By Kathleen Ammon, N.P.
Women’s health nurse practitioner in Malden, MA
Nearly half of all American pregnancies are unplanned, but better birth control access and education are driving that number down.
It may surprise you to learn that nearly half of all pregnancies in the United States are unplanned. However, a March 2016 study showed the rate of unintended pregnancies dropped to the lowest level in the past 30 years.
In 2008, 51 percent of pregnancies were unintended, compared with 45 percent in 2011. Massachusetts came in just above the national average, with 47 percent of pregnancies unintended. This is a welcome trend. It empowers women to better plan their lives – education, career, and starting a family.
I don’t think Americans are having less sex, so what’s driving this trend? There are three main factors: more birth control options, increased access to affordable contraception, and better education.
1. More birth control options
The growing popularity of long-acting reversible contraception (LARC) methods likely is a main driving force behind the decrease in unplanned pregnancies. These methods include IUDs, implants such as Nexplanon, and injections such as Depo-Provera.
For many years, physicians recommended IUDs only to women who had already given birth. Injections have been available for many years, and various forms of implants have been offered since the 1990s.
The birth control pill has been a go-to contraception option for some time, but the pill isn’t the best option for every woman:
- Certain medications – such as some antibiotics and anti-seizure medications – can counteract the effectiveness of the pill.
- Some women experience negative side effects, such as nausea, mood changes, and weight gain.
- It’s easy to forget to take the pill. The birth control pill needs to be taken at roughly the same time every day. Not doing this renders it much less effective.
Many national health organizations such as the American Congress of Obstetricians and Gynecologists now encourage most women to consider using a LARC method – whether they’ve had a baby or not. It seems to be working. According to the Centers for Disease Control and Prevention, 11.6 percent of women who used contraception in 2013 chose a LARC. That’s up from 6 percent in 2010 and 2.4 percent in 2002.
Unlike the pill, you don’t need to remember to use LARCs. Once in place, you don’t have to think about them again until it’s time to replace them – which for some can be up to 10 years! Because of this, their failure rate is 0.8 percent or lower, compared with a failure rate of 9 percent for the birth control pill.
The pill is still the most commonly used form of birth control – 25.9 percent of women who use contraception choose it. And for many women, it is an effective contraceptive method. However, as LARCs continue to grow in popularity, I think we’ll continue to see the number of unplanned pregnancies drop.
2. Increased access to affordable contraception
The recent study examining unintended pregnancy rates ended just after the Affordable Care Act took effect. The ACA requires insurers to cover the cost of most contraceptive methods. Women who previously may not have been able to afford birth control co-pays now have access to it at no additional cost. For that reason, I would expect the numbers in the study to be even lower now.
The ACA increased access to healthcare in general – and expanded our opportunity to educate women about their birth control options. Women in Massachusetts especially are fortunate to live in a state with a high number of healthcare providers and clinics, meaning most don’t have to travel far to get help or advice.
3. Better education about contraception
When I was younger, I only knew about condoms and the pill. The March 2016 study showed that 95 percent of unintended pregnancies could be attributed to the one-third of women who did not use contraceptives or used them inconsistently. While information about other forms of birth control is much more widespread today, we still have work to do to make sure women are fully educated about their birth control options and how to properly use them.
We start educating our patients in their teen years. Regardless of whether they’re sexually active, we want our young female patients to get comfortable talking about their bodies, their health, and their birth control options. We know you don’t want to think about your daughter growing up, but it’s important that she is well informed so she can make good decisions about her body and health down the road.
When women come in to see us, we ask about their health and lifestyle: What are their periods like? Are they sexually active? Do they want children and, if so, when? We can then discuss which birth control options may be right for them. No contraceptive method is perfect for every woman, and it may take a couple tries to find the right one. We also take care to educate women about anything that could make their form of birth control less effective, such not taking it as the same time each day or being prescribed certain medications.
We discuss contraception with all of our pregnant and postpartum patients to make sure they know they can become pregnant immediately after delivery – even if they are breastfeeding. We also discuss it with women approaching menopause. We want them know that even though their cycles may become irregular, they can still get pregnant.
Remember, you’re in control of your body and your future. We’re here to support you in your family planning decisions. If you have questions about your birth control options, schedule an appointment online or call 885-446-2362.
Tags: family health, malden, OB/GYN, women's health