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Thompson K.M.J.,University of California at San Francisco | Gelt M.,Planned Parenthood Federation of America | Gelt M.,National Training Center for Family Planning Service Delivery | Speidel J.J.,University of California at San Francisco | Harper C.C.,University of California at San Francisco
Perspectives on Sexual and Reproductive Health | Year: 2013

Context: Low knowledge of long-acting reversible contraceptives (LARC) and restrictive counseling practices have been documented among contraceptive care clinicians. However, little is known about health educators' counseling on LARC, how their practices compare with clinicians' and their specific training needs. Methods: A survey conducted in 2011-2012 assessed knowledge and practices related to LARC counseling and provision among 410 staff at 40 Planned Parenthood clinics. Clinicians' and health educators' knowledge and practices were compared via chi-square tests; use of evidence-based criteria was assessed in multivariable logistic regression analyses. Results: At least half of both types of staff routinely discussed LARC with clients, and nearly all considered the methods safe. Health educators considered a smaller proportion of clients candidates for LARC than did clinicians (57% vs. 77%), and they were less likely to consider IUDs for teenagers (79% vs. 96%), nulliparous women (82% vs. 98%) and unmarried clients (90% vs. 99%). In a multivariable model, health educators were less likely than clinicians to counsel clients using the least restrictive evidence-based criteria (odds ratio, 0.1). Sixty-four percent of health educators and 40% of clinicians desired additional LARC training. Conclusion: Even in clinics that specialize in reproductive health care, health educators are less likely than clinicians to apply current evidence-based criteria in counseling about LARC. To provide evidence-based contraceptive counseling, health educators need training on LARC eligibility and indications. © 2013 by the Guttmacher Institute. Source


Fjerstad M.,University of North Carolina at Chapel Hill | Trussell J.,Princeton University | Trussell J.,University of Hull | Lichtenberg E.S.,Northwestern University | And 2 more authors.
Contraception | Year: 2011

Background: In response to concerns about serious infections following medical abortion, in early 2006 the Planned Parenthood Federation of America changed the route of misoprostol administration from vaginal to buccal and required either routine antibiotic coverage or universal screening and treatment for chlamydia; in July 2007, the Planned Parenthood Federation of America began requiring routine antibiotic coverage for all medical abortions. We previously reported a pronounced drop in the rate of serious infections following the adoption of these new infection control measures. Our objective in this study was to assess whether the degree of severity of the serious infections differed in the three infection control groups (vaginal misoprostol and no antibiotics; buccal misoprostol and screen-and-treat method; buccal misoprostol and routine antibiotics) or, equivalently, to assess whether the declines in rates of serious infections after the adoption of new infection control measures differed across the degree of severity categories. Of particular importance is whether the new infection control measures selectively reduced the least severe serious infections but did not diminish the rate of the most severe infections. Methods: We performed a retrospective analysis assessing the degree of severity of infections before infection controls were implemented and after each of the two new measures was adopted: buccal administration of antibiotics with either screen-and-treat method or routine antibiotic coverage. We ranked the severity of infection from 1 (when treatment occurred in an emergency department) to 4 (when death occurred). We compared the distributions of the severity of serious infections in the three infection control groups (none; buccal misoprostol and screen-and-treat method; buccal misoprostol and routine antibiotics) or, equivalently, assessed whether the declines in rates of serious infections after the adoption of new infection control measures differed across the degree of severity categories using the Jonckheere-Terpstra test for a doubly ordered 4×3 table. Results: The distribution of infection by severity was the same for all three infection control groups. Likewise, when the two new infection control groups - buccal misoprostol plus either screen-and-treat method or routine antibiotics - were combined, the distribution of infection by severity was the same before and after the new measures were implemented. Conclusion: The pronounced decline in the rate of serious infections occurred in each category of severity. © 2011 Elsevier Inc. Source


Trussell J.,Princeton University | Trussell J.,University of Hull | Nucatola D.,Planned Parenthood Federation of America | Fjerstad M.,WomanCare Global | Lichtenberg E.S.,Northwestern University
Contraception | Year: 2014

Background From 2001 to March 2006 Planned Parenthood health centers throughout the United States provided medical abortion by a regimen of oral mifepristone followed 24-48 h later by vaginal misoprostol. In response to concerns about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration to buccal and required either routine antibiotic coverage or universal screening and treatment for chlamydia; in July 2007, Planned Parenthood began requiring routine antibiotic coverage for all medical abortions. Methods We performed a retrospective analysis of Planned Parenthood cases assessing the rates of mortality caused by infection following medical abortion during a time period when misoprostol was administered vaginally (2001 through March 2006), as compared with the rate from April 2006 to the end of 2012 after a change to buccal administration of misoprostol and after initiation of new infection-reduction strategies. Results The mortality rate dropped significantly in the 81-month period after the joint change to (1) buccal misoprostol replacing vaginal misoprostol and (2) either sexually transmitted infection (STI) screening or routine preventative antibiotic coverage (15 month period) or universal routine preventative antibiotic coverage as part of the medical abortion (66-month period), from 1.37/100,000 to 0.00/100,000, P=.013 (difference=1.37/100,000, 95% CI 0.47-4.03 per 100,000). Conclusion The infection-caused mortality rate following medical abortion declined by 100% following a change from vaginal to buccal administration of misoprostol combined with screen-and-treat or, far more commonly, routine antibiotic coverage. Significance Deaths from infection following medical abortion declined to zero after a change in the regimen. © 2014 Elsevier Inc. All rights reserved. Source


Giorgio M.M.,New York University | Kantor L.M.,Planned Parenthood Federation of America | Levine D.S.,Planned Parenthood Federation of America | Arons W.,Planned Parenthood Federation of America
Journal of Medical Internet Research | Year: 2013

Background: Teens and young adults in the United States are in need of sexual and reproductive health information, as evidenced by elevated rates of sexually transmitted infections (STIs), pregnancy, and births among this population. In-person sexuality education programs are helpful, but they are unlikely to rapidly accommodate teens and young adults in a moment of crisis. Evidence suggests that technologies such as instant messaging (IM) and text messaging may be effective ways to provide teens and young adults with sexual and reproductive health information. In September 2010, Planned Parenthood Federation of America launched a text and IM program designed to provide immediate answers to urgent sexual and reproductive health questions from a reliable and confidential source and to link young people to sexual and reproductive health services if needed. Objective: To assess whether this program is successful in reaching the target population, whether user characteristics vary by mode (IM vs text), and whether mode is associated with reaching individuals with high levels of worry or reducing worry postchat. Methods: Data were collected from prechat and postchat surveys for all IM and text message conversations between September 2010 and August 2011. A bivariate analysis was conducted using chi-square tests for differences in the main covariates by mode of conversation. In the multivariable analysis, logistic regression was used to identify factors that were independently associated with prechat levels of worry and changes in worry postchat. Results: A total of 32,589 conversations occurred during the program's first year. The odds of feeling very worried prechat were highest for IM users (adjusted odds ratio [AOR] 1.43, 95% CI 1.20-1.72), users 17 years and younger (AOR 1.62, 95% CI 1.50-1.74), Latino/Hispanic users (AOR 1.36, 95% CI 1.27-1.46), and black users (AOR 1.40, 95% CI 1.30-1.50). After controlling for the study covariates, there was no significant difference in the odds of feeling better (less worried) postchat between IM and text message users. Feeling better postchat was associated with being younger (=17 years: AOR 1.42, 95% CI 1.17-1.72; 18-24 years: AOR 1.20, 95% CI 1.02-1.42), being Latino/Hispanic (AOR 1.31, 95% CI 1.10-1.55), reporting that the service was very helpful (AOR 3.47, 95% CI 3.24-4.32), and asking about emergency contraception (AOR 1.35, 95% CI 1.13-1.61). The odds of feeling better were lowest for users with questions about STIs (AOR 0.61, 95% CI 0.47-0.78). Conclusions: The results from the process evaluation suggest that the program was able to provide informational support to vulnerable groups, such as teens and racial minorities, in moments of particular worry. Differences between the IM and text message users reveal that each mode appeals to a different population and that both are necessary to reach a diverse audience. Source


News Article
Site: http://www.nature.com/nature/current_issue/

When a journalist invites scientists to discuss their work in the pages of Nature, it is rare to encounter a resounding silence. But that was the case when our reporter reached out to biologists in the United States this autumn to ask about the value and applications of their research with human fetal tissue. Just two of the 18 scientists we contacted were willing to go on the record with details of their work. The reticence is understandable. A hostile political climate surrounds this research in the United States, where the release in July of covertly filmed videos ignited a firestorm of controversy. Made by anti-abortion campaigners, posing as executives of a fictional biological-supply company, the videos showed senior physicians from the Planned Parenthood Federation of America frankly discussing their supply of legally aborted human fetal tissue for research. The videos insinuated that the non-profit health-care provider was breaking the law by supplying the fetal tissue to biological-products companies for financial gain. But despite the numerous leading questions, the videos show no law-breaking. In exchange for the fetal tissue, the organization received only legally allowable costs: less than US$100 for each specimen, at 1% of its 700 clinics. If Planned Parenthood, which mainly provides contraception, cancer screening and other important health care, was seeking to get rich, it chose a strange way to do so. That has not stopped Republican politicians from seizing on the videos to make repeated, inaccurate and inflammatory accusations. Presidential hopeful Marco Rubio, a US senator from Florida, charged, with utterly no evidence, that the collection of fetal tissue has “created an incentive for people to be pushed into abortions so that those tissues can be harvested and sold for a profit”. Ted Cruz, a US senator from Texas who is also contending for the Republican presidential nomination, declared that Planned Parenthood is “an ongoing criminal enterprise”. It is not surprising then that, since July, even the small number of Planned Parenthood clinics supplying fetal tissue has dwindled. Or that when an unhinged gunman launched a murderous rampage last month, he chose a Planned Parenthood clinic in Colorado as a target. Nor is it surprising that US scientists who use fetal tissue are choosing to stay silent about the value of their work rather than to defend it publicly and face the real possibility of physical attack. (One scientist told The New York Times that in response to threats against him his institution had posted a guard outside his lab.) The two US-based biologists who did speak to Nature should be applauded for their courage. As the News Feature on page 178 shows, research that uses fetal tissue is worth defending. And there are ways in which the scientific community can rally round without putting individuals at risk. Admirably, the Association of American Medical Colleges (AAMC) is showing the way. The AAMC released a statement last week signed by 58 academic medical centres, scientific societies and allied groups. The statement outlined the medical advances that have been made possible by fetal tissue, and described the value of its current applications in areas such as developmental biology and research on infectious diseases. The authors wrote of their “grave concerns” about the numerous legislative proposals now in play in the US Congress and in a dozen states — proposals that would restrict or prohibit fetal tissue research. They warned eloquently that the proposed laws “would limit new research on vaccines not yet developed, for treatments not yet discovered, for causes of diseases not yet understood”. Nature shares the authors’ grave concerns, and joins the AAMC in calling on US lawmakers to reject proposals that restrict access to fetal tissue. The current episode is a reflection of a larger politics of division that has taken hold in the United States, and which has worsened alarmingly in recent months. It is time for a de-escalation of the rhetoric and the creation of a space for calm and rational discourse. In the case at hand, that could begin with greater separation of the issues of fetal tissue research and abortion. Clearly, there is fair, honest and understandable disagreement on the morality of the latter. In a democracy, opponents of abortion are free to do their best within the law to change the law. But nobody benefits when they target by proxy an activity that is tangential to the act that they abhor and that is doing a great deal to advance our understanding of health and disease.

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