Liya Kebede: Fighting for Maternal Health

According to Save the Children one in three women have no professional assistance during childbirth.
While the more fortunate are aided by traditional attendants many are alone during delivery putting them and their babies at grave risk.

In the age of modern medicine, why do so many mothers and newborns continue to go without proper care?

Source: http://english.aljazeera.net

ELLAONE - Longer-lasting "morning-after" pill to prevent pregnancy after unprotected sex

      The prescription drug, called Ella, is made by French company HRA Pharma and will be sold in the United States by Watson Pharmaceuticals. Known chemically as ulipristal, the drug already is sold in several European countries under the name ellaOne. HRA Pharma has said it has also begun seeking approval in other countries.

     
  It is the first emergency contraceptive approved since a five-year battle under the Bush administration ended with limited over-the-counter sales and age checks by pharmacists for a rival pill.
       Ella has been shown to prevent pregnancy for up to five days after unprotected sex.
       Women's groups, Democrats and other advocates say the pills offer women much-needed options to plan their families and provide a safety net when other birth control methods fail or women are raped.
       "Every woman deserves every option available to prevent an unplanned pregnancy, and there are many reasons why a woman may face the risk of unintended pregnancy -- from failure or improper use of birth control, to sexual assault," Cecile Richards, president of Planned Parenthood Federation of America, said in a statement.
        Ella is a type of selective progesterone receptor modulator, making it part of a class of drugs that interfere with the hormone progesterone that is crucial for pregnancy. The class also includes the abortion pill known as RU-486, or mifepristone, and sold as Danco Laboratories' Mifeprex. 

       Watson said the overall pregnancy rate for women who took Ella within three days of sex was 1.9 percent, lower than the anticipated rate of 5.6 percent. For women who took the drug two days to five days after sex, the pregnancy rate was 2.2 percent, lower than an expected rate of 5.5 percent. 

        Company officials and the FDA have said Ella appears to work primarily by preventing the release of a woman's egg for up to five days after unprotected sex, although the lining of the uterus is also affected.
     
Side effects of Ella
      -similar to those of Plan B, include headache, nausea, abdominal pain, pain/discomfort during menstruation (dysmenorrhea), fatigue, and dizziness. The drug should not be taken by women who are pregnant or nursing.
 The two emergency contraceptives work differently:

•  Plan B contains levonorgestrel, a progestin hormone used in lower doses in many birth control pills.

• Ella contains ulipristal, a non-hormonal drug that blocks the effects of key hormones necessary for conception.
• Plan B should be taken as soon as possible after sex. It may work for up to 72 hours, but is ineffective once insemination triggers the hormonal surge that leads to ovulation.
• While emergency contraception should not be delayed, Ella's effectiveness does not fade for 120 hours (five days) after sex, regardless of whether the hormonal surge has occurred.

Interactions

No interaction studies have been conducted. Ulipristal acetate is likely to interact with substrates of CYP3A4, like St John's wort or carbamazepine, but this might not be clinically relevant because only a single dose of the drug is taken.It might also interact with levonorgestrel and other substrates of the progesterone receptor, as well as with glucocorticoids.

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Birth Control Methods -Intrauterine Devices (IV)

Intrauterine Devices

Description

Although the intrauterine device (IUD) is a highly effective method of contraception, it is used by less than 2% of American women of reproductive age. The reason for such a small percentage stems from the withdrawal of FDA-approved IUDs in the 1970s. The Dalkon Shield IUD was withdrawn because of a series of litigations related to septic abortion deaths. The manufacturers withdrew their product because the cost of defending the lawsuits was deemed too expensive.Until as recently as 2000, the only 2 IUDs available in the United States were the Copper T380 (Pregna International; Mumbai, India) and the progesterone-releasing form, Progestasert (Alza; Mountain View, Calif). In December 2000, the FDA approved another form of IUD, the levonorgestrel intrauterine system termed Mirena (Berlex Laboratories; Montville, NJ). More than 2 million women in Europe have used this form of contraception in the past decade with great success.

Birth Control Methods - Hormonal Contraceptives (III)

Hormonal Contraceptives

Implants

The US Food and Drug Administration (FDA) approved the contraceptive use of levonorgestrel implants (Norplant) in 1990. This method consists of 6 silicone rubber rods, each measuring 34 mm long and 2.4 mm in diameter and each containing 36 mg of levonorgestrel. The implant releases approximately 80 mcg of levonorgestrel per 24 hours during the first year of use, achieving effective serum concentrations of 0.4-0.5 ng/mL within the first 24 hours. The rate of release decreases to an average of 30 mcg/d in the latter years of use. Release of the progestational agent by diffusion provides effective contraception for 5 years. Contraceptive protection begins within 24 hours of insertion if inserted during the first week of the menstrual cycle. The rods are inserted subcutaneously, usually in the woman's upper arm, where they are visible under the skin and can be easily palpated.^1,2
The mechanism of action is a combination of suppression of the LH surge, suppression of ovulation, development of viscous and scant cervical mucus to deter sperm penetration, and prevention of endometrial growth and development.
Efficacy
The contraceptive efficacy of the method is equivalent to that of surgical sterilization. Overall, pregnancy rates increase from 0.2% in the first year to 1.1% by the fifth year.
Advantages
The longevity of its effectiveness is an advantage. Its effectiveness is not related to its use in regards to coitus. Exogenous estrogen is absent. Prompt return to the previous state of fertility occurs upon removal. No adverse effect on breast milk production occurs.

Birth Control Methods - Mechanical Barriers (II)

Mechanical Barriers

Male Condom

The condom consists of a thin sheath placed over the glans and the shaft of the penis that is applied before any vaginal insertion. It is one of the most popular mechanical barriers. Among all of the barrier methods, the condom provides the most effective protection of the genital tract from STDs. Its usage has increased from 13.2-18.9% among all women of reproductive age because of the concern regarding the acquisition of HIV and STDs. It prevents pregnancy by acting as a barrier to the passage of semen into the vagina.
Efficacy
The failure rate of condoms in couples that use them consistently and correctly during the first year of use is estimated to be approximately 3%. However, the true failure rate is estimated to be approximately 14% during the first year of typical use. This marked difference of failure rates reflects errors in usage. Common errors with condoms usage include failure to use condoms with every act of intercourse and throughout intercourse, improper lubricant use with latex condoms (eg, oil-based lubricants), incorrect placement of the condom on the penis, and poor withdrawal technique.
Advantages
Condoms are readily available and are usually inexpensive. This method involves the male partner in the contraceptive choice. Condoms are effective against both pregnancy and STDs.
Disadvantages
Condoms possibly decrease enjoyment of sex. Some users may have a latex allergy. Condom breakage and slippage decrease effectiveness. Oil-based lubricants may damage the condom.

Birth Control Methods (I)

        
         The practice of contraception is as old as human existence. For centuries, humans have relied on their imagination to avoid pregnancy. Ancient writings noted on the Kahun papyrus dating to 1850 BCE refer to contraceptive techniques using a vaginal pessary of crocodile dung and fermented dough, which most likely created a hostile environment for sperm. The Kahun papyrus also refers to vaginal plugs of gum, honey, and acacia. During the early second century in Rome, Soranus of Ephesus created a highly acidic concoction of fruits, nuts, and wool that was placed at the cervical os to create a spermicidal barrier.
             Today, the voluntary control of fertility is of paramount importance to modern society. From a global perspective, countries currently face the crisis of rapid population growth that has begun to threaten human survival. At the present rate, the population of the world will double in 40 years; in several of the more socioeconomically disadvantaged countries, populations will double in less than 20 years.
On a smaller scale, effective control of reproduction can be essential to a woman's ability to achieve her individual goals and to contribute to her sense of well-being. A patient's choice of contraceptive method involves factors such as efficacy, safety, noncontraceptive benefits, cost, and personal considerations. This article addresses the predominant modes of contraception used in the United States, along with the safety, efficacy, advantages, disadvantages, and noncontraceptive benefits of each.

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