12/26/11

Teen sleepovers prevent unplanned 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.

12/07/11

HHS ruling on emergency contraception access is not evidence-based

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.

12/06/11

Uneven progress on sex education in California schools

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.

11/04/11

California family planning successes

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. Other studies 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.

10/31/11

7 billion people: A call to action

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.