Preventing unintended pregnancy: a pediatric opportunity.

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 longacting 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. 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. The cost for births resulting from unintended pregnancies was estimated to be $11.1 billion in 2006. 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 .99% for the copper IUD, levonorgestrel IUD, and the etonogestrel implant. Birth control pills have to be remembered to be taken daily and are 93% effective with typical use. Although physicians traditionally provide patients and parents with information on treatment options, we would unlikely recommend a vaccine that is 93% effective when another vaccine with a similar safety profile existed that was 99% effective like all LARC methods. These US Food and Drug Administration–approved LARC methods are very safe for most women. The contraceptive implant is one-half the cost of the contraceptive pill to the consumer at 12 months. Cost savings of preventing an unintended AUTHORS: Barry Zuckerman, MD,a Sacheen Nathan, MD,b and Kedar Mate, MDc Departments of Pediatrics and Obstetrics and Gynecology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts; and Institute for Healthcare Improvement, Weill Cornell Medical College, New York, New York