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Wellness Corner March 2015 - New Ideas in Contraception


Wellness Corner March 2015
New Ideas in Contraception

by Dr. Gary Pace

Few people will argue that contraception is a positive thing. Now, there are still some controversies: some may feel that teenagers should have limited access; or that certain types of birth control are unethical; or that easy access to is leading to a breakdown in societal values; or that insurance shouldn’t cover certain birth control methods. But taking steps to prevent unwanted pregnancies is generally considered responsible behavior.

Since the development of the effective hormonal contraceptives in the mid-1900s, research and development of new methods has been slower than many had hoped. Improving the current offerings is important, because almost half of all pregnancies currently occur in women who are using some form of birth control—hence they are not trying to get pregnant. Two fairly recent developments have occurred that are worth exploring.

Long-Acting Contraception

The first development is the ready availability of long-acting contraceptive devices, including the IUD (Copper-T), the hormone containing IUD (Mirena), and hormone-dispensing implants (currently Nexplanon). These forms of birth control require insertion by a medical professional, but they need no other attention for 3-10 years (depending on the apparatus). These methods are increasing in popularity with use increasing from 2.4% of all U.S. women using contraception in 2002 to 8.5% in 2009. Approximately 4.5% of women aged 15–19 years who are currently using a method of contraception use one of these forms, mainly the IUD. 

These methods are becoming more popular, mainly because they are so much more effective and extremely easy to use. Without having to remember to take daily pills or being forced to grab a device at the time of romance, the mistake rate is much lower with these long-acting approaches. In fact, the IUDs and implants have a pregnancy rate of less than 1 for every hundred women that use it for a year; pills/patches/shot/diaphragm have a pregnancy rate of 6-12 for a hundred women trying to use them properly for a year; the rate is even higher for those couples using condom/sponge/withdrawal/fertility awareness methods at over 18 per 100 women in a year.

Due to problematic experiences with an IUD called the Dalkon Shield, IUD usage dropped significantly in the 1970s. Since the development of these newer devices, side effects have decreased a lot, and they are becoming a preferred strategy. It even appears that they are safe for teens, and probably a very good way to help prevent teen pregnancy, since adolescents are particularly susceptible to forgetting pills and having problems with planning ahead.

Emergency Contraception

Emergency contraception, or the “morning-after pill,” has been available from doctors for several years, but in 2009, no prescription was needed for women and men 17 years and older. They work primarily by preventing ovulation or fertilization, not by aborting fertilized ova. The most common form of emergency contraception, pills used within three days of unprotected intercourse, decreases the chance of pregnancy by 70% (with a pregnancy rate of 2.2%).

Research has shown that providing easy access to emergency contraceptive pills does not affect rates of sexually transmitted infections, condom use, sexual risk-taking behavior, or unfortunately, pregnancy rates. This surprising finding that pregnancy rates in the population are not noticeably decreased is probably due to the fact that emergency contraception is terribly underused-- in some studies, women who actually had the pills at home used them less than 50% of the time that they had unprotected intercourse.  


With the abortion controversy continuing to be an issue in our country, and with significant legislative efforts being directed at limiting access to abortion, it seems important to prevent unintended pregnancy whenever possible. Clearly, for women or couples that want a reversible means (meaning they may want children in the future), the IUD or implant are a first-line option because they are so effective. Given the high rate of pregnancies with use of other forms of birth control, we want to be encouraging these longer-acting methods.

Emergency contraception should be easily available, with women well-versed in its use in order to decrease risk of pregnancy if unprotected intercourse should occur.  It is important to remember that none of these methods prevent sexually transmitted infections.