Women’s Reproductive Health, Freedom And Rights

Concentration Directors

Melissa Nothnagle MD, Assistant Professor of Family Medicine
Email: Melissa_Nothnagle@brown.edu
Phone: 401-729-2236
Memorial Hospital of Rhode Island, 111 Brewster St, Pawtucket, RI 02860

Rebecca Allen, MC, MPH, Assistant Professor of Obstetrics and Gynecology
Email: RHAllen@wihri.org
Phone: 401-274-1122, x2724
Women and Infants Hospital of RI, 101 Dudley Street, Providence RI 02905

Overview

Women's reproductive rights and freedom are key determinants of women's health and are highly influenced by women's roles in society. In the U.S. and abroad, women's reproductive health is threatened by limited access to effective contraception, timely diagnosis and treatment of sexually transmitted infections, safe abortion, skilled maternity care, and infertility treatments.
The purpose of the Women's Reproductive Health, Freedom and Rights curricular initiative and scholarly concentration is to prepare graduates to promote and advance women's reproductive health through patient care, education, research, and advocacy. Research has documented the need for comprehensive reproductive health education in U.S. medical schools. Few schools adequately address issues surrounding contraception, adolescent pregnancy and parenting, or causes and consequences of infertility. In 1999, less than 30% of U.S. medical programs required coursework in human sexuality or taught students how to take a detailed sexual history from patients. Downstream evidence of the impact of this failure to address such subjects is seen at the residency and postgraduate levels. For example, in 1996, less than two-thirds of Ob/Gyn resident physicians reported training in family planning and in 2003, less than half of academic internal medicine physicians expressed confidence in their own skills to provide oral contraception and Depo-Provera.
Medical knowledge alone, however, does not guarantee quality patient care. Effective reproductive health care also requires skilled history taking, patient education and counseling. Understanding of non-biological determinants of health and illness, including economic, psychological, social and cultural factors, is critical to ensuring quality reproductive health care for women. Physicians and other health professionals have a key role as advocates in protecting women's reproductive health, especially for underserved and/or vulnerable populations (including adolescents, incarcerated women, immigrants and refugees, women with disabilities, minorities, and LGBTQ women).
Concentrators will gain an in depth understanding of the relevance of reproductive health and rights in clinical practice and public health. Given the scope of the Women's Reproductive Health, Freedom and Rights initiative, scholarly concentrators are encouraged to engage in projects related not only to clinical and basic science research, but also medical education and advocacy.

Curriculum

Learning Objectives:

By graduation, medical students will be able to:

• Provide patient-centered counseling for reproductive health issues, such as unwanted pregnancy and abortion, contraception (including emergency contraception, prenatal health, breastfeeding, and STI prevention.
• Apply advanced knowledge in one or more of the following reproductive health content areas to care of patients: Human sexuality, contraception, abortion, pregnancy and birth, postnatal care and breastfeeding, sexual health, sexually transmitted diseases, sexual abuse, gender-based violence, infertility, cervical cancer/HPV, breast cancer, and adolescent reproductive health.
• Discuss the effects of gender inequality on women's reproductive health, rights, and freedom.
• Describe legal and other restrictions on access to reproductive health services and their effects on individual and public health, especially for vulnerable populations.
• Apply principles of medical ethics to resolve dilemmas regarding assisted reproductive technologies, limited access to resources, and conflicts between providers' beliefs and patient autonomy in reproductive health.
• Recognize the physician's role in protecting and advocating for reproductive health, rights and freedom.

Evaluation
For each learning objective, mastery will be evaluated:

1-2. Each student will participate in a clinical elective involving reproductive health in the 3rd or 4th year.
2-6. During the 2nd year, students will attend the seminar series on reproductive health, rights, and freedom.
2-4. During the 2nd year, Each student will write a position paper on a reproductive health issue, addressing gender inequality, legal, and/or public health issues that affect reproductive health.
1-5.  Each student will design, implement, evaluate, and present a concentration project involving research, education, or advocacy related to reproductive health, rights, and freedom.

• Students will identify a faculty advisor to mentor their project activities and will submit a project plan to be approved by the concentration directors
• Students will submit project progress reports to the concentration directors every 6 months.
• Students will complete written reports of their projects (preferably in a form suitable for peer-reviewed publication).  These will be evaluated by a review committee of reproductive health professionals.   
• Accepted projects will be presented to the reproductive health seminar group.  Students are also encouraged to present their projects at national conferences, and funding is available to support student travel to conferences to present their work.

Timeline

Project Examples

Scholarly products will most likely take the form of written reports.  Current student project topics include:

• Partner access to emergency contraception
• High-Risk Sexual  Behaviors among Female Sex Workers in Shanghai, China
• Improving prenatal patient education using Electronic Medical Record prompts
• Attitudes of non-physician healthcare workers regarding influenza vaccination in pregnancy
• Prenatal SSRI exposure effects on placental SERT expression
• Quality of care after sexual assault
• Barriers to breast cancer screening and genetic testing for Latina women

2009 Accepted Students & Scholarly Concentration Projects:

Maximum Number of Students

The scholarly concentration will be limited to 4 medical students per year.  

Faculty Mentors

Faculty (including but not limited to the following):

Family Medicine

• Susanna Magee, MD, MPH:  maternal and child health, prenatal care
• Melissa Nothnagle, MD: medical education, family planning
• Julie Taylor, MD, MSc:  breastfeeding

Internal medicine

• Susan Cu-Uvin MD: infectious diseases, HIV infection, international health
• Don Dizon, MD: medical oncology
• Christine Duffy, MD: sexuality, cancer survivors
• Amy Gottlieb, MD: women’s health, medical education
• Joseph Harwell MD: infectious diseases, HIV infection, international health
• Kelly McGarry, MD: women’s health, medical education
• Lucia Larson, MD:  obstetric medicine
• Jennifer Clarke, MD: women’s health

OB/GYN

• Rebecca Allen, MD, MPH: gynecology, family planning
• Brenna Anderson, MD, MPH: maternal fetal medicine, infectious diseases
• Sarah Fox, MD: pelvic pain, family planning, gynecology
• Donna LaFontaine, MD: emergency medicine, obstetrics, gynecology
• Kristin Matteson MD, MPH: gynecology, health care outcomes, family planning
• Trevor Tejada-Bergés, MD: gynecologic oncology
• Vivian Sung, MD, MPH: urogynecology

Psychiatry and Human Behavior

• Laura Stroud, PhD: physiological responses to stress, nicotine dependence, and sex differences in depression

Pediatrics

• James Padbury, MD: perinatal biology

Funding Opportunities (alternatives to Summer Assistantships)

The Women’s Reproductive Health, Rights, and Freedom Program has funds to support 4 SAs each year.

• Scholarly Concentrations Program Application
• Scholarly Concentrations Program White Paper
• Faculty Letter of Support

• Faculty Conflict of Interest Form