Making pregnancy safer for women globally

New research from the UCSF Bixby Center is answering important questions about how to make pregnancy safer for women worldwide. In two new studies, UCSF Bixby researchers examine novel approaches to make childbirth and abortion, two common pregnancy outcomes, safer — particularly for women without easy access to care.

The first study examined a novel approach to treat postpartum hemorrhage (PPH) – or heavy bleeding after giving birth — which is the leading cause of maternal death. The current approach to treat PPH, called universal prophylaxis, gives misoprostol or oxytocin to all women after birth. It is unclear if universal prophylaxis saves women's lives, as some women still bleed heavily despite the treatment. Cost and supply-chain issues also make it difficult to offer this treatment to all women. Given these issues, the researchers compared this approach with a novel approach — giving misoprostol to only the small proportion of women who bleed more than average after birth. 

They found that this novel approach resulted in substantially fewer women receiving medication (4.7 percent versus 99.7 percent). There was no difference in the rate of PPH, or the rate of transfer to other health facilities to treat complicated cases of PPH. The researchers concluded that this novel approach is a feasible alternative to universally medicating all women who give birth, and that it may be more acceptable, cost-effective and sustainable at the community level.

The second study investigated how to make abortion safer for women around the world. In countries where abortion is illegal or performed outside the health system, women may have complications such as prolonged bleeding. If women are concerned about seeking care for post-abortion bleeding, or if there is a delay in receiving care, they are at risk of death.  UCSF Bixby researchers have previously demonstrated that the non-pneumatic anti-shock garment (NASG), a low-technology first-aid device, decreases blood loss and deaths from PPH. In a new study, they confirmed that the NASG also decreases bleeding and death after an abortion.

With data collected in Egypt, Nigeria, Zambia, and Zimbabwe, they found that blood loss significantly decreased when providers used the NASG to  manage bleeding post-abortion. Women treated with the NASG were half as likely to die.  Adding the NASG to post-abortion care among women experiencing severe bleeding and shock has the potential to save the lives of tens of thousands of women each year.


New generation of women’s health tools on the horizon

Around the world, millions of women are at risk of unplanned pregnancy, HIV and other sexually transmitted infections (STIs). Recent developments in the emerging field of multipurpose prevention technologies (MPTs) are poised to deliver a new generation of safe and effective prevention methods that better meet women’s needs. At an upcoming conference, researchers from the UCSF Bixby Center and partners will announce new discoveries and recent developments in the field of MPTs that will soon enable women to simultaneously prevent unplanned pregnancy, HIV and other STIs.

At the upcoming World STI & HIV 2015 Congress in Australia, the UCSF Bixby Center is co-hosting a panel on MPTs with the World Health Organization (WHO), Initiative for Multipurpose Prevention Technologies (IMPT) and the Australasian Sexual Health Alliance (ASHA). The panel will focus on:

  • The array of products in development.
  • The role of MPTs in the prevention of infertility.
  • The need for rectal MPTs to reduce HIV and other STIs, and their potential impact for women and men who have sex with men.

“The growing field of MPTs is in an exciting phase of scientific advancement,” said Dr. Craig Cohen from the UCSF Bixby Center. “We are on the cusp of breakthroughs that will transform the health of women and families globally. Delivering HIV and STI prevention in combination with contraception has great potential to impact women’s health around the world. It is a promising moment for research and investment in this important field in order to make more effective prevention a reality.” More information about the panel and the conference can be found online.


Supporting interdisciplinary women’s health research

The UCSF Bixby Center is the new home of the Bridging Interdisciplinary Research Careers in Women’s Health (BIRCWH) program. The BIRCWH program is a joint initiative of UCSF and the Kaiser Permanente Division of Research<. It aims to foster the next generation of women’s health scholars through financial support, mentorship and research training. BIRWCH includes mentors and advisors from 11 of UCSF's departments and centers, as well as Kaiser.

BIRCWH emphasizes novel, interdisciplinary approaches to a wide range of women’s health issues, with a particular focus on translation into policy impact. The Bixby Center welcomes BIRCWH scholars to its family of fellows, including members of the Fellowship in Family Planning and GloCal Health Fellowship.


Women’s preferences for public versus private birth control services

Nearly 40 percent of women in developing countries seek birth control from the private sector. However, the reasons that women choose private or public providers are not well understood. In a new study, UCSF Bixby Center researchers examined women’s expectations and experiences when seeking family planning care from private and public facilities in Nairobi, Kenya. Through interviews and group discussions, the researchers explored women's decision-making about contraceptive use after giving birth. They found that women:

  • Preferred private over public facilities due to convenience and faster service. They avoided public facilities due to long wait times./li>
  • Believed that private facilities treated their customers with care and attention compared with public facilities, where participants experienced verbal harassment, inattention and rudeness.
  • Reported that they felt more confident about the quality of medical care in public facilities than in private, and believed that private providers prioritized profit over safe medical care.
  • Reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-making support.

As an increasing number of women in urban areas worldwide rely on private sector health providers, these private facilities can continue to attract clients with respectful care and efficient of service. However, private providers may need assistance with technical standards of care. Public facilities, on the other hand, can improve patient care by enhancing interpersonal relationships and efficiency. These findings are also relevant to the Family Planning 2020 goal of enabling 120 million more women and girls to use contraceptives by 2020.


Making a one-year supply of birth control a national standard

A group of federal lawmakers recently sent a letter to the Department of Health & Human Services (HHS) urging the agency to require health insurance plans to cover a 12-month supply of birth control without out-of-pocket costs. The letter cites a UCSF Bixby Center study that found a 12-month supply of birth control decreased unplanned pregnancies by 30 percent, compared with a supply of just one or three months. The study also found that giving women a one-year supply of birth control reduced the odds of an abortion by 46 percent.

Many insurance plans limit birth control prescriptions to one or three months. “If a woman is unable to refill her prescription at the time her insurance company requires, she may have a gap in her birth control use and her chanes of unintended pregnancy will increase,” the lawmakers wrote in the letter. "This is of particular concern for low- and middle-income women who may have unpredictable work hours, difficulty accessing transportation, or other barriers preventing them from getting to a pharmacy.”

The Centers for Disease Control and Prevention (CDC) and Office of Population Affairs (OPA) both advise health care providers to give women multiple cycles of birth control, ideally a year, to help reduce such gaps. Both Oregon and the District of Columbia recently passed laws ensuring residents have access to a one-year supply of birth control.