Innovations in Contraception

Cassing Hammond, MD

Effective contraception is a human right, an essential component of reproductive justice for both women and men. The World Health Organization (WHO) estimates that in 2008, use of modern contraceptives prevented 188 million unintended pregnancies, 1.2 million neonatal deaths, and 230,000 maternal deaths. Meanwhile, publically funded contraception prevents nearly 2 million pregnancies annually in the United States. Without such services, rates of unintended pregnancy and abortion in the United States would be nearly two-thirds higher, especially among poor women who rely on publically supported programs for birth control.[1]

Effective contraception provides many noncontraceptive benefits that improve the health and well-being of women, families, and communities. Many methods reduce rates of sexually transmitted infection, including transmission of HIV. Contraception reduces both maternal mortality and infant mortality. Controlling whether and when to have children allows women the autonomy to pursue education and participate in public life. Finally, effective family planning controls population growth, improving local economies, protecting the environment, and preventing civil unrest.[2]

Despite the well-established benefits of modern contraception, the world confronts an epidemic of unintended pregnancy. The UN Population Fund estimates that 225 million women in developing countries wishing to delay or stop childbearing currently use no method of contraception.[3] In the United States, roughly half of all pregnancies are unintended.[4] Lower-income women use contraceptives less often and less effectively than more affluent women and face five times the risk of unintended pregnancy.[5] Even though each dollar spent on publicly funded contraceptive services saves the U.S. health care system nearly $6, contraception programs funded by Title X, Medicaid, and the Affordable Care Act (ACA) face ongoing threats of reduced funding and outright elimination.[6]

Given the scope of unintended pregnancy and the availability of highly effective means of pregnancy prevention, reproductive health care providers have a moral duty to improve contraceptive care. They can improve care through their roles as clinicians and researchers. They can improve care by working with governmental and nongovernmental organizations that help provide contraceptive services. They can also improve care by contributing to professional journals and lay publications, such as the current edition of Seminars in Reproductive Medicine.

The authors dedicate this edition of Seminars to the proposition that every child should be a wanted child and that every pregnancy should be safely planned.

• References

• 1 Sonfield A, Hasstedt K, Kavanaugh ML, Anderson R. The social and economic benefits of women's ability to determine whether and when to have children. New York (NY): Guttmacher Institute; 2013. Available at: http://www.guttmacher.org/pubs/social-economic-benefits.pdf . Accessed December 28, 2015
• 2 Access to contraception. Committee Opinion No. 615. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015; 125: 250-255
• 3 WHO Media Center. Fact Sheet Number 351. Available at: http://www.who.int/mediacentre/factsheets/fs351/en/ . Accessed December 28, 2015
• 4 Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011; 84 (5) 478-485
• 5 Dehlendorf C, Rodriguez MI, Levy K, Borrero S, Steinauer J. Disparities in family planning. Am J Obstet Gynecol 2010; 202 (3) 214-220
• 6 Frost JJ, Zolna MR, Frohwirth L. Contraceptive needs and services, 2010. New York (NY): Guttmacher Institute; 2013 . Available at: http://www.guttmacher.org/pubs/win/contraceptive-needs-2010.pdf . Accessed December 28, 2015