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Rebecca Wind
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USE OF HIGHLY EFFECTIVE CONTRACEPTIVE METHODS INCREASES SUBSTANTIALLY, BUT REMAINS LOW AMONG WOMEN AT HIGHEST RISK OF UNPLANNED PREGNANCY

Greater Use Could Significantly Reduce Rates of Unintended Pregnancy

The proportion of women using highly effective long-acting reversible contraceptive methods—namely, the implant and intrauterine device (IUD)—increased significantly between 2002 and 2009, growing from 2.4% to 8.5%. This finding comes from a newly released study, "Changes In Use of Long-Acting Contraceptive Methods in the United States, 2007–2009," by Lawrence B. Finer et al. of the Guttmacher Institute, which also found that use of these methods increased among almost every demographic group. This increase occurred simultaneously with a decline in both sterilization and the use of less effective short-term methods such as condoms and the birth control pill. Despite this overall increase, use of long-acting methods in the United States remains substantially lower than in other developed countries such as the United Kingdom (11%), France (23%) and Norway (27%).

The authors analyzed data from the 2006–2010 National Survey of Family Growth, and found that the highest use of long-acting methods was among women aged 25–39 and among women who had already had at least one child. Notably, just 2% of women with no children had used these methods, compared with 15% of women with one or two children. The authors speculate that low levels of use among young women and among those who have not yet had children could be related to the high up-front costs of these methods, as well as provider misperceptions about who is an appropriate candidate for use.

"The average age at first sex is around 17, and the average age at first birth close to 25. As a result, the period during which women are at risk for unplanned pregnancy is much longer than it used to be," says Dr. Finer. "Young women in particular, the group at highest risk of unintended pregnancy, could benefit greatly from these highly effective contraceptive methods, which protect them over a much longer period and which require virtually no user intervention."

When used for their full term, which runs from three to 10 years depending on the method and brand, long-acting reversible contraceptive methods are highly cost-effective. More important, they are among the most effective methods currently available and have failure rates of less than 1%. Contrary to the views held by some, current medical guidelines show that use of these methods is safe for young women and women with no children.

The authors suggest that increasing awareness and use of the implant and IUD could give women more options that better meet their needs at different stages of their lives. More widespread use of highly effective long-acting methods could therefore play an important role in lowering the high rates of unintended pregnancy in the United States.

This article is currently available online, and will appear in a forthcoming issue of Fertility and Sterility.

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