Ten priorities for women's health.
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Biomedical subjects
Publications and source records attributed to Ann C Hwang.
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OBJECTIVES: Extensive data from clinical trials document mifepristone's safety and efficacy for induced abortion, but less information is available about its safety in routine clinical use. METHODS: Data on mifepristone abortion use from the Planned Parenthood Federation of America, the largest provider of mifepristone abortion in the United States, from 2001 through the first quarter of 2004 were collected using a centralized reporting system. Over the study period, 95,163 mifepristone abortions were provided. Reportable events are complications requiring inpatient or outpatient hospital treatment. RESULTS: Overall, 2.2 per 1000 women (95% CI 1.9-2.5) experienced a complication, most commonly, heavy bleeding. Mifepristone abortion mortality is estimated to be 1.1 per 100,000 based on one death (95% CI 0.3-5.9). CONCLUSIONS: The safety of mifepristone is high; few serious medical complications occur in routine clinical use.
CONTEXT: California's Reproductive Health Privacy Act, which became law in January 2003, clarified that advanced practice clinicians could legally provide medical abortion. Little is known about the characteristics associated with nonphysician clinicians' interest in receiving medical abortion training or their perceptions of barriers to medical abortion provision. METHODS: In early 2003, a total of 1,176 licensed advanced practice clinicians in California-nurse practitioners, physician assistants and certified nurse-midwives-completed a mail-in survey assessing their personal characteristics, beliefs and clinical practices. Weighted univariate and bivariate analyses were conducted to describe the respondents, their interest in receiving medical abortion training and their perceptions of barriers to providing such care. RESULTS: One-quarter of respondents desired training in medical abortion. A higher proportion of nurse-midwives than of nurse practitioners or physician assistants desired training (42% vs. 24% and 23%, respectively). The proportion of respondents desiring training also was elevated among clinicians who have prochoice attitudes, those who are familiar with medical abortion and those who spend at least one-third of their time providing care to women of reproductive age. Lack of training opportunities, legal uncertainties and clinical facility constraints were the most frequently reported perceived barriers to provision of medical abortion. CONCLUSIONS: Considerable proportions of advanced practice clinicians-especially of nurse-midwives-may be interested in receiving medical abortion training. Perceived barriers to providing medical abortion are amenable to change. Policies and programs are needed to ensure that interested, committed clinicians can overcome barriers to providing medical abortion for their patients.
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Family planning has long been acknowledged as an effective public health intervention. In recent years, however, family planning has come under increased scrutiny from conservative politicians and constituents. National US policies instituted since 2001 are resulting in cutbacks in family planning programs worldwide. In the long run, these conservative initiatives may set back several decades of progress in reproductive health and reproductive rights. In promoting an ideologically driven approach to sexual and reproductive health, the recent policy developments threaten to subvert ethical standards of medical care and the principle of evidence-based policy.
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