Expert Commentary

Effectiveness of long-acting reversible contraception

2012 study published in The New England Journal of Medicine on a range of long-lasting contraceptive options and their failure rates.

Birth control pills (iStock)

While women in the United States have made great strides toward equality over the last century, significant challenges remain. Women still are paid far below what men earn for comparable work, they are underrepresented in government, and their right to reproductive health, including contraception, continues to be hotly debated in both politics and law. This is particularly ironic given that the U.S. rate of teen pregnancy continues to be significantly higher than those of other developed countries.

In August 2012, a provision of the Affordable Care Act took effect that requires new health insurance policies for women to provide contraception without co-pays or deductibles. A 2012 study published in The New England Journal of Medicine, “Effectiveness of Long-Acting Reversible Contraception,” looked at the failure rates of  long-lasting methods of birth control. The study was based on data from more than 7,000 women who were provided with no-cost reversible contraception of their choice —  IUD, implant, DMPA injection, pills, patch or ring — for up to three years. Each participant provided demographic information and was interviewed about her reproductive history at three and six months and every six months thereafter for the duration of the study.

The key findings include:

  • During the study period, 334 unintended pregnancies occurred. “Failure rates in the group of participants who used the pills, patch or ring were 4.8%, 7.8%, and 9.4% in years 1, 2, and 3, respectively; the corresponding rates in the group using IUDs or implants were 0.3%, 0.6%, and 0.9%.” IUDs and implants were thus 10 to 16 times as effective as the other long-term contraceptive options.
  • “Long-acting reversible contraceptive methods, including intrauterine devices (IUDs) and subdermal implants, are not user-dependent and have very low failure rates (less than 1%), which rival those with sterilization. Despite their proven safety … IUDs are used by only 5.5% of women who use contraception in the United States.”
  • Women using long-acting reversible contraception methods were least likely to be uninsured, with only 40% having no health care coverage compared to 42% of the users of pills, patches or rings and 58% for those who chose injections.
  • Of the participants who experienced an unintended pregnancy, nearly 50% were uninsured, compared to only 40% of who didn’t experience a birth-control failure.

The researchers concluded, “Long-acting reversible methods of contraception (IUDs or implants) were more effective in preventing unintended pregnancy than contraceptive pills, patch or ring and worked well regardless of age.”

Tags: gender, children

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