UPDATE 9/9/19: The company that manufactures Daysy is now the subject of a legal investigation. More information is available here: http://www.khuranapc.com/daysy-investigation. If you purchased a Daysy, please be sure to read about the investigation and determine if you would like to speak with these lawyers to share your experience. (NOTE: as of 9/20/19 that link is no longer functional. I will share additional updates as they become available.)


In May 2019, 404 days after I submitted a commentary detailing egregious flaws in data collection and analysis of a study purporting to estimate contraceptive effectiveness of the Daysy thermometer -- that study was retracted from the journal Reproductive Health. The retraction note says: “Independent post-publication peer review has confirmed that there are fundamental flaws in the methodology which mean that the conclusions are unreliable due to selection bias and the retrospective self-reporting of whether pregnancies were intentional.”
 
Science reporter Stephanie Lee covered the retraction story in Buzzfeed. Prior writings had investigated Daysy and detailed unethical behaviors by Valley Electronics (Daysy’s manufacturer) – including that the company kicked people out of online forums for asking questions, and used manipulative language in their marketing materials. In a comment on PubPeer, I also detailed unethical behaviors by Valley Electronics.
 
I’m glad to have helped to remove junk science from the literature. Hopefully, fewer people will be made vulnerable to unintended pregnancy via misleading, unsupported claims. While the retraction was very important, it does not fully solve the problem. Elsewhere, I’ve described the concerning asymmetry between the rapid spread of misinformation on social media and the long, slow process of addressing misinformation in the scientific literature, and how this mismatch can ultimately impact public health.
 
So, I have more to say.

A few years ago, the Department of Population, Family, and Reproductive Health at Johns Hopkins Bloomberg School of Public Health asked me to give an "Amazing Alumni" lecture, as part of their 100th anniversary celebrations. I was beyond honored to be one of six alumni chosen to give a talk! I was asked to reflect on my career trajectory. Since most talks I do focus on research findings - it was a challenge (an intimidating one!) to put together a talk that was more personal. It was even more intimidating to deliver it to a room full of the people who taught me much of what I know about global public health!

I've worked on some controversial issues in sexual and reproductive health, so decided to make 'controversy' the theme. In retrospect, I'm annoyed I didn't sneak this Prince song in to the talk, but...live and learn.

It was a fun opportunity to reflect on some lessons learned so far in my career. The audio recording of my talk is posted here (a few minutes seem to be skipped near the end), and slides can be downloaded below.

What if I told you that a fancy thermometer was "similar in effectiveness" as an IUD at preventing pregnancy, and only required you to take your temperature once a day?
 
Well, if I told you that, I’d be misleading you and putting you at risk of an unintended pregnancy.
 
But, that’s what a company called Valley Electronics AG has been telling consumers, in hopes of selling their $330 device called Daysy.

Over the last several years, I've been collaborating on a project on measuring infertility in low resource settings with an amazing group of friends/colleagues: Dr. Carie Cox, Dr. Ozge Tuncalp, Dr. Alex McLain, and Dr. Marie Thoma. The journal Human Reproduction recently published our manuscript, called: Estimating infertility prevalence in low- to middle-income countries: an application of a current duration approach to Demographic and Health Survey data.

The letter below was sent to Judge Sam Benningfield, in response to this news story. Access to contraception is critical to ensure reproductive health, and inmates who desire it should be provided with access to it. However, any form of reproductive coercion is unacceptable, and enticing inmates to use contraception in exchange for reduced jail time is coercive.

For many years, scientists have tried to answer several questions about whether various hormonal contraceptive methods (i.e., pills, injectables, implants, hormone-releasing IUDs, patches, and vaginal rings) impact various HIV-related risks. Key questions on this subject include:

1. Are HIV-negative women who use specific methods of hormonal contraception more likely to acquire HIV?
2. Are women living with HIV who use specific methods of hormonal contraception more likely to transmit their infection to a male sexual partner?
3. Are women living with HIV and using specific methods of hormonal contraception likely to experience faster clinical disease progression?
4. If a woman living with HIV is using antiretroviral therapy (i.e., medications to treat HIV), will using any specific method of hormonal contraception result in drug interactions. In other words, could using both medications at the same time make either medication less effective, or more likely to result in side effects?

The first question is the most controversial, and is a critically important question for women's health - particularly for those living in high HIV prevalence countries, including many in Eastern and Southern Africa. However, for a number of methodological reasons (many of which are detailed in this paper), it is extremely complex to design studies that will provide definitive answers.

In January 2016, I attended the fourth International Conference on Family Planning. I've been very fortunate to be able to attend all four of these incredible gatherings: in Uganda in 2009, in Senegal in 2011, in Ethiopia in 2013, and in Indonesia in 2016.

At these conferences, I'm always reminded what it feels like to be surrounded by everyday heroes working in reproductive health, and I inevitably come home more inspired and reinvigorated. This year was particularly energized because of the large youth delegation that brought incredible spirit and talents to the conference!