Global statistics on unplanned pregnancies, abortions and STIs show that unprotected sex is still widely practised. More needs to be done to provide women and men with a wider choice of convenient protective options. To address this need, international efforts are focusing on developing multipurpose prevention technologies (MPTs) that address two or more indications simultaneously. These technologies would have significant advantages over single-indication products. They include inter alia novel barrier devices, drugs administered either as oral tablets or vaginal/rectal gels, drugs used in combination with medical devices, and genetically engineered organisms which secrete antimicrobial substances. As an example of progress in the MPT field, this paper describes an on-demand contraceptive/antimicrobial vaginal gel, Amphora (previously known as Acidform), now in an advanced stage of development. Clinical trials are currently being planned to find out whether this product’s promising antimicrobial profile translates into protective and preventive choices.

This issue of Contraception is dedicated to the Association of Reproductive Health Professionals (ARHP) in recognition of 50 years of high quality, evidence-based provider education and training. The issue features ARHP's 50th anniversary conference abstracts, late-breaking clinical and sociobehavioral research articles, ARHP's commentary from Lisa Harris and recommendations from ARHP's January 2013 Sexual and Reproductive Health (SRH) Workforce Summit to help move our field forward during a time of great change.

This presentation will feature epidemiologic trends, end-user needs and the rationale for MPTs. Sub-Saharan Africa and South/West Asia will be highlighted as examples of the 2 regions of the world with the greatest overlap of high unmet need for family planning, high HIV and STI rates, and high maternal and under-five mortality rates. In addition, existing technologies and emerging MPTs that can be used to reduce simultaneous sexual and reproductive health risks and outcomes will be explored.

A challenging economy, uncertain political support and evolving health technologies call for innovation, collaboration and fresh thinking for all members of the reproductive health community. Clinical practices in the United States are responding to these challenges by testing and implementing shared support services and information systems, driven by the economic downturn, emergence of electronic medical records, and impending health care laws [ [1] Fryer A, Doty M, Audet A. Sharing resources: opportunities for smaller primary care practices to increase their capacity for patient care. Findings from the 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. Issue Brief (Commonwealth Fund). 2011 Mar:4:115. Google Scholar ].

The majority of the professional communities who read this journal — reproductive health researchers, scientists, health care providers and advocates — are rewarded for their efforts with fresh insights and late-breaking research. Our field has a good handle on what needs to be done, and our research pipeline is bursting: We have identified the gaps, conducted needed research and are constantly seeking funds to do more.

The Society of Family Planning (SFP) and the Association of Reproductive Health Professionals (ARHP) are two organizations with different but complementary missions. Together, we write this editorial in order to raise awareness of how we work collaboratively, specifically around translating scientific research in family planning and abortion into direct patient care.

September 29, 2010, marks the 10th anniversary of Food and Drug Administration's approval of Mifeprex (mifepristone) in the United States. That moment 10 years ago brought women the promise of increased access to early, safe, noninvasive abortion and the potential mainstreaming of abortion services into the larger scope of routine comprehensive women's health care [ 1 Clark W.H. Gold M. Grossman D. Winikoff B. Can mifepristone medical abortion be simplified? A review of the evidence and questions for future research. Contraception. 2007; 75: 245-250 Google Scholar , 2 Finer L.B. Wei J. Effect of mifepristone on abortion access in the United States. Obstet Gynecol. 2009; 114: 623-630 Google Scholar ]. The arduous 12-year path to approval required an intensive level of collaboration among key professional, advocacy and research organizations, working closely to navigate abortion-related politics and meet the natural challenges of introducing a new medical option to women and their health care providers.

This editorial discusses solutions for reducing unintended pregnancies in the United States. It states that to help lower unintended pregnancy rates we must make the image of the well-trained clinician a reality and to accomplish this there must be significant federal investment in provider training and continuing education on reproductive health and family planning.

The 80 million unintended pregnancies that occur worldwide each year (38% of all pregnancies) can justifiably be deemed an epidemic. These pregnancies result in 42 million induced abortions and 34 million unintended births - births that contribute substantially to the annual world population growth of 78 million. Among developed countries the US record of family planning is uniquely deficient. Of 6.1 million pregnancies in 2001 half were unintended (as were more than 80% of the 800000 annual teen pregnancies) resulting in 1.3 million abortions 4 million births (of which one-third were unintended) and 800000 miscarriages. ... Leading causes of unintended pregnancy are closely related to contraceptive method choice. In 2002 more than half of contraceptive users relied on methods with high failure rates under typical use: 31% used the pill 18% the male condom and 5% the 3-month injectable. While with perfect use these methods are highly effective 9% of pill users 17% of condom users and 5% of injectable users will become pregnant during the first year of typical use. To make matters worse about half of condom and injectable contraception users - and almost one-third of pill users - will discontinue within a year. ... Past experience with the successful introduction of new contraceptives or reintroduction in the case of the IUC provides guidance to improve provision and use. Recommended activities include the following: 1) Undertake research; 2) Develop information and training materials; 3) Provide training and technical assistance; 4) Address the high cost of LARC methods; 5) Increase patient awareness; and 6) Fully fund family planning programs for low-income clients. (excerpt)

Young adults - loosely defined as people in their late teens to mid-20s-are a fluid group in an exploratory phase of their lives with their own language and style of communicating. These 20-somethings are continuously experimenting testing new concepts and acculturating in ways that mesh with their developing identities. These individuals are more mobile than children or older adults many are newly independent and less rooted in their communities than other age groups and they do not have as many societal or familial support systems as adolescents. Complicating matters there is a paucity of medical literature about contraceptive use and misuse in young adults. While the body of research on teens contraception and pregnancy is fairly robust more investigation is sorely needed to better understand barriers to care for these 20-something adults. As members of the reproductive health care team our challenge is to make it as easy as possible for this elusive population to receive the reproductive care they need. (excerpt)

The rapid advancement of reproductive science, fueled by such major events as the completion of the human genome project in April 2003 [ [1] National Human Genome Research Institute. All About The Human Genome Project (HGP). http://www.genome.gov/10001772. Accessed August 28, 2008. Google Scholar ] and marked by technologies such as preimplantation genetic diagnosis (PGD), has brought a sea of change in health care that has already begun to impact our lives. And, for all of the benefits and risks involved, reproductive genetics will continue to influence health care in significant ways over the next decade. The swift growth in these new technologies calls for reproductive health providers to thoroughly educate themselves, to better understand implications for health care practice, to advocate for clear safety measures to ensure the health and well-being of those who use these technologies and to advance policies that promote health equity.

The terms ���diversity��� and ���cultural competence��� are freely used by well-motivated health professionals to address real health care equity problems among various populations [ [1] Beach M.C. Price E.G. Cultural competence: a systematic review of health care provider educational interventions. Med Care. 2005; 43: 356-373 Google Scholar ]. The primary areas of concern have involved race and gender differences. Significant differences in health education and patient care also exist between socioeconomic classes, geographic locations (i.e., rural vs. urban, north vs. south), disabled and abled communities, sexual orientations and age groups. Many pilot projects and studies in the developed world have been conducted over the past decade in an attempt to understand, address and rectify these differences. Although well-meaning, these endeavors alone are not sufficient to address the complex social issues that are part of true cultural competence and diversity awareness.

The above represent some of the numerous ways, past and present, that advocates in the reproductive rights movement have tried to talk about abortion. This attempt to find the most persuasive language or frame has, of course, been going on a long time indeed, since the period of the Roe v Wade decision in 1973 but has taken on new urgency in light of the recent setbacks to providing legal abortion in the United States.

Health is a key issue in the approaching U.S. elections, and the voters' choices will impact future policies both domestically and internationally. This is a critical time to think about the policies needed to improve the health of women in the U.S. and around the globe. Women's health is often compromised by discriminatory practices and policies that neglect women's needs or impede their economic and social opportunities.

This was the headline of a story by journalist Ceci Connolly in the January 3, 2005, issue of the Washington Post. The data that prompted this article came from the National Center for Health Statistics surveys which had shown that the number of women in the United States who had sex in the previous 3 months but did not use birth control rose from 5.2% in 1995 to 7.4% in 2002, a statistically significant difference. In a country where almost half the pregnancies are already unplanned, this is a disturbing statistic as it would put at least 4.6 million sexually active women at risk of conceiving a child they had not planned. The traditional knee-jerk reaction to this news is to say that we need more and better methods of contraception that will appeal to more women and men who will use them more consistently. In short, we blame this sort of failure of men and women to use birth control on the imperfection of contraceptive technology and believe that if we could just find that perfect, or at least almost perfect, method of birth control, usage problems would diminish or even disappear. Is this a reasonable assumption backed by evidence? Should we continue to urge governments and industry to put more effort and money into developing new and better methods of contraception with the hope that it will result in lower rates of unplanned pregnancies?