Modern Methods Of Abortion Are Not Linked With An Increased Risk Of Preterm Birth

Modern Methods Of Abortion Are Not Linked With An Increased Risk Of Preterm Birth

The member between previous termination of pregnancy (premature delivery) and preterm delivery in a posterior pregnancy has disappeared over the the time 20-30 years, according to a study of facts from Scotland published in this week's PLOS Medicine. The study, led the agency of Gordon Smith from the University of Cambridge, construct that abortion was a strong put to hazard factor for subsequent preterm birth in the 1980s goal over the next 20 years, the part progressively weakened and was no longer gift among women giving birth from 2000 onwards.

These findings are important as the current recommendations to consider a possible increased risk of preterm lineage if a woman has an premature labor were based on studies before 2000. The current resolution indicates that there is no copula between abortion and the subsequent danger of preterm birth in modern constant exercise and so current guidelines may be delivered of to be revised.

By using a immense dataset from Scotland, the authors ground that out of 757,060 live leading births (excluding twins) between 1980 and 2008, 56,816 women reported unit previous termination, 5,790 women reported two previous terminations, and 822 women reported three or in addition previous terminations. After adjusting for motherly characteristics, the authors found that there was a strong link between voluntary preterm birth and previous abortion in 1980-1983, by a >30% increase in the dare to undertake of preterm birth with each anterior procedure. However, this link progressively weakened, by a 10-20% increase in hazard for preterm births in the 1990s, and nay link at all from 2000 onwards.

The likable explanation for these findings is changes in methods of want of success. Over the period 1992 to 2008, the authors construct that the procedure thought most likely to be lead to an increased jeopard of preterm birth (purely surgical premature delivery without the use of any drugs) decreased from 31% in 1992 to 0.4% in 2008. Furthermore, the adjust of medical terminations (procedures that avoided the practice of surgery altogether) increased from 18% to 68%.

These findings suggest that use of purely surgical effect may have been responsible for the increased exposure to harm of spontaneous preterm birth and in like manner, the phasing out of this proceeding in Scotland in the 1980s and 1990s may gain led to the subsequent disappearance of the established bind between previous termination and preterm distribution from 2000 onwards. However, the authors could not speedily test whether the two trends were of the same family because they did not have intelligence on the method of previous ending linked to subsequent birth outcome as antidote to individual women.

The authors say: "We get shown that previous abortion was a jeopardize factor for preterm birth among nulliparous women in Scotland earlier to 2000. However, increased use of medical methods of abortion and of cervical pre-handling prior to surgical abortion has been paralleled dint of a disappearance in the association."

The authors aggregate: "We believe that it is using specious arguments that modernising methods of termination of pregnancy worldwide may have ing an effective long-term strategy to subdue future rates of preterm birth."

Education About Abortion In The UK Is Failing Young People - EFC Report Highlights Advice For Schools And Head Teachers

Education About Abortion In The UK Is Failing Young People - EFC Report Highlights Advice For Schools And Head Teachers

A report published by Education For Choice (EFC) finds that education about abortion in the UK is failing young people.

Some schools are addressing the topic as part of comprehensive sex and relationships education (SRE), but there is evidence of widespread bad practice including medical misinformation being provided by teachers and visitors to schools.

The report pulls together findings from surveys with schools and young people, and an audit of teaching materials used. Young people describe negative experiences of the education they received, and report that some schools are using inappropriate teaching materials including graphic images and distressing, inaccurate video material.

Bad practice falls into three broad categories:

Misinformation - providing misinformation about contraception and abortion - for example, claiming that taking the pill or having a contraceptive implant can cause an abortion, or linking abortion to breast cancer and infertility.

Stigma - saying abortion is murder, that it is shameful and a sin. This is upsetting for those who have had an abortion, and may cause unnecessary distress for those who go on to experience abortion (one in three women in England and Wales).

Equalities - some anti-abortion groups invited into schools express views about sexuality and the family which are likely to be at odds with schools' equality and diversity policies and may negatively impact on students' wellbeing. For example, SPUC's opposition to same-sex marriage as documented on ITV's This Morning.

Laura Hurley, EFC Senior Project Officer, said:

"Schools have a key role in ensuring that young people are provided with education about pregnancy options that is sensitive and relevant to their experiences, as well as medically accurate, and must take steps to prevent students feeling stigmatised, distressed or discriminated against by information or images used.

"The government has said that schools should provide accurate information and many are not. This report includes recommendations for teachers, school governors and head teachers on how to deliver good quality education that supports young people's health and wellbeing."

Alice Hoyle, PSHE Advisory Teacher and Vice-Chair of the Sex Education Forum, said:

"Teaching about abortion is often seen as sensitive or tricky and this report shows some of the best and the worst examples of how it is done. It doesn't have to be that way. Young people need to know the law and their rights, they need to understand health issues related to pregnancy decisions and they need to understand there are a range of views about abortion. All teachers must have training and support to ensure this area moves from the too difficult box to a discussion they feel confident having as part of sex and relationships education. EFC's Abortion Education Toolkit will help them do that."

EFC provides a free toolkit on education about abortion which gives advice and examples of best practice in this area. EFC can also provide training, resources and advice for schools, teachers and professionals working with young people on all aspects of education about abortion. EFC's Abortion Education Toolkit as well as the report and executive summary can be downloaded here.

Advanced Practice Nurses And Physician Assistants Can Safely Perform Abortions

Advanced Practice Nurses And Physician Assistants Can Safely Perform Abortions

First trimester abortions are just as safe when performed by trained nurse practitioners, physician assistants and certified nurse midwives as when conducted by physicians, according to a new six-year study led by UCSF.

The study posted online in the American Journal of Public Health in advance of the print edition.

The publication comes a week before the 40th anniversary of the Roe vs. Wade, the landmark Supreme Court decision that made abortion legal in the United States.

Currently in the United States, a patchwork of state regulations determines who can provide abortions, with several states specifically prohibiting non-physician clinicians from performing the procedure.

The new study was designed to evaluate the safety of early aspiration abortions when performed by nurse practitioners, physician assistants and certified nurse midwives trained in the procedure. The study was conducted under a legal waiver from the Health Workforce Pilot Projects Program, a division of the California Office of Statewide Health Planning and Development. California law requires a legal clarification about who can perform aspiration abortions.

The researchers report in their study that the results show the pool of abortion providers could be safely expanded beyond physicians to include other trained health care professionals. They found that:

Nurse practitioners, certified nurse midwives and physician assistants can provide early abortion care that is clinically as safe as physicians;

Outpatient abortion is very safe, whether it is provided by physicians or by nurse practitioners, certified nurse midwives or physician assistants.

Nationally, 92 percent of abortions take place in the first trimester but studies find that black, uninsured and low-income women continue to have less access to this care, according to the researchers.

In California, 13 percent of women using state Medicaid insurance obtain abortions after the first trimester. Because the average cost of a second trimester abortion is substantially higher than a first trimester procedure and abortion complications increase as the pregnancy advances, shifting the population distribution of abortions to earlier gestations may result in safer, less costly care, according to the research team.

"Increasing the types of health care professionals who can provide early aspiration abortion care is one way to reduce this health care disparity,'' said lead author Tracy Weitz, PhD, MPA, a UCSF associate professor and director of Advancing New Standards in Reproductive Health at the UCSF Bixby Center for Global Reproductive Health. "Policy makers can now feel confident that expanding access to care in this way is evidence-based and will promote women's health.''

Currently, non-physicians are allowed to perform aspiration abortions in four states: Montana, Oregon, New Hampshire and Vermont. In other states, non-physician clinicians are permitted to perform medication but not aspiration abortions. In recent years, in an effort to limit abortion availability, several states have put laws on the books to prohibit non-physician clinicians from performing abortions.

In the study, 40 nurse practitioners, certified nurse midwives and physician assistants from four Planned Parenthood affiliates and from Kaiser Permanente of Northern California were trained to perform aspiration abortions. They were compared to a group of nearly 100 physicians, who had a mean of 14 years of experience providing abortions.

Altogether, 5,675 abortions were performed in the study by nurse practitioners, certified nurse midwives and physician assistants, compared to 5,812 abortions by physicians. The abortions were performed between August 2007 and August 2011 at 22 clinical facilities in California.

The researchers found that both groups of abortion providers had few complications -- less than 2 percent, including incomplete abortions, minor infection and pain. Statistically, according to the researchers, the complication rates were not different between the two groups of providers.

"The value of this study extends beyond the question of who can safely perform aspiration abortion services in California because it provides an example of how research can be used to answer relevant health care policy issues,'' said study co-author Diana Taylor, PhD, RNP, professor emeritus in the UCSF School of Nursing. "As the U.S. demand for cost-effective health care increases, workforce development has become a key component of health care reform. All qualified health professionals should perform clinical care to the fullest extent of their education and competency.''

Analysis Of Roe V. Wade Arrests Of And Forced Interventions On Pregnant Women

Analysis Of Roe V. Wade Arrests Of And Forced Interventions On Pregnant Women

"Arrests of and Forced Interventions on Pregnant Women in the United States, 1973-2005: Implications for Women's Legal Status and Public Health," an article by Lynn M. Paltrow and Jeanne Flavin in the Journal of Health Politics, Policy and Law (volume 38, issue 2), offers a groundbreaking, in-depth look at criminal and civil cases in which a woman's pregnancy was a deciding factor leading to attempted and actual deprivations of her physical liberty.

As "personhood" measures are promoted and the fortieth anniversary of Roe v. Wade approaches, this article broadens the conversation from one about abortion to one about health policy and the legal status of pregnant women.

Paltrow and Flavin identified 413 cases involving arrests, detentions, and equivalent deprivations of pregnant women's physical liberty between 1973 and 2005. The authors examine key characteristics of the women and cases (including socioeconomic status and race); identify the legal claims used to support the arrests, detentions, and forced interventions; and explore the role that health care providers played in facilitating deprivations of pregnant women's liberty.

The data presented in this study challenge the idea that such interventions are rare and isolated events. Analysis reveals how existing laws, including feticide statutes, have been used to justify the arrests of pregnant women; provides evidence of what is likely to occur if personhood measures pass; and highlights the ways in which arrests and forced interventions undermine maternal, fetal, and child health.

Paltrow and Flavin's unparalleled documentation and analysis of cases offers a basis for building a shared political agenda that advances public health and ensures that pregnant women do not lose their civil and human rights.

Early Medical Abortion Is "Safe And Effective"

Early Medical Abortion Is "Safe And Effective"

Early medical abortion (EMA) using mifepristone is an effective option with a favourable safety profile, according to the authors of the first large-scale Australian study of the drug published online by the Medical Journal of Australia.

The study analysed the outcomes of over 13 000 women who had an EMA (up to 63 days gestation) between 2009 and 2011 using mifepristone, which is also known as RU486. The data were collected from women who had EMAs at Marie Stopes International Australia (MSIA) clinics. MSIA doctors are among around 200 doctors around Australia who are authorised to prescribe mifepristone for EMA.

Dr Philip Goldstone, medical director of MSIA, and coauthors found that clinic administration of mifepristone and later self-administration of buccal misoprostol to complete the abortion process at home had a low failure rate (3.5%), and low rates of haemorrhage (0.1%) and known or suspected infection (0.2%). One woman, who did not seek medical advice despite signs of infection for a number of days, died from sepsis.

The authors found that the process was also well tolerated, with most women reporting the experience to be as they had expected or better than expected. "While the potential risk of serious infection should be kept in mind and monitored, these results indicate that the mifepristone - buccal misoprostol regimen is an effective option for Australian women seeking an abortion up to 63 days of gestation."

In an editorial in the same issue, Cairns gynaecologists Professor Caroline de Costa and Dr Michael Carrette wrote that the findings backed up extensive overseas studies that had shown mifepristone to be both safe and effective for EMA.

However, they were concerned about some of the reported outcomes, which they said had implications for the national provision of mifepristone. It was vital that arrangements for emergency care in the rare event of complications were well documented. "Access to a telephone helpline alone is insufficient, especially for women in rural areas", they wrote.

Also, not all women were suitable candidates for the procedure because the abortion is usually completed at the woman's home. "Some women in poor socioeconomic circumstances and those who cannot find a suitable support person may be better served by surgical abortion", the authors wrote.

Some women, such as those travelling long distances, might need to have the medical abortion in a day surgery, they noted.

"We look forward to EMA being available to all Australian women who request it, and wish to see EMA recognised as being as safe as a surgical alternative."

Multiple Abortions May Increase Risk Of Prematurity And Low Birth Weight In Future Pregnancies

Multiple Abortions May Increase Risk Of Prematurity And Low Birth Weight In Future Pregnancies

One of the largest studies to look at the effect of induced abortions on a subsequent first birth has found that women who have had three or more abortions have a higher risk of some adverse birth outcomes, such as delivering a baby prematurely and with a low birth weight.

The research, which is published online in Europe's leading reproductive medicine journal Human Reproduction [1] , found that among 300,858 Finnish mothers, 31,083 (10.3%) had had one induced abortion between 1996-2008, 4,417 (1.5%) had two, and 942 (0.3%) had three or more induced abortions before a first birth (excluding twins and triplets). Those who had had three or more induced abortions had a small, but statistically significant increased risk of having a baby with very low birth weight (less than 1500g), low birth weight (less than 2500g), or of a preterm birth (before 37 weeks), or very preterm birth (before 28 weeks), compared to women who had had no abortions. There was a slightly increased risk of a very preterm birth for women who had had two induced abortions.

Dr Reija Klemetti, an associate professor and senior researcher in public health at the National Institute for Health and Welfare in Helsinki, Finland, who led the research, said: "Our results suggest that induced abortions before the first birth, particularly three or more abortions, are associated with a marginally increased risk during the first birth. However, the increased risk is very small, particularly after only one or even two abortions, and women should not be alarmed by our findings."

Most of the induced abortions (88%) were surgically performed and nearly all (91%) were performed before 12 weeks gestation. The researchers adjusted their findings to take account of various factors that could affect birth outcomes, such as social background, marital status, age, smoking, previous ectopic pregnancies and miscarriages. Multiple births (twins and triplets) were excluded.

The risk of having a baby born very preterm appeared to increase slightly with each induced abortion, but only the risk from two abortions or more was statistically significant.

"To put these risks into perspective, for every 1000 women, three who have had no abortion will have a baby born under 28 weeks," said Dr Klemetti. "This rises to four women among those who have had one abortion, six women who have had two abortions, and 11 women who have had three or more."

Among women who had had three or more abortions, there was a statistically significant increased risk of a third (35%) of having a baby born preterm (before 37 weeks), a two-fold (225%) increased risk of very low birth weight, and a two-fifths (43%) increased risk of low birth weight.

The study also showed a small increased risk of a baby's death around the time of birth. However, the numbers for this finding were very low (1498 births or five per 1000 babies) and so should be treated with caution. In addition, the authors say they might not have been able to fully adjust for all the factors that could affect this result and perinatal deaths are sensitive to social factors such as poverty.

"Our study is the first large study to look at a broad set of perinatal outcomes and to control, at least partly, for the most important confounding factors such as smoking and socioeconomic position," said Dr Klemetti. "However, it is important to say that even though we adjusted for these factors, and also ectopic pregnancies and miscarriages, there might be some confounding for social class that we could not control for. Most probably, this may be related to women's (or some of these women's) way of life, life habits, and sexual and reproductive health.

"Furthermore, this is an observational study and, however large and well-controlled, it only shows there is a link between abortion and some adverse birth outcomes - it cannot prove that abortions are the cause.

"Finland has one of the lowest rates of induced abortion in Europe [2], but even so, a large number are carried out every year. In addition, Finland has good quality abortion and maternity care, and in other contexts, particularly in poorer countries, the situation may be different. For these reasons, even a very small increase in the risk of poor birth outcomes could have significant health implications, as preterm births and low birth weight can have serious, adverse effects on the health and well-being of both babies and mothers.

"We suggest that the potential for increased risks for subsequent births should be included in sex education, especially as there are other, good reasons to avoid induced abortions. Health professionals should also be informed about the potential risks of repeat abortions."

Study Finds Unique 'Anonymous Delivery' Law Effective In Decreasing Rates Of Neonaticide In Austria

Study Finds Unique 'Anonymous Delivery' Law Effective In Decreasing Rates Of Neonaticide In Austria

Rates of reported neonaticide have more than halved following the implementation of a unique 'anonymous delivery' law in Austria, finds a new study published on the 5th December in BJOG: An International Journal of Obstetrics and Gynaecology.

Researchers, from the Medical University of Vienna, looked at the rates of reported neonaticide (where a child is killed within the first 24 hours of birth) in Austria prior to and after the implementation of the 'anonymous delivery' law which was introduced in 2001. The law allows women access to antenatal care and to give birth in a hospital anonymously and free of charge.

Rates of neonaticide were obtained from police records pre and post the introduction of the law between 1991-2001 and 2002-2009. This data was then compared to data from Finland and Sweden, who also have a register for neonaticide but have no such law for anonymous delivery. Currently neonaticide is only governed by a specific law, separately from infanticide, in a few European countries.

Results from the study showed a reduction of more than half in the reported incidence of neonaticide from the pre to post-law data, decreasing from 7.2 per 100,000 births prior to the passage of the law (1991-2001) to 3.1 per 100,000 births after the passage of the law (2002-2009). The data from Finland and Sweden showed no such change over the same time period.

Importantly, the researchers noted that during this time there were no other known socioeconomic changes in Austria that could have impacted on the observed rates, such as passage of abortion laws or changes to childbirth benefits.

The researchers also investigated other preventative measures such as 'baby hatches' and 'safe havens', which allow for the safe handover of a newborn to government authorities and have been used in Austria and other countries around the world (including the US, Germany, Japan, South Africa). They estimated that in Austria there are 2-3 cases of babies being left in baby hatches reported per year, whereas cases of anonymous birth are in the range of 30-40 cases per year.

Claudia Klier, Associate Professor of Child & Adolescent Psychiatry at the Medical University of Vienna and co-author of the study, said:

"Neonaticide is usually the result of an unwanted pregnancy, and a resulting denial of that pregnancy, so it is often hard to gauge as those who commit neonaticide tend to evade the healthcare system.

"The passage of the anonymous delivery law and the subsequently major reduction in reports of neonaticide during this study period indicate that this has been a very effective tool in the prevention of this crime in Austria.

"It is clear that more research into neonaticide and its associated factors is needed to accurately identify and implement long-term solutions. However, we want to raise awareness of this option for women as we know this is a hidden crime and there may be many more cases than previously thought."

John Thorp, BJOG Deputy-Editor-in-Chief added:

"The results of this study are very compelling and highlight the benefits of anonymous birth. While preventative measures like baby hatches are good in theory, they still do not provide adequate support for the woman who is on her own not only during pregnancy but during the potentially dangerous delivery.

"It is therefore important to raise awareness of anonymous delivery as this approach could lead to a reduction in neonaticide rates."

Potential Solution To Melanoma's Resistance To Vemurafenib

Potential Solution To Melanoma's Resistance To Vemurafenib

Researchers at Moffitt Cancer Center in Tampa, Fla., and colleagues in California have found that the XL888 inhibitor can prevent resistance to the chemotherapy drug vemurafenib, commonly used for treating patients with melanoma.

Vemurafenib resistance is characterized by a diminished apoptosis (programmed cancer cell death) response. According to the researchers, the balance between apoptosis and cell survival is regulated by a family of proteins. The survival of melanoma cells is controlled, in part, by an anti-apoptotic protein (Mcl-1) that is regulated by a particular kind of inhibitor.

Their current findings, tested in six different models of vemurafenib resistance and in both test tube studies and in melanoma patients, demonstrated an induced apoptosis response and tumor regression when the XL888 inhibitor restored the effectiveness of vemurafenib.

The study appeared in a recent issue of Clinical Cancer Research, a publication of the American Association for Cancer Research.

"The impressive clinical response of melanoma patients to vemurafenib has been limited by drug resistance, a considerable challenge for which no management strategies previously existed," said study co-author Keiran S. M. Smalley, Ph.D., of Moffitt's departments of Molecular Oncology and Cutaneous Oncology. "However, we have demonstrated for the first time that the heat shock protein-90 (HSP90) inhibitor XL888 overcomes resistance through a number of mechanisms."

The diversity of resistance mechanism has been expected to complicate the design of future clinical trials to prevent or treat resistance to inhibitors such as vemurafenib.

"That expectation led us to hypothesize that inhibitor resistance might best be managed through broadly targeted strategies that inhibit multiple pathways simultaneously," explained Smalley.

The HSP90 family was known to maintain cancer cells by regulating cancer cells, making it a good target for treatment. According to the authors, the combination of vemurafenib and XL888 overcame vemurafenib resistance by targeting HSP90 through multiple signaling pathways.

There was already evidence that HSP90 inhibitors could overcome multiple drug chemotherapy resistance mechanisms in a number of cancers, including non-small lung cancer and breast cancer. Because XL888 is a novel, orally available inhibitor of HSP90, the researchers hoped that it would arrest the cancer cell cycle in melanoma cell lines.

In their study, the inhibition of HSP90 led to the degradation of the anti-apoptopiuc Mcl-1 protein. The responses to XL888 were characterized as "highly durable with no resistant colonies emerging following four weeks of continuous drug treatment." In other studies not using XL888, resistant colonies "emerged in every case," they reported.

"We have shown for the first time that all of the signaling proteins implicated in vemurafenib resistance are 'clients' of HSP90 and that inhibition of HSP90 can restore sensitivity to vemurafenib," concluded Smalley and his colleagues. "Our study provides the rationale for the dual targeting of HSP90 with XL888 and vemurafenib in treating melanoma patients in order to limit or prevent chemotherapy resistance."

The Gap Between Policy And Practice In Maternal Health And Maternal Mortality

The Gap Between Policy And Practice In Maternal Health And Maternal Mortality

As the UN Special Rapporteur on maternal mortality in India points out there is a 'yawning gulf between ... commendable maternal mortality policies and their urgent, focused, sustained, systematic and effective implementation.' Reproductive Health Matters explores the causes and impact of this gap, but also highlights hopeful signs of progress.

Two papers from India included in the issue capture both the good and bad news that characterise the gap between rhetoric and reality in maternal health and maternal mortality. In India a range of provisions to support better maternal nutrition and access to subsidised health care are required by law, but there is a wide gap between policy and practice. Preventable deaths are caused by several factors including a shortfall in antenatal care, delays in emergency obstetric care and inappropriate referral. Detailed case studies of women who died point to lack of accountability, discrimination on the grounds of poverty and caste, and according to Subha Sri Balakrishnan, author of one of the papers, "In some cases...quality of care (that) was so poor that it may be considered negligent."

Both papers follow subsequent action taken to seek government accountability and justice. In one paper, author Jameen Kaur, reports on the way in which a women's family sought redress in the courts, supported by human rights lawyers. The second paper details an investigation lead by Subha Sri Balakrishnan into maternal deaths in response to a public protest about local maternal deaths in Madhya Pradesh. The researchers presented their findings to district and state level health officials which led to some improvements in care.

Examples of using law to promote accountability and good practice are described in a paper from Latin America reporting on landmark decisions by the UN Committee on the Elimination of Discrimination Against Women (CEDAW) calling for appropriate maternal health care (Brazil) and decriminalisation of abortion to safeguard women's health (Peru). These are promising examples of the application of human rights to demand government responsibility for maternal deaths and to assert the rights of women not to die in pregnancy, childbirth and unsafe abortion.

Furthermore a new emphasis on evidence-based practice is described in several papers, providing grounds for optimism. It suggests there is a real desire to improve outcomes and the hope that new initiatives may have a greater chance of success in saving women's lives. Without the political commitment to addressing equity, however, important initiatives will continue to fail the poorest and most marginalised women. As one author notes, "The death of a woman due to pregnancy complications is not just a biological fact it is also a political choice."

How Chromosomes Pair Up

How Chromosomes Pair Up

After more than a century of study, mysteries still remain about the process of meiosis - a special type of cell division that helps ensure genetic diversity in sexually-reproducing organisms. Now, researchers at Stowers Institute for Medical Research shed light on an early and critical step in meiosis.

The research, to be published in the Nov. 8, 2011 issue of Current Biology, clarifies the role of key chromosomal regions called centromeres in the formation of a structure known as the synaptonemal complex (SC). "Understanding this and other mechanisms involved in meiosis is important because of the crucial role meiosis plays in normal reproduction - and the dire consequences of meiosis gone awry," says R. Scott Hawley, Ph.D., who led the research at Stowers.

"Failure of the meiotic division is probably the most common cause of spontaneous abortion and causes a number of birth defects such Down syndrome," Hawley says.

Meiosis reduces the number of chromosomes carried by an individual's regular cells by half, allocating precisely one copy of each chromosome to each egg or sperm cell and thus ensuring that the proper number of chromosomes is passed from parent to offspring. And because chromosomes come in pairs - 23 sets in humans - the chromosomes must be properly matched up before they can be divvied up.

"Chromosome 1 from your dad has to be paired with chromosome 1 from your mom, chromosome 2 from your dad with chromosome 2 from your mom, and so on," Hawley explains, "and that's a real trick. There's no room for error; the first step of pairing is the most critical part of the meiotic process. You get that part wrong, and everything else is going to fail."

The task is something like trying to find your mate in a big box store. It helps if you remember what they are wearing and what parts of the store they usually frequent (for example, movies or big-screen TVs). Similarly, chromosomes can pair up more easily if they're able to recognize their partners and find them at a specific place.

"Once they've identified each other at some place, they'll begin the process we call synapsis, which involves building this beautiful structure - the synaptonemal complex - and using it to form an intimate association that runs the entire length of each pair of chromosomes," Hawley explains.

Some model organisms employed in the study of meiosis, such as yeast and the roundworm Caenorhabditis elegans, use the ends of their chromosomes to facilitate the process. "These organisms gather all the chromosome ends against the nuclear envelope into one big cluster called a bouquet or into a bunch of smaller clusters called aggregates, and this brings the chromosome ends into proximity with each other," Hawley says. "This changes the problem of finding your homologue in this great big nucleus into one of finding your mate on just the surface of the inside of the nucleus."

But the fruit fly Drosophila melanogaster - the model organism in which meiosis has been thoroughly studied for more than a century, and which Hawley has studied for almost 40 years - has unusual chromosome ends that don't lend themselves to the same kind of clustering.

"So even though the study of meiosis began in Drosophila, we really haven't had any idea how chromosomes initiate synapsis in Drosophila," Hawley says. "Now, we show that instead of clustering their chromosome ends, flies cluster their centromeres - highly organized structures that chromosomes use to move during cell division. From there, the biology works pretty much as you would expect: synapsis is initiated at the centromeres, and it appears to spread out along the arms of the chromosomes."

The ramifications of the findings extend beyond fruit flies, as there's some evidence that synapsis starts at centromeres in other organisms. In addition, Hawley and coauthors found that centromere clustering may play a role later in meiosis, when chromosomes separate from their partners.

"There's reason to believe that some parts of that process will be at least explorable and potentially applicable to humans," Hawley said.

The work also is notable as an example of discovery-based science, Hawley said. "We didn't actually set out to study the initiation of meiosis; we were simply interested in characterizing the basic biology of early meiosis."

But postdoctoral researcher and first author Satomi Takeo, Ph.D., noticed that centromere clustering and synaptonemal complex initiation occurred in concert, and her continued observations revealed the role of centromeres in initiating synapsis.

"I was staring with tired eyes at the cells that I was analyzing," Takeo recalls. "Somehow I started looking at the spots I had previously ignored - probably because I thought they were just background noise - until I saw the connection between centromere clustering and synapsis initiation. After going through many images, I wrote an email to Scott, saying, 'This is really important, isn't it??' With that finding, everything else started to make sense."

New Study On Post-War Romanian Abortion Policy Demonstrates That Restrictions Result In Maternal Mortality

New Study On Post-War Romanian Abortion Policy Demonstrates That Restrictions Result In Maternal Mortality

A unique study published in today's edition of the Journal of Family Planning and Reproductive Health Care1, provides new evidence about the causal links between restrictions to abortion policy and maternal mortality. The study demonstrates that limiting abortion does not prevent women from seeking pregnancy terminations but simply increases the risks they face.

The study reveals women's fertility rate and abortion rates before, during and after the Romanian dictator Nicolae Ceausescu outlawed abortion in 1966 until his death in 1989. Prior to Nicolae Ceausescu's rise to power, access to surgical abortions had been easily available under the Soviet regime. Within days of the dictator's fall, the anti-abortion law was abolished and abortion was made available again on request.

The report's authors point out that the country's dramatic shifts in family planning policy offer a rare opportunity to study causal links between access to contraception and abortion and changes in reproductive outcomes. The two causal links that authors were able to surmise provide important lessons for all policy makers today:

Restricting access to safe abortion in Romania caused a dramatic increase in maternal mortality driven solely by unsafe abortion-related death

Increased access to modern contraception in Romania has not reduced fertility, but instead has reduced the need for women to resort to abortion

Professor Malcolm Potts, one of three authors and British director of the Bixby Centre for Population, Health and Sustainability at the University of California, Berkeley said:

"Countries that increasingly seek to restrict access to abortion and contraception should look and learn from Romania's example... All legislators in Britain and elsewhere who really care about women's safety - and, indeed, women's lives - need to pay attention to these findings,"

Key findings from the study reveal:

Nicolae Ceausescu outlawed abortion in order to increase Romania's fertility rate. However, after nearly doubling initially, it soon fell back to the level before abortion was outlawed as women gradually found solutions for regulating their fertility either through contraceptives procured illegally or through illegal abortions

For the 30 years abortion was outlawed, maternal mortality from unsafe abortion rocketed to an incredible 147 per 100 000 live births (see graph below and attached) before falling rapidly following the fall of Ceausescu's regime to 5.2 per 100 000 live births in 2010

Following the fall of Ceausescu's regime, the rise in contraceptive use has been accompanied by a decisive fall in the abortion rate from 163 per 1000 women in 1990 to 10.1 in 2010  

Ann Furedi, Chief Executive of the British Pregnancy Advisory Service (bpas) said: 'When women cannot obtain abortion legally in their own country, they either travel to countries where they can, or they risk their health by resorting to unlawful means at home.'  

Kate Guthrie, spokesperson for the Faculty of Sexual and Reproductive Healthcare said: "This study starkly demonstrates the risks, often with fatal consequences, that women will take to avoid unwanted pregnancy. Equally it shows the dramatic impact that easy access to contraception had on abortion."