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Current Issues
Prescribing Habits to Reduce the High Rate of Unintended Pregnancy
a report by
Anita L Nelson, MD
Professor, Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles
The Centers for Disease Control (CDC) recognized family planning with poses an even lower threat. However, there the similarities between those
condoms and birth control pills as one of the top 10 public health conditions end. A recent study of women who conceived without
accomplishments of the 20th century.
1
Family planning is one of the most intending to (but had used no contraception) found that over 40% of
cost-effective medical interventions, rivaling the cost-effectiveness of those women thought they could not get pregnant and another 30% were
vaccination. Every $1 of investment in family planning in the public really ambivalent about conceiving.
10
While some heart attack victims are
sector reduces immediate healthcare costs by at least $4, but varies by surprised when they have an MI, no one is ever ambivalent about suffering
method.
2,3
When longer-term costs are included, analyses have shown a a heart attack.
total saving of over $14 for every dollar spent.
4
Both maternal health and
infant outcomes are profoundly improved when pregnancies are planned Current Utilization Patterns
and prepared for. Contraception is unique in enabling couples to achieve A recent analysis of the largest US database of prescription refill patterns
that goal. Male condoms reduce the transmission of some of the most revealed that only 21–31% of women consistently refilled each of their
common sexually transmitted infections.
5
Current levels of contraceptive hormonal contraceptive prescriptions for 12 months on a timely basis (within
use in sub-Saharan Africa reduced births of HIV-infected newborns each two weeks of their anticipated re-fill date).
11
It is clear that this was a very
year by 173,000, which is significantly more than antiretroviral agents did generous definition, since even a two-week interruption in method use puts a
over three years.
6
Contraceptive use has also reduced numbers of HIV- woman at risk for pregnancy. Possession of the method does not guarantee
orphaned young children. As impressive as these accomplishments are, that women will use the method correctly and consistently. In their classic
the full potential of birth control has still not been realized. Almost half study, Potter et al. used computer chips embedded in the medication bottles
of unintended pregnancies occur in women who report that they used to automatically record the date and time the pills were taken from the
contraception during the month they conceived.
7
Nine out of 10 bottle. They found that more than 54% of women missed three or more pills
pregnancies that occur when a woman is using contraception result from of each pack by the third cycle of use.
12
A study of short-term use of depot
incorrect or inconsistent method use.
8
This article explores many of the medroxyprogesterone acetate (DMPA) found that of those women who did
real-world barriers to successful utilization of contraception and outlines return for re-injection, an average of 17.5% were late.
13
Similarly, even in a
many relatively new practice protocols and prescribing habits that have clinic where condoms were generously provided free of charge, only 56% of
been introduced to help close the gap between the potential pregnancy ‘condom users’ reported consistent condom use with every act of intercourse
protection that various methods offer and the pregnancy protection that in the previous two weeks.
14
In part, the failure of emergency contraception
is routinely realized in typical use (see Table 1).
9
(EC) to significantly reduce unintended pregnancy at a population level
15–17
can
be easily explained by the sheer magnitude of unprotected coital acts.
18
Contraception shares many of the same challenges that other preventive
health interventions face. For example, women with hypertension are also New Approaches to Enhance Contraceptive Success
often asymptomatic; antihypertensive medication only reduces a woman’s Several new developments in contraception have addressed the problems of
probability of suffering a myocardial infarction (MI), and non-use does not inconsistent and incorrect utilization of reversible methods of birth control. First
guarantee that the woman will actually have a heart attack. Sexually active has been the increasing use of long-lasting methods that require virtually no
women also face only a chance of pregnancy. The risk of pregnancy with effort to ensure contraceptive success (intrauterine devices [IUDs] and implants)
unprotected intercourse for one year is 85%; any single risk-taking episode and of different delivery systems that significantly reduce the need for frequent
administration (vaginal rings and transdermal patches). Second, there have
been changes in prescription practices to reduce many of the significant
Anita L Nelson, MD, is a Professor of Obstetrics and Gynecology
at the David Geffen School of Medicine at the University of
barriers women encounter as they try to gain access to contraception. Finally,
California, Los Angeles (UCLA). She is Chief of Women’s there have been new developments in many of the birth control methods that
Healthcare Programs at Harbor UCLA Medical Center, a
incentivize correct contraceptive use. There are still financial challenges that
Researcher at the Los Angeles Biomedical Research Institute,
and Medical Director of Research for the California Family
women face when trying to gain access to effective methods of birth control.
19
Health Council. Dr Nelson has published extensively in the areas
of contraception, gynecological infection, and outpatient care.
Longer-acting Methods
E: anitalnelson@earthlink.net The top tier methods of birth control (IUDs and implants) reliably deliver a
first-year failure rate of less than 1% in typical use simply because they are
14 © TOUCH BRIEFINGS 2008
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