Preventing Unintended Pregnancy: A Pediatric Opportunity

Abstract

* Abbreviations: IUD — : intrauterine device LARC — : long-acting reversible contraceptive Prevention is the cornerstone of pediatric practice, with immunization the prototype strategy because of its significant effectiveness in preventing selected infections. Other targets of prevention such as obesity, injuries, birth defects, and drug and alcohol use are important but lack simple, evidence-based, and equally effective strategies. We suggest that in response to the improvement in the effectiveness and safety of long-acting reversible contraceptives (LARCs; eg, intrauterine devices [IUDs], contraceptive implants), pediatricians have a special opportunity to prevent unintended pregnancy, not only in adolescents but in all women of childbearing age who bring their children into our offices for pediatric care. This commentary provides information about unintended pregnancy and the safety and effectiveness of LARC methods. We suggest specific opportunities for pediatricians to engage and motivate women to actively choose their reproductive futures and when to have their children. One-half of the 6.7 million pregnancies in the United States each year are unintended, 43% of which end in abortion.1 Although the studies have limitations, the data show that unintended live births suffer a disproportionately high rate of maternal and infant health problems, interfere with young mothers completing their education, and reduce the financial and emotional resources available to support and nurture existing children.2 The cost for births resulting from unintended pregnancies was estimated to be $11.1 billion in 2006.3 LARC methods are the most effective, safest, and most cost-effective reversible options to prevent unintended pregnancy. The 2 US Food and Drug Administration–approved methods (IUDs and the contraceptive implant) have higher efficacy rates compared with other reversible methods. The typical success rates during the first year of use are … Address correspondence to Barry Zuckerman, MD, Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, 771 Albany St, Dowling Building, 3rd Floor, Boston, MA 02118. E-mail: barry.zuckerman{at}bmc.org