Simply informing women about intrauterine and hormonal implant birth control options when they ask for family planning advice can dramatically decrease the number of unintended pregnancies, according to a national study just published in the medical journal The Lancet.
That's great news -- except that very few doctors in the United States recommend the IUD or implant to patients, even though the two methods are the most effective reversible birth control options on the market. It's hoped the study will serve as a catalyst for change.
"The U.S. has for decades had high rates of unintended pregnancy," said researcher Dr. Cynthia Harper, a professor of obstetrics, gynecology and reproductive sciences at University of California, San Francisco School of Medicine. "This is a health outcome that we can do something about, and it’s exciting we’ve found some that works."
The Background
Almost 37 percent of all pregnancies in the U.S. between 2006 and 2010 were unintended. While statistics on abortion are limited, it’s estimated that roughly half of all unintended pregnancies in the U.S. are terminated, according to a report from the National Center for Health Statistics. These numbers suggest there's a significant group of women who have not had a successful experience with or have had trouble accessing birth control.
Harper wondered if steering women toward the most effective forms of birth control could help reduce this number.
The Setup
Health care workers at 40 Planned Parenthood centers across the U.S. were selected at random to receive either updated training on how to educate women about contraceptive methods, or told to continue giving their standard spiel, which may or may not have included information about all methods. Then researchers recruited 1,500 women between 18 and 25 who received contraceptive counseling from those particular centers to be part of the study.
As part of the enhanced counseling, the women watched an educational video. They were told that IUDs and implants have nearly a 100 percent effectiveness, whereas the pill is about 91 percent effective and condoms are only 82 percent effective, based on average use.
Researchers later followed up with the patients to learn what kind of contraception they chose. A year later, they checked to see if the women had gotten unintentionally pregnant.
The Findings
Harper and her team found that the women who got information from the newly trained health workers were more likely to choose implants as their birth control method (28 percent) compared to those who hadn’t purposefully been given that information (17 percent). Most striking, said Harper, was that the pregnancy rate for women who had received the new counseling was almost half that of the women who had gone to a center that continued its usual contraception counseling routine.
It's important to note that the positive findings for this study only held true for women who had gone to the centers seeking family counseling information, as opposed to women who were being counseled about contraception after an abortion. In fact, women who had gotten IUD/implant information after an abortion had slightly higher rates of pregnancy in the next year than women who got the regular contraception information after an abortion. Past research shows that women who have an abortion are more likely to be at risk of an unintended pregnancy in the future, due to a complex mix of poverty, lack of access to good counseling and affordable birth control.
The Takeaway
Harper believes her study is a wakeup call to doctors, nurses and health clinics nationwide to seriously consider restructuring their birth control counseling to include information about IUDs and hormonal implants.
"The greatest takeaway is that we have the tools and the knowledge available now in the U.S. for women to prevent pregnancy if its not the right time for them to become pregnant,” she said.
The Catch
One of the biggest barriers to implants and IUDs is their upfront cost -- from $800 to $1,000 if a woman does not have insurance. Amortized over the many years each option lasts, they are still cheaper than pills or condoms, but many people find it unmanageable as an initial expense.
The Affordable Care Act mandates that insurance companies completely cover all FDA-approved birth control methods prescribed by a doctor, including IUDs. However, this only applies to women with private health insurance, excluding 38 percent of the women in Harper’s study.
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