Wayne C. Shields

Multipurpose prevention technologies for sexual and reproductive health: gaining momentum and promise

This editorial seeks to convey the key points of the discussions focused on multipurpose prevention technologies that took place at an international symposium on Advancing Prevention Technologies for Sexual and Reproductive Health. It also looks to engage health care professionals in the effort to fulfill the potential that these technologies might offer. Copyright

Ensuring successful development and introduction of multipurpose prevention technologies through an innovative partnership approach

Unintended pregnancies and the spread of sexually transmitted infections (STIs), including HIV, remain critical public health issues. Despite the apparent public health potential of comprehensive prevention methods, research and development for contraception and prevention of HIV and other STIs have historically remained separate because of different funding streams, policies and regulatory mechanisms. The result has led to missed opportunities to effectively and adequately address these interconnected sexual and reproductive health (SRH) risks. One global collaborative partnership to advance the comprehensive SRH prevention field is the Initiative for Multipurpose Prevention Technologies (IMPT). Begun in 2009, the aim of this cross-sector initiative is to advance the development and eventual introduction of combination products for women that provide simultaneous protection from multiple SRH risks. To date, the IMPT has engaged product developers, scientific researchers, healthcare providers, funders and community-based advocates in China, India, the USA and across Africa and western Europe behind this common agenda. The IMPT defines multipurpose prevention technologies (MPTs) as products that combine protection against unintended pregnancy and STIs, including HIV. The vision for MPTs is a suite of accessible products that are womaninitiated, efficient and easy to use. MPTs currently in development include intravaginal rings that combine a contraceptive hormone with anti-viral drugs for HIV and herpes simplex virus type 2 prevention; on-demand products such as a diaphragm loaded with an anti-HIV drug; and co-administered or co-formulated multipurpose injectables. These products could represent a powerful means of achieving high public health impact in at-risk populations around the world. The IMPT is in its fifth year and is navigating the boundaries of collaborative decision-making around a complex product development agenda. This editorial describes the structured and innovative approach developed by the Initiative to facilitate MPT development, funding and introduction.

A fast track solution for reducing unintended pregnancies in the US: increase federal support for life-long provider education and training in reproductive health

This editorial discusses solutions for reducing unintended pregnancies in the United States. It states that to help lower unintended pregnancy rates we must make the image of the well-trained clinician a reality and to accomplish this there must be significant federal investment in provider training and continuing education on reproductive health and family planning.

Title X: a sure-fire investment with at least a 300% return.

Restoring full funding—to assure family planning and reproductive health services for all low-income uninsured Americans who need them—is a sensible way to save money. Savings begin in the very first year. As your congressional representatives struggle to find budget solutions remind them that unintended pregnancy is a continuing and costly public health problem in the United States. Reproductive health and family planning services reduce unintended pregnancy prevent sexually transmitted diseases and save money. At a time when every dollar counts we must not miss the chance to make an investment with such immediate and important payoffs. (excerpt)

Bringing it home: our imperative to translate reproductive health research into real practice change.

This editorial stresses the importance of the reproductive health field to assertively identify and pursue equitable links between clinical and behavioral science and to put into practice the outcomes from well-designed research projects in order to sustain progress in this field. It states that the reproductive health field needs to intensify their efforts through research into practice and bringing their reproductive health expertise evidence-based research and knowledge of adult learning theory to all clinicians who can make a difference in public health. Copyright

International reproductive health still worth the investment

The United States has been a global leader in the international population arena for nearly 50 years. United States investments in maternal, reproductive and sexual health programs have been a tremendous success, saving and improving many millions of lives. But many challenges remain, and the collective education and advocacy efforts of the sexual and reproductive health community can help overcome them. The worlds population continues to grow at a rate of nearly 80 million people a year [1]. An estimated 215 million women throughout the developing world want, but do not have access to, modern methods of contraception, which contributes to some 76 million unintended pregnancies and 20 million unsafe abortions each year [2]. The number of women who die during childbirth remains unacceptably high, with hundreds of thousands still succumbing to mostly preventable maternal deaths each year [3]. Hundreds of thousands more women are injured during pregnancy, with tens of thousands facing the tragedies of obstetric fistulae or unsafe abortions [3]. AIDS is now the leading cause of death among women of reproductive age, and maternal mortality is the leading killer of women aged 15–19 years throughout the world [4]. Because of gender discrimination and sociocultural beliefs, young women are particularly illequipped to negotiate safer sex practices with their typically much older partners. Access to comprehensive sexual and reproductive health services can solve many of these grave challenges, and for many decades, the United States has supported the provision of such services for women and men in the developing world. At the International Conference on Population and Development (ICPD), held in Cairo, Egypt in 1994, the United States led the world — and joined leaders in health, science, medicine, womens rights and the environment — in committing to provide the funding and support needed to meet the worlds reproductive health needs [5]. In recent years, however, US policies around these issues have become increasingly divisive and politicized, contributing to insufficient funding and constrained programs. Indeed, while not all programs supported by the US government are as efficient as they might otherwise be— operating as they do in silos, with ideologically driven restrictions, and sometimes in competition with each other — the assistance

Bringing research to life: a collaborative partnership dedicated to improving reproductive health care

The Society of Family Planning (SFP) and the Association of Reproductive Health Professionals (ARHP) are two organizations with different but complementary missions. Together, we write this editorial in order to raise awareness of how we work collaboratively, specifically around translating scientific research in family planning and abortion into direct patient care. As Contraceptions two sponsoring organizations, SFP and ARHP represent a productive model for professional partnerships that can address key scientific issues while ultimately helping improve the quality of care. Academic societies like SFP, through their support for evidence-based research and development of practice guidelines, can enhance the effectiveness of professional education organizations like ARHP that develop continuing medical education programs and learning environments for health care providers of all disciplines and specialties. SFP and ARHP support the recommendation from Bradley et al. [1] that professional partnerships are an effective mechanism for disseminating the latest science and evidence regarding best practices. Carefully developed clinical guidelines help health care providers translate science into their daily interactions with patients. According to Ornstein et al. [2], “A well-crafted guideline promotes quality by reducing health-care variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective — or potentially harmful — interventions.” Clinical guidelines are also an essential component of effective training and education programs for health professionals [3]. Furthermore, the pressing public health issue of contraception and obesity provides an excellent example of how an effective partnership between a medical society such as SFP and a professional education group like ARHP can help work in tandem to translate research into practice with the goal of improving patient care. The leadership of the SFP identified a pressing need to address health risks associated with obesity among patients seeking contraceptive care. Unfortunately, the relationship between obesity and contraception has not been extensively studied, yet the need for provider education on the topic and the opportunity for improving the health of overweight patients

Happy anniversary mifepristone: a decade of promise and challenges.

September 29, 2010, marks the 10th anniversary of Food and Drug Administrations approval of Mifeprex (mifepristone) in the United States. That moment 10 years ago brought women the promise of increased access to early, safe, noninvasive abortion and the potential mainstreaming of abortion services into the larger scope of routine comprehensive womens health care [1,2]. The arduous 12-year path to approval required an intensive level of collaboration among key professional, advocacy and research organizations, working closely to navigate abortion-related politics and meet the natural challenges of introducing a new medical option to women and their health care providers. The motivation for working with such purpose was the potential to improve access to abortion and improve health care for women and families. Mifepristone can increase access to abortion for three compelling reasons: women can choose this method at earlier gestational ages than is typical for suction procedures; it can be obtained from primary care physicians (and advanced practice clinicians in some states) without the need for surgical facilities; and it can be completed in the privacy of the womans home. Mifepristone promises to expand abortion services by going outside the domain of a typical abortion clinic. It has the potential to increase the number and types of abortion providers while expanding access to care. Ideally, mifepristone can become a ubiquitous and essential component of womens health care practice, embraced not just by obstetrician/gynecologists but by all primary care clinicians. Mifepristone use has steadily increased over the past decade and is a likely factor in the trend toward very early abortions [2,3]. Since FDA approval, more than 1.3 million US women have chosen this method (personal communication with manufacturer, 2010). And the number of mifepristone abortions and abortion providers has increased significantly, even as the number of abortions and providers has decreased during the same period [2]. According to the latest Guttmacher data, the proportion of abortions performed in the US at less than 9 weeks of gestation increased 5% in just 4 years, from 58% in 2000 to 63% in 2004 (the most recent available data) [2]. Preliminary estimates indicate that mifepristone accounted for roughly 27% of eligible abortions in 2009 in the United States compared to 22% in 2005 [3].

Keeping abortion legal: a look beyond Roe v. Wade

The United States’ Supreme Court’s new term brings intense speculation about the possibility that a court retirement and new appointment might reverse the narrow margin of support that the Roe v. Wade abortion decision currently retains. Although upholding Roe is crucial an emphasis on the importance of the Supreme Court should not deflect attention from the ongoing erosion of abortion rights in the United States. Abortion rights are being undermined with new laws restricting access and funding and public debate focused narrowly on choice as a legal issue. (excerpt)

The war on words: sensible compromise or slow suicide?

In the wake of warnings that researchers who study AIDS and other sexually transmitted diseases may face special scrutiny complying with instructions from staff at the National Institutes of Health (NIH) to cleanse grant application abstracts of potentially controversial terms appears a prudent course of action. After all a quick document scan and a few minor wording changes seem like harmless compromises— but are they? (excerpt)