World Contraception Day

world-contraception-day

Today, September 26th, is World Contraception Day (WCD). Now in its ninth year, WCD envisions a world where every pregnancy is wanted and women are empowered with the resources and knowledge to make informed decisions about their sexual and reproductive health. Part of the larger Family Planning 2020 mission, WCD takes a multi-faceted approach to women’s health, encouraging increased sexual education, improved access to health care services, and eliminating challenges to cultural taboos based on myth or misconception.

As women’s health care providers, this mission aligns with our everyday efforts.  We counsel and educate our patients, helping their personal and professional goals align with their sexual and reproductive choices. Empowering women with choice and control over their contraceptive choices and family planning leads to happy and healthy individuals and families. Continue reading

ADMs, CME, and You: Just What the Doctor Ordered

I have almost completed the “sweep” of our fall Annual District Meetings. Once again, I’m impressed with the dedication of my ob–gyn colleagues across the United States. These meetings are proving to be educational, collegial, and administrative. I say ”administrative” because we discuss the “goings on” of each region, including the political factors impacting each of our states, the public health dilemmas we face, and the effect of changing practice patterns. I look forward to these information exchanges and to sharing insights with my colleagues about the forces influencing our practices and our patients.

For me, the educational component of the ADMs has been most exciting. In a time when physicians are increasingly getting their CME online, the ADM courses provide more than just the course information. They provide perspective and insight from the experts in the field in real time. At the District I, III, and IV ADM in Puerto Rico, Jeffrey F. Peipert, MD, PhD, argued for a paradigm shift in our approach to contraception in his presentation about the St. Louis CHOICE Project. With wider use of LARC (long-acting reversible contraception), we can significantly reduce our nation’s high rate of unplanned pregnancies and abortions and start to see healthier pregnancies. Dr. Peipert provided abundant pearls about how easy LARC is to provide to our patients and how it can improve reproductive health outcomes. We can all use this valuable information in our practices.

At the same ADM, Louis J. Guillette, PhD, gave a rousing talk about the impact of the environment on reproductive health. As it turns out, we both did research at the University of Colorado at almost the same time and even shared members of our thesis teams. Who would guess that our paths would cross 35 years later around shared interests? Dr. Guillette’s message: Increase awareness among our patients—without alarming them—about the vast amount of research implicating environmental factors on our health. And, Deborah A. Driscoll, MD, helped to simplify for us the complex world of genetic testing and familial cancers. Thanks to her, genomic microarray-based technologies are now part of our vocabulary.

Increasingly, physicians are earning more of their CME online. The reality is we are all crunched for time and online CME opportunities are valuable options. But online courses don’t allow for that in-person learning that is so often accompanied by practice pearls. Nor do they provide an opportunity for us to have personal, individual conversations with our colleagues which are so important. I hope that you’ll make plans to attend your next ADM…it’s definitely worth your time.

Remember, registration for the 2014 Annual Clinical Meeting in Chicago opens November 5, just a few weeks away!

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A Positive Step Toward Preventing Unplanned Pregnancy

The recent US recession did more than make us simply tighten our belts. It’s made many families think long and hard about contraception and when to have children. Research has shown that more women are delaying pregnancy since the start of the recession.

Tough economic times have also led to an increased need for publicly funded family planning services, especially among poor women, who are more likely to have an unintended pregnancy than women of higher socioeconomic status. Today, the Guttmacher Institute released some encouraging statistics—researchers found that publicly funded family planning efforts led to 2.2 million fewer unplanned pregnancies in the US in 2010. Guttmacher estimated that if not prevented these pregnancies would have resulted in more than 1 million unplanned births and more than 760,000 abortions. Additionally, the study showed that every dollar spent on contraceptive services yields $5.68 in public health care cost savings.

These new data underscore what women’s health professionals have known all along: that publicly funded family planning services provide an invaluable safety net for reproductive-age women. It’s great news to see these programs make a real difference in preventing unplanned pregnancy and its consequences.

ACOG has long supported the expansion of the Title X Family Planning program—the nation’s only family planning program dedicated to serving low-income and uninsured individuals regardless of their ability to pay. We will continue to advocate on behalf of the nearly 9 million women who use publicly funded services to ensure that all women—no matter their income—have access to the reproductive health services they need.

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Guest Blog: Every Reproductive-Age Woman At Risk, Every Time

Frances Casey, MD

Frances Casey, MD

Full implementation of the Affordable Care Act (ACA) will remove many of the financial barriers women face to obtain effective methods of contraception. While making contraception affordable for every woman is a good first step toward improved prevention of unintended pregnancies, it remains the responsibility of health care providers to counsel women about all methods of contraception and help them find the one that may be the most effective.

The CHOICE project demonstrated that removing financial barriers related to the most effective methods of contraception decreases rates of unintended pregnancy and abortion. But the CHOICE project also did something many of us ob-gyns do not. Every reproductive-age woman eligible for the study was read a script about the effectiveness of long-acting reversible contraceptives (LARC), such as intrauterine devices (IUD) and hormonal implants.Instead of discussing LARC with their patients, many providers continue recommending less effective contraceptive methods based on misconceptions that adolescents, women who have never been pregnant, or women they estimate are at high risk for sexually transmitted infections (STIs) are not good candidates for LARCs. However, according to ACOG, LARC is the most effective form of contraception available and safe for use in all of these groups.

Because LARCs don’t require ongoing effort by the user, continuation and correct usage rates are higher. This could significantly reduce unintended pregnancy among teens and women if widely adopted. Additionally, women at high risk of both STIs and unintended pregnancy can be screened, obtain a LARC method the same day, and receive treatment without removing the device. Women with medical conditions and physical and mental disabilities can also benefit from both the pregnancy prevention and the non-contraceptive benefits of LARC.

Other women may also benefit from a longer-acting option. Without strict breastfeeding, postpartum moms are at risk for ovulation and repeat pregnancies even earlier than six weeks after delivery. LARC methods can be inserted immediately following delivery or at four weeks postpartum. Despite slightly higher expulsion rates, the benefits of immediate postpartum insertion of LARC methods may outweigh risks for women who are unlikely to receive postpartum care.

Minimizing financial barriers will make contraceptive methods more accessible for women at risk of unintended pregnancies, but it is up to us, as their partners in prevention, to counsel them on the most effective methods, including LARCs, at every opportunity.

Frances Casey, MD, is a Family Planning Fellow at Washington Hospital Center in DC.

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Guest Blog: The Recipe for Preventing Unintended Pregnancy

Erika E. Levi, MD, MPH

Ob-gyns are on the front lines of the effort to decrease the rate of unintended pregnancy, which accounts for half of all pregnancies in the US. Now, we have more information about how we can best accomplish this goal.

Recent findings from the Contraceptive CHOICE Project made news headlines, and for good reason. The project—which included more than 9,000 contraception-seeking adolescents and women in the St. Louis region who were at risk for unintended pregnancy—found that the rate of unintended pregnancy dropped with just two simple interventions. Women were given:

  1. A short contraceptive counseling session that covered all methods of reversible contraception and emphasized the superior effectiveness of long-acting reversible contraception (LARC) methods: intrauterine devices (IUDs) and hormonal implants.
  2. The contraceptive method of their choice for free.

Seventy-five percent of the women selected a LARC method. Among all the women, there were lower rates of abortion, including repeat abortion, and lower rates of teen births. These findings support ACOG’s recommendations on the use of LARC methods as first-line contraceptive options to reduce unintended pregnancy and highlight the benefits of providing women with no-cost access to contraception.

ACOG advises ob-gyns to:

  • Provide counseling on all contraceptive options, including implants and IUDs, even if the patient initially states a preference for a specific contraceptive method
  • Encourage implants and IUDs for all appropriate women, including those who’ve never given birth
  • Adopt same-day insertion protocols. Screening for STIs may also occur on the day of insertion, if indicated
  • Avoid unnecessary delays to LARC initiation, such as waiting for a follow-up visit after an abortion or miscarriage or waiting to time insertion with the menstrual cycle
  • Advocate for coverage of all contraceptive methods by all insurance plans
  • Support local, state, federal, and private programs that provide contraception, including IUDs and implants

The problem of unintended pregnancy in the US is not going away. As ob-gyns, we are uniquely positioned to help women avoid unintended pregnancies. Let’s work with our patients and help them make the best choices for their reproductive health.

Erika E. Levi, MD, MPH, is a Family Planning Fellow at the University of North Carolina at Chapel Hill.

Guest Blog: Prevent Teen Pregnancy on a LARC

Elisabeth J. Woodhams, MD

In my Chicago clinic I see a lot of adolescents, and by extension, I prescribe a lot of contraception. Although, by “prescribe contraception” I actually mean “place IUDs and implants,” which, until recently, had been considered a fairly edgy clinical practice in some circles. Imagine my excitement, then, over ACOG’s latest recommendations from the Committee on Adolescent Health Care and the Long-Acting Contraception Work Group that encourage us to offer these two contraceptive methods as first-line options for sexually active teens.

Family planning specialists have long known that long-acting reversible contraception (LARC) devices are safe for adolescents and are significantly more effective at preventing pregnancy when compared with other forms of short-acting contraception, such as pills, patches, or vaginal rings. In fact, a recent study found that women using a LARC device were 20 times less likely to experience an unplanned pregnancy than women using short-acting methods. This is hugely important considering that:

  • 82% of adolescent pregnancies are unplanned
  • 20% of adolescent mothers will experience a second pregnancy within two years of their first pregnancy
  • Condoms are the most common method of contraception used by adolescents. While still important for preventing sexually transmitted infections (STIs), they are the least effective contraceptive method for preventing pregnancy.

LARC methods work better than short-acting ones because there’s no user error. As I tell my patients, a pack of pills only works if you’re actually taking them. Also, the continuation rates are better—in that same study, 86% of adolescents using a LARC device were still using it a year later, compared with 55% of those using a shorter-acting method.

And LARC methods are very safe for adolescents:

  •  IUD expulsion is uncommon in adolescents
  • There is no increased risk of infertility for IUD users
  • Any increased risk of pelvic inflammatory diseases (PID) is limited to the first 20 days after insertion of an IUD and is related to infection at the time of insertion rather than the IUD itself. This is another important reason ob-gyns should screen all their patients under 25 for chlamydia and gonorrhea annually.
  • IUDs and implants can be placed immediately post-delivery or post-abortion
  • IUDs and implants can decrease menstrual blood loss and decrease anemia, a plus for many teens

So make sure LARC methods are at the top of your list when you’re counseling adolescent patients. For many teens, LARC devices—combined with condoms for STI prevention—are the best way to ensure they get on the right reproductive track early.

Elisabeth J. Woodhams, MD, is a Family Planning Fellow at the University of Chicago in Illinois.

 

Access to Contraception Is Every Woman’s Right

You’d have to be living under a rock to have missed the recent political and culture debates about contraceptive access and coverage. Having practiced ob-gyn since the early 1970s, I can tell you that contraception is a fundamental part of women’s health care, just as important as Pap screening, prenatal care, and breast exams. ACOG has long advocated for the right of women to obtain contraception, expanded access to and coverage of it, and a doctor’s ability to prescribe contraception to his or her patients.

More than 80% of reproductive-age women will use contraception for a wide variety of reasons, not just for birth control. Hormonal contraceptives can help with gynecologic problems such as endometriosis, menstrual cycle irregularities, fibroids, and premenstrual syndrome. They also treat acne, improve bone density, help with perimenopausal symptoms, and reduce the risk of certain cancers.

Of course, many women use contraception to avoid pregnancy. However, not enough do, because roughly half of the pregnancies in the US are unintended. Unplanned pregnancies often cause undue strain on women, their families, and society. Lack of access and affordability of contraception deprives a woman of her right to plan a pregnancy at a time that makes most sense for her. Clearly, any campaign to reduce unintended pregnancy must be coupled with a comprehensive program of sex education and easily accessible options for contraceptive health.

I take pride in the fact that my patients turn to me for advice and guidance about medical issues, healthy lifestyle, screenings, immunizations, and their contraceptive needs. I trust that women know what’s best for their lives and their bodies. I also know that contraception is a basic necessity used to protect and improve women’s health. And I am not alone. I stand with ACOG in putting women first. I fully support the right of all women to unimpeded contraceptive access.

Birth Rates Drop During Recession

Raising a family is an expensive proposition. The estimated cost of raising a child born in 2010 until age 17 is almost $287,000. So it came as no surprise when the Pew Research Center released a recent report showing a decline in birth rates since the recession began in December 2007. Since then, the rate has dropped from 69.7 births per thousand women aged 15 to 44 to 66.7 births in 2009.

The drop was most pronounced among Hispanics. Between 2008 and 2009, the birth rate among Hispanics fell almost 6% compared with African-Americans who experienced a 2.4% decline, and whites who had a 1.6% drop. Experts say people are postponing having children because they don’t have the necessary financial resources. But regardless of the economy—planning a pregnancy always makes sense.

Unintended pregnancies can have significant health consequences for both mother and baby, especially if women don’t get prenatal care early and often. Decisions about family planning are at the core of a woman’s wellbeing and will have lasting repercussions over her entire lifespan. In good times and bad, it’s important to use a method of birth control that’s right for you. Take charge of your health now.