April 2021: Power Updates Edition
There are plenty of articles, publications, and stories published every month. In an effort to help you distinguish fact from fiction, save time in your already busy day, and share news you may not have otherwise seen, here are nine stories from the last month we thought you might find interesting:
In the last few years emergency contraception (EC) has become easier to access and available to more people without a prescription. In line with this increase, more women in the US who report having ever used EC has increased from 4% in 2002 to 20% in 2015. To better understand how geography affects the use of, access to, and counseling about EC, this study compared rural and urban people’s interactions with EC. Results found that in both urban and rural settings the use of EC at least once more than doubled from 2006-2008 and 2015-2017. However, even when controlling for demographic difference those living in rural areas were overall still less likely to have ever used EC. The authors note that this finding does not explain whether this is a choice or due to access barriers and call for improved counseling around EC.
This study compared the birth control choices of clients with low incomes who went to Title X-funded clinics and who paid out-of-pocked for their method before and after removing barriers such as availability and cost. During the control period (prior to removing barriers), only 16% of participants chose to use a long-active reversible contraceptive method. However, this figure increased to 26% after barriers were removed. Age and prior pregnancy were two indicating factors for people choosing a LARC method; 53% reported having had at least one pregnancy before. Results of this study show that cost remains a barrier to use of these methods and removing that barrier can increase people’s access to the method of their choice.
To better understand trends in birth control method choice and how those changes may influence gynecologic cancer risk, this study compared trends in the prevalence of pill and IUD usage over the course of 20 years. Overall, it found that pill usage decreased 2% annually while IUD use increased by 6.2% each year. Previous research has shown that use of the birth control pill is associated with a 30-50% reduction in risk of ovarian and endometrial cancer, so a reduction in pill use could be related to a reduction in the protective benefits of use. However, IUDs have the potential to reduce gynecologic cancer risk as well and increasing access to all birth control methods has the potential to reduce gynecologic cancer incidence overall.
From 2008 to 2015 the use of more than one method of contraception at last intercourse increased 4% to 18% among a nationally representative sample of women age 15-44. The mixture of methods used varied greatly with 53 unique combinations described; the most popular combinations included 58% reported using a condom and another method, nearly 30% reported using withdrawal and another method (that wasn’t a condom), and 12% reported using a permanent method and another method (that was not condoms or withdrawal).
Pregnancy and Birth
To better understand the feasibility of implementing pregnancy screening at syringe exchange programs, this study surveyed female syringe exchange clients to assess their perceived needs, values, and behavior intentions around parenting and whether they would consider entering treatment if they were pregnant. While both clients and the staff at syringe exchanges agree that voluntary pregnancy screening was needed, they reported that the programs cannot currently provide the service with the resources they currently have.
The authors of this study aimed to understand more of how the COVID-19 pandemic has affected people’s plans to conceive. Surveying more than 500 people—the majority of whom live in the UK—they found that more than 70% of respondents are postponing pregnancy while 27% had moved their pregnancy plans forward. Many of those who postponed pregnancy reported “concern about change in pregnancy care,” and “concern about the effects of the virus on mum or baby” as their main reasons for the decision.
Maternal mortality rates in the US are rising, and while the reasons behind this are complex, there is evidence showing that systemic racism plays a large role in the maternal mortality outcomes of women of color. To understand the relationship between maternal mortality and state-level abortion restrictions, this retrospective study looked at data and state policy changes across all 50 states. The data showed that the number of states with restrictive laws around abortion increased by more than 100% between 2000 and 2017. Overall states that restriction abortion have higher maternal mortality than those that either do not restrict or protect abortion care.
Twenty-seven states require a waiting period after counseling before people may obtain an abortion. Many of these states have framed their laws around the idea that people seeking an abortion require time for “mental clarity” in order to be “as certain as possible.” However, after surveying people searching online for abortion-care related keywords—first to understand their baseline and again one month later—this study found that the mandatory waiting period did not significantly increase a person’s certainty around their decision to obtain an abortion. This study clearly shows that restrictive state laws are not in line with patient wishes and do not assist in the decision-making process around abortion.
Sexual and Reproductive Health
Racism, classism, and homophobia all greatly affect a person’s sexual and reproductive health outcomes. At the same time, students of obstetrics and gynecology do not formally learn how these and other social detriments of health impact the lives of their future patients. After extensive research and community engagement the authors created an educational curriculum to teach clinical students about reproductive health equity.