Nearly half of all pregnancies in the United States are unintended—either mistimed or unwanted—even though most US women use some form of contraception.1 Experts estimate that at least half of all US women will experience an unintended pregnancy, and one in three will have an abortion by age 45.2
A wide array of highly effective hormonal and non-hormonal contraceptive methods are available to American women. Yet despite these options, many women prefer to use non-hormonal methods which, coupled with inconsistent, incorrect, and discontinued use, contribute to the prevalence of unintended pregnancy.
Why do women say they want to avoid hormones? They may be concerned about the safety of hormone use. They may fear side effects. They may perceive non-hormonal methods to be “more natural” and less disruptive of their body’s ecology and their libido.3
Avoidance of hormones is not always the issue when people choose methods that can be less reliable Cost also plays an important role. A recent study called the Contraceptive Choice Project was conducted by researchers at Washington University in St. Louis., This study found that when cost and knowledge barriers were removed to long-acting reversible contraceptive (LARC) methods such as intrauterine devices and implants, women were more likely to choose them.4 Sixty-seven percent of the 9,256 women ages 14 – 45 who were enrolled in the prospective study chose a long-acting method. Two-thirds of adolescents, who represented approximately 20 percent of the total study population, also chose a LARC method.5 LARC users were highly likely to continue with and be satisfied with their method. Among women who chose a LARC method, 86 percent were still using this method at one year. Only 55 percent of women who chose non – LARC methods were still using their method at one year. More over women using LARC methods had the highest satisfaction at one year follow-up.6
Knowledge is power, and it’s important for women and health care providers to be aware of the seven most effective contraceptive methods available in the US: tubal occlusion or ligation, vasectomy (for men), transcervical sterilization (Essure® micro-inserts), three reversible IUDs (Mirena® ,Skyla®, and Paragard® “Copper-T”) and a reversible implant (NEXPLANON). Most of these methods are hormone-free, although Mirena and Implanon do contain hormones. Other non-hormonal methods such as barrier and fertility-based awareness methods (Standard Days® and many others) also can be effective if they are used correctly and consistently, which often hinges on appropriate counseling and education. In the case of these less-effective methods, the guiding principle is that use of any method is better than use of no method at all, with its attendant 85 percent risk of unintended pregnancy.7