Effective contraception contributes to abortion declines in Iowa

There is growing evidence that increased use of highly effective contraception is associated with reductions in unintended pregnancies and abortion. New research from the UCSF Bixby Center examines whether increased access to intrauterine devices (IUDs) and implants in Iowa contributed to a decline in abortions in the state.

Between 2006 and 2008, access to family planning services increased in Iowa through a state Medicaid program and a privately funded initiative. During the same time, access to abortion expanded in Iowa through telemedicine provision of medical abortion. Even with this increased access to abortion services, the number of abortions in Iowa declined. Using data from more than 500,000 medical records, Bixby researchers found a strong connection between increases in IUD and implant use and the subsequent decline in abortions across Iowa. The researchers found that: 

  • A small increase of 1 new IUD or implant user per 100 women was associated with a 4% decline in abortion each year.
  • The decline happened in conjunction with an increase in the number of facilities offering abortion care to women, particularly in rural and remote areas

"To our knowledge, this is the first study to explore the relationship between IUD and implant use and reduction in abortion that was able to control for other factors, such as population density, poverty levels and the number of abortion clinics in a region,” Bixby Center researcher and lead study author Antonia Biggs said. “Our research adds to the growing body of evidence that an investment in highly effective family planning is money well spent.”

Given the increase in abortion access and lack of legal restrictions placed on abortion in Iowa from 2005 to 2012, the researchers concluded that reductions in abortions were not a result of laws restricting abortion access. These findings support the need to continuously provide women with access to safe and high-quality abortion and contraceptive services, which together help women plan for their and their families’ wellbeing.


Saving women’s lives in childbirth worldwide

Too many women around the world face the risk of death or disability from childbirth, and the UCSF Bixby Center is conducting groundbreaking research to make childbirth safer. Bixby Center researcher Suellen Miller recently discussed how the Safe Motherhood Program, which she founded in 2003, pioneered use of the Non-pneumatic Anti-shock Garment (NASG). The NASG is a first-aid device to stabilize women suffering from obstetric hemorrhage and shock, the leading cause of maternal death during which a woman bleeds heavily after giving birth.

In a new interview with WBAI Pacifica Radio’s “Healthstyles,” Miller discusses how the NASG helps reduce maternal mortality by 50 percent. The NASG can be applied by anyone after a short, simple training, and has been used by over 9,000 women in 20 countries. Miller also talks about how the SafeMotherhood Program partners with nongovernmental organizations, health ministries and other decision-makers to expand access to the NASG around the world. “Almost always now, people are saying, ‘We cannot let mothers die.’” Miller said. “And that has made the introduction of this device much easier…  You can say ‘Ok, if you’re interested in saving lives, here’s a device that can help.’”


Groundbreaking research proves that abortion is an extremely safe procedure

In the most comprehensive look yet at the safety of abortion, researchers at the UCSF Bixby Center found that the procedure is incredibly safe for women. In a new study published this week, Bixby Center researchers found that major complications from abortion are rare, occurring less than a quarter of one percent of procedures. This is: 

  • About the same frequency of complications as for colonoscopies. 
  • Less frequent than complications for wisdom tooth removal and tonsillectomy.

Although these new data are similar to what has been found in previous studies, this is the first study to examine complete data on all of the health care used by women who have received abortions. Since some women must travel long distances to find abortion providers, they tend to receive any needed follow-up care at facilities closer to where they live. For many women, this means their local emergency department. But, up until now, no study has systematically examined emergency department use for post-abortion care.

The researchers said they expect the study to contribute to the national debate over abortion safety. Many state legislatures have recently passed laws increasing various requirements for providers and clinics, purportedly to increase patient safety. But the researchers said that these laws were likely to make women travel further to get abortions or induce them on their own using unsafe methods, both of which may increase the risks for women. The policy debate over abortion restrictions in the United States will be better informed by weighing any theoretical and small reduction in patient risk against the increased risk to women’s health that occurs with reduced access to abortion care.


Addressing violence against women worldwide

Violence against women and girls is a global public health problem of epidemic proportions, with an estimated 35% of women and girls experiencing some form of physical or sexual violence in their lifetimes. The United Nations marks November 25 as the International Day for the Elimination of Violence Against Women, and advocates around the world are calling for a series of social, policy and legal changes to help curb such violence. The UCSF Bixby Center has examined the issue of sexual violence and reproductive coercion from multiple angles, generating rigorous evidence that can help inform needed policy changes.

The Bixby Center helped broaden access to emergency contraception (EC), a critical health tool for women following sexual assault. An estimated 7% of women will be sexually assaulted by a stranger, and many more (23%-36%, depending on the region) will experience unwanted sex from an intimate partner. Victims of sexual violence risk unwanted pregnancy and exposure to sexually transmitted infections, making EC access a health imperative and human right for sexual assault survivors. Bixby Center research has increased women’s access by helping to make EC available without a prescription and expanding the range of EC options.

Currently, the Bixby Center is studying sexual and reproductive empowerment, exploring how women’s agency affects their ability to control contraceptive use and pregnancy. Our investigators have created a tool to measure women’s reproductive autonomy. Separate research is looking at the effect of male coercion on women’s reproductive and sexual health decisions. For example, research from the Bixby Center provides an in-depth look at the ways women describe their partners’ influence in their decisions regarding abortion and women’s risk of violence from their male partners following an abortion. While violence against women and girls continues to be a pandemic, improved prevention and treatment measures are possible and essential. The UCSF Bixby Center supports the efforts of our researchers and partners to provide sexual assault survivors with the care they need. Photo credit: Cindy Chew


It's LARC Awareness Week

The UCSF Bixby Center for Global Reproductive Health has partnered with the California Family Health Council to spread the word about long-acting reversible contraception (LARC)—intrauterine devices (IUDs) and the implant. During LARC Awareness Week, the UCSF Bixby Center is sharing its ongoing and comprehensive research about LARC methods, which are over 99% effective at preventing pregnancy. About half of pregnancies in the US are accidental, and this hasn’t changed in the last two decades.  As more US women learn about and use IUDs and the implant, the rate of accidental pregnancy has declined.

The UCSF Bixby Center has explored different factors that influence LARC use. Many young women and health care providers have misinformation about IUDs and implants.  Providers with recent training about LARC are more likely to counsel their clients about the methods.  Women’s social networks also influence IUD use. Health care providers can encourage IUD users to share their personal experiences with their friends and family to spread the word about these methods.

To participate in LARC Awareness Week, spread the word about LARC on Twitter and Facebook @CalFamHealth and @Bedsider with the hashtag #LoveMyLARC.