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Increased access to long-acting contraception helps decrease rate of unintended pregnancy, says IU professor

IU School of Medicine • 2/2/17

INDIANAPOLIS – Although rates of unintended pregnancy in the United States have declined, studies still show that nearly half of all pregnancies nationwide are unintended, which can have negative outcomes for both mothers and infants.

Jeffrey Peipert, MD, PhD, Clarence E. Ehrlich Professor and Chair of the Department of Obstetrics and Gynecology at Indiana University School of Medicine, says a key strategy to curb the rate of unintended pregnancies in the U.S. should include increasing access to and use of long-acting reversible contraception, such as intra-uterine devices (IUDs) and hormonal implants.

In an article published Feb. 2 in the New England Journal of Medicine, Dr. Peipert and first author Kathryn Curtis, PhD, of the U.S. Centers for Disease Control and Prevention, write that IUDs and hormonal implants are the most highly effective reversible methods of contraception, yet, a 2011-2013 study found that only a small proportion of women ages 15 to 44 who reported using contraceptives were using long-acting reversible contraception.

“What clinicians and patients do not recognize is that IUDs and hormonal implants are 20 times more effective than the pill, patches and rings,” said Dr. Peipert, whose research includes studies on the effectiveness of long-acting reversible contraception and programs that provide access to these methods.

IUDs are T-shaped hormonal and non-hormonal medical devices that are placed inside the uterus to prevent fertilization. Hormonal implants are matchstick-sized rods that are inserted under the skin of the arm to prevent pregnancy. 

Dr. Peipert said one reason IUDs and hormonal implants are more effective at preventing pregnancy than other contraceptive methods—pills, patches and rings—may be that patients are free to forget about them. Once long-acting reversible contraceptives are in place, they remain effective for up to three to 10 years, depending on which type is used, with no additional maintenance needed, he said.

IUDs and hormonal implants are also safe for almost all women, including adolescents and women in the postpartum period, Dr. Peipert said. And contrary to some myths, long-acting methods do not cause infertility, infections or pain, he said.  In fact, the hormonal IUD is commonly used to reduce pain and heavy bleeding associated with menstruation.

Dr. Peipert said the rate of long-acting reversible contraception among American women is currently close to 12 percent. As access to and awareness of the effectiveness of these methods of contraception increase, he predicts that rate will continue to rise, which will further reduce the rate of unintended pregnancy in the U.S. However, if changes in health care limit access and reimbursements for contraceptive methods, the benefits of the long-acting methods may not be realized, given their higher upfront costs.

“If a patient asks for contraception, they should be offered the most effective methods,” Dr. Peipert said. “Clinicians and patients should know about IUDs and hormonal implants. If clinicians don’t offer them, patients should ask about them.”