NEW FRONTIERS IN CONTRACEPTIVE RESEARCH: A Blueprint for Action by Institute of Medicine of the National Academies

Author:Institute of Medicine of the National Academies
Language: eng
Format: epub
Tags: Health and Medicine : Medical Technologies and Treatments. Health and Medicine : Women's Health
Publisher: NATIONAL ACADEMY PRESS
Published: 2004-03-11T00:00:00+00:00

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Improving Contraceptive Use and Acceptability

Decisions about the contraceptive leads that should have highest priority and the delivery mechanisms that should be chosen require more than information on technology and biological sciences. Better understanding of various other factors, such as whether, how, under which circumstances, and by whom a method will be used, should influence whether to begin or continue development of a new contraceptive method. Furthermore, predicting whether couples will use a method consistently and correctly, or whether they will use it at all, requires substantive behavioral research that is performed before as well as after a delivery system is selected.

Even though contraceptive use is an integral part of modern life in most developed countries, at any given time a small proportion of women and their partners who are at risk for unintended pregnancy are not using any method. Studies have shown that in the United States, 7 percent of women at risk for unintended pregnancy were using no method of contraception in any given month. Almost half (47 percent) of all unintended pregnancies each year occurred among these women. The remaining 53 percent of all unintended pregnancies occurred among the 93 percent of U.S. couples who do use methods of contraception, largely because of the inconsistent and incorrect use of effective methods (Alan Guttmacher Institute, 2000; Henshaw, 1998). The same trend has been observed in other developed countries (Larsson et al., 2002; Rasch, 2002).

In less developed countries, pregnancies that result from nonuse and the use of ineffective, traditional methods of contraception are more common (Diaz et al., 1997), for a variety of reasons that include women’s attitudes (Brophy, 1990), opposition by husbands (Casterline et al., 2001), lack of knowledge about contraception (Xiao et al., 1999), and rural isolation (Saha, 1994). In a study of 43 developing countries, there was a correlation between a lower number of contraceptive methods available and percentage of married women of reproductive age with unmet contraceptive needs (Benagiano et al., 1999). In 2003, an estimated 705 million women (28.5 percent) in developing countries were at high risk for unintended pregnancy because they were using no contraceptive at all (19.5 percent) or were relying on a traditional method (periodic abstinence, withdrawal, or other nonsupply methods) likely to have relatively high failure rates (9.0 percent). These women accounted for an estimated 79 percent of the 76 million unintended pregnancies that occur annually in developing countries (Singh et al., 2003).

In general, the rates of unintended pregnancy associated with typical use of any contraceptive method (typical use failure rates) are higher than the rates of pregnancy that occur under conditions of perfect use of a method (perfect use or method failure rates). This gap reflects the difficulties that many couples have using their methods of choice correctly and consistently. For example, it is estimated that under conditions of perfect use, no more than 0.1 percent of women relying on combination oral contraceptives (the pill) will experience an unintended pregnancy within the first year of use (Trussell and Stewart, 1998). In fact, however, in the United States, an estimated 7.

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