Ibis Reproductive Health

July 2008

Ibis Reproductive Health, in collaboration with the Women's Health Research Unit (WHRU) at the University of Cape Town, will soon finish the first phase of data collection in a research project that could reveal important information about abortion services in the Western Cape Province of South Africa. Funded by the Safe Abortion Action Fund managed by the International Planned Parenthood Federation, Ibis and WHRU are investigating ways to improve second trimester abortion services in South Africa.

Though South Africa has a model abortion law, barriers to access, including a shortage of providers, provider opposition, stigma associated with abortion, and a lack of providers trained to perform abortions and facilities certified to provide abortions, can result in women resorting to unsafe abortion. Additionally, these barriers lead to a high proportion of second trimester terminations, which are inherently more risky. In South Africa 30% of abortions are performed at a gestational age of greater than 12 weeks, while in the United States approximately 10% of abortions are performed in the second trimester. The high rate of second trimester abortion in South Africa is a public health concern, given that every additional week of gestational age increases the risk of serious complication or death.

In the first phase of the project, which is currently underway and scheduled to finish in July, Ibis and WHRU are collecting baseline data on women's knowledge and attitudes about second trimester abortion. We are interviewing women who have undergone second trimester abortion procedures in five public hospitals in the Western Cape Province; two of the facilities involved in the study use medical induction, and three use a surgical technique called dilation and evacuation to perform second trimester abortions. The interviews explore women's experiences with referrals, barriers to obtaining the procedure, women's experience with counseling, support, and pain management available before, during, and after the procedure, and the specifics of the procedures the women undergo. So far, we have completed 219 interviews of a target of 250. In this first phase we will also interview staff at all five facilities to assess their opinions and attitudes regarding current service provision and the possibilities for expanding or improving second trimester abortion services.

These interviews are the first part of a larger project with an overall goal to improve access to high-quality second trimester termination services in the Western Cape Province of South Africa and create a model of care that could be scaled up on a national level. Eventually, Ibis also hopes to use this project as a stepping stone to a study which would randomize women seeking abortion in the second trimester in South Africa to a medication or surgical method. This research is crucial because there is very little clinical and acceptability evidence directly comparing surgical and medical methods of second trimester abortion.

Ibis's office in Johannesburg is uniquely situated to lead groundbreaking research like this study on second trimester abortion. We are also involved in a number of other projects in South Africa, including participating in a coalition of partners working to increase access to medication abortion and a project to improve sexual and reproductive health services for young women in Soweto, South Africa.

June 2008

From June 2-6, Ibis, PATH, and the INFO Project are hosting a global online forum to discuss health professionals' experiences with diaphragms in diverse settings and their role in family planning programs and other health care services. This free forum is part of the Implementing Best Practices (IBP) in Reproductive Health Knowledge Gateway's online discussion series. Click here to learn more and to register.

April 2008

Dr. Courtney B. Jackson and colleagues at Ibis Reproductive Health received the 2008 National Abortion Federation Scientific Poster Award. Entitled “Abortion training experiences among newly graduated Ob/Gyn residents,” the poster presents the results of a qualitative study dedicated to the factors influencing residents’ decisions to train in and intentions to provide abortion care. The findings reveal that training opportunities in pregnancy options counseling, abortion procedures counseling, and first trimester abortion procedures need to be strengthened and that requiring residents to use elective time to receive abortion training is impractical. A sociologist whose research focuses on increasing access to abortion care and addressing the abortion provider shortage, Dr. Jackson is the 2006-2008 Ellertson Fellow at Ibis Reproductive Health. Poster coauthors include Co-Principal Investigator Dr. Angel M. Foster and former Ibis intern Samantha Charm. The award was sponsored by SCI International, Inc. This study is one part of a mixed-methods project dedicated to investigating abortion training in Ob/Gyn residency programs. The larger project includes three components: 1) a content analysis of 246 Ob/Gyn residency program websites; 2) a survey of approximately 1,000 residents who completed residency in 2007; and 3) in-depth interviews with 36 physicians who completed residency in 2007. The study was commissioned by Physicians for Reproductive Choice and Health and supported by the Charlotte Ellertson Social Science Postdoctoral Fellowship in Abortion and Reproductive Health. For information about the study, please contact Dr. Jackson (cjackson@ibisreproductivehealth.org) or Dr. Foster (afoster@ibisreproductivehealth.org).
- Download poster abstract (PDF)
- Download poster (PDF)
Many other Ibis staff also made presentations at the 2008 NAF Annual Meeting. Senior Associate Dr. Deborah Kacanek gave a scientific paper on the availability of public funding for abortions in the US under the Hyde Amendment. Dr. Angel Foster and colleagues presented two posters, one on the physical, legal, and institutional barriers to abortion access in the West Bank, and another about a survey of the reproductive health content of Massachusetts nursing programs. Senior Associate Dr. Dan Grossman and colleagues presented a poster on the cost of medication abortion compared to aspiration abortion in Mexico City. Dr. Grossman was also a panelist on a session addressing how Latinas in the US and Latin America talk and feel about abortion.

In addition, the Ellertson Fellowship Program, coordinated at Ibis, organized the 5th Annual Social Scientists Networking Meeting, which brought together social scientists from diverse disciplines to share current and future research ideas and to discuss political and methodological challenges to research on abortion, particularly in the context of the US political climate.

Ibis, along with many other Boston-area women’s organizations, will co-present screenings of Flying: Confessions of a Free Woman on April 17, 18, and 19 at the Museum of Fine Arts in Boston. Directed by Jennifer Fox, Flying is a six-part, six-hour documentary about the female experience in the 21st century. As the filmmaker struggles to define her own life, she employs a technique called “passing the camera” to capture intimate conversations with women from 17 countries who talk about their experiences with everything from abortion and HIV/AIDS to marriage, motherhood, pregnancy, and sexuality. The New York Times described Flying as “a personal memoir, feminist manifesto, and diagnosis of global woman.” Click here for times and ticket information. To learn more about the film, visit www.flyingconfessions.com.
Ibis and the Massachusetts Department of Public Health (MDPH) Family Planning Program received a grant from the National Institute for Reproductive Health’s Low-Income Access Program for a project that will explore the impact of Massachusetts health care reform on low-income women’s access to contraception. In 2006, Massachusetts became the first state to pass legislation mandating that all residents have health insurance. As of July 2007, all state residents are required to be enrolled in a health insurance plan, and low-income residents may enroll in government-subsidized plans, which include family planning as a benefit. Together with the MDPH Family Planning Program, Ibis will collect preliminary data to examine whether health care reform is improving access to contraception for low-income women and to identify potential barriers created by reform. This project will help inform other state and federal efforts to expand health care coverage, lay the groundwork for future, more in-depth evaluations, and identify ways that advocates and policymakers concerned about reproductive health care can work to improve these programs.

March 2008

We are pleased to announce the 2008-2010 Charlotte Ellertson Social Science Postdoctoral Fellows in Abortion and Reproductive Health. Ellertson Fellows participate in a two-year postdoctoral research and leadership training fellowship. We selected five fellows for the third cohort of the Ellertson Fellowship, one at each of the five fellowship sites:
- Danielle Bessett, PhD expected May 2008 in Sociology from New York University, based at Ibis Reproductive Health
- Silvia De Zordo, PhD expected May 2008 in Social Anthropology from Ecole des Hautes Etudes en Sciences Sociales, based at Columbia University
- Megan Kavanaugh, DrPH expected August 2008 in Behavioral and Community Health Sciences from University of Pittsburg, based at the Guttmacher Institute
- Alison Norris, MD, PhD 2006 in Epidemiology and Public Health from Yale University, based at Johns Hopkins University
- Julia Steinberg, PhD expected May 2008 in Psychology from Arizona State University, based at the University of California, San Francisco
The objectives of the fellowship are to support a multidisciplinary cohort of promising new social science researchers who study abortion and reproductive health, and to produce and share research that informs policy and program design. Fellows are committed to research on abortion and careers that include a focus on scholarship and advocacy. To read the full announcement of the 2008-2010 Fellows, click here. For further information about the Ellertson Fellowship, please contact at fellowship(at)ibisreproductivehealth.org, or visit www.ibisreproductivehealth.org/fellowship/index.cfm.

February 2008

Ibis Senior Associate Dan Grossman quoted in Brownsville Herald article about women who self-induce their abortions using misoprostol

January 2008

On the 35th anniversary of the landmark Roe v. Wade ruling, Ibis board member Frances Kissling and former NARAL president Kate Michelman discuss the challenges facing the pro-choice movement in the Los Angeles Times.

December 2007

On December 5, 2007, Ibis Reproductive Health held its 5th anniversary fundraising event at the Radcliffe Gymnasium in Cambridge, MA. Guests enjoyed food and beverages donated by many local and community-minded businesses. In addition, Ibis staff members made the desserts, including the three-tiered birthday cake made by Ellertson Fellow Courtney Jackson. Jazz duo Carmen Staaf and Kendall Eddy gave an outstanding performance and guests engaged in competitive bidding at the silent auction, comprised of items donated by local businesses and from many of the regions in which Ibis works.

The evening’s highlight was Ibis board member Frances Kissling, who spoke about the state of reproductive health and rights in the US and internationally and encouraged the reproductive health professionals and allies in the room to continue to nurture and grow our community—because that is how movements are strengthened and sustained.

Click here to view photos and the list of sponsors and other businesses that contributed to the event.
Ibis recommends Abstinence Comes to Albuquerque, a documentary film about the events that unfolded when abstinence-only education was introduced in New Mexico’s public schools. Through interviews with national experts, state public health officials, parents, and others, the film highlights the differences between abstinence-only and comprehensive sex education. The 2005 film was recently revised to include discussion of the congressionally mandated Mathematica study on abstinence education programs and an update on what has happened in New Mexico. The film runs 45 minutes and is available for free, along with a discussion guide, at www.der.org/films/abstinence-comes-to-albuquerque.html.

November 2007

Research conducted by Ibis staff is cited in the Emergency Contraception (EC) Education Act of 2007, sponsored by Senator Patty Murray (D-WA). Recognizing that EC can be a safe and effective means of preventing unintended pregnancy, but that EC use and awareness are low, the bill proposes the creation of an EC public awareness and education program. Among its findings, the bill references Ibis’s research on the availability of EC in hospital emergency rooms. The study cited, which was published in the Annals of Emergency Medicine, included a survey of emergency room staff at Catholic and non-Catholic hospitals in the US and was authored by Ms. Teresa Harrison, SM. The study found that 42% of non-Catholic hospitals and 55% of Catholic hospitals said they do not dispense EC for any reason, including sexual assault. Further, very few hospitals provide EC without restrictions, even though EC is safe and has no contraindications, will not harm an existing pregnancy, and is most effective if taken within 24 hours of unprotected intercourse. Ibis commends Senator Murray and the bill’s co-sponsors for proposing this legislation. For more information about the study, please contact admin(at)ibisreproductivehealth.org.

October 2007

On October 13, 2007, the Lancet published a comment by Ibis board member Beth Fredrick written in response to new research on worldwide abortion rates and trends from the Guttmacher Institute and the World Health Organization published in the same issue. In her piece, Ms. Fredrick argues that we are not doing enough to stop unsafe abortion and need to invest in legal, policy, and health care reform as well as bolster advocacy efforts.

“In all of the data, one fact stands out: safe and legal abortion saves women’s lives and protects their health. There is no acceptable reason to allow women to die, fall ill, or become infertile as a result of unsafe abortion when the world community has both the knowledge and the means to prevent these deaths.”

Ms. Fredrick is the executive vice president of the International Women’s Health Coalition. View Lancet comment (registration required).

September 2007

Ibis board member Vanessa Northington Gamble has been named University Professor of Medical Humanities at The George Washington University in Washington, DC. An internationally recognized scholar on race, ethnicity, and justice in American medicine and public health, she is the first woman to hold the prestigious, endowed faculty position. Dr. Gamble comes to GW from Tuskegee University in Alabama, where she was director of the university’s National Center for Bioethics in Research and Health Care. Download press release.

Ibis Senior Associate Dan Grossman received the Ortho Outstanding Researcher Award at Reproductive Health 2007, a meeting sponsored by the Association of Reproductive Health Professionals, Planned Parenthood® Federation of America, the Society for the Advancement of Reproductive Care, and the Society of Family Planning. The award was for Dr. Grossman’s presentation entitled, “Self-screening for contraindications to oral contraceptives: evidence for the safety of over-the-counter access.” This study examined how well women from the general population could self-screen for contraindications to combined oral contraceptives (COCs) using a checklist. It concluded that over-the-counter provision of COCs would likely be safe, especially for younger women and if independent blood pressure screening were encouraged.

For more information, contact admin(at)ibisreproductivehealth.org.
Ibis was awarded a grant from the Society of Family Planning to study women’s experiences with abortion self-induction in San Francisco, Boston, and New York City. The study will use a mixed-methods approach to better understand this phenomenon, as well as to highlight the barriers that low-income women and women of color—especially Latinas—face in accessing abortion services in the US. Ibis will partner with Gynuity Health Projects to perform the portion of the study in New York. Click here for a complete list of the Society of Family Planning 2007 grant recipients.

August 2007

Research by Ibis and colleagues at PATH and the Population Council is highlighted in the current id21 focus, dedicated this month to the topic of unsafe abortion. Conducted before Mexico City’s recent move to legalize abortion, the study sought to estimate the economic costs of unsafe abortion from the perspective of the Mexico City health care system. It concluded that improved access to safe abortion would likely result in significant cost savings, in part by reducing the incidence of complications from unsafe abortion.

Click here to download the publication or request a printed copy by sending an email to admin(at)ibisreproductivehealth.org.

July 2007

July 13, 2007 – The Methods for Improving Reproductive Health in Africa (MIRA) trial found that the use of diaphragms and lubricant gel in addition to condoms for HIV prevention is no more effective than condoms alone. Ibis was a collaborating partner in the MIRA trial, led by researchers at UCSF, which enrolled more than 5,000 women in South Africa and Zimbabwe. The results are reported in an article published today online and in an upcoming edition of The Lancet.

To date, male and female condoms remain the only proven barrier methods for HIV prevention. Ibis supports continued research into new HIV prevention methods that give women and girls the power to protect their health.

Additional resources:
- For detailed information about the results, including a Q&A document, a fact sheet, and links to press coverage, visit the Cervical Barrier Advancement Society, coordinated at Ibis.
- Read the article and related commentary at www.thelancet.com. (Free registration required to view the article. Commentary available to subscribers only.)
- Learn more about female-controlled methods for HIV/STI prevention.
If you have any difficulty acessing these links or materials, please email admin(at)ibisreproductivehealth.org.

June 2007

Ibis is pleased to announce that it has received a grant award from the Safe Abortion Action Fund for a project to improve second trimester abortion services in the Western Cape Province of South Africa. Administered by the International Planned Parenthood Federation, the Safe Abortion Action Fund (SAAF) aims to reduce unsafe abortion worldwide and was established with funding from the governments of Denmark, Norway, Sweden, Switzerland, and the United Kingdom. Click here for more information about SAAF.
An article by Ibis President Kelly Blanchard, Senior Associate Dan Grossman, and colleagues at the University of California, San Francisco appeared in this month’s International Journal of Gynecology and Obstetrics. Named one of the “Editor’s Selections,” the article models how wider use of misoprostol could reduce maternal deaths resulting from unsafe abortion in resource-poor countries. The journal’s editors provided the following write-up:

“As has been reported in this journal on many occasions, unsafe abortion is a significant contributor to maternal mortality, especially in developing countries. The present paper addresses the issue of the potential use of misoprostol to induce elective abortion as a simple intervention to reduce maternal mortality, especially in the developing world. The basis of the evaluation is to determine the impact on maternal mortality if misoprostol were used to replace other, riskier, abortion techniques that are presently being used. The statistical analysis tested the above hypothesis and demonstrated that an increased use of misoprostol, which is an option already available for pregnancy termination in many countries, could significantly reduce maternal mortality due to abortion. As the authors appropriately point out, for misoprostol abortion to have the greatest impact on mortality, timely access to post-abortion care at hospitals and clinics is necessary. The obvious follow-up to this paper is documentation of the actual reduction in mortality rates in medical pregnancy termination as misoprostol use increases in developing countries. Maternal mortality is a terrible tragedy, and anything that we can do to reduce maternal morbidity and maternal death merits our attention.”

To request a copy of the article, please send an email to admin(at)ibisreproductivehealth.org.

Full citation: Harper CC, Blanchard K, Grossman D, Henderson JT, Darney PD. Reducing maternal mortality due to elective abortion: Potential impact of misoprostol in low-resource settings. Int J Gynecol Obstet 2007;98:66–69.

April 2007

Ibis Reproductive Health staff member Dr. Angel M. Foster and colleagues at a leading university in Palestine received the 2007 National Abortion Federation Scientific Poster Award. Entitled “Illicit sex, abortion, and so-called ‘honor-killings’: Attitudes and opinions of female university students in Palestine” the poster highlights the preliminary results of a study that investigates unmarried Palestinian women’s experiences with and attitudes toward pregnancy termination. The results reveal that among university students the permissibility of abortion is tied to the illicitness of the sexual encounter, and that abortion is often viewed as protective in cases in which the woman is unmarried. Completed in 2006, collaborating colleagues include co-investigator Francoise Daoud, MPN, BSN, RN from the Faculty of Nursing & Health Sciences, Bethlehem University and study-team members Sahar Abed, Katy Abu Sa'da, and Hiba Al-Ayasah from Bethlehem University. The award was sponsored by Ortho Women’s Health & Urology, a division of Ortho-McNeil Pharmaceutical, Inc.

This study is part of a larger multi-country project dedicated to the sexual and reproductive health knowledge, attitudes, and behaviors of never-married women in the Middle East and North Africa. For information about the study, please contact Dr. Foster (afoster(at)ibisreproductivehealth.org).
- Download poster abstract (PDF)
- Download poster (PDF)

We are pleased to announce the publication of a new Cochrane systematic review, “Advance provision of emergency contraception for pregnancy prevention.” We collaborated on this review with lead author Chelsea Polis, a doctoral student at Johns Hopkins and former Ibis staff member.

Women deserve the chance to protect themselves from unintended pregnancy, and emergency contraception (EC) provides a safe, effective option to do so. Our evaluation of current interventions to give women an advance supply of EC found that EC has not had an effect on population-level pregnancy rates. However, we also found that advance provision of EC does not appear to have harmful effects on sexual behavior or on the use of regular contraceptives for teens or adult women.

Click here to read The Cochrane Library’s press release. To receive a copy of the review, please send an email to admin(at)ibisreproductivehealth.org.

March 2007

On March 21st Ibis Reproductive Health Associate Dr. Angel M. Foster appeared as a guest on The Riz Khan Show. During the interactive live program dedicated to HIV/AIDS in the Middle East, Dr. Foster spoke about the importance of identifying and addressing the needs of unmarried women and the intersection between HIV and reproductive health. Other guest experts on the Al Jazeera English (AJE) program included Dr. Oussama Tawil UNAIDS Middle East Regional Director and Elie Aaraj, Executive Director of Soins Infirmiers et Développement Communautaire (Lebanon). Broadcast globally via satellite and cable to over 80 million households, AJE is the third largest English language news outlet worldwide and is the sister network to Al Jazeera Arabic.

For more information about our Middle East and North Africa Program, please contact Dr. Foster (afoster(at)ibisreproductivehealth.org).

November 2006

“Kelly Blanchard, President of Ibis Reproductive Health, receives Outstanding Young Professional Award.” November 15, 2006 | Boston, MA. Last week at the annual American Public Health Association meeting, Kelly Blanchard, the President of Ibis Reproductive Health, received the annual Outstanding Young Professional Award from the Population, Family Planning and Reproductive Health Section for her contributions to the field. Each year the section gives the award to a young professional who has made important contributions early in her/his career. “It is really an honor to receive this award, and I am thrilled to join the list of extraordinary individuals who have won the award in the past; I am also very proud to consider many of them close colleagues,” said Blanchard. Ibis Reproductive Health Board Chairman Chris Elias said, “It is wonderful to have the important contributions Kelly has made both at Ibis and in her career overall recognized in this way. We on the Ibis Board are very proud of her achievements.” Ms. Blanchard has published more than 35 articles in peer-reviewed journals on family planning and reproductive health. She joined Ibis Reproductive Health in 2003, opening the Johannesburg office, and in November 2004 was appointed President.

Additional resources: