The following papers have been published at http://jfprhc.bmj.com/content/early/recent

The financial costs to patients of diagnosing and excluding ectopic pregnancy (Unger et al)

In their article, Unger and his colleagues in Edinburgh report on their assessment of an area of patient experience that is not often considered when assessing medical interventions. The financial impact on patients’ lives of the need to seek medical attention can be considerable and may become more significant as economic hardship increases. This paper describes a well-conducted questionnaire study on the costs that patients themselves incurred in attending their general practitioners and a hospital clinic with a suspected ectopic pregnancy. The authors argue that such costs need to be factored into decisions regarding the cost-effectiveness of medical procedures. from David Horwell, Advisory Editor

Despite the best intentions: a reflection on low client numbers for a pilot telemedicine sexual health service (Garrett & Kirkman)

This “Better Way of Working” article describes the outcome of a pilot of a telemedicine sexual health service for rural youth in Victoria, Australia. Despite expecting high client numbers, few used the service. This article explores the reasons for the disappointing usage, and concludes that clinicians’ expertise and passion for improving access to health care may not be enough to guarantee successful design and implementation of the most appropriate service. from Gillian Robinson,  Associate Editor

Uptake and continuation rates of the intrauterine system in a university student general practice population in the UK (Armitage et al)

This is a very simple real-life observational study of a cohort of young nulliparous women in a university-based general practice choosing and continuing with LARCs as their first line method of contraception. This paper compels the reader to offer this ‘fit and forget’ method of contraceptive to our younger population, of course along with all other forms of contraception, as a matter of routine. from Scott Wilkes, Associate Editor

Removal of a fractured Nexplanon^® (Elliman)

In a letter to the editor Alyson Elliman describes removal of a partially fractured, curved implant with no obvious cause and asks if other clinicians have observed anything similar.

NICE Good Practice Guidance: Patient Group Directions is now under development.

This guidance is now in development and due to be published in April 2013

Stakeholder registration is now open.  To register your organisation as a stakeholder* send registration details (name of contact, name of organisation, email address) to pgd@nice.org.uk using the subject heading Patient group directions GPG stakeholder registration 2012/13

*for the purposes of this guidance stakeholders are:

• national patient and carer organisations that directly or indirectly represent the interests of people whose care is covered by the guidance
• national organisations that represent the healthcare professionals who provide the services described in the guidance
• companies that manufacture the medicines or devices used in the area covered by the guidance and whose interests may be significantly affected by the guidance
• providers and commissioners of health services in England, Wales and Northern Ireland
• statutory organisations including the Department of Health, the Welsh Assembly Government, NHS Quality Improvement Scotland, the Healthcare Commission and the National Patient Safety Agency
• research organisations that have done nationally recognised research in the area

See http://www.nice.org.uk/mpc/goodpracticeguidance/PatientGroupDirections.jsp for further information.

Philippine Government finally passes Reproductive Health Bill after 14 years.

This is a huge victory in the Philippines for access to maternal health services, family planning, and sex education. The reproductive health bill gives the national government the mandate to make reproductive health services accessible to poor families through information and education and the provision of free contraceptives.

“Getting to Zero: Zero new HIV infections. Zero deaths from AIDS-related illness. Zero discrimination” is the theme of World AIDS Day 2012 on 1 December. Life-saving antiretrovirals have reduced new HIV infections and deaths. The 2015 target of 15 million HIV-infected people on antiretroviral medicines worldwide looks more achievable now than ever before.

World AIDS Day – BMJ special promotion 

The BMJ Group is putting together a special promotional webpage for World AIDS Day on 1st December that will offer a week’s free access to all relevant content published by our full range of journals. Please click here for access

New resources for young people living with HIV 

To mark World AIDS day on the 1^st of December, the Children and Young People HIV Network, based at leading children’s charity the National Children’s Bureau, is sending a message of support to young people with HIV by launching a range of materials to support them in managing life with the condition.

The ‘Your Life’ leaflets and the ‘Studying with HIV’ guidance and LifeLinks resources are all available from www.ncb.org.uk/hiv

More than Half of those with HIV in the UK are Overweight:  The Surprising Issues Facing Those Living with HIV

The British Dietetic Association (BDA) will once again be supporting World Aids Day on 1st December. Early data from the BDA’s DHIVA specialist group audit suggests that more than half of people living with HIV in the UK are overweight or obese, with only about one-in-nine being underweight.

In fact by far the most common issues facing HIV dietitians in the outpatient clinic these days are dyslipidaemia, hypertension, diabetes and osteoporosis, with over 75% of HIV patients Vitamin D deficient. Dealing with these issues is not as straightforward as it might seem, with HIV-specific barriers to lifestyle change emerging.

Members report common themes from their patients, including a fear that deliberate weight loss might lead to others guessing their HIV status (“why are you getting thin – you don’t have AIDS do you?”), and a feeling that being overweight is safer (“I remember how ill and thin I was before starting ARVs and I don’t want to go back there again”). from Alastair Duncan, Chairman of the BDA’s DHIVA (Dietitians in HIV/Aids) specialist group.

UNITAID welcomed the good news this World AIDS Day that the number of children newly infected with HIV continues to decline but urges the international community to step up efforts for those children already living with the disease. more from the website

    2012 UNAIDS World AIDS Day Report

Australia Adopts Herd-Immunity Approach in Fight Against HPV

On July 12, 2012, Australia took a stand to become the first country to provide coverage of the Gardasil® vaccine to boys between the ages of 12 and 13, through a National Immunization Program-sponsored school-based initiative. In her press release, the minister of health, Tanya Plibersek, stated that the government-sponsored initiative was targeted to synergize with the current immunization program in girls to decrease the incidence of human papillomavirus (HPV) infection in the Australian population.

Girls don’t see HPV vaccine as green light for sex

A study by Bednarczyk et al in Atlanta and published in Pediatrics has concluded that HPV vaccination in the recommended ages was not associated with increased sexual activity–related outcome rates.

Nurses in Zimbabwe to prescribe HIV drug

Faced with the ambitious target of reaching 85 percent of people in need of HIV treatment by the end of 2012, the Zimbabwean government has announced that nurses will be trained to prescribe and manage antiretroviral (ARV) drug treatment. Experts welcomed the move but warned that nurses would have to be adequately prepared and supported to take on the additional duties. Previously, nurses were allowed only to administer the drugs after a doctor had prescribed them. Now, changes made in the job descriptions of nurses by the Nurses’ Council of Zimbabwe will see them prescribing the medication. Report from HIV/AIDS/Zimbabwe (HAZ)

UK Sexual Health Awards 2013

Nominations are invited in the following catergories:

• Sexual health professional of the year.
• JLS young person of the year.
• Adult sexual health service/project of the year.
• Pamela Sheridan young people’s sexual health service/project of the year.
• Rosemary Goodchild Award for excellence in sexual health journal.
• Sexual health media campaign/storyline of the year.
• Durex community pharmacy award.

More information and nomination forms from fpa/Brook

The First centre to offer abortions in Ireland to open in Belfast.

Marie Stopes International is set to open the ground-breaking clinic next week and, as to be expected, has polarised opinion. Women and sexual health providers welcome the move while there is the usual uproar from those against women’s choice. The clinic will only be offering what is already allowed within the current law but with the added benefit of somewhere women can go for help and support should they need to travel to England or Scotland to access services. Officially anounced today, though leaked last week, Dawn Purvis, Programme Director at Marie Stopes Northern Ireland said: “We believe this is great news for the people of Northern Ireland because we will be able to meet their family planning and sexual health needs in a way that has not been seen here before.  We have a new, purpose built, centrally-located specialist centre; our team are highly trained and dedicated health care professionals; and our services will be delivered in a confidential, sensitive and non-judgemental way”. The Service will offer contraceptive options, HIV testing, STI testing and treatment, ultrasound scanning, and medical abortion up to nine weeks gestation. More from mariestopes.org

Meanwhile,

Science ‘contradicts’ Cabinet Ministers’ claims

Attempts to reduce the time-limit on abortions following Maria Miller’s claim that “science has moved on” will hopefully flounder – assisted by the newly published infant mortality rates for 2010 which show no improvement in survival for extremely premature babies born at 22-23 weeks. More from ONS .
In addition, David Cameron stated in an interview that “… people need to know the govenment has got no plans to bring forward any legislation in this area, and any vote that does happen will be a free vote.” The last time MPs voted on the issue was in 2008 when they decided to retain the 24 weeks limit. In reality only one in ten abortions in England and Wales takes place after 13 weeks.

Cross-party unwanted pregnancy inquiry launches online survey

Amber Rudd MP has launched an online survey for women in the context of her parliamentary inquiry into unwanted pregnancy. It can be accessed at: http://bit.ly/Wjm2uQ

While in the US,

Free access to long-acting, reversible contraception has been shown to significantly reduce unplanned pregnancies and abortions. The ongoing Contraceptive CHOICE Project in Missouri featured mostly young and poor women from St. Louis.

Highlights from this issue include:

The effects of childhood sexual abuse on women’s lives and their attitudes to cervical screening

This commentary by Sarah Kelly is the and available free.

Barriers to cervical screening in women who have experienced sexual abuse: an exploratory study

This   article by Cadman et al. explores the barriers that women who have been sexually abused experience in accessing cervical screening.

Effect of domestic violence on contraceptive choice

This study from Nicaragua looks at the impact of intimate partner violence (IPV) on the choices that women make about their contraception.

Cervical screening among migrant women in London

A qualitative study exploring attitudes towards participation in the UK’s National Health Service Cervical Screening Programme (NHSCSP) amongst Central and Eastern European migrants throws some light on the reasons for variations in their participation.

Accessing referral for abortion in the USA

Dodge et al. have investigated the readiness of services that do not provide abortion to offer referral to other services.

Contraception challenges in Lesotho – not so different from the UK

In his 2011 Margaret Jackson Prize Essay, Nic Robertson gives readers a fascinating insight into the challenges facing contraception services, and problems encountered with use of current contraceptive methods, in Lesotho.

Private vs public abortion providers: implication for abortion stigma

This personal view article is written by a health professional who has experience of abortion services in both the private and public sectors in Australia and the UK. The contrast is worrying and raises a number of issues, especially since the political climate around abortion services generally seems to be becoming more, rather than less, conservative.

Patients’ thoughts and concerns about psychosexual therapy

Having previously considered the experiences of psychosexual therapists, the Journal’s Consumer Correspondent, Susan Quilliam, now explores what patients themselves think ‘psychosexual support’ might entail and identifies some of the questions they may voice in the consulting room.

Plus Letters to the Editor include:

Pitfalls of adapting emergency contraception CEU guidance

Entonox^® analgesia for IUD insertions and removals

Allergy to Nexplanon^®

Link to the Journal

There is still time to register for FIAPAC 2012 in Edinburgh – October 19th-20th

- Unwanted Pregnancy: A fact of life

ESC – Global Conference – Call for Papers

The First global conference on contraception, reproductive and sexual health will be held in Copenhagen from 22-25th May 2013. The closing date for submission of papers is 15th December. Further information is available from the website or using the QR-code below.

International Day of Action for the Decriminalisation of Abortion

 The April 2012 advisory group meeting of the International Campaign for Women’s Right to Safe Abortion called on everyone who has endorsed the Campaign to celebrate 28 September – this year and every year.

 1. Why 28 September?

This day of action has its origin in Latin America and the Caribbean, where women’s groups have been calling on their governments to decriminalize abortion around September 28 for many years. The date was chosen in commemoration of the abolition of slavery in Brazil, which is now remembered as the day of the “free womb”. The campaign has been coordinated in the region since 2010 by the Colectivo Mujer y Salud, Santo Domingo, Dominican Republic. In 2011, WGNRR called for globalisation of the campaign, and the Latin American and Caribbean Women’s Health Network, Ipas and many others have also organised events for this day.

 2. Why decriminalisation?

Because abortion is still subject to the criminal law or penal codes in almost every country in the world. On this date, we are saying with one voice around the world that it is time for this to change.

Abortion has been completely decriminalised  in only one country in the world – Canada. In 1988, Canada’s highest court struck down the federal law on abortion and the parliament did not replace it. Although there are abortion regulations at the state level, any re-criminalisation of abortion would be a violation of that court ruling. This represents the most complete form of normalisation of abortion possible, bringing it in line with all other medical procedures, making good medical practice and quality of care in service provision the only “issues” involved. Any breaches of medical practice would be punishable under other existing laws.

 In Victoria state in Australia, in 2008, abortion was decriminalised by both houses of the state parliament, but only up to 24 weeks of pregnancy. Under the new law, terminations of pregnancy are now regulated like any other medical procedure up to 24 weeks. The law provides women and health practitioners with clarity about the circumstances in which the termination of pregnancy can be performed; it did not expand or restrict access to services. This is more akin to “legalisation” than to decriminalisation, which have two different meanings legally.

 In almost every other country, providing abortions or the means to induce an abortion, having an induced abortion, and/or helping someone else to have an induced abortion are punishable in law in at least some instances. This is as true of Great Britain as it is of Brazil or Kenya.

Thus, decriminalisation of abortion aims to normalise induced abortion as a legitimate form of health care for women, and to ensure that there are no legal reasons why women cannot seek an abortion if they do not wish to continue a pregnancy.

 3. Why organise action in every country?

Action in every country – and putting together and disseminating a report from every country of what we organised – is one way to show that there are groups everywhere in the world fighting for women’s right to safe abortion.

BUT THE BOTTOM LINE IS THIS – (1) IT’S UP TO YOU WHETHER YOU ORGANISE SOMETHING, AND WHAT YOU ORGANISE, and (2) THE MORE GROUPS AND COUNTRIES WHO DO ORGANISE SOMETHING, NOT ONLY FOR 28 SEPTEMBER BUT THROUGHOUT THE YEAR, THE STRONGER OUR MOVEMENT WILL BE.

OUR ROLE AS CAMPAIGN COORDINATORS IS TO ENCOURAGE YOU TO JOIN IN, WORK TOGETHER WITH US AND EACH OTHER, GIVE YOU IDEAS IN CASE YOU WANT THEM, COLLECT AND SHARE YOUR REPORTS OF WHAT YOU ARE DOING, AND DISSEMINATE THEM AS WIDELY AS POSSIBLE.

by Marge Berer, on behalf of 1st advisory group meeting and coordination team,

International Campaign for Women’s Right to Safe Abortion

Your Future.

Your Choice.

Your Contraception.

WCD 2012 focuses on empowering young people to think ahead and build contraception into their plans, in order to prevent an unplanned pregnancy or sexually transmitted infection (STI).

• World Contraception Day (WCD) takes place on September 26 every year. This annual worldwide campaign centres around a vision for a world where every pregnancy is wanted

• Every year, countries and regions around the world organize events to mark World Contraception Day and to demonstrate their commitment to raising awareness of contraception and improving education regarding reproductive and sexual health.

•  Launched in 2007, WCD’s mission is to improve awareness of all contraceptive methods to enable young people around the world to make informed decisions on their sexual and reproductive health

• One of the most effective ways for young people to prevent an unplanned pregnancy or STI is to think ahead and consider the best contraceptive option for them – before having sex

•  An important part of planning for the future is knowing where to access accurate and unbiased information about contraception.

The WCD website, www.Your-Life.com, contains up to date information on contraception to help young people and educational material with some useful quizzes under the ‘Media Center’ tab.

The website/blog Impatient Optimists, which is supported  by the Bill & Melinda Gates Foundation, documents some of the difficulties people and countries around the world face trying to implement these aims.

http://www.londonfamilyplanningsummit.co.uk/ On 11 July 2012 the UK Government and the Bill & Melinda Gates Foundation with UNFPA and other partners hosted a groundbreaking summit that will mobilize global policy, financing, commodity, and service delivery commitments to support the rights of an additional 120 million women and girls in the world’s poorest countries to use contraceptive information, services and supplies, without coercion or discrimination, by 2020.

http://populationmatters.org/2012/ceo-blog/world-contraception-day-26-september-2012/ details the The Population Matters Annual General Meeting and Conference 2012 which will be held on Saturday 13th October 2012 in central London. The meeting is open to members, their guests and other interested parties on request. Advance registration is required.

WHO – 40 years of innovation in sexual and reproductive health

A comment piece in The Lancet by past and present directors of WHO’s Human Reproduction Programme (HRP) discusses the achievements of the Programme since it was established in 1972.

Online First – Evaluation of a community pharmacy delivered oral contraception service

“Anything for the weekend … and beyond, madam?” Community pharmacies increase oral contraceptive uptake

Parsons et al.’s evaluation of a community pharmacy delivered oral contraceptive (OC) service is of particular interest, as it demonstrates the value of providing OCs via this service outlet, especially for women who would not otherwise access long-term contraception. Between 2009 and 2011, seven specially trained pharmacists at five pharmacies in South-East London provided OCs under a Patient Group Direction (PGD) during 741 client consultations. The evaluation showed that trained pharmacists were clinically competent to provide OCs according to a PGD, and that the service was successful in attracting the population identified as most in need. Nearly half of all consultations occurred following emergency hormonal contraception supply, and nearly half of clients receiving an initial supply of OCs were first-time Pill users. Based on satisfaction questionnaires from a small sub-group, most clients valued this service, were happy about privacy, and would recommend it. Although the primary aim was to reduce teenage pregnancy , and nearly a quarter of clients were aged <20 years, the study shows that women aged 20+ years also require this service and should not be overlooked when formulating policies for service provision.
summary by Walli Bounds, Associate editor

Infertility: Survey shows nearly half of all GPs lack knowledge

Results of a comprehensive patient survey by the National Infertility Awareness Campaign (NIAC) shows that GPs need to be better informed about infertility treatment, including IVF, and the options available when the commissioning of IVF switches to local commissioning groups next year. The NIAC survey found that nearly 50% of GPs lacked the necessary knowledge of infertility and the treatment options available to provide an effective service. This could explain why some patients with fertility issues perceived their GPs as unsympathetic.

Calling All Baby Boomers: Get Your Hepatitis C Test

A report issued by the U.S. Centers for Disease Control and Prevention (CDC) recommended that all Americans born between 1945 and 1965 be tested for the hepatitis C virus (HCV). An estimated 2.7 million to 3.9 million people in the United States are infected with this liver-damaging—and sometimes lethal—virus, and many do not know they carry it. CDC calculates that roughly 75% of those infected are baby boomers: 3.25% of people born in that “birth cohort” test positive for HCV, which is five times higher than the rate in adults born before 1945 or after 1965. CDC has determined that universal testing of baby boomers is the most cost-effective strategy for detecting undiagnosed HCV infections.  As reported in Science

New lab for HIV research

The Indian Government has opened the new $12 million HIV Vaccine Translational Research Laboratory in New Delhi. The new Laboratory will aim to recruit around 30 scientists with the goal of creating a new vaccine against HIV, and will work in collaboration with the International AIDS Vaccine Initiative.  As reported in Science

The following papers have been published this month at http://jfprhc.bmj.com/content/early/recent

More than poverty: disruptive events among women having abortions in the USA (Jones)

We are all aware that poverty is associated with abortion but how many of us knew that bad (or disruptive) life events also play a major role? The research by Jones et al. demonstrates that more than half of the women seeking abortion had experienced a disruptive life event in the preceding 12 months. Women are making decisions about their abortion whilst in the midst of complex life events. The authors’ suggestions for changes in policy may not be directly relevant in the UK; however, the study findings are of wider significance. from Gillian Robinson,  Associate Editor

Psycho-social factors affect semen quality (Cao)

Semen quality appears to be declining and this cross-sectional study in China casts light upon some factors that may be associated with that decline. The research team analysed the semen of 1346 healthy 20-40-year-old Chinese men, capturing their psychological, social and behaviour profiles via questionnaire. It appears that stress, social class and underwear made from man-made fibres all play a significant part in declining semen quality. from Scott Wilkes,  Associate Editor

Young people and chlamydia – peer led strategies to increase the uptake of screening (Horner)

The major burden of Chlamydia trachomatis infection is borne in individuals under 25 years of age. Complications of untreated infection are manifold and encompass pelvic inflammatory disease, sub-fertility, epididymo-orchitis, urethritis, arthritis, conjunctivitis and proctitis. Despite high hopes, uptake of the English National Chlamydia Screening Programme has been lower than expected. As a result, the expected decline in chlamydia prevalence has not been observed. Paddy Horner’s group have investigated the use of a peer-led approach to increase screening and examine the feasibility and acceptability of this strategy in young people. Interestingly, although this is a relatively small proof of principle study, women peer-led screening was more successful than male in recruiting peers to participate in the programme. from Rachael Jones,  Associate Editor

Inequity in family planning provision in urban Nigeria: a providers’ perspective (Herbert)

In Nigeria contraceptive use is low: used by only 10% of married women and with 20% of women estimated to have an unmet need. Provision needs to improve, and understanding the roles and perspective of the mixed economy of contraceptive providers is a key step in designing better services. A qualitative study from the Nigerian Urban Reproductive Health Initiative explores the experiences and challenges faced by a range of providers in two urban Nigerian areas. Using structured in-depth interviews and checklists, researchers identified need for further training and support for all providers to empower them to provide a wider range of contraception. Few providers engaged in meaningful promotional activities for their products or services. Vulnerable groups, likely to have high needs for contraceptive advice and provision, were routinely excluded from family planning services: adolescents, married women and those seeking post-abortion care. Understanding the underlying reasons for this inequitable provision, and developing appropriate marketing strategies and materials will indeed be key to developing more sensitive service provision. from Imogen Stephens,  Associate Editor

New female condom, the ‘Woman’s Condom’ – will the Chinese go for it? (Coffey)

The need for products that simultaneously protect against unwanted pregnancy and STIs, including HIV, has prompted interest in the development of Multipurpose Prevention Technologies (MPTs), including new variants of the female condom. In this issue, Coffey and colleagues describe their survey of initial reactions to the ‘Woman’s Condom’ (which obtained marketing approval in China in 2010) by potential user groups in Shanghai. Their study demonstrates the importance of assessing the potential acceptability of new products in a range of populations, with differing expectations, needs and culture-specific influences. Their findings are of particular value to programme/service providers, in order to identify most likely adopters of this new type of female condom. from Walli Bounds,  Associate Editor