Simplifying contraception s complexities

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When The Pill was developed back in the early 1960s, medical and social philosophers predicted a sexual revolution, as reproductive and sexual fulfillment were, it seemed, finally untied from each other. However, complications ensued.

The sad fact is that the United States leads the world in unplanned, unintended pregnancies. This is especially problematic among our teenage girls, whose lives and plans are so often derailed by such an occurrence. Carrying a pregnancy to term and having a baby as an unwed teen often derails young lives, and of course the alternative termination of pregnancy is also tragic when 15- and 16-year olds have to make such a gut-wrenching decision.

Why the high rate of teen and adult unintended pregnancies in our technologically advanced society? Ironically, despite the information revolution enhanced by social media and the 24/7 blog cycle, many women are woefully uninformed about contraceptive options and which are the best choices for each individual. (Abstinence only sex education, ironically, is responsible to some extent for the ignorance is bliss approach to birth control and its devastating consequences).

Some women shun or abandon the pill because of experiences of or fear of adverse effects which are actually uncommon with the modern low-dose varieties. Condom use requires partner cooperation and appropriate regular use. Both methods result in relatively high failure rates, about 10% or more per year.

Because of these problems, the contraceptive candy store has grown tremendously, giving women of all ages more choices to prevent pregnancy. While this is a good thing, generally, for some women too many choices lead to consequences that could have been avoided.

For instance, in the 1970s and 80s when I was in practice, the intrauterine device (IUD) was a big deal. It required a minor surgical-type encounter to insert or remove, and was felt to raise the risk of infertility if the woman decided to become pregnant. One type, the Dalkon Shield, was blamed as a cause of pelvic inflammatory disease, a painful infection and a cause of infertility and the bad rap on it affected thinking on all IUDs up until recently.

Contraceptive implants came along in Europe and Asia in the 1980s, and were first allowed here in the U.S. in the 1990s. Their insertion is simple and painless, and so is removal, with the rapid return of fertility as the contraceptive hormone levels fall to normal with days of removal. Of course, local reactions can occur but are almost always of short duration.

Now, the American College of Obstetrics and Gynecology (ACOG) issued an Opinion calling for more widespread use of long-acting reversible contraception (LARC): IUDs and implants. The ACOG committee said:

"Intrauterine devices and the [birth-control] implant are the best reversible methods for preventing unintended pregnancy, rapid repeat pregnancy, and abortion in young women.

Since over 80% of pregnancies among teenagers are unplanned, and since LARC methods have a failure rate of under 1% per year, it is to be hoped that these methods do indeed become more widely accepted, and that obstacles to that goal are reduced. Two of the main obstacles are: a) lack of knowledge among primary care doctors about the benefits of LARCs, as well as their lack of the skills needed to utilize them; and b) lack of reproductive privacy for teens seeking effective contraception: only 21 states and the District of Columbia allow the decisions about birth control to be made between the teen and her doctor, without interference from parents or spouses.

Further, an international study published one year ago found that women with IUDs had a 50% lower risk of cervical cancer than did women who never had one.

So, women and docs, let s get with the 21st century program. It is not inconceivable no pun intended that the epidemic of unplanned pregnancies in our nation, unique in the developed world, can be stemmed to a significant extent if IUDs and contraceptive implants become more commonly utilized to replace the less effective methods now in use. The real beauty of these methods, besides their safety, is that a woman does not have to remember to use them and use them correctly each and every time sexual contact occurs they are always on board and ready for action. The only real downside: No protection from sexually-transmitted infections (inluding HIV) is obtained from these methods, so a barrier method (condoms are best) is also recommended.