Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe Read more: Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe

By srh
January 27th, 2014

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The European Medicines Agency (EMA) — the European version of the U.S. Food and Drug Administration (FDA) — launched a broad review of whether body weight influences the ability of emergency contraceptives to prevent unintended pregnancies.

The agency recently required makers of the European version of Plan B, called Norlevo, to add an alert that the product may be less effective for overweight women. The move was spurred by a 2011 study that found that women with a body mass index (BMI) greater than 25 who used levonorgestrel, which prevents pregnancy by blocking the release of the egg from the ovary, inhibiting fertilization or changing the uterine lining to discourage pregnancy, were four times more likely to get pregnant than women with lower BMIs.

Now, based on that study and other data, the EMA is turning its attention to other emergency contraceptive measures that rely on hormones to prevent pregnancy. These include Norlevo, Levonelle/Postinor and Levodonna which all contain the hormone levonorgestrel. All the medications are available over the counter, and the agency is also studying one prescription-based medication called ellaOne that includes ulipristal acetate.

It’s unclear why emergency contraception could be less effective in overweight women, but the U.S. FDA is also reviewing existing data to determine if any changes in labeling or action is necessary. Calls to the FDA were not immediately returned.

Reproductive health experts say women who are concerned about whether their emergency contraceptive will prevent pregnancy should consider other birth control methods known to be more effective, like the IUD.

Morning-After Pill May Not Work For Women Over 176 Pounds Read more:

By srh
November 26th, 2013

Widespread implications if true

A European company that makes an emergency contraceptive identical to the morning-after Plan B pill is set to warn consumers that the drug is completely ineffective for women over 176 pounds, and begins to lose effectiveness after 165 pounds, Mother Jones reports.

The European drug, Norlevo, will be repackaged to reflect the weight limits, according to the report, which could carry significant implications for American women if true and if also applicable to morning-after pills in the U.S. Norlevo is chemically identical to many of the most popular emergency contraceptive brands used in the U.S., including Plan B One-Step, Next Choice One-Dose, and My Way. American manufacturer of emergency contraceptives didn’t comment to Mother Jones, and the FDA has yet to weigh in on the matter.

According to weight data from the Centers for Disease Control and Prevention, the average American woman weighs 166 pounds, and the average non-Hispanic black woman between 20 and 39 weighs about 186 lbs. If the European manufacturer is correct, morning-after pills could be ineffective for many American women.

Plan B One-Step is the only emergency contraceptive available over-the-counter to women of all ages. Norlevo packages will include a pamphlet summarizing the new discovery.

Why It Takes Teens Equipped With Condoms to Encourage Family Planning in Africa Read more: Why It Takes Teens Equipped With Condoms to Encourage Family Planning in Africa

By srh
November 19th, 2013

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Ethiopia has over 77 million inhabitants, and is considered one of the poorer countries in Africa. But this year, it’s playing host to the annual International Family Planning Conference in its capital, Addis Ababa.

The conference showcases the fact that despite Ethiopia’s high poverty rate and political intrusions on free speech, it has one of the most progressive family planning policies in Africa. And that success is serving as a model, not only for other developing nations such as Rwanda and Malawi, but for developed ones as well.

Economically, family planning is critical for a country’s stability — by protecting women from unwanted pregnancies that can contribute to high maternal and child mortality rates, these programs also allow mothers to enter the work force, and empower them to contribute to their local economy. Family planning is a public health term for essentially means controlling the number of births a woman has, and spacing those births. The Bill and Melinda Gates Foundation estimate that 1 in 4 women’s lives could be saved if there were global access to contraception, for example. And family planning isn’t just focused on mothers. The Foundation found that about 3.2 million children die each year from preventable diseases, many of which could be avoided if families had access to proper medical care, such as immunizations and antibiotics.

Such efforts have translated into measurable changes already. In Ethiopia, public health facilities offer all available contraceptive methods for free, and that has contributed to a rise in contraceptive use among women. The percentage of women of reproductive age using family planning has jumped from 8% in 2000, to 15% in 2005, to 29% in 2011.

For men, the Ethiopian government sends male mentors directly to people’s homes, to educate those who are skeptical or against the idea of their wives planning their births. Family planning is also introduced to boys in primary school. Despite these attempts, however, male involvement in family planning is still considered a challenge for countries in the developing world.

What has worked to improve the way couples start their families and enhance childhood health? Here’s what Ethiopia, Rwanda and Malawi are doing right to strengthen family planning.

Recognizing that young people are sexually active: While it seems obvious, acknowledging that teens are having sex is a challenge for some administrations, especially conservative ones. A typical 18-year-old Ethiopian woman is already married and likely expecting her first child, and most women have around five. However, community health centers in that country now include youth services and private offices to not only educate teens, but provide them with the protection they need to practice safe sex or delay sexual activity.

Appreciating that most teens may not feel comfortable talking about sex with adults, some NGOs and organizations have taken more unconventional approaches to getting contraceptives to young people. Planned Parenthood Federation of America, for instance, partners with Mary Joy Aid Through Development to train Ethiopian teens to become peer health promoters. As promoters, they talk to other teens about sexual health issues and distribute contraceptives like pills and condoms.

“I’ve been surprised by young men asking what methods of contraceptives they should use,” says Josephat Nyamwaya, a program officer for the Planned Parenthood Federation of America’s Africa office, where he trains youth in many African communities like his roots in Nairobi. “I tell them at their age, condoms, but that they also need to support their girlfriends in their contraceptive decisions.”

Making family planning the law: In Ethiopia’s constitution, access to family planning is cited as a woman’s right. Similarly, Rwanda’s government has legislated strong policies for family planning, and saw uptake of contraceptives jump by 10-fold. In 2000, only 4% of married women of reproductive age were using modern contraceptive methods, but the rate spiked to 45% by 2010, thanks to the country’s National Family Planning Program, which revamped access to contraceptives by stocking up all public health clinics, trained more providers in family planning education, and encouraged more women to give birth in their health facilities rather than at home.

And to persuade couples to space children apart, or use contraceptives, the government of Malawi has focused on improving child health services. Ironically, the more dire their circumstances, the more children parents are likely to have, because they know that many won’t survive their first years. “You cannot tell people not to have [more] children if they don’t feel secure that they will survive,’ says Malawi Minister of Health, Catherine Gotani Hara.

Giving family planning prominence in the country’s constitution is an important step toward acknowledging the critical role that reproductive health plays in a country’s economic stability. “These countries that are having success have really come out front with the recognition that if they were to solve this problem, they would solve so many others in their country. When you don’t have that leadership, it’s really difficult to move forward,” says Beth Fredrick, director of advance family planning for the Bill & Melinda Gates Institute at Johns Hopkins School of Public Health.

Bringing family planning services to the people: In both Ethiopia and Malawi, health extension workers are the key to reaching community members and getting them to clinics, as well as providing them with access to family planning programs. In Ethiopia, every community is allocated a hospital, a smaller health center, and a health post—which is staffed by two health extension workers. To supplement their efforts, the governments of these countries, using funds from the U.S. Agency for International Development (USAID), developed the Women’s Development Army. Members of the army, which include local community mothers who are trained by extension workers, go door to door, educating women about family planning, and hosting small gatherings of five community members to discuss reproductive health and answer questions in an informal setting.

‘I had my first [of five children] when I was just 15 and didn’t know about family planning,’ says Yenenesh Deresa, a member of the Women’s Development Army of Burayu, Ethiopia. “Now we sit around coffee and I talk to women about family planning. They’re empowered to make their own decisions and have safer pregnancies.”

Realizing the value of educating girls: If countries like Ethiopia, Rwanda and Malawi can lower their fertility rate, there’s a possibility that they could experience a bump in the economy, known as reaching the demographic dividend. That’s when younger generations join the workforce, and the greater proportion of this cohort that can find employment and live independently, the fewer dependents a country has. The first step toward achieving this condition is to lower fertility rates, but the younger generation needs to be educated to succeed in the workforce and there needs to be jobs available as well. While educating both genders is critical for such success, making sure that girls receive their degrees is especially important, since about a quarter of girls in low-resource countries drop out of school once they get pregnant.

“Empowerment [of women without education] is complicated. If girls need to be educated and attend schools, they need to be protected from unplanned pregnancies,” says First Lady of Ethiopia, Roman Tesfaye. “If we do not address these issues for women, it will be too challenging to become a middle income country.”

The push to protect women through health measures that will keep her in schools is slowly playing out even in rural communities. “You can see that things are changing now for women. I am a woman, and I am a leader here,” says Zewdtu Areda, head of health zone near Muka Turi, Ethiopia where she oversees health services offered for the area.

Offering all forms of birth control: Even in the U.S., research shows that when all methods of contraception are offered at low cost, women tend to pick long-acting reversible contraceptives (like implants and IUDs) over condoms and pills. Ethiopia, Rwanda and Malawi all provide contraceptives at no cost in public health clinics, and in line with prior research, women tend to choose the longer-acting, more discreet methods. However, clinics continue to offer the less popular methods in order to give women a full spectrum of choices, so women can decide for themselves which methods are best for them.

Changing cultural acceptance of family planning: Health clinic workers often hear the same requests from women — they want birth control, but don’t want their husbands to know they are using a contraceptive. Even with progressive policies, in countries like Ethiopia cultural stigmas against limiting reproduction remain. Health workers often meet young women in public, outside of the clinic, to give women birth control so her husband won’t know she visited a family planning program.

Changing cultural norms remains a challenge, but officials in Rwanda rely on community health workers to talk to men about why they should support family planning and about how planning their children can mean having healthier children and potentially fewer children to support. They even encourage male family planning methods such as vasectomies. When men come in with their wives to discuss family planning measures, health workers cite the surgery as an option, and encourage it alongside circumcision to prevent diseases like HIV although it’s still not a popular choice.

In Malawi, public health officials are enlisting the help of respected elders. A campaign headed by community chiefs that promotes family planning for couples, for example, includes the voice and perspective of men. “In the villages, we try to include as many men as possible. Men are very affected. In rural settings in Malawi, the breadwinner is usually the man. So if they cannot control their family, they’re the ones in trouble,” says Gotani Hara.

Public health officials are hopeful that the success of these initiatives in the developing world could spill over to industrialized nations as well — including the U.S. — that still struggle to reduce rates of sexually transmitted diseases, unplanned pregnancies and infant mortality. If there is one lesson to learn from these programs, it’s that the most successful strategies don’t come from doctors or government officials, but from peers — mothers, friends or respected elders –  who, it turns out, have the strongest voice when it comes to talking about sex and families.

Long-term Pill use may double glaucoma risk

By srh
November 19th, 2013

Women who used birth control pills for three years or more have twice the risk of developing glaucoma later in life, according to new research.

Glaucoma is a disease that damages the eye’s optic nerve and is a leading cause of blindness in the United States.

It’s been well documented that low-estrogen levels following menopause contribute to glaucoma in women. Scientists don’t know exactly why this happens.  But years of using birth control pills, which can also lower estrogen levels, may add to the problem.

The study, conducted by researchers at University of California, San Francisco, Duke University School of Medicine and Third Affiliated Hospital of Nanchang University, Nanchang, China, did not differentiate between women who took low-estrogen or regular birth control pills. Investigators theorize that when women are not on the pill, their natural estrogen levels go up and down, which seems to prevent the eye from developing glaucoma.  When women go on the pill, their estrogen levels are consistent, and in some cases consistently low, which could cause them to develop the condition.

This research project is the first to suggest an increased risk of glaucoma in women who have used oral contraceptives for three or more years. The researchers looked at data on more than 3,400 women aged 40 and older from across the United States, who answered questionnaires about their reproductive health and eye exams.

“We believe at this point, by analyzing the data, there is an association between long-term birth control use and glaucoma,”  said Elaine Wang, of Duke University and an author of the study.

“Why?  We’re not sure. The next step is to examine the eyes carefully and look at exactly what is happening to a woman’s vision when she’s on birth control pills.  We need to verify these findings.”

Although study authors say more research needs to be done, they do stress that gynecologists and ophthalmologists need to be aware of the fact that oral contraceptives may play a role in glaucomatous diseases.  They believe doctors should make sure their female patients have their eyes screened for glaucoma, especially if they also have other risk factors, such as race, (African-Americans are at highest risk) family history of glaucoma or a history of increased eye pressure problems.

“This study should be an impetus for future research to prove the cause and effect of oral contraceptives and glaucoma,” said Dr. Shan Lin, lead researcher and professor of clinical ophthalmology at the University of California, San Francisco. “At this point, women who have taken oral contraceptives for three or more years should be screened for glaucoma and followed closely by an ophthalmologist, especially if they have any other existing risk factors.”

Because glaucoma affects 60 million people worldwide and is the leading cause of bilateral blindness, second only to cataracts, screening for the condition is encouraged for all people, especially over the age of 50. Although it can be treated, doctors say any new information on glaucoma is important.

“This supports the importance of getting screened, especially if you fall into the high risk category,” noted Dr. Thomas Yau, an ophthalmologist from Silver Spring, Maryland, and a member of the American Academy of Ophthalmology .  “It brings to the equation a possible new risk factor for glaucoma. Should we be raising the red flag?  Not yet, but birth control use should be looked at as a possible risk when talking to patients.”

The research was presented Monday at the annual meeting of the American Academy of Ophthalmology.

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Less Is More: One, Instead of Three Doses of HPV Vaccine May Protect Against Cervical Cancer Read more: One Dose of HPV Vaccine May Protect Against Cervical Cancer

By srh
November 5th, 2013

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Public-health officials may not have to worry so much about the low percentage of girls who don’t get all three doses of the human papillomavirus (HPV) vaccine.

The HPV vaccine is one of the best ways to prevent genital warts and infection with the virus that can cause cervical cancer, so since 2007, the Centers for Disease Control and Prevention recommended girls get three doses of the shot when they are 11 or 12 years old, and since 2011, advised that boys of the same age get routinely immunized as well. But about a third of eligible young people in the U.S. start the three-shot regimen, which takes six months to complete, and never complete the schedule; around half of eligible children are fully immunized against HPV.

Cost — all three doses of the immunization cost about $400 — and the lack of follow-up over six months contribute to the low compliance rate, so scientists have been investigating whether fewer doses could protect against infection just as well. A 2011 study reported that people had similar levels of protection at two doses, and now researchers believe even one shot may be enough.

The researchers studied Cervarix, which, like the other HPV vaccine approved by the Food and Drug Administration, Gardasil, protects against HPV subtypes 16 and 18. The researchers measured the immune response to the vaccine in groups of 78, 192 and 120 women who received one, two and three doses of the vaccine, respectively. They then compared the amount of antibodies these women produced against those of a group of 113 women who did not get immunized but had been infected with HPV at some point in their lives.

The vaccinated women in all three groups continued to show HPV antibodies in their blood for up to four years. These levels were similar among women who received two doses and those who were vaccinated with all three doses. But the women who just got one dose also had stable antibody levels, even though they were lower than those found in the other groups. These levels, however, were still 24 times higher than those among women who never received the vaccine but had been infected with the virus. So a single dose of the vaccine, the researchers believe, may be sufficient to provide some protection against infection with HPV.

They still aren’t sure, however, whether the antibodies generated by the vaccine are sufficient for long-term protection, such as that provided by immunizations against hepatitis A and polio, or whether people will need to boost waning levels of antibodies with additional shots over time.

There are hints that three doses may not be necessary, however. In Chile and British Columbia, public-health officials recommend just two doses of the HPV vaccine. But before the current recommendation in the U.S. is changed, more research is needed to clarify what type of protection the vaccines provide, and whether there are differences between the two currently approved shots. So for now, it’s not likely that the needle-phobic will get a break when it comes to getting up to date on their HPV shots.