Chelsea Polis

Population Council · Center for Biomedical Research

Objective: To summarize best available prospective data on typical and perfect use effectiveness of fertility awareness-based methods for avoiding pregnancy. Data sources: We conducted a systematic review of studies published in English, Spanish, French, or German by June 2017 in MEDLINE, EMBASE, CINAHL, Web of Science, and ClinicalTrials.gov....

Background: In March 2018, Dr. Martin C. Koch and colleagues published an analysis purporting to measure the effectiveness of the Daysy device and DaysyView app for the prevention of unintended pregnancy. Unfortunately, the analysis was flawed in multiple ways which render the estimates unreliable. Unreliable estimates of contraceptive effectivene...

Introduction: Concern about side effects and health issues are common reasons for contraceptive non-use or discontinuation. Contraceptive-induced menstrual bleeding changes (CIMBCs) are linked to these concerns. Research on women's responses to CIMBCs has not been mapped or summarized in a systematic scoping review. Methods: We conducted a syste...

STUDY QUESTION Can infertility prevalence be estimated using a current duration (CD) approach when applied to nationally representative Demographic and Health Survey (DHS) data collected routinely in low- or middle-income countries? SUMMARY ANSWER Our analysis suggests that a CD approach applied to DHS data from Nigeria provides infertility preval...

Objective and design: Some studies suggest that specific hormonal contraceptive (HC) methods (particularly depot medroxyprogesterone acetate [DMPA]) may increase women's HIV acquisition risk. We updated a systematic review to incorporate recent epidemiological data. Methods: We searched for articles published between 1/15/2014-1/15/2016, and han...

Background Mifepristone is a selective progesterone receptor modulator with decades of data demonstrating its potential as a highly effective emergency as well as non-emergency contraceptive. Despite considerable evidence pointing to the potential effectiveness of mifepristone as a non-emergency contraceptive, no systematic review has been conducte...

Background Abortion has been legal for multiple indications in Ghana since 1985, and efforts have been made to expand the availability of safe abortion care in the years since. However clandestine, and potentially unsafe, abortions remain common, suggesting numerous barriers to access persist; one possible barrier is poor knowledge of the abortion...

Objective We sought to develop consensus recommendations for improved measurement of contraceptive-induced menstrual changes (CIMCs) in contraceptive clinical trials to build upon previous standardization efforts. Study Design We undertook a virtual consensus-building process using a modified Delphi approach, incorporating aspects of Nominal Group...

The COVID-19 pandemic in the United States caused disruptions in care seeking and delivery during the spring of 2020, including for contraceptive care. We examined how some individuals experienced and responded to barriers to accessing contraceptive care by conducting a content analysis of relevant Reddit posts. We collected 2666 posts by scraping...

The COVID-19 pandemic has disproportionate effects on people living in low-and middle-income countries (LMICs), exacerbating weak health systems. We conducted a scoping review to identify, map, and synthesise studies in LMICs that measured the impact of COVID-19 on demand for, provision of, and access to contraceptive and abortion-related services,...

Background : Contraceptive-induced menstrual changes (CIMCs) can affect family planning (FP) users’ lives in both positive and negative ways, resulting in both opportunities and consequences. Despite this, and despite the important links between FP and menstrual health (MH), neither field adequately addresses CIMCs, including in research, product d...

Background Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana. Methods We utilize...

Plain English summary Young Ghanaian women can experience difficulties accessing sexual and reproductive health services, and many are not using contraception despite wanting to avoid pregnancy. To better understand their needs, we describe their preferences and behaviors around contraception and abortion. We surveyed a nationally representative sa...

Few studies in low- and middle-income countries have examined the use of fertility awareness-based methods (FABMs) for pregnancy prevention. Understanding the prevalence of FABM use among Ghanaian contraceptors and the characteristics and practices of users is essential. Our 2018 nationally representative survey of Ghanaian women included detailed...

Objective To understand the barriers and facilitators of hormonal contraceptive use among Ghanaian women, in order to help improve contraceptive counseling and reduce the high rates of unintended pregnancy. Study design We conducted a nationally representative community-based survey of 4139 women aged 15-49 in 2018, and used descriptive statistics...

Perceived infertility is an understudied phenomenon in low- and middle-income countries, where biomedical infertility can have severe consequences, particularly for women. We conducted a nationally representative survey of Ghanaian women, estimated the prevalence of and reasons for perceived infertility, and assessed factors associated with higher...

Context: Perceived infertility-an individual's belief that she or he is unable to conceive or impregnate a partner-may lead to contraceptive nonuse and unintended pregnancy, among other concerns, but has not been widely studied in low-income settings. Methods: A measure of perceived infertility previously used in the United States was included i...

Introduction Induced abortion estimates are critical for reproductive health programming. In countries like Ghana where abortion is somewhat legally restricted and highly stigmatised, official records are incomplete and different approaches are needed to measure abortion incidence. We conducted a study in Ghana to test five methodologies for estima...

Introduction Induced abortion is legally permitted in Ghana under specific conditions, but access to services that meet guidelines approved by government is limited. As part of a larger project comparing five methodologies to estimate abortion incidence, we implemented an indirect estimation approach: the Abortion Incidence Complications Methodolog...

Contraceptive failure is a major contributor to unintended pregnancy worldwide. DHS retrospective calendars, which are the most widely used data source for estimating contraceptive failure in low‐income countries, vary in quality across countries and surveys. We identified surveys with the most reliable calendar data and analyzed 105,322 episodes o...

Access to safe and effective contraceptive choices is a reproductive right and contributes tremendously to improvements in maternal and child health. Progestin-only injectables, particularly intramuscularly injected depot medroxyprogesterone acetate (DMPA-IM), have received increased attention given findings suggesting a potential association with...

Objectives: Contraceptive prevalence in the United States is typically calculated according to the most effective method of contraception reported. This could theoretically underestimate the number of women using fertility-awareness based methods (FABMs), including those who use other methods (e.g., condoms) during the fertile window, but the exte...

Objectives Abortion complications cause significant morbidity and mortality. We aimed to assess the severity and factors associated with abortion complications (induced or spontaneous), and the management of postabortion care (PAC) in Zimbabwe. Design Prospective, facility-based 28 day survey among women seeking PAC and their providers. Setting 1...

Objective: We modeled the potential impact of novel male contraceptive methods on averting unintended pregnancies in the US, South Africa, and Nigeria. Study design: We used an established methodology for calculating the number of couple-years of protection (CYP) provided by a given contraceptive method mix. We compared a "current scenario" (ref...

Background In Malawi, abortion is legal only if performed to save a woman’s life; other attempts to procure an abortion are punishable by 7–14 years imprisonment. Most induced abortions in Malawi are performed under unsafe conditions, contributing to Malawi’s high maternal mortality ratio. Malawians are currently debating whether to provide additio...

http://www.guttmacher.org/pubs/contraceptive-failure-rates-in-developing-world.pdf

Background: While most unintended pregnancies occur because couples do not use contraception, contraceptive failure is also an important underlying cause. However, few recent studies outside of the United States have estimated contraceptive failure rates, and most such studies have been restricted to married women, to a limited number of countries...

A 2014 technical brief examining evidence on drug interactions between hormonal contraception and antiretroviral medications; produced in collaboration with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Office of Population and Reproductive Health at the U.S. Agency for International Development (USAID), with technical input f...

A 2013 brief explaining evidence on hormonal contraceptive methods and HIV acquisition; produced in collaboration with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Office of Population and Reproductive Health at the U.S. Agency for International Development (USAID).

Objectives: Worldwide, women face sexual and reproductive health (SRH) risks including unintended pregnancy and sexually transmitted infections (STIs) including HIV. Multipurpose prevention technologies (MPTs) combine protection against two or more SRH risks into one product. Male and female condoms are the only currently available MPT products, b...

Effective family planning with modern contraception is an important intervention to prevent unintended pregnancies which also provides personal, familial, and societal benefits. Contraception is also the most cost-effective strategy to reduce the burden of mother-to-child HIV transmission for women living with HIV who wish to prevent pregnancy. The...

Whether use of various types of hormonal contraception (HC) affect risk of HIV acquisition is a critical question for women’s health. For this systematic review, we identified 22 studies published by January 15, 2014 which met inclusion criteria; we classified thirteen studies as having severe methodological limitations, and nine studies as “inform...

Progestin-only contraceptive injectables and implants are highly effective, longer-acting contraceptive methods that can be used in most circumstances. Globally, 6% of women using modern contraception use injectables and 1% use implants. Injectables are predominantly used in sub-Saharan Africa, and account for 43% of modern contraceptive methods us...

Demographic and Health Survey (DHS) data could potentially inform optimal strategies to reach women having unmet need with contraceptive services through integrated service delivery. Using 2010-11 DHS data from Nepal, Senegal, and Uganda, we estimate the proportion of married or cohabitating women of reproductive age (MWRA) having unmet need for fa...

Introduction Sayana Press, a subcutaneous formulation of depot medroxyprogesterone acetate (DMPA) prefilled in a Uniject injection system, could potentially improve and expand contraceptive injection services, but acceptability of Sayana Press is unknown. HIV-positive women have a particular need for contraception to avoid unintended pregnancy and...

Introduction: Determining whether hormonal contraception, particularly the injectable contraceptive depot-medroxyprogesterone acetate (DMPA), increases a woman's risk of HIV acquisition is a priority question for public health. However, assessing the relationship between various hormonal contraceptive methods and HIV acquisition with observational...

Whether or not the use of hormonal contraception affects risk of HIV acquisition is an important question for public health. We did a systematic review, searching PubMed and Embase, aiming to explore the possibility of an association between various forms of hormonal contraception and risk of HIV acquisition. We identified 20 relevant prospective s...

In their recent paper Bayer and colleagues argue that efforts to increase use of emergency contraceptive pills (ECPs) containing the active agent ulipristal would be cost-effective because savings from a reduction in unintended pregnancies would outweigh the cost of the drug. However a systematic literature review published simultaneously on the jo...

Objective: Systematically assess from the literature whether women living with HIV who use hormonal contraception are at increased risk of HIV-disease progression compared with those who do not use hormonal contraception. Methods: We searched PUBMED and EMBASE for articles published in peer-reviewed journals through December 15, 2011 for evidenc...

OBJECTIVE:: To systematically review epidemiologic evidence assessing whether hormonal contraception (HC) alters the risk of HIV transmission from an HIV-positive woman to an HIV-negative male partner. DESIGN:: Systematic review. METHODS:: We included articles published or in press through December 15, 2011. We assessed studies with direct evidence...

Background: Some, but not all, observational studies have suggested an increase in the risk of HIV acquisition for women using injectable hormonal contraception (IHC). Methods: We used country-level data to explore the effects of reducing IHC use on the number of HIV infections, the number of live births and the resulting net consequences on AID...

Background: There is limited evidence on the effect of injectable contraception on response to antiretroviral therapy (ART). Design: Using modified Poisson regression, we assessed data from 418 female Ugandan ART initiators to examine the effect of injectable contraceptive use on a composite virologic failure outcome (defined as failure to achie...

Perceived infertility is an individual's belief that she or he is unable to conceive or impregnate, regardless of whether this belief is medically accurate. This perception may lead to contraceptive nonuse, which may, in turn, lead to unintended pregnancy. Little research has examined perceived infertility among young adults, including potential as...

Little is known about what factors correlate with hormonal contraceptive (HC) use in HIV-infected women in sub-Saharan Africa. We assessed the trends in HC use among HIV-infected women in Rakai, Uganda; determined factors associated with HC use and considered whether those factors changed over time. HC use among HIV-infected women in Rakai increase...

This letter to the editor states its support of the provision of emergency contraception (EC) to individual women who will use it but suggests that the family planning community accept the unwelcome conclusion that advance EC provision alone will not likely result in a measurable population-level benefit. It concludes that limited valuable resource...

High viral load (VL) setpoint is a marker for rapid HIV progression. Few studies have examined whether use of hormonal contraception (HC) prior to HIV seroconversion affects VL setpoint. We determined VL setpoints in 285 HIV seroconverters using blood samples collected 6 months or more after estimated HIV seroconversion but before disease progressi...

To assess the association between hormonal contraceptive use and HIV progression. A retrospective analysis of 625 female HIV seroconverters from a Ugandan cohort study. Multivariate Cox regression analyses incorporating time-varying hormonal contraceptive exposure were used to estimate the adjusted hazard ratios of death, and a composite outcome of...

Claims that women who have elective abortions will experience psychological distress have fueled much of the recent debate on abortion. It has been argued that the emotional sequelae of abortion may not occur until months or years after the event. Despite unclear evidence on such a phenomenon, adverse mental health outcomes of abortion have been us...

To assess whether reported coercion at sexual debut is associated with a greater lifetime risk of attempting an abortion among women in Rakai, Uganda. Analysis of data from sexually experienced, ever-pregnant women in a longitudinal, population-based, open cohort study in 56 rural communities in Rakai, Uganda (n=4784). For univariate analysis, the...

Three randomized trials in Africa have shown that adult male circumcision reduces HIV acquisition in men by approximately 60%. It is biologically plausible that circumcision reduces HIV risk in men because the inner mucosa of the foreskin is lightly keratinized and has a high density of dendritic cells and other HIV target cells, making it vulnerab...

To investigate the relationship between adult male circumcision and sexual satisfaction and function in men, as observational studies on the effect of adult male circumcision on sexual satisfaction show conflicting results. We investigated self-reported sexual satisfaction and function among men enrolled in a randomized trial of male circumcision f...

Advance provision of emergency contraception can circumvent some obstacles to timely use. We performed a meta-analysis to summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. In August 2006, we se...

Emergency contraceptive pills can prevent unwanted pregnancy if taken soon after unprotected sex. Getting a prescription for emergency contraception can be difficult and time-consuming. Giving emergency contraception to women in advance could ensure that women have it on hand in case they need it. We searched for studies comparing women who got eme...

We systematically reviewed data on effects of increased access to emergency contraceptive pills on pregnancy rates and use of the pills. We searched MEDLINE, POPLINE, EMBASE, and LILACS, and we consulted with experts. We included studies that compared the effect of different levels of access to emergency contraceptive pills on pregnancy rates, use...

Background: Emergency contraception can prevent pregnancy when taken after unprotected intercourse. Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision, in which women receive a supply of emergency contraception before unprotected sex, could circumvent some obstacles to timely use. Obje...

In May 2003, Ibis Reproductive Health and the Office of Population Research at Princeton University launched the first Arabic-language website dedicated to emergency contraception. During the first 19 months of the website’s operation, 212 individuals completed an on-line Arabic-language survey dedicated to visitor demographics, website quality, an...

This study was undertaken to examine the inclusion and extent of abortion education in accredited nurse practitioner (NP), physician assistant (PA) and certified nurse-midwifery (CNM) programs in the United States. In January 2000, a confidential survey requesting information about the curricular inclusion of eight reproductive health topics was ma...

Emergency contraception (EC) has the potential to reduce significantly the incidence of unintended pregnancy worldwide. In May 2003, the first Arabic-language web site dedicated to disseminating information about and increasing awareness of EC was launched. This paper examines patterns of web site use and user profiles over a 19-month period. Analy...

Access to emergency contraception (EC) is an important option for women wanting to prevent an unintended pregnancy. In California, emergency rooms (ERs) are required to provide survivors of sexual assault with information about and access to EC. This study assessed the likelihood that a woman calling a Catholic hospital in California to inquire abo...

Our study explored a largely unacknowledged obstacle to abortion access in Massachusetts: the unwillingness of nurses to staff abortion procedures. Evidence suggests that nurses tend to be more likely to oppose abortion than other medical professionals. However, the attitudes and practices of hospital-based nurses regarding abortion have not been t...