With no budge in more than 20 years, are US unintended pregnancy rates finally on the decline?
Yes.
In 2008, the rate of unintended pregnancy was 54 per 1,000 among women and girls aged 15 to 44 years. In 2011, this rate dropped by 18%, to 45 per 1,000. Reducing the number of unintended pregnancies in the United States has been a challenge for decades, but increased use of long-acting reversible contraceptive methods could account for this recent decline in the unintended pregnancy rate in the United States, according to an analysis of trends.
Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008−2011. N Engl J Med. 2016;374(9):843–852.
The study authors concede that some of the reduction in unintended pregnancies can be attributed to the economic recession that occurred during the study time frame, when many women intentionally reduced or delayed childbearing. The more likely explanation, they point out, is the increased use of long-acting reversible contraception (LARC), particularly the intrauterine device (IUD). Notably, among US women using contraception, the rates of IUD use increased from 4% in 2007 to 12% in 2012.2
Nevertheless, while the unintended pregnancy rate has shown improvement, the rate in the United States still lags considerably behind that of other industrialized nations. In Western Europe, for example, the unintended pregnancy rate was 34% in 2012.3
What this evidence means for practiceAs the study data suggest, use of contraceptive methods that do not rely on a frequent activity by the user, such as LARC methods, is associated with improved adherence. Consequently, all LARC methods, including the IUD, are associated with a pregnancy rate of about 1% or less; this rate is equal to or better than the rates seen with many forms of tubal sterilization, and it is superior to that seen with other methods, such as oral contraceptives, which have a contraceptive failure rate of about 9%.4
,Finally, to correct disparities noted in this study that may be related particularly to access to contraceptive methods, the Affordable Care Act contains provisions that should lead to greater availability of contraceptive services in the United States.
—Ronald T. Burkman, MD
Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.
