Bixby Center

Carinne Brody’s Bixby-funded research on voucher programs featured by Population Council

Rebecca Braun — Fri, 27 Apr 2012 15:48:58 +0000

The Effectiveness of Vouchers: Where More Evidence is Needed

Good science requires more than just good data: we also need researchers dedicated to progress. In this two-part series, www.rhvouchers.org sits down with Carinne Brody, a DrPH student at the University of California, Berkeley who studies reproductive health voucher programs.

Brody has worked both in the field and behind the scenes reviewing and analyzing the health voucher literature. In this first post, we learn about her findings and conclusions from a 2011 review of voucher programs written for the UK’s Department for International Development (DFID). The second post will explore Brody’s time working directly with mothers in Cambodia.

The goals of health vouchers include reaching specific populations, increasing utilization, improving quality, and ultimately improving health outcomes. But do voucher programs actually achieve these goals? The conclusions of the 2011 DFID-funded review provide some insights to this question.

Brody and co-authors reported that among 24 studies evaluating 16 different health voucher programs, vouchers successfully targeted specific populations, increased health goods/service utilization, and enhanced quality improvement. The authors used a narrative synthesis approach to qualitatively summarize outcomes within five categories: targeting, utilization, efficiency, quality, and health impact.

Five main conclusions emerged:

there is modest evidence that vouchers effectively reach specific populations
there is insufficient evidence to determine whether vouchers deliver health goods/services more efficiently than competing health financing strategies
there is robust evidence that vouchers increase utilization
there is modest evidence that vouchers improve the quality of health services; and
the evidence indicates that voucher programs do not have an impact on the health of populations; however, this last conclusion was found to be unstable in a sensitivity analysis

Read the full article here:

http://www.rhvouchers.org/research/2012/the-effectiveness-of-vouchers-where-we-need-more-evidence

Drs. Potts & Campbell guide British Parliament report to debunk myths of population growth

Rebecca Braun — Sun, 22 Apr 2012 00:03:50 +0000

The British Parliament has published a report with “the invaluable input, guidance and support” of Dr. Martha Campbell and Prof. Malcolm Potts. Sex Ideology and Religion is authored by Richard Ottaway, Chairman of the UK Parliament Foreign Affairs Committee. Sex Ideology and Religion explores 10 myths that Campbell and Potts helped conceptualize about world popualtion growth, such as the assertion that Development is the Best Contracepive or that Technology and Human Ingenuity will solve our Problems.

Sex Ideology Religion – 10 myths about world population growth

Meyer, Bellows, Campbell & Potts publish systematic review on the impact of maternal health vouchers

Rebecca Braun — Mon, 12 Mar 2012 18:57:24 +0000

The Impact of Vouchers on the Use and Quality of Health Goods and Services in Developing Countries

Authors: Carinne Meyer, Nicole Bellows, Martha Campbell and Malcolm Potts

Abstract

Background: One approach to delivering health assistance to developing countries is the use of health voucher programmes, where vouchers are distributed to a targeted population for free or subsidised health goods/services. Theoretically, vouchers are expected to successfully target specific populations, increase utilisation, improve quality, enhance efficiency, and ultimately improve the health of populations.

Objectives: The primary objective of this systematic review is to assess whether voucher programmes thus far have been successful in achieving these desired outcomes.

Methods: Using explicit inclusion/exclusion criteria, a search of bibliographic databases, key journals, and organisational websites were conducted in September ␣ October 2010. Other search strategies used include bibliographic back-‐ referencing, supplemental keyword searches using specific programme information, and contacting key experts in the field. A narrative synthesis approach was taken to qualitatively summarise the identified quantitative outcome variables in five categories (targeting, utilisation, efficiency, quality, and health impact). Using the direction of effect of outcome variables and the confidence in the study findings, the findings for each category of outcomes were aggregated and assigned to one of five pre-‐established conclusion categories: (1) insufficient evidence; (2) evidence of no effect; (3) conflicting evidence; (4) modest evidence of effect; or (5) robust evidence of effect. Sub-‐group and sensitivity analyses were also performed. A quantitative meta-‐analysis was not conducted due to the heterogeneous natures of the outcome variables reviewed.

Results: A total of 24 studies evaluating 16 different health voucher programmes were identified in this review. The findings from 64 outcome variables informed five main conclusions: (1) there is modest evidence that voucher programmes effectively target voucher for health goods/services to specific populations (based on four programmes); (2) there is insufficient evidence to determine whether voucher programmes deliver health goods/services more efficiently than competing health financing strategies (based on one programme); (3) there is robust evidence that voucher programmes increase utilisation of health goods/services (based on 13 programmes); (4) there is modest evidence that voucher programmes improve the quality of health services (based on three programmes); and (5) the evidence indicates that voucher programmes do not have an impact on the health of populations (based on six programmes); however, this last conclusion was found to be unstable in a sensitivity analysis.

Conclusions: The evidence indicates that health voucher programmes have been successful in increasing utilisation of health goods/services, targeting specific populations, and improving the quality of services. While these results are encouraging, the subsequent link that voucher programmes improve the health of the population is not evident in the data analysed in this review. The methodology used in this analysis allows policy-‐makers to synthesise evidence from heterogeneous studies and therefore include more data than could be used in a standard meta-‐analysis. However, vouchers are still relatively new and the number of published studies evaluating vouchers is a limitation. Future reviews using this methodology can compare health voucher programmes to competing financing techniques and incorporate new evidence on voucher programmes for evaluations currently underway; however, the synthesis tools used in this review should be validated.

Read the full report here: HealthVouchers2011Meyer

Bixby Chair Dr. Malcolm Potts on NPR’s AirTalk: Should birth control be over-the-counter?

Rebecca Braun — Mon, 27 Feb 2012 19:02:35 +0000

Click here to listen to the broadcast from 2/23 on KPCC.

Should birth control pills be available over-the-counter?

The pill was first approved for oral contraceptive use in the United States in 1960. It’s one of the most studied – and some say, safest – medications on the market today. Yet, in most countries, including the U.S., women still need a doctor’s prescription to obtain them.

But there’s a growing movement underway to change that. The Oral Contraceptives Over-the-Counter Working Group is a coalition of health workers and advocates aiming to remove prescriptions as a barrier to pill access. They argue that prescription-only access to birth control is patronizing to women, limits contraceptive freedom and is ineffective against teen-pregnancy rates.

Obstetrician Malcolm Potts, who’s been studying contraceptives for decades, says not only is the pill safe, it has many health benefits such as a significant reduction in ovarian, uterine and bowel cancers and even melanomas. “The epidemiological data on pill safety are now so compelling,” Potts wrote in an op-ed in Monday’s Los Angeles Times, “that it seems likely the Food and Drug Administration would go along with such a proposal. The dose does not have to be adjusted to fit the user, and no one — not even a toddler who found her mom’s pills — has ever died from an overdose.” But to date, the FDA has never approved a “chronic use” medication, a drug taken daily for an unlimited amount of time, without a prescription.

So why isn’t the pill, like aspirin, available in every pharmacy? What would it take for the FDA to lift the prescription-only regulations? What impact might this change have on the cost of birth control and the battles over who’s going to pay for it? Is the pill really safe enough to be used without doctor oversight?

Guests:

Dr. Malcolm Potts, Bixby Professor at UC Berkeley, obstetrician and reproductive scientist who has studied oral contraceptives since the 1960s

Dr. Angela Lanfranchi, Clinical Assistant Professor of Surgery at Robert Wood Johnson Medical School, breast surgical oncologist

Bixby Chair Dr. Malcolm Potts publishes LA Times Op-Ed: A Contraception Game-Changer

Rebecca Braun — Mon, 20 Feb 2012 20:15:16 +0000

Published February 20, 2012

To read the op-ed online, go the LA Times

—

A Contraception Game Changer

By Malcolm Potts

February 20, 2012

In the battle over contraception, it’s time for the Roman Catholic Church to acknowledge the pill’s health benefits. The U.S. should even allow over-the-counter sales.

Presidents, politicians and physicians are fighting over who should pay for contraception, and women are getting hurt in the process.

Roman Catholic bishops reject even President Obama’s recent compromise not requiring religiously affiliated hospitals and universities to pay for contraception, saying it does not meet their standard of “religious liberty and moral convictions.”Planned Parenthood President Cecile Richards calls the row over insurance payments part of “a misleading and outrageous assault onwomen’s health.”

But before the acrimony grows any greater, let’s pause for a moment and consider one of the medical advances at the heart of this controversy — and how it might yet be a game-changer.

The hormonal formulation we call the pill is much more than a contraceptive. Our ancient ancestors didn’t ovulate as many times over their lifetimes as today’s women. They had later puberty, and once they started having children, they breast-fedwithout ovulating for long intervals. Evidence suggests they had as few as 30 menstrual cycles in a lifetime, compared with 300 or more today. This is significant because studies show that the greater the number of menstrual cycles a woman has, the greater the risk of uterine and ovarian cancer.

Women taking birth control pills are in a different situation. Because the pill mimics the hormone profile of pregnant and lactating women, those who take oral contraceptives tend to be hormonally more like their forebears, even though they tend to reach puberty earlier, have fewer pregnancies and lactate less often and for shorter periods.

Several years ago, British medical scientists published a 39-year follow-up of 23,000 women who started using the pill in the 1960s and 23,000 who did not. Among pill users, they found a significant reduction in ovarian, uterine and bowelcancers, and even melanomas. Another study of 17,000 women found that use of the pill was associated with a small but measurable increase in life expectancy.

Last December, at the Pontifical University of the Holy Cross in Vatican City, two Australian scientists, Kara Britt and Roger Short, gave a keynote address titled “The Plight of Nuns.” They recommended that nuns should take the pill for a couple of years during their lifetimes to reduce the increased risk of cancer associated with not having children. It was not a tongue-in-cheek criticism of the Vatican but good medical advice based on impeccable statistics and sound biological insights. It was also theologically sound.

The pill was first marketed in the 1950s not as a contraceptive but to regularize menstruation, and Pope Pius XII approved this use of the drug. More recently, Pope Benedict XVIendorsed the non-contraceptive benefits of condoms in some circumstances to prevent HIV infection among gay men.

The non-contraceptive benefits of using the pill are so powerful that the church should consider lifting restrictions on doctors in Catholic institutions and allow them to prescribe low-dose estrogen and progesterone tablets forwomen’s healthbenefits. Michael Galligan-Stierle, president of the Assn. of Catholic Colleges and Universities, maintains that Catholic institutions can prescribe drugs only for preventing disease. But the pill falls squarely into that category. In fact, more than 1 million women already take the pill for non-contraceptive purposes.

If the church is still queasy, here’s another idea. One simple solution to today’s birth control battles would be to sell the pill over the counter. The epidemiological data on pill safety are now so compelling that it seems likely the Food and Drug Administration would go along with such a proposal. The dose does not have to be adjusted to fit the user, and no one — not even a toddler who found her mom’s pills — has ever died from an overdose. An over-the-counter pill packet would need to carry some clear warnings: Women over the age of 35 who smoke should not use the pill, and those who are hypertensive or diabetic should seek the advice of a health professional. But many nonprescription drugs carry similar warnings.

Selling birth control pills over the counter would reassure millions of women who don’t take them because of misinformation about risks and side effects. The category of nonsteroidal anti-inflammatory drugs, to which aspirin and ibuprofen belong, is associated with 16,000 deaths a year, while the pill actually causes users to live slightly longer than average. The wider availability of the pill would help those who lack insurance or can’t afford to go to a doctor. Today, poor women have three times as many unintended pregnancies as wealthier women.

So why isn’t the pill sold next to aspirin in every pharmacy or gas station? Commercial greed and a strong patriarchal streak in American politics.

Prescription medicines bring higher profits thanover-the-counter drugs. As a doctor, I would recommend my loved ones use a low-dose generic pill whose safety has been well documented over a generation of use. A good generic manufacturer can make a packet of pills for under 20 cents, and they could be sold for $8 a month or less and still make a profit.

Sooner or later, one generic manufacturer will break ranks and ask the FDA to let the pill be sold without a prescription. Let’s hope it’s sooner.

Drs. Potts & Campbell to speak on Population & the Environment

Rebecca Braun — Sat, 28 Jan 2012 03:00:52 +0000

HowMany.org is pleased to welcome speakers Malcolm Potts and Martha Campbell of UC Berkeley’s Bixby Center for Population, Health & Sustainability. Dr. Potts is a Cambridge trained obstetrician and reproductive scientist, and Bixby professor at the School of Public Health at UC Berkeley. Dr. Campbell, also lecturer in global health at UC Berkeley, is a political scientist, health policy specialist and president of Berkeley-based Venture Strategies for Health and Development. Both Dr. Potts and Dr. Campbell spend time each year conducting field research in the developing world.

Drs. Potts and Campbell will engage the audience on what can be done to slow population growth as we confront global issues of economic hardship, threats to basic reproductive health care and fragile ecosystems disappearing at record rates. While there are many numbers and arguments for the Earth’s maximum sustainable human population, they all hinge on the question: In what manner shall the Earth’s species live?

What: Helping people understand how to slow population growth

Where: Berkeley Unitarian Universalists Fellowship Hall, 1924 Cedar St.

When: Thursday, February 9th, 2012 at 7:00 p.m.

Come one, come all - this event is free and open to the public

More information is available here.

Bixby Center Scientific Director Dr. Ndola Prata profiled in the Lancet

Rebecca Braun — Sat, 28 Jan 2012 02:55:09 +0000

Excerpt: “Ever since I was a little girl, I always wanted to fix things”, says Ndola Prata, Scientific Director of the Bixby Center for Population, Health and Sustainability at the University of California, Berkeley. Prata battles daily for more pragmatic approaches to reproductive and sexual health care. “I find myself questioning why we don’t focus on interventions that can be scaled up, thus reaching most of the women in need”, she says.

Read the entire article here.

National Geographic features WE CARE Solar, founded by Dr. Laura Stachel

Rebecca Braun — Tue, 17 Jan 2012 04:26:11 +0000

The latest installment of “Mobile Message” from the National Geographic NewsWatch features obstetrician Laura Stachel, Associate Director of Emergency Obstetric Research in West Africa for the Bixby Center for Population Health and Sustainability. Laura is the Co-Founder and Executive Director of WE CARE Solar, a non-profit working to save maternal and newborn lives utilizing solar powered solutions. Since 2008, Laura has been conducting research on maternal mortality in the developing world as she pursues her DrPH from UC Berkeley.

Read the article here: http://newswatch.nationalgeographic.com/2012/01/12/shine-a-light-the-suitcase-thats-saving-womens-lives/

(photo credit: WE CARE Solar)

New York Times features the Hookup, started by Bixby doctoral fellow Rebecca Braun

Rebecca Braun — Tue, 17 Jan 2012 04:13:47 +0000

A recent front page article from the New York Times featured the ‘Hookup’, a project started by Rebecca Braun, a doctoral fellow with the Bixby Center for Population, Health and Sustainability at UC Berkeley. The project links youth to sexual health information and services in California using mobile technology. Rebecca is applying a similar approach through her doctoral work at the Bixby Center, focusing the role of mHealth in improving family planning and maternal health in global settings.

Read the article here: http://www.nytimes.com/2011/12/31/us/sex-education-for-teenagers-online-and-in-texts.html

(photo credit: Peter Hoffman for The New York Times)

UC Global Health Day 2012

Rebecca Braun — Sat, 14 Jan 2012 00:34:08 +0000

Dwinelle Hall, UC Berkeley
Saturday, February 4, 2012
8:30am – 5pm

Join UC faculty, students and staff at the second University of California Global Health Day. In the morning the theme of the sessions will be Population Growth and Global Health. Afternoon sessions will cover a broad range of global health topics, and will be presented by faculty and students from across the UC system.

More info here: http://www.ucghi.universityofcalifornia.edu/news-events/uc-global-health-day/index.aspx