Contraceptive Use Patterns: It’s Time to Shift Our Thinking

October 31, 2011

Research presented at the ASRM's meeting shows that women at risk of unintended pregnancy are using some form of contraception. However there is a tendency for user dependent, short term contraception which has a higher failure rate than long term reversible contraception.

Despite the effectiveness and safety of long term reversible contraception, (LTRC), women continue to favor using short term reversible contraception (STRC).  This tendency for user dependent, short term contraception was brought to light when Kathy L. Schulman, of Outcomes Research Solutions Inc. in Bolton, Mass., and her colleagues evaluated data from the National Survey of Family Growth in 2002 and 2006 to 2008.

In her research, Ms. Schulman noted that while majority of women at risk for unintended pregnancy are using birth control, they rely more heavily on the forms that require a higher level of user dependency and accuracy.  “These types of contraception are highly user dependent, where as the user must consistently and accurately apply the birth control method to avoid pregnancy.   This is especially true of young, nulliparous woman, who are at risk of unintended pregnancy, “states Ms. Schulman.  “Typical use, first year, failure rates for the three most common methods of birth control (pill, male condom, withdrawal) range from a low of 8.7% for the pill to a high of 18.4% for withdrawal.  In contrast, the less user dependent, longer acting methods of birth control have first year, typical use failure rates that range from a low of 0.1% for the IUD Mirena and 1.0% for the Copper T IUD to a high of 6.7% for the 3 month injectable.“

Contraceptive use by age and parity varies greatly.  The research shows that Long Acting Permanent methods (LAP) (46.5% vs. 3.9%) and Long Acting Reversible methods (8.9% vs. 4.3%) are more commonly used in parous women who tend to be older (34.4 years vs. 25.2 years) and married (65.9% vs. 25.5%).  (Figure 2)  While Short Acting Hormonal Methods (STH) (17.1% vs. 51.0%) and Short Acting Barrier Methods (STB) (12.8% vs. 21.4%) are favored more prevalently by nulliparious women, with the highest use by the 25 to 29 year old group.  (Figure 3)
 


Figure 2
Distribution of Current Contraceptive Method by Age Group, Parous Women Only

(Images click open to full size)
 


Figure 3
Distribution of Current Contraceptive Method by Age Group, NulliParous Women Only


“The focus of education has been on the task of preventing pregnancy and how to use the method correctly but a new way of looking at education should be a shift towards the methods that are less user dependent.”  This shift of use could ultimately reduce the unintended pregnancy rate.

Ms. Schulman states, “Healthcare providers should note, when discussing the use of contraceptive and the options available, to take into consideration the patient, the degree of user dependency and the likely success rate.  Contraception that requires a higher rate of accurate and consistent user action is at a greater risk of failure.   Long term reversible contraception that is less user dependent should be discussed as a safe and reliable treatment option.  This is especially true with young, nulliparous women who are at risk of pregnancy. “

References:

Abstract:Contraceptive Use Patterns: Reversible, Permanent, Long and Short Acting Methods of Contraception K. L. Schulman, H. J. Cabral, A. Prezioso, J. Pocoski, L. A. Costa, A. W. Law Outcomes Research Solutions, Inc., Bolton, MA; Department of Biostatistics, Boston University School of Public Health, Quincy, MA; Health Economics and Outcomes Research, Bayer Healthcare Pharmaceuticals, Wayne, NJ