Strategies to prevent unintended pregnancy: increasing use of long-acting reversible contraception.
BACKGROUND
Despite increasing contraceptive availability, unintended pregnancy remains a global problem, representing as many as 30% of all known pregnancies. Various strategies have been proposed to reverse this disturbing trend, especially increased use of long-acting reversible contraceptive (LARC) methods. In this review we aim to discuss the role of LARC methods and importance of contraceptive counseling in reducing unintended pregnancy rates.


METHODS
References/resources cited were identified based on searches of medical literature (MEDLINE, 1990-2009), bibliographies of relevant publications and the Internet.


CONCLUSIONS
LARC methods-copper intrauterine devices (IUDs), progestogen-releasing intrauterine system and injectable and implantable contraceptives-are safe and effective contraceptive options (unintended pregnancy rates with typical versus perfect use: 0.05-3.0 versus 0.05-0.6%) that are appropriate for a wide range of women seeking to limit or space childbearing. Despite their safety and efficacy records, these methods remain underutilized; injectable and implantable methods are used by an estimated 3.4% and intrauterine methods by 15.5% of women worldwide. LARC methods require no daily or coital adherence and avoid the adverse events and health risks of estrogen-containing contraceptives. The copper IUD and progestin-only injections and implants have been shown to be more cost-effective than more commonly used methods, such as condoms and the pill (5-year savings: $13,373-$14,122, LARC; $12,239, condoms; $12,879, pill). Women who are considering use of LARC methods should receive comprehensive contraceptive counseling, as women who receive counseling before use demonstrate higher rates of after-use method satisfaction, continuation and acceptance than those who do not.
Blumenthal
P D
PD
Department of Obstetrics & Gynecology, Stanford University, Stanford, CA 94305-5317, USA. pblumen@stanford.edu
Voedisch
A
A
Gemzell-Danielsson
K
K
D003267:Contraception / Q000379:methods* / Q000523:psychology; D003268:Contraception Behavior / Q000639:trends*; D003271:Contraceptive Agents, Female / Q000494:pharmacology; D003376:Counseling; D005193:Family Planning Services; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000191:economics / Q000706:statistics & numerical data; D011247:Pregnancy; D018873:Pregnancy Rate; D049168:Pregnancy, Unplanned; D012307:Risk Factors; D012959:Socioeconomic Factors
D003271:Contraceptive Agents, Female