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.


Massive, open online course on abortion

The UCSF Bixby Center's Innovating Education in Reproductive Health program is excited to announce the upcoming launch of the first ever online course about abortion. Abortion is a common experience for women around the world, yet is often excluded from the curricula of health professionals. The free six-week course, Abortion: Quality Care and Public Health Implications, is hosted by Coursera, an education platform for massive, open, online courses (MOOCs). It will address abortion care from both clinical and social perspectives.

Dr. Jody Steinauer, Associate Professor of Obstetrics, Gynecology & Reproductive Sciences at UCSF, will facilitate the course, which features over twenty faculty  from multiple disciplines. The class will address abortion in the U.S. and around the world, framing the issue in a public health context. The aim of the course is to fill in the gaps left by the exclusion of abortion from mainstream curricula.

The course will run from October 13 through November 24, 2014. This course is geared toward clinicians, health care workers, and students. However, there are no prerequisites, and anyone is welcome to take the course. To enroll, go to coursera.org/course/abortion.



Women denied an abortion more likely to stay in abusive relationships

A long-term study among women seeking abortion in the U.S. showed that 8% of women sought an abortion because they had abusive partners. New research from this UCSF Bixby Center team shows that, compared to women who were able to end an unwanted pregnancy, those who could not access abortion care and ultimately gave birth were more likely to remain in physically abusive relationships over the next two and half years. Physical abuse included being pushed, hit, slapped, kicked, or choked. They concluded that “having a baby with an abusive man, compared to terminating the unwanted pregnancy, makes it harder to leave the abusive relationship.”

Read more in Salon.com.


Editorial examines the need for routine pelvic exams

In new guidelines, the American College of Physicians recommends that doctors stop performing routine pelvic exams for most women. There is no evidence that pelvic exams are effective at detecting diseases like cervical cancer and plenty to suggest that the procedure provokes fear, anxiety and pain in many women, according to the new practice guideline. In an editorial accompanying the new guidelines, UCSF researchers discuss the efficacy of routine pelvic exams and possible reaction among women's health care providers to the new guidelines. The guidelines build on the Bixby Center's longstanding and rigorous research on pelvic exams, cervical cancer and birth control.

The pelvic exam has “held a prominent place in women’s health for many decades and has come to be more of a ritual than an evidence-based practice.” The new recommendations may be “controversial” since the exam has “long been considered a fundamental component” of women’s health visits. For instance, 2012 guidelines from the American College of Obstetricians and Gynecologists continued to recommend annual pelvic exams for all women ages 21 and older, and a recent survey revealed that US Ob-Gyns conduct the exam for the vast majority of patients. “Ending such a prevalent practice with widespread support among women’s health providers will be met with formidable challenges,” according to the authors.

Even if the new recommendations do not change why and how often doctors perform pelvic exams, they should “prompt champions of this examination to clarify its goals and quantify its benefits and harms.” Given current evidence, providers who continue to offer the exam should at least be aware of the “uncertainty of its benefits and its potential to cause harm through false-positive testing and the cascade of events it prompts.