By Robert A. Hatcher, MD, MPH, Professor Emeritus, Department of Gynecology and Obstetrics, Emory University School of Medicine
For many in the fields of family planning and reproductive health, it is a new day — but it is not going to be a better day.
In our country, just less than half of all pregnancies (49%) are unintended.1 Women faced with unintended pregnancies may decide to have the child, look for a way to terminate the pregnancy, or not know what to do and delay any decisions.
There are five approaches to birth control that are extraordinarily effective. If women in their reproductive years who do not want to become pregnant choose one of these approaches to birth control, unintended pregnancy rates would fall. This also would dramatically reduce the number of women seeking an abortion.
What are those five approaches to birth control that are remarkably effective? The first is the Nexplanon implant. The percentage of women experiencing an unintended pregnancy with the implant is 0.1%. The next most effective method is vasectomy. If the couple is protected with this method, 0.51% of women become pregnant. The unintended pregnancy rate of hormonal intrauterine devices (IUD) is 0.1% to 0.4%.2
The least effective of the five methods is the copper IUD. It is associated with a pregnancy rate of 0.8%. That is a very small number, but the meaning may not be clear to patients. If a woman chooses to use a combined birth control pill, she is not using one of the five most effective methods, and the rate of unintended pregnancy is 7%. We can see that is a lot higher than the percentage experiencing pregnancy if protected by an implant, a vasectomy, or a copper IUD.
Dr. Claude Burnett in Athens, GA, presented information about contraceptive effectiveness throughout the offices of the Athens health department. To eliminate those numbers that are hard to determine (e.g., Nexplanon failure rate of 0.1%), he expressed the numbers per 10,000 women for each of the contraceptives:
- Nexplanon implant pregnancies in first year: 10 per 10,000 women;
- Male sterilization: 15 per 10,000;
- Mirena/Liletta hormonal IUD: 40 per 10,000;
- Female sterilization: 50 per 10,000;
- Paragard copper T IUD: 80 per 10,000.
Burnett also presented the pregnancy rates for other contraceptive methods:
- Combination birth control pills: 700 per 10,000;
- Condoms: 1,300 per 10,000;
- No method: 8,500 per 10,000.
This explains to women the remarkable effectiveness of implants, IUDs, and male or female sterilization.
Clearly, a couple is better served in terms of contraception effectiveness if they use an implant, one of the two IUDs, or one of the two means of sterilization.
It is a new day, and efforts to increase the choice of these very effective methods already are happening in our country.
Two further thoughts about these five methods: First, those methods are extremely safe. Second, one must always be careful that the decision to use those methods is the decision of the woman (or, in the case of vasectomy, the man) — not of the family planning community. These methods must be 100% voluntary. If presented well, many of the tragedies of unintended pregnancies in states where abortion is virtually impossible to obtain can be avoided. That is the new day that I want to see.
Dr. Robert A. Hatcher is the chairman of the Contraceptive Technology Update editorial board.
REFERENCES
- Cason P, Aiken ARA. Engaging with unintended pregnancy through patient-centered reproductive goals and contraceptive counseling. Contraceptive Technology. 21st edition. Ayers Company Publishers, 2018.
- Hatcher RA, Rachel SA, Zieman M. Choices. 2022.
For many in the fields of family planning and reproductive health, it is a new day — but it is not going to be a better day.
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