All posts by Ayesha Kazmi

Early study results suggest fertility app as effective as modern family planning methods

Early study results suggest fertility app as effective as modern family planning methods

2018-10-18

GEORGETOWN UNIVERSITY MEDICAL CENTER

Early results from a first-of-its-kind study suggests that typical use of a family planning app called Dot is as effective as other modern methods for avoiding an unplanned pregnancy.

Researchers from the Institute for Reproductive Health (IRH) at Georgetown University Medical Center are studying women’s use of the app for 13 menstrual cycles, or about one year. The ongoing prospective study design is the first to apply best-practice guidelines for assessing fertility awareness based methods in the testing of an app.

The interim results following Dot’s use for six cycles are published in the journal Contraception (title: Estimating six-cycle efficacy of the Dot app for pregnancy prevention.) Dot is owned by Cycle Technologies, which is solely responsible for the app.

Dot provides a woman with information about her fertility status each day of her menstrual cycle. It uses an algorithm and machine learning to identify the fertile days of her cycle based on her cycle lengths.

After women had been in the study for six cycles, the researchers found that the app had a typical-use failure rate of 3.5 percent, which suggests that Dot’s one-year typical efficacy rate will be comparable to other modern family planning methods such as the pill, injections, and vaginal ring.

“Given the growing interest in fertility apps, it was important to provide these early results,” says Victoria Jennings, PhD, principal investigator of the Dot efficacy study and director of the IRH.

718 participants in the United States enrolled in the study, and 419 participants completed six cycles of use. There were 15 confirmed pregnancies from cycles when participants used the method incorrectly (such as having unprotected sex on days of high fertility). No pregnancies occurred in cycles when participants reported correct use of the app during high risk days for pregnancy.

“Our purpose is to provide guidance to women who want to use Dot as well as to health providers and policy makers who are interested in this emerging method of family planning,” Jennings says. “We hope this paper contributes to the on-going discussion about the effectiveness of fertility apps and how their efficacy should be assessed.”

Final efficacy results are expected in early 2019.

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This study was supported by the United States Agency for International Development grant (OAAOAO13O00083).

In addition to Jennings, study authors include Liya T. Haile, Hanley M. Fultz and Dominick Shattuck of the IRH, and Rebecca G. Simmons of the University of Utah. The authors report having no personal financial interests related to the study. The Dot app is a proprietary technology developed by Cycle Technologies, a company owned by a family member of Jennings’.

About the Institute for Reproductive Health

The Institute for Reproductive Health at Georgetown University Medical Center has more than 30 years of experience in designing and implementing evidence-based programs that address critical needs in sexual and reproductive health. The Institute’s areas of research and program implementation include family planning, adolescents, gender equality, fertility awareness, and mobilizing technology for reproductive health. The Institute is highly respected for its focus on the introduction and scale-up of sustainable approaches to family planning and fertility awareness around the world. For more information, visit http://www.irh.org.

About Georgetown University Medical Center

Georgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC’s mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis — or “care of the whole person.” The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health. Connect with GUMC on Facebook (Facebook.com/GUMCUpdate), Twitter (@gumedcenter). Connect with Georgetown University School of Medicine on Facebook (Facebook.com/somgeorgetown), Twitter (@gumedicine) and Instagram (@georgetownmedicine).

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

https://www.eurekalert.org/pub_releases/2018-10/gumc-esr101518.php

Dear Men of #MeToo: Abuse Is Behaviour, Not a Symptom of Mental Illness

Dear Men of #MeToo: Abuse Is Behaviour, Not a Symptom of Mental Illness

2018-10-12

When abusers bring mental health issues as an excuse to their behaviours it gives birth to a misinformed and ableist narrative.

Trigger warning: Sexual harassment/abuse

The #MeToo movement has helped many women come out with their stories of sexual harassment and abuse at the hands of powerful men. It has also highlighted the problems associated with mental health. Many women have spoken up about the impact of these incidents on survivors and understanding why women take time to come out in the open with their narratives. At the same time, the more catchy mentions of ‘mental health’ have been furthered by the men accused of sexual harassment and assault themselves, through their carefully-worded apologies.

Mayank Jain, a journalist at the Business Standard, comedian Utsav Chakraborty and Abhishek Upadhya, an editor at India TV, attempted to use their mental health issues as a defence after being accused of predatory behaviour by several women. Words like “struggle”, “disease”, “seeking help” and “therapy” were littered on their Twitter timelines. These words say things that these men want us to know – but do they really matter? And why talk about it now?

Putting bad mental health on the table when you’re accused of misconduct is a common gambit. After the poet Mary Karr wrote about how her former partner David Foster Wallace had abused her physically and emotionally, a lot of backlash focused on Wallace’s mental health issues. In a personal essay for the New Yorker, celebrated author Junot Diaz talked about the repression of his childhood abuse and linked it to the accusations of assaulting and harassing multiple women. The courtroom trials of Roman Polanski mentioned his ‘mental illness’ several times, following his arrest for sexually abusing children.

The similarities are clear. All these men, and many others, influenced generations with their work in literature and the media, suffered from mental health issues and abused those who seemed less powerful. However, it would be amiss to connect abuse and mental health.

First off, there are similar patterns of violence perpetrated by people with as well as without  a mental illness. “The intersection of abusers with mental health issues is very thin,” Sadaf Vidha, a Mumbai-based psychologist whose clientele includes survivors of gender-based violence, says. “Think about it while reversing the roles – when women or minorities suffer from mental health issues, do we see them automatically abusing or assaulting other people?”

Research denies a link

The association of mental illness with abusive behaviour isn’t new; the ‘insanity defence’ is probably its most famous byproduct. Researches have been exploring this relationship for decades and have found prevalence of mental illness in convicted sex offenders, but no signs of a clear cause-effect has been found.

1999 study by Jenny Muzos of the Australian Institute Of Criminology dispels the myth that violent behaviour is associated with mental illness. It found that characteristics of crimes such as homicides committed by offenders diagnosed with a mental disorder were no different from those of crimes committed by other offenders.

After a undertaking series of studies, Nancy Erickson, an attorney and consultant on domestic violence and legal issues, concluded that while mental illness may or may not exist in abusers, the abuse they inflict is a behaviour and not a symptom.

meta-analysis of several studies by Andrew Klein, a professor of law at the Indiana University, Bloomington, and funded by the US Department of Justice, for the Battered Women Justice Project states that men who abuse are no more likely to suffer from mental illnesses than the ordinary population. Their paper reads, “Although batterers may suffer from depression or low self-esteem after being arrested or restrained, these conditions have not been found to have caused the abuse.”

Jaydip Sarkar, of the Institute of Mental Health, Singapore, asserted in a 2013 review of the assessments of mental health of sex offenders in India that rape, sexual harassment and other predatory behaviours are not necessarily the result of having a mental health problem.

The issue of perpetrators using stress as a result of work and/or substance abuse as an excuse was discussed in a 1999 review by Sarah Buel, a lawyer and professor at Arizona State University. Buel spent three decades working with survivors of domestic violence and concluded that though violence cannot be caused by stress, stress could exacerbate violence.

When abusers use mental health issues as a shield, it adds to a frightening, misinformed and ableist narrative. “Men directly or indirectly saying that abusive tendencies are due to mental health issues, is just another version of ‘I couldn’t control my desire/anger’,” Vidha added. “This is a very well-known pattern. Abusers will blame health, external environments or the victims, anything that allows them not to take responsibility for their misuse of power.”

The work of Lundy Bancroft

Jain’s tweet about him seeking therapy to “reform himself” was similar to Mark Halperin’s lengthy apology for reportedly assaulting about half a dozen women during his time at ABC News, in the early 2000s. In his statement, Halperin said he sought mental health counselling after he left ABC.

Lundy Bancroft spent years studying and counselling abusive men. In his 2002 book, Why Does He Do That? Inside the Minds of Angry and Controlling Men, Bancroft discusses the myth behind using mental health as a reason to abuse as well as to feed misguided beliefs that perhaps treatment that can ‘fix’ these men.For example, on Diaz’s reference to his childhood abuse, Bancroft writes, “… abusive men may find that accounts of childhood abuse is one of the best ways to pull heartstrings.”

Bancroft states that people have the potential to overcome emotional injuries from childhood and the impact of these injuries need not push the person to inflict same behaviour on others.

When Chakraborty mentioned his mental health, he was attempting to sneak it into his apology and lay the ground for sympathy. Bancroft pointedly dismisses this, writing “… abuse is a problem of values and not of psychology. Mental illness does not cause abusiveness anymore than alcohol does. Perceptions of life circumstances in these men are accurate, their minds work logically and they understand cause-effect.”

The same goes for Jain’s excuse and Upadhya claiming to seek professional help to address “these issues”. Bancroft continues, “I have yet to meet an abuser who has made any meaningful and lasting changes in his behaviour through therapy regardless of how much insight he may have gained.” He also writes that professional help will only help make them “happy, well-adjusted” abusers because interventions like psychotherapy can only address issues they are devised to address, and abusive behaviour isn’t one of them.

It is also important to differentiate between two types of destructive behaviour. One is where severe mental disorders like mania could cause a person to become destructive, as a result of which they may end up hurting the people around them. The other is where the destruction is intentional and isn’t motivated by the illness.

Of course, none of these means that any mental health issues these men may have are invalid or non-existent. They are likely to be as distressing for these men as they are for anyone else. However, the distress does not have anything to do with their inability to understand consent or the agency of the women.

“We are a patriarchal society and allowing mental health issues to become an excuse for abuse or assault will lead to massive misuse of policies and laws like the Mental Health Act,” Vidha said about the consequences of people buying into these connections. “We need to differentiate between what socialisation teaches men that is ‘okay to do’ and what their mental health conditions lead them to do.”

Mental health issues and predatory behaviour can coexist in a single mind but with some distance between each other. There are people who do suffer from a mental illness and are abusive towards women – and there are also people with a mental illness who do not engage in such behaviour. This is where human psychology takes a step back and calls value systems to the stage.

Prateek Sharma is a student pursuing a master’s degree in clinical psychology, a researcher and a mental health activist working to promote inclusive mental health care in India. He tweets @prateekshawarma.

https://thewire.in/health/dear-men-of-metoo-abuse-is-behaviour-not-a-symptom-of-mental-illness

 

Why Won’t Parents Talk About Helping Their Daughters Get Abortions?

Why Won’t Parents Talk About Helping Their Daughters Get Abortions?

“Your daughter’s 14, huh?” asked the guy at the wedding reception. “I guess you’re heading for the Grandma Danger Zone.” I wasn’t offended exactly (it was a party, after all, and most of us were drunk and speaking freely), but I was a bit surprised by the casualness with which a relative stranger commented on my child’s theoretical sexual activity. Trying to move the conversation along, I chuckled politely and replied, “Well, if she did get pregnant now, I would help her get an abortion, so that won’t be an issue.”

There was a long silence as this man and the other people in the conversation looked at me in shock. He’d made a lighthearted comment about my daughter’s potential teen pregnancy, and I’d responded in kind with a lighthearted comment about my daughter’s legal right to exercise her reproductive agency. Why did his comment garner laughs and knowing glances while mine elicited a full-on record scratch? Mercifully, someone changed the subject, and I was left with knowing that I, and not this man, had said something terribly wrong.

ut why? This was Massachusetts. These were liberals who would likely describe themselves as pro-choice. Yet somehow, my taking the concept of abortion from the theoretical to the concrete had shocked their sensibilities. And this wasn’t an isolated incident. I soon realized that being the parent of teenage girls meant many such conversations about the potential for their “bad decisions” ending in an unwanted pregnancy. Friends with girls the same age joked about warning their daughters to “keep their legs together” or not to get “knocked up.” Every time I pointed out that becoming pregnant needn’t result in having a baby, the universal reaction was mouths agape.

Yes, America remains fundamentally conservative on abortion, with Roe v. Wade freshly imperiled by the Kavanaugh Supreme Court. Although, in a recent Gallup poll, support for abortion rights is evenly split—about 48 percent on each side—the number of those who support abortion drops to 29 percent when people are asked if they think it should be legal under any circumstances. Part of this could be due to misinformation about things like fetal development and late-stage abortion, which can override our logical understanding of pregnancy in favor of a more emotional response. But it also has to do with our cultural values around pregnancy and a woman’s responsibility toward it. Often, it takes some other moral issue overcoming one’s fundamental distaste for the act of abortion itself (e.g., rape, incest, or a serious health risk to the mother) for the average American to accept it as a viable option. Our laws and regulations increasingly reflect an assumption that abortion is (only sometimes) a necessary evil, rather than a morally neutral health care option. Even among the progressive, pro-choice left, abortion is often talked about as a last resort—a horrible, traumatic event that must be avoided at all costs. But that’s not how I talk about abortion with my daughters.

Yes, I tell them, there are lots of good reasons to avoid an unwanted pregnancy in the first place: the potential physical dangers of unprotected sex, the potential emotional complications involved. But none of those should affect our ability to support, without judgment, a woman’s right to choose. I remind them that they are lucky to live in a state with access to safe and legal abortions and that should they find themselves in the position to need to avail themselves of those resources, I will give them the support they need.

I wish that other progressive parents were having the same conversations, but based on my experience, I suspect they’re not. And I get it. It’s one thing to believe in a theoretical person’s right to end an unwanted pregnancy; it’s entirely another to consider your own child’s behavior and its consequences. Perhaps parents are worried a child’s unwanted pregnancy might reflect poorly on their own parenting, implying that their daughter has made the kinds of “bad choices” she’d been dutifully taught to avoid. And talking about your daughter getting pregnant feels almost abstract, a cultural trope akin to joking about “getting out the shotgun” to defend her against unsavory gentleman callers. It’s not real; it’s just something parents say to indicate a general anxiety with watching one’s children grow into sexual maturity. Talking about your daughter getting an abortion, on the other hand, isn’t some common cultural shorthand or reference; it’s a specific reference to a specific procedure performed upon your specific daughter. Suddenly these abstract conversations are brought uncomfortably into the realm of the real and the possible. What would you do, the other parents are implicitly asked by my response, if your daughter had a pregnancy that she and you agreed should not be carried to term? What would you actually do? I think it’s time to stop shying away from this very real question, and its very real answer, and align our parenting with our politics.

So long as people still find it acceptable to joke about my daughters getting pregnant, I’ll continue to respond in kind by reiterating my support of their right to choose. I hope more pro-choice parents start to do the same. You’ll likely be met with a similar barrage of awkward silences and shocked looks, but I truly believe that the more comfortable we are talking about abortion without squeamishness or moral judgment, the more normalized it will become, even among those who already claim to support it. And honestly, making people at weddings or a moms’ night out a little uncomfortable is the very least we can do to help challenge cultural assumptions about women’s sexuality and reproductive rights. It’s a small but significant way we can move the needle in the cultural and political conversation around the ethics of abortion—and a huge way we can signal to our own children that we will practice what we preach when it comes to their bodies.