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LARCs are underutilized, even where Zika risk is high

 

Key clinical point: A Los Angeles County survey showed that most women surveyed were using less effective birth control methods.

Major finding: Of women surveyed who were using contraception, 20.6% were using a highly effective long-acting reversible contraceptive.

Data source: A population-based survey of 3,175 women in Los Angeles County who had previously given birth.

Disclosures: The study authors reported no outside sources of funding and no conflicts of interest.


 

AT ACOG 2017

 

– Los Angeles County officials report that few women surveyed are using the most effective contraceptive measures, a fact that concerns public health officials in an area at potential risk for local Zika virus infection.

With close to half of the births in Los Angeles County being unplanned and more than 59% of women reporting use of less effective contraceptive measures, educating providers on the why and the how of placing the most effective contraceptive measures could make a big difference, said Diana Ramos, MD, of the Los Angeles County Department of Public Health.

Dr. Diana Ramos Kari Oakes/Frontline Medical News
Dr. Diana Ramos
Dr. Ramos, who is the reproductive health program director for the department’s maternal, child, and adolescent health division, said that Los Angeles County is responsible for about one-quarter of the births in the state of California, with 131,000 live births annually. Additionally, Los Angeles County has been identified by the Centers for Disease Control and Prevention as one of the seven jurisdictions most at risk for local Zika virus transmission in the United States.

Los Angeles-area health care providers and public health officials are bracing themselves for a summer mosquito population explosion brought on by the West Coast’s very wet winter and spring of 2016-2017, Dr. Ramos said during a press briefing at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

This sets up the very real possibility of local transmission in the Los Angeles area in the summer of 2017, Dr. Ramos said, adding that the county has both Aedes aegypti and Aedes albopictus mosquitoes, two species capable of transmitting Zika virus.

Dr. Ramos and her colleagues drew from the Los Angeles Mommy and Baby (LAMB) project, a population-based survey of women who have recently given birth. As part of ongoing surveillance to assess whether the county is meeting the CDC’s Healthy People 2020 goals, the 2012 LAMB survey asked about preconception and perinatal experiences, including family planning methods used. From the 2012 survey, the investigators could then identify women who had not had a subsequent pregnancy. They excluded women who did not complete the family planning portion of the 2012 survey. A total of 3,175 women were queried in 2014 about their current family planning practices.

Overall, 28% of women said that they were using not using any form of birth control. The remaining women (n = 2,400) used a variety of methods, with condoms being the most common, used by 38.1%. Oral contraceptives were used by 15.6% of respondents, but nearly as many (14.8%) reported using the withdrawal method, and 6.1% said they used the rhythm method. An additional 15% reported that either they or their partner had undergone a permanent sterilization procedure. Vaginal rings were used by 1.7%.

Of the remaining women who were using birth control, 14.5% were using intrauterine devices, and 6.1% were using depot medroxyprogesterone acetate. These two methods of long-acting reversible contraception (LARC) represent some of the most effective methods to prevent conception, Dr. Ramos said. The fact that only one in five women is using these methods leaves room for provider and public education, she said.

Though some women used a combination of methods, the researchers estimated that about 59% of the women using any birth control were using methods proven to be less effective in real-world studies, including condoms, withdrawal, and the rhythm method.

Accordingly, she said her department is working with providers to expand awareness of the high efficacy rates and good safety profiles of LARCs, and also to educate the public that “the most effective contraceptive methods can decrease neonatal Zika complications by preventing unplanned pregnancies.” The hope, Dr. Ramos said, is to decrease the number of neonatal Zika cases.

Dr. Ramos and her coauthors reported no external sources of funding and no conflicts of interest.

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