FROM AN ACOG WEBINAR
Long-acting reversible contraception can lead to significantly decreased rates of pregnancy, abortion, and births among teenagers in the United States, according to a web presentation given by the American Congress of Obstetricians and Gynecologists.
“Teen birth is a public health issue,” said Dr. Melissa Kottke, director of the Jane Fonda Center for Adolescent Reproductive Health at Emory University, Atlanta, adding that teen birth is not only an outcome and predictor of poverty, but has a proven correlation with poor education attainment for teen mothers and is a $9 billion burden for taxpayers in the United States.
Long-acting reversible contraception (LARC) involves two methods of contraception, the intrauterine device (IUD) or the birth control implant, which are effective and reversible ways of preventing pregnancies for as long as several years. The IUD can be either hormonal, which releases progestin into the uterus and is effective for up to 5 years, or a copper IUD, which can be effective for up to 10 years. The implant method involves placing a small device in the patient’s arm, which secretes progestin to stop ovulation. According to ACOG, LARC methods result in fewer than 1 in 100 women getting pregnant during the first year of use, which is statistically similar to rates of outright sterilization.
Dr. Kottke cited a 2012 CHOICE study, published by the New England Journal of Medicine and conducted by researchers at Washington University in St. Louis, which enrolled 1,404 teenagers and gave them the option of choosing either shorter-acting contraceptive methods (28% chosen) or LARC (72% chosen); results showed that unintended pregnancies were 20 times more likely in teens who chose contraceptive methods like pills, patches, and rings than they were in teens who chose LARC ( N. Engl. J. Med. 2012;366:1998-2007 ).
Another study, known as the 2014 Colorado Family Planning Initiative (CFPI) published by Perspectives on Sexual and Reproductive Health, used private funds to provide LARC methods free of charge in 37 of Colorado’s 64 counties between 2008 and 2011. Over that span, LARC use among 15- to 24-year-olds increased from 4.5% to 19.4%, with insertion ratios for low-income young women increasing from 1:170 to 1:15. Annually, LARC insertions increased from 620 to 3,159 in 2008 and 2011, respectively ( Perspect. Sex. Reprod. Health 2014;46:125-32 ).
Counties which opted to receive LARC funding saw a 24% decrease in high-risk pregnancies, as opposed to just a 6% decrease in non-LARC counties. Abortion rates also fell by 34% and 18%, respectively, and LARC counties saw a 23% decrease in infants served by the federal Women, Infants, and Children’s (WIC) program.
Noting that rates of teen pregnancies, abortions, and births are at an all-time low across ages, ethnicities, and states, Dr. Kottke advised that while there is a lot of good news, there is also “an element of caution” that must be heeded: repeat teen births in the United States are still high, and must be reduced dramatically. Using LARC, she said, could help effectively combat this problem.
Around 66,800 repeat teen births occurred in the United States in 2010, all of which were in girls between the ages of 15 and 19 years. Of those, 57,200 were second births, 8,400 were third births, and 1,200 were in mothers giving birth to at least their fourth child. About 1,700 teenagers aged 15-17 years give birth each week, according to figures from the Centers for Disease Control and Prevention, and one in four teen births in the United States affect girls aged 15-17 years. However, Dr. Kottke noted that birth rates for girls aged 10-14 years have dropped to their lowest rate since the United States government began recording these statistics.
Dr. Kottke concluded by stating the importance of making pregnancy clinics and contraceptive information easily accessible for teenagers, adding the importance of respecting confidentiality, and making sure clinics and counselors are available outside of school hours so that teenagers can get the help and advice they need without having to miss out on school.
Dr. Kottke disclosed that she is an Implanon trainer with Merck. Several of her coinvestigators made similar disclosures.
