It's LARC Awareness Week

The UCSF Bixby Center for Global Reproductive Health has partnered with the California Family Health Council to spread the word about long-acting reversible contraception (LARC)—intrauterine devices (IUDs) and the implant. During LARC Awareness Week, the UCSF Bixby Center is sharing its ongoing and comprehensive research about LARC methods, which are over 99% effective at preventing pregnancy. About half of pregnancies in the US are accidental, and this hasn’t changed in the last two decades.  As more US women learn about and use IUDs and the implant, the rate of accidental pregnancy has declined.

The UCSF Bixby Center has explored different factors that influence LARC use. Many young women and health care providers have misinformation about IUDs and implants.  Providers with recent training about LARC are more likely to counsel their clients about the methods.  Women’s social networks also influence IUD use. Health care providers can encourage IUD users to share their personal experiences with their friends and family to spread the word about these methods.

To participate in LARC Awareness Week, spread the word about LARC on Twitter and Facebook @CalFamHealth and @Bedsider with the hashtag #LoveMyLARC.


Massive, open online course on abortion

The UCSF Bixby Center's Innovating Education in Reproductive Health program is excited to announce the upcoming launch of the first ever online course about abortion. Abortion is a common experience for women around the world, yet is often excluded from the curricula of health professionals. The free six-week course, Abortion: Quality Care and Public Health Implications, is hosted by Coursera, an education platform for massive, open, online courses (MOOCs). It will address abortion care from both clinical and social perspectives.

Dr. Jody Steinauer, Associate Professor of Obstetrics, Gynecology & Reproductive Sciences at UCSF, will facilitate the course, which features over twenty faculty  from multiple disciplines. The class will address abortion in the U.S. and around the world, framing the issue in a public health context. The aim of the course is to fill in the gaps left by the exclusion of abortion from mainstream curricula.

The course will run from October 13 through November 24, 2014. This course is geared toward clinicians, health care workers, and students. However, there are no prerequisites, and anyone is welcome to take the course. To enroll, go to coursera.org/course/abortion.



Women denied an abortion more likely to stay in abusive relationships

A long-term study among women seeking abortion in the U.S. showed that 8% of women sought an abortion because they had abusive partners. New research from this UCSF Bixby Center team shows that, compared to women who were able to end an unwanted pregnancy, those who could not access abortion care and ultimately gave birth were more likely to remain in physically abusive relationships over the next two and half years. Physical abuse included being pushed, hit, slapped, kicked, or choked. They concluded that “having a baby with an abusive man, compared to terminating the unwanted pregnancy, makes it harder to leave the abusive relationship.”

Read more in Salon.com.


Editorial examines the need for routine pelvic exams

In new guidelines, the American College of Physicians recommends that doctors stop performing routine pelvic exams for most women. There is no evidence that pelvic exams are effective at detecting diseases like cervical cancer and plenty to suggest that the procedure provokes fear, anxiety and pain in many women, according to the new practice guideline. In an editorial accompanying the new guidelines, UCSF researchers discuss the efficacy of routine pelvic exams and possible reaction among women's health care providers to the new guidelines. The guidelines build on the Bixby Center's longstanding and rigorous research on pelvic exams, cervical cancer and birth control.

The pelvic exam has “held a prominent place in women’s health for many decades and has come to be more of a ritual than an evidence-based practice.” The new recommendations may be “controversial” since the exam has “long been considered a fundamental component” of women’s health visits. For instance, 2012 guidelines from the American College of Obstetricians and Gynecologists continued to recommend annual pelvic exams for all women ages 21 and older, and a recent survey revealed that US Ob-Gyns conduct the exam for the vast majority of patients. “Ending such a prevalent practice with widespread support among women’s health providers will be met with formidable challenges,” according to the authors.

Even if the new recommendations do not change why and how often doctors perform pelvic exams, they should “prompt champions of this examination to clarify its goals and quantify its benefits and harms.” Given current evidence, providers who continue to offer the exam should at least be aware of the “uncertainty of its benefits and its potential to cause harm through false-positive testing and the cascade of events it prompts.


Improving birth control access for women living with HIV

Although contraception is an important preventive health care tool for all women, many women face barriers when trying to access birth control. In particular, HIV-positive women face unique challenges, such as misconceptions among health care providers about what methods are safe. In fact, there are no medical reasons to restrict contraceptive access to women at risk of HIV, and only one class of HIV medications—known as protease inhibitors—may interfere with hormonal contraception.

In order to better understand this issue, researchers with the UCSF Bixby Center surveyed doctors and nurses working in HIV-prevalent areas of South Africa and Zimbabwe. They found that most providers (85%) offered women oral contraceptive pills, but only about a quarter considered the pill appropriate for women with HIV or at risk of HIV. A higher proportion of providers considered injectable contraceptives appropriate for HIV-positive women (46%) or women at risk of HIV (42%). Few providers considered emergency contraception appropriate for women with HIV (13%) or at risk of HIV (16%).

These findings emphasize the urgent need to improve health care providers' knowledge about contraceptive safety, especially among providers caring for HIV-positive women. Integrating family planning and HIV care has already been shown to improve the quality of contraceptive care. Having access to a wide range of birth control options can help women protect their health and wellbeing, and make important decisions about their lives and families.