EditorialThe potential of long-acting reversible contraception to decrease unintended pregnancy
Section snippets
The problem
The 80 million unintended pregnancies that occur worldwide each year (38% of all pregnancies) can justifiably be deemed an “epidemic.” These pregnancies result in 42 million induced abortions and 34 million unintended births — births that contribute substantially to the annual world population growth of 78 million [1], [2].
Among developed countries, the US record of family planning is uniquely deficient. Of 6.1 million pregnancies in 2001, half were unintended (as were more than 80% of the
The potential of long-acting reversible contraception methods
Long-acting reversible contraception (LARC) methods, including intrauterine contraceptives and implants, have a proven record of very high effectiveness, many years of effectiveness, convenience, cost effectiveness, suitability for a wide variety of women and, in general, high user satisfaction [7], [8], [9], [10], [11], [12], [13], [14]. With typical use, the first year failure rate of the copper T 380A (ParaGard®) is 1%, the LNG-IUS (Mirena®) is 0.1% and the implant available in the USA
Barriers to increased use of LARC
Use of LARC in both the USA and worldwide will not reach its full potential until a number of barriers are addressed:
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Providers both lack information and are misinformed. Providers continue to be concerned about IUC use due to unsubstantiated risk related to STIs, ectopic pregnancy, infertility, use postpartum, use postabortion, use by nulliparous women, use by teens, patient acceptability and legal matters. A study of 816 contraceptive providers serving low-income clients through California's
Recommendations for action
Past experience with the successful introduction of new contraceptives, or reintroduction in the case of the IUC, provides guidance to improve provision and use. Recommended activities include the following:
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Undertake research to determine why provider practices are not evidence based, to elucidate health system barriers and to inform the design of interventions to encourage provision.
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Develop information and training materials to address knowledge gaps and misinformation, as well as
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2022, BMC Women's Health