Observations from CTU’s editorial advisory board
What do members of Contraceptive Technology Update’s editorial advisory board see as the top advancements in the field of family planning in the past 20 years?
Continued contraceptive efficacy with the reduction of steroidal dosage for combination oral contraceptives (OCs), introduction of long-acting systemic contraception (depot medroxyprogesterone acetate/DMPA/Depo Provera and Nor plant) for U.S. consumers, and increased aware- ness and availability of postcoital steroidal contraception, according to David Archer, MD, professor of obstetrics and gynecology and director of the Clinical Research Center at the Eastern Virginia Medical School in Norfolk. In his work with the research center, Archer has been involved in more than 150 clinical research protocols relative to contraception and menopause and published extensively on those subjects. He is a past president of the North American Menopause Society in Cleveland.
The advancement of readily-available contraception and the emergence of emergency contraceptive pills (ECPs) are two of the most important strides made in reproductive health, observes Willa Brown, MD, director of personal health services in the Howard County Health Department in Columbia, MD.
While working with student health at the University of Maryland, she developed a protocol and data tracking for emergency contraception. She testified at the federal Food and Drug Admin istration (FDA) hearings on emergency contraception, which led to the agency’s acceptance of ECP use. The Howard County Health Department now has an established ECP program and advises other clinics on its use. She is a fellow in the American College of Preventive Medicine and a contributing author to Modern Breast and Pelvic Examinations, Third Edition (National Council’s on Women’s Health, New York City).
The top developments in family planning in the past 20 years, says Linda Dominguez, RNC, OGNP, assistant medical director of Planned Parenthood of New Mexico in Albuquerque, are:
• introduction of lower-dose combined oral contraceptives and long-acting contraceptives;
• development of the Emergency Contraception Hotline and the emergence of emergency contraceptive pills from "out of the closet" and into practice;
• increased focus on of consumer-driven health care, including home pregnancy testing, self-treatment for vaginitis, reliance on the Internet for health/drug information, and direct marketing of drugs to the consumer.
In 1992, Dominguez received the National Nurse Practitioner of the Year award, sponsored by the Palo Alto, CA-based Syntex Corp.
The increasing availability of safe, effective long-acting methods, the maturation of knowledge in regard to the safety and noncontraceptive benefits of OCs, and the marketing of dedicated emergency contraceptive products rank as the top accomplishments, says Andrew Kaunitz, MD. Kaunitz, a board-certified obstetrician and gynecologist, is professor and assistant chair in the OB/GYN department at the University of Florida Health Science Center and director of menopause and gynecology services at the Medicus Women’s Diag nostic Center, both in Jacksonville.
Kaunitz has published more than 130 articles and chapters on reproductive health in several professional journals and serves on the editorial board of five publications. He has served as a consultant for the International Planned Parenthood Federa tion, the Ford Foundation, and others. He testified before the FDA during the contraceptive approval of DMPA and served as a consultant to the Ameri can College of Obstetricians and Gynecologists in the development of its technical bulletin on hormonal contraception.
Use of such long-acting methods such as DMPA, Norplant, and intrauterine devices, the increased availability of emergency contraception, and recognition of the noncontraceptive benefits of birth control methods top the list of major gains, says Anita Nelson, MD, professor in the obstetrics and gynecology department at the University of California in Los Angeles. Nelson is medical director of the women’s health care clinic and nurse practitioner training program at Harbor-University of California in Los Angeles Medical Center in Torrance. She also is the program director of women’s health care teams for the Coastal County Health Centers in Los Angeles County.
Most of Nelson’s research efforts have been in the areas of contraception, menopause, and gynecologic infection. She is principal investigator or investigator for several National Institutes of Health and National Institute of Child Health and Human Development grants, as well as commercially funded studies. She is a co-investigator for the Women’s Health Initiative. Nelson has written more than 40 articles for professional journals, and is a contributing author for Contraceptive Technology and Managing Contraception.
Emergency contraception listed
Amy Pollack, MD, MPH, cites advances in our knowledge base about female and male sterilization, the introduction, increasing availability, use of long-acting hormonal contraceptives, and the organized and systematic introduction of emergency contraception worldwide. Pollack is president of New York City-based AVSC International, a 54-year-old nonprofit organization working in the United States and internationally to ensure that women and men have access to quality reproductive health services and can make informed choices about their health care. She is an adjunct assistant professor in the division of population and family health at the Joseph L. Mailman School of Public Health at Columbia University in New York City. In addition to serving on the editorial board of three publications, she has served on technical advisory groups for USAID and the World Health Organization and recently served as a member of the U.S. delegation to the ICPD+5 Preparatory Committee. That committee is involved in a 20-year plan coordinated by the United Nations to promote sustainable, human-centered development and a stable population.
The introduction of extremely safe and effective OCs and the development of contraceptive implants for long-term pregnancy protection rank as the top advancements, says Michael Rosenberg, MD, MPH, president of Health Decisions, a Chapel Hill, NC private research firm specializing in reproductive health. Rosenberg, who practices emergency medicine, is a clinical professor of obstetrics and gynecology at the School of Medicine and adjunct professor of epidemiology at the School of Public Health, both at the University of North Carolina at Chapel Hill. Author of more than 130 scientific articles, Rosenberg’s professional achievements have been recognized by fellowship in the American College of Physicians, American College of Preventive Medicine, and the Amer ican College of Epidemiology.
The downturn and reemergence of the intra uter ine device, the introduction of the Norplant contraceptive implant, and the advent of medical abortion are three of the key developments in the last two decades, says Allan Rosenfield, MD. Since 1986, Rosenfield has served as dean of the Joseph L. Mailman School of Public Health and DeLamar Professor of Public Health at Columbia University in New York City. He also is a professor of obstetrics and gynecology in Columbia University’s School of Medicine.
Rosenfield is a diplomate of the American Board of Obstetrics and Gynecology, a fellow of the American College of Obstetricians and Gynecol ogists, and an elected member of the Institute of Medicine of the National Academy of Sciences. Rosenfield has written extensively on domestic and international issues in the fields of population, women’s reproductive health, obstetrics and gynecology, human rights, and health policy with more than 110 publications to date.
"Contraception in general has been the single greatest reason for the advancement and liberation of women in the past 30 years," states Sharon Schnare,RN, FNP, CNM, MSN. "It has reduced the death rate of women due to pregnancy, illegal abortion, ectopic pregnancy, pelvic inflammatory disease, endometrial and ovarian cancers."
Two other medical advances — the advent of medical abortion and emergency contraception — also rank as important milestones, says Schnare, who is certified as a nurse midwife, an obstetrics/gynecology nurse practitioner, and a family nurse practitioner. In addition to her position as a clinician with the Seattle King County Health Department in women’s and adolescent health care and the International District Community Health Center in Seattle, Schnare serves on the faculty of the University of Washington School of Nursing, department of nursing continuing education. She is an active consultant with the Peace Corps and the U.S. Public Health Service.
The emergence of emergency contraception in the United States, the development of long-acting hormonal contraceptive methods such as Norplant, Depo Provera, and Lunelle, and making abortion accessible to all women, regardless of socioeconomic class, rank as the top developments in the last 20 years, according to Wayne Shields, president and CEO of the Washington, DC-based Association of Reproductive Health Professionals (ARHP). ARHP is an interdisciplinary medical professional organization for physicians, nurse practitioners, physician assistants, nurses, researchers, educators, and other health care professionals.
Shields has been active in the fields of education, health care, and communications for 19 years, directing training and communications efforts for nonprofit, education, and for-profit organizations. Since joining ARHP in 1991, he has guided the development of educational programs for health care providers and the public on such issues as contraception, sexually transmitted diseases, HIV/AIDS, teen pregnancy prevention, meno pause, and sexuality. He serves on the board of directors of the National Organization on Adol escent Pregnancy, Parenting, and Prevention.
Informed consent tops the list
What does James Trussell, PhD, one of the original authors of Contraceptive Technology, see as the most important advancements of the past two decades? Emergency contraception, medical abortion, and an emphasis on informed consent to present women with all options, including risks and benefits, so they can make an informed choice.
Trussell is a professor of economics and public affairs, faculty associate of the Office of Population Research, and associate dean of the Woodrow Wilson School of Public and International Affairs at Princeton University. He is the author or co-author of more than 150 scientific publications, primarily in the areas of reproductive health and demographic methodology.
Trussell has been active in promoting emergency contraception as an important step in reducing the incidence of unintended pregnancy and the need for abortion. In addition to his research on this topic, He maintains an emergency contraception Web site and designed and launched a toll-free emergency contraception hotline (1-888-NOT- 2-LATE). He is a research associate of the National Bureau of Economic Research in Cambridge, MA.
The emergence of sub-50 mcg oral contraceptives with increased safety profiles and decreased side effects, the increase in emergency contraception awareness, and the introduction of depot medroxyprogesterone acetate top the list of family planning advances in the last 20 years, says Susan Wysocki, RNC, NP, president and CEO of the National Association of Nurse Practitioners in Women’s Health in Washington, DC.
Wysocki is a co-author of a family planning resource guide, Family Planning at Your Fingertips (Essential Medical Information Systems, Durant, OK, and Irvington Publishers, New York City) and numerous professional articles. She testified before the Atlanta-based Centers for Disease Control and Prevention to secure the inclusion of nurse practitioners in the Physician Performed Microscopy category in the Clinical Laboratory Improvement Amendment regulations. She also testified in legal proceedings to enjoin federal administrative rules that would have prohibited nurse practitioners from providing pregnancy counseling.