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USE OF LONG-ACTING REVERSIBLE CONTRACEPTIVE METHODS CONTINUES TO INCREASE IN THE UNITED STATES

Increases in These Highly Effective Methods Seen Across Virtually All Groups of Women

U.S. women are increasingly turning to highly effective long-acting reversible contraceptive (LARC) methods—particularly IUDs. According to “Changes in Use of Long-Acting Reversible Contraceptive Methods Among United States Women, 2009–2012,” by Guttmacher Institute researchers Megan L. Kavanaugh and colleagues, use of the IUD and the contraceptive implant by 15–44-year-old female contraceptive users increased from about 9% in 2009 to nearly 12% in 2012. Comparison with previous studies shows that this increase is a part of a decade-long trend: In 2002, only about 2.4% of U.S. women using contraception were using LARC methods.
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The authors analyzed data from the 2008–2010 and 2011–2013 rounds of the Centers for Disease Control and Prevention’s National Survey of Family Growth. They found that while LARC use increased across nearly every group of women studied, the most significant increases were among Hispanic women, those with private insurance, those with fewer than two sexual partners in the past year and those who had never had children.
With failure rates of less than 1% per year with typical use, LARCs are the most effective reversible methods available. “LARC methods have the potential to significantly decrease unintended pregnancy in the United States because they are ‘set and forget,’ meaning they require no intervention from women, resulting in greater effectiveness,” says Kavanaugh, the study’s lead author.
Because past research has shown great differences by race and income in the use of LARC methods—and has raised concerns about possible coercion or the targeting of certain groups with these methods—the authors paid special attention to associations between use and these characteristics. Their findings address the concern that LARC methods may be promoted specifically to black women: There was no increase in use among this group, while use did increase among women of other racial and ethnic groups. Further, in 2012, there were no differences in LARC use according to women’s poverty status.
“Unintended pregnancy is concentrated among poor and low-income women and women of color. These elevated rates are symptomatic of larger overarching inequalities that result in reduced access to reproductive health care and services. While LARC methods alone do not address these inequalities, understanding how the use of these methods differs among different groups of women is an important first step toward ensuring that all women have access to the most effective contraceptive methods,” Kavanaugh explains.
Further, the researchers caution that there is no single best contraceptive method for all women. They recommend that women be provided with accurate information about the full range of contraceptive methods, including LARC methods. “It is important that each woman’s stated preferences and childbearing goals be prioritized, so each can choose the method that is best for her,” Kavanaugh notes.
Although the data analyzed in this study predate the implementation of the Affordable Care Act’s contraceptive coverage guarantee, the authors note that this provision will likely contribute to a continued increase in women’s access to and use of the IUD, which would otherwise have high upfront costs.
“Initiating use of an implant or IUD can cost a month’s salary for a woman working full time at minimum wage,” says Kinsey Hasstedt, a public policy associate at Guttmacher. “More women who want to use these highly effective contraceptive methods should now be able to access them without out-of-pocket costs.”
“Changes in Use of Long-Acting Reversible Contraceptive Methods Among United States Women, 2009–2012” by Megan L. Kavanaugh et al. of the Guttmacher Institute, is currently available online and will be published in the forthcoming issue of Obstetrics & Gynecology.

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Sex Bias in Neuroscience and Biomedical Research
Annaliese K. Beery1 and Irving Zucker2,*
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The publisher's final edited version of this article is available at Neurosci Biobehav Rev
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Abstract
Female mammals have long been neglected in biomedical research. The NIH mandated enrollment of women in human clinical trials in 1993, but no similar initiatives exist to foster research on female animals. We reviewed sex bias in research on mammals in 10 biological fields for 2009 and their historical precedents. Male bias was evident in 8 disciplines and most prominent in neuroscience, with single-sex studies of male animals outnumbering those of females 5.5 to 1. In the past half-century, male bias in non-human studies has increased while declining in human studies. Studies of both sexes frequently fail to analyze results by sex. Underrepresentation of females in animal models of disease is also commonplace, and our understanding of female biology is compromised by these deficiencies. The majority of articles in several journals are conducted on rats and mice to the exclusion of other useful animal models. The belief that non-human female mammals are intrinsically more variable than males and too troublesome for routine inclusion in research protocols is without foundation. We recommend that when only one sex is studied, this should be indicated in article titles, and that funding agencies favor proposals that investigate both sexes and analyze data by sex.

Keywords: sex bias, animal models, nervous system diseases, estrous cycles, research strategies
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1. Introduction
Women and non-human female mammals have been given short shrift in biomedical research, often on the assumption that results from males apply to females, or because of concern that hormonal cycles decrease the homogeneity of study populations and confound effects of experimental manipulations (Wizemann and Pardue, 2001). Some consider males representative of the human species and differences from the male norm as atypical or abnormal; others seek to protect women from adverse effects of drugs (Marts and Keitt, 2004), and generalize findings on males to females without justification.

Epidemiological and clinical studies of men often generate different results from those for women, exemplified by sex differences in response to many drugs (Soldin and Mattison, 2009), in cardiovascular disease (Barrett-Connor, 1997, Berger et al., 2009) and in autoimmune dysfunction (Fish, 2008; Lockshin, 2006; Whitacre, 2001). Widespread prevalence of sex differences in human disease and neglect of women in biological research negatively impacts the health of women (Correa-de-Araujo, 2006). Understanding of these consequences eventually led to the US National Institute of Health Revitalization Act of 1993, which required enrollment of female participants in federally supported phase III clinical trials. A European Union program was designed to provide basic researchers with practical tools and best practice examples regarding sex and gender differences in study design (Klinge, 200. These interventions contributed to increased inclusion of women in clinical research in the USA, paralleled by similar changes in the European Union and Australia (Wetherington, 2007; Rogers and Ballantyne, 2008; Klinge, 2008; Soldin and Mattison, 2009), but most studies that enrolled both sexes did not provide sex-specific analysis (Hayes and Redberg, 200. No funding agency stipulations presently require enrollment of females in non-human animal research, nor has there been movement to conduct basic science studies on both sexes (Sandberg and Ji, 200.

A substantial portion of the NIH budget supports research on animal models, an enterprise that facilitated development of treatments to alleviate depredations of aging, autoimmune diseases, cancer, behavioral dysfunctions, cardiovascular disease, diabetes and other human afflictions (Council report, 1989). What remains in question is whether present-day research on animal models is sufficiently attentive to female subjects, and whether appropriate species are investigated. Previous analyses of a few journals and disciplines revealed a strong male sex bias (e.g., Berkley, 1992; Blanchard et al., 1995; Sechzer et al., 1994).

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2. Literature Survey
To gain a contemporary view of sex bias in the human and animal literatures, we systematically sampled journal articles from 2009 across a broad range of disciplines, including several that have not been canvassed for decades, and others never previously surveyed. We also tracked changes in sex bias and species utilization in 5 journals for six or more decades, beginning in 1909, for an historical perspective. Reports were categorized with respect to species studied, sex of subjects, whether both males and females were sampled, and if so whether outcomes were reported by sex or included sex as a covariate in modeling (cf Geller et al., 2006).

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“A grand jury’s indictment of two abortion opponents who covertly recorded
Planned Parenthood officials is the latest, most startling sign that a Republican
campaign against the group has run into trouble,” the New York Times reports.

“In a dozen states including Texas, where the grand jury in Houston examined
Planned Parenthood at the request of Republican officials but ended up indicting
the opponents, various investigations have concluded without finding any wrongdoing
by affiliates of the group. Eight states have declined to investigate since videos began
surfacing in June alleging that Planned Parenthood illegally sells tissue from aborted
fetuses.”

“In the presidential race, Republican candidates are competing to condemn Planned
Parenthood in an effort to appeal to conservative voters… Party strategists worry that
such attacks will backfire with the general electorate in November, especially among
women, younger voters and political independents.”