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Contraception Journal
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Contraception Highlights October 2013

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

Plan B: access to emergency contraception in the legal and political cross hairs
I. Glenn Cohen, Lisa Sullivan, Eli Y. Adashi
The 8-year legal feud over access to emergency contraception between reproductive health advocates and the FDA took multiple unexpected turns before coming to an abrupt end on June 10, 2013. On that day, the US Attorney for the Eastern District of New York indicated that the “government intends to . . . voluntarily withdraw its appeal in this matter.” In so doing, the FDA committed to making Plan B One-Step® available over-the-counter without age or point-of-sale restrictions. As we trace the origins of this long-running conflict, we will analyze the implications of the latest developments and reflect on what this case reveals about the precarious positioning of the FDA across the scientific–political divide. Read more>

Editorial

How to measure oral contraceptive adherence: an ongoing research challenge
Paula M. Castaño, Carolyn L. Westhoff
Missed oral contraceptive (OC) pills are a clinical concern for the obvious reason that if a woman does not take her pills in a reasonably consistent manner, she has a greater chance of ovulation and consequent pregnancy. Human beings, regardless of age, gender or medication type, have difficulty with daily medication compliance; however, for many medications, an occasional missed dose will not exact as extreme an outcome as an unintended pregnancy. Because irregularities in OC use are so prevalent, the effectiveness of this method in the United States hovers closer to 90% than the 99% that would be possible with consistent use. This gap between typical and perfect use is a dominant reason for the current and justified enthusiasm to achieve greater uptake of long-acting, highly effective, less user-dependent contraceptives. Despite the well-recognized difficulties with correct and consistent use, the daily oral contraceptive remains the most popular reversible contraceptive method for women in the United States and many other countries
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Commentary

Pregnancy: not a disease but still a health risk
J. Joseph Speidel, Corinne H. Rocca, Kirsten M.J. Thompson, Cynthia C. Harper
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Review Article

Sperm-specific ion channels: targets holding the most potential for male contraceptives in development
Li-Ping Zheng, Hua-Feng Wang, Bao-Ming Li, Xu-Hui Zeng
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Original Research Articles

Comparison of prospective daily diaries and retrospective recall to measure oral contraceptive adherence
Larissa R. Brunner Huber, Elizabeth C. Broel, Ashley N. Mitchelides, Jacek Dmochowski, Michael Dulin, Delia Scholes
Background: The purpose of this study was to determine if retrospective recall of oral contraceptive (OC) adherence provides data that are similar to data collected via daily diaries over the same time period. Factors associated with inconsistent agreement between prospective and retrospective measurements of adherence also were explored.
Conclusion: While prospective data collection via diaries may improve accuracy, the added expense and burden on study participants may not be necessary. However, the use of retrospective recall may not be appropriate for all study populations.
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The relationship between perinatal psychiatric disorders and contraception use among postpartum women
Alexandre Faisal-Cury, Paulo Rossi Menezes, Hsiang Huang
Background: The relationship between perinatal psychiatric disorders and the use of effective contraceptive methods among postpartum women served by primary care clinics has not been established.
Discussion: Although the use of an LECM after delivery is common, contraception choice is not associated with perinatal depressive/anxiety symptoms. However, women who delay the resumption of sexual activity after delivery should be counseled on the use of available contraceptive methods.
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Weight change at 12 months in users of three progestin-only contraceptive methods
Zevidah Vickery, Tessa Madden, Qiuhong Zhao, Gina M. Secura, Jenifer E. Allsworth, Jeffrey F. Peipert
Background: Concerns about weight gain may influence contraceptive use. We compared the change in body weight over the first 12 months of use between women using the etonogestrel (ENG) implant, the levonorgestrel intrauterine system (LNG-IUS) or depot medroxyprogesterone acetate (DMPA) with women using the copper intrauterine device (IUD).
Conclusions: Weight change was variable among women using progestin-only contraceptives. Black race was a significant predictor of weight gain among contraceptive users.
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Pathways to unsafe abortion in Ghana: the role of male partners, women and health care providers
Hilary M. Schwandt, Andreea A. Creanga, Richard M.K. Adanu, Kwabena A. Danso, Tsiri Agbenyega, Michelle J. Hindin
Background: Despite abortion being legal, complications from induced abortion are the second leading cause of maternal mortality in Ghana. The objective of this study was to understand the decision-making process associated with induced abortion in Ghana.
Conclusions: Women who choose to terminate a pregnancy without their male partners' knowledge should have the means (both financial and social) to do so safely. Interventions with health care providers should discourage judgemental attitudes and emphasize individually focused patient care.
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Practice of and attitudes towards family planning among South Asian American immigrants 
Huma Farid, Shazia Mehmood Siddique, Gloria Bachmann, Teresa Janevic, Aruna Pichika
Background: Previous studies performed outside of the US that examined contraceptive knowledge and beliefs in South Asian women identified significant barriers. Our study aimed to further understand these practices in this population residing in the US.
Conclusions: Clinicians caring for South Asian women should acknowledge both the barriers and the lack of contraceptive knowledge in this population and provide culturally competent family planning information to them during all women's health encounters.
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Randomized trial of the effect of tailored versus standard use of the combined oral contraceptive pill on continuation rates at 1 year
Judith Stephenson, Jill Shawe, Sabeena Panicker, Nataliya Brima, Andrew Copas, Ulrike Sauer, Chris Wilkinson, Hannat Akintomide, Paul O’Brien
Background: There is growing interest from women and clinicians in extended or tailored use of the combined oral contraceptive (COC) pill. Potential advantages include less bleeding, greater contraceptive efficacy and user satisfaction. We examined the effect of a tailored pill regimen, compared with the standard regimen, on continuation and satisfaction rates at 1 year and associated bleeding patterns.
Conclusions: In women familiar with standard use of the COC, switching to tailored COC use or continuing with standard use were both associated with high COC continuation rates and high satisfaction with contraceptive regimen and bleeding pattern. While significant differences tended to favor the standard group, tailored COC use was associated with significantly less bleeding, suited some women very well and can provide a suitable alternative to standard use.
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Racial and ethnic differences in men's knowledge and attitudes about contraception
Sonya Borrero, Amy Farkas, Christine Dehlendorf, Corinne H. Rocca
Background: Little is known about racial/ethnic differences in men's contraceptive knowledge and attitudes.
Conclusions: Efforts to educate men, especially men of color, about contraceptive methods are needed.
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Modification of 24-h ambulatory blood pressure and heart rate during contraception with the vaginal ring: a prospective study
Angelo Cagnacci, Renata Zanin, Antonella Napolitano, Serenella Arangino, Annibale Volpe
Background: Hypertension is recognized as a major risk factor for coronary, cerebral and renal vascular disease. Hormonal methods of contraception may increase the risk for cardiovascular events. We evaluated whether the combined hormonal contraceptive vaginal ring that releases 15-mcg ethinylestradiol and 120 mcg of etonogestrel each day influences 24-h ambulatory blood pressure.
Conclusions: In normotensive women, the vaginal ring slightly increases 24-h blood pressure and heart rate. The underlying mechanisms and the clinical impact of these slight modifications require further evaluation.
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Interest in over-the-counter access to oral contraceptives among women in the United States
Daniel Grossman, Kate Grindlay, Rick Li, Joseph E. Potter, James Trussell, Kelly Blanchard
Background: A growing body of evidence indicates that over-the-counter (OTC) access to oral contraceptive pills (OCPs) is safe and effective.
Conclusions: US women are supportive of OTC access to OCPs, and many would obtain refills OTC or start using OCPs if they were available OTC.
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Measurement of unmet need for family planning: longitudinal analysis of the impact of fertility desires on subsequent childbearing behaviors among urban women from Uttar Pradesh, India
Ilene S. Speizer, Lisa M. Calhoun, Theresa Hoke, Ranajit Sengupta
Background: The measure of unmet need relies on women's reported fertility desires; previous research has demonstrated that fertility desires may be fluid and not firm.
Conclusions: More nuanced assessments of fertility intentions may be needed to adequately gauge latent FP needs. Non-users of FP may be ambivalent about future childbearing and the timing of future births; these women may not have an unmet need for FP as typically defined.
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Barriers to D&E practice among family planning subspecialists
Jema K. Turk, Jody E. Steinauer, Uta Landy, Jennifer L. Kerns
Objective: Over 95% of all second-trimester abortions are managed by dilation and evacuation procedures (D&E) and account for nearly 9% of all abortions in the United States annually. The Fellowship in Family Planning (FFP) offers subspecialty training in abortion and contraception to obstetrician–gynecologists and family medicine physicians. Twenty years after the FFP founding, we report on the abortion practice characteristics and specific barriers these subspecialists face.
Conclusions: By identifying the barriers to D&E practice experienced by FP subspecialists, we can begin to develop a coordinated approach to eradicating modifiable barriers and, ultimately, improve access for women seeking D&E services.
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A statement on abortion by 100 professors of obstetrics: 40 years later
One Hundred Professors of Obstetrics and Gynecology
Abstract: In this Journal in 1972, 100 leaders in obstetrics and gynecology published a compelling statement that recognized the legalization of abortion in several states and anticipated the 1973 Supreme Court decision in Roe v Wade. They projected the numbers of legal abortions that likely would be required by women in the United States and described the role of the teaching hospital in meeting that responsibility. They wrote to express their concern for women's health in a new legal and medical era of reproductive control and to define the responsibilities of academic obstetrician–gynecologists. Forty years later, 100 professors examine the statement of their predecessors in light of medical advances and legal changes and suggest a further course of action for obstetrician gynecologists.
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Case Report

Removal of non-palpable Implanon® with the aid of a hook-wire marker
Kazem Nouri, Katia Pinker-Domenig, Johannes Ott, Ian Fraser, Christian Egarter
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Letters to the Editor

Letter to the Editor: K. Gemzell-Danielsson et al. Emergency contraception — mechanisms of action. Contraception 87 (2013) 300–308
Peter Hillemanns, Hermann Hepp
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Reply. Letter to the editor. Hillemanns Peter, Hepp Hermann, Letter to the Editor: K. Gemzell-Danielsson et al. Emergency contraception — mechanisms of action
Kristina Gemzell-Danielsson, PGL Lalitkumar, Cecilia Berger
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Comment on “Suspect Online Sellers and Contraceptive Access”
John Stanback, Daniel Grossman, Markus Steiner
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Reply to Stanback et al.'s “Suspect Online Sellers and Contraceptive Access”
Bryan A. Liang, Timothy K. Mackey, Kimberly M. Lovett
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