Bridging the Divide

A persistent gap exists between the women’s health research and policy advocacy communities. The two communities are united by their commitment to women’s health but divided by their different methods and language and by the lack of a connector that facilitates translation and communication between the two in a timely manner. The Jacobs Institute’s Bridging the Divide team seeks to serve as a connecting entity and link between the two groups.

The goal of the project is to engage the health research community and policy and advocacy networks in two-way communication. To accomplish this, Bridging the Divide is conducting a series of activities on timely women’s and reproductive health topics. The first was completed in December 2015, and focused on medication abortion. The second topic, completed in June 2016, focuses on long-acting reversible contraception.

A two-page summary of the project is available here

Medication Abortion

Medication abortion (also called medical abortion) is a safe method of abortion available for the past 15 years in the US. The Bridging the Divide white paper summarizes the scientific evidence related to the current medication abortion process and potential changes to the process that could make it even safer and more accessible for patients, as well as policy considerations and directions for future research.

In the fall of 2000, the US Food & Drug Administration (FDA) approved the drug Mifeprex© (generic: mifepristone) for use in medication abortions. That approval included requirements that affect both patients and providers and that are far more specific than typical requirements for prescription drugs. The package insert (also known as the product label) indicated procedures for mifepristone prescribers to follow, based on the regimen used during the drug’s pre-approval clinical trials. FDA has not approved any other abortion drugs besides Mifeprex.

Fifteen years later, in March 2016, the FDA approved an updated label for Mifeprex, marking an important step forward for access to abortion care and for evidence-based policy. Although the new label is progress toward policy that is informed and driven by scientific research, the change came many years after research data had demonstrated the safety and efficacy of widely used evidence-based protocols. In the intervening years, some states took advantage of the outdated requirements in the product label and implemented restrictive policy measures that prevented their residents from accessing care based on the latest evidence and best practice.

The Bridging the Divide white paper on the current state of medication abortion evidence and policy can be found below, along with a shorter summary document for policy-makers and a recently published commentary from the journal Women’s Health Issues.

Medication Abortion: Overview of Research & Policy in the United States
Medication Abortion: Overview of Research & Policy in the United States - Key Points for Policymakers 
Medication Abortion References by Topic
Commentary: For Medication Abortion, Science Should Guide Policy

Long-Acting Reversible Contraception

Long-acting reversible contraceptive (LARC) methods – specifically, intrauterine devices (IUDs) and subcutaneous hormone-releasing implants – demonstrate great potential in reducing unintended pregnancy. Although LARC methods have had a rocky history in the US and use rates have remained low here in comparison to other countries where the methods are available, there has been a significant increase in uptake of newer LARC products in recent years. Researchers have identified this change as a likely contributor to the declines seen in unintended pregnancy, abortion, and teen pregnancy rates.

Decades of research have shown that current LARC methods are highly safe and effective, yet research has identified many barriers that may prevent a woman who chooses a LARC as the contraceptive method that best meets her needs and preferences from getting it. These include inadequate provider knowledge and training, lack of awareness and education among potential users, and financial and health system barriers. There are also, however, encouraging research findings from assessments of interventions designed to reduce these barriers.

Despite the recent advances, some barriers to full, voluntary, and successful use of LARC methods remain but have the potential to be addressed through policy: implementation of insurance coverage for LARC insertion and removal, both under private plans and public programs, such as Medicaid; development of clinical performance measures for clinicians and/or health centers; and establishment of practices that ensure confidentiality and non-coercive provision of LARC methods, particularly for vulnerable populations.

The Bridging the Divide white paper on the current state of LARC evidence and policy can be found below:

Long-Acting Reversible Contraception: Overview of Research & Policy in the United States
Current Research and Policy on Long-Acting Reversible Contraception (LARC): Key Points for Policymakers
Long-Acting Reversible Contraception: Summary Tables
History of Long-Acting Reversible Contraception (LARC) in the United States
Long-Acting Reversible Contraception (LARC): State-Level and Regional Research on Reducing Barriers to Access