1. Focus on the data: Addressing controversial issues in sexual and reproductive health
Chelsea B. Polis, PhD
Senior Research Scientist, Guttmacher Institute
Associate, Department of Epidemiology, JHSPH
JHSPH Amazing Alumni Lecture Series
April 13, 2016

7. Excitement
Apprehension
Responsibility

8. Academic and professional journey
2014-present
Undergrad Clinical Assistant Doctoral Post-doctoral Senior Epi Senior Research
student Research Assistant Researcher student Fellow Advisor Scientist

9. Academic and professional journey
2014-present
Undergrad Clinical Assistant Doctoral Post-doctoral Senior Epi Senior Research
student Research Assistant Researcher student Fellow Advisor Scientist

10. Academic and professional journey
2014-present
Undergrad Clinical Assistant Doctoral Post-doctoral Senior Epi Senior Research
student Research Assistant Researcher student Fellow Advisor Scientist

11. Advance provision of emergency contraception
Lecture 4
Advance provision of emergency contraception
Does it decrease unintended pregnancies?
Does it increase risky sexual behaviors?

12. Advance provision of emergency contraception
Lecture 4
An FDA official worried that easier access to EC would lead teens to form
“sex-based cults centered around use of Plan B”
Advance provision of emergency contraception
Does it decrease unintended pregnancies?
Does it increase risky sexual behaviors?

13. Does advance provision of EC reduce pregnancy?
None of 11 RCTs showed any reduction in pregnancy rates
Polis, Grimes, Schaffer, Blanchard, Glasier, Harper. Cochrane Database of Systematic Reviews (updated review, 2010).

14. No reason to restrict access to EC for women of any age
Advance provision of EC does not reduce unintended pregnancy on a population level, nor does it increase risky behaviors
EC does reduce unintended pregnancy in individual women who use it correctly
(…and eventually, it did go over-the-counter!)

15. Academic and professional journey
2014-present
Undergrad Clinical Assistant Doctoral Post-doctoral Senior Epi Senior Research
student Research Assistant Researcher student Fellow Advisor Scientist

16. Does abortion have long-term negative mental health implications?

17. Severe depression and loss of self-esteem can follow.”
“While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained.
Severe depression and loss of self-esteem can follow.”
- U.S. Supreme Court Justice Anthony Kennedy, in decision to ban so-called “partial birth abortion”

18. High-quality studies do not suggest an association between abortion and adverse mental health outcomes
Charles, Polis, Sridhara, Blum. Contraception 2008;78:

19. Abortion Turnaway Study: mental health findings
Gestational limit for abortion
Within 2 weeks of limit
Up to 3 weeks above limit
“Near-limit” group:
received abortion
“Turnaway” group:
did not receive abortion
No evidence of “abortion trauma syndrome”
Short-term elevated risk of anxiety and low self-esteem
Foster et al. Psych Med Biggs et al. AJPH Biggs et al. Qual Life Res Rocca et al. PLoS One Biggs et al. BMJ 2016.

20. Academic and professional journey
2014-present
Undergrad Clinical Assistant Doctoral Post-doctoral Senior Epi Senior Research
student Research Assistant Researcher student Fellow Advisor Scientist

21. Observational studies of (mostly) DMPA and HIV acquisition Studies rated “informative but with important limitations” (2014)
Polis, Phillips, Curtis, Westreich, Steyn, Raymond, Hannaford, Norris Turner. Contraception 2014; 90:
Updated (2016) review currently in progress.

22. Steps towards clarifying the science on HC and HIV: systematic reviews & WHO consultations

23. Steps towards clarifying the science on HC and HIV: improving the quality of the evidence base
Participation in many conversations about a potential randomized trial on HC & HIV acquisition, now known as…

24. (graphic assumes a 50% increase in HIV acquisition risk with DMPA)
Steps towards clarifying the science on HC and HIV: modeling the impact of various policy options
% change in net maternal and AIDS deaths on cessation of injectable HC use
(graphic assumes a 50% increase in HIV acquisition risk with DMPA)
Butler AR, Smith JA, Polis CB, et al. AIDS 2013;27(1):

25. Steps towards communicating about HC-HIV issues: presentations, webinars, outreach to advocates, briefers, social media, etc.

26. Learn about new research, conferences, and conversations
Grow your global (interdisciplinary) academic network
Connect with individuals you may not otherwise have access to (& vice versa)
Create a tailored stream of information about topics you care about
Hone your voice for scientific communications
Amplify others’ voices
Be a vocal source of rigorous evidence
Engage with the media
Build a ready-made audience for when you have important things to share
Increase awareness of your research findings

29. Academic and professional journey
2014-present
Undergrad Clinical Assistant Doctoral Post-doctoral Senior Epi Senior Research
student Research Assistant Researcher student Fellow Advisor Scientist

30. Sample of Guttmacher projects (besides HC-HIV)
Estimating abortion incidence in Malawi

31. Sample of ongoing personal projects
Measurement of infertility in LMICs using DHS data
Systematic review: effectiveness of fertility awareness-based methods of contraception
Modeling public health impact of multipurpose prevention technologies (MPTs)
Scientific communications (Twitter, blogging)

32. Can we harness “controversy” for better science?
“A contemporary philosopher has suggested a paradigm of “oppositional collaboration” for areas with high ideological polarization, in which bioethicists (or scientists) with fundamentally opposed viewpoints work together to generate data that they all agree is as objective as possible for the relevant questions. This does not necessarily result in a change in values or agreement of the respective colleagues, but it can result in more accurate data and increased understanding and respect, extremely valuable outcomes.”
- Dr. Joseph Stanford (co-author on aforementioned FABM systematic review)
Stanford JB. Frontiers in Public Health 2016;4:27.

33. How to Survive a Controversy: Lessons learned (so far)
Feel the fear and do it anyway.
Integrity is everything.
Seek out all viewpoints & let the data be your North star.
Don’t let zealots ruffle you.
Lean on your family, friends, and mentors when needed.
Proactively communicate your science.
And remember…