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Contraception Journal
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Contraception Highlights January 2017

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

Providing family planning care in the context of Zika: a toolkit for providers from the US Office of Population Affairs
Christine Dehlendorf, Loretta Gavin, Susan Moskosky
The Zika virus is a newly emerging threat to women's reproductive health that is receiving increasing international and domestic attention. This virus can be passed from a pregnant woman to her fetus and cause microcephaly as well as other severe brain anomalies, and has also been linked to problems such as defects of the eye and pregnancy loss. Zika is transmitted both through the bites of Aedes species mosquitoes and through sex with a person who has been infected with Zika, and the virus has been circulating in South and Central America and the Caribbean (including Puerto Rico) since 2015. The first case of mosquito-borne transmission in the United States occurred in June 2016.
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Commentaries

Perspectives on variability in pharmacokinetics of an oral contraceptive product
William J. Jusko
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Clarification of contraceptive drug pharmacokinetics in obesity
William J. Jusko
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Review Articles

The safety of intrauterine devices among young women: a systematic review
Tara C. Jatlaoui, Halley E.M. Riley, Kathryn M. Curtis
Objective: The objective was to determine the association between use of intrauterine devices (IUDs) by young women and risk of adverse outcomes.
Conclusion: Overall evidence suggests that the risk of adverse outcomes related to pregnancy, perforation, infection, heavy bleeding or removals for bleeding among young IUD users is low and may not be clinically meaningful. However, the risk of expulsion, especially for Cu-IUDs, is higher for younger women compared with older women. If IUD expulsion occurs, a young woman is exposed to an increased risk of unintended pregnancy if replacement contraception is not initiated. IUDs are safe for young women and provide highly effective reversible contraception.
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A review of intrauterine contraception in the Asia-Pacific region
Deborah Bateson, Sukho Kang, Helen Paterson, Kuldip Singh
Objective: This study aims to review access to, uptake of and influencing factors on IUC use in the Asia-Pacific region.
Conclusions: Across the Asia-Pacific region, clear data gaps and unmet needs exist in terms of access to and uptake of IUC. We believe that several recommendations are necessary to update future practice and policy for enhanced IUC utilization so that women across this region have better access to IUC.
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Original Research Articles

Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies
Mario Philip R. Festin, Alexandre Peregoudov, Armando Seuc, James Kiarie, Marleen Temmerman
Objective: To estimate the effect of increased body weight and body mass index (BMI) on pregnancy rates with levonorgestrel (LNG) 1.5 mg used as emergency contraception (EC).
Implications: Access to LNG as EC should still be promoted to women who need them, and not be restricted in any weight or BMI category, with additional attention for counselling and advice for obese women.
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Levonorgestrel butanoate intramuscular injection does not reliably suppress ovulation for 90 days in obese and normal-BMI women: a pilot study
Alison B. Edelman, Ganesh Cherala, Hong Li, Francis Pau, Diana L. Blithe, Jeffrey T. Jensen
Background: We performed a pilot evaluation of a new formulation of levonorgestrel butanoate (LB) designed to be a long-acting injectable (6 months) contraceptive to determine pharmacodynamic end points in normal-body mass index (BMI) and obese women.
Implications: Since return of ovulation was earlier than expected for this LB injectable formulation, additional steps are needed to develop a preparation suitable as a longer-lasting product.
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Does body mass index or weight perception affect contraceptive use?
Kalpesh Bhuva, Jennifer L. Kraschnewski, Erik B. Lehman, Cynthia H. Chuang
Objective: Overweight and obese women may avoid contraceptive methods they believe are associated with weight gain. The objective of this study was to examine the role of weight and weight perception on contraceptive use.
Implications: Overweight and obese women may be reluctant to use contraceptive methods they believe are associated with weight gain (i.e., pills, shot), but how that affects contraceptive use is unclear. Compared with normal-weight women, overweight and obese women in this study were more likely to use LARCs than non-LARC prescription methods.
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Two-week postpartum intrauterine contraception insertion: a study of feasibility, patient acceptability and short-term outcomes
Matthew L. Zerden, Gretchen S. Stuart, Samantha Charm, Amy Bryant, Joanne Garrett, Jessica Morse
Objective: To determine the feasibility and acceptability of inserting the levonorgestrel intrauterine system, LNG 52 mg IUS (LNG IUS), at 2 weeks postpartum.
Implications: This study supports offering the LNG IUS beginning on the 14th postpartum day. The 4% expulsion rate is consistent with the rate of interval insertion and lower than immediate postplacental insertion. Additional research is needed to ensure a low risk of adverse events with other brands of intrauterine contraception.
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Six- and twelve-month documented removal rates among women electing postpartum inpatient compared to delayed or interval contraceptive implant insertions after Medicaid payment reform
Amy H. Crockett, Lesley Bundon Pickell, Emily C. Heberlein, Deborah L. Billings, Benjie Mills
Objective: This study aims to document 6- and 12-month removal rates for women receiving the contraceptive implant inpatient postpartum versus those receiving the same contraceptive method during an outpatient visit, in a setting where postpartum inpatient long-acting reversible contraceptive (LARC) services (devices plus provider insertion costs) are reimbursed by Medicaid.
Implications: A Medicaid payment policy that removes institutional barriers to offering postpartum inpatient contraceptive implants to women free-of-charge may facilitate meeting women's desires and intentions to delay subsequent pregnancy, as evidenced by low removal rates up to 12 months post-insertion. Further research with women is needed to assess how these services meet their postpartum contraceptive needs and desires to postpone or prevent subsequent pregnancy.
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Implications of employer coverage of contraception: Cost©\effectiveness
analysis of contraception coverage under an employer mandate
W. Canestaro, E. Vodicka, D. Downing, J. Trussell
Objectives: Mandatory employer-based insurance coverage of contraception in the US has been a controversial component of the Affordable Care Act (ACA). Prior research has examined the cost©\effectiveness of contraception in general; however, no studies have developed a formal decision model in the context of the new ACA provisions. As such, this study aims to estimate the relative cost©\effectiveness of insurance coverage of contraception under employer-sponsored insurance coverage taking into consideration newer regulations allowing for religious exemptions.
Implications: Insurance coverage was found to be significantly associated with women's choice of contraceptive method in a large nationally representative sample. Using a decision model to extrapolate to pregnancy outcomes, we found a large and statistically significant difference in unintended pregnancy and terminations. Denying women contraception coverage may have significant consequences for pregnancy outcomes.
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A randomized controlled trial of the impact of a family planning mHealth service on knowledge and use of contraception
Douglas Johnson, Randall Juras, Pamela Riley, Minki Chatterji, Phoebe Sloane, Soon Kyu Choi, Ben Johns
Objectives: mHealth, or the use of mobile phones for health, is a promising but largely untested method for increasing family planning knowledge in developing countries. This study estimates the effect of m4RH, an mHealth service in Kenya that provides family planning information via text message, on consumers' knowledge and use of contraception.
Implications: Text messages can be an effective method of increasing family planning knowledge but may be insufficient on their own to cause behavior change.
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National network television news coverage of contraception ¡ª a content analysis
Elizabeth W. Patton, Michelle H. Moniz, Lauren S. Hughes, Lorraine Buis, Joel Howell
Objective: The objective was to describe and analyze national network television news framing of contraception, recognizing that onscreen news can influence the public's knowledge and beliefs.
Implications: Media coverage of contraception may influence patients' views about contraception. Understanding the content, sources and medical accuracy of current media portrayals of contraception may enable health care professionals to dispel popular misperceptions.
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Maintaining rigor in research: flaws in a recent study and a reanalysis of the relationship between state abortion laws and maternal mortality in Mexico
Blair G. Darney, Biani Saavedra-Avendano, Rafael Lozano
Objective: A recent publication [Koch E, Chireau M, Pliego F, Stanford J, Haddad S, Calhoun B, Aracena P, Bravo M, Gatica S, Thorp J. Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states. BMJ Open 2015;5(2):e006013] claimed that Mexican states with more restrictive abortion laws had lower levels of maternal mortality. Our objectives are to replicate the analysis, reanalyze the data and offer a critique of the key flaws of the Koch study.
Implications: Transparency and integrity in research is crucial, as well as perhaps even more in politically contested topics such as abortion. Rigorous evidence about the health impacts of increasing access to safe abortion worldwide is needed.
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