More than 50 years ago, the birth control pill launched a social revolution and changed the way U.S. women shape their lives and families. But the pill and other popular birth control methods have never come close to eliminating unintended pregnancies – both because the methods can fail and because they rely on humans who sometimes miss pills, forget condoms or fail to show up for a shot.
Enter LARC – long-acting reversible contraception. The term refers to intrauterine devices (IUDs) and hormonal arm implants that can stay in place and keep working for up to a decade. They are not new, but they are getting new attention.
Among the reasons: research now shows they are safe, more than 99% effective and acceptable to large numbers of sexually active girls and women – meaning that if more women used them, another sea change could be at hand.
"We could empower almost every woman in America to control when and with whom she has a child," says Isabel Sawhill, a senior fellow in economic studies at the Brookings Institution.
Sawhill, who is a founder of the non-profit National Campaign to Prevent Teen and Unplanned Pregnancy, has just released a book called Generation Unbound: Drifting Into Sex and Parenthood Without Marriage. In it, she says that LARC could help further drive down teen pregnancy rates, but also could help many young adults avoid unintended single parenthood. That would be a good thing not just for those adults, she says, but for their children.
Sawhill is not the only high-profile LARC enthusiast. In September, the American Academy of Pediatrics said doctors should counsel sexually active teen girls that IUDs and implants are the most effective methods. The American College of Obstetricians and Gynecologists also lists them as first-line choices for teens and adults.
These recommendations are based on studies, including one that showed that when nearly 10,000 girls and women in St. Louis, Mo., were offered any birth control method for free and told that IUDs and implants worked best, 75% chose them. The latest results, published this month, show that teens in the study ended up with pregnancy, birth and abortion rates dramatically lower than nationwide averages.
Another reason the LARC idea is gaining traction: the Affordable Care Act says insurers must pay for all kinds of birth control, making the devices, which can cost up to $1,000, more accessible. Some employers have balked at such coverage for religious reasons – and gotten support in a recent Supreme Court decision – but the Obama administration is looking for ways to cover women whose employers opt out.
Still, many women "have never even heard of these things," and many doctors don't know much about them either, says Heather Boonstra, director of public policy at the non-profit Guttmacher Institute. With just about 5% of women now using the methods, word-of-mouth is limited too, she says.
Also, like all birth control methods, LARCs have downsides. The insertion of an IUD, a T-shaped device pushed into the womb through the cervix, can be painful. Hormonal arm implants can cause unpredictable menstrual bleeding. IUDs and implants don't protect against sexually transmitted diseases, so condoms are still needed.
And there are other worries. Brad Wilcox, director the National Marriage Project and associate professor of sociology at the University of Virginia, says the promotion of LARC methods as a solution to social problems "will only augment the culture where sex is disconnected from love and commitment." It will not help build stronger relationships or do anything to promote male responsibility, he says.
"I don't think there is any magic pill here that's going to solve the challenges of family formation and family stability," he says.
Even those pushing for wider LARC use have one concern: that enthusiasm could veer into coercion, by doctors, state legislators or others.
"We have a shameful history in this country of promoting compulsory sterilization, especially with women of color and poor women, and it's something we have to be very careful to avoid" with highly effective contraception, Sawhill says. "Nobody is talking about anything other than voluntary programs."
0 comments:
Post a Comment