Training clinic staff about birth control options reduces pregnancies

By Andrew M. Seaman (Reuters Health) - Training staffers at reproductive health clinics to educate women about birth control options ultimately cut pregnancy rates in half, according to a new study. "Our impetus for doing this study is that unintended pregnancy has been extremely high in the U.S. for decades," said Cynthia Harper, the study's lead author from the Bixby Center for Global Reproductive Health at the University of California, San Francisco. She and her colleagues write in The Lancet that more than half of U.S. pregnancies are unintended. "The unwanted pregnancies are concentrated among young women 18 to 25," she said. "We tried to develop and test an intervention that would help women prevent pregnancy until they want to be pregnant." For the new study, the researchers randomly assigned 40 Planned Parenthood reproductive health clinics to receive training or continue normal care without the added training from 2011 to 2013. Twenty clinics received evidence-based training on counseling and the insertion of intrauterine devices (IUDs) or progestin implants - collectively known as long-acting reversible contraceptives (LARCs). IUDs are placed in the uterus, where they prevent pregnancy. The implant, about the size of a matchstick, is inserted under the skin of the arm, where it releases controlled amounts of the hormone progestin to block pregnancy. "There is in general a low level of knowledge in our country about these methods," Harper said. While birth control pills do not work about 9 percent of the time and condoms fail about 18 percent of the time, LARCs only fail less than 1 percent of the time, the researchers write. About 1,500 women who attended the 40 clinics for pregnancy prevention or abortion services answered questionnaires after their visits. About 71 percent of women who attended clinics that received training said they'd been counseled about LARCs, compared to about 39 percent of women at clinics without the additional training. About 28 percent of women at the trained clinics also ended up selecting LARCs, compared to about 17 percent of women at the untrained clinics. The researchers found the pregnancy rate among women attending the trained clinics for pregnancy prevention was about 8 pregnancies per 100 women per year, compared to about 15 pregnancies per 100 women per year among those at the untrained clinics. Overall, the additional training reduced the risk of pregnancy among women attending the clinics for pregnancy prevention by about half, the researchers calculated. There was no difference in pregnancy rates among women who were attending the clinics for abortion services, however. "Policies and restrictions aimed at abortion have this spillover effect," Harper said. They may keep women from accessing birth control on the same day as abortion services, she added. While those women can return to the clinic, Harper said, “it’s a matter of convenience and having them right there.” Since the original study, she said, the training program has expanded to include doctors and nurses at primary care practices, teen clinics, public hospitals and various other settings. "Women tend not to know about these options - particularly young women, which is why the education piece was so important," Harper said. She added that women should ask their healthcare providers about their birth control options. SOURCE: http://bit.ly/1aVmHg2 The Lancet, online June 16, 2015.