Our expert is Mitchell D. Creinin, MD, Professor and Director of Family Planning, Department of Obstetrics and Gynecology, University of California, Davis.

If there is a medical topic you would like to see explored here, please let me know!

 

Very best,
Mitzi Perdue
[email protected]

POPULATION GROWTH IS DEPLETING RESOURCES NEEDED FOR OUR SURVIVAL

The global population is currently 7.2 billion people, and by 2050, it’s projected to be 10 billion. This may have effects we can’t reverse. Humans are the biggest users of earth’s resources, and we’re using these resources up at a rate that risks depleting the core of what we need for our survival.

TOO MANY PREGNANCIES ARE UNINTENDED

In the United States, 51% of the 6.7 million pregnancies each year are unintended. In the age group 15-17 years old, 91% of all pregnancies are unintended. As women get older, the proportion of unintended pregnancies goes down, but the overall rate for all pregnancies is still 51%. We have more and newer contraception methods, and for women of means, the unintended pregnancy rates are going down. However, for poor women, the rate is going up, with the result that in spite of new methods, the overall national unintended pregnancy rate has not fallen.

WE NEED TO DO MORE TO PREVENT UNINTENDED PREGNANCIES

In addition to the impact on the planet, the consequences for the individual are grim. An unintended pregnancy may keep a woman from finishing her education, and this in turn will influence her career; her ability to earn; her likelihood of poverty; and the trajectory of her entire life. With so much at stake, we should be doing much more to help her with one of the most important aspects of her life, the ability to choose if and when she wants a child. In school, we’re used to talking about the importance of getting good grades or where she’s going to college, but an unintended pregnancy will influence her life far more than either of these. We need to put as much emphasis on preventing unintended pregnancy as we do on grades or college. And in our primary care practices, we should keep in perspective the fact that contraception will have a far greater impact on her life than many of the things we routinely do, such as for example, pap smears.

TECHNIQUES THAT WORK FOR PREVENTING UNINTENDED PREGNANCIES

We know from the CHOICE program in St. Louis, which included 1,404 teens, that by counseling, encouraging the use of LARC (Long Acting Reversible Contraception), and by making contraception free, we can greatly reduce the number of unintended pregnancies. When we compare these approaches to the national statistics, we find that these approaches reduced the number of teen births by 80% and reduced the number of abortions by 75%.

The CHOICE project also showed that with LARC choices such as IUDs or implants, 85% of women are using them a year later. In the case of prescriptions for birth control pills there was only a 50% chance that a woman would still be using birth control pills a year later. LARC methods aren’t right for every woman, but most do well with it, including sexually active teens as young as 14 years old.

Implants and IUDs result in less than one pregnancy per 100 women per year, making them the most effective reversible family planning methods. Withdrawal or spermicides are the least effective, resulting in roughly 30 pregnancies per 100 women per year.

GET RID OF THE BARRIERS TO EFFECTIVE CONTRACEPTION

It is a lot easier to write a prescription than to insert an IUD or implant, but the IUD and implant are far more effective. If no one in your practice has been trained in IUD or implant insertion, try to have someone get the training, since your patient may not act on your referral. Try to have IUDs or implants available at the time of the first visit, since she may not come back for the follow-up visit. Also, keep in mind that cost is no longer the barrier it once was, partly because of better insurance coverage, and partly because nonprofits are making IUDs available for $50 in the public sector, as opposed to the $300-$500 that IUDs recently cost.