Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 38, Number 4, December 2006
FYI


STD TESTING MADE EASY

A Web-based program designed to facilitate self-administered chlamydia screening among women aged 14 and older received overwhelmingly favorable reviews from women who used it between July 2004 and January 2005.1 Visitors to the Web site, which was advertised to Maryland women in flyers and radio advertisements, were offered free screening kits that included a sterile swab, instructions for swabbing the vagina, contact information, consent forms, a questionnaire and a postage-paid return mailer. (Testing and, if necessary, treatment also were free of charge.) A total of 1,254 kits were requested; nine in 10 requests were made via e-mail, and the rest by phone or in person at participating pharmacies or community sites. Some 400 kits were mailed in for testing, and 10% contained samples that were chlamydia-positive. Nine in 10 women who mailed in kits said that they would like to collect their own sample, and the same proportion considered self-administered screening safe. Nearly all considered the procedure very easy (65%) or easy (26%), and none found it very difficult; 86% would use this method again. The preferred means for obtaining the kit was through the mail (reported by 73% of women). The investigators note that a Web-based program may have particular appeal to adolescents, for whom confidentiality concerns and costs are often barriers to care.

1. Gaydos CA et al., Internet-based screening for Chlamydia trachomatis to reach nonclinic populations with mailed self-administered vaginal swabs, Sexually Transmitted Diseases, 2006, 33(7):451–457.

NEW PROGRAM WILL TRACK HIV TREATMENTS AND OUTCOMES

A new, federally financed electronic network will provide "the first formal way to track HIV/AIDS treatments and outcomes on a broad, comprehensive scale," according to the project=paragraphs principal investigator.1 Seven medical centers will participate in the network, which will contain information on about 15,000 people with HIV or AIDS. Data will be collected at kiosks in medical center waiting rooms and will cover a range of topics, including symptoms, body image and adherence to medical regimens. The pooling of information should enable physicians to compare the actual effectiveness of various treatments with their effectiveness in clinical trials, and to examine how treatments for HIV and AIDS interact with those for conditions related to aging. Under the project grant, another five centers can be added to the network.

1. Altman LK, Electronic network to pool information about HIV, New York Times, Oct. 10, 2006, p. F7.

BEEN THERE, DONE THAT; NOW YOU TRY

Participation in a peer counseling program aimed at encouraging breast-feeding was associated with elevated rates of breast-feeding at 12 weeks among women who bore premature infants at an inner-city hospital in 2001–2004.1 Specially trained local-area women with breast-feeding experience who served as peer counselors visited with program participants within 72 hours after they delivered and kept in weekly contact with them for six weeks. Outcomes among these women were compared with those among a similar group, who received standard of care treatment, including access to breast-feeding classes and to professional staff who are trained in breast-feeding management. At 12 weeks, participants had nearly three times as high odds of breast-feeding (exclusively or with supplemental feeding) as controls (odds ratio, 2.8); the odds of breast-feeding at 12 weeks also were higher among black women with peer counselors than among other black mothers (3.6). Noting that several professional groups encourage prolonged breast-feeding, the researchers remark that this practice probably is especially important for premature infants, who face many health risks.

1. Merewood A et al., The effect of peer counselors on breastfeeding rates in the neonatal intensive care unit: results of a randomized controlled trial, Archive of Pediatrics and Adolescent Medicine, 2006, 160(7):681–685.

PATCH VS. PILL: PATCH LOSES

The pill outperformed the contraceptive patch in terms of continuation and effectiveness in a cohort of New York State women, most of whom were at high risk for unintended pregnancy and abortion.1 The cohort consisted of 1,230 women attending one of three Planned Parenthood clinics between late 2003 and early 2005, of whom 579 obtained the pill and 651 the patch; none had used hormonal contraceptives before. Nine in 10 women were classified as being at high risk because they were younger than 16, were nonwhite or Hispanic, had government health coverage or had had an abortion. Patch users were significantly more likely than pill users not to return to the clinic for follow-up (45% vs. 30%); among those who returned, patch users were significantly less likely than pill users to continue their method beyond the first 70 days (67% vs. 89%). Continuation of patch use was associated with working full-time but not with other socioeconomic or demographic variables. Over the course of the study, pill users had 3.6 pregnancies per 100 woman-years of use, and patch users had 14.8. The researchers encourage efforts to explore ways that providers can help women at high risk to use the patch effectively.

1. Bakhru A and Stanwood N, Performance of contraceptive patch compared with oral contraceptive pill in a high-risk population, Obstetrics & Gynecology, 2006, 108(2):378–386.

SCHOOL HEALTH CENTERS MAY HELP LOWER FERTILITY

An analysis of fertility rates among black adolescents in Denver suggests that school-based health centers may help teenagers avoid childbearing.1 Fertility declined among black teenagers throughout the country in the mid-1990s; a particularly steep drop in Colorado was driven by sharp declines in Denver. Between 1992 and 1997, the fertility rate among black teenagers in that city fell by 77% (from 165 to 38 births per 1,000 female students) in areas where public high schools had comprehensive health centers. During the same interval, the rate fell by significantly less—56% (from 86 to 38 per 1,000)—in areas without school-based health centers. The analysts observe that if the 56% decline represents a secular trend, then in the absence of school health centers, the rate in areas with these facilities would have fallen to 73 per 1,000, or nearly twice the actual figure for 1997. They suggest that the difference is due to school-based health centers=paragraph educational efforts and "aggressive identification, intervention, and follow-up with students with high-risk behaviors."

1. Ricketts SA and Guernsey BP, School- based health centers and the decline in black teen fertility during the 1990s in Denver, Colorado, American Journal of Public Health, 2006, 96(9):1588–1592.

BUSINESS IS BUSINESS—OR IS IT?

Do "pregnancy clinics" that seek to dissuade women from having abortions really believe that their tactics are essentially just business plans? Apparently so, according to a clinic director in Maryland, quoted as saying that they set up shop close to abortion clinics "just like McDonald=paragraphs and Starbucks look for competitors to be next to."1 In contrast to McDonald=paragraphs and Starbucks, however, pregnancy clinics do not always deliver what they advertise. Abortion rights advocates contend that although they present themselves as neutral clinical facilities, they are driven by a conservative agenda and aim to confuse and frighten vulnerable women. An increasingly popular tactic among these clinics is to show pregnant women ultrasound images of their fetus; a 2005 sur-vey of a large network of pregnancy clinics found that nearly three-quarters of women who had been "strongly leaning" toward having an abortion changed their minds after seeing a sonogram.

1. Chandler MA, Antiabortion centers offer sonograms to further cause, Washington Post, Sept. 9, 2006, p. A1.

FLY THE FRIENDLY SKIES

Working with national governments, nongovernmental organizations and foundations, a new organization, UNITAID, has launched an innovative scheme to fight AIDS, malaria and tuberculosis.1 Participating countries will levy a tax on airline tickets to help "provide a stable and continuous source of financing to boost public health systems in developing countries [and] to facilitate poor people=paragraphs access to drugs."2 As many as 14 countries may participate in the initiative next year, when the tax is expected to bring in about $300 million. France, which began collecting the airline tax this summer, is expected to contribute $250 million of that total; the United States does not plan to participate.

1. UNITAID, UNITAID=paragraphs core principles, <http://www.unitaid.ey/EN http://www.unitaid.eu/EN-Inutaid-unis-pour-soigner.html>, accessed Oct. 12, 2006.

2. Dugger CW, Five nations to tax airfare to raise funds for AIDS drugs, New York Times, Sept. 19, 2006, <http:// www.nytimes.com/2006/09/19/world/19health.html?_r=1&ref=world&oref=slogin>, accessed Sept. 25, 2006.

U.S. ABORTION TRAINING

In a 2004 survey of directors of obstetrics and gynecology residency programs, 51% of respondents said that their programs routinely provide abortion training (although residents may opt out if they have religious or moral objections), 39% that optional abortion training is available and 10% that their programs do not provide abortion training.1 Routine training is most common in programs that train seven or more residents a year (71%); those located in New England (62%), the Mid-Atlantic region (76%) or Pacific states (80%); and those with no religious affiliation (55%). In 85% of programs with routine training, at least half of residents learn to perform first-trimester surgical abortions; in 59%, at least half are trained to provide first-trimester medical abortion. Thirty-six percent of these programs train half or more of residents in second-trimester dilation and evacuation; 51%, in second-trimester induction. By contrast, only 14–31% of programs that offer abortion training as an option say that at least half of residents learn any of these procedures. Survey respondents represented 73% of U.S. obstetrics and gynecology training programs; in a 1998 survey with a similar response rate, 31% of programs were reported to offer routine abortion training.

1. Eastwood KL et al., Abortion training in United States obstetrics and gynecology residency programs, Obstetrics & Gynecology, 2006, 108(2): 303–308.

CAN DES RISK BE PASSED ON?

Certain risks associated with prenatal exposure to diethylstilbestrol (DES) may be carried over to the next generation, according to results of a study of 463 women whose mothers had been exposed to DES prenatally and 330 whose mothers had not been exposed to the drug.1 Daughters of DES-exposed women began having regular menstrual periods at a later age than others (mean, 16.2 vs. 15.8 years), had had fewer live births (mean, 1.6 vs. 1.9) and had higher odds of reporting that their menstrual periods were usually irregular (odds ratio, 1.5). The two groups had similar odds of having experienced amenorrhea or infertility, having been pregnant, having had a live birth and having had an adverse birth outcome (miscarriage, ectopic pregnancy, stillbirth, neonatal death or hydatidiform mole). The analysts acknowledge that many women in the study cohort, who were largely younger than 25 and unmarried, had not yet attempted to start families, and the findings are therefore preliminary. By the same token, they point out that the findings are "consistent with speculation that DES exposure during a critical window in human development results in heritable changes in gene function."

1. Titus-Ernstoff L et al., Menstrual and reproductive characteristics of women whose mothers were exposed in utero to diethylstilbestrol (DES), International Journal of Epidemiology, 2006, 35(4):862–868.