CORE Brief: Medical Student Education on Abortion: The Current LandscapeFile: Medical-Student-Education-about-Abortion.pdf
This week CORE Director Jenny Higgins and colleagues published a new article in JAMA Internal Medicine, titled “Association Between Patients’ Perceptions of the Sexual Acceptability of Contraceptive Methods and Continued Use Over Time.”
Contraception is one of the most commonly used healthcare products in the United States, and it allows people to engage in sexual activity without experiencing unwanted pregnancies. But contraceptive research, education, and clinical care rarely consider the birth control’s sexual acceptability—that is, how contraceptives affect people’s sexual experiences, and how those effects may shape use over time.
Higgins and colleagues’ new study in JAMA Internal Medicine sheds light on this important issue–and suggests that contraceptives’ effects on people’s sex lives can have major consequences for birth control practices.
The research team included scholars from the University of Wisconsin-Madison and the University of Utah. The team conducted a study of 2,000 people who started a new contraceptive method. Research participants could switch or discontinue their method at any time, for free. They found that at one month, about half of contraceptive clients reported that their method had led to a positive impact on their sex life, less than a third reported no sexual change, and one in six reported a negative sexual impact.
The team then examined how these sexual impacts at one month helped predict people’s continued use of their contraceptive method at six months. They found that those who reported a negative impact on their sex life were upwards of three times as likely to discontinue or switch their method compared to people who reported a positive sexual impact. And this effect on contraceptive use over time was much stronger than factors that we more commonly consider: changes in vaginal bleeding, physical side effects such as headaches or bloating, and psychological side effects such as changes in mood.
“Our study shows that people’s sexual experiences of their contraceptive method seem to matter a lot in whether people like their method and use it over time. It’s important that we pay more attention to sexual acceptability in our contraceptive research, clinical care, and education,” said Dr. Higgins. For example, both clinicians and educators could emphasize that patients’ sexual experiences of their methods are important and encourage them to find a method that works for them, sexually and otherwise. “It’s also great news that contraception seems to have a positive sexual impact on so many people’s sex lives,” Dr. Higgins said. “And I urge those people who think their method is a sexual detractor to keep trying other methods—they deserve to find one that they like!”
Read the open-access research letter in JAMA Internal Medicine.
In a article in Obstetrics & Gynecology, also known as the Green Journal, authors Tiffany L. Green, PhD, Jasmine Y. Zapata, MD, Heidi W. Brown, MD, MAS, and Nao Hagiwara, PhD address the limitations of existing implicit bias interventions as a strategy for achieving maternal health equity. Entitled “Rethinking Bias to Achieve Maternal Health Equity: Changing Organizations, Not Just Individuals,” the article focuses on how institutionally sanctioned racial stereotyping harms Black maternal health and marginalizes a key group in the fight for health equity—Black physicians. Finally, Green and colleagues provide strategies to address racial bias in perinatal health care and structural barriers impeding Black physicians’ success, addressing the importance of physician training and the physician pipeline to increasing equity and maternal health outcomes.
Read the full article here.
In a new article for Health Affairs titled “The Need For Accurate Contraceptive Awareness And Advocacy Among Health Care Providers,” CORE Researchers Jenny Higgins, Lindsay M. Cannon, Laurel W. Rice and David K. Turok investigate how health care professionals understand and define pregnancy, the mechanisms of contraception, and the differences between contraception and abortifacients. Broad misunderstandings of these terms contribute to health policies that limit access to the full range of FDA-approved contraceptive methods.
The team writes, “According to the American College of Obstetricians and Gynecologists (ACOG), pregnancy is defined as “the period of time from implantation to delivery,” which begins when a fertilized egg is implanted into the uterine wall. This definition is consistent across all major US medical organizations and US governmental agencies. Abortion has a precise meaning in the medical and scientific community as a termination of pregnancy. As such, an abortifacient, or drug that causes an abortion, works after a fertilized egg has implanted into the uterine lining.
In contrast, a method of contraception must prevent pregnancy by preventing the fertilization of an egg or by preventing the implantation of a fertilized egg. Thus, to be considered a contraceptive product, a method must prevent pregnancy before a pregnancy is established through the process of implantation. Thus, contraceptive methods including but not limited to pills, patches, rings, IUDs, injections, implants, sterilization, emergency contraception, and barrier methods, all prevent pregnancy prior to implantation; none disrupt an existing pregnancy.
There are two methods of contraception that tend to be especially misunderstood: IUDs and pill-based emergency contraception.”
To read the full article and see survey data from healthcare providers, go to healthaffairs.org.
The authors express gratitude to the University of Wisconsin Survey Center for their invaluable methodological expertise and survey administration. They also thank the supporters and staff of UW CORE. Finally, they are grateful to Freya Riedlin at the Center for Reproductive Rights for helping identify political appointees’ statements about contraception.