Birth Con­trol: What's Best?

Wellness Update - - Birth Control: What's Best? -

Astudy to eval­u­ate birth-con­trol meth­ods has found dra­matic dif­fer­ences in their ef­fec­tive­ness. Women who used short­term meth­ods like birth-con­trol pills, the patch or vagi­nal ring were 20 times more likely to have an un­in­tended preg­nancy than those who used longer-act­ing forms such as an in­trauter­ine de­vice (IUD) or im­plant.

Re­sults of the study, by re­searchers at Washington Univer­sity School of Medicine in St. Louis, are re­ported May 24, 2012 in the New Eng­land Jour­nal of Medicine.

Birth-con­trol pills are the most com­monly used re­versible con­tra­cep­tive in the United States, but their ef­fec­tive­ness hinges on women remembering to take a pill ev­ery day and hav­ing easy ac­cess to re­fills.

In the study, birth-con­trol pills and other short-term con­tra­cep­tive meth­ods, such as the con­tra­cep­tive patch or ring, were es­pe­cially un­re­li­able among younger women. For those un­der 21 who used birth-con­trol pills, the patch or ring, the risk of un­planned preg­nancy was al­most twice as high as the risk among older women. This find­ing sug­gests that in­creased ado­les­cent use of longer act­ing con­tra­cep­tive meth­ods could pre­vent sub­stan­tially more un­planned preg­nan­cies.

“This study is the best ev­i­dence we have that lon­gact­ing re­versible meth­ods are far su­pe­rior to the birth-con­trol pill, patch and ring,” says se­nior au­thor Jef­frey Peipert, MD, the Robert J. Terry Pro­fes­sor of Obstetrics and Gyne­col­ogy. “IUDs and im­plants are more ef­fec­tive be­cause women can for­get about them af­ter clin­i­cians put the de­vices in place.”

Un­in­tended preg­nancy is a ma­jor prob­lem in the United States. About 3 mil­lion preg­nan­cies per year — 50 per­cent of all preg­nan­cies — are un­planned. The rate of un­in­tended preg­nancy in the United States is much higher than in other devel­oped na­tions, and past stud­ies have shown that about half of th­ese preg­nan­cies re­sult from con­tra­cep­tive fail­ure.

IUDs are in­serted into the uterus by a health-care provider. The hor­monal IUD is ap­proved for five years, and the cop­per IUD can be used for as long as 10 years. Hor­monal im­plants are in­serted un­der the skin of the up­per arm and are ef­fec­tive for three years. Many women, how­ever, can­not af­ford the up­front costs of th­ese meth­ods, which can be more than $500.

“We know that IUDs and im­plants have very low fail­ure rates — less than 1 per­cent,” says Brooke Win­ner, MD, a fourth-year res­i­dent at Barnes-Jewish Hospi­tal and the study’s lead au­thor. “But although IUDs are very ef­fec­tive and have been proven safe in women and ado­les­cents, they only are cho­sen by 5.5 per­cent of women in the United States who use con­tra­cep­tion.”

Ear­lier con­tra­cep­tive stud­ies asked women to re­call the birth-con­trol method they used and num­ber of preg­nan­cies. For this study, the in­ves­ti­ga­tors wanted to de­ter­mine whether ed­u­cat­ing women about the ef­fec­tive­ness of var­i­ous birth-con­trol op­tions and hav­ing them choose a method with­out con­sid­er­ing cost would re­duce the rate of un­in­tended preg­nancy. Birth con­trol was pro­vided to women at no cost.

The study in­volved more than 7,500 women en­rolled in the Con­tra­cep­tive CHOICE project. Par­tic­i­pants were ages 14-45 and at high risk of un­in­tended preg­nancy. The women were sex­u­ally ac­tive or planned to be­come sex­u­ally ac­tive in the next six months. They ei­ther were not cur­rently us­ing con­tra­cep­tion or wanted to switch birth-con­trol meth­ods. The women also said they did not want to be­come preg­nant for the next 12 months.

Par­tic­i­pants in this report could choose among the fol­low­ing birth-con­trol meth­ods: IUD, im­plant, birth-con­trol pills, patch, ring and con­tra­cep­tive in­jec­tion. The women were coun­seled about the con­tra­cep­tive meth­ods, in­clud­ing their ef­fec­tive­ness, side ef­fects, risks and ben­e­fits. Par­tic­i­pants were per­mit­ted to dis­con­tinue or switch meth­ods as many times as de­sired dur­ing the study.

In­ves­ti­ga­tors in­ter­viewed par­tic­i­pants by tele­phone at three and six months and ev­ery six months there­after for the re­main­der of the study. Dur­ing each in­ter­view, par­tic­i­pants were asked about missed pe­ri­ods and pos­si­ble preg­nancy. Any par­tic­i­pant who thought she might be preg­nant was asked to come in for a urine preg­nancy test. Those who were preg­nant were asked if it was in­tended and what con­tra­cep­tive method, if any, they were us­ing at time of con­cep­tion.

Over the three-year study, 334 women be­came preg­nant. Of th­ese, 156 preg­nan­cies were due to con­tra­cep­tive fail­ure. Over­all, 133 (4.55 per­cent) of women us­ing pills, the patch or ring had con­tra­cep­tive fail­ure, com­pared with 21 (0.27 per­cent) of women us­ing IUDs and im­plants.

“This study also is im­por­tant be­cause it showed that when IUDs and im­plants are pro­vided at no cost, about 75 per­cent of women chose th­ese meth­ods for birth con­trol,” Win­ner says.

Women who chose an IUD or im­plant were more likely to be older, to have pub­lic health in­surance and to have more chil­dren than women who chose other con­tra­cep­tive meth­ods. Women who chose pills, the patch or ring were more likely to have pri­vate health in­surance and to not have had chil­dren pre­vi­ously.

“If there were a drug for can­cer, heart disease or di­a­betes that was 20 times more ef­fec­tive, we would rec­om­mend it first,” he says. “Un­in­tended preg­nan­cies can have neg­a­tive ef­fects on women’s health and ed­u­ca­tion and the health of new­borns.” -This in­for­ma­tion pro­vided courtesy of Washington Univer­sity in St. Louis School of Medicine

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