Dr. Amy Whitaker joins panel discussion on abortion care

Dr. Amy Whitaker joined IL Congresswoman Jan Schakowsky on Monday, September 21 at Personal PAC for a panel discussion about issues surrounding choice. Illinois appellate judge Laura Liu moderated the panel.

Dr. Whitaker spoke about her passion for abortion care. She also described the situations our patients are in as well as the barriers that doctors face in providing abortion care.

To learn more about PersonalPAC, check out the hashtag #‎GetPersonalWithPersonalPAC‬ on Facebook and Twitter.

Congresswoman Jan Schakwosky and Dr. Amy Whitaker

Appellate Judge Laura Liu moderates the panel

Liletta: New IUD approved by the FDA

The U.S. Food and Drug Administration (FDA) recently approved Liletta™, a new hormonal intrauterine device (IUD). This levonorgestrel-releasing IUD inhibits uterine lining from thickening and has been FDA approved for up to three years to prevent pregnancy. Liletta, found to be more than 99 percent effective, is already available in Europe and should arrive in the USA within the next few months.

Liletta was developed by Actavis and the non-profit Medicines360. Given the current high cost of IUDs, Medicines360 has focused on making Liletta affordable and accessible to all women. FDA approval was based on results from the largest hormonal IUD trial conducted in the U.S. The Section of Family Planning has been proud to participate in this study since 2010, as part of our broader commitment to research that improves contraceptive access for women.

Our previous research revealed various barriers in accessing the most effective methods, including cost. One recent study, conducted with support from the Office of Population Affairs, explored systems-level barriers to IUD provision. This research led to the development of a toolkit for clinical staff and health care providers to use in identifying and addressing barriers in their own clinics. We are also currently researching the feasibility and effectiveness of using mobile applications for contraceptive counseling in clinic waiting rooms. Our current studies follow previous research on an initial application, available here as an iOS app.

The Section supports the FDA’s approval of Liletta given its effectiveness at preventing pregnancy and ease of use for most women.

“Increasing the array of available and affordable contraceptive methods helps women find a method that best helps them achieve their reproductive health goals”, said Dr. Melissa Gilliam, Chief of the Section of Family Planning and lead investigator for the Section’s study site.

 

Section/Ci3 Study Featured in IUD Community Newsletter

Ci3 launch

A research study co-authored by Section staff, Ci3 Founder and Director Dr. Melissa Gilliam and Ci3 Executive Director Dr. Brandon Hill was recently featured in the IUD Community Newsletter. “Impact of a theory-based video on initiation of long-action reversible contraception after abortion” was published online ahead of print in the American Journal of Obstetrics & Gynecology and presented at the 2014 Annual Meeting of the Fellowship of Family Planning in April 2014. Read the abstract here.

Section study finds young women involve a parent in abortion when they anticipate support

‘Cause it’s like, ‘man what are they going to think’ and ‘are they going to hate me for this?’ That is what goes through your mind.

When a young woman seeks to terminate a pregnancy, how does she decide whether to talk to a parent? A recent study from the Section of Family Planning and Contraceptive Research at the University of Chicago found that pregnant teens will turn to parents and adults who are engaged in their lives and who will offer support, regardless of her decision. Young women will avoid talking with parents who are less involved or may try to prevent them from seeking care.

The study, recently published online ahead of print in the American Journal of Public Health, explored the factors young women under age 18 consider when deciding to involve a parent. Researchers conducted interviews with 30 minors seeking abortion in Illinois, prior to implementation of a parental notice law in 2013. Currently, there are 38 states with laws requiring a parent provide consent or receive notification before a minor can access abortion.

Image courtesy of the Illinois Caucus for Adolescent Health (icah.org)

Image courtesy of the Illinois Caucus for Adolescent Health (icah.org)

“There’s a commonly accepted idea that teens will try to hide their pregnancy or abortion decision. However, pregnant young women actually do turn to parents in the majority of cases. In our study, 70% of the young women involved a parent or guardian. They thought carefully about which parents and adults in their lives they could turn to for help in making their decision,” said Lee Hasselbacher, policy researcher at the Section of Family Planning.

While each young woman’s family circumstance was different, there were several common motivations for involving a parent. Factors in favor included close and supportive relationships, need for help with logistics like travel or payment, or experiences that made discovery of the pregnancy seem inevitable.

I mean, I wouldn’t normally tell my dad but it came to a point where I needed another $50 for the abortion to be done and so I relied on daddy.

Minors expressed a range of motivations for not telling a parent about their abortion as well. Some teens worried that if their parent learned of their decision, it would dramatically change their relationship or feared it would even lead to anger or harm. Young women also discussed the lack of a relationship or presence as a reason they did not want to involve a parent.

To me that [disclosing pregnancy and abortion] would start a whole lot of drama and right now um, our relationship is like- is kind of on good terms but it’s not so for me telling her this um, I think it like would go back down the drain.

One of the strongest findings was that among those young women who did not involve either parent, most were concerned that one or both parents would directly interfere with their decision to get an abortion.

She just told me, like, it’s not right… and she told me like, if I did get pregnant, like, she told me she wouldn’t let me have one. She said it’s my responsibility.

“This study reveals the complicated lives of pregnant young women and suggests that young women, not policymakers, are the ones best able to identify those people in their lives who can help them deal with a pregnancy. This study reinforces the need to listen to these young women and support policies that encourage family communication long before a pregnancy or abortion decision,” said Dr. Melissa Gilliam, Chief of the Section of Family Planning and Contraceptive Research and author on the study.

Reference

Hasselbacher LA, Dekleva A, Tristan S, Gilliam ML. Factors Influencing Parental Involvement Among Minors Seeking an Abortion: A Qualitative Study. Am J Public Health. Published online ahead of print September 11, 2014: e1-e5. Doi:10.2105/AJPH.2014.302116.

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New Section research assesses systematic barriers to IUD care

iudAt the Section of Family Planning & Contraceptive Research, we are committed to conducting quality research about the effectiveness of IUDs as birth control, especially for young women.

IUDs require little user maintenance, last between 7 and 12 years, and are highly effective at preventing pregnancy. As our earlier research has shown, in order to reduce undesired pregnancy amongst young women, it is critical to remove unnecessary barriers to choosing the IUD. One way to improve the quality of IUD services and the number of women receiving this contraceptive method is to assess the underlying problems that prevent women from receiving an IUD at their scheduled appointment.

Section Chief Dr. Melissa Gilliam’s research on these systematic barriers to IUD care was published in the July 2014 online edition of Contraception.

This article describes the novel use of a systematic approach to evaluating clinical care, called Failure Modes Effects and Criticality Analysis (FMECA). This step-by-step approach was originally developed by engineers to evaluate high-risk industries such as nuclear power and commercial aviation in order to identify practices that contribute to poor quality, unsafe, or unreliable inefficiencies. When adapted to healthcare, team members use FMECA to evaluate the systems and processes of a specific type of clinic care (eg IUD care). “Failures” are identified from qualitative and quantitative data, determining the frequency and impact in order to prioritize redesign and improvements.

For example, a failure in IUD delivery would be a patient calling and cancelling an appointment, but the cancellation is not entered into the scheduling system.

Dr. Gilliam’s study used the FMECA process to evaluate IUD services at three Title X clinics and identified three main failures during the scheduling and intake processes: 1) The patient does not show up for appointment or cancels; 2) The patient recently had unprotected intercourse; and 3) Limited time for counseling, informing, and placing IUDs. This FMECA drew upon interviews with IUD clients, the clinical care team, and reviewed administrative data at all three clinics.

After reviewing the failures, the researchers and clinical care team created solutions to the identified failures: implementing a revised scheduling call script and developing an app to be used in the waiting room. To address cancellations and no-shows, the new call center script reminded patients to keep their appointment or call to cancel beforehand. The script also addressed the need to abstain from unprotected intercourse prior to the appointment. The third failure, limited time, was also addressed by this revision, which identified potentially eligible IUD patients beforehand and saved time at the actual appointment. The barrier of limited time was also addressed with the waiting room “app”, which maximized the wait time by counseling women about contraceptive options.

After the completion of this study, the research team developed an online toolkit describing processes, procedures, and tools for an FMECA and shared with Title X clinics nationally.

To read our published research on the impact of the revised call script and the waiting room app, click here and here.

Clear communication during appointment scheduling can increase LARC uptake

Portrait of a female doctor using a computer while being on the phone

UPDATE: the final version of this article is now online. Read the abstract and download the full article in PDF format.

A new study from Dr. Melissa Gilliam and former Section staff discusses why some scheduled IUD appointments do not result in placement.

“Impact of a revised appointment scheduling script on IUD service delivery in three Title X family planning clinics” was published in the June 2014 online issue of Contraception.

This study began by reviewing clinic administrative data, which showed that women did not receive a desired IUD because of cancellations, no-shows, the need for an IUD-specific appointment, lack of awareness of clinic guidelines, and unknown pregnancy status.

With these systems-level barriers in mind, the researchers created a simple and scalable intervention: revising the appointment scheduling call script. The revised script used by telephone schedulers at a call center addressed these common mishaps and met national Title X guidelines. Along with the revised script, visual tools reminded schedulers to explain behavior prerequisites such as “Do not have unprotected sex at least two weeks prior to an appointment” and “Continue to use pills, patches, or rings up until the appointment”. The script also prompted schedulers to communicate logistical requirements such as bringing an ID, proof of insurance or cash to pay for the procedure, and instructions to call and cancel an appointment if necessary.

Before the new script was instituted, only 47 percent of patients at these sites successfully received an IUD at their scheduled appointment. After implementation of the revised script, 60 percent of scheduled appointments resulted in the desired IUD insertion. Additionally, the no-show rates decreased from 40 to 23 percent, and in particular, young women were more likely to keep their scheduled appointment.

This study shows that a simple IUD appointment scheduling script with clear communication improves LARC uptake. Additionally, as many clinics in the US move forward to computerized and centralized call centers, improving patient communication during the scheduling process may have a broad impact on clinical efficiency.

Related: Development and testing of an iOS waiting room “app” for contraceptive counseling in a Title X family planning clinic

 

Asking Your Doctor about Birth Control

Studies have shown using contraception consistently and correctly reduces rates of unplanned pregnancy.

For many women, that is easier said than done. Complicated lives, medical issues, and safety concerns are important factors to consider when choosing the best birth control method. And what matters in the end is having a birth control method that meets individual needs.

SHAPE Magazine interviewed Section faculty Dr. Julie Chor about “3 Birth Control Questions You Must Ask Your Doctor”. Dr. Chor is an experienced contraceptive counselor, and in the article she advises all women to talk to their doctor about birth control options. She stresses the basics, such as asking how often you need to remember to take a form of contraception and if that realistically fits into your lifestyle.

Earlier this year, FitPregnancy asked Dr. Chor about the best postpartum birth control and she gave her expert advice about how IUDs help attain a healthy pregnancy interval.

Dr. Chor can answer your questions about birth control during her clinic hours at the University of Chicago Hospitals where she provides contraceptive counseling and family planning services. Make an appointment here.

 

Use of an iOS Waiting Room “App” Improves LARC Knowledge

image from www.securedgenetworks.comSection Chief and Ci3 Founder and Director Dr. Melissa Gilliam has published a research article in the American Journal of Obstetrics and Gynecology called Development and Testing of an iOS Waiting Room “App” for Contraceptive Counseling in a Title X Family Planning Clinic.

Data shows that long-acting reversible contraception (LARC) methods (the IUD and implant) are highly effective forms of contraception, but used by less than 10 percent of US women. After talking to clinic staff and analyzing appointment data at three Title X clinics in Chicago, this study found that a lack of contraceptive counseling during a scheduled appointment contributes to the under-use of LARC methods.

This study began by identifying key failures in IUD service delivery, including inadequate counseling time, non-use of waiting room pamphlets, and failure to counsel all women on LARC methods. As a result, the research team opted to create a counseling “app” to increase women’s contraceptive knowledge and interest in the most effective methods.

Results showed that users were highly satisfied with the app and it was easy to use. A brief (<15 min) app session significantly improved women’s knowledge scores on the relative effectiveness of LARC compared with other methods—before she even met with the healthcare provider. App testers (n=17) preferred the interactive, visually appealing design and video testimonials. In the pilot RCT (n=52), app users had significantly higher knowledge of contraceptive effectiveness (p=0.0001) and increased interest in the implant (7.1% to 32.1%, p=0.02) post-intervention. While app users reported increased interest in the contraceptive implant, the app had no discernible impact on women’s interest in the IUD.

The study concluded that integrating app usage into the Title X setting is highly acceptable, informative, and easily integrated into waiting room situations or downloaded onto smartphones in advance of a visit. Thus, apps could be a mechanism for implementing timely, evidenced-based educational information to a wide network of clinics and clients.

Abortion & Reproductive Health Care for Incarcerated Women

orange-is-the-new-black-01Orange is the New Black returned for a second season to Netflix last Friday and continued a major plot line involving a pregnant inmate and the father of her baby, who happens to be a guard in the prison. What started as a secret romance escalated quickly due to the difficulties pregnant women face while behind bars. Legally speaking, a sexual relationship between an inmate and prison official can never be considered consensual and so the characters hatched a series of plans about how to deal with the pregnancy. Could she secretly terminate the pregnancy without anyone finding out? Could she continue the pregnancy and receive adequate health care? Could she hide the pregnancy and the true father? What happens when she goes into labor? What punishment(s) will the couple endure for their actions?

While the TV show mixes fact and fiction, it does honestly depict the reality of what happens when a woman becomes pregnant in prison or enters prison already pregnant. In addition to this ongoing pregnancy plot line, in the first season an inmate entered prison pregnant, went into labor and delivered in a hospital, and was separated from her baby shortly afterwards and returned to prison. Between six and 10 percent of women are already pregnant when admitted to a prison or jail and they can become pregnant during private visits with partners, home visits, while in work release programs, or as a result of sexual assault [ACOG]. Studies also show that approximately 14 percent of girls are pregnant when they arrive to juvenile detention.

In recognition of the prevalence of these realities, the Section published a policy brief on Abortion & Reproductive Health Care for Incarcerated Women. Although our brief focuses on Illinois policies and programs, incarcerated women in state and federal facilities across the United States face myriad barriers to receiving reproductive heath care, including abortion services. Despite having the constitutional right to have an abortion (as guaranteed under Roe v Wade), accessing the procedure while incarcerated presents many challenges, including facilities’ ad hoc responses to abortion requests and the logistics and challenges of organizing transportation and payment.

The brief also discusses the practice of shackling, prison nursery programs, and policy reforms needed to address the gendered needs of women prisoners.

Although Orange is the New Black errs on the dramatic side of storytelling, it does provide an overdue platform for discussing the basic human rights of incarcerated women who have the same rights as civilians to make decisions about their own bodies.

Section and Ci3 Launch Online Access Guide

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In the fall of 2012, the Section of Family Planning and Contraceptive Research, Ci3 (the Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health), and the Urban Initiative of the National Institute for Reproductive Health held a roundtable discussion at the University of Chicago to explore the status of abortion access in the region. More than 50 participants working in fields connected to reproductive health, rights, justice, and well-being joined the discussion. Several key proposals to improve abortion access emerged over the course of that day.

One such proposal was the development of Accessing Abortion in Illinois, a guide for health and social service providers so they can help navigate clinical, legal and financial barriers to abortion access in Illinois.

Talking about getting an abortion can be difficult, which can make actually obtaining one even harder. Recent study findings suggest that two out of three people who have an abortion anticipate experiencing stigma if others were to learn about it. In a large national survey, 58% of those seeking abortion felt they needed to keep their abortion secret from friends and family and 17% believed their regular healthcare provider would treat them differently if they knew about the abortion. At the same time, states have introduced a record number of abortion regulations in the last few years, making it more complicated for individuals considering abortion to navigate access and financial obstacles.

Yet, despite stigma and regulations, one in three women will have an abortion in her lifetime. Pregnant persons seek abortion for a wide range of reasons, and often consider many personal factors when making their decision. Health and social service providers are uniquely positioned to counsel individuals who are thinking about abortion and make sure they have the information, support, and resources to get the care they need. For example, individuals commonly consult with a primary care provider to confirm a positive pregnancy test, seek options counseling, or obtain referrals. Pregnant persons may also turn to social service providers such as social workers, case managers, counselors and ministers for help in making a decision about a pregnancy and to find information about abortion care. In Illinois there are fewer than 40 providers offering abortion services and 92% of Illinois counties have no provider. As a result, health and social service providers can be critically important in connecting individuals with abortion care.

Accessing Abortion in Illinois was made possible through the support of the National Institute for Reproductive Health.

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