04/30/13

Pelvic Exams may be Unnecessary for Asymptomatic Women

Performing routine pelvic exams may be medically unnecessary for healthy women with no symptoms.  So why do physicians continue to perform such exams with no clear evidence that they provide preventive benefit? Research at the UCSF Bixby Center, sought to answer this question. The national study, led by Drs. Jillian Henderson and George Sawaya, gathered and analyzed clinician perspectives via a mailed survey on the bimanual pelvic examination for asymptomatic women across the lifespan.

The survey asked a representative sample of over 500 providers whether they would perform a pelvic exam in varying clinical scenarios. Nearly all obstetrician gynecologists would perform pelvic exams in asymptomatic women in part because women expect it and normal results reassure patients that they are healthy. Nearly half of physicians surveyed incorrectly believe the exam is important for detecting ovarian cancer despite longstanding evidence that it isn’t effective for this purpose.  

This study shows a need to further evaluate the appropriateness of the routine use of the pelvic exam for healthy women, as it takes up clinical time that could be devoted to other concerns and can impede women’s access to birth control. Drs. Henderson and Sawaya’s work has already made its mark in the public – Jane Brody’s article “Questioning the Pelvic Exam” was featured in the New York Times blog, Well, this Monday.

04/08/13

Emergency Contraception Available Over-the-Counter for All Ages

On April 5^th, 2013 a federal district judge ruled that levonorgestrel emergency contraception must be available without a prescription for women of all ages within the next 30 days. Until pharmacies implement this change, women aged 16 and younger will still need a prescription to buy levonorgestrel emergency contraception. 

It has been over a year since the U.S. Department of Health and Human Services (HHS) blocked a Food and Drug Administration decision to make Plan B One Step emergency contraception available without prescription for all ages.  Today’s court ruling cited this HHS action as “politically motivated, scientifically unjustified, and contrary to agency precedent.”

Research conducted by UCSF Bixby Center members provided evidence for the FDA that women aged 12-17 are able to safely and correctly use levonorgestrel emergency contraception by following instructions on the package and showed that HHS’s cited concerns about a lack of evidence for safe EC use by girls under age 12 was not prompted by scientific concerns.

UPDATE: On Tuesday, April 30, the U.S. FDA announced that it has approved the availability of Plan B One-Step for women aged 15 and older without a prescription.

02/11/13

Turnaway Study Releases Preliminary Findings

At the American Public Health Association (APHA) annual meeting in October 2012, UCSF Bixby Center researchers shared the first findings from the Turnaway Study.  This study examines the effects of access to abortion services on women’s lives, comparing women who received an abortion to those who were denied care because they presented past the gestational limit of the clinic. The study’s Principal Investigator, Diana Greene Foster, reported that “there is no evidence of a post-abortion trauma syndrome, receiving an abortion does not increase the incidence of mental health disorders compared to having an unwanted birth.” Another important finding was that the socioeconomic consequences for women denied abortions are substantial. “Women denied abortion were more likely to be receiving public assistance (76% vs. 44%) and have household income below the federal poverty level (67% vs. 56%) than women who received an abortion,” said Dr. Foster.  Since these initial findings were announced at APHA, the Turnaway Study has received significant media attention, including Dr. Foster’s appearance on the Melissa Harris-Perry Show. 

The Turnaway Study’s research team will continue to collect data and report findings in the coming years.  The team is also expanding its investigation internationally with a Global Turnaway Study, which studies access to legal abortion and the consequences of illegal abortion and childbirth in Cambodia, Colombia, India, Nepal, South Africa and Tunisia. The global research effort will replicate the domestic study’s design in a range of different cultural and legal environments in where the rates of maternal mortality and morbidity are higher than they are in the US.

01/10/13

Environmental toxins and pregnancy

There is increasing evidence that exposure to environmental chemicals at levels encountered in daily life can have negative effects on women’s reproductive and children’s developmental health. Research from the UCSF Bixby Center’s Program on Reproductive Health and the Environment (PRHE) shows that nearly every pregnant woman in the US has measureable levels of multiple such chemicals in her body.

Exposure to certain environmental chemicals has been linked to birth defects; premature deliveries, stillbirths, and infants with low birth weight; and problems with nervous system development. New evidence also suggests that some environmental chemicals in men’s and women’s bodies are linked with reduced fertility.

Yet a recent PRHE survey shows that most Obstetrician-Gynecologists do not talk to their prenatal patients about environmental chemicals.  Nearly all Ob-Gyns in the survey routinely talked to pregnant patients about alcohol, smoking, and weight gain. Most (86%) also discussed how to limit workplace hazards, and some (44%) talked about the risks of certain types of fish containing high levels of mercury.  But few (5-19%) physicians discussed common sources of environmental chemicals like pesticides, air pollution, processed and canned foods, cosmetics, and the fumes from gas and other solvents.

With so many sources of environmental chemicals and increasing evidence of their harm during pregnancy, women need specific information about how to reduce their exposure.  Most of the Ob-Gyns in the survey (86%) believed that could help their patients reduce their exposure, but they were concerned that this is not their area of expertise.  Ob-Gyns noted the need for clear-cut practice guidelines on environmental chemicals and reproductive health, and that they trust information from the American College of Obstetricians and Gynecologists.

Reducing or preventing preconception and prenatal exposure to environmental chemicals can have multiple benefits lasting a lifetime. PRHE has developed free resources that clinicians and families can use to learn about and discuss the issue of environmental chemicals and reproductive health.  

09/26/12

World Contraception Day: A celebration and a call to action

On World Contraception Day 2012, the UCSF Bixby Center celebrates the positive impact of contraception around the globe.  Voluntary use of contraceptives allows women to decide if and when to have a child—and empowers them to raise healthier and more prosperous families.  Use of contraceptives in developing countries already prevents 218 million unintended pregnancies, 118,000 maternal deaths, and 1.8 million infant deaths each year.   

We also see room for improvement: research shows that not all women’s needs are met by the current contraceptive options.  Women’s experiences with side effects and low effectiveness in real world conditions are major flaws of many methods.  The most effective reversible methods, the implant and intrauterine device, require a highly skilled healthcare provider for placement and removal, and they can be prohibitively expensive.  We must invest now in an array of new contraceptives that enhance user control, have added health benefits like the prevention of HIV, and that meet women’s needs.