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.
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.
Harper C.C.,University of California at San Francisco |
Rocca C.H.,University of California at San Francisco |
Thompson K.M.,University of California at San Francisco |
Morfesis J.,Planned Parenthood Federation of America |
And 5 more authors.
The Lancet | Year: 2015
Background Unintended pregnancy remains a serious public health challenge in the USA. We assessed the effects of an intervention to increase patients' access to long-acting reversible contraceptives (LARCs) on pregnancy rates. Methods We did a cluster randomised trial in 40 reproductive health clinics across the USA in 2011-13. 20 clinics were randomly assigned to receive evidence-based training on providing counselling and insertion of intrauterine devices (IUDs) or progestin implants and 20 to provide standard care. Usual costs for contraception were maintained at all sites. We recruited women aged 18-25 years attending family planning or abortion care visits and not desiring pregnancy in the next 12 months. The primary outcome was selection of an IUD or implant at the clinic visit and secondary outcome was pregnancy within 12 months. We used generalised estimating equations for clustered data to measure the intervention effect on contraceptive selection, and used survival analysis to assess pregnancy rates. Findings Of 1500 women enrolled, more at intervention than control sites reported receiving counselling on IUDs or implants (565 [71%] of 797 vs 271 [39%] of 693, odds ratio 3·8, 95% CI 2·8-5·2) and more selected LARCs during the clinic visit (224 [28%] vs 117 [17%], 1·9, 1·3-2·8). The pregnancy rate was lower in intervention group than in the control group after family planning visits (7·9 vs 15·4 per 100 person-years), but not after abortion visits (26·5 vs 22·3 per 100 person-years). We found a significant intervention effect on pregnancy rates in women attending family planning visits (hazard ratio 0·54, 95% CI 0·34-0·85). Interpretation The pregnancy rate can be reduced by provision of counselling on long-term reversible contraception and access to devices during family planning counselling visits. Funding William and Flora Hewlett Foundation. © 2015 Elsevier Ltd.
News Article | December 9, 2015
Every month, Lishan Su receives a small test tube on ice from a company in California. In it is a piece of liver from a human fetus aborted at between 14 and 19 weeks of pregnancy. Su and his staff at the University of North Carolina at Chapel Hill carefully grind the liver, centrifuge it and then extract and purify liver- and blood-forming stem cells. They inject the cells into the livers of newborn mice, and allow those mice to mature. The resulting animals are the only ‘humanized’ mice with both functioning human liver and immune cells and, for Su, they are invaluable in his work on hepatitis B and C, allowing him to probe how the viruses evade the human immune system and cause chronic liver diseases. “Using fetal tissue is not an easy choice, but so far there is no better choice,” says Su, who has tried, and failed, to make a humanized mouse with other techniques. “Many, many biomedical researchers depend on fetal tissue research to really save human lives,” he says. “And I think many of them feel the same way.” An explosive climate has surrounded US research with fetal tissues since July, when an anti-abortion group called the Center for Medical Progress in Irvine, California, released covertly filmed videos in which senior physicians from the Planned Parenthood Federation of America bluntly and dispassionately discussed their harvesting of fetal organs from abortions for use in research. Planned Parenthood is a non-profit women’s health provider that received US$528 million of government money in 2014, much of it in reimbursements for services ranging from contraception to cancer screenings, which it provides largely to poor women. Abortions, which are performed at about half of Planned Parenthood’s 700 clinics, constitute 3% of its services. A handful of clinics in two states supply fetal tissue for research. The videos provoked a furore that has intensified over the past few weeks. On 3 December, the Republican-led US Senate voted to strip Planned Parenthood of government funding. This is despite the fact that fetal tissue research is legal, the US National Institutes of Health (NIH) has been funding it for decades and President Obama is sure to veto the bill, should it reach his desk. A few days earlier, on 27 November, a gunman shot dead three people at a Planned Parenthood clinic in Colorado Springs, Colorado. In a post-arrest interview, the suspect is reported to have said “no more baby parts”. The episode has shone a spotlight on a little-discussed arm of biomedical research, raising the questions of why, how and how widely fetal tissue is used. To find out, Nature turned to an NIH database of research grants funded in 2014 to find those using fresh human fetal tissue, and in October contacted 18 researchers working with it. Su was one of only two who were willing to be interviewed. Most requests were declined or went unanswered; a public-affairs officer at one major Texas university refused to have a researcher speak to Nature to keep that person “safe”. The figures show that in 2014, the NIH funded 164 projects using the tissue, at a cost of $76 million. This is slightly less than half of what the agency spent on work with human embryonic stem cells (ES cells), which has also been highly controversial, and 0.27% of the $27.9 billion it spent on all research. (By comparison, the UK Medical Research Council spent 0.16% — £1.24 million ($1.9 million) — of its total spending on research on five projects involving fetal tissue in the 12 months up to 31 March 2015.) Analysis of the NIH projects shows that the tissue is used most heavily for research on infectious diseases, especially HIV/AIDS; in the study of retinal function and disease; and in studies of normal and anomalous fetal development (see ‘Fetal tissue research by discipline’). Opponents argue that the work is not necessary because other model systems and techniques can be used. “This is antiquated science,” says David Prentice, the vice-president and research director at the Charlotte Lozier Institute, the research arm of the Susan B. Anthony List, which is an anti-abortion organization in Washington DC. “There are better and, frankly, more successful alternatives.” But supporters of the research counter that fetal tissue is legally obtained, that it would otherwise be destroyed, that such work has already led to major medical advances and that, if there were better alternatives, they would turn to them. “Fetal tissue is a flexible, less-differentiated tissue. It grows readily and adapts to new environments, allowing researchers to study basic biology or use it as a tool in a way that can’t be replicated with adult tissue,” says Carrie Wolinetz, the NIH’s associate director for science policy. “I get very frustrated when misinformed people go on about how it can all be done with computer models or cell cultures or stem cells or animals,” says Paul Fowler, a reproductive biologist at the University of Aberdeen Institute of Medical Sciences, UK, who in January published a study using livers from aborted fetuses to probe the impacts of maternal smoking on liver development1. “In some areas, the human is absolutely dramatically different than rodents.” Some argue that the entire episode represents a thinly cloaked attempt to attack and limit access to abortion by eroding support and funding for Planned Parenthood. “People are talking about fetal tissue, but really what this discussion is about is abortion,” says Shari Gelber, a specialist in maternal–fetal medicine at Weill-Cornell Medical College in New York City, who has argued for the value of the research. Cell lines derived from aborted fetal tissue have been fairly commonplace in research and medicine since the creation in the 1960s of the WI-38 cell strain, which was derived at the Wistar Institute in Philadelphia, Pennsylvania, and MRC-5, which came from a Medical Research Council laboratory in London (see Nature 498, 422–426; 2013). Viruses multiply readily in these cells, and they are used to manufacture many globally important vaccines, including those against measles, rubella, rabies, chicken pox, shingles and hepatitis A. Companies have shipped at least 5.8 billion vaccines made with these two cell lines which, with others, have become standard laboratory tools in studies of ageing and drug toxicity. (Research with such lines is not covered by US regulations governing the use of fresh fetal cells and tissue nor captured in the NIH database.) In the past 25 years, fetal cell lines have been used in a roster of medical advances, including the production of a blockbuster arthritis drug and therapeutic proteins that fight cystic fibrosis and haemophilia. But off-the-shelf fetal cell lines are of limited use for scientists because they do not faithfully mimic native tissue and represent only a subset of cell types: WI-38 and MRC-5, for example, were derived from fetal lungs. The lines can also accumulate mutations after replicating in vitro over time. And creating humanized mice such as Su’s requires whole pieces of fetal organs to provide sufficient numbers of stem cells. For all of these reasons, researchers turn to fresh tissue. In the United States, this is collected at medical centres and clinics that perform abortions under a patchwork of laws and regulations governing consent, tissue collection and transfer (see ‘Fetal tissue and the law’). US law says that clinics can recover “reasonable payments” to offset the costs of providing the tissue, but it makes it a felony to profit from doing so. Planned Parenthood officials say that its clinics obtain full and informed consent from women choosing to donate fetal remains for research, and the organization announced in October that its clinics will no longer recover costs of $45–60 per specimen for collecting the tissue. From the clinics, fetal tissue is then often passed to biological-research supply companies, which act as intermediaries and process the tissue before selling it to researchers. Su pays $830 for each sample of fetal liver tissue supplied to his lab by one of the most widely used suppliers, Advanced Bioscience Resources in Alameda, California. The category of fetal tissue work that draws most NIH funding is the study of HIV and AIDS: it accounts for 64 of the 164 NIH grants. Researchers in this field have long struggled with the paucity of effective models for this uniquely human disease. The standard models, macaques, are expensive to breed, are infected with SIV instead of HIV and have immune responses that are different from those of people. The flexibility and adaptability of fetal tissue — and its richness as a source of stem cells — has allowed the creation of a number of mice with humanized immune systems. Prominent among these is the BLT (bone marrow–liver–thymus) mouse, which was created in 20062. This model is made by destroying the animal’s immune system and then surgically transplanting liver and thymus tissue fragments from a human fetus into the mouse. The immune system is further humanized with a bone-marrow transplant, using blood-forming stem cells from the same fetal liver. The animal enables studies of, for instance, immune responses that are key to developing an effective HIV vaccine. The mouse has “accelerated the study of HIV pathogenesis and novel approaches to harness anti-viral immunity to control HIV”, reads a recent review by several NIH-funded scientists who are using the mouse3. The mouse has also helped to demonstrate that prophylactic drugs may prevent vaginal HIV infection — a strategy that is now in late-stage human trials. The animal is currently being used to examine how genital infection with herpes simplex virus alters immunity at the vaginal mucosa, making it easier for HIV to infect. In a similar vein, Su is now using his humanized mouse to examine the mechanisms by which hepatitis C and HIV co-infection can hasten liver disease. There are drawbacks: the BLT mouse’s average lifespan is relatively short, at only around 8.5 months, because the animals tend to develop cancers of the thymus. And the humanized immune system is not inherited, so the model must be created again and again — leading to the constant demand for fetal tissue that so disturbs abortion opponents. In some research areas, fetal tissue may, in time, be replaced by other materials and methods: alternative, flexible cell types, including human ES cells and induced pluripotent stem (iPS) cells, and organoids, which are lab-created cellular structures that resemble tissue from normal organs. But there is one area in which, scientists say, fetal tissue is needed by definition: studies of early human development, and why it sometimes goes wrong. “Human fetal tissue is likely never going to be replaced in some areas of research, particularly relative to fetal development,” says Wolinetz. And the application of such work goes far beyond understanding developmental disorders such as congenital heart disease or other malformations, says Neil Hanley, an endocrinologist at the University of Manchester, UK. “For a wide range, now, of adult diseases and disorders, we know that they have their origins during very early human development,” he says — type 2 diabetes and schizophrenia are both cases in point. “And unless you understand normal you’re not going to understand abnormal.” The 30 developmental-biology grants involving fetal tissue that were awarded by the NIH in 2014 range from a study of the differentiation of myoblasts, which are the embryonic precursors of muscle cells, to several examinations of development of the urogenital tract — studies with relevance, for instance, to hypospadias, a common condition in which the urethra fails to close and the underside of the penis is incompletely formed. One project is creating a three-dimensional atlas of gene expression in the genital tubercle, the precursor of the penis. Another is probing gene activity in cells lining the fetal intestine to help explain excessive intestinal inflammation in premature babies. Hanley says that such studies are important, particularly because gene regulation — the finely tuned symphony that controls when and where genes are active — can vary strikingly between species, so findings in other animals often do not hold true in humans. More than half of the 30 grants are for studies of brain development, and many of these projects are seeking advances in combating maladies such as autism, schizophrenia and Alzheimer’s disease. Larry Goldstein, a neurobiologist at the University of California San Diego School of Medicine in La Jolla, uses cells called astrocytes from the brains of aborted fetuses to nourish neurons that he has derived from iPS cells and that have mutations associated with Alzheimer’s disease. The astrocytes are thought to secrete factors that keep the neurons healthy in culture, and he uses the system to study the pathogenesis of the disease and to test potential drugs. Goldstein hopes eventually to derive the astrocytes, too, from iPS cells. But “the human fetal astrocytes that we get at present are the gold standard that we use, and will use, to compare astrocytes that we make by differentiation”, he says. He has also used neurons from aborted fetal brains to compare with the neurons made from iPS cells4. “As long as fetal tissue is available, this is a very valuable use of it,” he says. Another 23 of the NIH grants using fetal tissue involve eye development and disease. Damage to the retinal pigment epithelium (RPE), a single layer of cells at the back of the eye, has a key role in a number of eye diseases, including age-related macular degeneration, the most common cause of blindness in adults in the developed world. The 2000s saw advances in ways to create cell cultures with RPE dissected from the eyes of fetuses, allowing scientists to study the function of these cells in a dish. And although some scientists have turned to stem cells to generate RPE, like Goldstein they continue to use fetal tissue as a benchmark of normal development and function. Goldstein agreed to speak to Nature, he says, because “somebody has to speak up responsibly”. He stressed that he and his colleagues think hard about the ethics of their work. “We are not happy about how the material became available, but we would not be willing to see it wasted and just thrown away.” Occasionally, fetal tissue is used for clinical work. Last year, a company called Neuralstem in Germantown, Maryland, in collaboration with scientists at the University of California, San Diego, launched a trial in which stem cells from fetal spinal cord were implanted to treat spinal-cord injuries. In May, researchers in the United Kingdom and Sweden launched a study in which dopaminergic neurons from aborted fetuses are transplanted into the brains of patients with Parkinson’s disease (see Nature 510,195–196; 2014). Research with fetal tissue is less controversial in countries where abortion is more widely accepted. The Planned Parenthood videos caused even some supporters of fetal tissue research to feel uncomfortable. In one video, physician Deborah Nucatola, the group’s senior director of medical services, describes how she crushes fetuses above and below key organs to preserve them intact for research. She also described turning a fetus into a breech presentation to deliver the head last, when the cervix is more dilated, thus preserving the brain. This raised the question of whether physicians are altering abortion techniques to accommodate research requests, violating a widely held precept of research ethics. Arthur Caplan, a bioethicist at the New York University School of Medicine, dismisses the videos as “pure politics”, but some of the footage “did get my eyebrow to arch”, he says. “You can’t use a different approach to the abortion to try to preserve something. Those are just no-no’s.” Planned Parenthood spokeswoman Amanda Harrington says that the organization is not aware of any instances in which the method of an abortion has been changed to preserve organs. But, she adds, “if minor adjustments that have no bearing on the woman’s health and safety are done when the woman has expressed a desire to donate tissue, that is entirely appropriate and ethical and legal”. Women’s health and safety, she says, “is always the number one priority”. The question for many scientists is what the fallout of the controversy will be. On the heels of the Colorado shootings, some Republicans in Congress backed off earlier attempts to defund Planned Parenthood, and President Obama is expected to veto any bill that does so. This means that the lasting damage of the videos may end up being inflicted not on Planned Parenthood’s budget, but on science. Since July, four bills that would criminalize or otherwise restrict the research have been introduced in the US Congress, and lawmakers have launched similar efforts in a dozen state legislatures. (Missouri, Arizona and North Dakota already ban the research.) Su felt the climate for his research grow colder when, on 1 October, a new North Carolina law was signed that makes it a felony to sell fetal tissue for any amount within the state. Su receives the tissue he uses from outside the state, but the message behind the new law concerns him. “I hope this current controversy, or possible congressional interventions, won’t slow down biomedical research,” he says. “The benefit is bigger than the drawback on this.” The controversy “absolutely puts fetal tissue research at risk”, says Caplan. “Young scientists are unlikely to enter a field riven with controversy, where funding is uncertain and physical threats are a real possibility.” Caplan says that parallels could emerge with events in the early 2000s, when the use of human ES cells in US research became politically fraught. Then, tight federal regulations governing NIH funding of the research were adopted, but some states, including California and Massachusetts, responded by pouring money into the science all the same. “To move ahead, the reality is that fetal tissue research need not be funded or permitted everywhere,” Caplan says. “It needs to be allowed somewhere.”
News Article | February 23, 2017
Members of the American Medical Student Association (AMSA) are a vital force of future physicians who believe that patients and health professionals are partners in the management of health care and that access to high-quality, equitable health care is a right and not a privilege. At AMSA, activism is a way of life and student idealism is transformed into meaningful public service, innovation and institutional change. AMSA’s Advocacy Day is the start to our weekend-long Annual Convention and Exposition in Crystal City, Virginia. On this day, over 200 physicians-in-training will descend upon Capitol Hill for a full day of advocacy and activism. Students will convene in the morning for training about meeting with elected officials, to talk more about the issues they are passionately advocating on behalf of and to meet like-minded students. Following a morning of preparation, these future physicians will don their white coats and head to Upper Senate Park from 12:30pm to 2pm where they will rally for health care. They will hear from speakers representing organizations partnering for this day of events including: the Committee of Interns and Residents (CIR), SNMA (Student National Medical Association), LMSA (Latino Medical Student Association), AACOM (American Association of Colleges of Osteopathic Medicine) and PPFA (Planned Parenthood Federation of America) before heading to meet with their elected officials to discuss issues affecting our nation’s health. AMSA’s Education and Advocacy Fellow, Dr. Matt Moy says that “Some feel physicians have no space in politics, but are we not citizens? Are we not immigrants, students in debt, patients and minorities? We are constituents, and staying silent is not an option. We need to let our elected officials know who and what they represent and it starts here, today at AMSA’s Advocacy Day.” "As the next generation of physician leaders, AMSA members have a moral imperative to stand up to injustice and advocate for the health of their communities. Just like medicine, activism is not easy, but it is our responsibility to do the right thing by caring for the most vulnerable,” said Baltimore City Health Commissioner and former AMSA President Dr. Leana Wen. “Recognizing that everything is tied to health, I urge future physicians to ask difficult questions, call out the problems they see, and speak up for those who do not have the privilege or power to do so. Now is the time to act – our patients’ lives depend on it.” Together, we are standing in solidarity to ensure that our patients have access to the health care they need to live their lives to their fullest potential. We are health care providers. We are patients. We are citizens. We are exercising our rights today so that every person will have access to their human right of quality, affordable, equitable health care tomorrow. AMSA’s National President, Dr. Kelly Thibert notes that “Now, more than ever, we need to empower and be empowered to utilize our voices and to help raise the voices of others. For more than 65 years, AMSA has fought for the rights of our patients and we have no intention of easing up anytime soon. Our Advocacy Day is just one of the many times you can expect to hear from physicians-in-training moving forward.” We are America’s physicians of tomorrow and we value access to quality, affordable health care. AMSA will continue to put patients over politics and will fight for the care and rights of our patients, always. AMSA is the oldest and largest independent association of physicians-in-training in the United States. Founded in 1950, AMSA is a student-governed, non-profit organization committed to representing the concerns of physicians-in-training. To learn more about AMSA, our strategic priorities, or joining the organization, please visit us online at http://www.amsa.org/.
Kohn J.E.,Planned Parenthood Federation of America |
Nucatola D.L.,Planned Parenthood Federation of America
Contraception | Year: 2016
Objective The copper intrauterine contraceptive (IUC) is the most effective method of emergency contraception (EC), yet it is underutilized. The objective was to evaluate a pilot project integrating the copper IUC into EC care. Study Design Single-group evaluation study. Nine geographically diverse reproductive health centers implemented 6-month pilot interventions. All interventions included staff education and inclusion of the IUC in EC patient counseling; some sites developed patient education materials. Health center staff completed manual monthly tracking forms of the number of EC patients receiving oral levonorgestrel, ulipristal acetate or the copper IUC. Sites also tracked and reported the number of patients returning for removal during the 6-month pilot period and for 5 subsequent months. Main study outcomes included the number of IUC for EC insertions, the proportion that were same-day insertions and the proportion of patients receiving each EC type during the pilot period. A secondary outcome was the number of patients who had returned for removal at 5 months postpilot. Results There were 101 IUC insertions for EC during the pilot period. Seventy-seven percent were same-day insertions; the remainder returned for insertion within 5 days of unprotected intercourse. The percentage of EC patients choosing the IUC varied by site from 1 to 16% (overall = 7%). At 5 months postpilot, 20 patients (20%) had returned for removal. Conclusions Some women will be interested in the copper IUC for EC, and therefore, all women should be offered this option. Results suggest that the large majority continued to use the IUC for ongoing contraception. Implications Copper IUCs are a viable option for women in need of EC. All women should be offered the most effective EC option. © 2016 Elsevier Inc. All rights reserved.
Kohn J.E.,Planned Parenthood Federation of America |
Lopez P.M.,Planned Parenthood Federation of America |
Simons H.R.,Planned Parenthood Federation of America
Contraception | Year: 2015
Objectives As obesity may affect the efficacy of some contraceptives, we examined weight, body mass index (BMI) and prevalence of obesity among female contraceptive clients at 231 U.S. health centers. A secondary aim was to analyze differences in contraceptive method use by obesity status. Study design Cross-sectional study using de-identified electronic health record data from family planning centers. We analyzed contraceptive visits made by 147,336 females aged 15-44 years in 2013. Results A total of 46.1% of clients had BMI 25. Mean body weight was 154.4 lb (S.D.= 41.9); mean BMI was 26.1 (S.D.= 6.6). A total of 40% had BMI 26, when levonorgestrel emergency contraception may become less effective. Obese clients had higher odds of using a tier 1 or tier 3 contraceptive method and had lower odds of using a tier 2 or hormonal method than non-obese clients. Conclusions About half of contraceptive clients would be categorized as overweight or obese. Contraceptive method choices differed by obesity status. Implications About half of contraceptive clients in this study population were overweight or obese. Contraceptive method choices differed by obesity status. All women - regardless of body size - should receive unbiased, evidence-based counseling on the full range of contraceptive options so that they can make informed choices. © 2015 2015 Elsevier Inc. All rights reserved.
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.
News Article | December 9, 2015
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.
News Article | November 23, 2016
In the two weeks since the election, Planned Parenthood Federation of America has seen a huge increase in volunteers and donations – over 200,000 donations in a single week. But this surge in support hasn't reached many other reproductive health organizations. And many of these centers are already struggling to meet a spike in demand for long-acting contraception after the election of Donald Trump. Susie Markus, executive director of the Wyoming Health Council, says that she's heard people in Wyoming say they're going to donate to Planned Parenthood. "But there's only one Planned Parenthood in Wyoming." Her organization is the umbrella group for 15 publicly funded family planning centers in Wyoming. She's been hoping for donations, but none have come in. The nonprofit Wyoming Health Council is funded in part by Title X, a 46-year-old federal law that helps provide family planning services to the poor by distributing funds to regional grantees. They in turn support 3,951 facilities, including local health departments, federally qualified health centers, independent clinics and hospital outpatient units. About 13 percent of the facilities are run by Planned Parenthood. Title X doesn't just cover birth control; it also covers breast and cervical cancer screenings, pregnancy counseling, and testing and treatment for sexually-transmitted diseases and other services, but not abortion. Centers funded by Title X are required to see all patients, regardless of insurance coverage, and charge them on a sliding scale based on income. Clinics cover the difference between the cost of the visit and what patients can pay. In states like Indiana, funding is already so tight that the post-election rush on IUDs and other long-lasting contraceptives like implants has left clinics scraping for money. IUDs come with a high up-front cost – up to $1,000 for the device and insertion. "At the end of the day, we've decided that if a woman wants an IUD, we will get it for her," says Kristen Adams, president and CEO of the Indiana Family Health Council, a nonprofit that distributes funds to 26 clinics in the state. "That means a lot of budget shifting." Because the clinics provide same-day services, Adams says they typically have a few IUDs in stock. "But can we afford to keep 20 on our shelves? No." Family planning organizations in other states say they can handle a brief spike in patients, but if the rush of women seeking IUDs and other reproductive services continues, things might get difficult. "Our demand for IUDs has about doubled, but we don't know if that's a short term spike or not. I think it would take a more consistent increase for it to begin to be an issue," says Kate Brogan, Maine Family Planning's vice president for public affairs. She says that Maine Family Planning has also seen a slight increase in donations. This sentiment is echoed in California, which is served by Essential Access Health, the largest Title X-funded network in the country, with more than 340 clinics. According to Amy Moy, their vice president of public affairs, California's network serves about 1 million people, or one quarter of the people eligible for Title X services nationwide. She says that the state has additional programs that fund family planning for people with low incomes. One of those centers, the Women's Community Clinic in San Francisco, has received some election-related donations, but "not like the increase Planned Parenthood has seen," says Carlina Hansen, their executive director. If the demand for long-acting contraceptives continues, she says her clinic will need to open up more appointments and possibly increase staffing. "We already operate at a loss, and donations help us carry that loss. If we need to increase our staff, balancing our budget gets difficult." Even in states like California, Title X grantees are worried about the future. The Affordable Care Act and Medicaid expansion have increased the number of patients whose family planning visits are covered by insurance. If those expansions are rolled back, state programs and clinics will be pressed to take on the additional cost. And advocates are worried Title X will find itself on the chopping block. It's not an unfounded concern. In the last several years, numerous bills have been introduced in Congress to block Title X funds from organizations that also provide abortions, like Planned Parenthood. In 2011, the House voted to defund Title X in its entirety, but the measure didn't pass the Senate. Still, for the last several years Title X funding has decreased, from $317.5 million in 2010 to $286.5 million in 2016. Under a Trump administration and with a Republican Congress, those numbers could shrink even more. "If we lost Title X funding — oh, gosh, given the history of Title X battles in Congress, I think that's a real question," says Brogan in Maine. "Right now we have over 50 clinics. There's no way we'd be able to maintain that without Title X."