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Over the past 20 years the rate of teenage pregnancy has steadily declined, and with that trend the rates of pregnancy termination have declined as well.

This is a success largely fueled by the availability of contraception and improved patient education. Yet the U.S still has a teen pregnancy rate 7 times higher than that of most developed countries. There are 2.8 million unintended pregnancies in the U.S. each year, including 430,000 in young women aged 15 to 19 and 124,000 in those aged 15 to 17. We know that teen pregnancy is associated with delays in prenatal care, increased fetal exposure to alcohol and tobacco, poorer health outcomes for the newborn and negative impact on social and economic outcomes for the mother.

How can this be happening in an age in which we have highly effective contraception? The answer is in the actual effectiveness of these methods when used in real life settings. Take a look at the table below. For every hundred women using a particular technique for 10 years, it shows how many will have an unintended pregnancy:

Unplanned Pregnancy/100 Women over 10 Year Period

  • ⚪ Condoms: 86/100
  • ⚪ Pill or patch: 61/100
  • ⚪ Depo-progesterone (shot): 46/100
  • ✔️ Copper IUD: 8/100
  • ✔️ Hormonal IUD: 2/100
  • ✔️ Hormonal implant: 1/100

Most people are startled to learn, for instance, that birth control pills have a 10 year failure rate of 61%. Of course if the pill is taken properly and if no medications are prescribed which may interfere with it, its effectiveness is vastly better. But in real life things happen.
IUDs and implants are called Long Acting Reversible Contraception, or LARC, and have a much higher rate of success in preventing unplanned pregnancy. In addition the Affordable Care Act requires that all forms of contraception must be covered by insurance, without cost to the patient. Yet less than 5% of women choose LARC as their contraception method. There are several reasons for this; studies have shown that notwithstanding the ACA requirements for coverage many insurers do not properly cover all of the costs of LARC, which can be as much as $1000 (for the IUD or implant plus costs of insertion). Few primary care practices stock an inventory of LARC (due to costs) and delays in obtaining it result in lower rates of use. And many providers were incorrectly taught that LARC should not be used in teenagers or in women who have never been pregnant.
A large study carried out over 5 years has shown that with good patient education, same day availability and no cost to the patient 72% of adolescents will choose LARC, and that the use of LARC results in significantly decreased costs associated with pregnancy and significant decreases in the rates of pre-term birth. It should be no surprise that the CDC states that all clinicians should offer the full range of contraceptive services to patients who wish to delay or prevent pregnancy.

Noah Nesin, MD

Dr. Nesin, Vice President of Medical Affairs for PCHC, is a family doctor with 30 years of experience.

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