Our 2012 Symposium is focused on the many international projects coordinated by the UCSF Bixby Center. Dr. Jaime Sepulveda will deliver a keynote address on global health research at UCSF. Panels will include:
Late-breaking report on HIV & family planning integration from Nairobi
Accomplishments of the UCSF Bixby Center and University of Zimbabwe collaboration
Changes in Nepal, South Africa and Kenya that allowed safer abortion provision, and how these settings differ.
UCSF Bixby Center Co-Directors, Drs. Claire Brindis, Philip Darney, and Joseph Speidel will provide remarks. The Symposium will be followed by a wine and cheese reception.
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.
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.
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.”
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).
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.
The United States has one of the highest rates of unintended pregnancy among the world's developed nations. A series of articles in theJournal of Obstetric, Gynecologic and Neonatal Nursingaddresses this issue. The articles - authored by ANSIRH researchers Diana Taylor and Amy Levi, and UCSF School of Nursing students Kim Dau and Evelyn Angel James - offer information on current pregnancy prevention strategies and a blueprint for a coordinated public health model of unintended pregnancy prevention. Primary care and women's health nurses are already important for women's contraceptive access, and will become increasingly crucial as U.S. healthcare evolves toward preventive care.
Reducing unintended pregnancies has been a goal for the U.S. Department of Health and Human Services since 2002, but to date, the rate has not changed. In fact, the rate of unintended pregnancy has increased for young and low-income women. The authors point out that unintended pregnancy is a preventable occurrence, but one that requires a coordinated effort of health care providers with basic knowledge on evidence-based and effective care. The clinical skills required to offer the full range of contraceptive methods may not have been offered to nurses and primary care clinicians during their training. The authors offer resources that will help clinicians better prepare to promote preconception care and the overall reproductive health of women at risk of an unintended 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.
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.
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.
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. Otherstudies 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.
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.
New research from ANSIRH and the Harvard School of Public Health explores how healthcare providers offering abortion services experience and cope with the stigma associated with this aspect of their work. For this study, researchers conducted interviews with 14 physicians, nurses, and nurse-midwives who provide abortion care services, and found that stigma can negatively affect those who deliver abortion care. But providers also actively resisted being stigmatized by focusing on the ways that abortion care helps their patients. The researchers conclude that: “while stigma exacts a price on individuals within the abortion-providing community, it also taxes the integrity of the healthcare system… [by calling] into question any institution, payer, or entity that facilitates abortion services.” Stigma marginalizes abortion care, keeping it separate from other aspects of healthcare, despite the fact that abortion is one of the most common healthcare procedures in the US.
Two new studies from UCSF Bixby Center members explore the role of
contraceptive use in racial and ethnic disparities in unintended
pregnancy rates. They find that Californian women of differing race and
ethnicity have distinct contraceptive use patterns that are not
explained by the cost of the methods, nor women’s socioeconomic
situation.
In one study led by Dr. Christine Dehlendorf,
researchers examined the relationships between race, ethnicity and
contraceptive method use by Family PACT clients from 2001-2007. Family PACT
is California’s Medicaid family planning program, which makes
contraception free to women with no insurance and women under 200% of
the federal poverty limit. The program served over a million
women in 2007. The authors found that “the contraceptive methods women
received differed substantially by race and ethnicity.” Taking into
account age and the number of children women had, “white women were more
likely than Latina, black or Asian women to receive the pill, ring or
IUD, while Latina and black women were more likely than whites to
receive the injectable, patch or barrier methods.” While the use of
less effective contraceptives may be one factor in racial and ethnic
disparities in unintended pregnancy rates, the authors point out that it
is not the whole picture.
The second study, led by Dr. Grace Shih, examined whether income and education were related to contraceptive use by women of varying race and ethnicity. Using data from the 2006-2008 California Women’s Health Survey, the authors found similar disparate use of birth control by race and ethnicity. They also found that differences in educational level did not explain these disparities. Income levels were related to the use of hormonal contraceptives, with women below 200% of the federal poverty level 30-40% less likely to use these methods. Women’s knowledge about contraception, their preferences for various methods, and health care
providers’ recommendations may all vary by race and ethnicity and
contribute to these disparities. Both studies point to the need for an
improved understanding of contraceptive knowledge, choices and use among
women of different race and ethnicity.
Dr. George Tiller
and the staff of the former Wichita Women’s Health Care Services clinic
offered compassionate care for women with wanted pregnancies that went
terribly wrong late in gestation. After the murder of Dr. Tiller in May
2009 and closure of the clinic shortly thereafter, Bixby Center
sociologist Dr. Carole Joffe
began exploring how the staff of the unique clinic coped with working
in an environment attacked by antiabortion activists on a daily basis.
In her special report, Dr. Joffe also documents the services developed for the clinic’s patients, who travelled from all over the country. In interviews with seven former staff members, the sustained protests of the clinic emerged
as a paradoxical galvanizing force for the work of the late Dr. Tiller
and his staff. Gratitude from patients was another source of sustenance; one staff member said, “I have never worked for any physician where there was that kind of love and appreciation from patients… they really felt like they had their lives back, that this was a place of healing for them.” The availability of abortion for women who need one late in pregnancy remains extremely limited, but the services pioneered in Wichita are being replicated in other centers around the US.
A centerpiece of the Patient Protection and Affordable Care Act
of 2010 (ACA) is coverage of preventive health care services—an
important shift from treatment for existing illnesses. The ACA will remove cost-sharing requirements for patients from a list of preventive services, making those screenings, counseling and procedures free. This new emphasis on preventive care is intended to foster health and well-being, and save money that would otherwise be spent on costly acute care treatments. Women stand to benefit from this shift, particularly due to their higher burden of chronic disease and disability.
Three independent bodies recommended preventive services in the ACA (the US Preventive Services Task Force, the American Academy of Pediatrics’ Bright Futures, and the
Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices), but there were critical gaps in preventive
services for women’s health. The US Department of Health and Human Services (HHS) requested that the Institute of Medicine (IOM) convene a group of experts to recommend additional evidence-based preventive measures to ensure women's health and well-being.
yearly well-woman preventive care visits to obtain recommended preventive services
contraceptive methods and counseling to prevent unintended pregnancies
counseling on sexually transmitted infections (STIs)
human papillomavirus (HPV) DNA testing as part of cervical cancer screening for women over 30
counseling and screening for HIV
screening for gestational diabetes
lactation counseling and equipment to promote breast-feeding
screening and counseling to detect and prevent interpersonal and domestic violence
If adopted by HHS, these recommendations would expand the scope of screening for cervical cancer, STI counseling, and HIV counseling and screening. They recommend that contraceptive counseling, methods and
provision be included as key preventive services, echoing 27 states that have already made contraceptive coverage mandatory for private insurers. They also recommend expansion of preventive services available to pregnant women to include screening for increasingly common gestational diabetes and support for breastfeeding. Finally, they recommend culturally competent screening and counseling for interpersonal and domestic violence.
Dr. Brindis noted that these recommendations were crafted by “carefully reviewing existing evidence,” allowing the committee to “identify those clinical areas especially relevant to women’s health and ways to decrease traditional barriers women encounter in accessing preventive care.”
HIV-positive women with bacterial vaginosis (BV) are more likely to transmit HIV to their male partners than women without BV. Taking into account women’s age, pregnancy status, incidents of unprotected sex, other partners, viral load, and other sexually transmitted infections, men whose partners had BV were 3 times more likely to acquire HIV compared to men whose partners had normal vaginal flora. This finding from the Partners in Prevention Study was presented today by Dr. Craig Cohen at the International AIDS Society Conference in Rome.
BV is a very common condition, affecting 30-50% of women in Sub-Saharan Africa, in which the normal bacteria living in the vagina are out of balance. Research had shown previously that women with BV had a 60% increase in male-to-female HIV transmission.
The mechanism through which BV increases HIV transmission is not known, but Dr. Cohen’s team suggests two possibilities. Normal vaginal bacterial flora may be protective against HIV, killing some of the virus and reducing the proportion capable of causing an infection in a partner. In the case of female-to male transmission, BV may also indirectly increase a male partner’s susceptibility by activating his Langerhans and CD4 cells.
This study confirms that there is a critical need for improved BV treatments. The current treatment options are inadequate, with BV recurring in up to 70% of women treated with antibiotics within 3 months.
When health care providers give women a one-year supply of birth control pills, rates of unintended pregnancies and abortions decline. New research from Bixby Center members Diana Greene Foster, PhD, Philip Darney, MD, MSc, and Michael Policar, MD, MPH, shows that women given one or three packs of pills at a time had a significantly higher risk of unintended pregnancy and abortion compared to women given a year's supply. The authors estimate that giving all women in the study a year of pill packs would have averted about 1,300 pregnancies and 300 abortions. Providing a year of pills is not only good medical practice - it can save taxpayer dollars.
The study linked data on 84,401 women who received birth control pills in January, 2006, via California's family planning Medicaid expansion program (Family PACT) to hospital records from Medi-Cal showing pregnancies and births in 2006. About 19,000 women received 12 months of pills from Family PACT providers. Compared to the 65,000 women in the study who received either one or three packs of pills at a time, their odds of pregnancy decreased by 30% and odds of abortion decreased by 46%.
This study's findings are particularly significant now, as the US House of Representatives has voted to "de-fund Planned Parenthood," and eliminate Title X, a safety-net federal family planning program.
Philanthropedia has honored the Bixby Center as a Top Nonprofit working in women’s reproductive health, rights, and justice.
Philanthropedia is a nonprofit organization that helps donors make smarter grants and gifts by connecting them with the highest impact nonprofits working on the causes they care about. Our award was based on Philanthropedia’s survey of 192 experts.
Craig Cohen, MD, MPH, a professor of obstetrics, gynecology and reproductive sciences at UCSF, and Bethany Holt Young of the Coalition Advancing Multipurpose Innovations (CAMI) are exploring new solutions to improve sexual and reproductive health.
CAMI explains the recent advances in “multipurpose prevention technologies” —technologies to address different reproductive health needs simultaneously. Condoms are an example of a multipurpose prevention technology, protecting against both unplanned pregnancy and sexually transmitted infections (STIs), including HIV. Dr. Cohen’s vision for a better technology is a vaginal ring that slowly releases “a chemical which would essentially reduce the risk of HIV acquisition” and simultaneously protect against pregnancy.
Both teams analyzed data from the US National Comorbidity study. Steinberg and Finer “were unable to reproduce the most basic tabulations of Coleman and colleagues,” calling into question the validity of their results. Steinberg and Finer’s analysis provides compelling evidence that abortion does not endanger women’s mental health; rather, a history of mental health disorders is the strongest predictor of poor mental health after an abortion.
The national media paid attention: see some of the coverage in the Washington Post and CBS News.
New research shows that nearly one-third of women’s health care providers require a pelvic exam before they will provide a prescription for birth control pills. There is no medical need for a pelvic exam before using oral contraception, but it remains common practice to link them. This may create an unnecessary hurdle for women who want birth control pills. One of the study authors, Dr. George Sawaya, said, "In my view, we should have as few barriers as possible to women trying to get effective birth control."
Clinicians were more likely to require pelvic exams if they were older or served a higher proportion of Medicaid patients. Those working in private practice were two times more likely than those working in family planning or community clinics to require a pelvic exam. The researchers noted that “in the absence of adequate financial incentives for contraceptive counseling as an important clinical activity in its own right, providers are incentivized to conduct a physical exam with a well-reimbursed billing code,” such as a pelvic exam. In addition to creating unnecessary costs, conducting unneeded pelvic exams and pap smears may lead to false positive results that require further investigation. “Any (test) we do with an asymptomatic person has a chance of resulting in a false-positive,” Dr. Sawaya noted.
Family AIDS Care and Education Services (FACES), was founded in Kenya in 2004. It is a joint clinical and research program, co-directed by Craig Cohen, MD, MPH, professor of obstetrics, gynecology and reproductive sciences at UCSF, and Elizabeth Bukusi, MBChB, MD, PhD of the Kenya Medical Research Institute (KEMRI).
FACES clinics offer HIV testing, counseling and treatment services, and to date, have served more than 75,000 Kenyans. For those in need, the program provides free antiretroviral medicines. The health and well-being of people living in the Kenyan communities served by FACES has measurably improved.
While the program has been a tremendous success, its growth poses new challenges. One example is “loss to follow-up”—patients who have been diagnosed with HIV but do not come back for antiretroviral medicine. At FACES, the loss to follow-up rate is around 30 percent. Clinic workers have been making special efforts to track down the patients and, if possible, get them back into treatment.
New research led by Dr. Cohen suggests that malaria infection might increase women's susceptibility to HIV and AIDS. This could be part of the explanation for sub-Saharan Africa’s higher rate of HIV, and suggests a new avenue for FACES clinical care.
Craig Cohen MD, MPH provides commentary to allAfrica.com about his recent research, which suggests that Malaria infection might increase women's susceptibility to HIV and AIDS.
In the San Francisco Chronicle editorial "End practice of shackling pregnant inmates," (8/26/2010) Dr. Carolyn Sufrin writes in support of California AB1900; if passed, this legislation would mandate that pregnant inmates incur the least restrictive forms of restraint as possible. You can also read Lois Kazakoff's response to Dr. Sufrin's editorial, here.
ANSIRH’s Lori Freedman, PhD, has found a gap between physician willingness to provide abortion care and their ability to offer these services. In Willing and Unable: Doctors’ Constraints in Abortion Care, Dr. Freedman explores this gap. Freedman interviewed 30 obstetrician-gynecologists who received abortion training in their residency programs; of those 30 physicians, 18 wanted to provide abortion care, but only three were able to do so. Freedman found that these doctors encountered a variety of structural barriers, including senior members of a group practice who disallowed abortion care. Intimidated by “the stigma and contention surrounding abortion” (RealityCast), many group practices are unwilling to provide abortion, sending patients to free-standing clinics such as Planned Parenthood, instead. Although abortion is the most common medical procedure for women of reproductive age, refusal to offer abortion care within the context of routine medical care reinforces this stigma and contention.
Freedman’s book is an important addition to the many voices of the abortion debate. Her work steps above the oft-quoted ethical and religious tropes and highlights the systematic barriers—both objective and subjective—that preclude obstetrician gynecologists from providing abortion care.
Janet Turan, PhD, MPH, is the 2010 recipient of the Pathways to Discovery Mentor Award. The Pathways to Discovery Program helps motivated students from the School of Medicine, School of Nursing, School of Dentistry, and School of Pharmacy develop knowledge, skills, and experiences that will help them contribute to the health community beyond individual patient care.
Dr. Grossman, along with colleagues at the University of Texas, are studying oral contraceptive use along the US-Mexico border, where American women have the option of obtaining pills over the counter in Mexican pharmacies. For more information, see Dr. Grossman's recent article "Clinic Versus Over-the-Counter Access to Oral Contraception: Choices Women Make Along the US-Mexico Border" (American Journal of Public Health, 4/15/10).
In recognition of her distinguished career dedicated to reproductive health scholarship, teaching, publishing, and activism, Prof. Carole Joffe will be honored with the Irvin M. Cushner Lectureship at Reproductive Health 2010. For more information about the annual meeting awards, click here.
Prof. Tracy Weitz, PhD, MPA, Director of ANSIRH, responds to Rep. Bart Stupak's effort to prohibit federal funding of abortion services within the Affordable Health Care for America Act on the Rachel Maddow Show (clip here) (MSNBC, 3/17/10).
The American College of Obstetricians and Gynecologists (ACOG) has issued new guidelines for cervical cancer screening. Dr. George Sawaya's studies on the benefits and risks of cervical cancer screening were instrumental in these new recommendations.
According to Obstetrics and Gynecology, “the Roy M. Pitkin Award was established in 1998 to honor departments of obstetrics and gynecology that promote and demonstrate excellence in research. The award consists of a $5,000 unrestricted grant presented to each department whose faculty, fellows, or residents published 1 of the 4 most outstanding manuscripts in Obstetrics & Gynecology during the past year. We recognize both the authors and the departments for the quality of the research and publication of the results.”
Dr. Claire Brindis discusses the federal court order for over-the-counter sale of Plan B® emergency contraception to be expanded to 17-year-old women (KGO News Talk 810 AM, 4/22/09). For more information about Plan B®, see the FDA website.
Dr. Darney participates on a panel addressing teen pregnancy and birthrates in California and the nation. Radio program achrived here: "Teen Birthrate" (KQED Forum, 5/22/08).
A CDC study published in the Journal of Adolescent Health concluded that sex education increased the likelihood that teens would delay sex. Dr. Claire Brindis explains to Science Daily that sex education is needed to counter the "mythology" around sex; teach anatomy, physiology and contraception; and give teens ways of dealing wisely with sexually risky situations.
The UCSF News Office reports that the Bill & Melinda Gates Foundation has given UCSF researchers nearly $1.4 million to expand African research trials on the non-pneumatic anti-shock garment (NASG). The director of Safe Motherhood Programs, Dr. Suellen Miller, hopes the NASG will help to reduce maternal mortality worldwide.
Dr. Claire Brindis discusses the factors that lead to the 19 million STD infections diagnosed each year in the United States in "Breaking the silence" (CNN, 12/5/07).
Claire Brindis, DrPH, and Douglas Kirby, PhD, of ETR Associates, describe California's family planning program for low income men and women, Family PACT, which also provides contraceptives to low income teens. California teaches comprehensive sex education in schools in contrast to Texas, which promotes an abstinence-only curriculum. Dr. Brindis's research shows that, from 1991-2004, California's teen birth rate fell by 47 percent, while the United States' teen birth rate fell by one third. During the same period Texas's teen birth rate fell by 19 percent.
This October, UCSF faculty members associated with the Bixby Center participated in both an evidence-based medicine and problem-based learning training course and a high-level policy seminar with medical educators in Vietnam. The group, led by Uta Landy, PhD, included Drs. Eugene Washington, Lee Learman, Philip Darney, Rebecca Jackson, and George Sawaya. The training course was a follow up to an earlier course held in June by faculty members Drs. Sawaya and Jody Steinauer. The final course in this series is scheduled for spring 2008 in Ho Chi Minh City. Dr. Landy hopes this program will serve as a model program for improving medical education in other countries.
Nancy Padian, PhD, director of the Women's Global Health Imperative (WGHI), congratulated the Women's Global Health Scholars for concluding the program's first year with the determination and know-how to carve out leadership positions in health care around the world and for exceeding the goals they had set at the start of the year. The first class of Women's Global Health Scholars hailed from Africa (Kenya, Malawi, Tanzania, South Africa, Uganda, Zimbabwe, Botswana), Asia (China, India, Vietnam), Eastern Europe (Turkey, Georgia), and Latin America (Brazil, Argentina, Peru). The program consists of two one-week courses at UCSF, monthly virtual meetings, and ongoing mentorship.
San Francisco General
Hospital does not use digoxin or
potassium chloride injections
to ensure fetal demise in late-term abortions because, "We do not believe
that our patients should take a risk for which the only clear benefit is a
legal one to the physician," wrote Dr. Philip Darney, San Francisco
General Hospital’s Chief of Obstetrics & Gynecology, in an e-mailed response to the reporter's inquiry. "Shots assist in aborting fetuses" (Goldberg, 8/10/07) focused on doctors' reactions to the U.S.
Supreme Court's April decision to uphold the Partial-Birth Abortion Ban Act.
The Act imposes the possibility of a two-year prison sentence for abortions in which the fetus is partially
delivered while alive.
Dr. Nancy Padian reviewed methods for preventing transmission of HIV in the context of her recent study of diaphragms as a barrier method of HIV prevention and made recommendations for future research during a plenary session of the 4th International AIDS Society Conference in Sydney, Australia. Dr. Padian's speech, "Synthesizing Our Options: Biomedical Prevention Technologies in the Context of Behavioural Interventions," was covered by:
Dr. Claire Brindis speaks about the importance of comprehensive sex education on the WBUR morning news program On Point. See additional coverage of this radio event at UCSF Today.
Dr. Nancy Padian announced that a clinical trial involving 5,045 women in South Africa and Zimbabwe found no statistical difference in the rate of new HIV infections in the two study arms: those who received a diaphragm plus lubricant along with male condoms for their partners and those who only received male condoms. The study, "Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomised controlled trial" (The Lancet, 2007 Jul 21;370(9583):251-61), was widely covered by the following media outlets:
Dr. Claire Brindis discusses the importance of comprehensive sex education in the San Francisco Chronicle article "Abstinence-only sex ed finds few scientific fans" (Weiss, 2/11/07). Even in California — which has seen the second largest decline in teen pregnancy rates in the nation from 1991-2004 (and has not accepted federal aid that would require abstinence-only education programs) — it is important to keep educating our diverse population.
The Society for Medical Anthropology (SMA) awarded the 2006 Steven Polgar Prize to Vincanne Adams and co-authors Suellen Miller, Sienna Craig, Nyima, Sonam, Droyoung, Lhakpen, and Michael Varner for "The Challenge of Cross-Cultural Clinical Trials Research: Case Report from the Tibetan Autonomous Region, People's Republic of China" (Medical Anthropology Quarterly, 2005;19(3):267-289). The Polgar Prize is awarded annually for the best paper published in SMA’s journal Medical Anthropology Quarterly.
Tina Raine, MD, discusses emergency contraception and unintended pregnancy in The New York Times article "F.D.A. Approved Broader Access to Next-Day Pill" (Harris, 8/25/06). The FDA announced its decision today to approve Plan B emergency contraception for over-the-counter access to women aged 18 and over. Please see the FDA webpage for more information about Plan B.
Philip Darney, MD, MSc, was quoted in The Washington Post's article "Period: Full Stop?" (Payne, 6/6/06) which discusses the continuous use of hormonal contraception (e.g., birth control pills, the patch, or the vaginal ring).
Her Majesty Queen Rania Al-Abdullah is hosting the Global Women's Action Network for Children Conference June 11-13, 2006. The conference will be jointly launched by the Jordanian National Council for Family Affairs and the US-based Children's Defense Fund. The conference participants will include prominent political and academic figures, including the Liberian President Ellen Johnson-Sirleaf and Nobel Peace Prize Laureates Shirin Ebadi and Wangari Maathai. Dr. Suellen Miller has been asked to speak on maternal mortality and the Non-pneumatic Anti-Shock Garment (NASG).
Tori Sutherland, a Women's Global Health Imperative (WGHI) Safe Motherhood Program intern, co-authors essay with Dr. Suellen Miller, which is featured in "On The Ground," the blog of The New York Times columnist Nicholas Kristof.The essay details an eye-opening trip to Egypt, Yemen, and Nigeria to observe conditions in maternal health hospitals, where needs are great and the means to help women are stretched thin.
"A new tool in keeping women HIV free" (Graves & Miller, 11/9/05) highlights the importance of microbicide research for HIV prevention, especially in contexts where women lack control over sexual decision-making.
"Fetal Pain: A Systematic Multidisciplinary Review of the Evidence," which appeared in the August issue of the Journal of the American Medical Association, examines whether a fetus feels pain and whether safe and effective techniques exist for providing direct fetal anesthesia. The review finds that fetal perception of pain is unlikely before 29 or 30 weeks. The article also finds that there is little data addressing the effectiveness of direct fetal anesthesia or the safety of such techniques on pregnant women.
In the powerful "Lives" feature "Haiti Eyes" (7/24/05), Dr. Maternowska describes her life-threatening experience in Haiti, where she has done public health work for 22 years.
Dr. Krishnan, director of HIV prevention programs in India for the Women’s Global Health Imperative, was named a recipient of the 2004 Presidential Early Career Awards for Scientists and Engineers. The award, from the Office of Science and Technology Policy, is the nation's highest honor for professionals at the outset of their independent research careers. Dr. Krishnan, is an epidemiologist who works in Southern India. She is conducting two studies that examine the relationship between economic opportunity and HIV prevention among girls and investigate gender-based power dynamics and susceptibility to HIV among married women. She also explores the barriers to treatment adherence and AIDS-related stigma.
Dr. Felicia H. Stewart, Co-Director of the Center and Director of Advancing New Standards In Reproductive Health (ANSIRH), has been named winner of the 2005 Olivia Schieffelin Nordberg Award for excellence in writing and editing in the population sciences. Dr. Stewart writes about both the science and the values of the population field. Without sacrificing rigor, she makes scientific material accessible to nonprofessionals. And as an activist she is uniquely sensitive to the social responsibility of scientists and the need for moral clarity in a field often driven by political factions. The Award will be presented at a Population Council reception in New York in June.
Congratulations to Center Co-Founders Philip Darney, MD, MSc, and Nancy Padian, PhD, MPH, who were elected to the Institute of Medicine. The IOM elected 65 new members, raising the Institute's total active membership to 1,416. Election is considered one of the highest honors in the fields of medicine and health.
Dr. Eleanor Drey, Medical Director of the San Francisco General Hospital's Women's Options Center, was deemed a Local Hero in the San Francisco Bay Guardian's Best of the Bay 2004. As the article so aptly puts it, we are "blessed to have Drey, who's a calm yet impassioned advocate for family planning and the clinic's disadvantaged patients, defending an essential medical service that's perpetually under political attack."
We are pleased to announce that Prof. Carole Joffe has been selected as the 2005 recipient of the Sociologists for Women in Society (SWS) Feminist Activist Award. SWS is honoring Prof. Joffe for her dedication and commitment to the issue of reproductive rights for women. She will be presented with the award at the American Sociological Association summer meeting this August.
Center Co-Founder, Nancy Padian, PhD, MPH, and the Shaping the Health of Adolescents in Zimbabwe (SHAZ) program featured in "Saying No to 'Sugar Daddies'" (Chase, 2/25/04).
