Advocating for Women's Reproductive Health
November 19, 2021
Stephanie Teal, MD, MPH, new Obstetrician and Gynecologist-in-Chief for University Hospitals, is dedicated to improving women’s options and outcomes
Innovations in Obstetrics & Gynecology | Fall 2021
For women with complex medical conditions, such as seizure disorders, diabetes or cancer, their health care focus typically falls on trying to manage their different medications and receiving the specialty care they need to reduce complications from their condition. Getting effective contraceptive care often doesn’t enter into the equation, with perhaps both the patient and the specialist choosing to focus on other issues.
However, Stephanie Teal, MD, MPH, new Obstetrician and Gynecologist-in-Chief for University Hospitals and Chair of the Department of Obstetrics and Gynecology at UH Cleveland Medical Center, has spent almost two decades trying to change that. In her previous position as Division Chief and Fellowship Director of Complex Family Planning in the Department of Obstetrics and Gynecology at the University of Colorado School of Medicine, she ran a busy contraception clinic for women with a wide range of complex medical issues. She’s now bringing that model to Cleveland; the new clinic will open in the UH Rainbow Babies & Children’s Ahuja Center for Women & Children in January 2022.
“The people who need the best contraception are often those who have medical conditions or medicines that they use that make getting good contraception difficult,” she says. “The solution is to treat each patient as an individual and elicit her preferences, understand what medications she’s on, what her disease status is, and work in concert with her other medical specialists. A common denominator for many of these issues is that we need to avoid estrogens, and we do now have many more highly effective, non-estrogen-containing contraceptive methods, even if we need to avoid progestins as well.”
Dr. Teal, in fact, has spent much of her career trying to improve the contraceptive options available to all women, not just those with complex medical conditions. While at the University of Colorado, she was prinicipal investigator for the NIH-funded Contraceptive Clinical Trials Network. Her work with these trials is continuing in Cleveland, with University Hospitals as an added sub-site in the network. This addition will benefit the ongoing science of these clinical trials by diversifying the patient participant base, Dr. Teal says.
“Because the demographics of the population are different in Colorado and Ohio, both sites are very excited,” she says. “When we are developing new contraceptive methods, we will have a wider variety of potential participants in the trials.”
Trials under way in the Contraceptive Clinical Trials Network, she says, are evaluating a wide range of improvements to current contraception methods for women, from self-administered injections that don’t require an office visit, to smaller-frame, more comfortable IUDs, to progestin-only options and even a hormone-free selective progesterone receptor modulator. The goal with all of it, she says, is to better meet the needs of the patient.
“When contraceptives first came out, women were told they were lucky to have anything, so put up with it and deal with the side effects,” she says. “But that does not meet our mission of putting the patient first and creating the best quality of life we can, especially when you’re talking about contraception, which most women use for most of their reproductive lives. We’re trying to have safer methods, better quality of life, fewer side effects, and patient-controlled so that the person herself can start and stop them when it makes sense for her and her family without coming to the doctor.”
Women are interested in the longer-acting reversible contraceptive methods that have been developed as a result of research in this network, Dr. Teal says. One of her previous studies showed that when women had access to any of the FDA-approved contraceptive methods free of charge, removing issues of access and cost from the equation, 70 percent of women chose one of the long-acting reversible methods, such as an IUD or an implant. Long-acting, reversible methods are an especially good fit for adolescents, she says, whose motivation to remain compliant taking the pill may wax and wane over time, complicated by hectic teen lives.
“We found that for young people who are interested in IUDs and implants, which is between 50 and 70 percent when they are offered, those do the absolute best job for adolescents in getting them through their adolescence without an unintended pregnancy,” Dr. Teal says.
The issue with these methods continues to be insurance coverage and cost.
“They’re most cost-effective because they’re the least likely to fail and people tend to use them between one and three years,” she says. “But if insurance doesn’t cover it, it’s very expensive up front.”
Dr. Teal is now about six months into her new position at University Hospitals. One key priority, she says, is continuing the integration between the system’s academic medical center and community hospitals to create a unified vision for women’s health in the region.
“In coming here, I really saw this as an opportunity to enter this system at a time when we’re getting away from the distinction between the ivory tower and the community hospitals and instead becoming an integrated, high-quality, high-value network all across Northeast Ohio,” she says. “We have the same vision and philosophy and over-arching mission to put the patient at the center of the care.”
To that end, the UH Department of Obstetrics and Gynecology is an integral part of a massive building project under way at UH Ahuja Medical Center, which is adding labor and delivery services. Maternal-fetal medicine specialists are also being deployed in the community in new ways. The department has been raising funds for a mobile ultrasound clinic to serve pregnant women across Northeast Ohio who may not be able to travel to a hospital or doctor’s office – an important aspect of addressing the region’s significant problem with infant mortality. Dr. Teal says that effort is about to come to fruition – and none too soon.
“We want to do more surveillance of moms and babies throughout pregnancy and make sure that babies get through that first year of life successfully,” she says.
For Dr. Teal, these and other projects keep her motivated in meeting the responsibilities that come with health care leadership, particularly at UH.
“The role of chair means you can have influence in terms of setting a vision for women’s health for a region,” she says. “UH really offered that more than anywhere else I looked at. It’s such a fantastic integrated system, and the quality standards are high and consistent across the board. It’s great to have everyone working together on the important issues we need to address for our community.”