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Contraception Journal
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Contraception Highlights June 2015

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

Performance measures for contraceptive care: what are we actually trying to measure?
Christine Dehlendorf, Helen Bellanca, Michael Policar
Over the past two decades, there has been increased attention to quality in health care, including the use of standardized measures to track performance within health care institutions, by plans and by individual providers [1]. These measures are a means to document quality of care so as to allow comparisons by consumers, payers and others. In addition, they can be used to incentivize quality improvement through such means as linking physician payments to their performance on quality measures. The Affordable Care Act (ACA) furthers this trend, with an emphasis on a pay-for-performance model based on quality and effectiveness measures
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Review

How does intimate partner violence affect condom and oral contraceptive Use in the United States?: A systematic review of the literature
Julie N. Bergmann, Jamila K. Stockman
Introduction: Intimate partner violence (IPV) is estimated to affect 25% of adult women in the United States alone. IPV directly impacts women’s ability to use contraception, resulting in many of unintended pregnancies and STIs. This review examines the relationship between IPV and condom and oral contraceptive use within the United States at two levels: the female victim’s perspective on barriers to condom and oral contraceptive use, in conjunction with experiencing IPV (Aim 1) and the male perpetrator’s perspective regarding condom and oral contraceptive use (Aim 2).
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Original Research Articles

Associations of intimate partner violence with unintended pregnancy and pre-pregnancy contraceptive use in South Asia
Anita Raj, Lotus McDougal
Objective: To assess associations of intimate partner violence (IPV) with pregnancy intendedness and pre-pregnancy contraceptive use among pregnant women in South Asia.
Implications: Family planning services are reaching women affected by sexual IPV, and programs should be sensitive to this concern and the heightened vulnerability to contraceptive failure these women face. Long-acting reversible contraception could be beneficial by allowing women to have greater reproductive control in situations of compromised sexual autonomy.
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Differences in contraceptive use between family planning providers and the U.S. population: results of a nationwide survey
Lisa F. Stern, Hannah R. Simons, Julia E. Kohn, Elie J. Debevec, Johanna M. Morfesis, Ashlesha A. Patel
Objectives: To describe contraceptive use among U.S. female family planning providers and to compare their contraceptive choices to the general population.
Implications: Family planning providers report higher use of LARC than the general population. This may reflect differences in preferences and access. Providers might consider sharing these findings with patients, while maintaining patient choice and autonomy.
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Weight and body mass index among female contraceptive clients
Julia E. Kohn, Priscilla M. Lopez, Hannah R. Simons
Objectives: As obesity may affect the efficacy of some contraceptives, we examined weight, body mass index (BMI) and prevalence of obesity among female contraceptive clients at 231 U.S. health centers. A secondary aim was to analyze differences in contraceptive method use by obesity status.
Implications: About half of contraceptive clients in this study population were overweight or obese. Contraceptive method choices differed by obesity status. All women — regardless of body size — should receive unbiased, evidence-based counseling on the full range of contraceptive options so that they can make informed choices.
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Recruitment and retention strategies for expert nurses in abortion care provision
Monica R. McLemore, Amy Levi, E. Angel James
Objectives: The purpose of this thematic analysis is to describe recruitment, retention and career development strategies for expert nurses in abortion care provision.
Implications: The findings from our study should encourage employers to provide exposure opportunities, develop activities to recruit and retain nurses, and to support career development in abortion care provision. Additionally, future workforce development efforts should include and engage nursing education institutions and employers to design structured support for this trajectory.
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Hormonal contraception does not increase women’s HIV acquisition risk in Zambian discordant couples, 1994–2012
Kristin M. Wall, William Kilembe, Bellington Vwalika, Naw Htee Khu, Ilene Brill, Elwyn Chomba, Brent A. Johnson, Lisa Haddad, Amanda Tichacek, Susan Allen
Objective: To determine the impact of hormonal contraceptive methods on risk of HIV acquisition among HIV-negative women cohabiting with HIV-positive male partners.
Implications: These findings add to a controversial literature and uniquely address several common design and analytic challenges faced by previous studies. After controlling for confounders, we found no association between hormonal contraception and HIV acquisition risk in women. We support promoting condoms for HIV prevention and increasing the contraceptive method mix to decrease unintended pregnancy.
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The effect of sevoflurane on interventions for blood loss during dilation and evacuation procedures at 18–24 weeks of gestation: a randomized controlled trial
Elizabeth Micks, Alison Edelman, Rosanne Botha, Paula Bednarek, Mark Nichols, Jeffrey T. Jensen
Objective: The objective was to evaluate whether the use of sevoflurane during general anesthesia for dilation and evacuation (D&E) procedures increases the frequency of interventions to treat excess bleeding.
Implications: In this randomized, double-blinded, placebo-controlled trial, sevoflurane did not significantly increase the risk of intervention for bleeding during D&Es. However, this agent should be used with caution as an anesthetic for surgical abortions.
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Ovulatory effects of three oral contraceptive regimens: a randomized, open-label, descriptive trial
Larry Seidman, Robin Kroll, Brandon Howard, Nancy Ricciotti, Jennifer Hsieh, Herman Weiss
Objective: This study describes ovarian activity suppression of a 21/7-active low-dose combined oral contraceptive (COC) regimen that included only ethinyl estradiol (EE) during the traditional hormone-free interval (HFI) and two commercially available 28-day regimens, a 24/4 and a 21/7 regimen.
Implications: The 21/7-active low-dose COC regimen (DSG/EE+7 days EE) that included only EE during the traditional HFI showed suppression of ovarian follicular activity that was similar to the 24/4 (DRSP/EE+4 days PBO) and the 21/7 (LNG/EE+7 days PBO) comparator regimens.
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Early serum human chorionic gonadotropin (hCG) trends after medication abortion
Katherine D. Pocius, Rie Maurer, Jennifer Fortin, Alisa B. Goldberg, Deborah Bartz
Objectives: Despite increased reliance on human chorionic gonadotropin (hCG) for early pregnancy monitoring, there is limited information about hCG trends soon after medication abortion. The purpose of this study was to determine if there is a predictable decline in serum hCG values shortly after medication abortion.
Implications: This study provides the largest cohort of patients followed with serial hCG values in the first few days after medication abortion. Our findings demonstrate the trend in hCG decline in this population, which may be predictable by Day 5.
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The experiences and adaptations of abortion providers practicing under a new TRAP law: a qualitative study
Rebecca J. Mercier, Mara Buchbinder, Amy Bryant, Laura Britton
Objective: Abortion laws are proliferating in the United States, but little is known about their impact on abortion providers. In 2011, North Carolina instituted the Woman’s Right to Know (WRTK) Act, which mandates a 24-h waiting period and counseling with state-prescribed information prior to abortion. We performed a qualitative study to explore the experiences of abortion providers practicing under this law.
Implications: Laws like WRTK are burdensome for providers. Providers adapt their clinical practices not only to comply with laws but also to minimize the emotional and practical impacts on patients. The effects on providers, frequently not a central consideration, should be considered in ongoing debates regarding abortion regulation.
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How does religious affiliation affect women's attitudes toward reproductive health policy? Implications for the Affordable Care Act
Elizabeth W. Patton, Kelli Stidham Hall, Vanessa K. Dalton
Bakcground: Supreme Court cases challenging the Affordable Care Act (ACA) mandate for employer-provided reproductive health care have focused on religiously based opposition to coverage. Little is known about women's perspectives on such reproductive health policies.
Implications: Recent challenges to the ACA contraceptive mandate appear to equate religious belief with opposition to employer-sponsored reproductive health coverage, but women's views are more complex.
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Correspondence

More data are needed for Essure hysteroscopic sterilization device
Diana Zuckerman, Laurén Abla Doamekpor
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Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization
Aileen M. Gariepy, On behalf of Mitchell D. Creinin, Kenneth J. Smith, Xiao Xu
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