Archives
Latebreakers

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm

Ambivalence

Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception

Contraceptivetechnology.com New and Improved

Abortion in the U.S.: safe, declining, and under threat
April 2018

 

Between 1980 and 2014, the abortion rate declined by more than half, from 29.3 to 14.6/1000 women, according to a major new consensus study report from the National Academies of Science, Engineering, and Medicine. While the advisory committee said the reason for three-decade decline was not fully understood, it called out the increasing use of contraceptives, especially long-acting methods and historic declines in the rate of unintended pregnancy, which readers may assume go hand-in-hand with more widespread use of contraception and of highly effective contraceptive methods. Additionally, rates have been impacted by more limited access to abortion services in an increasing numbers of states.

The report found that abortion care services—pre-abortion care, medication abortion (accounting for 45% of abortions prior to 9 weeks’ gestation), aspiration abortion (accounting for 68% of all abortions), and post-abortion care—are highly safe and highly effective. Aspiration abortion rarely results in complications, with risk increasing as the gestational age increases. Induction, used in 2% of abortions at 14 weeks’ gestation or later, rarely leads to serious complications.

“The safety and high-quality of abortion care stands in contrast to the extensive regulatory requirements that state laws impose,” according to the consensus report. Some states have instituted regulations that increase risks and costs by requiring unnecessary services and multiple visits and that have led to the closure of clinics. In 2014, half (25) of U.S. states had 5 or fewer abortion clinics. Nearly 39% of women lived in a county without an abortion provider. Nearly 1 in 3 women living in rural communities had to traveled more than 100 miles to have an abortion.

Few women have medical contraindications for obtaining an abortion. These contraindications include confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass, an IUD in place, chronic adrenal failure, concurrent long-term systemic corticosteroid therapy, hemorrhagic disorders or concurrent anticoagulant therapy, inherited porphyria, specific contraindications to using mifepristone, and allergy to mifepristone, misoprostol, or other prostaglandins.

Few women suffer complications following abortion. Obesity— notably a BMI >30 or weight over >200 pounds, or with an abortion performed after 14 weeks’ gestation—could possibly be a risk factor for complications during a D&E abortion, but it is not a risk factor for medication or aspiration abortions. Despite reported findings from a small number of poorly controlled studies, a woman is not more likely to suffer depression, anxiety, or PTSD following abortion. (In contrast, women who have been denied an abortion may be more likely to experience anxiety.] While preterm birth is more likely if pregnancy occurs fewer than 6 months following abortion, this is the same as the risk from pregnancy following childbirth or miscarriage. However, the risk of preterm birth may increase with an increased number of prior abortions.

More than 90% of abortions are performed early, before 13 weeks’ gestation. Currently, 38% are performed < 6 weeks’ gestation, but that percentage will increase as medication abortion becomes more prevalent.

National Academies of Sciences, Engineering, and Medicine, The safety and quality of abortion care in the United States. Washing, DC: The National Academies Press. Accessed Mar. 29, 2018 at www.nap.edu/read/24950/