Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 34, Number 4, July/August 2002
FYI


MIFEPRISTONE ON THE (MIS?)INFORMATION SUPERHIGHWAY

Women who search the Web to learn about medical abortion using mifepristone may not get a complete, objective picture, according to a review of 40 consumer-oriented Web sites providing detailed information about the procedure.1 Regardless of whether the sites favor medical abortion (15 sites), oppose it (16) or take no obvious stance (nine), fewer than four in five note an author's name, fewer than three in five state an academic or professional affiliation, and no more than half provide references for the information they present. The majority of sites, irrespective of ideology, explain mifepristone's mode of action (87-94%) and efficiency (78-94%), and discuss the pain and bleeding associated with the procedure (67-81%). However, a significantly higher proportion of those that support medical abortion than of those that oppose it provide links to sites with additional information (60% vs. 19%). And considerably higher proportions of opposing than supporting sites include incorrect information (56% vs. 7%) or graphic descriptions apparently intended to dissuade women from undergoing medical abortion (31% vs. 0%). These findings, the investigators observe, reinforce the need for "quality control of medical information on the Internet."

1. Mashiach RM, Seidman GI and Seidman DS, Use of mifepristone as an example of conflicting and misleading medical information on the Internet, BJOG, 2002, 109(4):437-442.

HOW DO CHILDREN DO AFTER IN VITRO?

Children born after in vitro fertilization have elevated odds of developing neurological problems, according to a Swedish population-based study.1 Of 5,680 children born to women who underwent in vitro fertilization between 1982 and 1995, 2% developed a disability, twice the proportion among 11,360 controls. The most common diagnoses among children born after in vitro fertilization were cerebral palsy and suspected developmental delay; the odds of these conditions were quadrupled (odds ratios, 3.7 and 4.0, respectively) for these children. Odds ratios remained elevated (2.8 and 2.0, respectively) when only singletons were considered, but the result for suspected developmental delay was not statistically significant; among twins, the risk of these diagnoses did not differ between children born after in vitro fertilization and others. Low birth weight and preterm birth were associated with increased risks of cerebral palsy and suspected developmental delay, but when these and other potentially confounding factors were taken into account, in vitro fertilization still had a significant effect on the risk of cerebral palsy (odds ratios, 2.1-2.9). Thus, while acknowledging the contribution of other factors to risks after in vitro fertilization, the researchers comment that an effect of the procedure itself "cannot be excluded."

1. Strömberg B et al., Neurological sequelae in children born after in-vitro fertilisation: a population-based study, Lancet, 2002, 359(9305):461-465.

MUST-SEE TV?

Three-quarters of 15-17-year-olds polled in April 2002 said that TV portrayals of sexual situations have an appreciable influence on the sexual behavior of youth their age, but only one in five said that what they see on TV influences their own behavior.1 Of the 503 participants in the telephone survey, 60% (52% of males and 69% of females) reported that they had ever learned something from a scene on TV that would help them say no to a sexual situation that made them uncomfortable; 43% overall (49% of those who were sexually active and 39% of others) had learned something about how to talk to a partner about safer sex. Nevertheless, only 11% considered any TV character a good role model for sexual decision- making. One-third of both males and females had talked to their parents about a sexual issue because of something they had seen on TV.

1. The Henry J. Kaiser Family Foundation, Teens, Sex and TV, Menlo Park, CA: The Henry J. Kaiser Family Foundation, 2002.

SWISS MOVEMENT

As the result of a referendum held in June, women in Switzerland will soon be able to get a legal abortion during the first 12 weeks of pregnancy simply by requesting it in writing and agreeing to receive counseling and medical advice.1 Seventy-two percent of voters approved the measure, which will considerably ease the country's 60-year-old abortion law. That law--one of the most restrictive in Europe--allows pregnancy termination only if the pregnancy endangers a woman's health or resulted from rape. (In practice, most Swiss women seeking abortions have been able to obtain them at clinics, usually on the grounds that a psychiatrist supported their decision.) The new law, which will go into effect in October, further provides that after 12 weeks, a woman may obtain an abortion if a physician agrees that continuing the pregnancy would cause her health problems or "profound distress." Also on the ballot was a measure that would have further restricted abortion, prohibiting it even in cases of rape; that proposal was voted down by 82% of the electorate.

1. Olson E, Swiss voters lift restriction on abortions, New York Times, June 3, 2002, <http://www.nytimes.com/2002/ 06/03/international/europe/03SWIS.html>, accessed June 4, 2002.

MEDICAL ABORTION: DECISIONS, DECISIONS

Two medical abortion regimens, one using methotrexate followed by misoprostol and the other using mifepristone followed by misoprostol, had generally similar profiles with respect to effectiveness, side effects, complications and acceptability in a multicenter, controlled trial.1 Roughly 500 women were assigned to each regimen, and in both groups, about 95% had a successful abortion without surgical intervention. The major difference in outcomes was that the abortion occurred more quickly for those using mifepristone than for those who took methotrexate (three vs. seven days, on average). Complication rates were similar for the two groups, as were the overall proportions who had side effects after taking either of the study drugs or the misoprostol. However, women using methotrexate were more likely than those in the mifepristone group to have fever, chills or diarrhea after taking the misoprostol; they also rated the worst of the pain slightly higher (6.3 vs. 5.8 on a scale of 0-10). The vast majority of both groups said that they would choose their method again, although the proportion was significantly higher among women who took mifepristone (88%) than among those who used methotrexate (83%).

1. Wiebe E et al., Comparison of abortions induced by methotrexate or mifepristone followed by misoprostol, Obstetrics & Gynecology, 2002,

CONDOMS AS A POLITICAL TOOL

Last issue's FYI reported on new, tony vending machines selling female condoms in Paris, which were installed as part of President Jacques Chirac's efforts to win women's votes in this spring's election. Now comes word that as nationwide elections in Germany near, the Social Democratic Party (the party of incumbent Chancellor Gerhard Schroëder) has begun selling condoms in its signature red color with the slogan "Feel Good, SPD."1 The party's condoms sell in boxes of 100 for about $40. Chancellor Schroëder's center-left coalition is running neck and neck with the conservative opposition.

1. Homola V, Germany: the joy of politics, New York Times, June 18, 2002, p. A9.

U.S. TEENAGE BIRTHRATE CONTINUES TO FALL

For the 10th consecutive year, the birthrate among U.S. women aged 15-19 declined between 2000 and 2001; the 5% drop brought the rate to an all-time low of 45.9 births per 1,000 teenagers.1 The decline was greater among 15-17-year-olds (8%) than among older adolescents (4%). Black teenagers and white women registered the largest declines (8% and 7%, respectively), and young women of Hispanic descent, the smallest (2%); intermediate declines occurred among Asians and Pacific Islanders (5%) and among American Indians (3%). Since 1991, the teenage birthrate has fallen by 26%; declines have been above average among 15-17-year-olds (35%) and black adolescents (37%). Health and Human Services Secretary Tommy G. Thompson commented that the nation has reached "an important milestone" in the fight to prevent teenage pregnancy, but he urges continued efforts at the community level.

1. Department of Health and Human Services, HHS report shows teen birth rate falls to new record low in 2001, news release, June 6, 2002, <www.hhs. gov/news/press/2002pres/20020606.html>, accessed June 6, 2002.

HEAVIEST WOMEN HAVE THE MOST PILL FAILURES

A woman's weight may affect how well oral contraceptives work for her, according to results of a retrospective cohort analysis of 755 randomly selected members of a health maintenance organization in Washington State.1 In the course of nearly 3,000 person-years of pill use, 106 pregnancies (or 3.8 per 100 person-years of use) occurred. The pregnancy rate was 5.6 per 100 person-years of use among women in the highest quartile of body weight, compared with 2.7-3.6 per 100 among those in the three lower quartiles. Analyses controlling for parity confirmed that women in the highest quartile had a significantly greater risk of experiencing pill failure than did all other women combined (relative risk, 1.6). The difference was not significant among users of high-dose pills, but the risk was elevated among those taking oral contraceptives with less than 50 mcg and, particularly, less than 35 mcg of estrogen (2.6 and 4.5, respectively). While acknowledging that they lacked detailed data about women's weight and contraceptive use that would lead to more definitive conclusions, the researchers remark that a woman's weight may "affect metabolism sufficiently to compromise contraceptive effectiveness" and may be an important consideration in her choice of the pill.

1. Holt VL, Cushing-Haugen KL and Daling JR, Body weight and risk of oral contraceptive failure, Obstetrics & Gynecology, 2002, 99(5, pt. 1):820-827.

WHAT IS WELFARE REFORM DOING FOR TEENAGERS?

Teenage women in the post-welfare reform era are less likely than their counterparts of two decades ago ever to have received welfare, and they have better outcomes related to welfare use, according to analyses of data from the 1979 and 1997 rounds of the National Longitudinal Survey of Youth.1 For example, 5% of 19-year-old women in the later survey whose family background placed them at high risk of going on welfare reported any welfare receipt, compared with 10% of similarly disadvantaged young women participating in the earlier survey. The proportions who had ever given birth were 19% and 28%, respectively; 16% of those surveyed in 1997, but 26% of those surveyed in 1979, had dropped out of school. Furthermore, teenage mothers are now less likely to receive welfare or to live with a spouse, and are more likely to live with at least one parent, than were young mothers in the late 1970s. The analysts caution that "establishing definitively that welfare reform is responsible for these changes will require further investigation."

1. Kaestner R, Korenman S and O'Neill J, Has welfare reform changed teenage behaviors? Working Paper, New York: National Bureau of Economic Research, 2002, No. w8932.