The New York Times recently published an op-ed piece about the rising rate of unplanned births outside of marriage. The author, Isabel Sawhill, has been researching causes for why this is happening. A senior fellow at the Brookings Institution, Sawhill has also written a book called, Generation Unbound: Drifting Into Sex and Parenthood without Marriage and says one reason for the increase is a lack of awareness about options for contraception that help women better plan for when they want to get pregnant.
Some options, known as long-acting reversible contraceptives, or LARCs, are proven to be more effective at preventing unplanned pregnancies than the birth control pill or a condom. Those more well-known methods require a woman to take an action in order to prevent pregnancy. But LARCs are already in place, so the user won’t get pregnant until she’s ready to have the contraception removed.
The most well-known LARC is probably the intrauterine contraceptive (IUC), Several decades ago, these were known as intrauterine devices (IUDs), and they became very unpopular after one particular brand, the Dalkon Shield, caused health problems in women who used them. The modern IUC has been considered safe by the American College of Obstetricians and Gynecologists for a long time. The American Academy of Pediatrics also recommends their use for sexually active teenage girls.
Other LARC methods use pregnancy-preventing hormones. One is an implant called Nexplanon. It is a silicone rod, no bigger than a matchstick that is inserted under the skin on the inside of the upper arm. The hormone interrupts a woman’s menstrual cycle. But if she decides she wants to try and become pregnant, the effects of the hormone wear off very quickly after the Nexplanon is removed.
Both the implant and IUCs require training to insert or remove. This is a simple procedure that can be performed by an OB/GYN or another qualified provider right in the exam room. Nexplanon is effective for up to three years before it needs to be replaced. Some types of IUCs can be left in place for as long as 12 years.
A third LARC is an injection of a hormone called Depo Provera (Depo). Depo is given every three months. The injection is usually given by a nurse or a medical provider, but in some cases a patient may self-inject at home. The pregnancy-preventing effects of a shot last for about 12 weeks. Unlike an IUC or the Implant, a woman might have to wait a longer period of time for effects of Depo to wear off before she is able to become pregnant.
The upfront costs for LARCs can be higher than other types of contraception, depending on individual health insurance benefits, but the lifetime costs end up being less expensive. LARCs might cause side effects that are a nuisance, but they do not carry the same medical risk as contraceptives that use estrogen. It should also be noted that none of these methods protect the user against sexually transmitted infections.
Whether you should get an IUC, an implant, or a shot is something you should discuss with your primary care provider or your reproductive health care provider, including Planned Parenthood. They can help you assess your situation and guide you toward a decision that works best for your life.
Roxanne Karter, APRN is a board-certified adult nurse practitioner at Brattleboro Internal Medicine, a member of BMH Physician Group. She can be reached by calling 802-257-2611.