Many currently available birth control methods are effective, but only when they are actually used. A new study shows that methods such as the IUD and hormonal implants, which require no further attention once they are in place, are substantially more effective than methods that require daily attention, such as taking a pill. This story emphasizes the difference in effectiveness without providing much context about how contraceptive decisions are made, which involves weighing effectiveness against other factors such as side effects, cost, and future pregnancy plans.
Preventing unwanted pregnancy is a critical health issue, for women, men, and the society at large, with current estimates of 3 million unplanned pregnancies per year in the U.S., of which half result from failure of birth control methods. Women have many options for birth control, and reliable evidence about the relative effectiveness of each method is an essential factor in making decisions about contraception.
There is no discussion of the costs of long-acting methods (IUDs, implants, and long-acting injections) compared to alternatives such as the birth control pill, patch, or ring, although there is acknowledgement that insurance may not cover long-acting methods. It only briefly addresses IUDs and implants with this line: “can cost patients several hundred dollars if not paid for by insurance.”
The report clearly quantifies the difference in failure rates of the various methods, which range from less than 1% for long-acting methods to about 5% (after 1 year of use) and 9% (after 3 years) for the pill and patch. There is no consideration of other benefits aside from prevention of pregnancy, which can be an important factor in choice of method for some women. For example, the oral contraceptive pill can lessen menstrual cramps, and some IUDs also treat excessively heavy periods.
No mention is made of side effects that may accompany long-acting contraceptive methods, nor of those associated with the birth control pill/patch/ring. While effectiveness in preventing pregnancy is a paramount concern, women also weigh side effects in making a decision about which method to use.
The report notes that the study involved a cohort of 7500 women ages 14 to 45 who were initiating or changing birth control methods and who sought to avoid pregnancy for at least one year.
An independent expert is cited and makes clear that effectiveness, while important, is only one factor in a woman’s decision about a contraceptive method.
The potential for conflict of interest is adequately addressed, noting that one of the researchers is involved in training doctors on how to use one of the implantable methods.
Mixed bag:
The story does a good job of comparing alternatives from the standpoint of effectiveness. However it neglects any consideration of how they compare in terms of side effects and cost.
The higher cost of IUDs and implants can be a significant barrier to availability, as can access to health care providers trained to insert these devices. The story briefly mentions cost issues and lack of insurance coverage for these two options, but it is not clear how often lack of access to care affects availability. We’ll give the story the benefit of the doubt on this criterion.
Older studies have looked retrospectively at the effectiveness of different contraceptive methods, but this study provides a prospective look at how well they work in the real world, among typical users. The novelty is that this study was prospective, allowing more reliable measurement of outcomes such as pregnancy, and that it involved a large, diverse population of U.S. women. The story appropriately referred to the confirmatory nature of the study and how it gives doctors “new ammunition to recommend these (long-lasting) methods.”
The report does not appear to rely on a press release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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