05/09/12

Individualized, evidence-based counseling for abortion

There is little scientific evidence about best practices in patient education and counseling related to abortion care. Yet many recently enacted state laws mandate specific counseling and education practices for abortion patients. A new study from UCSF Bixby Center researchers sheds light on the counseling practices and patient needs at one U.S. clinic providing abortion care. The study used data drawn from patient medical records and a counseling needs assessment form, which patients complete when they arrive at the clinic.

The study found that nearly nine out of ten women seeking abortion care had high confidence in their decision to terminate the pregnancy. Nearly all patients in the study had told someone about their decision, and the large majority of people they had told were supportive of the decision—whether it was a male partner, mother, or friend. Taking into account women’s demographics, social support, and decision-making characteristics, women were less likely to feel highly confident of their decision if they were under 20 years old, had not completed high school, were Black, had a history of depression, or had spiritual concerns about abortion.

The study concludes women’s attitudes and decisions about abortion are complex and require “individualized approaches to patient education and counseling.” Patient-centered care in the context of abortion can be a challenge due to constantly changing laws and mandated counseling that is not based on evidence. Future research should address how different counseling approaches affect women’s well-being following an abortion so that all health care providers offering this basic service can meet their patient’s needs.

04/20/12

HPV vaccine may be linked to declining genital warts

A few strains of human papillomavirus (HPV) are the major cause of cervical cancer (16 and 18) and the cause of most genital warts (6 and 11). In the U.S., some young women started using a vaccine—Gardasil—that protects against all four of these HPV strains in 2006. Clinical trials showed that the vaccine conferred high levels of protection from HPV to an individual woman, but we are still awaiting evidence regarding a population-level effect of the vaccine. Because cervical cancer usually develops many years after a woman first contracts a high-risk strain of HPV, it will be at least a decade before we can assess the vaccine's impact on cancer incidence and mortality rates.

Genital warts are usually on a much faster timeline than cervical cancer—they develop within a few weeks or months after exposure to the HPV strains that cause them. A new study from the California Department of Public Health's (CADPH) Sexually Transmitted Disease Control Branch assessed the incidence of genital warts in California Family PACT clients over four years, 2007-2010. UCSF Bixby Center members and study authors Drs. Heidi Bauer and Joan Chow showed a significant decline in the number of genital warts diagnoses for women and men under age 26. The ecological study used billing data from over 8 million Family PACT clients, and further found no change or slight increases in the number of genital warts diagnoses for clients age 26 and over. An ecological study cannot assess a causal relationship between the observed declines in genital warts and use of the quadrivalent vaccine, but it does provide interesting insight to the dynamics of HPV infection in a large population.

03/23/12

Adolescents can successfully use over-the-counter Plan B One-Step

Unintended pregnancy is elevated among teens in the United States and is far more common than in other developed countries.  Emergency contraceptive pills, like Plan B One-Step, provide effective pregnancy prevention but females under age 17 must have a prescription to purchase them. The pills are most effective when taken promptly, so waiting for a clinic to open after the weekend can mean higher failure rates.  The U.S. Food and Drug administration recently considered several studies on levonorgestrel emergency contraception among females under 17, and decided that adolescents could safely use the product without a prescription.

One of the studies the FDA considered was from UCSF Bixby Center researchers, Drs. Tina Raine and Cynthia Harper, and has now been published  in Obstetrics & Gynecology.  The study shows that females younger than 17 can read Plan B One-Step’s label and understand whether or not to use it, and then use it correctly, in over-the-counter conditions. The study included females aged 13-17, and found no differences in their ability to choose or use Plan B by age. 

In an unprecedented move, the U.S. Department of Health and Human Services Secretary Kathleen Sebelius overturned the FDA decision.  Secretary Sebelius objected to the fact that there are no data on whether 11 and 12-year olds can safely use the product.  There are no data about such young girls because their need for emergency contraception is exceedingly rare.  Secretary Sebelius’ decision, however, means that 15 and 16 year olds, who may be sexually active and need access to emergency contraception, may not get it in time to prevent pregnancy. Adult women as well must still wait for pharmacy hours to obtain the product when needed since it will remain behind the counter. In response to the situation, Dr. Harper commented, “We need to direct our policy efforts toward reducing unintended pregnancy, so that teens and young women in this country have the opportunity to complete their education, to contribute to the labor force and to take proper care of the children they do have.”

03/22/12

Uta Landy and Philip Darney receive Margaret Sanger Award

Congratulations to Uta Landy and Philip Darney, UCSF Bixby Center members recognized by Planned Parenthood with their highest honor, the Margaret Sanger Award.

The award recognizes “leadership, excellence, and outstanding contributions to the reproductive health and rights movement.” Drs. Landy and Darney have devoted their careers to training the next generation of women’s health care providers. Dr. Landy directs the Ryan Residency Training Program and the Fellowship in Family Planning. Dr. Darney is a professor in the department of UCSF Obstetrics, Gynecology & Reproductive Sciences, former chief of Obstetrics and Gynecology at the San Francisco General Hospital, and co-founder of the UCSF Bixby Center.

The Margaret Sanger Award is given annually, and past recipients have included the Reverend Martin Luther King (1966), Alan Guttmacher, Sr. (1972), Katherine Hepburn (1983), Bella Abzug (1991), Justice Harry Blackmun (1996), Delores Huerta (2007), Kenneth Edelin (2008), Secretary of State Hillary Rodham Clinton (2009) and Anthony Romero (2011).

03/07/12

Examining barriers to use of intrauterine devices (IUD)

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.