Association of Reproductive Health Professionals
Association of Reproductive Health Professionals
Reproductive Health Topics Publications & Resources Professional Education Newsroom Membership Policy & Advocacy About Us
Contraception Journal
Send To A Friend Send To A Friend Bookmark this Page Share this page
Contraception Highlights October 2014

Editorial

DMPA and HIV: do we need a trial?
Carolyn L. Westhoff, Beverly Winikoff
Whether hormonal contraceptive use increases the risk of HIV acquisition is still a much debated question. In countries that endure the double challenges of high HIV prevalence and high maternal mortality, the need for safe contraceptives is enormous, yet the meaning of "safe" becomes impossible to parse because of competing risks. Effective contraceptive use in these settings clearly and dramatically reduces maternal mortality. If women--or clinicians or health systems--avoid some contraceptives due to fear of HIV, will overall maternal deaths increase or decrease? The answer may vary by country and population subgroup, and thus general advice for public health policy is paralyzed.
Login to read full article

Commentaries

DMPA and HIV: why we need a trial
Helen Rees for The ECHO Consortium
Recent articles by Ralph et al. and Gollub and Stein, as well as an accompanying commentary by Jones in the current issue of Contraception, have challenged the concept of conducting a randomized trial to determine whether injectable depot medroxyprogesterone acetate (DMPA) increases the risk of HIV acquisition. They all raise concerns about the evidence, the methodology, the ethics, the feasibility and the return on investment of such an undertaking. While those authors acknowledge the uncertainty of the evidence regarding the effect of hormonal contraception, particularly DMPA, on increased HIV risk, they argue that the observational data are of sufficiently high quality to inform women of the potential risks and recommend against investing in a randomized trial to answer the question.
Login to read full article

Time to focus on improving the contraceptive method mix in high HIV prevalence settings and let go of unanswerable questions
Heidi E. Jones
The evidence on the impact of depot medroxyprogesterone acetate (DMPA), a progestin-only injectable form of contraception, on increased HIV-1 acquisition is mixed. A meta-analysis of observational data from 18 studies of over 38,000 women with 1887 incident HIV infections, adjusted for region, age, partner status, time-varying number of sexual partners and time-varying condom use, suggests that the use of DMPA increases the risk of HIV-1 acquisition by 1.5 times [95% confidence interval (CI), 1.2–1.8] compared to women not using hormonal contraceptive methods. Further, a recent, planned secondary analysis of 3163 women from an HIV prevention trial in Uganda, South Africa and Zimbabwe (the VOICE study) found that DMPA users had 1.4 times (95% CI 1.0–2.0) the hazard of HIV acquisition compared to users of norethistoerone enanthate (NET-EN) injectable contraception. In this study, HIV incidence among DMPA users was 8.0 per 100 woman–years compared to 5.4 per 100 woman–years among NET-EN users, resulting in 2.6 additional cases of HIV per 100 woman–years for DMPA users compared to NET-EN users. Thus, while the findings are mixed, our best estimates are that DMPA use increases HIV acquisition modestly.
Login to read full article

Review Article

Hormonal contraceptive methods and risk of HIV acquisition in women: a systematic review of epidemiological evidence
Chelsea B. Polis, Sharon J. Phillips, Kathryn M. Curtis, Daniel J. Westreich, Petrus S. Steyn, Elizabeth Raymond, Philip Hannaford, Abigail Norris Turner
Read abstract
Login to read full article

Original Research Articles

Clinicians' perceptions and provision of hormonal contraceptives for HIV-positive and at-risk women in Southern Africa: an original research article
Kelly Blanchard, Tsungai Chipato, Gita Ramjee, Tzadzaa Nhemachena, Cynthia C. Harper, the Provider Study Writing Committee
Objective: To assess clinician provision of hormonal contraception for HIV-positive and at-risk women in Southern Africa.
Conclusions: These findings emphasize the need to improve clinicians' awareness of evidence-based guidelines for hormonal contraception for women at high risk of HIV and HIV-positive women. Evidence-based information that oral contraception and injections are appropriate is essential. Contraceptive education should be integrated into HIV training to reach at-risk populations.
Read abstract
Login to read full article

Dual method use at last sexual encounter: a nationally representative, episode-level analysis of US men and women: Prepared for resubmission to Contraception
Jenny A. Higgins, Nicole K. Smith, Stephanie A. Sanders, Vanessa Schick, Debby Herbenick, Michael Reece, Brian Dodge, J. Dennis Fortenberry
Objectives: Male condom use in conjunction with other contraceptives increases protection against pregnancy and sexually transmitted infections. However, few analyses contextualize dual method use within the sexual episode, include reports from men or explore gendered patterns in reporting.
Conclustions: Many people classified as "dual users" in previous studies may not be using dual methods consistently or correctly. Researchers and practitioners should inquire how and how often condoms are used when assessing and addressing dual method use. Furthermore, though men have rarely been surveyed about dual method use, they can provide consistent contraceptive estimates and may be more likely to report condom practices such as late application or early removal.
Read abstract
Login to read full article

Acceptability of a transdermal gel-based male hormonal contraceptive in a randomized controlled trial
Mara Y. Roth, Grace Shih, Niloufar Ilani, Christina Wang, Stephanie T. Page, William J. Bremner, Ronald S. Swerdloff, Regine Sitruk-Ware, Diana L. Blithe, John K. Amory
Objectives: Fifty percent of pregnancies in the United States are unintended despite numerous contraceptive methods available to women. The only male contraceptive methods, vasectomy and condoms, are used by 10% and 16% of couples, respectively. Prior studies have shown efficacy of male hormonal contraceptives in development, but few have evaluated patient acceptability and potential use if commercially available. The objective of this study is to determine if a transdermal gel-based male hormonal contraceptive regimen, containing testosterone and Nestorone® gels, would be acceptable to study participants as a primary contraceptive method.
Implications: A substantial portion of men report they would use this transdermal male contraceptive regimen if commercially available. This method would provide a novel, reversible method of contraception for men, whose current choices are limited to condoms and vasectomy.
Read abstract
Login to read full article

Male access to emergency contraception in pharmacies: a mystery shopper survey
David L. Bell, Elvis J. Camacho, Andrew B. Velasquez
Background: Pharmacy access to emergency contraception (EC) could involve men in pregnancy prevention. The objectives were to assess the availability and cost of EC.
Conclusions: Overall, males had a 20% probability of not being able to access EC. The national dialogue should include males.
Read abstract
Login to read full article

Pull and pray or extra protection? Contraceptive strategies involving withdrawal among US adult women
Rachel K. Jones, Laura D. Lindberg, Jenny A. Higgins
Introduction: Research assessing contraceptive use often focuses on the most effective method used and suggests that very few women rely on withdrawal. We adopted a new measurement strategy in an attempt to measure contraceptive practices and withdrawal in particular.
Implicatios: Health care providers who discuss contraception should include withdrawal in these conversations. A substantial minority of individuals has used it recently, and many appear to be using it as a backup or secondary method. If dual use were more widespread, it could help reduce the incidence of unintended pregnancy.
Read abstract
Login to read full article

Tubal ligation in Catholic hospitals: a qualitative study of ob–gyns' experiences
Debra B. Stulberg, Yael Hoffman, Irma Hasham Dahlquist, Lori R. Freedman
Objective: Tubal sterilization remains one of the most commonly requested contraceptive methods in the United States. Catholic hospital policy prohibits all sterilizations, but this ban is not uniformly enforced. We conducted this study to assess obstetrician–gynecologists' beliefs and experiences with tubal ligation in Catholic hospitals.
Implications statement: Tubal sterilization, even when medically indicated or in conjunction with cesarean delivery, is severely restricted for women delivering in Catholic hospitals. For women whose only access to hospital care is at a Catholic institution, religious policies can prevent them from receiving a desired sterilization and place them at risk for future undesired pregnancy.
Read abstract
Login to read full article

Are women aware of religious restrictions on reproductive health at Catholic hospitals? A survey of women’s expectations and preferences for family planning care
Maryam Guiahi, Jeanelle Sheeder, Stephanie Teal
Objective: To understand if women anticipate a difference in reproductive healthcare when attending a Catholic institution.
Implications: Women did not anticipate differences in reproductive healthcare based on institution type (Catholic vs. secular) and, thus, their ability to act as informed healthcare consumers may be constrained.
Read abstract
Login to read full article

Contraceptive awareness and birth control selection in female kidney and liver transplant recipients
Monika Szpotanska-Sikorska, Bronislawa Pietrzak, Miroslaw Wielgos
Objective(s): Interest has increased regarding the issue of contraception in transplant recipients. The purpose of this study was to assess birth control selection and the role of contraceptive counseling sessions in female kidney transplant (KT) and liver transplant (LT) recipients.
Implications: Current literature and data regarding contraception among female organ transplant recipients remain limited and are predominantly limited to a single population. The purpose of the study was to assess the level of satisfaction and the reasons underlying birth control selection in female kidney and LT recipients.
Read abstract
Login to read full article

Efficacy of fennel and combined oral contraceptive on depot medroxyprogesterone acetate-induced amenorrhea: a randomized placebo-controlled trial
Ensiyeh Mohebbi-kian, Sakineh Mohammad-Alizadeh-Charandabi, Reza Bekhradi
Objectives: We aimed to determine the efficacy of fennel and low-dose combined oral contraceptive (LD-COC) on inducing menstrual bleeding and method continuation in women using depot medroxyprogesterone acetate (DMPA) who had no menstrual bleeding within the previous 45 to 140 days.
Conclusions: Fennel and LD-COC can resolve DMPA-induced amenorrhea and increase continuation rate of this contraceptive method.
Read abstract
Login to read full article

Pharmacy-based interventions for initiating effective contraception following the use of emergency contraception: a pilot study
L. Michie, S.T. Cameron, A. Glasier, N. Larke, A. Muir, A. Lorimer
Objectives: In Scotland most women get emergency contraception (EC) from pharmacies. Pharmacists currently cannot provide effective ongoing contraception after EC. In this pilot study, we aimed to determine the feasibility of a larger study designed to ascertain if pharmacy-based interventions can increase the uptake of effective contraception after EC.
Implications statement: For women obtaining EC from a pharmacy, simple interventions such as supplying 1 month of a POP, or offering rapid access to a FPC, hold promise as strategies to increase the uptake of effective contraception after EC.
Read abstract
Login to read full article

Assessment of copper corrosion from frameless copper IUDs after long-term in utero residence
Dirk Wildemeersch, Pieter-Jan Sabbe, Mark G. Dowsett, Victoria Flexer, Paul Thompson, David Walker, Pam A. Thomas, Annemie Adriaens
Objective: To assess the site-specific corrosive behavior of the frameless intrauterine device (IUD) following long-term exposure to the uterine environment.
Implications statement: Release of copper ions from both sides of the copper tubes of the frameless GyneFix® IUD allows the IUD to be reduced in size, contributing to better toleration. The impact on menstrual bleeding is also minimized by a smaller size of the foreign body.
Read abstract
Login to read full article

Controversies in family planning: pregnancy termination in women with uterine anatomic abnormalities
Lisa M. Goldthwaite, Stephanie B. Teal
Read abstract
Login to read full article

Erratum

Erratum for Reproductive Health 2014 Poster Abstracts

Login to read erratum