Executive Summary
Training clinicians to inform women that different birth control methods have very different levels of effectiveness proved key in cutting the number of unintended pregnancies among young women seeking family planning services, data suggests from a new national study from the Bixby Center for Global and Reproductive Health at the University of California, San Francisco.
-
By educating young women about the safety and effectiveness of long-acting reversible contraceptives such as intrauterine devices and the contraceptive implant, unintended pregnancy rates dropped by nearly half — from 15 to eight per 100 women — in women seeking family planning services.
-
The study was conducted in 40 U.S. Planned Parenthood centers. It is the first clinic-based intervention in a randomized trial to reduce unintended pregnancies, according to researchers.
Training clinicians to inform women that different birth control methods have very different levels of effectiveness proved key in cutting the number of unintended pregnancies among young women seeking family planning services, data suggests from a new national study from the Bixby Center for Global and Reproductive Health at the University of California, San Francisco (UCSF).1 By educating young women about the safety and effectiveness of long-acting reversible contraceptives (LARCs) such as intrauterine devices and the contraceptive implant, unintended pregnancy rates dropped by nearly half — from 15 to eight per 100 women — in women seeking family planning services.
The study was conducted in 40 U.S. Planned Parenthood centers. It is the first clinic-based intervention in a randomized trial to reduce unintended pregnancies, according to researchers.
There has been a heavy reliance in the United States on the Pill and condoms for young people, observed Cynthia Harper, PhD, professor of obstetrics, gynecology, and reproductive sciences at UCSF and Bixby Center faculty member. It is easy for people to forget to use these methods, which can lead to accidental pregnancies, said Harper in a press statement accompanying the online publication of the research.
“It’s important that women also learn about methods that give a higher level of protection against pregnancy when they seek contraceptive care,” noted Harper, who served as lead author of the research paper. “Women consider healthcare providers a highly trusted source of information on birth control, so it’s especially important that providers tell women about all of the methods they can use.”
Training cited
The study shows how important it is that women’s healthcare providers have full information about available birth control methods and are trained to provide all of these methods to patients at the same visit, said Carolyn Westhoff, MD, MSc, senior medical advisor at Planned Parenthood Federation of America.
“It’s one very important part of making sure that women can have the birth control of their choosing, without any barriers,” noted Westhoff, who is professor of epidemiology and population and family health at the New York Presbyterian Hospital and at the Columbia University Medical Center and professor of obstetrics and gynecology at the New York Presbyterian Hospital and at the Columbia University Medical Center, College of Physicians and Surgeons, all in New York City.
To conduct the study, researchers tested the training at Planned Parenthood health centers across the country, some of which provided abortion and others that provided only family planning services. The research team assigned half of the health centers at random to receive the contraceptive training, with the other half proceeding with their standard course of care. To enter the study, women had to be between age 18 and 25, attending family planning or abortion care visits, and not desiring pregnancy in the next 12 months. A total of 1,500 women were enrolled.
For example, providers would explain that while less than 1% of women using an implant or intrauterine device will get pregnant in a year, while on average, 9% of women on the Pill and 18% of women whose male partners use condoms will get pregnant in that same period of time.
What did researchers find? While 71% of the providers who received the training discussed LARC methods with their patients, just 39% of providers in the control group did. As a result, 28% of women in the intervention group chose LARC methods, compared with 17% in the control group. Women reported a high level of autonomy in choosing their birth control methods and said they made the choice on their own or did it with their providers.
When it came to reduction in the number of unintended pregnancies, researchers report rates dropped from 15 to eight per 100 women over a year, but only among the women who had come to clinics seeking family planning services. For reasons that are not entirely clear, there was no effect among the women who sought birth control after an abortion, researchers note. Fewer women wanting to use intrauterine devices or implants post-abortion were able to obtain them, and nearly a quarter were pregnant again within a year, researchers report. Restrictions on using public funding for contraception in places that provide abortions might have discouraged many women; nearly 38% of the women in the study had no medical insurance.1
Program goes wide
In 2011, Planned Parenthood made a major shift in policy and increased access to health services and education, says Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta. This new approach follows suit, he explains.
“Once again, Planned Parenthood has led the way,” observes Hatcher. “This organization has been the leader in providing contraceptive services since the 1920s, and its comprehensive approach to birth control services and well-woman services is simply remarkable.”
The Bixby Center is now offering its “Beyond the Pill” training to healthcare providers outside of Planned Parenthood, says Harper.
“Since study completion, we have entered our implementation science phase, where we are bringing the training to many practices throughout the country, including large urban departments of health, public hospitals, teen clinics, and primary care community clinics,” reports Harper in an interview with Contraceptive Technology Update. “We continue to train Planned Parenthood health centers as well, and other reproductive health specialist sites.”
The continuing education-accredited training consists of a half-day program with components for all staff. It offers up-to-date science and professional guidelines on LARC methods, features patient-centered counseling skills, and emphasizes shared decision-making. The training includes information on client eligibility for intrauterine devices and the implant, common misunderstandings about LARC methods, and billing and clinic flow troubleshooting.
A health educators’ practicum provides opportunities to role play client counseling scenarios and build counseling skills, while a clinician practicum provides hands-on insertion practice with pelvic models and clinical pearls for insertion and removal. [For training information, contact national training coordinator Jennifer Grand, MS, at [email protected], or phone (415) 502-0331.]
Publication available
The Bixby Center also has released a new publication, Intrauterine Devices and Implants: A Guide to Reimbursement, to provide information on patient coverage, stocking, and reimbursement.
The guide is a joint project of the Bixby Center and the American College of Obstetricians and Gynecologists National Family Planning and Reproductive Health Association, National Health Law Program, and the National Women’s Law Center. (To access the guide, visit http://bit.ly/1MhrmeA.)
“Intrauterine devices and implants are safe and highly effective forms of contraception, but their high cost often creates obstacles for providers to offer these methods to women,” Bixby Center officials state. “This new guide aims to decrease the cost barriers for providers and patients alike.”
-
Harper CC, Rocca CH, Thompson KM, et al. Reductions in pregnancy rates in the USA with long-acting reversible contraception: A cluster randomised trial. Lancet 2015; doi:10.1016/S0140-6736(14)62460-0.
