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Contraception Journal
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Contraception Highlights June 2014

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

Lawsuits against Mirena®: Potential impact on public health
Antoinette A. Danvers, Gretchen S. Stuart, Amy G. Bryant
Patient requests for removal of the levonorgestrel-releasing intrauterine system (Mirena®) have recently increased in our clinic. Patients report being frightened by television or Internet publicity (e.g., “call 1-800-BAD-DRUG”). These patient requests and reports prompted us to investigate current and past litigation surrounding intrauterine contraception (IUC). Widespread use of IUC may set the stage for another epidemic of lawsuits against this safe and effective contraceptive method. In this commentary, the authors explore the historical and current litigation environment for Mirena®, the impact of the media on women's perceptions of contraceptive devices, and the negative impact inappropriate litigation can have on women's health.
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Editorial

Postpartum contraception: optimizing interpregnancy intervals
Stephanie B. Teal
In this issue of Contraception, several research groups present new information on factors influencing the delivery and uptake of postpartum contraception. Singh et al. report on patient-level factors in postpartum contraceptive choices in New Mexico, and Mody et al. examine the utilization of postpartum contraception by women in Mumbai. Huang et al. describe an intervention to increase postpartum contraceptive use among rural-to-urban migrants in Shanghai and discuss patient characteristics associated with method choice. Jatlaoui et al. report on postplacental intrauterine device (IUD) insertion by residents after vaginal delivery, and Whitaker presents a randomized controlled trial of postplacental IUD insertion after cesarean delivery. Why this focus on contraception for women who recently delivered?
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Commentary

Contraceptive sex acceptability: a commentary, synopsis and agenda for future research
Jenny A. Higgins, Anne R. Davis
In 2005, Severy and Newcomer argued that sexuality is a “critical issue” in contraceptive and sexually transmitted infection (STI) prevention acceptability research. Yet, few studies explore current methods' direct effects, if any, on women's libido, enjoyment, arousal, lubrication or orgasm, let alone how such effects shape contraceptive uptake, continuation and adherence. Furthermore, researchers have thoroughly investigated contraceptive side effects such as weight gain and vaginal bleeding but rarely are such changes explored as possible sexual detractors — despite their influence on women's bodies, desires and sexual selves. The overwhelming majority of sexual activity occurs during times when women wish to avoid pregnancy; contraception is expressly designed for non-procreative sexual activity. Investigating both negative and positive aspects of contraceptive practices represents a vital and understudied area for the contraceptive field.
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Reviews

Extended use of the intrauterine device: a literature review and recommendations for clinical practice
Justine P. Wu, Sarah Pickle
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The safety, efficacy and acceptability of task sharing tubal sterilization to midlevel providers: a systematic review
Maria Isabel Rodriguez, Cristin Gordon-Maclean
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Original Research Articles

Postpartum contraceptive choices among ethnically diverse women in New Mexico
Rameet H. Singh, Rebecca G. Rogers, Lawrence Leeman, Noelle Borders, Jessica Highfill, Eve Espey
Objectives: The objective of the study was to determine if postpartum contraceptive choices by primiparous women differ by ethnicity.
Conclusion: DMPA use was higher among Hispanic and AI women and IUD/implant use lower in AI women compared to non-Hispanic white women.
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Postpartum contraception utilization among low-income women seeking immunization for infants in Mumbai, India
Sheila K. Mody, Saritha Nair, Anindita Dasgupta, Anita Raj, Balaiah Donta, Niranjan Saggurti, D.D. Naik, Jay G. Silverman
Objective: The objective was to examine postpartum contraception utilization among Indian women seeking immunization for their infants in three low-income communities in Mumbai, India.
Implications: This original research study is a unique contribution to the literature because it presents data regarding the nonuse of postpartum contraception among women seeking immunizations for their infants in urban centers in a developing country. It also reveals barriers to not using postpartum contraception and provides data for future interventions.
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The free perinatal/postpartum contraceptive services project for migrant women in Shanghai: effects on the incidence of unintended pregnancy
Yongmei Huang, Ruth Merkatz, Haoping Zhu, Kevin Roberts, Régine Sitruk-Ware, Linan Cheng, The Perinatal/Postpartum Contraceptive Services Project for Migrant Women Study Group
Objective: In 2006, the incidence of unintended pregnancy among rural-to-urban migrant women (RUMW) in Shanghai was reported as 12.8 per 100 women-years during the first year postpartum. Among permanent residents of Shanghai, that same rate was 3.8 per 100 women-years. An intervention study was designed to address the unmet need for family planning services among this underserved population of RUMW and reduce their high postpartum unintended pregnancy incidence.
Implications: The maternity setting at the time of early labor and prior to postpartum hospital discharge is a practical venue and an optimal time to provide contraception counseling and for postpartum women to initiate use of contraceptive methods. Supporting services during the first year postpartum are also essential to encourage women to continue contraceptive use and reduce the incidence of postpartum unintended pregnancy.
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Postplacental intrauterine device insertion at a teaching hospital
Tara C. Jatlaoui, Michele Marcus, Denise J. Jamieson, Peggy Goedken, Carrie Cwiak
Objective: To determine whether postplacental intrauterine device (IUD) insertion can be safely and effectively performed within a teaching program.
Implications: A training protocol may safely and feasibly be initiated among physicians, advanced practice clinicians or trainees with no prior experience with postplacental IUD insertion. By initiating this practice, access to highly effective contraception may increase for patients who have difficulty returning for a visit or otherwise receiving effective methods.
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Postplacental insertion of the levonorgestrel intrauterine device after cesarean delivery vs. delayed insertion: a randomized controlled trial
Amy K. Whitaker, Loraine K. Endres, Stephanie Q. Mistretta, Melissa L. Gilliam
Objective: This trial was designed to compare levonorgestrel intrauterine device (LNG-IUD) use at 1 year after delivery between women randomized to postplacental insertion at the time of cesarean delivery and delayed insertion 4–8 weeks after delivery.
Implications: Postplacental insertion of an IUD may improve use of highly effective contraception during the postpartum period. While our results suggest higher expulsion after postplacental insertion compared to delayed insertion and similar IUD use at 12 months, our trial was insufficient to definitively test our hypothesis.
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Blockade of tubal patency following transcervical administration of polidocanol foam: initial studies in rhesus macaques
Jeffrey T. Jensen, Carol Hanna, Shan Yao, Elizabeth Micks, Alison Edelman, Lindsay Holden, Ov D. Slayde
Objective: To demonstrate the feasibility of polidocanol foam (PF) as a nonsurgical method of female permanent contraception using a nonhuman primate model.
Implications: This study in rhesus macaques supports further development of transcervical administration of PF as a nonsurgical approach to permanent contraception. A nonsurgical method could reduce risks and costs associated with surgical female sterilization and increase access to permanent contraception.
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Reconsidering racial/ethnic differences in sterilization in the United States
Kari White, Joseph E. Potter
Objective: Cross-sectional studies have found that low-income and racial/ethnic minority women are more likely to use female sterilization and less likely to rely on a partner’s vasectomy than women with higher incomes and whites. However, studies of pregnant and postpartum women report that racial/ethnic minorities, particularly low-income minority women, face greater barriers in obtaining a sterilization than do whites and those with higher incomes. In this paper, we address this apparent contradiction by examining the likelihood a woman gets a sterilization following each delivery, which removes from the comparison any difference in the number of births she has experienced.
Implications: Low-income minorities are less likely to undergo sterilization than low-income whites and privately insured minorities, which may result from barriers to obtaining permanent contraception, and exposes women to unintended pregnancies.
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Do mobile family planning clinics facilitate vasectomy use in Nepal?
Sabu S. Padmadas, Fiifi Amoako Johnson, Tiziana Leone, Govinda P. Dahal
Background: Nepal has a distinct topography that makes reproductive health and family planning services difficult to access, particularly in remote mountain and hill regions where over a quarter of modern contraceptive users rely exclusively on vasectomy.
Implications: Family planning interventions in hard-to-reach communities could consider mobile clinic as an effective strategy to promote male-based modern methods. Improving access to vasectomy could substantially reduce unmet need for family planning in countries experiencing rapid fertility transition.
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Who chooses vasectomy in Rwanda? Survey data from couples who chose vasectomy, 2010-2012
Dominick Shattuck, Jennifer Wesson, Theophile Nsengiyumva, Leonard Kagabo, Helen Bristow, Trinity Zan, Fidele Ngabo
Background: Vasectomy is safe and highly effective; however, it remains an underused method of family planning (FP) in Africa. In view of this, three Rwandan physicians were trained in no-scalpel vasectomy with thermal cautery and fascial interposition on the prostatic end as vasectomy trainers in 2010, and this initiative has resulted in over 2900 vasectomy clients from February 2010 to December 2012.
Implications: Until this project, vasectomy projects in sub-Saharan Africa were viewed as unrealistic. This study confirms factors influencing vasectomy uptake identified in earlier research, but does so within a robust sample of vasectomy users and their wives and provides a strong understanding of who likely vasectomy users are in this context. Promotion of vasectomy services should be considered as an essential element of a healthy contraceptive method mix.
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Obstetrician–Gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations
Alicia T. Luchowski, Britta L. Anderson, Michael L. Power, Greta B. Raglan, Eve Espey, Jay Schulkin
Objectives: Use of intrauterine devices (IUDs) by US women is low despite their suitability for most women of reproductive age and in a variety of clinical contexts. This study examined obstetrician–gynecologists' practices and opinions about the use of IUDs in adolescents, nulliparous women and other patient groups, as well as for emergency contraception.
Implications: This study shows that obstetrician–gynecologists still do not offer IUDs to appropriate candidates, such as nulliparous women and adolescents, and rarely provide the copper IUD as emergency contraception.
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Obstetrician–Gynecologists and contraception: long-acting reversible contraception practices and education
Alicia T. Luchowski, Britta L. Anderson, Michael L. Power, Greta B. Raglan, Eve Espey, Jay Schulkin
Objectives: Long-acting reversible contraception (LARC) — the copper and levonorgestrel intrauterine devices (IUDs) and the single-rod implant — are safe and effective but account for a small proportion of contraceptive use by US women. This study examined obstetrician–gynecologists' knowledge, training, practice and beliefs regarding LARC methods.
Implications: This study shows that obstetrician–gynecologists generally offer IUDs, but fewer offer the single-rod contraceptive implant. Recent continuing education strongly predicted whether obstetrician–gynecologists inserted implants and was also associated with other practices that encourage LARC use.
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