In August 2003, North Carolina became the first U.S. state to offer restitution to victims of state-ordered sterilizations carried out by its eugenics program between 1929 and 1975. The decision was ...prompted by newspaper stories based on the research of Johanna Schoen, who was granted unique access to summaries of 7,500 case histories and the papers of the North Carolina Eugenics Board.In this book, Schoen situates the state's reproductive politics in a national and global context. Widening her focus to include birth control, sterilization, and abortion policies across the nation, she demonstrates how each method for limiting unwanted pregnancies had the potential both to expand and to limit women's reproductive choices. Such programs overwhelmingly targeted poor and nonwhite populations, yet they also extended a measure of reproductive control to poor women that was previously out of reach.On an international level, the United States has influenced reproductive health policies by, for example, tying foreign aid to the recipients' compliance with U.S. notions about family planning. The availability of U.S.-funded family planning aid has proved to be a double-edged sword, offering unprecedented opportunities to poor women while subjecting foreign patients to medical experimentation that would be considered unacceptable at home.Drawing on the voices of health and science professionals, civic benefactors, and American women themselves, Schoen's study allows deeper understandings of the modern welfare state and the lives of women.
A transpacific history of clashing imperial ambitions, Contraceptive Diplomacy turns to the history of the birth control movement in the United States and Japan to interpret the struggle for hegemony ...in the Pacific through the lens of transnational feminism. As the birth control movement spread beyond national and racial borders, it shed its radical bearings and was pressed into the service of larger ideological debates around fertility rates and overpopulation, global competitiveness, and eugenics. By the time of the Cold War, a transnational coalition for women's sexual liberation had been handed over to imperial machinations, enabling state-sponsored population control projects that effectively disempowered women and deprived them of reproductive freedom. In this book, Aiko Takeuchi-Demirci follows the relationship between two iconic birth control activists, Margaret Sanger in the United States and Ishimoto Shizue in Japan, as well as other intellectuals and policymakers in both countries who supported their campaigns, to make sense of the complex transnational exchanges occurring around contraception. The birth control movement facilitated U.S. expansionism, exceptionalism, and anti-communist policy and was welcomed in Japan as a hallmark of modernity. By telling the story of reproductive politics in a transnational context, Takeuchi-Demirci draws connections between birth control activism and the history of eugenics, racism, and imperialism.
BACKGROUND: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, ...internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. METHODS: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span age 10-54 years and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10-14 years and 50-54 years was estimated from data on fertility in women aged 15-19 years and 45-49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories.
Anti-Müllerian hormone has become the clinical biomarker-based standard to assess ovarian reserve. As anti-Müllerian hormone testing becomes more common, more individuals are seeking to interpret the ...values obtained while using contraceptives. To appropriately counsel women, a better understanding of anti-Müllerian hormone levels in women using different contraceptives is needed.
To study the association between different forms of contraceptives and anti-Müllerian levels in women of reproductive age.
This is a cross-sectional study including 27,125 US-based women aged 20 to 46 years, accessing reproductive hormone results through Modern Fertility and who provided informed consent to participate in the research. Anti-Müllerian hormone levels were collected through dried blood spot card (95.9%) or venipuncture (4.1%), and previous work has shown high correlation between hormone levels collected by these 2 methods. Multiple linear regressions were run to compare anti-Müllerian hormone levels in women using contraceptives with women not on any contraceptive, controlling for age, age of menarche, body mass index, smoking, sample collection method, cycle day, and self-reported polycystic ovary syndrome diagnosis. We also analyzed whether duration of contraceptive use predicted anti-Müllerian hormone levels in users of the hormonal intrauterine device and combined oral contraceptive pill, given the size of these contraceptive groups.
Mean anti-Müllerian hormone levels were statistically significantly lower in women using the combined oral contraceptive pill (23.68% lower; coefficient, 0.76; 95% confidence interval, 0.72–0.81; P<.001), vaginal ring (22.07% lower; coefficient, 0.78; 95% confidence interval, 0.71–0.86; P<.001), hormonal intrauterine device (6.73% lower; coefficient, 0.93; 95% confidence interval, 0.88–0.99; P=.014), implant (23.44% lower; coefficient, 0.77; 95% confidence interval, 0.69–0.85; P<.001), or progestin-only pill (14.80% lower; coefficient, 0.85; 95% confidence interval, 0.76–0.96; P=.007) than women not on any contraceptive when controlling for covariates. Anti-Müllerian hormone levels were not significantly different when comparing women not using any contraceptives to those using the copper intrauterine device (1.57% lower; coefficient, 0.98; 95% confidence interval, 0.92–1.05, P=.600). Associations between contraceptive use and anti-Müllerian hormone levels did not differ based on self-reported polycystic ovary syndrome diagnosis. Duration of hormonal intrauterine device use, but not of combined oral contraceptive pill use, was slightly positively associated with anti-Müllerian hormone levels, although this small magnitude effect is likely not clinically meaningful (coefficient, 1.002; 95% confidence interval, 1.0005–1.003; P=.007).
Current hormonal contraceptive use is associated with a lower mean anti-Müllerian hormone level than that of women who are not on contraceptives, with variability in the percent difference across contraceptive methods. These data provide guidance for clinicians on how to interpret anti-Müllerian hormone levels assessed while on contraceptives and may facilitate more patients to continue contraceptive use while being evaluated for their ovarian reserve.
A sweeping chronicle of women's battles for reproductive freedom throughout American history, Pregnancy and Power explores the many forces--social, racial, economic, and political--that have shaped ...women's reproductive lives in the United States. Leading historian Rickie Solinger argues that a woman's control over her body involves much more than the right to choose an abortion. Reproductive politics were at play when slaveholders devised breeding schemes, when the U.S. government took Indian children from their families in the nineteenth century, and when doctors pressed Latina women to be sterilized in the 1970s. Tracing the diverse plot lines of women's reproductive lives throughout American history, Solinger redefines the idea of reproductive freedom, putting race and class at the center of the effort to control sex and pregnancy in America over time. Solinger asks which women have how many children under what circumstances, and shows how reproductive experiences have been encouraged or coerced, rewarded or punished, honored or exploited over the last 250 years. Viewed in this way, the debate over reproductive rights raises questions about access to sex education and prenatal care, about housing laws, about access to citizenship, and about which women lose children to adoption and foster care. Pregnancy and Power shows that a complete understanding of reproductive politics must take into account the many players shaping public policy-- lawmakers, educators, employers, clergy, physicians--as well as the consequences for women who obey and resist these policies. Tracing the diverse plotlines of women's reproductive lives throughout American history, Solinger redefines the idea of reproductive freedom, putting race and class at the center of the struggle to control sex and pregnancy in America.
To determine whether pharmacist prescription of combined hormonal contraception is associated with inappropriate prescription to women with medical contraindications.
We conducted a retrosopective ...cohort study of all short-acting, hormonal contraceptive users (pill, patch, ring, injectable) in Oregon's All Payer All Claims database from January 1, 2016 to December 31, 2018. Our primary outcome was the proportion of women receiving a combined hormonal method who had a Medical Eligibility Category (MEC) 3 or 4 condition. We identified potential contraindications using International Classification of Disease codes. We conducted descriptive analyses of contraindication prevalence and prescription error rate by prescriber type. We used a multivariable logistic regression model to test the association between pharmacist prescriber and population characteristics.
Our study sample consisted of 439,240 contraceptive users, of which 3782 (0.86%) received their prescriptions from a pharmacist. Women aged 25 to 29 were more likely than women over age 35 to receive contraception from a pharmacist (adjusted odds ratio (aOR) 2.74, 95% confidence interval CI 2.44–3.08). Pharmacist prescriptions were slightly less likely in rural areas (aOR 0.78, 95% CI 0.69–0.89) and among women on Medicaid, relative to those with commercial insurance (aOR 0.21, 95% CI 0.19–0.24). Among women given contraception in a clinical setting, 4.25% had evidence of an MEC 3 or 4 contraindication, compared to 0.9% for women seen by a pharmacist. Rates of prescribing a combined method to women with a potential contraindication were not meaningfully different by prescriber type (2.16% for clinicians vs 0.74% for pharmacists).
Rates of contraceptive prescribing with a contraindication were relatively low and did not differ between clinicians and pharmacists.
Pharmacists can safely screen for medical contraindications to combined hormonal contraception.
Background: Phentermine/topiramate combination product is approved for obesity in the US with a Risk Evaluation and Mitigation Strategy (REMS). We aimed to assess the impact of this REMS that ...educates on congenital malformations and emphasizes contraceptive use and pregnancy testing to prevent prenatal exposure. Methods: We conducted a retrospective cohort study using a nationwide health insurance claims database (2012-2018). The three study cohorts included women aged 12-55 who received phentermine/ topiramate, topiramate (obesity use), or other obesity drugs (liraglutide, lorcaserin, bupropion/naltrexone). We measured prenatal exposure in two ways: 1) presence of pregnancy at treatment initiation and 2) pregnancy conception during treatment. We ascertained prescription contraceptives use and pregnancy testing before and during treatment. We adjusted for confounders with propensity score method. Results: We observed 156,280 treatment episodes across three cohorts. The prevalence of pregnancy at treatment initiation (per 1000 episodes) was 0.8 for phentermine/topiramate, 1.7 for other obesity drugs, and 1.6 for topiramate users. The prevalence ratios (95% confidence interval) were 0.54 (0.31, 0.95) and 0.47 (0.27, 0.81), comparing phentermine/topiramate with topiramate and other obesity drugs. The incidence rate of pregnancy conception during treatment (per 1000 person-years) was 8.7, 15.0, and 15.7, respectively, and the rate ratios were 0.61 (0.40, 0.91) and 0.56 (0.37, 0.83). Approximately 20% of patients across all cohorts had contraceptive use before treatment, and a similar proportion had >50% of treatment days covered by contraceptives. Few patients had pregnancy tests before treatment initiation (<5%), but testing was more common in the phentermine/topiramate cohort. Conclusions: Phentermine/topiramate users were less likely to have prenatal exposure than topiramate and other obesity drugs users. Still, potential prenatal exposures were detected, suggesting the need for further risk mitigation.
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