Experts recommend women pick long-term birth control method

Adolescent girls and college-age women often face tight monthly budgets, but a local student leader in women's issues says the question should never have to be, "This month, will I pay for my birth control or my tuition?"

"Our main priority should be to be a student who can take care of her body," Chatham University junior Linah Richer said.

While most women using contraception opt for the pill -- which can be inexpensive and easy to access but unreliable if used inconsistently -- the American College of Obstetricians and Gynecologists hopes adolescent patients, and women in general, will consider more long-term methods of birth control, such as an intrauterine device or a contraceptive implant.

PG graphic: Birth control use among unintended teen pregnancies
(Click image for larger version)

The abstract of the committee opinion released in early October states: "Long-acting reversible contraception (LARC) -- intrauterine devices and the contraceptive implant -- are safe and appropriate contraceptive methods for most women and adolescents.

"The LARC methods are top-tier contraceptives based in effectiveness, with pregnancy rates of less than 1 [percent] per year for perfect use and typical use.

"These contraceptives have the highest rates of satisfaction and continuation of all reversible contraceptives. Adolescents are at high risk of unintended pregnancy and may benefit from increased access to LARC methods."

In 2002, about 2.4 percent of women using contraception chose IUDs, but today that number is about 8.5 percent, said Tina Raine-Bennett, research director at the Women's Health Research Institute's Division of Research in Oakland, Calif., and chairwoman of the ACOG Committee on Adolescent Health, which issued the opinion.

"They are catching on," she said. "I see more women coming in now because they have a friend who has had a good experience."

Planned Parenthood of Western Pennsylvania has seen a drastic increase in popularity, too. In 2002, three women opted for an IUD. In a decade, that number has grown to 760.

Women can choose between two types of IUDs. Hormone-free copper ParaGard can be used for up to 10 years, while Mirena releases hormones to prevent pregnancy for up to five years. Copper IUDs can make periods heavier and longer, while periods can disappear completely with the hormone-releasing version, Dr. Raine-Bennett said, adding that less than 5 percent of women experience side effects from the hormones.

The devices are T-shaped and must be inserted into a woman's uterus through the cervix by her doctor, a medical procedure that takes about three minutes, she said.

Both are 99 percent effective in preventing pregnancy, according to the Centers for Disease Control and Prevention.

Another type of long-term contraception is the implant, a thin rod inserted under the skin of a woman's upper arm in a procedure that takes about a minute, Dr. Raine-Bennett said. For up to three years, Nexplanon releases hormones preventing about 99 percent of pregnancies, according to the CDC.

The committee opinion notes that less than 1 percent of women using contraception chose implants, a number even lower among adolescents. Dr. Raine-Bennett said the implant is less popular than the IUD because it hasn't been around as long and can cause periods to be irregular.

Access to IUDs can be limited by circumstance, and the committee opinion notes that deterrents range from the devices' cost to fears about the safety of IUDs.

But when cost and other barriers are lifted, the opinion notes that the Contraceptive CHOICE Project found that more than two-thirds of women age 14-20 chose LARC methods. The project, at the Washington University in St. Louis School of Medicine, recruited 9,256 women and studies the effect of free access to birth control methods.

Perhaps the biggest consideration for women -- and especially adolescent girls -- is a contraceptive's upfront cost.

At an average of about $700-$800 before insurance, the $10-$50 cost of a monthly pack of birth control pills can seem favorable.

Without a reduced fee, the lowest price Planned Parenthood of Western Pennsylvania can offer Mirena is $800, said Rebecca Cavanaugh, vice president for public affairs for the local chapter.

An implant is a bit cheaper at about $400-500 because it lasts for only three years, Dr. Raine-Bennett said.

"I think a lot of college students couldn't pay for that upfront," Ms. Richer, 19, said, adding that a college-aged woman's access to reliable contraceptives is "very crucial."

Ms. Richer, who has interned for Planned Parenthood, founded a feminist organization at Chatham called Feminist Activists Creating Equality, which she said aims to help shape "world-ready women."

"I think that comes with knowing your rights and knowing what's available for you," the Moon native said.

Dr. Raine-Bennett said that when you look to the long-term financial commitment, IUDs can be cheaper for patients and insurance companies.

"If you consider the number of pregnancies it prevents, it becomes more cost-effective," she said.

Among girls age 15-19 who did not intend to become pregnant, "less than 1 percent used one of the most effective methods [of contraceptives], such as an intrauterine device," the CDC reported in January. The same study found 21 percent used a highly effective method of contraception -- such as the pill -- and 24.2 percent were using condoms, considered moderately effective.

When the Obama administration's Affordable Care Act kicks in in 2014, the initial upfront cost could be covered by insurance companies, though it is unclear what kinds of contraceptives will be covered by the plan, Ms. Cavanaugh said.

The committee opinion even notes: "Proposed health care reform provisions to cover all FDA-approved contraceptive methods, including LARC methods, without copayments or deductibles for these preventative health services, may ease this burden."

Although a small risk of infection exists within the first 20 days the IUD has been inserted, according to the committee opinion -- generations of grandmothers and mothers feared IUDs after a bout of infection linked to one device in the 1970s, Dr. Raine-Bennett said.

Like any medical treatment or procedure, in some 40 years, IUDs have advanced significantly, she said.

The risk of developing pelvic inflammatory disease after the insertion of an IUD is very low, according to a study of nearly 60,000 women released last week by researchers at the University of California, San Francisco, and Kaiser Permanente Northern California Division of Research.

"Complications of IUDs and the contraceptive implant are rare and differ little between adolescents and older women," the physicians committee opinion states.

Before girls and women can weigh these factors, though, doctors must first offer IUDs to patients, Dr. Raine-Bennett said.

The doctor must also be trained to insert the contraceptive, and reassure the patient that it's safe and the procedure isn't uncomfortable. Much like women's periods, each woman will have a different experience, she said.

"Patients should ask their provider, 'How many have you done?' and 'How comfortable do you feel doing this?' This is a simple procedure for an experienced provider," Dr. Raine-Bennett said.

"I think the important thing is that if your goal is to prevent pregnancy, there are two important things," she concluded. "Women need to feel comfortable, and women really want something that is effective."

To read the committee opinion: http:/

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Lexi Belculfine: or 412-263-1316. Twitter: @LexiBelc. First Published November 26, 2012 5:00 AM


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