Is it time for easier access to contraception?
Posted by on December 10, 2012 - 2:22pm

Several health experts are proposing to make the birth control pill available in the U.S.  without a prescription (as they are in many parts of the world). The American College of Obstetricians and Gynecologists (ACOG)  released a statement calling for oral contraceptives to be sold over-the-counter, no longer requiring a doctor’s prescription.

ACOG considered a host of issues, including the safety of birth control pills; whether pharmacists should have a screening role (which could raise the moral objection issue) ; adherence to taking the pill; whether women would skip other preventive care if they didn’t visit a health care provider for a prescription; and cost.

ACOG addresses frequent objections to OTC oral contraceptives by concluding that “several studies have shown that women can self-screen for contraindications,” and “cervical cancer screening or sexually transmitted infection (STI) screening is not required for initiating OC use and should not be used as barriers to access.”

ACOG recognizes  making the pill non-prescription might increase the cost for women who have health insurance which would only pay for prescribed drugs, and would have to pay out-of-pocket for the over-the-counter version.

The National Latina Institute for Reproductive Health issued this response to that concern:    The recommendation that birth control be available over-the-counter supports what we know about Latinas and contraception: over-the-counter access will greatly reduce the systemic barriers, like poverty, immigration status and language, that currently prevent Latinas from regularly accessing birth control and results in higher rates of unintended pregnancy.

Pre-Prescribing Emergency Contraception to Teens
On a similar issue, the American Academy of Pediatrics(APP), issued a statement recognizing high teen birth rates in the United States and barriers to access to emergency contraception for adolescents 17  and younger. The AAP strongly admonishes pediatricians who refuse to discuss or provide contraception to teens based on their own beliefs, stating:

  • Pediatricians have a duty to inform their patients about relevant, legally available treatment options to which they object and have a moral obligation to refer patients to other physicians who will provide and educate about those services. Failure to inform/educate about availability and access to emergency-contraception services violates this duty to their adolescent and young adult patients.
  • The AAP recommends that physicians provide prescriptions to emergency contraception like Plan B in advance, so teens have it ready if and when the need arises. They also urge physicians to provide accurate information to teens on this topic, and, “At the policy level, pediatricians should advocate for increased nonprescription access to emergency contraception for teenagers regardless of age and for insurance coverage of emergency contraception to reduce cost barriers.”

HHS Urged to Remove Restrictions on Emergency Contraception
Finally, a petition is circulating urging the U.S. Department of Health and Human Services to remove restrictions on emergency contraception and make it available to women of all ages without a prescription.

SOURCE:  Our Bodies, Our Selves

More women choosing IUDs
Posted by on September 4, 2012 - 1:50pm

A growing number of U.S. women may be opting for intrauterine devices (IUDs) as their birth control method, a national survey finds.  That's good news, researchers say, since IUDs and contraceptive implants are the most effective forms of reversible birth control.

In the U.S., though, they are still far from the most popular, with use lagging well behind birth control pills and condoms.   In the new study, researchers found that in 2009, 8.5 percent of U.S. women using birth control chose an IUD or implant - with the large majority going with the IUD.

That was up from just under four percent in 2007, according to findings published in the journal Fertility and Sterility.

"We saw some pretty notable growth," said lead researcher Lawrence B. Finer of the Guttmacher Institute in New York, a sexual and reproductive health organization.  Some of the possible reasons given:    medical societies, like the American College of Obstetricians and Gynecologists (ACOG), have endorsed IUDs and implants; and an increase in advertisements for IUDs.

ACOG says the devices should be offered as "first-line" options for most women, because of their effectiveness and safety.

IUDs are implanted in the uterus, where they release small amounts of either copper or the hormone progestin to prevent pregnancy.   It is estimated that with IUDs, between 0.2 - 0.8 % of women will have an unplanned pregnancy.  It is effective for 5-10 years depending on the device.   The contraceptive implant, about the size of a matchstick, is inserted under the skin of the arm, where it releases controlled amounts of progestin.  The rate for unplanned pregnancy with implants is 0.05% and it works for 3 years.

"They are basically ‘set and forget' methods," Finer said.

In contrast, the Pill and condoms must be used perfectly to be most effective. And with the way people typically use them, the unintended pregnancy rate is about 9.0%  per year.    With condoms alone, it's between 18 and 21 percent.

More could be done to encourage U.S. women to opt for IUDs and implants, according to Finer.    In some other countries, the devices are much more popular: in France and Norway, for example, about one-quarter of women on birth control use IUDs or implants. And in China, a full 41 percent do, Finer's team says in its report.

SAFETY MISCONCEPTIONS

When IUDs first came out, there were concerns that they might raise the risk of pelvic infection and jeopardize women's future fertility. So the original IUD labeling said the devices were contraindicated for women who'd never had children.   But it's now known that IUDs do not carry those risks.     "Many doctors continue to have outdated ideas about who can and cannot use an IUD," Finer said.

Cost may be another issue keeping women from using IUDs and implants.   The devices have a big upfront cost: the price of an IUD is $500-900 which does not include the doctor's charges for putting them in.    The Implanon implant costs between $400 and $800, with all charges considered.

Since the devices last for years, they are cost-effective in the long run, Finer said.

Birth control pills, for instance, cost anywhere from about $10 to $50 per month, depending on whether a woman uses generic or brand-name pills.   Finer said that may change, though, with healthcare reform. The new law considers birth control part of preventive healthcare, and most health plans must cover it without co-pays and deductibles.

IUDs and implants can have unwanted side effects, however. With the implant, irregular menstrual bleeding is most common; some women stop having their periods altogether.

"There's no one best birth control method for all couples," Finer said.    But he added that now that many couples are putting off having children until their 30s, more women may want to consider long-acting birth control options.

SOURCE: http://bit.ly/MRSbZO Fertility and Sterility, online July 13, 2012.

Reuters Health
Newer Contraceptive Methods Needed Among Developing Countries
Posted by on May 23, 2011 - 8:24am

Seven out of 10 women in Sub-Saharan Africa, South Central Asia and Southeast Asia who want to avoid pregnancy but are not using modern contraceptives report reasons for nonuse that indicate currently available methods do not satisfy their needs, according to new Guttmacher research. The findings suggest that substantially bringing down unintended pregnancy rates in these developing regions will require increased investment in the development of new methods that better address women’s concerns and life circumstances.

The report, Contraceptive Technologies: Responding to Women’s Needs, focuses on the three regions that together account for the majority of women in the developing world with an unmet need for contraception. Overall, 40% of pregnancies in these regions—about 49 million—are unintended. Each year, these pregnancies result in 21 million unplanned births, an equal number of abortions (three-quarters of which are unsafe) and 116,000 maternal deaths.

“The findings make clear that meeting the need for contraception requires not only increased access and counseling, but the development of new methods that better meet women’s needs,” says Jacqueline E Darroch, senior fellow at the Guttmacher Institute and one of the study’s authors.

To gain insight into why so many women in developing countries are not using modern contraceptives, researchers analyzed nationally representative data from Demographic and Health Surveys and other sources. They found that the majority of women with an unmet need for contraception are 25 or older and live in rural areas, and about four in 10 are poor. The reasons women most frequently given for not using a method are concerns about health risks or side effects (23%); infrequent sex (21%); being postpartum or breast-feeding (17%); and opposition from their partners (10%).
The findings shed light on the types of methods that could have the greatest impact on increasing contraceptive use: Developing new contraceptive methods that have negligible side effects, are appropriate for breast-feeding women and could be used on demand has the potential to greatly reduce unmet need for contraception. So would methods that women can use without their partner’s knowledge.

The report shows that overcoming method-related reasons for contraceptive nonuse could reduce unintended pregnancy by as much as 59% in these regions. Unintended births and induced abortions could be reduced by similar proportions, and 70,000 maternal deaths could be prevented. However, the researchers note that new contraceptive methods alone will not overcome all reasons for nonuse. Other causes, including poor access to and quality of contraceptive services must also be addressed.

Currently, 104 million women in Sub-Saharan Africa, South Central Asia and Southeast Asia have an unmet need for modern contraceptive methods because of method-related reasons. Taking into account projected population growth, this number will increase to 161 million in the next four decades if concerns about currently available methods are not addressed. The researchers note that there has been a lack of attention and resources dedicated to contraceptive research and development, and that there is a vital, immediate need to reinvigorate the field.
In addition to long-term work to develop new contraceptive methods, they point out that adaptations to current methods could make them more widely acceptable and easier to use. They conclude that immediate headway toward satisfying unmet need could be made by ensuring that women and couples receive more accurate information about the risk of unintended pregnancy and have greater access to quality counseling and services that offer a range of methods.
The report, Contraceptive Technologies: Responding to Women’s Needs, was funded by a grant from the Bill & Melinda Gates Foundation. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation.
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Source:  Guttmacher Institute