A New Mechanism of Non-Hormonal Contraception using Mucoadhesive Polymers

A New Mechanism of Non-Hormonal Contraception using Mucoadhesive Polymers

Effective family planning is critical for women’s empowerment and improvement in child and maternal health, yet nearly half of the world’s pregnancies are unintended(1), representing a clear unmet need for contraception. Hormonal contraceptive regimens offer high efficacy but may induce a systemic side effect profile that reduces compliance. New research into contraceptive development has stagnated since the 1980s, due to the exit of the U.S. pharmaceutical industry from the arena. Consequently, existing pericoital non-hormonal contraceptives, such as spermicides and gels, are unsatisfactory, suffering from high failure rates in typical use as well as high discontinuation rates, which partially stem from vaginal irritation and discomfort. To solve these issues, Schimpf and colleagues, reporting in Science Translational Medicine(2), proposed a novel mechanism that could represent the next generation in contraceptive design. They developed a formulation of chitosan mucoadhesive polymers that can be topically applied to physically reinforce the cervical mucus barrier against sperm penetration. Their vaginal gel formulation decreased average uterine sperm...
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OCTOBER 2022 DIRECTOR’S MESSAGE

OCTOBER 2022 DIRECTOR’S MESSAGE

Be an Outlier for Change      Next week marks almost five months since the Supreme Court handed down their decision in Dobbs versus Jackson Women’s Health, overturning the constitutional protection for abortion enshrined by Roe v Wade in 1973. Although the past fifteen years have seen an incredibly successful assault on reproductive rights and access to essential health care for pregnancy, the Dobbs decision led to the enactment of trigger bans in thirteen states, with an additional thirteen states having restrictive or very restrictive laws that are anticipated to lead to bans in the near future. In the first 100 days post-Dobbs, much has been written about the legal climate, how individuals and families have been affected and the legislative victories on both sides of the debate. One of the most striking things I’ve read, however, was a policy analysis by the Guttmacher Institute classifying the US as a global outlier on abortion rights. While the US has often taken pride in...
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FACULTY SPOTLIGHT: AN INTERVIEW WITH DR. EMILY HERFEL

FACULTY SPOTLIGHT: AN INTERVIEW WITH DR. EMILY HERFEL

Emily Herfel, DO, Msc-GH, FACOG (Fellow of the American College of Osteopathic Obstetricians and Gynecologists), is an assistant professor at Duke Department of Obstetrics and Gynecology, an affiliate at the Duke Center for Global Reproductive Health, and a volunteer professor at Kilimanjaro Christian Medical Center in Moshi, Tanzania. Dr. Herfel completed her undergraduate work at John Carroll University in Cleveland, Ohio followed by a Doctor of Osteopathy at Heritage College of Osteopathic Medicine in Athens, Ohio. She completed residency at OhioHealth Doctors Hospital in Columbus, Ohio. She then went on to receive her Masters of Science in Global Health through a Women’s Global Health Fellowship at Duke University. During that fellowship, she received an NIH-Fogarty grant to complete her project in Kisumu, Kenya. I had an enriching conversation with Dr. Herfel to learn more about her experiences within the global health sphere and her passion for reproductive health care. “Right in the heart of COVID, in July 2020, I moved to...
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Webinar Series

Webinar Series

The Center for Global Reproductive Health and the Center for Policy Impact in Global Health recently partnered to convene a webinar on “The unfinished agenda of maternal and child health in Africa and Asia: promising directions to address maternal mortality challenges.” The panel, moderated by Dr. Megan Huchko, included: Dr. Mariam Claeson, former Director of the Global Financing Facility for Every Women Every Child at the World Bank and now at the Karolinska Institute Dr. Qjan Long, Assistant Professor at Duke Kunshan University, formerly worked at the Department of Reproductive Health and Research, WHO Ms. Jacquelyn Caglia, Director of Learning, Communications for Merck for Mothers Experts discussed the historic and current challenges in addressing maternal and child mortality in the region, and brought up some promising innovations and strategies with the potential to effect these disparities in the future. The webinar can be seen here, with a fill description of the background and discussion on the CPIGH website....
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The Failures of American Sex-Education

The Failures of American Sex-Education

As the topic of sexual and reproductive health re-enters the public consciousness in America through the overturning of Roe v. Wade, it becomes increasingly important to access American Sex Education, or rather, the failures of it, and how we teach these topics to our most impressionable population, children. The state of sex-education in this country is in shambles. Though the majority of Americans support sex-education in middle school and in high school, what exactly does that education look like?  The first and one of the most important things to note about sex-education in the states is that there is no universal regulation of it. Only thirty nine states, plus DC, even have government mandated sex-education [5]. Within the states with mandated sex-education, only thirteen must provide “medically accurate” sex-education [1]. The content of what is covered in sex-education varies widely from state to state, within states that do have government mandated sex-education, it is often left to individual districts to decide...
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Maternal Mortality: Why is Race a Factor?

Maternal Mortality: Why is Race a Factor?

The United States is one of the leading nations in medical advancement and spends a significant portion of expenditures in healthcare and yet, we have the highest rate of maternal mortality (ratio of 57) among developed countries. About 57 mothers die during childbirth per 100,000 birth in a year. Maternal mortality is defined as the death of a mother due to pregnancy and/or childbirth complications [3]. These complications can arise due to a variety of factors including environmental lifestyle, predisposing conditions, risk factors, genetics and socioeconomic factors [1]. Pregnancy complications are likely to arise in women with higher maternal age and those with chronic cardiovascular conditions. Preeclampsia is a condition in which women develop high blood pressure due to preexisting cardiovascular conditions and kidney disease. Black non-Hispanic mothers are 2.5 times more likely to die from pregnancy or labor complications compared to white women and 3.5 times more likely to die than Hispanic women [3]. Why is there a disparity in...
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Myna Mahila Foundation Combats Period Taboo in Urban Indian Communities

Myna Mahila Foundation Combats Period Taboo in Urban Indian Communities

Although stigma surrounding menstruation exists around the world, this stigma manifests in a way that has a deeply negative effect on the lives of menstruators in some communities in India. In these communities, periods are treated as dirty and impure. Many menstruators are not allowed to pray, go to the temple, or enter the kitchen while on their period. Due to the negative stigma surrounding menstruation, menstruators in these communities do not discuss menstruation. Many men do not even know what menstruation is. Menstruators feel ashamed buying sanitary pads from male workers at health stores and are thus forced to use unsanitary cloth rags during their cycles. As a result of the lack of access to proper menstrual hygiene products and community support, in some Indian communities, young menstruators are forced to end their education after they get their period.  Despite how pervasive this taboo is in many Indian communities, there are a variety of efforts to combat this detrimental stigma....
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Hybrid GRH

Our paper, “Uptake and correlates of cervical cancer screening among women attending a community-based multi-disease health campaign in Kenya,” is published in the BMC Women’s Health. In this paper, we describe the acceptability and uptake of a model of integrated HPV-based cervical cancer screening as part of a series of multi-disease community health campaigns offered in Kisumu, Kenya. We also describe the prevalence and predictors of both screening and positive HPV results among women attending these campaigns. Although there is an increased risk of cervical cancer among women living with HIV, many HIV-care programs do not offer integrated cervical cancer screening. To address the cervical cancer screening gap in Kenya, we leveraged the community health campaigns facilitated by the Family AIDS Care & Education Services and provided multi-disease testing to achieve a high population coverage for HIV-testing and HPV-based cervical cancer screening in western Kenya, an area with high rates of HIV. In addition to HIV testing, the campaigns provided screening...
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Jacob Stocks and his experience working on mSaada

Jacob Stocks and his experience working on mSaada

Duke MsGH ’20, Jacob Stocks, talks about his experience working on an mHealth app to support cervical cancer screening in western Kenya.  The app was developed by four Duke seniors (‘T20) as part of their Computer Science Capstone course. Stocks’ experience co-designing the app with end-users, clinicians and community health volunteers in Kenya, was published recently in JMIR Formative Research. In 2019, I worked alongside members of the Center for Global Reproductive Health to develop and pilot test mSaada, a mobile phone app for use by lay-providers during cervical cancer screening. This experience was an exercise in self-reflection, flexibility, and perseverance, as the study team had to acknowledge the gaps in our intervention and work effectively and efficiently to address them while adapting to additional challenges as they arose. Our team, working face-to-face with local collaborators as well as virtually with app developers, conducted feedback sessions with community health volunteers and clinicians in Kisumu and Migori, Kenya. The main findings of this...
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From Dormmates to Research Collaborators

From Dormmates to Research Collaborators

In fall 2019, when Rachel Mundaden and Ramya Ginjupalli (T’22) applied to spend the following summer in Kisumu, Kenya, as part of the Center’s Student Research Training program, no one could have predicted the COVID-19 pandemic, and the resultant global disruptions in almost every aspect of people’s lives.  Travel and fieldwork were soon out of the question, but these two were able to pivot to develop the content expertise and skills in qualitative methods necessary to carry out an analysis of focus groups discussions designed to better understand stigma related to cervical cancer and human papillomavirus in Kenya.  They spoke to DGHI about their experience and how it felt to have a published manuscript resulting from this work. Check it out here: https://globalhealth.duke.edu/news/dormmates-research-collaborators    ...
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