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 "This has really important public health implications in the United
States, where we have had persistent challenges in trying to
decrease unintended pregnancy," said Cynthia Harper, a professor of
obstetrics, gynecology and reproductive services at the University
of California, San Francisco. She was not involved in the research.
"The findings were surprising because they had such a large impact,"
she told Reuters Health.
The report in the October 2 New England Journal of Medicine comes at
a time when more than 600,000 U.S. teens become pregnant each year.
By age 20, about 20 percent of white teens and 40 percent of
Hispanic and black teens will have been pregnant, according to The
National Campaign to Prevent Teen and Unplanned Pregnancy.
The new study comes from the Contraceptive CHOICE Project conducted
in the St. Louis area. It was designed to see if teen pregnancy
rates could be brought down by aggressively providing information on
contraceptives and offering contraception for free.
"For many years, parents, practitioners and policy makers thought,
'Those (long-acting contraception) methods aren't for teens; they're
not going to want those methods.' We were able to demonstrate that
if they are properly counseled and if they have a choice, they will
pick those methods, actually use them, and have really great
outcomes as a result," said chief author Gina Secura of the
Washington University School of Medicine in St. Louis.
The teens, all of whom had sought contraceptive services through a
clinic, were told about various types of birth control, including
the long-term injectable and implantable contraceptives such as IUDs
that have been used around the world for years and whose effects are
reversible. Generally, fewer than 5 percent of U.S. teens use such
methods.
Ultimately, 72 percent of the 1,404 teenage girls and women enrolled
in the study went with an intrauterine device (IUD) or an implant.
Only 12.5 percent opted for an oral contraceptive pill. The
volunteers were followed for as long as three years during the study
period, which lasted from 2008 to 2013.
The annual rate of pregnancy was 3.40 percent compared to 15.85
percent in a survey of sexually experienced U.S. teens and women in
the same age group. The likelihood of giving birth each year was
1.94 percent among the St. Louis teens versus 9.40 percent
nationally.
The abortion rate was 0.97 percent when the long-acting
contraception was free, compared to 4.15 percent in the rest of the
U.S.
"These methods are not known by teens and providers are not used to
providing them," Harper said.
She said young women seeking contraception should initially ask
their doctor which method is the most effective because - unlike
doctor-patient discussions about other medical treatments - when it
comes to contraception, "effectiveness is not always one of the
things that is discussed."
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"What we saw was that among the teens who started with the
shorter-acting methods like the pill or the patch, after a while
they started to see they were forgetting to use them. And they then
transitioned to a long-acting method," Secura told Reuters Health.
The girls and women in the study were not new to sex. Nearly half
had already had an unintended pregnancy, 18 percent reported having
had at least one abortion and nearly three quarters reported having
sexual intercourse during the 30 days before they enrolled in the
study. Only 3 percent were sexually inexperienced.
When the researchers compared the young women in the study to all
U.S. women - both sexually experienced and inexperienced - ages 15
to 19, they found that the program reduced the pregnancy rate by 41
percent, the birth rate by 44 percent and the abortion rate by 34
percent.
Secura said more teens and young adults are not using the
longer-acting methods because, "Historically, it's been easier for
practitioners to write a prescription for pills and have a teen go
on her way."
In addition, inserting long-acting contraception devices "take more
training than some family physicians are used to," Harper said.
The other problem: the longer-acting methods are far more expensive,
at first.
"The up-front costs are anywhere from $500 to $1,000, depending on
the device and the cost of the insertion," said Secura.
"You reach cost neutrality within two years with the long-acting
methods. But these methods last three, four, five, or six years. So
not only are they more effective, they start to regain the financial
investment while they're still in use," she said.
"Hopefully, data like this can show people why it's so important to
cover contraceptives for women's health," said Harper.
SOURCE: http://bit.ly/1DO0r4l
The New England Journal of Medicine, online October 1, 2014.
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