“Vessel”: A documentary and a movement

The new documentary “Vessel” leaves the audience inspired, furious, and perhaps above all, gobsmacked with the profile of Dr. Rebecca Gomperts, a Dutch abortion provider and all around revolutionary. Gomperts first gained notoriety in 1999, when she created a mobile clinic aboard a ship and sailed to countries where abortion remains illegal. She aimed to reduce the number of unsafe abortions and unwanted pregnancies by providing sexual health services, including early medical abortions, in international waters. Because the ship flew under the flag and laws of its home country, The Netherlands, the team could provide mifepristone* and misoprostol** (the medicines, when taken together, cause an abortion) to women within the first 12 weeks of a pregnancy.

Dr. Rebecca Gomperts aboard the ship as it arrives in Spain (image courtesy of vesselthefilm.com)

Dr. Rebecca Gomperts aboard the ship as it arrives in Spain (image courtesy of vesselthefilm.com)

The documentary highlights the gumption and resources needed to create such a novel (and enviable) social enterprise. When the ship finally takes to sea under the moniker Women on Waves, protesters and media await them at the shore. At nearly every port, authorities and politicians ensured that the ship struggled to dock, stay, and allow local women to board. Yet, as word got out of the ship’s arrival, the team received hundreds of phone calls requesting appointments and information.

The first half of the film follows the ship’s journeys and the mission of relaying the message that medical abortion with misoprostol (with or without mifepristone) gives women the possibility to safely do medical abortions themselves. This option needed a platform, and so Women on Waves transitioned from the open sea to focusing on empowering women how to do a medical abortion by distributing information through the internet, stealth advertising, and by supporting the creation of safe abortion telephone hotlines. If women could not come to the ship, thought Gomperts, she would directly deliver them the pills.

The latter half of the film follows what arose from this experience: Women on Web. Women had already figured out that taking misoprostol, available as an ulcer medication, could induce a miscarriage. Misoprostol was known for being safe, but women around the world kept asking: How do we get it?

So, along with the website, Gomperts and her team launched campaigns around the world—in Portugal, Ecuador, Morocco, and more—where they advertised the information hotline and how women could procure a safe abortion. One scene in the film plays out like a heist as the team schemes to raise a banner advertising their contact number from a statue of the Virgin Mary. Throughout, the calls for help kept coming, as did the backlash.

But Gomperts did not let backlash, or the fear of any such judgment or consequence, hold her back.

Image courtesy of vesselthefilm.com

Image courtesy of vesselthefilm.com

One of the biggest takeaways from “Vessel”, besides the impressive central character, is how much fun the team appeared to be having on the boat and on the ground when planning covert advertisement campaigns. It was a refreshing reminder that empowerment should be enjoyable. Helping women receive normal medical care should feel good.

Although not explored directly in the film, Dr. Gomperts refuses to work with and in the United States. In previous interviews, she explains why she does not mail pills to women in the United States. We know all too well that although abortion has been legal in the United States since 1973, women’s access to abortion is constantly restricted by the political and religious right via TRAP laws and other legislation.

Gomperts puts the onus on us—advocates in the United States—to push for legislative change and until then, to provide medical care any way possible. She challenges women’s groups to find reliable sources for misoprostol pills and to refer women or deliver to women in order to administer safely at home. She does not want to endanger her own work, and so she calls out the abortion rights groups in the United States to rise up to the challenge of our time.

Gomperts maintained throughout the film that her work is not a personal mission, but a response to a need. She never intended to be an activist, but a doctor who alleviated suffering.

To wit, when grilled by the media about her personal life (“Have you ever had an abortion?”) she  replies,

“Are you going to ask somebody working for Amnesty International if they’ve been tortured, no, come on, this is about whether or not women have basic human rights” […] “you cannot force any women to go through an unwanted pregnancy… it’s a humiliation, it’s a torture for them.”

Although she did not intend to be an activist or an anecdote, Dr. Gomperts is an ally worth emulating. She saw a need, and set out to meet that need. “Vessel” is essential viewing for abortion rights workers in the United States. May we address the needs we see and meet them, so that when women need an abortion, they do not have to rely upon obscure interventions, but upon equal, affordable, basic healthcare systems already in place.

Thank you to The Nightingale Cinema in Chicago for hosting the screening. See where else the film is screening here or watch on Video on Demand platforms or iTunes now!

*Also known as Mifeprex; RU-486

**Also known as Cytotec

HIV Testing in Variety of Clinical Settings

In Supporting the Integration of HIV Testing into Primary Care Settings, published in The American Journal of Public Health, authors Janet J. Myers, et al, examined the efforts of the US network of AIDS Education and Training Centers (AETCs) to increase HIV testing capacity across a variety of clinical settings.

Authors utilized quantitative process data from 8 regional AETCs from 2008 and 2009, along with qualitative program descriptions to demonstrate how AETC education helped providers integrate HIV testing into routine clinical care with the goals of being able to diagnosis an infection as early as possible and providing treatment.

When compared with other AETC training, results indicated that HIV testing training was generally longer and utilized a broader variety of strategies to educate more providers per training.  It was also found that educational trainings did provide a platform for providers to master comprehension of their primary care responsibility to address public health concerns through HIV testing.  These AETC efforts illustrate not only how integration of the principles of primary care and public health can be promoted through professional training, but how integral these skills are to comprehensive and well-rounded clinical care practice.

Reshaping Adolescent Sexual Health through Story Telling and Games

In the article From Intervention to Invitation: Reshaping Adolescent Sexual Health through Story Telling and Games, published in the African Journal of Reproductive Health, authors Melissa Gilliam, et al, from the Section of Family Planning and Contraceptive Research reviewed Game Changer Chicago. This project aims to reframe and retool adolescent sexual health education to focus on inviting rather than intervening with youth, which encourages self-empowerment that catalyzes increased awareness and self-efficacy. In addition to describing the Section’s ongoing work with sexuality education, technology and gaming, the article explores the project’s potential for successful implementation among youth in Africa.

Youth in both Chicago and Nigeria face disproportionately high rates of mortality and morbidity due to poor sexual and reproductive health. Game Changer Chicago is an initiative that incorporates digital storytelling, new media, and game design to conduct workshops with youth around issues of sexuality and emotional health. The intervention’s international, interdisciplinary team designed a series of workshops for teens to tell their stories in digital, “transmedia” formats.

Due to the positive feedback from youth participants, and the project’s promising potential to reach a wide audience online, the authors conclude that the program can continue to be successfully utilized and expanded by teens and adolescent reproductive health advocates in both domestic and international settings.

Abortion Training Initiative in New York City Hospitals

In The New York City Mayoral Abortion Training Initiative at Public Hospitals, published in Contraception, authors Maryam Guiahi, et al, set out to describe and understand the first-ever abortion training political initiative on the provision of abortion services and abortion residency training.

In 2002, NARAL/NY obtained the support of newly elected Mayor Michael Bloomberg to integrate residency training in abortion care into the eight New York City (NYC) public hospitals that have OB/GYN training programs. The authors completed in-depth interviews with 22 participants who have knowledge of abortion training and services in the NYC public hospital system before and/or after the initiative.

In these interviews, respondents identified strategies that helped achieve renovation of abortion facilities, updating of abortion services and protocols, and training of abortion providers. The initiative led to the introduction of several modern abortion methods including medication abortion and MVAs for first-trimester abortions and D&Es for second-trimester abortion. The initiative also expanded the provision of immediate postabortion contraception. Respondents also identified public health impacts including improvement of abortion services, empowerment of abortion providers, and legitimization of abortion training and services.

Authors concluded that this political initiative should be a model for other city governments to influence obstetrics and gynecology resident training and the provision of abortion services.

Tailored Health Messaging Improves Contraceptive Adherance

In Tailored Health Messaging Improves Contraceptive Continuation and Adherence: Results from a Randomized Controlled Trial, published in Contraception, authors Samantha Garbers, et al, conducted interventions to improve contraceptive method continuation and adherence, given that discontinuation and incorrect use of contraceptive methods may contribute to as many as 1 million unintended pregnancies annually in the United States.

The authors conducted a randomized controlled trial of 224 patients at two family planning sites which tested the efficacy of a computer-based contraceptive assessment module in increasing the proportion of patients who continued use of their chosen contraceptive method 4 months after the family planning visit.

Results indicated that family planning patients who used the module and received individually tailored health materials were significantly more likely to continue use of their chosen contraceptive method [95% compared to 77%; odds ratio (OR)=5.48; 95% confidence interval (CI): 1.72–17.42] and to adhere to this method (86% compared to 69%; OR=2.74; 95% CI: 1.21–6.21). No significant differences in these outcomes were found for participants who used the module but did not receive tailored materials when compared to the control group.

The authors concluded that tailored health materials significantly improved contraceptive method continuation and adherence, but noted that additional research on the impact of the intervention on continuation and adherence in a larger sample and over a longer follow-up period is merited.

Using New Digital Media to Improve Adolescent Sexual Health

In Interventions Using New Digital Media to Improve Adolescent Sexual Health: A Systematic Review, in press with the Journal of Adolescent Health, authors Kylene Guse, et al, analyze studies that evaluated the impact of new digital media programs on youth knowledge, attitudes, and behaviors.

New digital media (e.g., the Internet, text messaging, and social networking sites [SNS]) have dramatically altered the communication landscape, especially for youth. These communication platforms present new tools for engaging youth in sexual health promotion and risk reduction. The authors concluded that the use of new digital media provides an innovative platform for sexual health interventions among adolescents, but studies with longer (>1 year) follow-up and measurement of behavioral outcomes are needed to provide a more robust evidence base from which to judge their effectiveness in changing adolescent sexual behavior.

The authors also found that the reviewed studies used a wide range of approaches to intervention and targeted a wide range of sexual and reproductive health behaviors, including sexual initiation, use of social media sites, and adherence to medication. The studies demonstrated that new digital media interventions were can be tailored to the audience as well as reach diverse populations of youth. Some studies in the review also suggest how behavioral theories may inform new digital media interventions. Future research should consider the aspects of existing theories that are best suited for technology-based interventions, and whether new theories that address the unique affordances of new digital media (e.g., tailored interventions, peer-shared interventions) are needed.

Publicly Funded Family Planning Agencies and Health Information Technology

In Health Information Technology and Publicly Funded Family Planning Agencies: Readiness, Use and Challenges, published by The Guttmacher Institute, authors Jennifer J. Frost, et al, sought to provide policymakers and program planners with the information needed to assist publicly funded family planning centers in making the leap forward in Health Information Technology (HIT) use.  To this end, the authors conducted an assessment and gap analysis of the current HIT capabilities and anticipated barriers among a nationally representative sample of publicly funded family planning agencies.

Publicly funded family planning centers are an integral component in providing sexual and reproductive health services to low-income women and men each year.  They allow women and couples to avoid unintended pregnancies, plan the timing of wanted pregnancies, and receive a range of preventive health services, treatment for sexually transmitted infections (STIs) and referrals for other needed care.  For many women, visits to publicly funded family planning providers are the only regular health care they receive.

In late 2010 and early 2011, researchers surveyed a nationally representative sample of agencies providing publicly funded contraceptive services; 461 agencies responded to this survey, for a total response rate of 52%.  Then, in May 2011, researchers contacted 20 agencies that had provided notable responses to the questionnaire’s open-ended questions.  Representatives from 10 of the 20 agencies agreed to follow-up interviews which were conducted to expand upon the agencies’ closed- and open-ended responses which resulted in a thorough understanding of agency HIT utilization.

Results indicated that the top three barriers to successfully adopting and utilizing HIT are financial: implementation costs (cited by 67% of agencies), ongoing costs (62%) and acquisition costs (58%).  Other common challenges include identifying or building an appropriate EHR system (37%) and obtaining necessary IT support and expertise (34%).  Health departments are the most likely to report that many aspects of HIT implementation were problematic, and FQHCs are the least likely to report such challenges.

Rapid HIV Testing in Dental Practices

In Rapid HIV Testing in Dental Practices, published in the American Journal of Public Health, authors Karolynn Siegel, et al, sought to find out how willing dentists are to provide rapid HIV tests. The authors suggest that the dental setting is a promising though largely unexplored venue in which to offer the HIV rapid test using oral fluid.

In this study, researchers interviewed 40 private practice dentists to ascertain their attitudes towards providing rapid HIV testing.  After interviews were completed, the principal concerns regarding offering patients HIV testing were false results, offending patients, viewing HIV testing as outside the scope of licensure, anticipating low patient acceptance of HIV testing in a dental setting, expecting inadequate reimbursement and potential negative impact on the practice.

Interestingly, dentists did not generally indicate a preoccupation with transmission risks, staff opposition to testing or the complexity of making referrals for follow-up after a positive result.

In order to adequately engage dentists more in primary prevention and population-based HIV screening, a larger cultural change appears to be required. Only 1 out of 40 dentists interviewed had even heard about the rapid HIV test before they were contacted about this study.