Ethinyl Estradiol vs Estradiol Valerate in Combined Oral Contraceptives - Effect on Glucose Tolerance: A Randomized, Controlled Clinical Trial To compare the effects of two formulations of combined oral contraceptives (COCs), estradiol valerate (EV) and ethinyl estradiol (EE) combined with dienogest (DNG), and DNG-only, on glucose tolerance.Study DesignWe performed a randomized, controlled 9-week clinical trial. Inclusion criteria were: age 18–35 years, regular menstrual cycle (28±7 days), no polycystic ovaries, non-smoking, no contraindications for COC use and a 2-month wash-out from hormonal contraceptive use. The women were randomized to EV+DNG (n=20), EE+DNG (n=20), and DNG-only (n=19), and evaluated at baseline, at 4-5 weeks and 8-9 weeks of treatment.
Twelve-month prescribing of contraceptive pill, patch, and ring before and after a standardized electronic medical record order change To evaluate the proportion of 12-month contraceptive pill, patch, and ring prescriptions before and after an institution-wide change of default electronic medical record facility orders to dispensing 12-month supply.Study DesignThis retrospective pre-post study compares outpatient contraception prescriptions from August 10, 2019 through April 9, 2020 obtained from our institutional electronic medical record prescription database. On December 10, 2019, we facilitated a change in the default orders for dispensing self-administered hormonal contraceptives from one-month to 12-months.
Abortion restrictions in the state of Georgia: Anticipated impact on people seeking abortion To explore the impact of restrictive abortion policies in the state of Georgia on the lives of people seeking abortion and how they would manage unwanted pregnancies.Study design: We conducted a cross sectional study of English and Spanish-speaking people seeking abortion from three high-volume outpatient abortion clinics in Atlanta, Georgia from April 2019 through August 2019. Participants completed a multiple-choice questionnaire. We used bivariable and multivariable analysis to explore relationships between demographic characteristics and how people would manage their unwanted pregnancies if abortion were illegal in the state.
Youth opinions about Title X funding and policy in the United States: A mixed methods text message survey We aim to assess youth awareness of and opinions about Title X policy changes in 2019.Study DesignWe analyzed data from four open-ended questions and demographic items collected through MyVoice, a national text message survey of youth aged 14–24. We calculated descriptive statistics to summarize awareness of and opinions about Title X. We integrated the quantitative findings with qualitative themes to achieve deeper understanding of the beliefs that inform youth opinions.
COVID-19 Highlights the Policy Barriers and Complexities of Postpartum Sterilization Multiple barriers exist to sterilization in the postpartum period. One such barrier, the Medicaid Title XIX sterilization policy, requires publicly insured patients to complete a sterilization consent form at least 30 days prior to their scheduled procedure. While this policy was set in place in the 1970s to address the practice of coerced sterilization among marginalized women, it has served as a significant barrier to obtaining the procedure in the contemporary period. The COVID-19 pandemic has highlighted specific complexities surrounding postpartum sterilization and created additional barriers for women desiring this contraceptive method.
Exploring the reproductive decision support needs and preferences of women with cystic fibrosis As women with cystic fibrosis (CF) live longer, healthier lives, they increasingly face decisions related to their reproductive health. This qualitative study explores their unique decision support needs and preferences to aid in the development of a CF-specific reproductive goals decision aid.Study DesignWomenwith CF age 18-44 years participated in individual, semi-structured, telephone-based interviews, and women with CF age 18 years and older participated in semi-structured focus group discussions (FGDs).
Complex Family Planning: a newly accredited, landmark fellowship As of July 2020, U.S. Obstetrics and Gynecology training programs can apply for accreditation by the Accreditation Council for Graduate Medical Education (ACGME) in Complex Family Planning (CFP). Formerly known as the Fellowship in Family Planning, first launched 1991 by Dr. Phillip Darney at the University of California in San Francisco, the program subsequently expanded nationally under Dr. Uta Landy’s leadership. The CFP fellowship provides post-graduate obstetrician-gynecologists with additional training in abortion and contraception and opportunities to establish themselves as leaders in clinical care, research, and medical education.
Severe systemic delayed dermatitis in a patient with nickel–titanium sterilization microinserts perforating the uterus We report a case of severe systemic delayed dermatitis in a patient with nickel–titanium sterilization microinserts placement complicated by uterine perforation and polyethylene terephthalate (PET) exposure. We hypothesize that delayed dermatitis may be caused by the exposure of PET fibers in this patient with underlying autoimmune disorder. Further research on the use of PET and the potential of systemic dermatologic reactions when exposure occurs is needed, especially when considering the inclusion of PET in future implant device development.
Mifepristone for emergency contraception: Case for recommendation in practice guidelines One in four pregnancies is unintended, threatening the lives and well-being of women and adolescents globally . The risks of unintended pregnancy are greatest in low- and middle-income countries where maternal mortality rates are highest . Emergency contraception (EC) is an effective and essential intervention to prevent unintended pregnancies, however barriers at the client, provider, and system levels exist [3,4].
Medication Abortion Up to 70 Days of Gestation Medication abortion, also referred to as medical abortion, is a safe and effective method of providing abortion. Medication abortion involves the use of medicines rather than uterine aspiration to induce an abortion. The U.S. Food and Drug Administration (FDA)-approved medication abortion regimen includes mifepristone and misoprostol. The purpose of this document is to provide updated evidence-based guidance on the provision of medication abortion up to 70 days (or 10 weeks) of gestation. Information about medication abortion after 70 days of gestation is provided in other ACOG publications .
Women's knowledge of their state's abortion regulations. A national survey States vary significantly in their regulation of abortion. Misinformation about abortion is pervasive and propagated by state-mandated scripts that contain abortion myths. We sought to investigate women’s knowledge of abortion laws in their state. Our secondary objective was to describe women’s ability to discern myths about abortion from facts about abortion.
Featured research at the 2020 Society of Family Planning Annual Meeting The Society of Family Planning is pleased to host its Annual Meeting October 9-10, 2020. However, this year is different with the meeting occurring virtually due to the COVID-19 pandemic. The change in format means our community will not be coming together in the usual way. One of the greatest benefits of the Annual Meeting is the opportunity for family planning scholars, clinicians, and partners to gather and network. While the format will be new, the content will continue to include presentations of unpublished research and clinical practice updates as well as thought-provoking plenaries.
Society of Family Planning Annual Meeting 2020 – Scientific abstracts, October 9-10, 2020 These scientific abstracts are scheduled for presentation at the 2020 Society of Family Planning Annual Meeting. This year, 312 abstracts were submitted for consideration, of which 15 were selected for oral presentation and 82 were selected for poster presentation. The scientific abstract review was completed by the Scientific Abstract Working Group, which was Tessa Madden, MD, MPH (chair), Nerys Benfield, MD, MPH, Aileen Gariepy, MD, MPH, FACOG, MHS, Sadia Haider, MD, MPH, and David Hubacher, PhD.
Hand-held device to remove a single-rod subdermal contraceptive implant: Results of early trials in Sweden Long-acting reversible contraceptives (LARCs) such as subdermal implants and intrauterine devices are promoted and increasingly used worldwide. Hence, in the light of this we also need to ensure easy access to the reversibility, i.e. emphasise the R in LARC. Our overall aim is to develop a device to facilitate implant removals. We evaluated the safety and performance of the two initial field prototypes where the main outcome was percentage of successful fixations and secondary outcomes were percentage of successful removals without the use of additional tools, duration of the procedure, satisfaction and adverse events.
Working in the shadows, under the spotlight – Reflections on lessons learnt in the Republic of Ireland after the first 18 months of more liberal Abortion Care In January 2019, abortion care became more widely available in the Republic of Ireland (ROI). Prior to this abortion was only available when there was a “significant risk to the life of the mother” due to either physical or mental health conditions , resulting in about 25 legal abortions occurring every year . Following a public referendum in 2018 that allowed a constitutional change, abortion is permitted in four specific circumstances . These include abortion under 12 weeks gestation (12+0) for any reason, and later in pregnancy if there is significant risk to the life or health of the pregnant person or in the case of a “fatal fetal abnormality” where the fetus had a condition likely to lead to death within pregnancy or the first 28 days of life.
P81 Family planning and the Flint water crisis Objectives: In 2014, officials in Flint, Michigan changed the city’s water source to reduce costs, exposing residents to legionella, lead, and other bacteria. We sought to understand the impacts of water contamination on residents’ reproductive health outcomes and decision-making.
P72 “I really can’t take it out now”: Provider and administrator attitudes and experiences with early LARC removal Objectives: The American College of Obstetrics and Gynecology recommends long-acting reversible contraception (LARC), including the intrauterine device (IUD) and sub-dermal implant, for most women. However, some women discontinue LARC methods early. While researchers have examined such discontinuation, most do so from women’s perspectives. Few studies investigate the perspectives and experiences of providers or clinic administrators. We explore administrators’ perspectives for managing early LARC removal, their relationship to provider attitudes, and the potential implications for women’s decisions to use LARCs or remove them early.
P65 Analyzing state-level contraceptive coverage laws with policy surveillance Objectives: Beginning in 2014, states began enacting contraceptive mandates, often referred to as “Contraceptive Equity” laws, which prevent insurers from using medical management techniques, like cost-sharing, prior authorization, prescription requirements, gender restrictions, or quantity limitations. This longitudinal study identified state laws that mandate broader contraceptive coverage than the federal requirement under the Affordable Care Act (ACA).
P23 MEDICAL ABORTION AT OR AFTER 13 WEEKS GESTATION PROVIDED THROUGH TELEMEDICINE SERVICES Objectives: Self-administration of medical abortion (MA) is well-established in early pregnancy, but research of self-use in later pregnancy is lacking. We aimed to evaluate cases of medical abortion ≥13 weeks gestation provided through Women on Web’s telemedicine service to determine the effectiveness and safety of self-administration in this gestational age range.
P17 Examining attitudes toward abortion: Do people’s attitudes change when considering gestational age and fetal development? Objectives: Since the 1970’s, the General Social Survey (GSS) has assessed US adults’ abortion attitudes via seven items examining specific scenarios (eg, rape, financial reasons, any reason). These data indicate general support for abortion and suggest attitudes have remained relatively stable. However, these items do not account for gestational age of the pregnancy. Given the increase in legislation restricting abortion based on gestational age (eg, six-weeks) and fetal development (eg, fetal pain), we re-assessed the GSS items, adding both gestational age and specific fetal development markers that are often referenced in legislation.
P16 State abortion policies and ability to obtain an abortion Objectives: Most studies evaluating state policies or barriers to abortion are conducted among abortion patients, which limits our knowledge to only those able to access abortion care. We sought to understand the impact of state-level policies on obtaining an abortion among a pregnant population.
P11 Crisis pregnancy centers and abortion facilities in the US: A spatial policy analysis Objectives: Crisis pregnancy centers (CPCs) provide limited pregnancy-related services and attempt to dissuade people from seeking abortions. Twenty-five states support CPCs through funding or mandatory referrals. We performed a county-level spatial analysis of CPCs and abortion facilities (AFs) nationally, comparing trends in states with supportive versus non-supportive CPC policies.
P5 Public perceptions of physicians who provide abortion care Objectives: Abortion public discourse in the US is highly polarized and politicized. Until recently, the voices of abortion caregivers have been mostly absent from public spaces, and depictions of them have been shaped by anti-abortion forces. We sought to understand the general public’s perceptions of abortion-providing physicians.
P3 Efficacy and validity of referrals for abnormal placentation at a tertiary care facility Objectives: Concern for abnormal placentation including possible placenta accreta is a common reason for referral from freestanding abortion clinics to tertiary care centers. Placenta accreta (PA) referrals to tertiary care facilities have been under-studied in the setting of abortion care. The purpose of this study is to determine the incidence of perioperative complications including hemorrhage among patients referred for abnormal placentation versus patients referred for other reasons.
O8 Exploring access to and attitudes towards abortion and contraception among Black women living in the south Objectives: Access to reproductive health care services is challenging for many in the United States but in the South access has become even more limited. In states like Georgia and North Carolina, 32% of women aged 13–44 are in need of publicly funded contraceptive services and supplies. Concurrently, women in these states face several barriers to abortion care such as gestational age bans, waiting periods and coverage bans. SisterSong and Ibis Reproductive Health partnered with Black-led organizations in both states to capture abortion and contraceptive experiences of individuals who identify as Black women.
O7 The role of complexity and ambiguity in shaping abortion attitudes Objectives: Recognizing and tolerating complexity has been shown to be key in successfully navigating conflict about contested topics. Abortion conversations are often highly polarized and lacking nuance. Yet many Americans experience some level of discomfort with abortion. We sought to understand if acknowledging ambiguity and complexity in abortion conversations could help manage discomfort and ultimately increase support for abortion.
O6 A narrative intervention to decrease individual level abortion stigma: A randomized controlled trial Objectives: Abortion stigma is pervasive in the US. While abortion itself does not cause mental illness, abortion stigma may worsen psychological responses to the procedure. Few intervention studies have addressed abortion stigma. Psychological research demonstrates improved coping through cognitive restructuring and reconstructing personal narratives. With a theoretical framework grounded in cognitive therapy, this study tests whether a narrative intervention reduces abortion stigma.
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