New data show dissatisfaction with birth control is associated with unplanned pregnancy and decreased satisfaction with sexual intimacy.
Results from a new national survey conducted by the Emory University School of Medicine demonstrate for the first time that new mothers have unique contraceptive needs that are currently unmet, and these unmet needs may have broad personal and societal consequences.

Illustrating a shift in their contraceptive needs, nearly half (43 percent) of the 502 new and expectant mothers surveyed report that they currently use or are considering using a different method of birth control than they used prior to becoming pregnant.

"Though our survey is the first of its kind, the results reinforce what many busy mothers already know," said Miriam Zieman, M.D., assistant professor of gynecology and obstetrics at the Emory University School of Medicine. "A woman's life changes dramatically with the birth of a baby -- and so do her contraceptive concerns and considerations. New mothers want birth control options that are simple, effective and give them the peace of mind that allows them to adjust to the hectic routine of having a new child."

The impact of unmet needs
According to the survey, a woman's discontent with her contraception can have serious implications for intimate relationships with her partner. Fifty-seven percent of new mothers report that the frequency of sexual intercourse has decreased since the birth of their first child. Survey findings also indicate that women who are dissatisfied with their contraceptive are more than twice as likely than their satisfied counterparts to indicate some level of dissatisfaction with their sex life since the birth of their first or most recent baby.

One in three (33 percent) of new and expectant mothers surveyed report that their most recent pregnancy was unplanned. Fifty-three percent of those unplanned pregnancies occurred among dissatisfied users of contraceptives, making dissatisfied users more than three times more likely to have had an unplanned pregnancy. According to the survey, nearly half (46 percent) of new and expectant mothers indicated some level of dissatisfaction with their current method of birth control. Satisfaction with non-barrier methods (61 percent) is more than twice that of barrier methods, such as condoms (28 percent).

"About half of all pregnancies in the U.S. are unintended. Four in 10 of these pregnancies end in abortion and the resulting direct and indirect costs to society exceed $13 billion each year," says Dr. Zieman. "A woman's dissatisfaction with her method of birth control adds directly to this burden."

With so many busy parents trying to simplify their contraception, it is not surprising that sterilization is the second most popular method of birth control among U.S. couples. Unfortunately, (according to other surveys) nearly 25 percent of couples who use sterilization end up regretting their decision, and reversing this procedure, when possible, is very difficult and costly.

The ideal contraceptive
The Emory survey demonstrates significant differences in needs and preferences between new mothers and expectant mothers that underscore a new mother's desire to simplify her life. For example, significantly more new mothers than pregnant women surveyed agree that their "ideal" contraceptive would be easy to use, provide long-term protection from pregnancy and would not require a monthly trip to the pharmacy.

The survey also uncovered specific details about additional attributes that new mothers consider important and "ideal."

  • Highly effective ? Nearly all new mothers surveyed (97 percent) agree that it is very important for the ideal contraceptive method to be highly effective in preventing pregnancy, and more than half (52 percent) agree that efficacy is more important to them now than before pregnancy.

  • Allows for spontaneity ? An overwhelming majority (94 percent) of new mothers agree that it is highly important that the ideal contraceptive does not inhibit enjoyment of sex, and 35 percent state that this is more important to them now than prior to pregnancy.

  • Hassle-free ? A vast majority (90 percent) of new mothers agree that the ideal method of birth control is "hassle-free," and many (40 percent) report that such a method is more important to them now than prior to when they were pregnant.

  • Nothing to think about -- A majority (89 percent) of new mothers say it is highly important that the ideal contraceptive not require frequent thought; nearly half (49 percent) say that having a contraceptive that "is there and it works" is more important to them now than prior to pregnancy.

  • Provides long-term protection from pregnancy ? Most (79 percent) new mothers say it is very important for the ideal method to provide long-term protection. Many (43 percent) state that long-acting contraception is more important to them now than before their pregnancy.

  • Shortens or lightens periods ? A majority (77 percent) of new mothers find it highly important for the ideal contraceptive to shorten or lighten periods, and 31 percent report that this attribute has increased in importance since prior to their last pregnancy.

    Unfortunately, many of these same new mothers say the contraceptives they currently use most often do not possess these attributes. More than half (51 percent) do not agree that their birth control shortens or lightens their period, 43 percent do not think their contraceptive is something that "is there and it works" or something they don't have to think about frequently and 40 percent do not agree that their chosen method provides long-term protection from pregnancy.

    Intrauterine Contraception: An important reversible alternative for busy moms
    In recent years there have been many advances in contraception, including new forms of intrauterine contraception. Intrauterine contraceptives are easy to use, provide long-term protection from pregnancy and do not require a monthly trip to the pharmacy -- "ideal" contraceptive attributes reported by new mothers and pregnant women. Users of intrauterine contraceptives are more satisfied than users of any other contraceptive: 96 percent of women currently using IUDs are satisfied with that method.

    When prompted with an overview of intrauterine contraception, 65 percent of new mothers say learning about the option from the survey was "an important increase in their knowledge of birth control options," and 44 percent rate it better than their current or most recent method of birth control. Compare this to the fact that while 86 percent of new mothers surveyed report having discussed birth control options with their health care provider either during their pregnancy or shortly after giving birth, a recent study published in Obstetrics & Gynecology shows that U.S. physicians discussed new or different contraceptive options with only 15 percent of patients. Perhaps this explains why less than one percent of women in the U.S. use an intrauterine contraceptive, while worldwide, intrauterine contraception is the most popular method of reversible contraception.

    "For many reasons, intrauterine contraceptives are ideal for a busy mom's lifestyle," said Robert A. Hatcher M.D., professor of gynecology and obstetrics. "Both of our currently available intrauterine contraceptives are highly effective for a number of years and can be removed at any time if a woman wishes to become pregnant." Upon removal, fertility returns rapidly. Both intrauterine contraceptives have a small, flexible, t-shaped body that can be inserted in a simple procedure during a routine office visit.

    The newest option, Mirena, the levonorgestrel-releasing intrauterine system, lasts for five years and is more than 99 percent effective. Mirena delivers a low dose of the hormone levonorgestrel (a progestin) directly to the lining of the uterus, and its use usually results in shorter lighter periods (82 percent of new mothers surveyed like the idea of having shorter, lighter periods with Mirena).

    The other intrauterine contraceptive, the ParaGard T-380A Intrauterine Copper Contraceptive, releases copper ions, instead of a hormone, into the uterus, lasts for 10 years and is also more than 99 percent effective.

    After being prompted with a product-specific description of Mirena, more than half (53 percent) of new mothers rate Mirena to be better than their current or most recent method of birth control. In addition, 41 percent rate the copper method to be better than their current or most recent contraceptive.

    Intrauterine contraception is recommended for women in stable, mutually monogamous relationships who have had at least one child. Only a doctor can determine if intrauterine contraception is appropriate, but women with a history of or at risk for pelvic inflammatory disease (PID) or ectopic pregnancy should not use Mirena. Otherwise, most moms are typically good candidates for Mirena. Side effects are uncommon and may include a cyst on the ovaries, missed menstrual periods, irregular bleeding or spotting for the first 3-6 months, or lighter, shorter periods thereafter. Mirena does not protect against HIV (AIDS) and other sexually transmitted diseases.

    Mirena frees a mom from worrying about birth control for up to five years, but if she decides to have more children, she can have Mirena removed and her fertility will return rapidly. Eighty percent of women who want to become pregnant will become pregnant in the first year after Mirena is removed.

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