Effectiveness of Long-Acting Reversible Contraception
This study involved women at high risk for unintended pregnancy who received free contraception. Long-acting reversible contraception was associated with a significantly lower risk of pregnancy than contraceptive pills, patch, or ring and was highly effective regardless of age. Unintended pregnancy...
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| Published in: | The New England journal of medicine Vol. 366; no. 21; pp. 1998 - 2007 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Waltham, MA
Massachusetts Medical Society
24.05.2012
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| Subjects: | |
| ISSN: | 0028-4793, 1533-4406, 1533-4406 |
| Online Access: | Get full text |
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| Abstract | This study involved women at high risk for unintended pregnancy who received free contraception. Long-acting reversible contraception was associated with a significantly lower risk of pregnancy than contraceptive pills, patch, or ring and was highly effective regardless of age.
Unintended pregnancy is a major problem in the United States. Approximately 3 million pregnancies per year — 50% of all pregnancies — are unintended, and this rate is significantly higher than that in other developed countries.
1
Unintended pregnancy in the United States results in 1.2 million abortions per year,
2
has negative effects on women's health and education and the health of newborns, and imposes a considerable personal burden as well as a financial burden on families and society.
3
Approximately half of unintended pregnancies result from contraceptive failure, usually owing to incorrect or inconsistent use of contraception, and the remainder are . . . |
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| AbstractList | The rate of unintended pregnancy in the United States is much higher than in other developed nations. Approximately half of unintended pregnancies are due to contraceptive failure, largely owing to inconsistent or incorrect use.
We designed a large prospective cohort study to promote the use of long-acting reversible contraceptive methods as a means of reducing unintended pregnancies in our region. Participants were provided with reversible contraception of their choice at no cost. We compared the rate of failure of long-acting reversible contraception (intrauterine devices [IUDs] and implants) with other commonly prescribed contraceptive methods (oral contraceptive pills, transdermal patch, contraceptive vaginal ring, and depot medroxyprogesterone acetate [DMPA] injection) in the overall cohort and in groups stratified according to age (less than 21 years of age vs. 21 years or older).
Among the 7486 participants included in this analysis, we identified 334 unintended pregnancies. The contraceptive failure rate among participants using pills, patch, or ring was 4.55 per 100 participant-years, as compared with 0.27 among participants using long-acting reversible contraception (hazard ratio after adjustment for age, educational level, and history with respect to unintended pregnancy, 21.8; 95% confidence interval, 13.7 to 34.9). Among participants who used pills, patch, or ring, those who were less than 21 years of age had a risk of unintended pregnancy that was almost twice as high as the risk among older participants. Rates of unintended pregnancy were similarly low among participants using DMPA injection and those using an IUD or implant, regardless of age.
The effectiveness of long-acting reversible contraception is superior to that of contraceptive pills, patch, or ring and is not altered in adolescents and young women. (Funded by the Susan Thompson Buffet Foundation.). The rate of unintended pregnancy in the United States is much higher than in other developed nations. Approximately half of unintended pregnancies are due to contraceptive failure, largely owing to inconsistent or incorrect use.BACKGROUNDThe rate of unintended pregnancy in the United States is much higher than in other developed nations. Approximately half of unintended pregnancies are due to contraceptive failure, largely owing to inconsistent or incorrect use.We designed a large prospective cohort study to promote the use of long-acting reversible contraceptive methods as a means of reducing unintended pregnancies in our region. Participants were provided with reversible contraception of their choice at no cost. We compared the rate of failure of long-acting reversible contraception (intrauterine devices [IUDs] and implants) with other commonly prescribed contraceptive methods (oral contraceptive pills, transdermal patch, contraceptive vaginal ring, and depot medroxyprogesterone acetate [DMPA] injection) in the overall cohort and in groups stratified according to age (less than 21 years of age vs. 21 years or older).METHODSWe designed a large prospective cohort study to promote the use of long-acting reversible contraceptive methods as a means of reducing unintended pregnancies in our region. Participants were provided with reversible contraception of their choice at no cost. We compared the rate of failure of long-acting reversible contraception (intrauterine devices [IUDs] and implants) with other commonly prescribed contraceptive methods (oral contraceptive pills, transdermal patch, contraceptive vaginal ring, and depot medroxyprogesterone acetate [DMPA] injection) in the overall cohort and in groups stratified according to age (less than 21 years of age vs. 21 years or older).Among the 7486 participants included in this analysis, we identified 334 unintended pregnancies. The contraceptive failure rate among participants using pills, patch, or ring was 4.55 per 100 participant-years, as compared with 0.27 among participants using long-acting reversible contraception (hazard ratio after adjustment for age, educational level, and history with respect to unintended pregnancy, 21.8; 95% confidence interval, 13.7 to 34.9). Among participants who used pills, patch, or ring, those who were less than 21 years of age had a risk of unintended pregnancy that was almost twice as high as the risk among older participants. Rates of unintended pregnancy were similarly low among participants using DMPA injection and those using an IUD or implant, regardless of age.RESULTSAmong the 7486 participants included in this analysis, we identified 334 unintended pregnancies. The contraceptive failure rate among participants using pills, patch, or ring was 4.55 per 100 participant-years, as compared with 0.27 among participants using long-acting reversible contraception (hazard ratio after adjustment for age, educational level, and history with respect to unintended pregnancy, 21.8; 95% confidence interval, 13.7 to 34.9). Among participants who used pills, patch, or ring, those who were less than 21 years of age had a risk of unintended pregnancy that was almost twice as high as the risk among older participants. Rates of unintended pregnancy were similarly low among participants using DMPA injection and those using an IUD or implant, regardless of age.The effectiveness of long-acting reversible contraception is superior to that of contraceptive pills, patch, or ring and is not altered in adolescents and young women. (Funded by the Susan Thompson Buffet Foundation.).CONCLUSIONSThe effectiveness of long-acting reversible contraception is superior to that of contraceptive pills, patch, or ring and is not altered in adolescents and young women. (Funded by the Susan Thompson Buffet Foundation.). This study involved women at high risk for unintended pregnancy who received free contraception. Long-acting reversible contraception was associated with a significantly lower risk of pregnancy than contraceptive pills, patch, or ring and was highly effective regardless of age. Unintended pregnancy is a major problem in the United States. Approximately 3 million pregnancies per year — 50% of all pregnancies — are unintended, and this rate is significantly higher than that in other developed countries. 1 Unintended pregnancy in the United States results in 1.2 million abortions per year, 2 has negative effects on women's health and education and the health of newborns, and imposes a considerable personal burden as well as a financial burden on families and society. 3 Approximately half of unintended pregnancies result from contraceptive failure, usually owing to incorrect or inconsistent use of contraception, and the remainder are . . . BackgroundThe rate of unintended pregnancy in the United States is much higher than in other developed nations. Approximately half of unintended pregnancies are due to contraceptive failure, largely owing to inconsistent or incorrect use.MethodsWe designed a large prospective cohort study to promote the use of long-acting reversible contraceptive methods as a means of reducing unintended pregnancies in our region. Participants were provided with reversible contraception of their choice at no cost. We compared the rate of failure of long-acting reversible contraception (intrauterine devices [IUDs] and implants) with other commonly prescribed contraceptive methods (oral contraceptive pills, transdermal patch, contraceptive vaginal ring, and depot medroxyprogesterone acetate [DMPA] injection) in the overall cohort and in groups stratified according to age (less than 21 years of age vs. 21 years or older).ResultsAmong the 7486 participants included in this analysis, we identified 334 unintended pregnancies. The contraceptive failure rate among participants using pills, patch, or ring was 4.55 per 100 participant-years, as compared with 0.27 among participants using long-acting reversible contraception (hazard ratio after adjustment for age, educational level, and history with respect to unintended pregnancy, 21.8; 95% confidence interval, 13.7 to 34.9). Among participants who used pills, patch, or ring, those who were less than 21 years of age had a risk of unintended pregnancy that was almost twice as high as the risk among older participants. Rates of unintended pregnancy were similarly low among participants using DMPA injection and those using an IUD or implant, regardless of age.ConclusionsThe effectiveness of long-acting reversible contraception is superior to that of contraceptive pills, patch, or ring and is not altered in adolescents and young women. (Funded by the Susan Thompson Buffet Foundation.) |
| Author | Winner, Brooke Peipert, Jeffrey F Madden, Tessa Zhao, Qiuhong Allsworth, Jenifer E Secura, Gina M Buckel, Christina |
| Author_xml | – sequence: 1 givenname: Brooke surname: Winner fullname: Winner, Brooke organization: From the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis – sequence: 2 givenname: Jeffrey F surname: Peipert fullname: Peipert, Jeffrey F organization: From the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis – sequence: 3 givenname: Qiuhong surname: Zhao fullname: Zhao, Qiuhong organization: From the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis – sequence: 4 givenname: Christina surname: Buckel fullname: Buckel, Christina organization: From the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis – sequence: 5 givenname: Tessa surname: Madden fullname: Madden, Tessa organization: From the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis – sequence: 6 givenname: Jenifer E surname: Allsworth fullname: Allsworth, Jenifer E organization: From the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis – sequence: 7 givenname: Gina M surname: Secura fullname: Secura, Gina M organization: From the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis |
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| References | Kost, K, Singh, S, Vaughan, B, Trussell, J, Bankole, A (r004) 2008; 77 Finer, LB, Henshaw, SK (r005) 2006; 38 Ventura, SJ, Abma, JC, Mosher, WD, Henshaw, SK (r002) 2009; 58 Peipert, JF, Zhao, Q, Allsworth, JE (r010) 2011; 117 Bajos, N, Leridon, H, Goulard, H, Oustry, P, Job-Spira, N (r012) 2003; 18 (r011) 2007; 110 Fu, H, Darroch, JE, Haas, T, Ranjit, N (r008) 1999; 31 (r015) 2010; 59 r009 r013 r003 Mosher, WD, Jones, J (r007) 2010; 29 Woods, JL, Shew, ML, Tu, W, Ofner, S, Ott, MA, Fortenberry, JD (r019) 2006; 39 Frost, JJ, Darroch, JE, Remez, L (r006) 2008; 1 Farley, TM, Rosenberg, MJ, Rowe, PJ, Chen, JH, Meirik, O (r016) 1992; 339 Finer, LB, Zolna, MR (r001) 2011; 84 Cleland, K, Peipert, JF, Westhoff, C, Spear, S, Trussell, J (r014) 2011; 364 Mansour, D, Korver, T, Marintcheva-Petrova, M, Fraser, IS (r018) 2008; 13 Davis, AJ (r017) 2011; 23 Mosher WD (r007) 2010; 29 Frost JJ (r006) 2008; 1 r010 r011 r001 r012 Ventura SJ (r002) 2009; 58 r017 r018 r008 r019 r014 r004 r005 r016 23217071 - J Midwifery Womens Health. 2012 Nov-Dec;57(6):636-7 |
| References_xml | – volume: 117 start-page: 1105 year: 2011 end-page: 1113 ident: r010 article-title: Continuation and satisfaction of reversible contraception. publication-title: Obstet Gynecol – volume: 38 start-page: 90 year: 2006 end-page: 96 ident: r005 article-title: Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. publication-title: Perspect Sex Reprod Health – ident: r009 – volume: 59 start-page: 1 year: 2010 end-page: 86 ident: r015 article-title: S. medical eligibility criteria for contraceptive use, 2010. publication-title: MMWR Recomm Rep – volume: 1 start-page: 1 year: 2008 end-page: 8 ident: r006 article-title: Improving contraceptive use in the United States. publication-title: Issues Brief (Alan Guttmacher Inst) – ident: r003 article-title: Brown S, Eisenberg L. The best intentions: unintended pregnancy and the wellbeing of children and families. Washington, DC: National Academy Press, 1995. – volume: 364 start-page: e37 year: 2011 end-page: e37 ident: r014 article-title: Family planning as a cost-saving preventive health service. publication-title: N Engl J Med – volume: 18 start-page: 994 year: 2003 end-page: 999 ident: r012 article-title: Contraception: from accessibility to efficiency. publication-title: Hum Reprod – volume: 31 start-page: 56 year: 1999 end-page: 63 ident: r008 article-title: Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth. publication-title: Fam Plann Perspect – volume: 339 start-page: 785 year: 1992 end-page: 788 ident: r016 article-title: Intrauterine devices and pelvic inflammatory disease: an international perspective. publication-title: Lancet – volume: 77 start-page: 10 year: 2008 end-page: 21 ident: r004 article-title: Estimates of contraceptive failure from the 2002 National Survey of Family Growth. publication-title: Contraception – volume: 29 start-page: 1 year: 2010 end-page: 44 ident: r007 article-title: Use of contraception in the United States: 1982-2008. publication-title: Vital Health Stat 23 – volume: 23 start-page: 557 year: 2011 end-page: 565 ident: r017 article-title: Intrauterine devices in adolescents. publication-title: Curr Opin Pediatr – ident: r013 article-title: Secura GM, Allsworth JE, Madden T, Mullersman JL, Peipert JF. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol 2010;203(2):115.e1-115.e7. – volume: 84 start-page: 478 year: 2011 end-page: 485 ident: r001 article-title: Unintended pregnancy in the United States: incidence and disparities, 2006. publication-title: Contraception – volume: 110 start-page: 1493 year: 2007 end-page: 1495 ident: r011 article-title: 392, December 2007: intrauterine device and adolescents. publication-title: Obstet Gynecol ;ACOG Committee opinion no – volume: 13 start-page: 13 year: 2008 end-page: 28 ident: r018 article-title: The effects of Implanon on menstrual bleeding patterns. publication-title: Eur J Contracept Reprod Health Care – volume: 58 start-page: 1 year: 2009 end-page: 14 ident: r002 article-title: Estimated pregnancy rates for the United States, 1990-2005: an update. publication-title: Natl Vital Stat Rep – volume: 39 start-page: 381 year: 2006 end-page: 387 ident: r019 article-title: Patterns of oral contraceptive pill-taking and condom use among adolescent contraceptive pill users. publication-title: J Adolesc Health – ident: r010 doi: 10.1097/AOG.0b013e31821188ad – volume: 59 start-page: 1 year: 2010 ident: r015 publication-title: MMWR Recomm Rep – ident: r004 doi: 10.1016/j.contraception.2007.09.013 – ident: r001 doi: 10.1016/j.contraception.2011.07.013 – ident: r018 doi: 10.1080/13625180801959931 – ident: r012 doi: 10.1093/humrep/deg215 – ident: r008 doi: 10.2307/2991640 – ident: r016 doi: 10.1016/0140-6736(92)91904-M – volume: 29 start-page: 1 year: 2010 ident: r007 publication-title: Vital Health Stat 23 – ident: r017 doi: 10.1097/MOP.0b013e32834a99d8 – ident: r005 doi: 10.1363/3809006 – volume: 1 start-page: 1 year: 2008 ident: r006 publication-title: Issues Brief (Alan Guttmacher Inst) – volume: 58 start-page: 1 year: 2009 ident: r002 publication-title: Natl Vital Stat Rep – ident: r011 doi: 10.1097/01.AOG.0000291575.93944.1a – ident: r014 doi: 10.1056/NEJMp1104373 – ident: r019 doi: 10.1016/j.jadohealth.2005.12.014 – reference: 23217071 - J Midwifery Womens Health. 2012 Nov-Dec;57(6):636-7 |
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