Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

It’s time to expand the use of long-acting, reversible contraceptives

John Schumann, MD
Conditions
February 10, 2016
Share
Tweet
Share

Quick: Which U.S. state has the highest rate of unintended pregnancy?

I’ll reveal below, but I learned the answer and several other surprising facts in an interview with Mark Edwards, the co-founder of Upstream USA, a non-profit advocacy organization that provides technical assistance to health enterprises (medical practices, clinics, public health departments) in the use of long-acting, reversible contraceptives (known in the trade as LARC).

LARC consists of two options: IUDs (intrauterine devices) and implants — which are small, match-sized, plastic rods that deliver a slow, steady dose of hormone to prevent pregnancy. They are planted in the upper arm of women to provide another form of hassle-free contraception.

Both of these methods can be discontinued at any time, at which point fertility returns — faster, I’m told, than in the case of oral contraceptives.

Here’s a fact that surprised me about oral contraceptives (a.k.a. “The Pill”): Though when taken reliably their “success rate” as a means of preventing unwanted pregnancy is considered to be 99 percent, over a 10 year use period, due to the challenging nature of remembering to take a daily pill, it’s likely that 61 percent of those taking the pill exclusively for birth control will become pregnant. Most definitely not the intended outcome.

Big picture: Every year in the U.S., there are about 6.6 million pregnancies. Of those, 3.4 million, or slightly more than half, are accidental: either altogether unwanted or “significantly mistimed” — what we in the health care business describe as a pregnancy occurring 2 or more years before desired. The vast majority of these accidental pregnancies occur in women in their 20s (though teen pregnancy is a concern, only 20 percent of unplanned pregnancies are in teens, and the vast majority of those are in women 18 to 19 years old. In fact, the teen pregnancy rate has fallen significantly in the last 25 years).

That’s why, regardless of your politics, offering LARC to any woman of childbearing age is crucial. At the very first visit. As a primary care doc myself, I know that family planning often falls down the list of concerns for patients that I see because there are so many other issues people wish to bring up in our short office visits. Thus, opportunities to provide women with LARC often fall through the cracks.

Upstream USA’s methodology includes technical assistance — training staff up to ask every woman that comes in a simple question: “Do you intend to get pregnant in the next year?”

If “yes,” proceed on to other matters. If “no,” offer LARC right then and there. And the provider (doctor, nurse practitioner, or physician assistant) is trained up to put in an IUD or implant on the spot. No waiting until next time.

Why is this so important? Women with unplanned pregnancies are at greater risk for staying or falling into poverty. Their opportunity to advance in their education is diminished. Children should be brought into the world wanted — with parents that are prepared — with the maturity and resources to succeed.

It’s a fundamental choice for a woman to decide if and when she wants to have children. Of course, fewer unplanned pregnancies also means less need for abortion.

So what Upstream USA is offering is win-win-win. It’s bipartisan: a rare area that people on all sides of the political spectrum can agree upon. Upstream USA’s first big success was in none other than Texas. The organization also has partnerships in a number of other red and blue states.

The state with the highest rate of unplanned pregnancy? Surprisingly, Delaware. Upstream USA is there, too. And going big — across the whole state.

ADVERTISEMENT

John Schumann is an internal medicine physician who blogs at GlassHospital.

Image credit: Shutterstock.com

Prev

Show some love to the lab techs by watching this epic anthem

February 10, 2016 Kevin 1
…
Next

Will cardiologists become slow and methodical internists again?

February 10, 2016 Kevin 2
…

Tagged as: OB/GYN

Post navigation

< Previous Post
Show some love to the lab techs by watching this epic anthem
Next Post >
Will cardiologists become slow and methodical internists again?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by John Schumann, MD

  • Doctors as the gatekeepers of marijuana is a race to the bottom

    John Schumann, MD
  • Rallying at the end of life

    John Schumann, MD
  • The evolution of a hospital admission

    John Schumann, MD

Related Posts

  • It’s time to make oral contraceptives available without a prescription

    Jeffrey A. Singer, MD
  • Doctors: It’s time to unionize

    Thomas D. Guastavino, MD
  • Finding happiness in the time of COVID

    Anonymous
  • A medical student’s reflection on time, the scarcest resource

    Natasha Abadilla
  • It’s time to ban productivity from medicine

    Robert Centor, MD
  • It is time to make the unvaccinated pay their fair share

    Hayward Zwerling, MD

More in Conditions

  • Financing cancer or fighting it: the real cost of tobacco

    Dr. Bhavin P. Vadodariya
  • 5 cancer myths that could delay your diagnosis or treatment

    Joseph Alvarnas, MD
  • When bleeding disorders meet IVF: Navigating von Willebrand disease in fertility treatment

    Oluyemisi Famuyiwa, MD
  • What one diagnosis can change: the movement to make dining safer

    Lianne Mandelbaum, PT
  • How kindness in disguise is holding women back in academic medicine

    Sylk Sotto, EdD, MPS, MBA
  • Measles is back: Why vaccination is more vital than ever

    American College of Physicians
  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • How self-improving AI systems are redefining intelligence and what it means for health care

      Harvey Castro, MD, MBA | Tech
    • How blockchain could rescue nursing home patients from deadly miscommunication

      Adwait Chafale | Tech
    • When service doesn’t mean another certification

      Maureen Gibbons, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • How self-improving AI systems are redefining intelligence and what it means for health care

      Harvey Castro, MD, MBA | Tech
    • How blockchain could rescue nursing home patients from deadly miscommunication

      Adwait Chafale | Tech
    • When service doesn’t mean another certification

      Maureen Gibbons, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

It’s time to expand the use of long-acting, reversible contraceptives
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...