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Reassessing the importance of long-acting contraception

Published:October 20, 2016DOI:https://doi.org/10.1016/j.ajog.2016.10.012

      Background

      Several recent studies have highlighted the need for greater use of long-acting contraception. The most influential of these studies is the Contraceptive CHOICE Project, which was credited with substantially reducing participants’ pregnancy risk by increasing their use of long-acting methods such as intrauterine devices and subdermal implants. However, because participants’ rates of nonuse and condom use fell to zero at the outset of the intervention, it is possible that sizable pregnancy reductions could still have been achieved if enrollees had chosen shorter-acting, female-controlled methods such as oral contraception.

      Objective

      The objective of the study was to estimate the proportion of the CHOICE Project’s fertility impacts that could have been achieved without any increase in long-acting method use.

      Study Design

      The FamilyScape 3.0 microsimulation model was used to estimate CHOICE’s impact on pregnancy risk and to simulate the counterfactual effect of moving all nonusers and condom users onto shorter-acting, female-controlled methods. FamilyScape models the sexual and contraceptive behaviors of women in the United States between 2006 and 2010, which is the period when CHOICE was implemented.

      Results

      Nearly three quarters of the CHOICE intervention’s effects on pregnancy risk could have been achieved if participants had chosen shorter-acting, female-controlled methods over long-acting methods.

      Conclusion

      Prioritizing the adoption of long-acting contraception may not be the most advisable strategy for reducing unintended pregnancy. The most impactful interventions will likely be those that increase the use of female-controlled methods, long-acting or otherwise.

      Key words

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      Linked Article

      • Long-acting reversible contraceptive acceptability and unintended pregnancy among women presenting for short-acting methods: a randomized patient preference trial
        American Journal of Obstetrics & GynecologyVol. 216Issue 2
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          Measures of contraceptive effectiveness combine technology and user-related factors. Observational studies show higher effectiveness of long-acting reversible contraception compared with short-acting reversible contraception. Women who choose long-acting reversible contraception may differ in key ways from women who choose short-acting reversible contraception, and it may be these differences that are responsible for the high effectiveness of long-acting reversible contraception. Wider use of long-acting reversible contraception is recommended, but scientific evidence of acceptability and successful use is lacking in a population that typically opts for short-acting methods.
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