03/25/15

Abortion does not cause risky alcohol use

Some previous research has found higher levels of alcohol use among women who have received abortions, and these findings are often used to discourage women from accessing abortion care. However, new research from the UCSF Bixby Center challenges the notion that abortion is related to increased alcohol use. Using data from the Turnaway Study, researchers found that women who had a child from an unwanted pregnancy reduced alcohol consumption over a two-year period, while women who had abortions resumed their typical pre-pregnancy alcohol consumption. This new study shows that the difference in alcohol consumption for these two groups is due primarily to reductions among women continuing pregnancies rather than increases among women having abortions.

There was no evidence that having an abortion lead to risky or problematic drinking over time, or that it caused women to start binge drinking. These new findings join others showing that abortion care is medically safe and does not have negative consequences for women.

03/17/15

Louisiana law would drastically limit abortion access

In 2014, Louisiana passed a law requiring abortion providers to have hospital admitting privileges. The law is temporarily on hold while a court case challenging it continues. According to new research from the UCSF Bixby Center, this law would close all of the state’s abortion facilities, forcing three-quarters of Louisiana women to travel 150 miles or more each way for services.

Using data from three of the five Louisiana abortion care facilities in the year before the law was scheduled to take effect, Bixby Center researchers aimed to describe who would be affected if the law went into effect. They found that:

  • Louisiana women in the study had traveled, on average, 58 miles each way to have an abortion. 
  • If Louisiana’s abortion facilities closed, the average distance would more than triple to 208 miles each way, about the distance from New York to Boston. 
  • Most women who had abortions at the three Louisiana facilities had no education beyond high school. They were also more likely to live in areas where average incomes were below the state mean.

The study may actually underestimate the distance women would have to travel, since three of Louisiana­’s neighboring states—Texas, Mississippi and Alabama—have also passed admitting privilege laws and other restrictions that could close their abortion care facilities. Forcing women to travel further would likely contribute to delays in care and put an additional financial burden on women. The researchers concluded that Louisiana’s law would put a considerable burden on many Louisiana women, particularly those who are already financially vulnerable.

03/16/15

Over-the-counter birth control would reduce intended pregnancies, save money

About half of pregnancies in the U.S. are accidental, with inconsistent use and non-use of birth control being the leading causes. For some women, going to a healthcare provider to obtain a prescription stands in the way of using birth control. Making oral contraceptives available without a prescription has the potential to increase the number of women using this method and reduce gaps in use.

New research from the UCSF Bixby Center examines how non-prescription oral contraceptives might impact women's access, use and pregnancies, as well as public health costs. Using national and state data, the researchers found that if women were able to obtain oral contraceptives without a prescription as a covered health insurance benefit, there would be an 11 to 21 percent increase in the number of women using the Pill. As a result, the rate of accidental pregnancies in the U.S. would decrease by 7 to 25 percent.

The researchers also considered the public sector costs of providing oral contraceptives without a prescription and of providing medical care for unintended pregnancy. They found that the combined costs would be reduced for public health plans that chose to cover oral contraceptives without a prescription. Despite these cost savings, it is relatively uncommon for public health insurance to cover non-prescription methods of birth control.

“In the era of no-co-pay contraception, there is still a need for over-the-counter birth control to fill the gap when women run out of pills while traveling, for example, or for those who find it inconvenient to get to a clinic," study co-author Dan Grossman said. "But to reach the largest number of women most in need, it's critical that a future [non-prescription] pill be covered by insurance.

02/25/15

Preventing cervical cancer among HIV-positive women

Cervical cancer, caused by human papilloma virus (HPV), is a leading cause of cancer-related death among women in low-resource settings. Some areas with the high cervical cancer prevalence, such as sub-Saharan Africa, also have high HIV prevalence. Among HIV-positive women, a weakened immune system and inability to clear HPV may lead to an increased risk of cervical cancer; studies have found a 2- to 22-fold increase in the incidence of invasive cervical cancer among women living with HIV compared with the general population.

The high risk of cervical cancer among HIV-positive women underscores the urgent need for effective cervical cancer prevention programs tailored to their needs. To help develop such programs, researchers with the UCSF Bixby Center worked with a group of HIV-positive women with cervical cancer in Western Kenya. The researchers saw the women six and twelve months following a treatment to clear abnormal cervical cells. The treatment effectively reduced the risk of cancer for up to one year, with only 13% of women experiencing a return of cervical cancer. However, among the women who did experience a return of the disease, the researchers observed a high proportion of invasive cancer.

Because of the risk of developing invasive cancer after treatment, HIV-positive women should receive continued and close follow-up care for cervical cancer. However, the standard of care in low-resource settings means that many cases of invasive cervical cancer could be missed. For instance, without collecting specimen samples of cervical tissue, cases of invasive disease may be missed, especially among HIV-positive women. The researchers call for a continued investigation of the most cost-effective and feasible programs to prevent and treat cervical cancer worldwide.

02/03/15

Abortion and mental health issues unrelated

Although the relationship between abortion and mental health has been a topic of scientific debate and public interest for the past three decades, few studies have been designed to examine this relationship specifically. Researchers with the UCSF Bixby Center conducted a study to examine this relationship and fill this gap in the scientific literature.

Using data from the Turnaway Study, the researchers found that anxiety and depression were not more common among women having an abortion. Specifically: 

  • Among women who received an abortion, depression and anxiety symptoms remained steady or decreased over the 2 years after the procedure. 
  • Levels of anxiety symptoms were initially higher among those denied an abortion compared with those receiving one, but the two groups converged over time. 
  • Women who received abortion close to gestational age limits initially had similar levels of depression and lower levels of anxiety compared to women who were denied abortions and subsequently carried their pregnancies to term.

These findings show that relative to unwanted childbearing, abortion does not lead to an increased risk of mental health problems among women. Opponents of legalized abortion have suggested that abortion is a traumatic event with severe consequences for women’s mental health, but this study and others indicate definitively that abortion does not cause mental health issues. Policymakers should take this into account when legislating women’s access to safe and high-quality abortion care.