Study: Free Birth Control Slashes Abortion Rates

2012-10-08

By Olivia B. Waxman
What would happen if women at risk for unintended pregnancies received the birth control of their choice — especially the more effective kinds — at no cost?

The national abortion rate would plummet, according to a study conducted by researchers at the Washington University School of Medicine in St. Louis and published in the journal Obstetrics & Gynecology on Thursday.

The researchers enrolled 9,256 women from the St. Louis region into the Contraceptive Choice Project between August 2007 and September 2011. The women were aged 14 to 45, with an average age of 25, and many were poor and uninsured with low education. Nearly two-thirds had had an unintended pregnancy previously. Participants were either not using a reversible contraception method or willing to switch to a new one.

(LIST: 8 Preventive Health Services that Women Start Getting for Free Today)

Researchers provided free, FDA-approved birth control to the women for three years. The women were given their choice of contraception, including oral birth control pills and long-acting reversible contraceptive (LARC) methods like implants and IUDs. The researchers specially briefed the participants on the “superior effectiveness” of LARC methods — the T-shaped IUD, or intrauterine device, has close to 100% effectiveness and can last five to 10 years, for instance — and 75% of women chose those devices over the pill, patch or ring.

Over the course of the study, which lasted from 2008 to 2010, women experienced far fewer unintended pregnancies than expected: there were 4.4 to 7.5 abortions per 1,000 women in the study, after adjusting for age and race — much fewer than the national rate of 19.6 abortions per 1,000 women and lower also than the rate in the St. Louis area of 13.4 to 17 abortions per 1,000 women.

The effect of free contraception on the teen birth rate was remarkable: there were 6.3 births per 1,000 girls aged 15 to 19 in the study, compared with the national rate of 34.3 births per 1,000 teen girls.

(MORE: Which Birth Control Works Best? (Hint: It’s Not the Pill))

The findings come amidst contention over President Obama’s health-care law, which offers women FDA-approved birth control without a copay. As of August 1, contraception is covered for women signing up for new health insurance plans or renewing their existing plans.

“[C]hanges in contraceptive policy simulating the Contraceptive Choice Project would prevent as many as 41% to 71% of abortions performed annually in the United States,” the study’s authors wrote.

Nearly half of the more than 6 million pregnancies that occur each year are unintended, and about 43% of them end in abortion. Further, about 1 million births are unintended, costing U.S. taxpayers about $11 billion a year in associated expenses. Low-income women with less education are far more likely to have an unintended pregnancy than their wealthier, educated peers.

About half of unplanned pregnancies occur in women who are using no contraception; in other cases, women may be using short-acting contraception, like condoms or pills, which can fail if not used properly. In contrast, methods like IUDs, which are fitted into the uterus, or hormonal implants, which are surgically placed under the skin of the upper arm, can be placed and then forgotten about — no need to remember to refill a prescription or take a pill at the same time each day.

(MORE: What Got Lost in the Birth-Control Debate)

Women who choose long-acting contraception are more likely to stick with it as well: in the study, 85% were still using it a year later, compared with 35% of those choosing pills or other short-acting forms of birth control. “Because LARC methods have been shown to have higher continuation rates than other reversible methods, the number of adolescents and women using no contraception would decline, further decreasing the unintended pregnancy rate,” the authors conclude.

Yet American women use LARC methods at far lower rates than in other countries. In large part, that’s because of cost: upfront costs to implant an IUD, which requires a doctor visit, can total $500 to $1,000, for example. Over a decade, however, birth control pills can cost just as much. American doctors also tend not to recommend long-acting birth control to women as often as they do the pill or patch, though IUDs and implants may be up to 20 times more effective.

That’s why the American College of Obstetricians and Gynecologists is now urging doctors to recommend IUDs and implants as “first-line” contraceptive choices to their teen patients.

Smoking mothers’ embryos ‘grow more slowly

2012-07-10

Time-lapse photography has shown that embryos of smoking women develop more slowly.

French academics in an IVF clinic took regular pictures of an egg from the moment it was fertilised until it was ready to be implanted into the mother.

At all stages of development, embryos from smokers were consistently a couple of hours behind, a study showed.

The lead researcher, from Nantes University Hospital, said: “You want a baby, quit smoking”.

Smoking is known to reduce the chances of having a child. It is why some hospitals in the UK ask couples to give up smoking before they are given fertility treatment.

As eggs fertilised through IVF initially develop in the laboratory before being implanted, it gave doctors a unique opportunity to film the embryos as they divide into more and more cells.
Slow start

Researchers watched 868 embryos develop – 139 from smokers.

n the clinic the embryos of non-smokers reached the five-cell stage after 49 hours. In the smokers it took 50 hours. The eight-cell stage took 62 hours in smokers’ embryos, while non-smokers’ embryos reached that point after 58 hours.

Senior embryologist and lead researcher, Dr Thomas Freour, told the BBC: “Embryos from smoking women, they behave slower, there is a delay in their development.

“On average it is about two hours, it is significant and nobody knew that before.”

This study cannot say what impact the slower development has, or if this affected the chances of having a child.

Dr Freour speculated that “if they go slower, maybe something is starting to go wrong and they wouldn’t implant.”

His advice was simple: “You should quit smoking, it couldn’t be easier. What else can I say? You want a baby, quit smoking.”

Dr Allan Pacey, senior lecturer in andrology at the University of Sheffield, said it was an “interesting” study which pioneered the use of new technology.

“It uses a fancy piece of equipment called an embryoscope which allows scientists to watch in real time how embryos develop without disturbing them.

“It’s early days for this machine but we need trials like this to test its potential, we know our current methods of embryo selection are based on what looks good down the microscope to a trained eye.”

The findings were presented at the European Society for Human Reproduction and Embryology (ESHRE) meeting in Turkey.

Which Birth Control Works Best? (Hint: It’s Not the Pill)

2012-06-07

Long-lasting contraceptives such as the intrauterine device (IUD) and implants are better at preventing pregnancy than more popular birth control methods, including the pill, patch and vaginal rings, a new study concludes.

The study involved 7,486 women participating in the Contraceptive Choice Project, run by researchers at Washington University School of Medicine in St. Louis. The women, aged 14 to 45, were given their choice of contraception for free and then tracked for up to three years for unintended pregnancy. The results, published in the New England Journal of Medicine, found that longer-lasting contraceptives were up to 20 times more effective — that is, women using IUDs, implants or hormone injections were up to 20 times less likely to get pregnant — after three years than the shorter-acting methods of birth control.

(MORE: Plan B: 1 in 5 Pharmacists May Deny Eligible Teens Access to Emergency Contraception)

Among the 1,500 women who chose to use birth control pills, patches or vaginal rings, 4.8% became pregnant after one year, compared with only 0.3% of the nearly 5,800 women who chose IUDs or implantable contraceptives. After three years, 9.4% of women using short-acting contraceptives got pregnant, compared with 0.9% of those using longer-acting methods.

Women using hormone injections (a minority at 176) had even better success, with 0.1% becoming pregnant after one year and 0.7% becoming pregnant after three years.

The results, while striking, aren’t all that surprising, considering that shorter term options depend on consistent compliance to work most effectively: pills must be take daily and patches and rings must be replaced within days or weeks.

In contrast, IUDs, which are fitted into the uterus, last five or 10 years, depending on the device. Hormonal implants, which are surgically placed under the skin of the upper arm, are effective for three years. And injections last three months.

(MORE: The Pill at 50: Sex, Freedom and Paradox)

How well a birth-control method worked depended also on the age of the user: younger women, under 21, using pills, patches or vaginal rings were nearly twice as likely to become pregnant as older women who used the same contraceptives. Why? Because they were more likely to forget to take their pills or to change their patch or ring. There were no age-related differences in pregnancy rates among women using IUDs, implants or injections.

Overall, poorer women with less education were also more likely to experience contraceptive failures.

The researchers hope their results will prompt more women to consider using long-acting contraceptives to prevent unwanted pregnancy. Each year in the U.S., there are an estimated 3 million unplanned pregnancies, about 1.2 million of which lead to abortion, according to the study. About half of unintended pregnancies occur because of because of incorrect or inconsistent use of contraception, including condoms and birth-control pills.

Still, the pill is the most commonly used contraceptive in the U.S. That may be because women don’t hear about long-acting methods as often as other contraceptives, or because women are more comfortable taking a pill or using a patch than having a device implanted in their body. Another factor: cost. IUDs and implants are expensive and aren’t typically covered by insurance.

(MORE: Teen Sex Ed: Instead of Promoting Promiscuity, It Delays First Sex)

“Nationally, only about 5 percent are using long-lasting methods like IUDs and implants. We know one of the barriers to why they’re not using them more frequently is up-front costs,” the study’s lead author, Dr. Brooke Winner of Washington University School of Medicine, told Reuters. “If [more] women were using these products nationally, there would be a very significant drop in unintended pregnancies, which would have far-reaching effects.”

While longer-lasting contraceptives can be more expensive up front, they may turn out to cost about the same as the pill when the expense is broken down by day, the researchers noted. IUDs and implants can be removed when women wish to become pregnant, and fertility typically returns immediately.

The researchers hope their study will also encourage doctors to consider IUDs and implants when discussing birth control with their patients. “If there were a drug for cancer, heart disease or diabetes that was 20 times more effective we would recommend it first,” another study author, Dr. Jeffrey Peipert, a professor of obstetrics and gynecology at Washington University, told the Wall Street Journal.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

Read more: http://healthland.time.com/2012/05/24/iuds-and-implants-beat-the-pill-in-preventing-pregnancy/?iid=hl-main-feature#ixzz1x5mUfmlM

Is Mom’s Lack of Vitamin D in Pregnancy Linked with Child’s Weight? By Alexandra Sifferlin | @acsifferlin | May 23, 2012

2012-05-24

Maintaining good health during pregnancy is one of the surest ways mothers can protect their developing babies’ well-being. A new study suggests that adequate levels of vitamin D could be one such protective factor.

Some data have linked low vitamin D levels to weight gain and obesity in women and children, but in the new study researchers at the University of Southampton in the U.K. found that association may begin the womb: children born to mothers with low levels of the vitamin during pregnancy had more body fat at age 6 than those whose mothers weren’t vitamin deficient.

The study, published in the American Journal of Clinical Nutrition, looked at the vitamin D levels of 977 pregnant women and the body composition of their kids. All the women were part of the Southampton Women’s Survey — one of the largest women’s surveys in the U.K.

Continue reading Is Mom’s Lack of Vitamin D in Pregnancy Linked with Child’s Weight? By Alexandra Sifferlin | @acsifferlin | May 23, 2012 →