Brief summaries for the 2009 SFP annual business meeting:
Small grants
An alternative model for emergency contraception: Prostaglandin inhibitor-induced luteolysis
Alison Edelman, Oregon Health Sciences University ($15,000)
As an initial step toward understanding the contraceptive potential of blocking prostaglandin synthesis, we tested the hypothesis that the use of a specific prostaglandin endoperoxide-2 (PTGS2) inhibitor would prevent luteal development and function. We found that daily administration of a PTGS2 inhibitor may delay the timing of luteal events, and therefore fertility, in women. And thus, may hold potential as an emergency contraceptive.
Meaning, resilience, and self-care for the abortion team project
Lisa Harris, University of Michigan ($14,904)
Doing abortion work brings unique rewards and carries unique burdens. We designed an experimental supportive intervention (the Providers’ Share Workshop) in which participants used discussion, journaling and artwork as expressive modes. Seventeen abortion workers participated in 6 group meetings over a three month period. Workers raised the following issues repeatedly: violence (against providers, against women and against fetuses); emotional compartmentalization or “walling off;” the difficulties of doing abortion work as a pregnant provider or parent of young children; marginalization within mainstream medical communities; anger with anti-choice activism; dissatisfaction/de-identification with pro-choice movements for not routinely representing the experiences of workers “in the trenches;” and compulsory silence regarding all of these issues. Over the course of the workshop participants experienced heightened sense of “team,” resulting in improved well-being, enhanced work satisfaction, and decreased feeling of burden. We conclude that the Providers’ Share Workshop may strengthen the US abortion-providing workforce, and should be tested in larger studies.
Blood loss at the time of first trimester surgical abortion in anticoagulated women
Bliss Kaneshiro, Oregon Health Sciences University ($14,737)
The objective of this study is to compare blood loss resulting from surgical termination of pregnancy up to 12 weeks gestation between women who are anticoagulated to therapeutic levels and those who are not anticoagulated. This prospective study is being conducted at three sites in the United States. Because there is a paucity of literature on this topic, this study will impact the way in which we provide abortion procedures to medically complicated women.
Large grants
Paracervical block with combined ketorolac and lidocaine in first trimester surgical abortion
Catherine Cansino, Johns Hopkins University ($83,740)
We conducted a double-masked, placebo-controlled randomized clinical trial of 50 women undergoing first trimester surgical abortions (< 11 weeks) who received either oral ibuprofen with a lidocaine-alone paracervical block or an oral placebo and paracervical block with combined ketorolac and lidocaine. Our results indicated that paracervical block with combined ketorolac and lidocaine significantly decreased perceived pain associated with cervical dilation during first trimester surgical abortion. This analgesic mixture may be offered as an alternative pain regimen to women seeking first trimester surgical abortion.
Acceptability of implantable etonorgestrel (Implanon) as contraception immediately following a surgical abortion
Eleanor Drey, University of California, San Francisco ($89,818)
The study evaluates the safety and pharmacokinetics of intra-amniotic and intra-fetal digoxin injection before late second-trimester pregnancy termination by dilation and evacuation (D&E). Patients having a D&E between 19 to 23 weeks gestation receive either 1.5 mg intra-amniotic or 1.0 mg intra-fetal digoxin by intrauterine injection. To describe the safety in 20 subjects, for 24 hours they have Holter cardiac monitoring and assessment of serial serum digoxin levels, electrolytes, blood count and clotting parameters and an additional set of labs 48 hours after the digoxin injection.
Combined oral contraceptives and body weight: Do oral contraceptives cause weight gain?
Alison Edelman, Oregon Health Sciences University ($120,000)
Human studies have not been able to conclusively determine if combined oral contraceptives affect body weight. We examined the relationship of oral contraceptives on body weight, basal metabolic rate, activity level, and % body fat and lean muscle mass in obese and normal BMI non-human primates. Overall, oral contraceptive use appears to increase 24 hour metabolic rates in female monkeys which in turn appears to differentially affect weight and % body fat depending on baseline weight (greater decreases in the obese group) without affecting % lean muscle mass or activity levels.
Abortion self-induction among low-income women in San Francisco, Boston, and New York:
A quantitative and qualitative study
Daniel Grossman, Ibis Reproductive Health ($120,000)
Ibis Reproductive Health, in collaboration with Gynuity Health Projects, conducted a mixed methods study to better understand abortion self-induction outside of the clinic setting in three US cities with large Latina immigrant populations: Boston, New York, and San Francisco. Through surveys implemented in primary care and full-scope obstetrics and gynecology clinics serving predominantly low-income women, we examined women’s knowledge about, experience with, and attitudes toward abortion laws and services, as well as their awareness about and use of misoprostol and other agents to self-induce; we also conducted in-depth interviews with women reporting previous self-induction to explore the reasons why they chose initially not to use legal abortion clinics, and their experience with self-induction. Results from the survey show that though knowledge of misoprostol is less common than we hypothesized, 57% of study participants named at least one method of self-induction and 4% of study participants who had ever been pregnant had attempted to induce an abortion on their own using a range of methods, most of which do not work and some of which are dangerous, highlighting the need for access to safe abortion care for low-income and immigrant women.
Contraceptive decision-making by Latina diabetics
Stephanie Teal, University of Colorado ($119,177)
In this study we designed and feasibility-tested a comprehensive life history calendar linking reproductive and diabetic events amongst Latina diabetics to evaluate the influence of diabetes on reproductive behavior. We described and compared contraceptive use of diabetics and non-diabetics, and compared the time-to-pregnancy during episodes of non-contraceptive use in these two populations. Finally, we conducted qualitative interviews with our diabetic subjects, using the calendar as a springboard, to investigate themes influencing their reproductive behaviors.
Immediate post-placental insertion of the levonorgestrel-releasing intrauterine system after cesarean delivery vs. 4-8 week post-delivery interval insertion
Amy Whitaker, University of Chicago ($72,339)
The “Pixie” study is a randomized controlled trial comparing outcomes after immediate postplacental insertion of the levonorgestrel-releasing intrauterine system to outcomes after interval insertion performed 4-8 weeks after delivery, for patients undergoing scheduled cesarean delivery. Our primary outcome is usage at 12 months after cesarean delivery. This study is in the recruitment phase.
