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Contraception Highlights August 2013

Thinking (Re)Productively
Expert analysis on pressing issues from the Association of Reproductive Health Professionals

Abortion politics and the production of knowledge
Lisa H. Harris
It is common to think of scientific research and the knowledge it generates as neutral. This is, of course, never the case. The relevant question is not how to rid science of values but, instead, to ask which values belong? In the current state of abortion research, antiabortion values determine U.S. research policy. Abortion research, as well as the study of infertility and in vitro fertilization, are declared illegitimate in covert and overt ways. Federal policy impedes both basic and clinical research in abortion and bans funding of research that would pose more than minimal risk to a fetus or an embryo. This leaves unanswered scientific questions about abortion, infertility, miscarriage, and contraception. Since moral ground is also occupied by people who support abortion rights, there is a competing moral claim to consider changing federal research funding policy as an issue of reproductive justice. Women and families deserve access to knowledge across the spectrum of reproductive health issues, whether they seek to end or to start a pregnancy. Read more >

Editorial

ARHP's 50th anniversary: five decades of provider education in sexual reproductive health
Wayne C. Shields, Linda Dominguez, Carolyn Westhoff
This issue of Contraception is dedicated to the Association of Reproductive Health Professionals (ARHP) in recognition of 50 years of high quality, evidence-based provider education and training. The issue features the abstracts being presented at September’s Reproductive Health conference, a Thinking (Re)Productively Commentary from Lisa Harris, and recommendations from ARHP's Sexual and Reproductive Health (SRH) Workforce Summit designed to help move our field forward during a time of great change. Login to read the full editorial

Commentaries

Sexual and Reproductive Health Workforce Project: Overview and recommendations from the SRH Workforce Summit, January 2013
Melissa Nothnagle, Joyce Cappiello, Diana Taylor
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SRH Workforce Summit: now is the time to bring sexual and reproductive health to primary care
Joyce Cappiello, Melissa Nothnagle
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The interprofessional sexual and reproductive health care team
Amy Levi, Linda Burdette, Kathy Hill-Besinque, Patricia Aikins Murphy
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The need for reproductive and sexual health discussions with adolescent and young adult cancer patients
Devin Murphy, James L. Klosky, Amanda Termuhlen, Kelly K. Sawczyn, Gwendolyn P. Quinn
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Original Research Articles

“We have to what?”: lessons learned about engaging support staff in an interprofessional intervention to implement MVA for management of spontaneous abortion
Blair G. Darney, Deborah VanDerhei, Marcia R. Weaver, Nancy G. Stevens, Sarah W. Prager
Background: Including support staff in practice change initiatives is a promising strategy to successfully implement new reproductive health services. The Resident Training Initiative in Miscarriage Management (RTI-MM) is an intervention designed to facilitate implementation of manual vacuum aspiration (MVA) for management of spontaneous abortion. The purpose of this study was to identify training program components that enhanced interprofessional training and provide lessons learned for engaging support staff in implementing uterine evacuation services.
Conclusions: We present lessons learned that may be transferrable to other clinic sites: engage site leadership in a commitment to interprofessional training; engage support staff as teachers and learners and in shared values and building professionalism.
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Intrauterine contraception: impact of provider training on participant knowledge and provision
Carrie Lewis, Philip Darney, Heike Thiel de Bocanegra
Background: In California’s Medicaid family planning expansion, the Family Planning, Access, Care and Treatment (Family PACT) Program, only 1.9% of contracepting women received intrauterine contraception (IUC) in 2006. Ten skills-based IUC provider trainings were offered from 2007 to 2010.
Conclusions: This study shows that skills-based training is an important strategy for the increase of IUC provision.
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The use of fertility awareness methods (FAM) among young adult Latina and black women: what do they know and how well do they use it? Use of FAM among Latina and black women in the United States
Lina Guzman, Selma Caal, Kristen Peterson, Manica Ramos, Shelby Hickman
Objectives: Although a sizeable percentage of minority women use fertility awareness methods (FAM), little is known about their use in the United States. We sought to fill this gap by examining FAM use among Latina and black women — groups that have high rates of unintended childbearing and FAM use — focusing on knowledge, sources of information and accuracy of use. Unlike other methods, accurate use of FAM requires relatively high levels of knowledge.
Conclusions: Findings speak to a gap in reproductive literacy that has important implications for FAM users. The gap between behavior and knowledge could help account for high failure rates associated with FAM use.
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Team-based learning: a novel approach to medical student education in family planning
Sheila K. Mody, Jessica Kiley, Lori Gawron, Patricia Garcia, Cassing Hammond
Background: Medical schools are increasingly using team-based learning (TBL). We compared medical student satisfaction and understanding of key concepts in family planning following TBL and traditional lectures.
Conclusion: As a learning strategy for family planning, TBL resulted in high student satisfaction. This is the first study to evaluate this innovative teaching style for medical student education in family planning.
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Structured contraceptive counseling provided by the Contraceptive CHOICE Project
Tessa Madden, Jennifer L. Mullersman, Karen J. Omvig, Gina M. Secura, Jeffrey F. Peipert
Background: We describe the contraceptive counseling provided by the Contraceptive CHOICE Project (CHOICE) and compare contraceptive methods selected between the university research site and community partner clinics.
Conclusion: Structured contraceptive counseling can be effectively provided in a clinical research setting by staff without prior health care experience or clinical training.
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Women's preferences for contraceptive counseling and decision making
Christine Dehlendorf, Kira Levy, Allison Kelley, Kevin Grumbach,
Background: Little is known about what women value in their interactions with family planning providers and in decision making about contraception.
Conclusion: While, in the absence of medical contraindications, decision making about contraception has often been conceptualized as a woman's autonomous decision, our data indicate that providers of contraceptive counseling can participate in the decision-making process within limits. Differences in preferences seen by race/ethnicity illustrate one example of the importance of individualizing counseling to match women's preferences.
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Medical student intrauterine device knowledge and attitudes: an assessment of clerkship training
Deborah Bartz, Jennifer Tang, Rie Maurer, Elizabeth Janiak
Background: Studies demonstrate that many clinician populations have poor knowledge of and harbor negative attitudes towards intrauterine devices (IUDs). We set out to assess the impact of the clinical clerkship in obstetrics and gynecology on medical student IUD knowledge and attitudes.
Conclusions: US medical student IUD knowledge and attitudes are significantly improved through the obstetrics and gynecology clerkship. However, significant gaps in knowledge persist postclerkship.
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Contraception counseling, pregnancy intention and contraception use in women with medical problems: an analysis of data from the Maryland Pregnancy Risk Assessment Monitoring System (PRAMS)
Jamila B. Perritt, Anne Burke, Roxanne Jamshidli, Jiangxia Wang, Michelle Fox
Background: Data from the Maryland Pregnancy Risk Assessment Monitoring System (PRAMS) were used to evaluate whether women with selected medical comorbidities are less likely than healthier women to report receiving contraceptive counseling during pregnancy and to report using contraception postpartum.
Conclusions: Overall, there was no difference in the report of receiving contraceptive counseling in women with selected medical comorbidities as compared to than those without. In addition, they were not more likely to report receiving contraceptive counseling either despite higher risk of pregnancy complications. These results indicate lost opportunities for effective counseling that could improve health outcomes.
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Perceptions of intrauterine contraception among women seeking primary care
Lisa S. Callegari, Sara M. Parisi, Eleanor Bimla Schwarz
Background: Intrauterine contraception (IUC) is safe, highly effective and has few medical contraindications. Primary care providers see many women with chronic conditions who might benefit from IUC.
Conclusions: Many women seeking primary care have inaccurate perceptions of IUC and may benefit from counseling about the advantages of this approach to preventing unintended pregnancy.
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The benefits of family planning training: a 10-year review of the Ryan Residency Training Program
Jody E. Steinauer, Jema K. Turk, Maura C. Fulton, Kristin H. Simonson, Uta Landy
Objective: The objective was to determine the effect of routine, opt-out abortion and family planning training on clinical exposure to uterine evacuation, contraception and other gynecologic skills.
Conclusion: Routine, opt-out training in abortion and family planning gives OB-GYN residents an opportunity to increase proficiency in patient counseling, contraception care, ultrasound and all aspects of uterine evacuation, regardless of level of participation.
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Group versus individual family planning counseling in Ghana: a randomized, noninferiority trial
Hilary M. Schwandt, Andreea A. Creanga, Kwabena A. Danso, Richard M.K. Adanu, Tsiri Agbenyega, Michelle J. Hindin
Background: Group, rather than individual, family planning counseling has the potential to increase family planning knowledge and use through more efficient use of limited human resources.
Conclusions: Group family planning counseling was as effective as individual family planning counseling in increasing modern contraceptive knowledge among female gynecology patients in Ghana.
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Family planning and contraceptive decision-making by economically disadvantaged, African–American women
Eric J. Hodgson, Charlene Collier, Laura Hayes, Leslie A. Curry, Liana Fraenkel
Background: Significant racial disparities exist in the US unplanned pregnancy rate. We conducted a qualitative study using the theory of planned behavior as a framework to describe how low-income, African–American women approach family planning.
Conclusions: Contraception education should occur before sexual debut, should involve trusted family and community members and should positively frame issues in terms of achieving life goals.
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Reproductive Health 2013 Conference Abstracts

The Reproductive Health 2013 abstracts are drawn from the oral and poster presentations which will be presented at the meeting. Make plans to attend Reproductive Health 2013 September 19-21 to get the latest in sexual and reproductive health research and network with the top researchers in the field.

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