Support goes a long way toward increasing the effectiveness of birth control

New research challenges the assumption that implants and other long-acting birth control methods are by far the most effective choice.

The HER Salt Lake Contraceptive Initiative first provided participants with contraceptive counseling focused on their needs and values. Then, the initiative allowed them to start their chosen method immediately and provided them with refills and other supports. By centering their preferences and making their choice in terms of contraception accessible, participants experienced similarly low failure rates whatever the method, researchers report June 16 Open JAMA Network.

“It shows that patients don’t have to choose between something they like and something they need — very often a method can be both,” says Katharine White, chief of obstetrics and gynecology at Boston Medical Center, who was not involved in the study. “This is not about repressing any method. It’s about opening up the scope and broadening our vision” of options that meet people’s values, she said.

The HER Salt Lake Study, conducted by a University of Utah research team, included four Salt Lake City family planning clinics. The study was open to people who were likely to become pregnant between the ages of 16 and 45 and whose income was below the federal poverty level. Included participants planned to avoid pregnancy for at least one year and were either a new patient seeking contraception or an established patient seeking a new method.

Seven reversible contraceptive methods were offered: the copper intrauterine device, or IUD, the hormonal IUD, the contraceptive implant, the contraceptive injection, the pill, the vaginal ring or the male condom. The first three methods are placed by a medical provider, the injection takes place in a doctor’s office, and the remaining options are controlled by the user.

“Patients received their preferred method, had timely access to it, felt respected, and could stop and change methods at any time,” says Jessica Sanders, a reproductive health researcher at University of Utah Health.

The analysis included more than 4,000 participants, 82 percent of whom completed the full three years of follow-up. The research team tracked how long people continued using their original method. The team also calculated the contraceptive failure rate, defined as pregnancy despite using the original method in the previous four weeks. This represents 96 pregnancies.

Over three years, there was approximately 1 pregnancy per 100 participants per year among users of all methods except male condoms. The variation was narrow overall, ranging from 0.7 percent per year for hormonal IUD users to 1.6 percent per year for pill users. The estimated rate of condom users, 2.6 percent, is limited by the small sample size.

“People should feel truly valuable in whatever decision they make,” Sanders says. “These are all effective methods for preventing pregnancy.”

The greater parity between the effectiveness of different methods contrasts with a memorable statistic from a 2012 study. The Contraceptive CHOICE Project’s stated goal was to promote the use of long-acting reversible contraceptives, according to the project team at Washington University School of Medicine in St. Louis. The study reported that participants using the contraceptive patch, pill or ring had a failure rate of 4.6 per 100 people per year, about 20 times higher than that of implants or IUDs.

“What HER Salt Lake adds is incredible proof that having ideal access and support to use [preferred] These methods actually increase the effectiveness of short-term methods to prevent pregnancy,” says Anu Manchikanti Gómez, a sexual and reproductive health equity researcher at the University of California, Berkeley, who was not involved in the study.

This support and access can prevent consistent usage errors. And it’s not just about forgetting to take a pill. It can be difficult for some people to take time off work to see a doctor. Others don’t have transportation to get to the pharmacy. “A missed renewal, a delayed appointment, an out-of-pocket fee, or an unavailable method creates this gap – it doesn’t necessarily depend on the person,” Sanders says. “Small disruptions matter.”

The study also adds to the evidence for respecting patient preferences in choosing a contraceptive method. Person-centered contraceptive counseling focuses on patient values ​​and priorities. This could include effectiveness, avoidance of side effects, or the ability to start and stop a method at home rather than relying on a doctor’s visit. Often, healthcare providers thought primarily in terms of efficiencyrecommending long-acting methods instead of prioritizing patient preferences.

White begins conversations about contraception by asking, “What is important to you about your birth control?” » and leaves the possibility of letting the patient be the guide. “When people feel heard,” she says, “they are more likely to have confidence in the care they receive.” [and] to get back to them if they have any problems.