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Lack of Knowledge on Long-Term Contraception Is the Real Danger for Women

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February 4, 2014

This article originally appeared in The Huffington Post on Feb. 3, 2014.

By Jessica Kiley

My 27-year-old patient Carrie (not her real name) came to my office for her routine six-week check-up after delivering a healthy baby boy, Michael, her first child. Before her pregnancy, she had used an IUD for contraception that allowed her to finish college, get married, and plan the appropriate time to start her family.

On this most recent visit, Carrie received a new IUD. She will decide when she'll give Michael a brother or sister. She's like the majority of women, who say using birth control helps them achieve their educational, career, and family planning goals.

Millions of women in this country and the health professionals who treat them understand birth control is essential. Birth control fosters health. Safe, effective birth control benefits women and families. As an obstetrician-gynecologist, I have spent more than 10 years delivering babies, helping women plan pregnancies and giving women their necessary birth control.

But contraception only enters the national dialogue in fits and starts, weighed down with the baggage of political rhetoric.

A story in the January issue of Vanity Fair features a young woman who died of blood clots in her lungs while using a vaginal ring for birth control. The story discusses the liability of the pharmaceutical manufacturer, Merck, on its highly successful NuVaRing, stating that the contraceptive poses danger to women because it could cause blood clots and strokes.

Recent information about an emergency contraceptive drug used in Europe, Norlevo,revealed these pills may not be effective for women who weigh more than 175 pounds. Industry forecasts released this week show emergency contraception in Europe is expected to grow 28 percent as a market by 2017, to a value of $7.3 million.

In the United States, Norlevo is a "morning after pill" similar to a medication called Plan B One-Step. Women use it after unprotected intercourse, to prevent pregnancy.

It is time to shift the conversation away from one investigative story, one announcement or one forecast and to the bigger issue. The overall benefit of reliable, long-acting birth control is the optimal focus of the national contraception conversation, not the latest whirlwind discussion about rare risks associated with using birth control, or about body weight and the effectiveness of monthly or emergency contraceptives.

Setting politics and religion aside, it is true that contraceptive medications as a whole serve an important role in women's health. But the latest media stories about the dangers of using these birth control methods are not where the sound bytes should end. A much bigger issue is at risk.

To best serve women and families -- and ultimately society -- why not instead shift the talking points and reactions to reliable birth control methods that remove the need for emergency contraception, daily pill-taking or monthly placement of a ring in the vagina?

Just as controversy exists about emergency contraception, there are problems with promoting reliable contraceptive methods in the U.S. Women face many barriers to receiving contraception -- lack of knowledge of their own fertility, financial constraints, poor coverage by some insurance plans, refusal of faith-based hospitals to administer them, or lack of access in far too many communities.

But perhaps the most resolvable is some physicians' ignorance in recommending one of the most highly-effective methods, the intrauterine device (IUD).

The types of birth control with the lowest failure rates are the long-acting reversible contraceptives, or LARC methods.These include IUDs, which are placed in the uterus, and implants, which go under the skin in the upper arm. Certainly, I have no financial interest in the companies that manufacture these products, only a professional concern for my patients.

Once either contraceptive is placed, the woman enjoys protection from unplanned pregnancy without needing to do anything else for three, five or 10 years, depending on the specific method. The risk of unintended pregnancy is less than one percent. Sadly, only 5 percent of women who use birth control use IUDs.

The general medical community recognizes the effectiveness of these methods, but there are perpetual myths amongst patients and providers that lead to underuse of the IUD. Some think that a woman must have had a baby before getting an IUD. They believe IUDs cause infection and infertility. Providers tell adolescents they cannot have IUDs.

The truth is a woman of any age can use the IUD, regardless of whether or not she has delivered a baby. Placing the IUD is a simple, safe procedure that takes about 5 minutes. Not having had a baby does not prevent doctors from safely and easily placing the IUD. A recent study showed that teenagers and adults had the same rates of successful IUD placements, even if they had never been pregnant.

In 2001, a classic study demonstrated that IUDs do not cause infertility. One concern raised by those hesitant to recommend IUDs is that infection can occur on the genital tract and cause blockage of the fallopian tubes. In their New England Journal of Medicinestudy, researchers showed that women with infertility due to blocked tubes were not more likely to have used an IUD than women with infertility with normal tubes. Other research has shown that women have a quick return to fertility after having an IUD removed.

These women are real, as real as my own patients. But unfortunately, the lack of knowledge about the benefits of IUDs is real. And for millions of women, that knowledge gap is the true emergency.

- Jessica Kiley is an assistant professor of medicine at Northwestern University.