MENSTRUATION MATTERS

If you quit the pill would you replace it with forget-about-it or mindful birth control?

How you feel about your body, your menstrual cycle and your sexual relationship(s) will influence your choice. Another consideration might be your attitude towards an unintended pregnancy.

Photo: Public Domain // LARC birth control methods are highly effective, in part, because women can "forget about them."

On the Coming off the Pill (COTP) MIND MAP GUIDE I proposed in an earlier post in this Coming Off The Pill series, mindful methods dominate the Birth Control branch: condom, spermicide, diaphragm, fertility awareness and copper IUD. Only the latter could be considered forget-about-it birth control.     Have it put in, then forget about it.

What got me thinking about this dichotomy is the Contraceptive CHOICE Project, a new study by researchers at Washington University School of Medicine in St. Louis. More than 7500 participants were free to choose, with all costs covered, from a range of contraceptives. (Diaphragms and fertility awareness training were not included.) Contraceptive failure rates over the course of the study were compared for the methods offered. The key result?

“Women who used birth-control pills, the patch or vaginal ring were 20 times more likely to have an unintended pregnancy than those who used longer-acting forms such as an intrauterine device (IUD) or implant.”

The difference in effectiveness was even more profound for women under 21 who used the pill, patch or ring. Their risk for unintended pregnancy with these methods, versus long-acting reversible contraceptives (LARCs), was almost twice as high as for older women.

The reason for the higher failure rates is human error. Women, and especially women under 21 it seems, don’t always remember to take their pills, change their patches, or check to ensure their rings haven’t fallen out. These methods require a certain degree of mindfulness. The reason that LARCs are more effective, according to senior author Dr. Jeffrey Peipert, is because women can forget about them after clinicians put the devices in place.

There are several things I find troubling about the researchers’ contention that forget-about-it birth control is better just because it’s more effective, and that these methods should be among the first offered to women by clinicians.

Firstly, they fail to acknowledge that many women do not tolerate these “forget-about-them” methods. Among the choices made available to study participants were the contraceptive shot, which I presume was Depo-Provera, and an unspecified hormonal implant. (Implants are slow-release hormonal devices inserted under the skin of a woman’s arm.) Side effects and ongoing problems with such methods abound, and are anything but forgettable. IUDs, both copper and the hormonal Mirena, have fewer drawbacks but they aren’t problem free either. Women experience a range of side effects with the copper IUD. As for the Mirena, some women love it, others hate it.

Secondly, the implication that women under 21 especially should be encouraged (perhaps coerced?) by clinicians to use forget-about-it LARC birth control methods just makes me sad. I get that preventing teen pregnancy is an important public health goal, but the potential for harm to young women’s overall health and psycho-sexual development by the use of such methods, Depo-Provera and contraceptive implants in particular, should be cause for caution and concern.

Maybe it’s time to research mindful birth control methods. Might more women choose barrier and fertility awareness based methods if expert training and support to ensure confident, effective use of these methods were provided free of charge, as were the expensive LARC methods in this study? I guarantee researchers would have no trouble finding women to participate.

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