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Hormonal contraceptives are widely prescribed due to their effectiveness and convenience and have become an integral part of family planning strategies worldwide. In the United States, approximately 65% of reproductive-aged women are estimated to be using contraceptive options, with approximately 33% using one or a combination of hormonal contraceptives. While these methods have undeniably contributed to improved reproductive health, recent studies have raised concerns regarding their potential effect on metabolic health. Despite widespread anecdotal reports, epidemiological research has been mixed as to whether hormonal contraceptives contribute to metabolic health effects. As such, the goals of this study were to assess the adipogenic activity of common hormonal contraceptive chemicals and their mixtures. Five different models of adipogenesis were used to provide a rigorous assessment of metabolism-disrupting effects. Interestingly, every individual contraceptive (both estrogens and progestins) and each mixture promoted significant adipogenesis (eg, triglyceride accumulation and/or preadipocyte proliferation). These effects appeared to be mediated in part through estrogen receptor signaling, particularly for the contraceptive mixtures, as cotreatment with fulvestrant acted to inhibit contraceptive-mediated proadipogenic effects on triglyceride accumulation. In conclusion, this research provides valuable insights into the complex interactions between hormonal contraceptives and adipocyte development. The results suggest that both progestins and estrogens within these contraceptives can influence adipogenesis, and the specific effects may vary based on the receptor disruption profiles. Further research is warranted to establish translation of these findings to in vivo models and to further assess causal mechanisms underlying these effects. [ABSTRACT FROM AUTHOR]

The impact of community-wide teen pregnancy prevention initiatives (CWIs) on local U.S. birth rates among adolescents aged 15 to 19 years was examined using synthetic control methodology within a quasi-experimental design. CWIs were implemented in 10 U.S. communities from 2010 to 2015. Each initiative implemented evidence-based teen pregnancy prevention interventions at local organizations and enhanced best practices in adolescent reproductive health care at local health centers, while engaging diverse community sectors. The synthetic control method was used to estimate the impact of each CWI on overall and race- and ethnicity-specific teen births relative to rates in synthetic control communities. Additionally, we estimated the overall effect of CWIs across communities by pooling results from the 10 synthetic control case studies using the mean percentile rank. Pooled data across all 10 communities indicated an estimated average of 6.6 fewer births per 1000 teens per year overall during the initiative relative to each community's synthetic control (p =.001). By race and ethnicity, there were an estimated average of 6.4 fewer births per 1000 teens per year among Black teens (p =.03), 10.7 fewer births among Hispanic teens (p =.03), and 4.2 fewer births (p =.10) among White teens. Results from individual communities indicated an intervention effect on overall and/or race/ethnicity-specific teen birth rates in five communities. This study demonstrates the value of synthetic control methods in evaluating community-level outcomes of programmatic efforts. Findings indicate the CWIs had a positive impact on teen birth rates and have the potential to address racial and ethnic disparities in those rates. [ABSTRACT FROM AUTHOR]

Purpose: Adolescent pregnancy remains an important public health issue in the United States as it has profound health consequences for both mother and child. Evidence shows that improved contraception use is a critical factor in decreasing rates of adolescent pregnancy. In order to provide effective and engaging contraception education, it is important to understand adolescents' attitudes, questions, and misconceptions around the topic and its delivery. Methods: Two searches were conducted using PubMed. Articles were limited to those published in the last 10 years that were written in English. The first search was completed using the search terms "Adolescent attitudes on sex education in the United States", and resulted in 688 articles. The second search was completed using the search terms "Adolescent attitudes on contraception in the United States", and resulted in 840 articles. Articles including contraception but focusing more on HIV, pre-exposure prophylaxis (PrEP), LGBTQ+ health and practices, human papillomavirus (HPV) vaccination, and studies completed in other countries were excluded. Remaining articles were screened by the authors for inclusion, and articles were included if they addressed information on adolescent attitudes on both contraception for pregnancy prevention and sex education, including education by schools, community organizations, the media, peers, parents, and physicians. A total of 56 articles were included in the review. Results: The overwhelming theme that emerged from the review is that adolescents prefer comprehensive sex education in a safe space that allows for exploration and questioning. Adolescents want to ask their parents questions about sexual health without fear of punishment, and they desire the opportunity to learn from their physicians in a confidential environment. Conclusion: The foundation of effective sex education is a non-judgmental, confidential, and safe space where adolescents can ask questions. There are multiple resources that adolescents use to gather information and establish their preferences and attitudes. [ABSTRACT FROM AUTHOR]

The Supreme Court decided Box v. Planned Parenthood of Indiana and Kentucky in 2019. Justice Clarence Thomas's opinion in the case claimed there was a direct connection between the legalization of abortion, in the late 20th Century, and the beginnings of the birth control movement a full three quarters of a century earlier. "Many eugenicists," Thomas argued, "supported legalizing abortion." Justice Samuel Alito highlighted similar claims in Dobbs v. Jackson Women's Health, citing a brief entitled "The Eugenic Era Lives on through the Abortion Movement." That brief was an echo of Justice Thomas' misguided attempt at history in the Box opinion. Similar claims reoccur in Judge Matthew Kacsmaryk's opinion in the Texas mifepristone case, Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration. These false claims are the focus of this article. There is no evidence that early leaders of the eugenics movement supported abortion as part of the movement for birth control. It is accurate to describe those leaders as anti-abortion, and their followers as people who condemned abortion for moral, legal, and medical reasons. [ABSTRACT FROM AUTHOR]

In 2022, HRA Pharma announced that it had submitted a long-awaited application with the Food and Drug Administration (FDA) to switch Opill to over-thecounter (OTC) status. This was the first time that a drug company had filed such an application. Efforts to "f~ee the pill" from the prescription began almost thirty years earlier. In 1993, the FDAproposed holding an open public meeting to discuss making the pill available over-the-counter. But pharmaceutical companies were reluctant to take on the challenge to make an oral contraceptive available OTC. The challenge was assumed by the Oral Contraceptives Over-the-Counter Working Group, founded in 2004, now called the Free the Pill coalition. Their goal was to make an OTC oral contraceptive that was affordable and accessible. This article explores their nineteen-year-long effort that has grown into a movement. The recent overturning of Roe v. Wiide has added a sense of increasing urgency to their effort to bring an OTC oral contraceptive to market. [ABSTRACT FROM AUTHOR]

This article traces the history of Straight Talk, a sex education curriculum introduced into US. high schools in the mid-1980s. Straight Talk was sponsored by Ortho Pharmaceutical, who offered the program as a "public service" to combat the socalled epidemic of teenage pregnancy that had inspired panic on both sides of the political spectrum. In fact, Straight Talk was part of a campaign to promote Ortho's newest product: the low-dose, multiphasic pill Ortho - Novum 7 /7 /7. Drawing on media reports, curricular materials and public relations (PR) documents, I argue that Straight Talk is a prime example of shadow marketing" in the pharmaceutical industry, in which companies use PR strategies to skirt regulations on direct-to-consumer advertising. While on the surface Straight Talk looked like a typical comprehensive sex education curriculum, its bias toward the Pill-in particular, the low-dose multiphasic pill-belied Ortho's claims of neutrality. The curriculum's promotion of the Pill also came at the expense of other contraceptive methods, such as the condom, a troubling omission in the age of HIV/AIDS. [ABSTRACT FROM AUTHOR]

Objective(s): To understand how contraception method use differed between women prescribed and not prescribed medications for opioid use disorder (MOUD) among commercially-insured and Medicaid-insured women.Study Design: IBM Watson Health MarketScan Commercial Claims and Encounters database and the Multi-State Medicaid database were used to calculate the (1) crude prevalence, and (2) adjusted odds ratios (adjusted for demographic characteristics) of using long-acting reversible or short-acting hormonal contraception methods or female sterilization compared with none of these methods (no method) in 2018 by MOUD status among women with OUD, aged 20 to 49 years, with continuous health insurance coverage through commercial insurance or Medicaid for ≥6 years. Claims data was used to define contraception use. Fisher exact test or χ2 test with a P-value ≤ 0.0001, based on the Holm-Bonferroni method, and 95% confidence intervals were used to determine statistically significant differences for prevalence estimates and adjusted odds ratios, respectively.Results: Only 41% of commercially-insured and Medicaid-insured women with OUD were prescribed MOUD. Medicaid-insured women with OUD prescribed MOUD had a significantly lower crude prevalence of using no method (71.1% vs 79.0%) and higher odds of using female sterilization (aOR, 1.33; 95% CI: 1.06-1.67 vs no method) than those not prescribed MOUD. Among commercially-insured women there were no differences in contraceptive use by MOUD status and 66% used no method.Conclusions: Among women with ≥ 6 years of continuous insurance coverage, contraceptive use differed by MOUD status and insurance. Prescribing MOUD for women with OUD can be improved to ensure quality care.Implications: Only two in five women with OUD had evidence of being prescribed MOUD, and majority did not use prescription contraception or female sterilization. Our findings support opportunities to improve prescribing for MOUD and integrate contraception and MOUD services to improve clinical care among women with OUD. [ABSTRACT FROM AUTHOR]

Adolescent pregnancies and births in the United States have undergone dramatic declines in recent decades. We aimed to estimate the contribution of changes in 3 proximal behaviors to these declines among 14- to 18-year-olds for 2007-2017: 1) delays in age at first sexual intercourse, 2) declines in number of sexual partners, and 3) changes in contraceptive use, particularly uptake of long-acting reversible contraception (LARC). We adapted an existing iterative dynamic population model and parameterized it using 6 waves of the Centers for Disease Control and Prevention's Youth Risk Behavior Survey. We compared pregnancies from observed behavioral trends with counterfactual scenarios that assumed constant behaviors over the decade. We calculated outcomes by cause, year, and age. We found that changes in these behaviors could explain pregnancy reductions of 496,200, 78,500, and 40,700 over the decade, respectively, with total medical and societal cost savings of $9.71 billion, $1.54 billion, and $796 million. LARC adoption, particularly among 18-year-olds, could explain much of the improvement from contraception use. The 3 factors together did not fully explain observed birth declines; adding a 50% decline in sex acts per partner did. Delays in first sexual intercourse contributed the most to declining births over this decade, although all behaviors considered had major effects. Differences from earlier models could result from differences in years and ages covered. Evidence-based teen pregnancy prevention programs, including comprehensive sex education, youth-friendly reproductive health services, and parental and community support, can continue to address these drivers and reduce teen pregnancy. [ABSTRACT FROM AUTHOR]

Long-acting reversible contraceptive (LARC) methods are effective options for pregnancy prevention. Currently available products in the United States include an etonogestrel implant, a copper intrauterine device (IUD), and several levonorgestrel IUDs. With increasing prevalence and duration of use, our understanding of efficacy, risks, and benefits has evolved. In addition to a brief discussion on nomenclature and LARC use within a framework of bodily autonomy and reproductive justice, this review covers clinical challenges with placement and removal, evidence-based duration of use, and how to mitigate side effects. Although all obstetrician-gynecologists as well as primary care clinicians can safely provide LARCs, complex family planning specialists are an expert referral source for challenging cases and evidence-based care as contraceptive technology continues to develop. [ABSTRACT FROM AUTHOR]

Simple Summary: Because the ethical foundation for the management of free-roaming horses and burros is very muddled, debates over approaches to their management, including fertility control, focus almost exclusively on practicality. In the U.S., this tendency is reinforced by the federal laws that govern public lands management, which center decision-making processes on calculations about how to divide yield among users. Inevitably, outside market forces bias these decisions towards overuse, which ultimately harms the land. In our view, the land and all its inhabitants, including free-roaming horses and burros, wildlife, and people, will only thrive if the pressures of commercial use are removed, and if management is guided by ethics of care, which have rich and diverse cultural origins. Application of care ethics will specifically provide more clarity to horse and burro management, including the selection of appropriate fertility control agents. To be effective and publicly acceptable, management of free-roaming horses and burros in the United States and elsewhere needs a consistent ethical framing of the animals and the land they occupy. In the U.S., the two laws that largely govern wild horse and burro management, the 1971 Wild Free-Roaming Horse and Burro Act and the 1976 Federal Land Policy and Management Act ("FLPMA"), rest on conflicting foundations, the former based on an ethic of care and the latter on largely utilitarian principles. These conflicts specifically fuel debates over the selection of appropriate fertility control agents for horse and burro management. Because land-use and management decisions are largely controlled by the FLPMA, and because the ethical treatment of animals is typically considered under conditions established by their use, both the larger debate about equids and land management and the specific debate about fertility control are dominated by cost/benefit calculations and avoid broader ethical considerations. In our view, the long-term health and ethical treatment of free-roaming horses and burros, the lands they occupy, and the wildlife and people they share it with will require the replacement of the resource-use model with a more holistic, care-based approach. [ABSTRACT FROM AUTHOR]

Free-roaming horses (Equus ferus caballus; horses) inhabit public rangelands located primarily in 10 western U.S. states. Recent horse population increases are impacting rangeland ecosystems, native wildlife species and their habitats, and exacerbating conflicts with domestic livestock grazing. While contraceptives and physical sterilization are promising options to manage horse herd levels, public opinion concerning the use of fertility control is not well understood. To better inform policymakers, we completed a rigorous study of a random sample of public land stakeholders across the United States (n = 3,500) in 2020 using a Likert scale online survey to assess their level of agreement with the general use of reproductive controls and their preferences regarding 4 available reproductive control options. We used chi-square likelihood ratio tests to determine the associations between the knowledge of horse origins in North America and horse management in the United States, and public support of contraception and sterilization methods to control horse populations. We also assessed the associations between survey responses and respondent demographics. Most respondents either "somewhat agreed" or "strongly agreed" with the use of contraceptives to control horse birth rates (36.6% and 26.9%, respectively) when no specific type of contraceptive was described. Respondents who believed horses were native to North America "strongly agreed" with the statement regarding the use of contraceptives less often (22.2%) than respondents who recognized that European explorers introduced horses (36.6%) or believed horses arrived by crossing a land bridge (35.8%); however, this association exhibited very low power to predict the response (λ < 0.1). Similarly, while there were some associations indicated by chi-square analyses between demographic variables and support for contraceptives, these associations exhibited very low power to explain the responses. When asked to rank 4 generalized population control options, more respondents ranked physical sterilization as their preferred option (37.1%). There was an association between age and ranking order of sterilization. For ages 18--53, the range was 40.6-45.3%, significantly more than older ages, 54 to ≥73, where the range was 31.1-33.8%. Knowledge did not influence the preference for control options. Our results suggest that our respondents were more supportive of the use of contraceptives or sterilization, when described in generalities, to control the birth rates in free-roaming horses. Our research provides policymakers with objective, novel insights into public knowledge and perceptions concerning the population control of free-roaming horses on designated western rangelands. We encourage the federal, state, and tribal agencies charged with the management of free-roaming horses to develop and deliver outreach programs to better educate public land stakeholders about the ecological and economic impacts of free-roaming horses on western landscapes and efficacy of available population management options to mitigate impact and sustain herds. [ABSTRACT FROM AUTHOR]

Wild equid (horses [Equus ferus] and burros [E. asinus]) populations have increased on public lands in the United States since the passage of the Wild Free-Roaming Horses and Burros Act of 1971. As of March 1, 2022, the Bureau of Land Management (BLM) estimated that wild equid populations on designated herd management areas (HMAs) may exceed 82,000 animals. In 2020, the total population of wild equids in the United States was estimated to exceed 300,000 animals. The BLM sets an appropriate management level (AML) for wild horse and burro herds on each HMA and removes animals when AMLs are exceeded. At present, the number of animals removed and placed in long-term holding is greater than the number adopted and sold. In 2021, the cost of caring for 59,000 animals in government holding facilities was >$72 million USD. Although the management of wild equid populations remains controversial among stakeholders, fertility control has gained wider acceptance, with injectable immunocontraceptive vaccines already employed to manage herds. Contemporary stakeholder views of wild equid management decisions may also reflect global shifts in public attitudes to wildlife management. These attitudes are driving both decisions and innovations in alternative approaches, such as fertility control, to manage wildlife. In this context, the Botstiber Institute for Wildlife Fertility Control is acting as a catalyst to advance the use of effective, sustainable fertility control methods to mitigate human--wildlife conflicts and promote coexistence worldwide. [ABSTRACT FROM AUTHOR]

Decisions related to controversial problems in natural resource management receive the greatest support when they account for multiple objectives of stakeholders in a structured and transparent fashion. In the United States, management of free-roaming horses (Equus caballus; horses) is a controversial multiple-objective problem because disparate stakeholder groups have varying objectives and opinions about how to manage fast-growing horse populations in ways that sustain both natural ecosystems and healthy horses. Despite much decision-support research on management alternatives that prevent excessive population size or cost, horse management decisions still receive resistance from a variety of stakeholder groups, potentially because decisions fail to explicitly or transparently account for multiple objectives of diverse stakeholders. Here, we used a predictive model for horse populations to evaluate the degree to which alternative management strategies involving removals and fertility control treatment with the immunocontraceptive vaccine PZP-22 maximize 4 objectives in horse management: maximize ecosystem health, maximize horse health, minimize effects on horse behavior, and minimize management cost. We simulated scenarios varying in management action, frequency, magnitude, and starting population size over a 10-year interval and evaluated scenario performance with a weighted multiple-objective utility reward function. Management involving high-magnitude removals along with PZP-22 treatment generally outperformed other alternatives by achieving higher reward relative to alternatives in 2 scenario analyses. Simulation of 1,372 scenarios at 5 starting population sizes generally found that management with biannual removals and 2 doses of PZP-22 treatment for half of eligible females during years 1 and 5 generated the most rewarding outcomes. However, a removal scenario with more frequent PZP-22 application generated the greatest reward when starting population size was already within target population size range. Our paper demonstrates how values and objectives of diverse stakeholders can be used to support management decisions in ways that might lead to greater acceptance of decisions by a broad array of stakeholder groups. [ABSTRACT FROM AUTHOR]

The management of free-roaming horses (Equus ferus) and burros (E. asinus) in the United States has been referred to as a "wicked problem" because, although there are population control options, societal values will ultimately determine what is acceptable and what is not. In the United States, free-roaming equids are managed by different types of organizations and agencies, and the landscapes that these animals inhabit vary widely in terms of access, size, topography, climate, natural resources, flora, and fauna. This landscape diversity, coupled with contemporary socioeconomic and political environments, means that adaptive management practices are needed to regulate these free-roaming populations. The Bureau of Land Management (BLM) currently manages free-roaming equids on 177 herd management areas in the United States by applying fertility control measures in situ and/or removing horses, which are either adopted by private individuals or sent to long-term holding facilities. The BLM off-range population currently includes >50,000 animals and costs approximately $50 million USD per year to maintain; on-range equid numbers were estimated in March 2022 to be approximately 82,384. On-range populations can grow at 15--20% annually, and current estimates far exceed the designated appropriate management level of 26,715. To reduce population recruitment, managers need better information about effective, long-lasting or permanent fertility control measures. Because mares breed only once a year, fertility control studies take years to complete. Some contraceptive approaches have been studied for decades, and results from various trials can collectively inform future research directions and actions. Employing 1 or more fertility control tools in concert with removals offers the best potential for success. Active, iterative, cooperative, and thoughtful management practices can protect free-roaming horses while simultaneously protecting the habitat. Herein, we review contraceptive vaccines, intrauterine devices, and surgical sterilization options for controlling fertility of free-roaming horses. This review provides managers with a "fertility control toolbox" and guides future research. [ABSTRACT FROM AUTHOR]

A non-hormonal prescription vaginal pH modulator (VPM) gel (Phexxi®), with active ingredients lactic acid, citric acid and potassium bitartrate, has recently been approved for prevention of pregnancy in the United States. The objective of this review is to compile the evidence available from published preclinical and clinical trials to support its use. PubMed was searched for published literature on VPM gel. Two Phase III trials were found on clinicaltrials.gov database. The results demonstrated that VPM gel is safe, with minimal side effects, and effective (cumulative 6–7 cycle pregnancy rate of 4.1–13.65%, (Pearl Index 27.5) as a contraceptive. Microbicidal effects suggest potential for the prevention of sexually transmitted infections (STIs); currently a Phase III clinical trial is being conducted to evaluate prevention of chlamydia and gonorrhea. Non-hormonal reversible contraceptive options have been limited to the highly effective copper-releasing intrauterine device that requires insertion by a trained clinician, and less effective coitally associated barrier and spermicide options which are typically available over-the-counter. Spermicides, which improve efficacy of barrier devices, may increase the risk of HIV/STIs. VPM gel provides a new safe, effective non-hormonal contraceptive option, with potential for prevention of STIs. [ABSTRACT FROM AUTHOR]

Background: Use of HIV PrEP (pre-exposure prophylaxis) is a strategic tool in the effort to end the HIV epidemic. 20% of new HIV infections in the US are among cis-gender women, yet they comprise only 5% of all PrEP users. Black women disproportionately bear the burden of new HIV acquisition and accounted for almost 60% of new HIV diagnoses among women in 2018. Increasing understanding and uptake of PrEP among women at risk of HIV acquisition in alignment with their reproductive values and preferences is key to increasing PrEP uptake and decreasing HIV burden in this population. Objective: This study examines how experiences with contraception among women of color shape their perceptions and preferences regarding HIV PrEP to inform counseling that aligns with their reproductive values. Methods: Women aged 18–45 who self-identified as Black or Latina were recruited at an academic medical center in the Bronx from June 2018 to July 2019. We enrolled 30 participants seeking family planning care (10), prenatal care (10), or care for sexually transmitted infections (10). Participants completed a brief written survey assessing their risk of HIV acquisition. Semi-structured, face-to-face interviews were then audio-recorded, transcribed, and entered into Dedoose. Grounded theory and constant comparison approaches were used to analyze the data. Results: Twenty-one participants (70%) screened positive for HIV acquisition risk. Four had received information on PrEP from a medical provider prior to the interview. Three themes emerged from the qualitative analysis: (1) Similar to oral contraception, women conceptualized PrEP as a "daily pill" to support their reproductive health; (2) Women perceived PrEP as a tool to support autonomy and pleasure in their sexual health; (3) Like birth control, women desired multiple delivery options for HIV prophylaxis. Conclusions: Contraception may serve as a frame of reference when counseling about PrEP among cis-women at risk of acquiring HIV. Our study suggests that this approach re-contextualizes counseling on PrEP within a sex-positive framework that prioritizes pleasure, safety, and autonomy as integral to sexual and reproductive wellness. Consideration of historically marginalized women's experiences with contraception and reproductive values may facilitate their use of PrEP. Plain Language Summary: PrEP (pre-exposure prophylaxis) is a medicine taken daily by people at risk of getting HIV from sex or injection drug use. Although PrEP is a safe and effective medication for women, the use of PrEP remains exceedingly low among cis-gender women at risk of HIV in the US. This study examines how experiences with contraception among women of color, who disproportionately bear the burden of HIV acquisition, shape their perceptions and preferences regarding PrEP. We interviewed 30 women who self-identified as Black or Latina at an academic medical center in the Bronx. Similar to oral contraception, women in this study conceptualized PrEP as a "daily pill" to support their reproductive health. This report details how women's experiences with contraception may serve as the foundation to re-contextualize conversations on PrEP within a sex-positive framework that prioritizes pleasure, safety, and autonomy as integral to sexual and reproductive wellness. [ABSTRACT FROM AUTHOR]

Background: Postpartum contraception prevents unintended pregnancies and short interpregnancy intervals. The Pregnancy Risk Assessment Monitoring System (PRAMS) collects population-based data on postpartum contraception nonuse and reasons for not using postpartum contraception. In addition to quantitative questions, PRAMS collects open-text responses that are typically left unused by secondary quantitative analyses. However, abundant preexisting open-text data can serve as a resource for improving quantitative measurement accuracy and qualitatively uncovering unexpected responses. We used PRAMS survey questions to explore unprompted reasons for not using postpartum contraception and offer insight into the validity of categorical responses.Methods and Findings: We used 31,208 categorical 2012 PRAMS survey responses from postpartum women in the US to calculate original prevalences of postpartum contraception use and nonuse and reasons for contraception nonuse. A content analysis of open-text responses systematically recoded data to mitigate survey bias and ensure consistency, resulting in adjusted prevalence calculations and identification of other nonuse themes. Recoded contraception nonuse slightly differed from original reports (21.5% versus 19.4%). Both calculations showed that many respondents reporting nonuse may be at a low risk for pregnancy due to factors like tubal ligation or abstinence. Most frequent nonuse reasons were not wanting to use birth control (27.1%) and side effect concerns (25.0%). Other open-text responses showed common themes of infertility, and breastfeeding as contraception. Comparing quantitative and qualitative responses revealed contradicting information, suggesting respondent misinterpretation and confusion surrounding the term "pregnancy prevention." Though this analysis may be limited by manual coding error and researcher biases, we avoided coding exhaustion via 1-hour coding periods and validated reliability through intercoder kappa scores.Conclusions: In this study, we observed that respondents reporting contraception nonuse often described other methods of pregnancy prevention and contraception barriers that were not included in categorical response options. Open-text responses shed light on a more comprehensive list of pregnancy prevention methods and nonuse options. Our findings contribute to survey questions that can lead to more accurate depiction of postpartum contraceptive behavior. Additionally, future use of these qualitative methods may be used to improve other health behavior survey development and resulting data. [ABSTRACT FROM AUTHOR]

Adolescents are at risk for unwanted pregnancy when they become sexually active, and contraception is an important part of mitigating this risk. Use of contraceptive methods, and long-acting reversible contraceptive methods such as implants and intrauterine devices in particular, has increased among adolescents. Although sexual activity has declined and contraceptive use has increased among adolescents in the United States in recent years, the unintended pregnancy rate remains high. All of the currently available contraceptive methods are safe and effective for adolescents to use; however, adolescents may have specific concerns about side effect profiles and unscheduled bleeding that should be addressed during contraceptive counseling. Healthcare providers should prioritize adolescents' needs and preferences when approaching contraceptive counseling, and also consider the unique access and confidentiality issues that adolescents face when accessing contraception. [ABSTRACT FROM AUTHOR]

The first three years of the Trump Administration had dire effects on the status of reproductive rights in the United States. Within this context, reproductive rights, health, and justice advocates had to respond creatively and forcefully, sometimes utilizing tactics that involved strategic compromises to accomplish their goals. This essay examines the politics of compromise occurring within contemporary fights for equitable access to comprehensive sexual health education and contraception. Analyzing news media and public policy in relation to these advocacy efforts, this essay illustrates that arguments made for sex education in the name of preventing teen pregnancy and for long-acting, reversible contraceptives in the name of preventing abortion undermine the goal of reproductive self-determination. These arguments reinforce notions that have long plagued advocacy for sex education and birth control in the United States—that certain people are illegitimate reproducers and that specific reproductive options are intolerable. As such, these strategic compromises often support the directing of resources toward programs that constrain, rather than enable, reproductive freedom for all people. [ABSTRACT FROM AUTHOR]

The social politics of women's alcohol use is controversial given current debates over maternal-fetal health, fetal alcohol syndrome, and debates about welfare. Exploring the early twentieth century intersections of Prohibition, birth control reform, and alcohol politics reveals the historical roots of current recommendations surrounding women, alcohol, and public assistance. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of Health-E You/Salud iTu, a mobile health application (app), on increasing knowledge, self-efficacy and contraception use among Latina adolescents, its impact on visit quality, and app satisfaction.Study Design: This study used cluster-randomized controlled trial (CRCT) of 18 school-based health centers (SBHCs). Prior to the visit, intervention participants received the patient-centered contraceptive decision-making support app and controls answered sexual health questions on iPads. Participants completed a previsit questionnaire and 3 follow-up surveys (48 hours, 3-, and 6-months) after the recruitment visit (where intervention participants completed the app). Differences in adolescents' contraceptive knowledge, self-efficacy, and use over the 6-month follow-up were assessed by generalized mixed effects regression models.Results: A total of 1,360 Latina adolescents participated; 57.2% responded to the 48-hour survey, 50.1% to the 3-month, 49.7% to the 6-month, and 42.3% to both the 3- and 6-month surveys. Health-E You users' demonstrated significant increases in pre-post knowledge (p < 0.001). Intervention participants who completed the follow-up survey reported greater increases in mean self-efficacy from baseline (23.2 intervention vs. 22.5 controls) to 6 months (26.1 vs. 23.4; b = 1.58, 95% CI 0.38-2.77, p = 0.01), and greater increases in non-barrier contraceptive use from baseline (29% intervention vs. 30% controls) to 3 months (63% vs. 45%; OR = 3.29, 95% CI 1.04-10.36, p = 0.04) and 6 months (63% vs. 44%; OR = 5.54, 95% CI 1.70-18.06, p = 0.005). Providers and adolescents reported high app satisfaction and stated it improved visit quality.Conclusions: While data suggest that Health-E You improved outcomes, findings must be interpreted cautiously. Intervention participants had higher baseline sexual activity rates, more recruitment visits for pregnancy testing, emergency contraception or birth control, and lower completion rates of follow-up surveys than controls.Implications: Despite declines in adolescent pregnancy in the United States, Latinas continue to have disproportionately high rates compared to white females. The Health-E You app may be an effective support tool for both adolescents and providers in SBHCs, and possibly other clinical settings, across the country to increase contraceptive use and thereby decrease unintended pregnancies. It could potentially reduce disparities in adolescent pregnancies and create more efficient visit time spent between clients and their providers. [ABSTRACT FROM AUTHOR]

The US fertility transition in the nineteenth century is unusual. Not only did it start from a very high fertility level and very early in the nation's development, but it also took place long before the nation's mortality transition, industrialization, and urbanization. This paper assembles new county-level, householdlevel, and individual-level data, including new complete-count IPUMS microdata databases of the 1830-1880 censuses, to evaluate different theories for the nineteenth-century American fertility transition. We construct cross-sectional models of net fertility for currently-married white couples in census years 1830-1880 and test the results with a subset of couples linked between the 1850-1860, 1860-1870, and 1870-1880 censuses. We find evidence of marital fertility control consistent with hypotheses as early as 1830. The results indicate support for several different but complementary theories of the early US fertility decline, including the land availability, conventional structuralist, ideational, child demand/quality-quantity tradeoff, and life cycle savings theories. [ABSTRACT FROM AUTHOR]

Youths experiencing homelessness (YEH) become pregnant at five times the general population rate. Education, social, and health care systems struggle to adequately address this young community's sexual and reproductive health needs, yet social workers are well positioned across sectors to address their sexual and reproductive health and well-being. A growing body of literature exists on the factors affecting YEH's access and selection of birth control, prompting the present review that aimed to understand this process and inform better attuned sexual and reproductive health approaches. Using a systematic search and analytic approach, we retrieved 203 articles, of which 23 met inclusion criteria. Key findings emerged across socioecological levels, including barriers and facilitators to condom use; the differential impact on YEH of hormonal birth control side effects; and the devastating effects of economic insecurity leading to sexual exploitation, survival sex, and exposure to violence. Implications include the need for multilevel intervention that addresses youths' knowledge, attitudes, and behavior as well the need to improve social norms and system design to provide better attuned care for YEH. [ABSTRACT FROM AUTHOR]

Background: Digital fertility awareness-based methods of birth control are an attractive alternative to hormonal or invasive birth control for modern women. They are also popular among women who may be planning a pregnancy over the coming years and wish to learn about their individual menstrual cycle. The aim of this study was to assess the effectiveness of the Natural Cycles app at preventing pregnancy for a cohort of women from the United States and to describe the key demographics of current users of the app in such a cohort. Materials and Methods: This prospective real-world cohort study included users who purchased an annual subscription to prevent pregnancy. Demographics were assessed through answers to in-app questionnaires. Birth control effectiveness estimates for the entire cohort were calculated using 1-year pearl index (PI) and 13-cycle cumulative pregnancy probability (Kaplan–Meier life table analysis). Results: The study included 5879 women who contributed an average of 10.5 months of data for a total of 5125 woman-years of exposure. The average user was 30 years old with a body mass index of 24 and reported being in a stable relationship. With typical use, the app had a 13-cycle cumulative pregnancy probability of 7.2% and a 1-year typical use PI of 6.2. When the app was used under perfect use, the PI was 2.0. Conclusions: The data presented in this study give insights into the cohort of women using this app in the United States, and provide country-specific effectiveness estimates. The contraceptive effectiveness of the app was in line with previously published figures from Natural Cycles (PI of seven for typical use and two for perfect use). [ABSTRACT FROM AUTHOR]

Objective: Effective contraception prevents unintended pregnancy which disproportionately affects women in the criminal justice system. This study examined selected variables associated with contraceptive use by women on probation and parole living on the United States–Mexico border. Design: This quantitative correlational study examined individual and interpersonal variables—age, parity, ethnicity, prior contraception, self‐efficacy, pregnancy attitudes, and reproductive autonomy—that may influence contraception among 52 women under community supervision. Measures: Variable were examined with bivariate, multivariate analyses, and hierarchical logistic regression. Data were collected from a demographic and contraceptive use survey, and validated scales measuring reproductive autonomy and pregnancy attitudes. Results: Contraceptive methods were used by 89% of the women; 65% used effective methods, but this decreased to 35% among those released within the past year. Reproductive autonomy was associated with effective contraceptive use. Prior contraception and contraceptive self‐efficacy were significant, but wide confidence intervals suggested instability. The remaining variables were insignificant. Conclusion: No known studies have examined contraception use among women on probation and parole on the border. More women used some form of contraception than might be predicted. Collaborative efforts between correctional facilities and the community are needed to expand access to contraception. [ABSTRACT FROM AUTHOR]

Importance: Catamenial epilepsy (CE) is exacerbated by hormonal fluctuations during the menstrual cycle. Approximately 1.7 million women have epilepsy in the United States. CE affects more than 40% of women with epilepsy. There is a paucity of literature addressing this condition from a clinical standpoint, and the literature that does exist is limited to the neurological community. This article reviews the diagnosis and management of CE for the non-neurologist. Women with CE have early touch points in their care with numerous health care providers before ever consulting with a specialist, including OB/GYNs, pediatricians, emergency department physicians, and family medicine providers. In addition, women affected by CE have seizures that are more recalcitrant to traditional epilepsy treatment regimens. To optimize management in patients affected by CE, menstrual physiology must be understood, individualized hormonal contraception treatment considered, and adjustments and interactions with antiepileptic drugs addressed. Observations: CE is a unique subset of seizure disorders affected by menstrual fluctuations of progesterone and estrogen. The diagnosis of CE has been refined and clarified. There is an ever-increasing understanding of the importance and variety of options of hormonal contraception available to help manage CE. Furthermore, antiepileptic drugs and contraception can interact, so attention must be directed to optimizing both regimens to prevent uncontrolled seizures and pregnancy. Conclusion and Relevance: CE can be diagnosed with charting of menstrual cycles and seizure activity. Hormonal treatments that induce amenorrhea have been shown to reduce CE. Optimizing antiepileptic drug dosing and contraceptive methods also can minimize unplanned pregnancies in women affected by CE. [ABSTRACT FROM AUTHOR]

The Affordable Care Act mandated that employers provide contraceptive coverage to workers at no cost. In July, the U.S. Supreme Court allowed a Trump administration regulation to let employers with religious or moral objections opt out of the mandate. [ABSTRACT FROM AUTHOR]

Objectives: Healthy People 2020 establishes objectives for reducing the proportion of pregnancies in the United States that are unintended and for improving contraceptive use. This analysis describes ways to more closely align measurement of contraceptive use with periods of risk for unintended pregnancy using the National Survey of Family Growth (NSFG).Methods: Using the 2011-2015 NSFG we constructed two measures of contraceptive use for women we defined as at risk of an unintended pregnancy: (1) we augmented a measure of recent contraceptive use by recoding non-users according to their method use during their last month of sex in the past 12 months; (2) we augmented use at last sex in the past 12 months by excluding women who were pregnant at last sex. Estimates were compared overall and within 5-year age groups.Results: The augmented measure of recent contraceptive use found fewer women to be using no contraception than the standard measure (7.3% vs 15.4%; p < .001); greater differences were found between the two measures for younger women. When considering contraceptive use at last sex, the augmented measure identified fewer women as using no contraception (15.8% vs 21.0%; p < .001) than the standard measure and more women to be using a most effective method (33.3% vs 31.1%; p = .04) than the standard measure.Conclusions: Aligning periods of unintended pregnancy risk with contraceptive use assessment reduced estimates of no contraceptive use; changes in estimates by method type varied by age.Implications: When assessing contraceptive use for the purpose of unintended pregnancy prevention, researchers may consider the methods described here to further align contraceptive use measurement with periods of unintended pregnancy risk. [ABSTRACT FROM AUTHOR]

Objective: We sought to test whether participation in an online group including IUD users influenced IUD-related knowledge, attitudes, and behavior among IUD non-users, as a proof-of-concept evaluation of information dissemination for less commonly used or novel contraceptives.Study Design: We conducted a blinded, randomized controlled trial on the effect of online communication with IUD users within an online program called Birth Control Connect. Participants were women age 18-45 living in the United States who had never used an IUD. We invited participants randomized to the intervention to join two-week, nine-member discussion groups including four satisfied IUD users and five IUD non-users; we invited control participants to groups including nine IUD non-users. We performed chi-squared tests on IUD knowledge, information-seeking, informational support and use in immediate post-surveys, and t-tests comparing change in IUD attitudes and frequency of logins to discussion groups.Results: We invited 488 IUD non-users and enrolled them into 70 groups between October 2015 and April 2016. We found increased positive attitudes towards the IUD in the intervention arm (0.65-point increase between pre- and post-surveys, versus 0.05 mean change for control arm, p = 0.03 for hormonal IUD, with a trend in the same direction for the non-hormonal IUD). Informational support also increased, with 70.3% of intervention arm participants self-reporting that they gained a better idea of what the IUD would be like, compared to 51.3% in control arm (p < 0.01). Of intervention participants, 63.3% versus 51.3% of control participants reported gaining new information from their group (p = 0.03). There were no differences in correct responses to knowledge items or information-seeking between groups.Conclusions: Online exposure to IUD users increased positive attitudes toward the IUD and informational support for decision-making about the IUD among non-users.Implications Statement: Online spaces provide a promising environment for the exchange of accurate, useful contraceptive information based on real user experiences. Interventions aiming to harness social communication through structured online conversations (e.g., on existing social media platforms) about user experiences with lesser-known contraceptive methods such as the IUD may be worthwhile. [ABSTRACT FROM AUTHOR]

Contraception is a practice with extensive and complicated social and scientific histories. From cycle tracking, to the very first prescription contraceptive pill, to now having over-the-counter contraceptives on demand, family planning is an aspect of healthcare that has undergone and will continue to undergo several transformations through time. This review provides a comprehensive overview of current reversible hormonal and non-hormonal birth control methods as well as their mechanism of action, safety, and effectiveness specifically for individuals who can become pregnant. Additionally, we discuss the latest Food and Drug Administration (FDA)-approved hormonal method containing estetrol and drospirenone that has not yet been used worldwide as well as the first FDA-approved hormonal over-the-counter progestin-only pills. We also review available data on novel hormonal delivery through microchip, microneedle, and the latest FDA-approved non-hormonal methods such as vaginal pH regulators. Finally, this review will assist in advancing female contraceptive method development by underlining constructive directions for future pursuits. Information was gathered from the NCBI and Google Scholars databases using English and included publications from 1900 to present. Search terms included contraceptive names as well as efficacy, safety, and mechanism of action. In summary, we suggest that investigators consider the side effects and acceptability together with the efficacy of contraceptive candidate towards their development., (© The Author(s) 2023. Published by Oxford University Press on behalf of Society for the Study of Reproduction. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To determine the current risks of infertility and impaired fecundity as well as the live birth/pregnancy ratio among women with epilepsy (WWE) in the USA and whether antiepileptic drug (AED) use is a factor. Methods: These retrospective survey data come from the 2010‐2014 Epilepsy Birth Control Registry (EBCR) Web‐based survey of 1000 WWE in the USA, aged 18‐47 years, who provided demographic, epilepsy, AED, reproductive, and contraceptive data. We report risks of infertility and impaired fecundity, live birth/pregnancy ratio, and whether outcomes differ by AED use or category versus No AED. Results: A total of 978 of the 1000 USA WWE reported reproductive data; 373 WWE had 724 pregnancies and 445 births. An additional 38 WWE (9.2%, 95% confidence interval [CI] = 6.7‐12.4%) tried to conceive but were infertile. A total of 72.5% had a live birth outcome for their first pregnancy, 89.0% had at least one live birth for their first two pregnancies, and 61.6% had two live births for their first two pregnancies. Eighty‐four of 406 WWE (20.7%, 95% CI = 17.0‐2.9%) had impaired fecundity. The risk of impaired fecundity trended higher on AED polytherapy than on No AED (risk ratio [RR] = 1.79, 95% CI = 0.94‐3.11, P = .08). The ratio of live birth/unaborted pregnancy (445/594, 74.9%) was similar among WWE on No AED (71.3%), AED monotherapy (71.8%), and polytherapy (69.7%). None of the AED categories differed significantly from No AED. Note that glucuronidated AED (lamotrigine), which had the highest ratio of live birth/pregnancy (89.1%), compared favorably to enzyme‐inhibiting AED (valproate), which had the lowest (63.3%; RR = 1.41, 95% CI = 1.05‐1.88, P = .02). Significance: The EBCR finds 9.2% infertility risk and 20.7% impaired fecundity risk among WWE in the USA. Impaired fecundity trended higher on AED polytherapy than on No AED. Live birth/pregnancy ratio was higher with the use of lamotrigine than valproate. These findings may provide WWE a more objective basis for pregnancy planning. [ABSTRACT FROM AUTHOR]

This Note argues that it is harmful and unnecessary to require women to obtain prescriptions for access to hormonal birth control. Requiring a prescription is necessarily a barrier to access which hurts women and hamstrings the ability to dictate their own reproductive plans. It is also an irrational regulation in light of the relative safety of hormonal birth control pills, particularly progestin-only formulations, compared to other drugs readily available on the shelves. Leading medical organizations, including the American College of Obstetrics and Gynecologists, advocate for over-thecounter access to hormonal birth control. While acknowledging that not every woman will have positive outcomes taking hormonal birth control pills, this Note argues that women are capable of taking hormonal birth control as directed and are able to selfidentify if they themselves are at risk for complications. Following a long line of cases that establish reproduction as a fundamental right in the United States, it follows that requiring a prescription for access can and should be analyzed under the Fifth and Fourteenth Amendment Due Process clauses, particularly under the Undue Burden standard. Certain prerequisites, such as pelvic exams, once thought to be necessary to safely prescribe hormonal birth control, are now widely considered unnecessary in determining whether a particular woman can safely take birth control pills. This Note goes further and argues that such prerequisites are an unconstitutional method of holding vital medication hostage from women who desire to control their reproductive health. [ABSTRACT FROM AUTHOR]

Homeless female adolescents in the United States have disproportionately high rates of pregnancy compared to general population youth. Little is known about how homeless youth decide whether to use birth control and which birth control method to select. The current study explores how homeless female youth participating in a holistic sexual health program called Wahine ("woman") Talk experience this process, using data from in-depth interviews (N = 3) with 11 homeless adolescent girls. Data were analyzed using Interpretative Phenomenological Analysis, proceeding through reading and re-reading, initial noting, forming emergent and super-ordinate themes, repeating steps for each interview, and developing final themes and subthemes. Four final themes emerged, which, for most participants, were experienced sequentially: Getting Acclimated, Becoming Close and Building Trust, Addressing Fear, and Making the Choice. Study findings suggest that for homeless female youth, basic needs and relationship building must be addressed prior to the delivery of trauma-informed birth control-related content and effective linkage to (sexual) healthcare. Implications for practice, policy, and future research are discussed. • The rate of homeless teen pregnancy is five times greater than the general youth population. • Little is known about how homeless youth experience accessing and selecting birth control. • For study participants, accessing and selecting birth control contains four steps experienced sequentially. • Homeless youth perceive risk of sexual assault/unwanted pregnancies, which motivates accessing birth control. • Meeting basic needs and building a trusted relationship is critical for trauma-informed healthcare for homeless youth. [ABSTRACT FROM AUTHOR]

Abstract Study Objective Nearly 20 million adolescents receive emergency department (ED) care each year, many of whom have untreated reproductive health issues. ED visits represent an opportunity to provide appropriate care, however, ED physician reproductive health care practices and capabilities in the United States have not been described. We sought to characterize pediatric ED director's individual practice and ED system resources for providing adolescent reproductive health care. Design, Setting, Participants, and Interventions We invited pediatric ED division and/or medical directors nationally to participate in an anonymous, online survey. Main Outcome Measures Outcomes included ED directors' personal practice regarding providing adolescent patients reproductive health care, and their ED's resources and standard practice regarding screening adolescents for sexually transmitted infections (STIs) and other reproductive health concerns. Results One hundred thirty-five of 442 (30.5%) ED directors responded. Respondents were 73% (90/124) male, with a median of 18 (interquartile range, 13-23) years of experience and 63% (84/134) working in urban EDs. Seventy-one percent (90/130) preferred face-to-face interviews for obtaining a sexual history, but only 59% (77/130) of participants "always ask parents to leave the room for sensitive questions." Eighty-four percent (106/127) were receptive to pregnancy prevention interventions being initiated in the ED, with 75% (80/106) of those willing to provide an intervention. Only 16% (21/128) indicated their ED has a universal STI screening program, and only 18% (23/126) "always" successfully notify patients of a positive STI test. Conclusion ED directors are comfortable providing adolescent reproductive health care, and many individual- and ED-level opportunities exist to provide improved reproductive health care for adolescents in the ED. [ABSTRACT FROM AUTHOR]

The article shares the author's thoughts concerning the assessment of fertility control through abortion in the U.S. The author notes that from the global point of view, fantastically accelerating rate of the world population was probably the most serious problem they would be facing in the immediate future. He said that abortion was likely to be one of the most effective methods of fertility control in a certain sector of population. He adds that evidence has demonstrated that under certain circumstances, abortion can be highly effective even in highly advance countries. He points out that realization of the demographic and surgical of abortion was necessary in order to understand the magnitude of the problem.

The author proposes a general method of automobile licensing which preserves free choice, is concerned on environmental quality and avoids certain undesirable consequences of other proposals. He suggests that problems in air pollution can be solved by a system of limiting the actual number of automobiles used which involves the licensing of automobiles. The proposal for population control is also discoursed.

Marketing is a field in transition. In recent years, its spectrum has broadened to involve marketing of social causes. So far, we have been flooded with literature and discussions of the theoretical underpinnings of broadening the concept of marketing. There seems to be a greater need now to examine available evidence of "broadening type" applications, especially in the most controversial area of "social marketing." This is a report on a social marketing application. It explores the application of marketing technology in family planning. [ABSTRACT FROM AUTHOR]