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FDA discourages use of laparoscopic power morcellation for removal of uterus or uterine fibroids

April 18, 2014 Comments off

FDA discourages use of laparoscopic power morcellation for removal of uterus or uterine fibroids
Source: U.S. Food and Drug Administration

In a safety communication notice issued today, the U.S. Food and Drug Administration discouraged the use of laparoscopic power morcellation for the removal of the uterus (hysterectomy) or uterine fibroids (myomectomy) in women because, based on an analysis of currently available data, it poses a risk of spreading unsuspected cancerous tissue, notably uterine sarcomas, beyond the uterus.

Laparoscopic power morcellation is one of several available treatments for fibroids. It is a procedure that uses a medical device to divide the uterine tissue into smaller pieces or fragments so it can be removed through a small incision in the abdomen, such as during laparoscopy.

Uterine fibroids are non-cancerous growths that originate from the smooth muscle tissue in the wall of the uterus. According to the National Institutes of Health, most women will develop uterine fibroids at some point in their lives. While most uterine fibroids do not cause problems, they can cause symptoms, such as heavy or prolonged menstrual bleeding, pelvic pressure or pain, and frequent urination, sometimes requiring medical or surgical therapy.

Based on an analysis of currently available data, the FDA has determined that approximately 1 in 350 women who are undergoing hysterectomy or myomectomy for fibroids have an unsuspected type of uterine cancer called uterine sarcoma. If laparoscopic power morcellation is performed in these women, there is a risk that the procedure will spread the cancerous tissue within the abdomen and pelvis, significantly worsening the patient’s likelihood of long-term survival.

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Growing Gap Between First Sex and First Birth Means Women Face Longer Period of Risk for Unintended Pregnancy

April 15, 2014 Comments off

Growing Gap Between First Sex and First Birth Means Women Face Longer Period of Risk for Unintended Pregnancy
Source: Guttmacher Institute

The typical age at which teens first have sex has remained relatively stable over the past several decades, increasing slightly to 17.8 for women and 18.1 for men in the most recent cohort for whom data are available. For women coming of age in the mid-2000s, the median age at first sex was about the same as that of women 35 years earlier, according to “Trends in Ages at Key Reproductive Transitions in the United States, 1951–2010,” by Lawrence B. Finer and Jesse M. Philbin. However, the typical time between first sex and first birth has increased from three years for women born in 1940 to almost 10 years for women born in 1982.

“This is the period of highest risk for unintended pregnancy,” says Dr. Finer. “Later childbearing means many women are at risk for a decade or more before they have kids. The growing length of this period makes it vital that women have access to a wide range of effective methods of contraception—not just the condoms and pills that women commonly use now, but also highly effective long-acting methods like the IUD and the implant. The latter methods don’t require any regular action on the woman’s part, which might be particularly helpful for teens and young adults.”

CRS — Abortion: Judicial History and Legislative Response (updated)

April 11, 2014 Comments off

Abortion: Judicial History and Legislative Response (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

In 1973, the U.S. Supreme Court concluded in Roe v. Wade that the U.S. Constitution protects a woman’s decision to terminate her pregnancy. In Doe v. Bolton, a companion decision, the Court found that a state may not unduly burden the exercise of that fundamental right with regulations that prohibit or substantially limit access to the means of effectuating the decision to have an abortion. Rather than settle the issue, the Court’s rulings since Roe and Doe have continued to generate debate and have precipitated a variety of governmental actions at the national, state, and local levels designed either to nullify the rulings or limit their effect. These governmental regulations have, in turn, spawned further litigation in which resulting judicial refinements in the law have been no more successful in dampening the controversy.

State Policy Trends: More Supportive Legislation, Even As Attacks on Abortion Rights Continue

April 10, 2014 Comments off

State Policy Trends: More Supportive Legislation, Even As Attacks on Abortion Rights Continue
Source: Guttmacher Institute

The 2014 legislative session got off to a fast start, with legislators introducing a combined 733 provisions related to sexual and reproductive health and rights in nearly all the states that have legislative sessions this year (legislatures in Montana, Nevada, North Dakota and Texas will not meet in 2014). See here for the full analysis of the first quarter of 2014.

Significantly, legislators quickly showed a clear interest in protecting or expanding access to sexual and reproductive health care. Some 64 provisions have been introduced so far this year to expand or protect access to abortion, more than had been introduced in any year in the last quarter century. And only three months into the year, two new provisions protecting abortion rights have been enacted, and three others have passed one legislative chamber. Similarly, seven measures designed to expand access to other sexual and reproductive health services have passed at least one legislative body in six states and the District of Columbia.

As in recent years, however, state legislatures continued to take aim at abortion rights. Legislators in 38 states introduced 303 provisions seeking to limit women’s access to care. By March 31, three new abortion restrictions had been enacted, and 36 had passed one legislative chamber.

Vital Signs: Births to Teens Aged 15–17 Years — United States, 1991–2012

April 8, 2014 Comments off

Vital Signs: Births to Teens Aged 15–17 Years — United States, 1991–2012
Source: Morbidity and Mortality Weekly Report (CDC)

Background:
Teens who give birth at age 15–17 years are at increased risk for adverse medical and social outcomes of teen pregnancy.

Methods:
To examine trends in the rate and proportion of births to teens aged 15–19 years that were to teens aged 15–17 years, CDC analyzed 1991–2012 National Vital Statistics System data. National Survey of Family Growth (NSFG) data from 2006–2010 were used to examine sexual experience, contraceptive use, and receipt of prevention opportunities among female teens aged 15–17 years.

Results:
During 1991–2012, the rate of births per 1,000 teens declined from 17.9 to 5.4 for teens aged 15 years, 36.9 to 12.9 for those aged 16 years, and 60.6 to 23.7 for those aged 17 years. In 2012, the birth rate per 1,000 teens aged 15–17 years was higher for Hispanics (25.5), non-Hispanic blacks (21.9), and American Indians/Alaska Natives (17.0) compared with non-Hispanic whites (8.4) and Asians/Pacific Islanders (4.1). The rate also varied by state, ranging from 6.2 per 1,000 teens aged 15–17 years in New Hampshire to 29.0 in the District of Columbia. In 2012, there were 86,423 births to teens aged 15–17 years, accounting for 28% of all births to teens aged 15–19 years. This percentage declined from 36% in 1991 to 28% in 2012 (p <0.001). NSFG data for 2006–2010 indicate that although 91% of female teens aged 15–17 years received formal sex education on birth control or how to say no to sex, 24% had not spoken with parents about either topic; among sexually experienced female teens, 83% reported no formal sex education before first sex. Among currently sexually active female teens (those who had sex within 3 months of the survey) aged 15–17 years, 58% used clinical birth control services in the past 12 months, and 92% used contraception at last sex; however, only 1% used the most effective reversible contraceptive methods.

Conclusions:
Births to teens aged 15–17 years have declined but still account for approximately one quarter of births to teens aged 15–19 years.

Implications for public health practice:
These data highlight opportunities to increase younger teens exposure to interventions that delay initiation of sex and provide contraceptive services for those who are sexually active; these strategies include support for evidence-based programs that reach youths before they initiate sex, resources for parents in talking to teens about sex and contraception, and access to reproductive health-care services.

Moving Forward: Family Planning in the Era of Health Reform

April 8, 2014 Comments off

Moving Forward: Family Planning in the Era of Health Reform (PDF)
Source: Guttmacher Institute
From press release:

The highly successful U.S. family planning effort helps almost nine million disadvantaged women each year to plan their families and protect their health, while also substantially reducing rates of unintended pregnancy and saving taxpayers more than $10 billion, according to a new Guttmacher report. The report, Moving Forward: Family Planning in the Era of Health Reform, synthesizes the most up-to-date data and analyses to illustrate the current and future importance of family planning programs and the safety-net providers at the heart of this effort.

Circumcision Rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have?

April 7, 2014 Comments off

Circumcision Rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have?
Source: Mayo Clinic Proceedings

The objective of this review was to assess the trend in the US male circumcision rate and the impact that the affirmative 2012 American Academy of Pediatrics policy statement might have on neonatal circumcision practice. We searched PubMed for the term circumcision to retrieve relevant articles. This review was prompted by a recent report by the Centers for Disease Control and Prevention that found a slight increase, from 79% to 81%, in the prevalence of circumcision in males aged 14 to 59 years during the past decade. There were racial and ethnic disparities, with prevalence rising to 91% in white, 76% in black, and 44% in Hispanic males. Because data on neonatal circumcision are equivocal, we undertook a critical analysis of hospital discharge data. After correction for underreporting, we found that the percentage had declined from 83% in the 1960s to 77% by 2010. A risk-benefit analysis of conditions that neonatal circumcision protects against revealed that benefits exceed risks by at least 100 to 1 and that over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin. Other analyses show that neonatal male circumcision is cost-effective for disease prevention. The benefits of circumcision begin in the neonatal period by protection against infections that can damage the pediatric kidney. Given the substantial risk of adverse conditions and disease, some argue that failure to circumcise a baby boy may be unethical because it diminishes his right to good health. There is no long-term adverse effect of neonatal circumcision on sexual function or pleasure. The affirmative 2012 American Academy of Pediatrics policy supports parental education about, access to, and insurance and Medicaid coverage for elective infant circumcision. As with vaccination, circumcision of newborn boys should be part of public health policies. Campaigns should prioritize population subgroups with lower circumcision prevalence and a higher burden of diseases that can be ameliorated by circumcision.

See: Call for circumcision gets a boost from experts (Science Daily)

Abortion Coverage Under the Affordable Care Act: The Laws Tell Only Half the Story

March 31, 2014 Comments off

Abortion Coverage Under the Affordable Care Act: The Laws Tell Only Half the Story
Source: Guttamacher Institute
From press release:

Consumers purchasing health coverage through the marketplaces created under the Affordable Care Act (ACA) have no easy way—and often no way at all—to find out whether a health plan covers abortion care, according to a new Guttmacher analysis. The analysis lays out how this lack of transparency can be addressed by the Obama administration, which has the authority to ensure health plan issuers make such information readily available to consumers nationwide.

Unanticipated Effects of California’s Paid Family Leave Program

March 28, 2014 Comments off

Unanticipated Effects of California’s Paid Family Leave Program (PDF)
Source: Institute for the Study of Labor

We examine the effect of California Paid Family Leave (CPFL) on young women’s (less than 42 years of age) labor force participation and unemployment. CPFL enables workers to take at most six weeks of paid leave over a 12 month period in order to bond with new born or adopted children, or to care for sick family members or ailing parents. The policy benefits women, especially young women, since they are more prone to take such a leave. However, the effect of the policy on labor market outcomes is less clear. We apply difference-in-difference techniques to identify the effects of the CPFL legislation on young women’s labor force participation and unemployment. We find that the labor force participation rate, the unemployment rate, and the duration of unemployment among young women rose in California compared to states that did not adopt paid family leave. The latter two findings regarding higher young women’s unemployment and unemployment duration are unanticipated effects of the CPFL program. We utilize a unique placebo test to validate the robustness of these results.

Trends in Out-of-Hospital Births in the United States, 1990–2012

March 25, 2014 Comments off

Trends in Out-of-Hospital Births in the United States, 1990–2012
Source: National Center for Health Statistics

Key findings

  • The percentage of out-of-hospital births increased from 1.26% of U.S. births in 2011 to 1.36% in 2012, continuing an increase that began in 2004.
  • In 2012, out-of-hospital births comprised 2.05% of births to non-Hispanic white women, 0.49% to non-Hispanic black women, 0.46% to Hispanic women, 0.81% to American Indian women, and 0.54% to Asian or Pacific Islander women.
  • In 2012, out-of-hospital births comprised 3%–6% of births in Alaska, Idaho, Montana, Oregon, Pennsylvania, and Washington, and between 2% and 3% of births in Delaware, Indiana, Utah, Vermont, and Wisconsin. Rhode Island (0.33%), Mississippi (0.38%), and Alabama (0.39%) had the lowest percentages of out-of-hospital births.
  • In 2012, the risk profile of out-of-hospital births was lower than for hospital births, with fewer births to teen mothers, and fewer preterm, low birthweight, and multiple births.

Routine Prenatal Care Visits by Provider Specialty in the United States, 2009–2010

March 25, 2014 Comments off

Routine Prenatal Care Visits by Provider Specialty in the United States, 2009–2010
Source: National Center for Health Statistics

Key findings
Data from the 2009 and 2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey

  • At 14.1% of routine prenatal care visits in the United States in 2009–2010, women saw providers whose specialty was not obstetrics and gynecology (ob/gyn).
  • The percentage of routine prenatal care visits that were made to non-ob/gyn providers was highest (20.5%) among women aged 15–19.
  • Visits to non-ob/gyn providers accounted for a higher percentage of routine prenatal care visits among women with Medicaid (24.3%) and women with no insurance (23.1%) compared with women with private insurance (7.3%).
  • The percentage of routine prenatal care visits to non-ob/gyn providers was lower among women in large suburban areas (5.1%) compared with those in urban areas (14.4%) or in small towns or suburbs (22.4%).

Trends in Out-of-Hospital Births in the United States

March 21, 2014 Comments off

Trends in Out-of-Hospital Births in the United States
Source: National Center for Health Statistics

Key findings

  • The percentage of out-of-hospital births increased from 1.26% of U.S. births in 2011 to 1.36% in 2012, continuing an increase that began in 2004.
  • In 2012, out-of-hospital births comprised 2.05% of births to non-Hispanic white women, 0.49% to non-Hispanic black women, 0.46% to Hispanic women, 0.81% to American Indian women, and 0.54% to Asian or Pacific Islander women.
  • In 2012, out-of-hospital births comprised 3%–6% of births in Alaska, Idaho, Montana, Oregon, Pennsylvania, and Washington, and between 2% and 3% of births in Delaware, Indiana, Utah, Vermont, and Wisconsin. Rhode Island (0.33%), Mississippi (0.38%), and Alabama (0.39%) had the lowest percentages of out-of-hospital births.
  • In 2012, the risk profile of out-of-hospital births was lower than for hospital births, with fewer births to teen mothers, and fewer preterm, low birthweight, and multiple births.

The Miracle Drugs: Hormone Replacement Therapy and Labor Market Behavior of Middle-Aged Women

March 20, 2014 Comments off

The Miracle Drugs: Hormone Replacement Therapy and Labor Market Behavior of Middle-Aged Women (PDF)
Source: Institute for the Study of Labor

In an aging society, determining which factors contribute to the employment of older individuals is increasingly important. We examine the impact of medical innovations on the employment of middle-aged women focusing on the specific case of Hormone Replacement Therapy (HRT), a common treatment for the alleviation of negative menopausal symptoms. HRT medications were among the most popular prescriptions in the United States until 2002 when the Women’s Health Initiative Study – the largest randomized control trial on women ever undertaken – documented the health risks associated with their long term use. We exploit the release of these findings within a Fixed Effect Instrumental Variable framework to address the endogeneity in HRT use. Our results indicate substantial benefits of HRT use to the short-term employment of middle-aged women.

Guideline on the Use of Devices for Adult Male Circumcision for HIV Prevention

March 14, 2014 Comments off

Guideline on the Use of Devices for Adult Male Circumcision for HIV Prevention
Source: World Health Organization (via National Center for Biotechnology Information)

This guideline provides an evidence-based recommendation on the use of adult male circumcision devices for HIV prevention in public health programmes in high HIV prevalence, resource-limited settings. It also presents key programmatic considerations for the introduction and use of these devices in public health HIV prevention programmes. The primary audiences are policy- and decision-makers, programme managers, health-care providers, donors and implementing agencies.

The guideline was developed according to the WHO standards and requirements for guideline development. The process involved internal and external consultations with technical experts, national programme managers, consumer advocates and an evidence review methodologist. Two complementary annexes are also available.

Teen Births Are Falling: What’s Going On?

March 14, 2014 Comments off

Teen Births Are Falling: What’s Going On?
Source: Brookings Institution

The United States has experienced a remarkable 52 percent decline in teen childbearing since 1991. Understanding the causes of this decline are important for developing subsequent policies to continue this trend. This decline can be distinguished by two periods. Teen births fell at a rate of 2.5 percent per year between 1991 and 2008; that rate tripled to 7.5 percent per year between 2008 and 2012. We investigate these two periods separately.

As Supreme Court Takes Up Contraceptive Coverage Cases, New Guttmacher Analysis Puts the Facts Front and Center

March 12, 2014 Comments off

As Supreme Court Takes Up Contraceptive Coverage Cases, New Guttmacher Analysis Puts the Facts Front and Center
Source: Guttmacher Institute

The cases on the Affordable Care Act’s contraceptive coverage guarantee that will be heard by the U.S. Supreme Court on March 25 revolve around several important questions of fact that have been misinterpreted and obfuscated by the guarantee’s opponents. To help ensure that the debate is informed by facts, not misinformation, a new Guttmacher analysis—based in part on a Supreme Court amicus brief the Institute filed in January—sets the record straight.

“We want to clarify key points, including many that should be self-evident but have nevertheless been challenged by an ideological onslaught from anti-contraception activists,” says Adam Sonfield, a Guttmacher senior public policy associate and author of the new analysis. “Among these points are basics like the fact that contraception is distinct from abortion, that contraceptive methods aren’t interchangeable and that cost and lack of method choice can very much interfere with a woman’s ability to use the method that is most appropriate for her needs and circumstances.”

Sonfield presents extensive data from the Guttmacher Institute and other leading authorities that document why the ACA’s requirement that most private health plans cover contraceptive counseling, services and supplies without out-of-pocket costs for patients is necessary and appropriate.

Primary Cesarean Delivery Rates, by State: Results From the Revised Birth Certificate, 2006–2012

March 6, 2014 Comments off

Primary Cesarean Delivery Rates, by State: Results From the Revised Birth Certificate, 2006–2012 (PDF)
Source: National Center for Health Statistics

Objectives
This report describes state-specific trends in pri­ mary cesarean delivery rates from 2006 through 2012 for reporting areas that implemented the 2003 U.S. Standard Certificate of Live Birth by January 1, 2006, and from 2009 through 2012 for reporting areas that implemented the 2003 revision by January 1, 2009. State-specific changes by gestational age are also explored.

Methods
Data for 2006–2012 are based on 100% of singleton births to residents of the reporting areas that implemented the 2003 birth certificate revision by January 1 of each year. Results are not generalizable to the entire United States—the reporting areas do not represent a random sample of U.S. births.

Results
The primary cesarean delivery rate for the 2006 reporting area (19 states) increased from 21.9% in 2006 to 22.4% in 2009, and then declined to 21.9% in 2012. For the 2009 reporting area (28 states and New York City), the primary cesarean rate declined from 22.1% to 21.5% during 2009–2012. Rates for 16 of 29 areas declined during 2009–2012; the remaining states were unchanged. By gesta­ tional age, state-specific primary cesarean delivery rates at 38 weeks declined for 18 of 29 areas from 2009 to 2012; few state-specific changes were observed at other gestational ages. The primary cesarean delivery rate for the 38 states, District of Columbia, and New York City that were using the revised certificate by January 1, 2012, was 21.5%. State-specific rates ranged from 12.5% (Utah) to 26.9% (Florida and Louisiana).

Factors Associated with Successful Discontinuation of Hormone Therapy

February 18, 2014 Comments off

Factors Associated with Successful Discontinuation of Hormone Therapy
Source: Journal of Women’s Health

Background:
Careful management of symptoms, particularly sleep and mood disturbances, may assist women in discontinuing hormone therapy (HT). We sought to describe characteristics associated with successful HT cessation in women who attempted to discontinue estrogen pills/patches with or without progestin.

Methods:
We invited 2,328 women, aged 45–70, enrolled January 1, 2005, to May 31, 2006, at Group Health in Washington State and Harvard Vanguard Medical Associates in Massachusetts, to participate in a telephone survey about HT practices. For the sample, we selected 2,090 women with estrogen dispensings (pharmacy data) during the study period, 200 women without HT dispensing after January 2005, and 240 women with no estrogen dispensings; 1,358 (58.3%) completed the survey. These analyses are based on survey responses.

Results:
Among 802 women who attempted HT discontinuation, the mean age was 50 years, 93% were postmenopausal, 90% were white, 30% had had a hysterectomy, and 75% experienced hot flashes after discontinuation. Those who did not succeed had greater trouble sleeping (74% vs. 57%) and mood disturbances (51% vs. 34%) than those who succeeded. In multivariable analyses, factors associated with successful discontinuation included doctor advice (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.68–4.08), lack of symptom improvement (OR 4.21, CI 1.50–12.17), vaginal bleeding (OR 5.96, CI 1.44–24.6), and learning to cope with symptoms (OR 3.36, CI 2.21–5.11). Factors associated with unsuccessful HT discontinuation included trouble sleeping (OR 0.40, CI 0.26–0.61) and mood swings or depression (OR 0.63, CI 0.42–0.92).

Conclusions:
Doctor advice is strongly associated with successful HT discontinuation. Symptom management, particularly sleep and mood disturbances, may help women discontinue HT.

Worldwide prevalence of non-partner sexual violence: a systematic review

February 17, 2014 Comments off

Worldwide prevalence of non-partner sexual violence: a systematic review
Source: The Lancet

Background
Several highly publicised rapes and murders of young women in India and South Africa have focused international attention on sexual violence. These cases are extremes of the wider phenomenon of sexual violence against women, but the true extent is poorly quantified. We did a systematic review to estimate prevalence.

Methods
We searched for articles published from Jan 1, 1998, to Dec 31, 2011, and manually search reference lists and contacted experts to identify population-based data on the prevalence of women’s reported experiences of sexual violence from age 15 years onwards, by anyone except intimate partners. We used random effects meta-regression to calculate adjusted and unadjusted prevalence for regions, which we weighted by population size to calculate the worldwide estimate.

Findings
We identified 7231 studies from which we obtained 412 estimates covering 56 countries. In 2010 7·2% (95% CI 5·2—9·1) of women worldwide had ever experienced non-partner sexual violence. The highest estimates were in sub-Saharan Africa, central (21%, 95%CI 4·5—37·5) and sub-Saharan Africa, southern (17·4%, 11·4—23·3). The lowest prevalence was for Asia, south (3·3%, 0—8·3). Limited data were available from sub-Saharan Africa, central, North Africa/Middle East, Europe, eastern, and Asia Pacific, high income.

Interpretation
Sexual violence against women is common worldwide, with endemic levels seen in some areas, although large variations between settings need to be interpreted with caution because of differences in data availability and levels of disclosure. Nevertheless, our findings indicate a pressing health and human rights concern.

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Pregnancy- and Child-Related Legal and Policy Issues Concerning Justice-Involved Women

February 7, 2014 Comments off

Pregnancy- and Child-Related Legal and Policy Issues Concerning Justice-Involved Women (PDF)
Source: National Institute of Corrections

This document provides an overview of pregnancy- and child-related legal questions concerning justice-involved women that can be raised in correctional settings. It updates and expands the Legal Appendix, written by Southwestern Law School Professor Myrna Raeder, that is included in Gender-Responsive Strategies: Research, Practice, and Guiding Principles for Women Offenders, by Barbara Bloom and colleagues, published by the National Institute of Corrections (NIC) in 2003. The information presented here is expected to be pertinent to a wide audience, only some of whom have legal training. Commissioners of correctional departments and their legal staff, wardens, sheriffs, and other prison and jail administrators; community correctional officials; service providers; and stakeholders, including advocates for inmates, should all be able to reference this document as a starting point for analyzing family issues that affect a large percentage of female inmates. A variety of resources, legal and otherwise, are cited to help further research about these issues. Administrators and policymakers may find it useful to review their policies in light of these pregnancy- and child-related legal questions and answers, with the caveat that their responses must be dictated in part by the specific laws and policies that exist in the particular jurisdiction where their facility is located, and by the specific circumstances of each issue that arises.

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