Guest Column

What's in a name when it comes to birth control?

By Robert Hatcher, MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta

Several descriptive phrases are now being coined when family planning providers discuss such highly effective reversible methods as intrauterine contraception (ParaGard Copper T 380A intrauterine device, Duramed Pharmaceuticals, and the Mirena levonorgestrel intrauterine system, Bayer HealthCare Pharmaceuticals) and the contraceptive implant (Implanon, Schering-Plough Corp.).

In attending the recent 2010 Contraceptive Technology conferences in Boston and San Francisco, I was struck by the number of different phrases that providers are using to discuss these highly effective methods.

One such phrase that succinctly captures the outstanding effectiveness of these contraceptive options is "top-tier" or "top-of-the-line" methods. These phrases stem from a chart developed from material from the World Health Organization's Medical Eligibility Criteria for Contraceptive Use.1 The chart shows the different "tiers" of contraceptives, ranked by effectiveness. A panel of global family planning experts developed the graphic chart to present all contraceptive methods on a continuum of effectiveness. Research indicates this simple counseling chart can improve women's understanding of contraceptive effectiveness better than more complex tools.2 It is recreated on page 26 in the latest edition of Contraceptive Technology,3 as well as in at the Family Health International web site. (To access the handout, go to www.fhi.org. Select "Publications," "Reproductive Health," "Service Delivery Tools," and "Comparing the Effectiveness of Family Planning Methods." The chart is also available in Spanish and French.)

When saying that something is "top of the line," it is self-explanatory. Just as when someone describes a BMW as a top-of-the-line auto, it is clearly evident that such an item is indeed at the top of its class. With rates at less than one pregnancy per year per 100 women, both forms of intrauterine contraception and the contraceptive implant definitely qualify as top-of-the-line methods.

Other names to know

When thinking about long-acting methods, also consider the term HER-C, which stands for highly effective reversible contraception. This phrase was used by 2010 Contraceptive Technology conference speaker Eleanor Bimla Schwarz, MD, MS, assistant professor in the departments of medicine and obstetrics, gynecology and reproductive medicine at the University of Pittsburgh School of Medicine.4Another way to think about these methods is to term them as "you-can't-forge- me" methods, because women do not have to take a daily pill or insert a device prior to sexual activity, says Schwarz.

Many family planning research scientists, such as Jeffrey Peipert, MD, MPH, MHA, professor of obstetrics and gynecology at the Washington University School of Medicine in St. Louis, refer to long-acting methods as "LARC"— long acting reversible contraception. Peipert is leading a cohort study of 10,000 women in the St. Louis region and is looking at use of these methods through the Contraceptive Choice Project. The project is providing birth control at no cost to all participants for three years; 70% of women are choosing long-acting methods.

"Reversible sterilization" is a term used by David Grimes, MD, FACOG, FACPM, vice president of biomedical affairs at the Research Triangle Park, NC-based Family Health International and clinical professor in the Department of Obstetrics and Gynecology at the Chapel Hill, NC-based University of North Carolina School of Medicine. This phrase tells you two things about these methods in one fell swoop: they are reversible, and like sterilization, they are very effective.

So which phrase is best when talking about the Copper T-380A intrauterine device (IUD), the levonorgestrel intrauterine system (LNG IUS), and the contraceptive implant? Each has its own merit. When discussing the subject with university family planning students, I talk about how each phrase can teach people something about these extraordinary methods.

The important thing about long-acting reversible contraceptives is to include them in every counseling session regarding birth control options. With more awareness of their benefits, more women might be willing to consider them for pregnancy prevention.

References

  1. World Health Organization. Medical Eligibility Criteria for Contraceptive Use. Third ed. Geneva: WHO; 2004.
  2. Steiner MJ, Trussell J, Mehta N, et al. Communicating contraceptive effectiveness: A randomized controlled trial to inform a World Health Organization family planning handbook. Am J Obstet Gynecol 2006; 195:85-91.
  3. Trussell J. Choosing a contraceptive: Efficacy, safety, and personal considerations. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 19th revised edition. New York: Ardent Media; 2007.
  4. Schwarz EB. New data on highly-effective reversible contraception: what's the latest? Presented at the Contraceptive Technology conference. Boston. April 2010.