Both birth control technology and its use are imperfect. As such, approximately 60% of all pregnancies in the US are unplanned and unintended, with almost 45% of all live births being the result of unintended pregnancy. More than 50% of unintended pregnancies and 33% of all pregnancies in the US end in abortion. That emergency postcoital contraception (EPC) is used only rarely in the US is one reason why unintended pregnancy rates are higher in that country relative to other developed countries. EPC is a method for managing unprotected coital exposure by the pharmacologic or mechanical inhibition of fertilization or implantation. Knowledge and easy access to EPC could prevent an estimated 2.3 million unintended pregnancies per year in the US and reduce the number of abortions by 800,000 annually. The author stresses the moral and professional responsibility which family planning providers have to provide their clients with postcoital contraception.
Oral contraceptives (OC) were first introduced in the US in the early 1960s as an efficient, convenient, and reversible method of contraception. The pill has since undergone many changes. Most OCs prescribed today contain 35 mcg of estrogen and 0.5-1 mg of progestin, approximately one-third the estrogen and one-tenth the progestin in the original OCs. Considerable scientific research, economic analysis, and social marketing have yielded invaluable data on how OCs, the most popular form of birth control in the US, have affected the lives of women, men, and society overall. Researchers have also investigated the health risks and benefits of OC use. Both truths and myths exist about the effects of OC use. A 1993 Gallup poll conducted for the American College of Obstetricians and Gynecologists found that 65% of patients believe oral pill use to be at least as dangerous as pregnancy. 58%, however, were unable to name one non-contraceptive benefit of the pill. A 1995 Harris poll conducted for the American Medical Association found that although 96% of reproductive-age women considered themselves to be knowledgeable or very knowledgeable about contraception, 56% incorrectly believed a woman periodically needs to give her body a rest from OC use. The authors discuss the benefits and risks of using OC.
In 1995, researchers developed a model to compare the effectiveness and economic costs per person of different contraceptive methods. The model addressed the direct medical costs of method use, adverse and beneficial side effects, and unintended pregnancies. Indirect costs, such as the price of travel to and from a clinic, or loss of productivity in case of hospitalization, were not measured. All costs were evaluated from the perspective of both a private and a public payer. The study assessed the effects of all sexually active women of reproductive age in the US using each method for periods of 1, 2, 3, 4, or 5 years. 15 methods were compared. The outcome measure calculated for each was the number of pregnancies avoided, defined as the difference between the number expected to occur with no method and the number expected to occur using that method. The use of any of the evaluated methods proved to be more effective and less costly than using no method at all.
Women need accurate information about the various forms of contraception from which they may choose. Findings from four recent national telephone surveys conducted among reproductive-age women in the US since 1993, however, indicate that women in the US are not well informed or are misinformed about oral and other forms of contraception. Brief summaries are presented of the following surveys: the 1993 Gallup Organization follow-up survey conducted for the American College of Obstetricians and Gynecologists of 995 women's views on contraception, the 1995 Lou Harris and Associates telephone poll conducted for the American Medical Association of US women's attitudes and perceptions about reproductive health matters, the January 1996 Kaiser Family Foundation survey of 279 women's perceptions about contraception, and the Health Benefits of Contraception, ARHP survey of 280 women. The second part of this latter survey will be completed later in 1996. The common theme in the four surveys is that women do not have enough accurate information about contraception. Reproductive health professionals need to take advantage of every opportunity to provide such information, correct misperceptions, improve their counseling skills, and spread the word about the health benefits of contraception.
The Association of Reproductive Health Professionals (ARHP) has available a multimedia educational program informing physicians, nurse practitioners, clinical staff, and patients about Depo-Provera. It is called "New Developments in Contraception: Depo-Provera". The Upjohn company partially funded the program. It consists of 4 videotapes, 2 brochures, and a reference book on clinical proceedings. "DMPA: A New Contraceptive Option" is an 18-minute videotape giving an overview of Depo-Provera for physicians and nurse practitioners. It addresses pharmokinetics, efficacy, safety, side effects, patient selection, administration, and medical management of medroxyprogesterone acetate. "DMPA: Patient Counseling and Clinical Staff Procedures" is a 15-minute video including patient counseling scenarios and discussion of usual patient questions. Clients can view the "Choosing a Birth Control Method" video to get a balanced overview of 5 reversible contraceptives. It provides graphics, discussions between patients and providers, and patients' comments on their experiences with the various methods. The fourth video is a Spanish language version of the "Choosing a Birth Control Method" video. One brochure complements the "Choosing a Birth control Method" video; the other one "Questions and Answers About Birth Control Shots", centers on Depo-Provera. ARHP plans to distribute 55,000 copies of its multimedia educational program to health care professionals and to family planning and Planned Parenthood clinics in the US. This program advances and rounds out ARHP'S National Program to Prevent Unintended Pregnancy.
