Medication Abortion Rebounded in Texas After FDA Approved Label Change for Mifeprex®

Sarah Baum, MPHinvestigator at the Texas Policy Evaluation ProjectAssociate at Ibis Reproductive Health

Sarah Baum

MedicalResearch.com Interview with:
Sarah Baum, MPH

investigator at the Texas Policy Evaluation Project
Associate at Ibis Reproductive Health

MedicalResearch.com: What is the background for this study?  

Response: Before 2013, use of medication abortion in Texas mirrored national trends, which have steadily increased since the approval of mifepristone–one of the two medications used for medication abortion–in 2000. However, House Bill 2 (HB 2), which was implemented on November 1, 2013, imposed restrictions on medication abortion and required providers to follow the outdated mifepristone label. HB 2 reduced the gestational age limit to 49 days and generally required four visits.

On March 29, 2016, the US Food and Drug Administration (FDA) approved a revised label for Mifeprex® (mifepristone 200 mg) that reflected evidence-based practice, which essentially nullified the medication abortion restrictions in HB 2. The label change brought medication abortion prescribing guidelines in line with evidence-based practice, reducing the number of required in-person visits from four to two and extending the period when patients can take the pill from seven weeks of pregnancy to 10 weeks. Continue reading

New Male Contraceptive May Make Pregnancy An Uphill Swim

MedicalResearch.com Interview with:

Dr-Michael O'Rand

Dr. O’Rand

Michael O’Rand, PhD
Retired professor of cell biology and physiology in the University of North Carolina at Chapel Hill School of Medicine, and president/CEO of Eppin Pharma, Inc

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: My lab at the UNC School of Medicine discovered the protein Eppin in 2004. It coats the sperm cell. Through our subsequent research, we learned it is essential for sperm protection in the female. We thought it could make an excellent target for a male contraceptive.

Subsequently we developed a compound called EP055 that would bind to Eppin and as a result stop sperm from swimming. In our latest study published in PLOS One, we show that EP055 substantially limits sperm motility in non-human primates. And we showed the effect of EP055 is temporary, which would make it a good contraceptive.

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Relationship Status Helps Determine Contraception Choice

MedicalResearch.com Interview with:
“Birth control pills” by lookcatalog is licensed under CC BY 2.0Marie Harvey, DrPH MPH
Lisa P. Oakley, PhD MPH
College of Public Health and Human Sciences
Oregon State University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Because decisions about contraceptives are often made by young adults in the context of their relationships and specific partners, the characteristics of that relationship and feelings about that partner will likely influence how those decisions are made. Many studies have previously investigated individual factors that affect contraceptive choice and when examining partner influences have used questions that were not specific to a particular partner. Intuition, however, suggests that feelings for a specific partner would likely influence one’s perception of risk for disease acquisition, and thereby, their contraceptive choice. So, it was important to us to look at the influences of each specific partner and how the unique dynamics of each partnership influence contraceptive use.

In this study, we investigated how relationship qualities and dynamics (such as commitment and sexual decision-making) impact contraceptive choice above and beyond individual factors. We also used partner-specific questions.

We found that both individual and partner-specific relationship qualities and dynamics predicted contraceptive use, but these factors varied by contraceptive method. For example, young adults who reported greater exclusivity with a specific partner and more relationship commitment were less likely to use only condoms with that partner. Additionally, individuals who felt they played a strong role in making sexual decisions in their relationship were also more likely to only use condoms. Continue reading

Hormone Combination Effective For Male Contraception But With Many Side Effects

MedicalResearch.com Interview with:
Mario Philip Reyes Festin, MD

World Health Organization
Geneva, Switzerland. 

MedicalResearch.com: What is the background for this study?

Response: Researchers are trying to identify a hormonal male contraceptive that is effective, reversible, safe, acceptable, affordable, and available. Most of the research has been done either by groups of university researchers. However, in the 1990s, WHO undertook two multi-center, multinational studies.

The studies were unable to provide evidence to support the development of a commercially viable, and user-acceptable product.

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CDC Urges Wider Availability of Contraceptives In Regions Affected by Zika

MedicalResearch.com Interview with:

Charlan D. Kroelinger, PhD Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion CDC

Dr. Charlan Kroelinger

Charlan D. Kroelinger, PhD
Division of Reproductive Health
National Center for Chronic Disease Prevention and Health Promotion
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Zika virus infection during pregnancy can cause microcephaly and other severe fetal brain defects. Doctors have also found other problems in pregnancies and among infants infected with Zika virus before birth, such as absent or poorly developed brain structures, defects of the eye, hearing deficits, and impaired growth. Nearly half of all pregnancies in the United States are unintended. Increased access to birth control may lead to reductions in unintended pregnancies, which may result in fewer adverse pregnancy and birth outcomes in the context of a Zika virus outbreak.

A new report from CDC estimates that use of highly effective, reversible forms of birth control, called long-acting reversible contraception (LARC), which includes intrauterine devices (IUDs) and implants, remains lower than use of moderate or less effective methods such as oral contraceptive pills and condoms, although contraception use varied across states and by age group and race/ethnicity.

CDC scientists used data from four state-based surveillance systems to estimate contraception use for non-pregnant and postpartum women at risk for unintended pregnancy and sexually active female high school students who live in states with the potential for local Zika virus transmission. Less than one in four sexually active women of reproductive age and fewer than one in 10 sexually active female high school students reported using LARC. A higher percentage of postpartum women reported LARC use. Moderately effective and less effective contraceptive methods, including pills, patches, rings, injections, condoms and other barrier methods, were used more frequently than highly effective methods. These estimates are of concern because the most commonly used methods of contraception are not as effective at preventing unintended pregnancy.

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High School Girls Using Long-Acting Reversible Contraception Less Likely To Use Condoms

MedicalResearch.com Interview with:

Riley Steiner MPH Epidemiologist in the Division of Adolescent and School Health Centers for Disease Control and Prevention

Riley Steiner

Riley Steiner MPH
Epidemiologist in the Division of Adolescent and School Health
Centers for Disease Control and Prevention

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Using data from the 2013 national Youth Risk Behavior Survey (YRBS), our analysis looks at differences in condom use and other sexual risk behaviors among users of a variety of contraceptive methods. We found that sexually active high school females using long-acting reversible contraception (LARC) are less likely to use condoms when compared to those using oral contraceptives.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: The findings highlight a need to increase condom use among all users of highly and moderately effective contraceptive methods (LARC, Depo-Provera, patch, ring, or oral contraceptives) to prevent STDs. As LARC use increases among adolescents, we need to remind teens that  long-acting reversible contraception methods do not protect against STIs and that condoms should also be used for STI prevention. Health care professionals can help adolescents develop strategies for correct and consistent condom use for STI prevention in addition to helping adolescents choose the contraceptive method that works best for them to prevent unintended pregnancy. To ensure this happens, providers need training and tools to effectively address both pregnancy and STI prevention within the same clinical visit.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Research is needed to improve our understanding of the motivations for condom use among adolescents using highly or moderately effective contraceptive methods, as well as provider perceptions and recommendation of LARC for adolescents. Such data will help to explain why adolescent long-acting reversible contraception users may be less likely to use condoms compared to oral contraceptive users. Additionally, we need to continue to monitor the rates at which condoms are used alongside other contraceptive options. 

MedicalResearch.com: Is there anything else you would like to add?

Response: The findings should not deter adolescent  long-acting reversible contraception use but rather inform how STI prevention is addressed as LARC use increases among adolescents. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Steiner RJ, Liddon N, Swartzendruber AL, Rasberry CN, Sales JM. Long-Acting Reversible Contraception and Condom Use Among Female US High School Students: Implications for Sexually Transmitted Infection Prevention. JAMA Pediatr.Published online March 14, 2016. doi:10.1001/jamapediatrics.2016.0007.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Immediate Postpartum Contraception Implant Is Cost Effective, But Most Insurance Plans Don’t Cover It

Aileen Gariepy, MD, MPH Assistant Professor Section of Family Planning Department of Obstetrics, Gynecology, and Reproductive Sciences Yale School of Medicine New Haven, CT 06510MedicalResearch.com Interview with:
Aileen Gariepy, MD, MPH

Assistant Professor Section of Family Planning
Department of Obstetrics, Gynecology, and Reproductive Sciences
Yale School of Medicine
New Haven, CT

Medical Research: What is the background for this study? What are the main findings?

Dr. Gariepy: Women who have just given birth are often highly motivated to prevent a rapid, repeat pregnancy.  For women who desire the contraceptive implant, a highly effective reversible form of contraception that is placed in the arm and can last for 3 years, new research shows that it is more cost-effective to place the implant while women are still in the hospital after giving birth, compared to delaying insertion to the postpartum visit 6-8 weeks later which is currently the most common practice.

When the costs associated with the implant insertion and the costs of unintended pregnancy are compared in women who receive immediate contraceptive implant insertion (while still in the hospital after giving birth) to women who are asked to come back in 6-8 weeks for the implant insertion (delayed insertion), immediate insertion is expected to save $1,263 per patient.  Based on these estimates, for every 1,000 women using postpartum implant, immediate placement is expected to avert 191 unintended pregnancies and save $1,263,000 compared with delayed insertion in the first year. Cost savings would continue to increase for the second and third year after insertion.

In fact, over half of U.S. pregnancies are unintended.  Maternal and infant care costs for unintended pregnancies amount to $11.1 billion annually for public insurance programs alone. The immediate postpartum period (after delivery but before discharge home) provides an ideal opportunity for initiating contraceptives as patients are motivated and timing is convenient.

However, the majority of insurance company policies do not provide coverage for insertion of the contraceptive implant when the new mother is still in the hospital.  This lack of reimbursement is the most significant barrier to providing this highly effective contraceptive method for women who have just delivered a baby.  Surprisingly, the reason most insurance companies do not offer reimbursement for immediate insertion is due to an outdated insurance protocol, “the global obstetric fee” which precludes separate reimbursement of individual procedures (like inserting the implant).

The main reason that immediate insertion results in cost savings is because more women will get the implant compared to a strategy of delayed insertion.  Women can get pregnant again within 4 weeks of delivering a baby.  Starting contraception as soon as possible after giving birth is important because most women will resume sexual activity before their postpartum office visit and therefore will be at risk of pregnancy. And approximately 35% of women do not return for a postpartum visit.

Even for women who want another pregnancy soon, the implant has benefits.  When women conceive and deliver a baby within 2 years of last giving birth, there is a significantly higher risk of poor maternal and neonatal outcomes, including preterm birth, low birth weight, and even early neonatal and maternal death.  Birth spacing is better for moms and babies.
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Long-acting Reversible Contraception Use Fluctuated Over 30 Years

MedicalResearch.com Interview with:
Amy Branum
M.S.P.H., Ph.D and Jo Jones Ph.D
Center for Health Statistics
Division of Vital Statistics, Reproductive Statistics Branch

Medical Research: What is the background for this study?

Response: This data brief was based on multiple years of the National Survey of Family Growth (NSFG).  The NSFG, first conducted in 1973, is administered by NCHS in response to a legal mandate that says that NCHS “shall collect statistics on …family formation, growth, and dissolution.” (PHS Act, Sec 306). Up through the 2002 NSFG, the survey was conducted periodically; with the 2006-2010 data collection, the NSFG is a continuous survey with interviews conducted over multiple years.  We felt it was important to examine long-term trends in  Long-acting Reversible Contraception use due to fluctuations over time in IUD and implant acceptability and availability as contraception methods, especially in light of recent efforts to promote LARC use to prevent unintended pregnancies and for birth spacing.

Medical Research: What are the main findings?

Response: We found that Long-acting Reversible Contraception use declined between 1982 and 1988, remained stable through 2002 and then increased almost five-fold between 2002 and 2011-2013 (from 1.5% to 7.2).  Long-acting Reversible Contraception use has, and continues to be, generally highest among women aged 25-34 but has increased the most among women 15-24 since 2002.  Hispanic women used Long-acting Reversible Contraception at higher rates in 1982 compared to non-Hispanic white and non-Hispanic black women but patterns of use diverged after 1995 so that by 2011-2013, patterns of use were more similar by race and Hispanic origin.  Women who have at least one previous live birth have used, and continue to use, LARCs at a higher rate compared to women with no previous births. Continue reading

Simple Information Sheet Improves Contraception Knowledge In Isotretinoin Study

MedicalResearch.com Interview with:
Dr. Eleanor B. Schwarz, M.D., M.S
University of California, Davis
Sacramento, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Schwarz: The background for this study is that…

Women treated with Isotretinoin receive a lot of scary information about this medication’s risk of causing birth defects, but few receive clear information on the most effective ways to protect themselves from undesired pregnancy and the risks of medication-induced birth defects.

Our main finding is that women who spent less than a minute reviewing a simple information sheet were significantly more likely to be aware that some contraceptives are considerably more effective than others.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Schwarz: Clinicians who prescribe medications that can cause birth defects should make sure their patients are aware of the fact that women using a birth control pill are typically twenty times more likely to experience a contraceptive failure than those using a subdermal contraceptive implant (e.g. Nexplanon) or intrauterine contraceptive (e.g. Mirena, ParaGard).

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Contraception Decision-Making: What Are Women’s Priorities?

Rachel Thompson PhD Postdoctoral Research Fellow The Dartmouth Center for Health Care Delivery Science Dartmouth CollegeMedicalResearch.com: Interview with
Rachel Thompson PhD
Postdoctoral Research Fellow
The Dartmouth Center for Health Care Delivery Science
Dartmouth College


MedicalResearch: What are the main findings of the study?

Dr. Thompson: This study, which surveyed 417 women aged 15-45 years and 188 contraceptive care providers in 2013, found important differences in what matters most to these two groups when it comes to discussing and deciding on a contraceptive method. Women’s most important question when choosing a contraceptive was “Is it safe?” – this was in the top three questions for 42% of women but only 21% of providers. Alternatively, providers’ most important question was “How is it used?”. Information on side effects and how a method actually works to prevent pregnancy was also a higher priority for women than for providers.
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