Increasing the use of long-acting reversible contraception

Of the 6.7 million pregnancies in the US each year 48% are unplanned. Disturbingly, about half occur in women who were using contraception at the time of conception.  That statistic haunts me. As health care providers we must take that to heart and change the way we think about birth control counseling. Is there more that we can do to help prevent unplanned pregnancy in those who are actively using birth control?

When we break down the statistics and focus on young people the numbers are even more striking.  Shows like Teen Mom and 16 and Pregnant draw media attention to teen pregnancy.  Ironically, young women ages 15-19 are the most likely group to have used birth control the last time they had sex. The problem is this age group typically chooses methods with higher failure rates such as cycle timing, condoms, withdrawal method and birth control pills. The result is unsurprising: unplanned pregnancies.

Young patients often ask me, “What is the best birth control?” My answer is always the same: “The one that you will use.” There is no “right” answer. Effective contraceptive counseling involves not only providing information and options,  but also matching the right method to the right person.

Research shows that pregnancies occur less often when one chooses a contraception option that requires the least amount of effort. This is not a surprise.  Condoms work great unless you never take them out of your pocket. Birth control pills also are effective but not if you forget to swallow them. Despite the many contraception options available many patients are unaware of the choices.  Linguistically speaking the phrase “birth control” is synonymous with oral contraceptives for many people. Birth control refers to many more methods than just birth control pills. Health care providers should never assume patients know all of the alternatives. Pregnancy can be prevented with a variety of non-daily options that are safe and easy to use.

When discussing  contraception with young patients, start with methods that require the least amount of effort and then work backwards to the methods that require the most effort. Direct patients to the options that have the best track record. Keep in mind that efficacy has a direct correlation with compliance. The more effort the birth control method demands from the patient the less effective it will be long term.

At MacArthur OB/GYN we always start with the Mirena IUD, Paragard IUD and Nexplanon. We discuss the risks, benefits and potential side effects. These methods involve one visit for insertion and one for removal providing coverage for 5 years, 10 years and 3 years respectively. These methods have the highest efficacy rates and excellent continuation rates. They have excellent safety profiles, few side effects and few medical contraindications. Despite that, nationwide less than 10% of adolescents are using these methods collectively referred to as LARCs (long-acting reversible contraception). We focus on LARCs because they have the highest success rate at preventing unplanned pregnancy. We spend time addressing fears, misconceptions and myths. We make sure our patients are aware of these options. We use technology in the office via an on screen waiting room PowerPoint presentation highlighting the birth control options. We use social media platforms to educate our patients on their birth control choices. As a result a much higher percent of our young patients are choosing LARCs as their preferred method of contraception.

While the patient should ultimately choose the best for her, the health provider should be guiding her to the methods that can best meet her goal of preventing pregnancy. By increasing the use of LARCs we can dramatically impact the number of young women struggling with unplanned pregnancy while using contraception.

Jeff Livingston is an obstetrician-gynecologist at MacArthur OB/GYN, also on Facebook.  He can be reached on Twitter @macobgyn.

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