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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Article info
Publication history
Published online: October 20, 2016
Accepted:
October 11,
2016
Received in revised form:
October 1,
2016
Received:
August 15,
2016
Footnotes
The funders did not participate in the design of the study; in the collection, analysis, and interpretation of the data; in the writing of the manuscript; or in the decision to submit it for publication.
The authors report no conflict of interest.
Cite this article as: Karpilow QC & Thomas AT. Reassessing the importance of long-acting contraception. Am J Obstet Gynecol 2017;216:148.e1-14.
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Copyright
© 2016 Elsevier Inc. All rights reserved.
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- Long-acting reversible contraceptive acceptability and unintended pregnancy among women presenting for short-acting methods: a randomized patient preference trialAmerican Journal of Obstetrics & GynecologyVol. 216Issue 2
- PreviewMeasures 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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