James Trussell

• Princeton University

Emergency contraceptive (EC) pills may be less effective for women with higher body mass index (BMI), but little is known about public response to the fact that EC may lose efficacy as weight increases. In November 2013, European authorities changed the label for a levonorgestrel EC product to warn of a reduction in effectiveness for women with hig...

Background Incorporating thorough contraception counselling into an abortion consultation is challenging. We compared contraceptive choices and methods received between two counselling models: (1) telephone counselling separate from the abortion consultation and (2) face-to-face counselling integrated into the consultation. Methods We obtained de-...

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...

Objective: To examine reasons for seeking abortion services outside the formal healthcare system in Great Britain, where abortion is legally available. Study design: We conducted a mixed-methods study among women resident in England, Scotland, and Wales who requested at-home medication abortion through online telemedicine initiative Women on Web...

Objectives To assess self reported outcomes and adverse events after self sourced medical abortion through online telemedicine. Design Population based study. Setting Republic of Ireland and Northern Ireland, where abortion is unavailable through the formal healthcare system except in a few restricted circumstances. Population 1000 women who underw...

Appendix: Supplementary table

Context: Contraceptive failure rates measure a woman's probability of becoming pregnant while using a contraceptive. Information about these rates enables couples to make informed contraceptive choices. Failure rates were last estimated for 2002, and social and economic changes that have occurred since then necessitate a reestimation. Methods: T...

Objective: To examine contraceptive choices among women seeking termination of pregnancy (TOP) and the provision of the chosen methods. Design: Population-based study. Setting: British Pregnancy Advisory Service (BPAS) clinics in England and Wales. Population: Between 1 January 2011 and 31 December 2014, 211 215 women had a TOP at BPAS, were...

Objective: To compare use of contraceptive methods at last heterosexual intercourse among 15-44year-old women and men at risk of unintended pregnancy in the United States. Study design: We employed data from the National Survey of Family Growth (NSFG) 2006-2013. We considered women and men to be at-risk of unintended pregnancy if they had interc...

Objective: To examine the characteristics and experiences of women in Ireland and Northern Ireland seeking at-home medical termination of pregnancy (TOP) using online telemedicine. Design: Population-based study. Setting: Ireland and Northern Ireland. Population: Between 1 January 2010 and 31 December 2015, 5650 women requested at-home medic...

Objectives: This study describes women's reasons for seeking ulipristal acetate (UPA) for emergency contraception (EC) through the only authorized online retailer for UPA EC in the US. Study design: Women aged 14 to 59 years, living in states that allow prescription medications to be shipped from out-of-state, accessed the KwikMed online pharmac...

Context: Unintended pregnancy is a universal benchmark for reproductive health, but whether variations reflect differences in measurement and how well measures predict pregnancy outcomes warrant further examination. U.S. and British measures of unintended and unplanned pregnancy offer a useful comparison. Methods: Some 220 women seeking pregnanc...

Plain language summary Effects of progestin-only birth control on weight Progestin-only contraceptives (POCs) can be used by women who cannot or should not take the hormone estrogen. Many POCs are long acting, cost less than some other methods, and work well to prevent pregnancy. Some people worry that weight gain is a side effect of these birth c...

This study examined differences in women's anticipated emotional orientations toward unintended pregnancy by relationship status and race and ethnicity. Data from a prospective survey of 437 women aged 18 to 44 years who intended no more children for at least 2 years were analyzed along with 27 in-depth interviews among a diverse subsample. Cohabit...

To the Editor: On November 17, 2015, the Pan American Health Organization (PAHO) issued an epidemiologic alert regarding Zika virus in Latin America.(1) Several countries subsequently issued health advisories, including cautions about microcephaly, declarations of national emergency, and unprecedented warnings urging women to avoid pregnancy. Yet i...

This is the final version of the article. It first appeared from the Massachusetts Medical Society via http://dx.doi.org/10.1056/NEJMc1605389

INTRODUCTION: Although antiretroviral therapy (ART) reduces individual tuberculosis (TB) risk by two-thirds the population-level impact remains uncertain. Cape Town reports high TB notification rates associated with endemic HIV. We examined population trends in TB notification rates during a 10-year period of expanding ART. METHODS: Annual Cape Tow...

Objectives: Mandatory weekend working for NHS consultants is currently the subject of intense political debate. The Secretary of State for Health's proposed 7-day contract policy is based on the claim that such working patterns will improve patient outcomes. We evaluate this claim by taking advantage of as-if-at-random presentation of women for no...

Effect of obesity on the effectiveness of hormonal contraceptives We applaud Yamazaki and her Food and Drug Administration (FDA) colleagues for providing convincing evidence that combined oral contraceptive (COC) failure is statistically significantly higher among obese than among nonobese women [1]. The Pearl index (PI) was 3.14 among 2707 obese w...

Objective: Unintended pregnancies (UPs) are associated with a significant cost burden, but the full cost burden in Canada is not known. The objectives of this study were to quantify the direct cost of UPs in Canada, the proportion of cost attributable to UPs and imperfect contraceptive adherence and the potential cost savings with increased uptake...

Objective: This study has two aims. The first is to assess the proportion of unplanned pregnancies among women attending antenatal clinics (ANCs) and those undergoing induced abortion (IA). The second is to assess both their previous contraceptive use and contraceptive intention, with particular focus on the use or consideration of any long-acting...

Background: Regulatory agencies in the United States (US) and Europe differ in requirements for defining pregnancies after the last dose of oral contraceptive, sometimes resulting in discrepant Pearl Indices (PIs) for the same product despite identical clinical data. This brief report highlights one such example, a 91-day extended-regimen combined...

We examine the lifetime and past-year prevalence and circumstances of unprotected intercourse among members of the Society of Family Planning (SFP), a professional reproductive health organization in the United States. We invited the membership of SFP (n=477) via email to participate in an anonymous online survey. The response rate was 70% (n=340)....

Pregnancy is associated with a significant cost for employers providing health insurance benefits to their employees. The latest study on the topic was published in 2002, estimating the unintended pregnancy rate for women covered by employer-sponsored insurance benefits to be approximately 29%. The primary objective of this study was to update the...

Emergency contraception (EC) prevents pregnancy after unprotected sex or contraceptive failure. Use of EC has increased markedly in countries where a product is available over the counter, yet barriers to availability and use remain. Although effective in clinical trials, it has not yet been possible to show a public health benefit of EC in terms o...

This is the author accepted manuscript. The final version is available via Wiley at http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13306/abstract.

Since 1979, US federal appropriations bills have prohibited the use of federal funds from covering abortion care for Peace Corps volunteers. There are no exceptions; unlike other groups that receive health care through US federal funding streams, including Medicaid recipients, federal employees, and women in federal prisons, abortion care is not co...

The objective of this study was to quantify the cost burden of unintended pregnancies (UPs) in Norway, and to estimate the proportion of costs due to imperfect contraceptive adherence. Potential cost savings that could arise from increased uptake of long-acting reversible contraception (LARC) were also investigated. An economic model was constructe...

Focusing on intrauterine contraceptives (IUC), contraceptive implants, and emergency contraceptives, we review recent advances in contraceptive development and discuss progress in policies to improve access to the most effective methods. We report on the shift in practice towards routinely providing IUCs and implants to young and nulliparous women,...

Background. Estimates indicate that approximately 3.5% of American women are currently using intra-uterine contraception (IUC) and 1.9% have ever used the contraceptive implant. Despite widespread promotion, the availability of new products and expanded eligibility criteria, women’s uptake of IUCs and implants is low. Methods. Data presented here...

Several options for emergency contraception are available in the United States. This article describes each method, including efficacy, mode of action, safety, side effect profile, and availability. The most effective emergency contraceptive is the copper intrauterine device (IUD), followed by ulipristal acetate and levonorgestrel pills. Levonorges...

Aim To discover whether a hand-out explaining the benefits of intrauterine contraceptives (IUCs) and implants could increase their uptake in Hull, UK. Methods We developed a simple double-sided A4 hand-out. On one side was a script with pictures of copper and levonorgestrel IUCs next to a 20 pence coin and of an implant beside a hairgrip. On the ot...

Objectives: This analysis aimed to estimate the average annual cost of available reversible contraceptive methods in the United States. In line with literature suggesting long-acting reversible contraceptive (LARC) methods become increasingly cost-saving with extended duration of use, it aimed to also quantify minimum duration of use required for...

This comprehensive review of the emotive and often controversial topic of abortion provides clinicians with a multidisciplinary focus on abortion services, discussing clinical topics in their sociological, legal and ethical context. It is particularly timely as novel methods of service delivery make this vital resource more accessible, allowing abo...

Objective To examine the impact of subject characteristics on efficacy as measured by the Pearl Index (PI) in clinical trials and to make study populations similar by matching. Methods Our analysis used US data from four large Phase III studies. We compared results from one fertility control patch study with pooled data from three studies with vir...

Objectives Previously we showed that increasing the choice of emergency contraception (EC) guided by medical eligibility did not result in wholesale large-scale usage of ulipristal acetate (UPA). This further 12-month study aimed to answer three questions. (1) Does offering choice of EC lead to change in methods used? (2) Are women who choose UPA m...

Introduction: Since 1979 annual appropriations bills have restricted abortion coverage for US Peace Corps Volunteers. There are no exceptions to the coverage ban, even in cases when the pregnancy threatens the woman’s life or when the pregnancy resulted from rape or incest. Through in-depth interviews with returned Peace Corps volunteers (RPCVs) we...

Female sterilization, often performed by tubal ligation, is highly effective at preventing unintended pregnancy. Low-income women and those from minority racial and ethnic groups may face barriers to access to a sterilization procedure. One barrier is the federal policy on sterilizations funded by Medicaid. Although the policy was designed to prote...

Emergency contraception (EC) is a method of birth control that is taken after unprotected intercourse. It can be taken when a regular method of contraception is not used or is used incorrectly. EC is particularly important for victims of sexual assault or reproductive coercion. There are three methods of EC available in the USA: oral levonorgestrel...

Though designed to protect vulnerable populations, federal policy regarding Medicaid-funded sterilization procedures such as tubal ligation creates substantial barriers for low-income women who wish to undergo such a procedure, restricting their reproductive autonomy.

Objective Evaluate pregnancy complication rates and related charges in users of 84/7, 21/7, and 24/4 combined oral contraceptives (COCs). Study Design Data were obtained from the i3 InVision Data Mart™ retrospective claims database. Subjects were aged 15–40 years; first prescribed a COC between 1/1/2006 and 4/1/2011; and continuously insured for ≥...

Objective To evaluate the initial safety and effectiveness of the Intrauterine Ball, a copper intrauterine device which upon insertion in the uterus takes a three dimensional spherical form. Study Design Fifteen women were followed for one year, with follow-up visits at 1, 3, 6, 9, and 12 months. Results The physician reported that all devices wer...

Objective We investigate trends in contraceptive behaviors in France and how they may have contributed to fluctuations in unintended pregnancy rates over time and across subgroups of the population between 2000 and 2010. Study design Data are drawn from 3 national surveys in France, comprising 4714 women ages 15 to 49 in 2000, 8613 in 2005 and 526...

Family planning methods that act when administered after fertilisation would have substantial benefits: they could be used longer after sex than current emergency contraceptives, and potentially a woman could use them only on relatively rare occasions when her menstrual period is delayed. Although such methods would displease abortion opponents, th...

To evaluate pregnancy rates with 84/7, 21/7, and 24/4 combined oral contraceptives (COCs). Data were obtained from the i3Invision Data Mart(TM) retrospective claims database. Subjects were 15 to 40 years; first prescribed COCs between January 1, 2006 and April 1, 2011; and continuously insured for ≥1 year. Eighty four over seven users (84/7) were m...

Medicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilizatio...

Background: The authors sought to investigate associations between young women's use of alcohol and other substances and their sexual and reproductive health (SRH) service utilization. Methods: The authors used data from 4421 young women aged 15-24 years in the nationally representative study, National Survey of Family Growth, 2002-2008. The aut...

We prospectively examined the influence of young women's depression and stress symptoms on their weekly consistency of contraceptive method use. Women ages 18-20 years (n=689) participating in a longitudinal cohort study completed weekly journals assessing reproductive, relationship and health characteristics. We used data through 12 months of foll...

The worldwide expansion of the Internet offers an important modality of disseminating medically accurate information about medication abortion. We chronicle the story of www.medicationabortion.com, an English-, Spanish-, Arabic- and French-language website dedicated to three early abortion regimens. We evaluated the website use patterns from 2005 t...

Background: Despite several drawbacks, the Pearl Index continues to be the most widely used statistical measure of contraceptive failure. However, Pearl indices reported in studies of newer hormonal contraceptives appear to be increasing. Study design: We searched PubMed and Medical Intelligence Solutions databases for prospective trials evaluat...

Purpose: We prospectively examined the influence of young women's depression and psychological stress symptoms on their weekly contraceptive method use. Methods: We examined data from 689 women ages 18-20 years participating in a longitudinal cohort study. Women completed 8,877 weekly journals over the first year, which assessed reproductive, re...

Objective: To examine the association between religiosity and sexual and contraceptive behaviours in France. Methods: Data were drawn from the 2005 Health Barometer survey, a random sample of 7495 women and 5634 men aged 15 to 44. We used logistic regression models to study the associations between religiosity and sexual and contraceptive behavi...

Active management of the third stage of labor is recommended for the prevention of post-partum hemorrhage and commonly entails prophylactic administration of a uterotonic agent, controlled cord traction, and uterine massage. While oxytocin is the first-choice uterotonic, it is not known whether its effectiveness varies by route of administration. T...

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...

: To analyze rates of significant adverse events and outcomes in women having a medical abortion at Planned Parenthood health centers in 2009 and 2010 and to identify changes in the rates of adverse events and outcomes between the 2 years. : In this database review we analyzed data from Planned Parenthood affiliates that provided medical abortion i...

Background: From 2001 to March 2006 Planned Parenthood health centers throughout the United States provided medical abortion by a regimen of oral mifepristone followed 24 to 48 hours later by vaginal misoprostol. In response to concerns about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration to buc...

BACKGROUND: Contraceptives vary by effectiveness, duration of effect, and the total costs related to the method used and unintended pregnancies (UP). Health care payers and women incur higher initial costs for long-acting reversible contraceptives, such as intrauterine contraceptives and implants, than for short-acting reversible contraceptives, su...

Study question: What is the predictive value of pregnancy intentions on contraceptive behaviours among women aged 18-19? Summary answer: Women aged 18-19 have high levels of inconsistent use of contraception, which mostly occur at times when women strongly wish to avoid a pregnancy. What is known already: Pregnancy intentions provide an indica...

Objective: To investigate associations between young women's use of substances and preventive sexual and reproductive health (SRH) services. Methods: We used data from young women 15-24yrs (n=4,421) in the National Survey of Family Growth, 2002-2008. With descriptive, bivariate and multivariate logistic regression statistics, we analyzed relation...

Objective: To estimate the prevalence of types of combined oral contraceptive (COC) use among women in the United States. Methods: We analyzed data from 12,279 women ages 15-44 years in the population-based reproductive health study, the National Survey of Family Growth. Data were collected continuously via in-person, computerized household inter...

Objective: To evaluate the total costs of unintended pregnancy (UP) in the United States from a third-party healthcare payer perspective and to illustrate the potential role for long-acting reversible contraception (LARC) in reducing health care expenditure. Methods: An economic model was constructed to estimate direct costs of UP as well as the pr...

Objective Depression and psychological stress contribute to high-risk sexual behavior and medication misuse yet their influence on contraceptive use patterns is unknown. We examined relationships between young women's psychological symptoms and consistency of contraceptive use. Methods Women ages 18-19 years (n=1,250) participating in a longitudi...

The copper IUD is the most effective emergency contraceptive available, but rarely used. In the past decade, scientific and policy efforts have succeeded in transforming emergency contraceptive pills from a well-kept secret to a range of accessible dedicated products. However, unprotected intercourse remains high in the U.S.. While pills have advan...

Background: This study evaluated the total costs of unintended pregnancy (UP) in the United States (US) from a third-party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure. Study design: An economic model was constructed to estimate...

Background: A growing body of evidence indicates that over-the-counter (OTC) access to oral contraceptive pills (OCPs) is safe and effective. Study Design: We performed a nationally representative survey of adult women at risk of unintended pregnancy using a probability-based online panel. In November–December 2011, 2046 eligible women completed th...