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Contraception Journal
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Contraception Highlights November 2015

Editorial

Daniel R. Mishell Jr., MD, Outstanding Article Award 2015
This award honors the principal investigators who have published the most outstanding articles in Contraception over the preceding academic year (July to June).
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Commentary

A definition of modern contraceptive methods
David Hubacher, James Trussell
Modern contraceptive methods were invented so couples could act on natural impulses and desires with diminished risks of pregnancy. Modern contraceptive methods are technological advances designed to overcome biology. In this regard, modern methods must enable couples to have sexual intercourse at any mutually-desired time.
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Review

Complications from first-trimester aspiration abortion: a systematic review of the literature
Kari White, Erin Carroll, Daniel Grossman
Objective: We conducted a systematic review to examine the prevalence of minor and major complications following first-trimester aspiration abortion requiring medical or surgical intervention.
Implications: Laws requiring abortion providers to have hospital admitting privileges or facilities to meet ambulatory surgical center standards would be unlikely to improve the safety of first-trimester aspiration abortion in office settings.
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Original Research Articles

Drospirenone-only oral contraceptive: results from a multicenter noncomparative trial of efficacy, safety and tolerability
David F. Archer, Hans-Joachim Ahrendt, Dominique Drouin
Objectives: This study was performed to assess the contraceptive efficacy of the drospirenone (DRSP)-only pill and to provide information regarding its safety and cycle-control profile.
Implications: A novel 4-mg DRSP-only pill taken daily for 24 days followed by a placebo for 4 days demonstrated contraceptive efficacy similar to that of currently marketed Combination estrogen plus progestin Oral Contraceptive, with a good safety profile, and favorable cycle control.
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Effect of obesity on the effectiveness of hormonal contraceptives: an individual participant data meta-analysis
Michiyo Yamazaki, Kate Dwyer, Mahboob Sobhan, Daniel Davis, Myong-Jin Kim, Lisa Soule, Gerald Willett, Chongwoo Yu
Objective: The objective of this investigation was to assess the potential effect of obesity on the effectiveness of hormonal contraceptives (HCs).
Conclusions: Results of this meta-analysis suggest that obese women may have a higher pregnancy rate during COC use compared to non-obese women. Future analysis should assess differences in pharmacodynamics or compliance that could potentially account for the observed difference in unintended pregnancy rates.
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Safety of first-trimester uterine evacuation in the outpatient setting for women with common chronic conditions
Maryam Guiahi, Georgia Schiller, Jeanelle Sheeder, Stephanie Teal
Objective: We compared complications of outpatient first-trimester uterine evacuation between women with medical comorbidities and healthy peers.
Implications: Women with common chronic conditions undergoing outpatient first-trimester uterine evacuation do not appear to be at greater risk of complications compared to healthy peers.
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The influence of trust in health care systems on postabortion contraceptive choice
Rachel E. Stacey, Angela Dempsey
Objections: This study investigates whether trust in the health care system or other patient-level characteristics are associated with interest in immediate initiation of long-acting reversible contraception (LARC) after abortion.
Implications: This research underscores the importance of policies and clinical practices that promote access to LARC methods on the day of an abortion. Further research is needed to elucidate factors that correlate with choice of LARC postabortion.
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Medication abortion failure in women with and without previous cesarean delivery
Christine E. Dehlendorf, Edith E. Fox, Rose F. Ali, Nora C. Anderson, Reiley D. Reed, E. Steve Lichtenberg
Objective: To investigate the association between previous cesarean delivery and medication abortion failure and the association between parity and failure.
Implications: Our results suggest that if there are differences in women's odds of medication abortion failure by obstetric history, such differences are unlikely to be large. Providers and patients may factor this information into decision making about methods of pregnancy termination.
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Toll free but not judgment free: evaluating postabortion support services in Ontario
Kathryn J. LaRoche, Angel M. Foster
Introduction: Crisis pregnancy centers (CPCs) account for the majority of advertised postabortion support providers in Ontario, Canada's largest and most populous province. Although the deceptive tactics used by CPCs to dissuade women from seeking abortion care are well documented, their provision of postabortion support has not been previously explored. Our study aimed to fill this gap.
Implications: Postabortion support services appear to be a new frontier by which CPCs are able to stigmatize and pathologize abortion. Increasing awareness of and access to existing nonjudgmental, nondirective postabortion services appears warranted.
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“We can lose our life for the abortion”: exploring the dynamics shaping abortion care in peri-urban Yangon, Myanmar
Grace Sheehy, Yadanar Aung, Angel M. Foster
Objectives: Induced abortion in Myanmar is severely legally restricted and permissible only to save a woman’s life. As a result, unsafe abortion is common and contributes significantly to maternal mortality. Our overall study aimed to explore women’s reproductive health needs in peri-urban Yangon, a dynamic series of townships on the periphery of the country’s largest city characterized by poor infrastructure, slum settlements and a mobile, migrant population. In this paper, we focus specifically on the perceptions, opinions and experiences of both adult women and key informants with respect to induced abortion and postabortion care in peri-urban Yangon.
Implications: Measures to increase access to safe, legal abortion care and reduce harm from unsafe abortion need to be expanded. Developing strategies to liberalize Myanmar’s abortion law, raising awareness about misoprostol, training clinicians to provide woman-centered postabortion care and documenting the cost of unsafe abortion to the public sector appear warranted.
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Desire for female sterilization among women wishing to limit births in rural Rakai, Uganda
Tom Lutalo, Ron Gray, Sanyukta Mathur, Maria Wawer, David Guwatudde, John Santelli, Fred Nalugoda, Fredrick Makumbi
Objective: Uganda has an unmet need for family planning of 34% and a total fertility rate of 6.2. We assessed the desire for female sterilization among sexually active women who wanted to stop childbearing in rural Rakai district, Uganda.
Implications: A large unmet need for permanent female contraception services exists in Uganda. Efforts to increase the method mix by increasing permanent contraception services could reduce fertility rates and undesired births.
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Novel restricted access to vasectomy in Iran: addressing changing trends in vasectomy clients' characteristics over 16 years in northwestern Iran
Hamidreza Farrokh-Eslamlou, Sima Oshnouei, Vahid Alinejad
Objectives: This study is designed to evaluate the popularity of vasectomy in Iran. The study was conducted to calculate the frequency of vasectomy over time, to
compare vasectomy users' characteristics with the general population and whether these characteristics have changed over time.
Conclusions: This study highlighted a dramatic rise in the use of vasectomy between 1996 and 2011 in Iran. While the characteristics of vasectomy users versus general population were different, especially in age, education, resident area, number and sex of their children, there were significant changes from two 8-year study time periods.
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Young men’s awareness and knowledge of intrauterine devices in the United States
Cassondra J. Marshall, Anu Manchikanti Gomez
Objective: Increasing use of long-acting methods of contraception, such as intrauterine devices (IUDs), has been recognized as a promising strategy to reduce the incidence of unintended pregnancy. While men may play an important role in promoting or discouraging contraceptive use, very little research has examined men’s knowledge of and attitudes toward IUDs.
Implications: Male partners are influential in contraceptive use, yet little research has examined their IUD knowledge. Our findings indicate that healthcare providers may play important role in increasing young men’s knowledge of contraceptive methods, including IUDs. This study highlights the need to better incorporate young men into contraception rese<a target="blank" href=arch and programs.
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How do pregnancy intentions affect contraceptive choices when cost is not a factor? A study of privately insured women
Carol S. Weisman, Erik B. Lehman, Richard S. Legro, Diana L. Velott, Cynthia H. Chuang
Objective: The objective was to test the hypothesis that among privately insured women who have contraceptive coverage without cost-sharing, using prescription contraception is predicted primarily by pregnancy intentions.
Implications: This study is among the first to examine privately insured women’s contraception choices in the context of contraceptive coverage without cost-sharing; it shows that use of prescription contraception is predicted by pregnancy risk exposure and pregnancy intentions.
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Contraceptive service needs of women with young children presenting for pediatric care
Krishna K. Upadhya, Anne E. Burke, Arik V. Marcell, Kamila Mistry, Tina L. Cheng
Objectives: The primary objective of this study is to characterize the need for contraceptive services and contraceptive method use among women with young children presenting to child health clinics. A secondary objective is to characterize the factors, including access to care and health needs, that exist in this population and to evaluate their association with contraceptive method use.
Implications: Child health clinics may be a novel site for providing contraceptive care to women with children as part of a strategy to reduce unplanned pregnancies.
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