pregnant: you are no longer considered “full term.” The American College of Obstetricians and Gynecologists (ACOG) announced today that they would introduce a new classification system for the end of pregnancy.  Previously women who were 37 to 41 weeks pregnant were all considered “Full Term” and women 42+ weeks “Post-term”.  The new classification system calls for four groups:  “Early Term” (37-38 weeks), “Full Term” (39-40 weeks), “Late Term” (41 weeks) and “Post-term” (42+weeks).

I know, that’s a lot of terms. But the big change here is to separate out the 37 to 38 week period and acknowledge that, for most babies, this isn’t the ideal time to be born. Evidence has been piling up that babies born in this period do worse than babies born at 39 or 40 weeks. One very recent paper shows babies at 37 to 38 weeks are more likely than those born later to need time in the NICU, mechanical ventilation and IV fluids. But as induction and scheduled C-sections have become more common, the share of babies born at 37 or 38 weeks has risen from 17% in 1983 to 27% in 2009. Many of these deliveries are elective and driven, at least in part, by the perception by women (or their doctors) that things are ready to go at 37 weeks. The push to reduce these early-term deliveries has been going on for years.

This change in wording could make a big difference in practice. Early term births are expensive because of their added complications and by explicitly distinguishing them it makes it easier for insurers to refuse to cover elective births in this period. The problem, however, with having a strict guideline like this is that sometimes people start to treat it the cutoff itself as meaningful.

It is worth reflecting back on why this change is even necessary.  The idea that 37 weeks is “full term” is intended to be descriptive.  As pregnancy moves forward, the baby becomes more developed.  Among the last organs to develop are the lungs, and usually this happens by 37 weeks, so calling 37 weeks “full term” is simply an acknowledgement of this. But women, and their doctors, can start to think that when you move from 36 weeks 7 days pregnant to 37 weeks 0 days pregnant there is a magic switch which means your baby is ready.  This is obviously not the case.

This is illustrative of a broader issue, in medicine and elsewhere, with any kind of sharp rule-like cutoff.  In one example, researchers have shown that as a result of drawing the cutoff for very low birth weight at 1500 grams, babies born right below 1500 grams of weight actually have better outcomes than those right above, because they are given extra treatment.  Again, there is nothing biologically special about 1500 versus 1499.  The cutoff is descriptive, and when it’s treated as a rule, odd things happen. The same issues come up in finance, closer to my own field, when looking at lenders who used sharp cutoffs in credit scores in deciding who to lend to.  There is nothing special about a credit score of 620 compared to 619, and when you treat it like there is, you can get into trouble.

The worry, of course, to return to the babies, is that what is happening here is we are replacing one rule with another. The new guidelines fix one issue, but could lead doctors (in theory) to be too cautious about delivery in 37 or 38 weeks when medically warranted. It could also lead them to be too gung-ho about delivery as soon as you hit 39 weeks. The best case would be if women and their doctors took these terms as they are intended— as descriptive guidelines, not rules—and got better about letting nature take its course unless there is a medical reason not to.  If that happens, this truly will be a major change, and not just for the women at 38 weeks.