Angie DeRosa

When it comes to willingness to switch contraception method, a team of researchers has looked into whether method type, satisfaction with use, and confidence in correct use were independently associated with switching intentions.

According to the authors, data were collected from a probability-based sample survey conducted in Delaware and Maryland in 2016 and 2017 among women ages 18 to 44. The women’s current contraceptive methods at the time of the study were classified into five categories: coitally-dependent methods (barrier methods, withdrawal, and natural family planning); oral contraceptive pills, patches, and rings; injections; implants; and intrauterine contraception (IUC). Satisfaction, confidence, and switching intentions were dichotomized into being very versus less satisfied; being completely versus less confident; and having very low versus greater switching intentions, the authors said.

“We conducted binomial logistic regression to examine whether method type, satisfaction, and confidence were independently associated with having very low switching intentions, adjusting for a range of covariates including socio-demographics, perceived health, religious attendance frequency, sexual, contraceptive, and reproductive experiences, and state of residence,” they said.

Among 1,077 women using reversible contraception, those using IUC versus implants, pills, patches, or rings, and coitally-dependent methods were more likely to have very low switching intentions, the study authors wrote. Among all survey respondents, those who were very satisfied and those who were completely confident in correct use were also more likely to report very low switching intentions.

Based on the study participants, the authors found that using IUC, being very satisfied, and being very confident in correct use were independently associated with having very low switching intentions.

Steinberg JR, Marthey D, Xie L, Boudreaux M. Contraceptive method type and satisfaction, confidence in use, and switching intentions. 

. 2021 Feb 20:S0010-7824(21)00051-2. doi: 10.1016/j.contraception.2021.02.010. Epub ahead of print. PMID: 33621581.

Articles

When it comes to willingness to switch contraception method, a team of researchers has looked into whether method type, satisfaction with use, and confidence in correct use were independently associated with switching intentions. 

Study examines switching intentions in contraception use

The mechanism of action (MOA) of emergency contraceptive pills (ECPs) is frequently mischaracterized among the general public, according to authors of a recent study published in the journal 

. The researchers’ objective was to identify how members of the general public understand the mechanisms of ECPs.

The results may reflect poor quality sex education and public information, and confusion introduced by FDA-approved labels, the study authors said. “Additional research should identify whether public perception of ECPs’ mechanisms influences policy, health care provision, and use of ECPs,” they wrote.

The study design included recruiting a convenience sample from social media for a survey about reproductive health attitudes and analyzing spontaneous descriptions of how ECPs work.

“We inductively coded responses to create themes and subthemes, and collapsed subthemes into three MOA categories based on previous research,” the authors wrote.

The researchers received 1443 responses, where 533 mentioned an MOA in their description of ECPs. While nearly half of these responses (49.5%) stated that ECPs prevent pregnancy before fertilization occurs (in accordance with most biomedical ECP research), over 60% described a mechanism related to preventing implantation of a fertilized egg, the authors wrote. Of the responses, 9 percent described a post-implantation mechanism that would be considered abortion by mainstream medical standards. Some respondents conveyed significant confusion about the biological processes involved with pregnancy and pregnancy prevention, they said.

“The largest group of responses described a mechanism—preventing implantation of a fertilized egg—listed on the Food and Drug Administration (FDA)-approved ECP labels that does not reflect most relevant biomedical research,” they said.

Cleland, K; Marcantonio, TL.; Hunt, ME.; Jozkowski, KN. “It prevents a fertilized egg from attaching … and causes a miscarriage of the baby”: A qualitative assessment of how people understand the mechanism of action of emergency contraceptive pills.” 

doi.org/10.1016/j.contraception.2021.01.009

The mechanism of action (MOA) of emergency contraceptive pills (ECPs) is frequently mischaracterized among the general public, according to authors of a recent study published in the journal Contraception. 

Public confusion on emergency contraceptive pills persists

It now has reversed that. In its updated 

“Pregnant women are at higher risk of severe COVID-19 compared with women of childbearing age who are not pregnant, and COVID-19 has been associated with an increased risk of preterm birth. The available data on mRNA-1273 vaccination of pregnant women are insufficient to assess vaccine efficacy or vaccine-associated risks in pregnancy. However, it should be noted that the mRNA-1273 vaccine is not a live virus vaccine, and the mRNA does not enter the nucleus of the cell and is degraded quickly. Developmental and reproductive toxicology (DART) studies in animals have not shown harmful effects in pregnancy.”

There are further studies planned in pregnant women in the coming months, WHO said. “As data from these studies become available, recommendations on vaccination will be updated accordingly,” the guidance reads. 

“In the interim, WHO recommends not to use mRNA-1273 in pregnancy, unless the benefit of vaccinating a pregnant woman outweighs the potential vaccine risks, such as in health workers at high risk of exposure and pregnant women with comorbidities placing them in a high-risk group for severe COVID-19. Information and, if possible, counselling on the lack of safety and efficacy data for pregnant women should be provided. WHO does not recommend pregnancy testing prior to vaccination. WHO does not recommend delaying pregnancy following vaccination.”

Clinical trials for the Moderna vaccine or the one developed by Pfizer Inc. and BioNTech SE did not include women who are pregnant.

When WHO issued the guidance recommending that pregnant women should not receive the vaccine, it provoked immediate response from leading health care associations in women’s health, particularly the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal Fetal Medicine (SMFM), which issued a 

“ACOG and SMFM continue to stress that both COVID-19 vaccines currently authorized by the U.S. Food and Drug Administration should not be withheld from pregnant individuals who choose to receive the vaccine,” the statement read. 

ACOG’s and SMFM’s current guidance on the COVID-19 vaccine in pregnant patients remains in place.

“Despite efforts by ACOG and SMFM to advocate for their inclusion, clinical trials that informed the emergency use authorization (EUA) of the vaccines did not include pregnant individuals,” they stated. 

“However, preliminary developmental and reproductive toxicity (DART) studies for both the Pfizer-BioNtech and Moderna vaccines are encouraging, with no safety signals reported. DART animal studies provide the first safety data to help inform the use of these vaccines in pregnancy until there are more data in this specific population. These studies do not indicate any adverse effects on female reproduction or fetal/embryonal development. ACOG and SMFM strongly urge manufacturers and federal agencies to collect and report data regarding the use of these vaccines in pregnancy."

“Data have demonstrated that symptomatic pregnant individuals with COVID-19 are at increased risk of more severe illness and death compared with nonpregnant peers,” the statement continues. “Many pregnant individuals have medical conditions known to put them at further increased risk of severe illness and complications. Therefore, given clear evidence of the dangers of COVID-19 in pregnancy, an absence of data demonstrating adverse effects associated with the vaccine in pregnancy, and in the interest of patient autonomy, ACOG and SMFM recommend that pregnant individuals be free to make their own informed decisions regarding COVID-19 vaccination.”

On February 10, the National Institutes of Health (NIH) issued a media advisory calling for greater inclusion of pregnant and lactating people in COVID-19 vaccine research. The advisory was based on a viewpoint by Diana W. Bianchi, M.D., director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the NIH, and colleagues, which appears in 

“The conflicting information being provided to pregnant individuals stems from long-standing obstacles to the inclusion of pregnant and lactating people in clinical research,” the authors write. “The data provided by the manufacturers in the Emergency Use Authorizations for both the Pfizer and Moderna vaccines described the specific exclusion of pregnant people; those who became pregnant during the trials (n = 36) provided very limited data to inform evidence of safety and effectiveness in this population.”

The full viewpoint can be accessed and read at the link provided above.

The World Health Organization (WHO) had previously issued guidance recommending that pregnant women should not receive the Moderna Inc. vaccine unless the individual is at high risk of exposure or having a severe case.

WHO reverses position on COVID-19 vaccines

 series features Editor in Chief, Catherine Y. Spong, MD. 

We talked with her about what compelled her to join 

, become an MFM, and begin the Human Placenta Project at the National Institute of Child Health and Human Development. 

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Angie DeRosa

Articles

Study examines switching intentions in contraception use

Public confusion on emergency contraceptive pills persists

WHO reverses position on COVID-19 vaccines

Meet the Board: Catherine Y. Spong, MD