Female contraception has changed the world. By allowing women to control their reproduction, malady contraception dramatically reduces unwanted pregnancies and provides women with far greater opportunity to gain a higher education and well-paid employment.
While rhythm and barrier contraception methods provided some protection for generations, diagnosis the major step forward was the introduction of hormonal types of birth control. Regulators approved the first birth control pill in 1960 and within a few years the majority of married North American women were using it. For several decades “the pill” was patients’ and doctors’ first choice for contraception.
But in recent years, erectile two things have changed.
First, a growing proportion of unplanned pregnancies are due to contraceptive failure rather than failure to use contraception. That shed light on the fact that although the yearly rate of pregnancy for a sexually active woman on oral contraceptives can be as little as 0.3% (3 pregnancies per 1,000), the rate is 9% (90 pregnancies per 1,000) for a typical user.
That’s testimony to the fact that while the oral contraceptive is more reliable and easier to use than previous methods, it still requires effort and discipline. And the tendency to forget a pill or not take it at the right time is most common in teens and young women, the very groups that are most vulnerable to unwanted pregnancy.
The other change is the renewed acceptance of intrauterine devices (IUDs) as a safe method of contraception.
Women who are presently of reproductive age are too young to remember that the IUD rose in popularity parallel to the oral contraceptive until the early 1970s. That’s when a particular IUD, the “Dalkon Shield”, caused an unusually high number of pelvic infections, sometimes leading to permanent infertility and even death.
For the following generation, the IUD was widely considered unsafe. Even after research showed that the Dalkon Shield had a unique design flaw – a braided, multifilament string that helped bacteria to enter the uterus – women and their doctors shied away from any IUD.
However, IUD design changed and progressed: IUDs became smaller, more durable, easier to insert and safer. And though we previously believed that an IUD was only appropriate for a woman who had completed a pregnancy, newer studies demonstrated that an IUD could be safely used in any female of reproductive age.
The result is a change in recommendations for what we now refer to as long-acting reversible contraception (LARC), a term that includes both IUDs and hormonal implants that can be inserted under the skin. First, the American Academy of Pediatrics (AAP) 2014 Policy Statement advised that LARC should be the preferred contraceptive choice for adolescents. Then in September the American College of Gynecologists (ACOG) LARC Working Group stated that we can reduce undesired pregnancy by opting for LARC over other reversible contraceptive method (reversible meaning any method other than sterilization).
If you look at this table of contraception failure rates, it’s easy to understand why the recommendations have changed:
As you can see, IUDs are even more effective than sterilization and, as noted earlier, fail much less frequently than hormonal contraceptives. Moreover, the IUD’s effectiveness doesn’t depend on user behaviour; there is no difference between typical and perfect use.
Beyond contraceptive effectiveness, the IUD has an additional advantage: it’s less expensive than hormones and barrier methods, costing about $50 per year over the 5 year lifespan of a device.
Nevertheless, there are some negative aspects. Women experience some discomfort during the insertion procedure and some may find that the IUD makes their periods more unpleasant. There is also a small risk of complications, though they mostly related to inserting the IUD and very rarely lead to permanent harm.
As a just-released study of recent contraceptive use shows, women are responding to the message about the relative merits of LARC by increasingly choosing such methods. And the overwhelming majority of LARC users select the IUD.
Furthermore, some researchers believe that the trend toward women using LARC is responsible for the steady drop in abortion rates. Though others think that limits on abortion access have caused the reduction, reduced availability would’ve caused variation depending on local laws. But the trend is similar in every US state, which suggests that access isn’t a factor.
Instead, it appears that we are successfully reducing the number of undesired pregnancies. Given that we have no evidence of a widespread decrease in sexual activity or willingness to carry unwanted pregnancy to term that means that more effective contraception must be the underlying cause.
To summarize, LARC is more effective, easier to use and cheaper than the hormone-based contraception that women have predominantly used over the past half-century. As women’s awareness increases and time passes we can expect IUD use to grow and unintended pregnancy and abortion to continue their steady decline.