If we want to decrease the number of unwanted pregnancies in the United States, we would do well to pay attention to the results of two recent studies on contraception. Both show that long-term methods of birth control, in particular the intrauterine device, are far more effective than the pill at preventing pregnancy.
One study, published this spring in the New England Journal of Medicine, compared the effectiveness of different kinds of birth control in the lives of 7,500 women over a three-year period. In that time, 9.4 percent of the women who used the pill, hormonal patches or vaginal hormonal rings became pregnant, compared to just 0.9 percent of women who chose IUDs or long-acting hormonal implants instead.
Teens and younger women were twice as likely as older women to suffer birth control failure — unless they chose the IUD or implants.
What did the study reveal? That human factors — such as forgetting to take the pill at the same time every day — play a huge role in contraceptive failure and unwanted pregnancies. When that human error factor is removed, women enjoyed a 99.1 percent effectiveness rate from contraception.
Imagine if we could reduce the rate of pregnancies caused by contraceptive failure — not failure to use contraception — by 90 percent. Given that women who use contraception are likely committed to not having children at that point in their lives, this reduction would likely produce a dramatic reduction in abortions as well.
The second study, published in the journal Human Reproduction, showed that the IUD is remarkably effective when used as emergency contraception (EC) — contraception used after unprotected sex or rape. The current method of EC prescribed by clinics and physicians is the so-called morning-after pill. Plan B, which is taken within 72 hours after unprotected sex or rape, has a failure rate of 1 percent to 2 percent. The IUD, on the other hand, had a failure rate of only one or two per thousand women, or just 0.09 percent.
As these studies show, the IUD is as close to a fertility off/on switch as we’ve come. It’s remarkably effective, lasting five to 12 years, depending on the kind of IUD, and it’s almost immediately reversible. As an added benefit, the IUD has been shown to dramatically reduce a woman’s risk for endometrial cancer. That’s a win-win-win for women.
Ideally, OB/GYNs, clinics and hospitals across the country should study this information and encourage rape victims and women seeking contraception, emergency or otherwise, to try the IUD. Sadly, it’s not that easy.
Many doctors aren’t familiar with the most recent scholarship on newer IUDs, and they steer women, particularly teens and younger women, toward the pill. Others wouldn’t know to offer an IUD as emergency contraception even if they had a stockpile of IUDs on hand. Also, IUDs are rarely kept in supply, meaning that women could become pregnant in the time it took for their practitioner to order an IUD.
Further, the cost — about $500 up front, plus a couple of doctor visits — puts IUDs out of many women’s reach.
It’s time for a sea change in how we supply contraception.
The Patient Protection and Affordable Care Act (PPACA), often called Obamacare, may supply some of that change, by removing cost as a factor. PPACA calls for all FDA-approved contraception methods to be made available at no cost just like other forms of preventive health care. And when cost is not an issue, women choose IUDs in much greater numbers.
Susan Levy, executive director of Boulder Valley Women’s Health, says she’s interested to see what the impact of PPACA will be on women’s choice of contraceptive. At the clinic, private grant money that helps with the cost of IUDs has had an impact already on women’s decisions.
“Just in terms of the use of IUDs as birth control, we have seen an increase in the use of IUDs, especially when you remove the cost as a barrier,” Levy says. “Every year the numbers have gone up in terms of the percentage of women who are choosing that.”
The private grant has enabled practitioners to offer abortion patients IUDs on abortion day, so that they leave with a long-term method of birth control in place and don’t have to return for a second appointment.
“About one-third are leaving with some long-acting form of contraception,” Levy says.
To make IUDs available as emergency birth control, however, would require facilities, including hospital emergency rooms that treat rape victims, to keep IUDs on hand and have health care providers capable of safely inserting IUDs available for walk-in appointments. We’re a long way from that.
But perhaps now, with science to point the way and health care reform on the horizon, we can overhaul what’s available to women, enabling them finally to have the control over their fertility that the pill promised 50 years ago.
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