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Dr. Jones: What would the life of women and their children look like if every woman had the information and ability to plan every pregnancy? This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah health care, and this is The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: In the United States, almost half of all pregnancies are unplanned. In about half of those, the unplanned pregnancies were mistimed and about one-half of those pregnancies were unwanted. What would happen in the lives of women if they had all the information they needed to make a careful decision about pregnancy, or contraception, and they could get any method of contraception they wanted for free? Dr. Turok is a clinical professor in the Department of Obstetrics and Gynecology here at the University of Utah and a specialist of family planning.

Welcome, Dr. Turok. What happens in young women's lives when they have an unplanned pregnancy?

Dr. Turok: The largest group of women who have abortions in this country are those who have unintended pregnancies and as you mentioned, it a lot of people. It's over a million women a year. And for women who continue with a pregnancy, pregnancy is a chaotic time, as is child rearing, and if you're not planning for it from the get go, it further complicates things.

A population of people who have had planned pregnancies and a population of people who have had unplanned pregnancies and the children thereof, the kids from unplanned pregnancies are more likely to be born premature, to end up in the newborn ICU, to have less medical care in their first year of life, to do less well in school, and to not finish school.

Dr. Jones: So there are good reasons to build a structure around which families can be planned. We all want the kids that come to us, we don't all, but most of us want the kids that came to us because we, after the fact, create this incredible story about our kid was the miracle we didn't planned, but we love. But there are consequences to having babies that aren't planned.

Dr. Turok: There certainly are. The best predictor of having loving parents around to care for a child is to have been planning for that child from the beginning. And it's such an important predictor of how well children do that anything that we can do to help people time their pregnancies so they end up with the children they want, when they want them, only helps everybody.

Dr. Jones: In other countries, I know Europe does a pretty does a good job, people in Scandinavia do a pretty good job planning their children. What's keeping us in the U.S. from planning our children? Why do we have the highest rate of unplanned pregnancies in the Western world?

Dr. Turok: The difference between Scandinavia and the United States are many things. It's sexuality education, it's the conversations that children and young people and their parents have regarding the expectations for intimate partners. And it's the availability of contraception. In Scandinavia many more women use the most effective, reversible methods of contraception like IUD's and implants. And what we've seen in the United States in the past decade is that as communities and states have broadened the availability of these most effective methods, the rates of unintended pregnancy and abortion have plummeted.

Dr. Jones: What is it about America? Is it that we are a multicultural country? Because we don't have a unified healthcare system? Is it because we have diversity in income across the country? We have people who are truly poor. Why are we different than the Scandinavians, other than we don't have as many blonde people?

Dr. Turok: The biggest thing we see in disparities of unintended pregnancy are along socioeconomic lines, and race and class, and women of color, women who have completed less education, women who have fewer financial resources, are much more likely to have unintended pregnancies. In making opposites available and really removing all barriers to obtain methods of contraception will aid those people in determining when and if they have children.

Dr. Jones: We still have to reach out though to women. Women have to be thinking about contraception rather than just saying "oops", or, This is just what happens to me, and it happened to my mother and it happened to my sister." So how are we going to reach out to a vulnerable population of women here in Utah, here in Salt Lake County, to get their attention and say, "Are you sexually active?" Or whatever that means. "Do you want contraception? Do you want it for free? Come and see us." How are we going to reach out to the people who don't think they're going to get pregnant?

Dr. Turok: We've been working on this for quite some time, and the number one place people who want to initiate contraception, who have barrier of obtaining it come to in Salt Lake County is Planned Parenthood. So that's why we are collaborating with the four Planned Parenthood clinics in Salt Lake County to provide any method of contraception that women want that's offered at those clinics for free. And that includes the most expensive and the most effective methods, which are IUD's and implants.

Dr. Jones: And women who come in, they can get their method for free, but some of them actually might be willing to let us contact them in the years to come to see what happened with their lives using whatever method they chose.

Dr. Turok: Right. So we've started this project called "HER Salt Lake," or the HER Salt Lake Contraceptive Initiative, and what it does is we have three six-month periods. The first period is just the way it has been for very long, where people essentially have to figure out how they're going to get their method and pay for it.

The second period we eliminate all the costs. You walk in, you get the method you want, regardless of the ability to pay. And you don't pay anything.

And the third six-month period, we have a media campaign where women 18-29 years old will receive information on they had held devices that promotes the information about IUD's and implants and connects them with the places where they can get it for free. It'll be on Facebook, it'll be on Twitter, but it'll also be on pop up ads. It'll be modulated along the way to optimize the message and the way people receive it and when they get it. It requires a lot of community support, and support from outside resources, but we can get this done and we're working on creating a durable solution for this.

Dr. Jones: Years ago we had a picture of a pie which looked at the pregnancy outcomes in this country with the unplanned rate at a little over 50%, and for years and years that didn't budge, and you told me that your life's work was going to be to move the needle. How do you think it's going?

Dr. Turok: Yeah I think what I said was, if the shape of the pie doesn't change during the course of my work life, I'm going to be really upset that I didn't spend enough time skiing with my kids.

Dr. Jones: Dr. Turok, thanks for joining us and thank you for moving the slice of the pie that will be afforded to children who've been planned.

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Interviewer: If you've been into the Sugar House Health Center recently, you may have noticed a new addition. It's called a health information station, and you're wondering, "What do I do with that thing?" We're going to find out right now. Erica Lake is the Associate Director of the Hope Fox Eccles Health Library. Tell me about the health information station. You're pretty excited about this.

Dr. Lake: I am. As far as we know, it's the first type of information station of its kind. Health information kiosks have been used for decades in different health care facilities and in community settings, but it usually involves just having some set Internet sites on there or set health risk assessments for a particular disease, and what we're offering is a different way to access information. We have a live video chat system, and it's through a Skype phone so people don't even have to know how to use a computer. They just have to know how to use, well, an old-fashioned phone. Pick up the phone and start talking and you'll see the video screen pick up automatically. It rings the Hope Fox Eccles Health Library. That's at University Hospital, and our staff members are there. You'll see them on the video. We can remote the computers that are at the Sugar House Health Center so we can do the navigating and the searching for the patron who's there, so they don't have to worry about knowing how to get around and click on different health information sites that we're showing them.

Interviewer: Is that a big problem, people that don't know how to use the Internet? To me, it seems like if I went to the doctor, I got some information, I would just go home and find out what I want to do. Why is the station there?

Dr. Lake: For a lot of people, of course, they can do that. But then there's a huge segment of our population that doesn't even have access to a computer, so that's one reason why we wanted to kick off this new service at the Sugar House Health Center is because we know that there's a fairly large patient population there that doesn't have access to their own personal computer. Even if you do have access to a computer, you may not be as comfortable with navigating it and searching and going from authoritative health sites and finding those online.

Interviewer: What's the other advantage of having it right there in the health center?

Dr. Lake: Studies have found that the majority of people seeking health information do it immediately before or after an appointment with their health care provider, so that's why we're so excited to have it at the clinic. We're capitalizing on that time when people are already thinking about their care. They've just walked out of their appointment. They're thinking about what was discussed or they're about to go into their appointment and they're trying to get some questions together about what they want to ask. On either end of that time, they can utilize the health information station.

Interviewer: That's pretty handy. Has the usage been pretty decent so far?

Dr. Lake: Well, we're just getting started, but all of the staff there at the Sugar House Health Center has been wonderful and they're really enthusiastic about it. They're the ones who are going to be encouraging their patients during the appointment to go out there and set aside some time to use the station.

Interviewer: So one of the ways I can think I would use it is after I talk with my doctor a lot of times, it's a quick conversation and maybe I didn't quite catch everything or there's always that one more question that I forget. Is that another use for this?

Dr. Lake: Right. Yes. That happens frequently. Of course we know that appointments are usually . . . the average is 12 minutes long, so you may not have time to ask all the questions that you want to ask or let's say you have another question that's for a family member and it may not be appropriate to ask that during the time, but you want to go on and get a little bit more information. You can utilize the health information station that way.

Interviewer: Sounds a great way to get some solid advice from people that know. It's legitimate and real and research based. Any other thoughts on the kiosks or the information stations, the health information stations as you call them? Love the name, by the way.

Dr. Lake: Well, we hope that we'll introduce people to a lot of new resources that are online. There are lots of videos and images and things that you can look at. Let's say you don't want to read some information. You want to be able to look at a diagram on something to understand your condition a little better or you want to be able to watch a video about a procedure that you're going to be having. We can show you those.
We can find information in all different languages. We know that there are a lot of fairly unique non-English language requirements at the Sugar House Health Center. Burmese is one, and we can help those patients. Then, a lot of people think that they just need basic information but there are plenty of patients that we've helped that are either further along in a condition and they're ready for reading the biomedical literature itself and they want to be able to review those studies themselves. We're able to offer that tailored assistance.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: There are new requirements for researchers to consider sex and gender differences in their research designs. We're going to learn more about that right now and also about the 2014 info fair, Women's Health, Sex, and Gender Research Conference. Jean Shipman is the director of the Spencer S. Eccles Health Sciences Library. Let's talk about the info fair that's coming up and why is this important to researchers?

Jean Shipman: Scott, this is really going to be an issue for anybody applying for research grants and subcontracts, because it's going to be required more and more than researchers indicate how they're accounting for both sex and gender differences in their research.

Interviewer: This is kind of a new trend.

Jean Shipman: New in that NIH is going to start requiring that people look at tissue differences between men and women, particularly. Also, we've gotten funding to raise awareness about this issue from NIH and the Office of Research and Women's Health, particularly in the National Library of Medicine, as this is important that people become more aware.

Interviewer: Why does the NIH believe it is so important?

Jean Shipman: Every generation discovers something new, but we've discovered that we've been biased in our research in the past in using male reference standards for a lot of the design of research protocols and also not recognizing that there may be differential physiological differences in the research for men and women.

Interviewer: How has this played out in real world ways?

Jean Shipman: Well, an example is on 60 Minutes. They had an Ambien example where women were being double dosed because they were receiving the same dosage as men, but their physiological makeup requires less. We're seeing it highlighted more and more in the public culture as well as in true research.

Interviewer: Eventually this is going to become the way researchers are judged on their research if I understand correctly. Could you explain that?

Jean Shipman: I really predict that this could be a criterion in scoring for research grants, how much a researcher has considered these differences between men and women physiologically and biologically as well as their gender tendency. Where is their socioeconomic fallout for how they consider themselves and conduct their lives?

Interviewer: Let's talk a little bit about the 2014 info fair which deals with women's health, sex, and gender research. What types of things could a researcher learn at this conference?

Jean Shipman: We're hoping to make it a local application as well as national. Our keynote speaker is Dr. Caroline Clancy from the National Office of Veterans' Affairs, who is a well known researcher in this area. She's going to speak about her research but also the importance of considering this research difference in your protocol. We kick off the day with local experts, and we put a call out for contributors for posters and we'll have about 15 examples of research being conducted here at the University itself that deals with this topic. Those researchers are sharing their presentations for their research but also looking for partners in crime, other researchers who may have an interest that could join in their efforts.
Then we're going to have a keynote and then a follow-up panel of experts from the campus, both campuses of the University, who will talk about the resources that are available to local researchers and then we'll also have another panel that will highlight five of the posters with the researchers talking more specifically about how they have accounted for these differences in their research.

Interviewer: So some real good information on something that's going to be a concern of all researchers here very quickly, it sounds like.

Jean Shipman: It is. It will also highlight the need as well as get some real life examples and also identify resources available for you in the future.

Interviewer: What about the general public? Can the general public also attend?

Jean Shipman: We welcome the general public. In fact, this is sponsored by the Snyder Family's endowment to the library. It's a lecture series. The info fair has happened for about 25 years now. With their generous support, we offer this to the community as an awareness for them, too. As a general consumer, I hope that people can come away from this symposium saying to their private practice provider, "Hey, have you considered the difference in this dosage before you give me a treatment for a medication if I'm a woman?" Just to cause a little bit more conversation to happen between providers and consumers on this topic.

Interviewer: Any final thoughts on this info fair or this issue in general?

Jean Shipman: I really hope that people will leave with a different mindset. If we have encouraged our University as library partners, the Marriott Library and the Eccles Library are working together on this symposium along with the Center of Excellence in Women's Health on the campus, if we can just say that we've affected 20% change in people's opinion on this or their knowledge of this, we will consider it to be a very successful event.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.