Does Tennessee's Mandatory Waiting Period Law Systematically Prevent Residents of the Most Economically Disadvantaged Zip Codes from Accessing Abortion? An Exploratory Analysis.

Background: In 2015, Tennessee enacted a law requiring a 48-hour wait and two clinic visits to obtain an abortion.

Methods: Using data from a Tennessee clinic in 2016, we explore whether abortion seekers from the most economically disadvantaged ZIP codes and those who lived farther from the clinic were less likely to return for the abortion procedure at the second visit.

Results: Rates of non-return were 44%-91% higher among residents of neighborhoods in which ≥25% of the population was below federal poverty level, ≥25% of the female population was below federal poverty level, and median annual household income was <$35,000.

Feasibility of Multilevel Pregnancy Tests for Telemedicine Abortion Service Follow-Up: A Pilot Study.

Context: Telemedicine clients wishing to confirm a successful medication abortion outside of a clinic setting are commonly instructed to use high-sensitivity urine pregnancy tests, which can take up to four weeks to yield accurate results. Multilevel urine pregnancy tests (MLPTs), which provide accurate results in one week, are a promising alternative, but their use has not been evaluated within telemedicine services.

Methods: From November 2017 to May 2018, 165 eligible and consenting pregnant people who contacted safe2choose-an organization providing telemedicine abortion services internationally-for medication abortion were enrolled in a pilot study and mailed a package containing medication abortion drugs, two MLPTs and instructions.

Exploring potential interest in missed period pills in two US states.

Objective: Missed period pills (MPP) are uterine evacuation medications used for treatment of delayed menses without prior pregnancy confirmation. This study explores potential interest in missed period pills in two US states.

Study Design: We enrolled people seeking pregnancy test services at nine health centers in two US states between June 2015 and October 2017.

Scaling up interventions: findings and lessons learned from an external evaluation of Niger's National Initiative to reduce postpartum hemorrhage.

Background: Niger has one of the highest maternal mortality ratios in Sub Saharan Africa, of which postpartum hemorrhage is the leading cause. In 2014, Health and Development International and the Ministry of Health of Niger launched an initiative to introduce and scale-up three PPH interventions in health facilities nationwide: misoprostol, uterine balloon tamponade, and the non-pneumatic anti-shock garment.

Methods: A two-phase mixed-methods evaluation was conducted to assess implementation of the initiative.

Early abortion with buccal versus sublingual misoprostol alone: a multicenter, randomized trial.

Objective: To compare efficacy, safety/side effects and acceptability of buccal versus sublingual administration of a misoprostol-only regimen commonly used for early medical abortion.

Study Design: We conducted a randomized trial at six clinics in two Latin American countries. We randomized women seeking early abortion to buccal or sublingual administration of three doses of misoprostol 800 mcg repeated every 3 h.

Postpartum hemorrhage prevention in Nepal: a program assessment.

Background: In 2009, the Nepal Ministry of Health and Population launched a national program for prevention of postpartum hemorrhage (PPH) during home births that features advance distribution of misoprostol to pregnant women. In the years since, the government has scaled-up the program throughout much of the country. This paper presents findings from the first large-scale assessment of the effectiveness of the advance distribution program.

Serial multilevel urine pregnancy testing to assess medical abortion outcome: a meta-analysis.

Objectives: To summarize data on the accuracy of a strategy designed to exclude ongoing pregnancy after medical abortion treatment by observing a decline in urine human chorionic gonadotropin (hCG) concentration as estimated by multilevel urine pregnancy tests (MLPTs) performed before and after treatment.

Study Design: We collated original data from seven studies performed by our organization that evaluated the accuracy of the MLPT strategy for assessment of outcome of medical abortion. Our first analysis included data from the five studies in which each participant was evaluated both with the MLPT strategy and with ultrasound or other clinical assessment.

How effective are the components of active management of the third stage of labor?

Background: Active management of the third stage of labor is recommended for the prevention of post-partum hemorrhage and commonly entails prophylactic administration of a uterotonic agent, controlled cord traction, and uterine massage. While oxytocin is the first-choice uterotonic, it is not known whether its effectiveness varies by route of administration. There is also insufficient evidence regarding the value of controlled cord traction or uterine massage.

Male circumcision for HIV prevention: clinical practices and attitudes among healthcare providers in South Africa and Zimbabwe.

Background: This study aimed to document the clinical practices and attitudes of health care providers in South Africa and Zimbabwe on male circumcision for human immunodeficiency virus (HIV) prevention.

Methods: We conducted national surveys of physicians and nurses in both countries in 2008-2009 (N = 1444). Data on male circumcision for HIV prevention were analyzed; outcomes were patient counseling, provision of services, and desire for training.

Misoprostol for the prevention and treatment of postpartum hemorrhage.

Introduction: Uterotonic drugs are recommended for the prevention and treatment of postpartum hemorrhage (PPH), and oxytocin is considered the gold standard for both indications due to its established efficacy and safety. Unfortunately, access to oxytocin is still limited in many low-resource settings due to the need for cool storage, sterile equipment and administration by skilled personnel. Misoprostol , an E1 prostaglandin analog, has therefore been explored as an alternative for such settings due to its proven ability to induce uterine contractions, low cost, stability at room temperature and ease of administration.

Abused patient's attitudes about mandatory reporting of intimate partner abuse injuries to police.

Objectives: This study examines abused women's preferences regarding medical clinician reporting of intimate partner abuse injuries to police. It also examines the influence of specific demographic factors on abused women's reporting preferences.

Methods: Telephone interviews were conducted with a random sample of women patients attending one of three public primary care clinics associated with the San Francisco Community Health Network.