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Limited Access to Female Contraceptives: A Public Health Crisis
Limited access and understanding of female contraceptives have posed a threat to women, causing a public health crisis.
Unintended pregnancy threatens public health and is exacerbated by limited access and understanding of female contraceptives. The CDC identifies unintended pregnancy as “a pregnancy that is either unwanted, such as the pregnancy occurred when no children or no more children were desired. Or the pregnancy is mistimed, such as the pregnancy occurred earlier than desired.”
Based on 2011 data from the CDC, 45% of pregnancies in the United States are unintended. Despite the national average decreasing since 2008, certain groups are still at a significantly higher risk of unintended pregnancies.
According to a publication in BMC, unintended or unwanted pregnancies have historically been a global issue that affects women’s health and may even be fatal.
Researchers in the BMC publication state, “many women, particularly women of color, do not have adequate access to reliable and affordable contraception resulting in major health disparities among this group.”
The researchers state that increased rates of unintended pregnancy may be attributed to a lack of access to contraceptive methods.
The AMA Journal of Ethics notes, “Black women are more likely than white women to report using a contraceptive method associated with lower efficacy or no contraception at all. They are, therefore, three times as likely as white women to experience an unintended pregnancy. Also, Hispanic women are less likely to use highly effective forms of contraception and twice as likely to experience unintended pregnancy as white women.”
Various contraceptive methods are available, most of which are intended for women. Considering there are no oral contraceptives for men on the market, the burden of preventing unwanted pregnancies with contraception falls on people with uteruses.
Intrauterine Devices
The CDC states that there are two kinds of intrauterine devices for contraception: the levonorgestrel intrauterine system (LNG IUD) and the copper T intrauterine device (IUD). Both devices take on a “T” shape and are inserted into the uterus by a trained medical professional.
LNG IUD
The LNG IUD is a hormonal form of birth control that releases progestin daily to prevent pregnancy. Aside from its 99.6–99.9% efficacy rate, one benefit of this birth control is that it can stay implanted for 3–6 years.
The Cleveland Clinic defines progestin as “a synthetic version of the hormone progesterone, which is involved in the menstrual cycle and pregnancy.” According to the Cleveland Clinic, progestin prevents ovulation, thickens the cervical mucus to prevent sperm from traveling and fertilizing the egg, and thins the uterine lining to prevent an egg from attaching.
The three hormonal IUDs available in the US are Mirena, Kyleena, and Liletta.
Copper IUD
Patients looking for an even more prolonged form of birth control may opt for the copper IUD, which can be used for up to 10 years. While the copper IUD is approximately 99.2% effective, it is one of the few non-hormonal forms of birth control. Copper IUDs may also function as emergency contraception if a copper IUD is inserted within five days of unprotected sex.
Oral Contraceptives
The combination pill and minipill are the two types of oral contraceptives.
The University of Iowa Hospitals and Clinics states that the combination pill consists of estrogen and progesterone. Unlike combination pills, the minipill is a progestin-only oral contraceptive. Data from the Cleveland Clinic suggests that, if the medication is taken at the same time every day, it is 99% effective.
Other Hormonal Birth Control Methods
There are multiple other hormonal birth control methods, including the implant, the shot, the patch, and the vaginal ring.
The Implant
The implant is a 99.9% effective method of birth control that consists of “a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin released into the body over three years,” according to the CDC.
The Shot
An additional form of progestin-based birth control is a hormonal injection, which is 96% effective and administered every three months.
The Patch
An article from the Mayo Clinic compares the birth control patch with combination birth control pills, which release estrogen and progestin to prevent pregnancy. While the birth control pill is consumed orally, the patch is placed on the skin for 21 days and then removed to allow for menstruation. After seven days, a new patch can be applied. While perfect use enables this method of birth control to be 99% effective, up to 9 of every 100 women using this method of birth control get pregnant.
Hormonal Vaginal Ring
According to Planned Parenthood, the hormonal vaginal ring, including the NuvaRing and Annovera, is approximately 99% effective when used appropriately and, on average, is 91% effective. This device is a small flexible ring inserted into the vagina that releases hormones that prevent pregnancy.
Non-Hormonal Contraceptives
Female non-hormonal birth controls include the diaphragm, sponge, spermicides, and female condoms.
Despite taking on different forms, sponges and spermicides function by using a chemical that kills the sperm, thus preventing fertilization.
According to the CDC, spermicides can be foam, gel, cream, film, suppository, or tablet. Within an hour before intercourse, spermicide is inserted into the vagina and left for up to 8 hours. The sponge contains spermicide and is inserted into the vagina covering the cervix. Spermicides are approximately 79% effective while the sponge’s efficacy varies from 73% to 86% depending on previous births.
Similarly, the diaphragm is inserted into the vagina and covers the cervix, creating a barrier to prevent sperm from fertilizing the egg. Often the diaphragm is used in conjunction with a spermicide. Diaphragms have a failure rate of approximately 17%.
Finally, the female condom, like a male condom, provides a direct physical barrier that prevents pregnancy. The female condom is only 79% effective which is 8% less than the male condom.
Permanent Contraception: Tubal Ligation
Tubal ligation is the only permanent form of birth control for women. Mayo Clinic says, “during tubal ligation, the fallopian tubes are cut, tied, or blocked to prevent pregnancy permanently. Tubal ligation prevents an egg from traveling from the ovaries through the fallopian tubes and blocks sperm from traveling up the fallopian tubes to the egg. The procedure doesn't affect your menstrual cycle.”
Access to Care
While all these birth control methods are well-researched and available to the public, there are still multiple barriers to obtaining contraception.
The American College of Obstetrics and Gynecology (ACOG) states that “multiple barriers prevent women from obtaining contraceptives or using them effectively and consistently.”
ACOG puts forth multiple recommendations on how to improve access to care. These recommendations include the following:
- increased funding for family planning programs
- prompt referrals
- over-the-counter access to oral contraception
- increased contraceptive research
- access to comprehensive sexual education
A 2020 publication in the Journal of Adolescent Health found that “a review of the literature of the past three decades offers strong support for comprehensive sex education. The findings provide evidence for the effectiveness of approaches that address a broad definition of sexual health and well-being and take positive, affirming, and inclusive approaches to human sexuality, across multiple grade levels.”
As the rhetoric around contraception, unintended pregnancy, and reproductive rights changes, patients able to become pregnant may consider furthering their education on contraceptive methods. Healthcare professionals should continue providing information and access to contraceptive methods as patients learn to navigate this complex and impactful aspect of their lives.
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