Doctors have little training regarding pregnant people with disabilities. Credit: Frank de Kleine / flickr creative commons

Studies shed light on how many women have unintended pregnancies, and why the numbers remain stubbornly high despite better methods of contraception.

By Rose Hoban

In July, the National Association for City and County Health Officials named the health department in Gaston County one of the three best county departments in the U.S.

One of the reasons cited for the prestigious award was the way the Gaston County Department of Health and Human Services aggressively treats women who come in seeking reproductive care.

“In our county, anyone can come to us and get any kind of birth control,” said Medical Director Velma Taormina. “That means intrauterine devises, subdermal implants, long-acting reversible contraceptives … the most effective of modern contraceptives.”

Taormina also said every doctor, nurse and nurse practitioner in the department has extensive training in up-to-date contraceptive technology.

“Everyone has the same background, and we script it out,” Taormina said. “We go over all the patient education with them. Everyone who works there can answer any question that a client might ask them.”

She also said the county clinics are open every day, with someone who knows about birth control on duty at all times.

Taormina said all of this is because county officials were looking for a way to address a persistent problem: unintended pregnancy.

A new report from the Guttmacher Institute, a national organization that studies issues around reproductive health, indicates Gaston County is wise in its aggressive emphasis on birth control. The report finds that even though more women overall are planning when to have children, more than half of pregnancies in North Carolina are still unplanned. And data also show that many women lack consistent access to contraceptives that could help them plan the timing of their children’s births.

In the most recent Guttmacher data from 2008, which compares all states to one another, North Carolina ranked 31st in the rate of unintended pregnancies with 52 percent, about the same as Texas but lower than most states in the South.

Young, sexually active and unprotected

“Many of the people in those studies are young women who want to get pregnant … someday,” said Elizabeth Finley of the Adolescent Pregnancy Prevention Campaign  of North Carolina.

EPT_pregnantFinley said focus groups conducted by her organization and the National Campaign to Prevent Teen Pregnancy show many women in their late teens and 20s underestimate the benefits of contraceptives and overestimate the negatives.

“They’ll have heard that so-and-so’s cousin used an [intrauterine device] and got pregnant anyway,” she said.

Finley said that even though modern contraceptives are more effective and have fewer side effects than did contraceptives for their mothers’ generation – and are also more reversible than young women realize – younger women also tend to be concerned about the side effects they hear listed at the end of commercials, and therefore stay away from contraceptives.

The result is that young women use contraceptives less consistently than they could and many end up with pregnancies that they weren’t planning. According to the Guttmacher data, that was about 99,000 pregnancies in North Carolina in 2008.

Of those pregnancies, 58 percent of women went on to have the babies, about 14 percent had miscarriages and about 28 percent had abortions.

More recent data from the North Carolina Pregnancy Assessment Monitoring System, a survey sponsored and led by the Centers for Disease Control and Prevention, gives additional insight about unintended pregnancies. In 2011, for young women under 20, 80.6 percent said their pregnancies were unintended; for women between 20 and 24, 58.1 percent of pregnancies were unintended.

But as women age, they become more deliberate about planning births. In the 25-34 age group, 33 percent of pregnancies are unintended, while for 35-and-over, that rate drops to 27 percent unintended.

“As they get older, women are shifting from, ‘I want to get pregnant some day, but not now,’ to ‘I want to get pregnant soon,'” Finley said.

Unmet need

While unintended pregnancies can be the result of young women’s ambivalence about birth control, many unintended pregnancies are the result of women being unable to get contraception, said Taormina.

Mirena Intrauterine device.
Mirena Intrauterine device. Image courtesy hic et nunc, wikimedia creative commons

She said a lot of general practitioners might not be up on the latest in contraceptive technologies and will only offer older methods, such as Depo Provera, a contraceptive shot given every three months, or contraceptive pills that have to be taken every day. And if a patient lapses on either method, it becomes more likely they can become unintentionally pregnant.

For poorer women who rely on health departments, there are other barriers.

“In a lot of health departments, they set aside a certain time for reproductive health visits, because that’s when a provider is available,” Taormina said. “But what if the woman isn’t available?”

She said that’s why her clinic has people available every day to help women with reproductive health care.

And Taormina said not a lot of doctors are up on some of the longer-acting contraceptive methods that can be placed under the skin or directly in the uterus and that last for several years. Those need to be inserted during a short window during a woman’s menstrual cycle, and sometimes the timing of the provider being in a clinic and a woman being available for an appointment don’t correspond.

Then there are financial issues, from insurance not covering contraceptives for some people to others who have high-deductible policies with high out-of-pocket costs.

Taormina said data her department collected about Gaston County women on Medicaid found that 55 percent of them didn’t plan their pregnancies. And that ends up costing the Medicaid program money.

According to a separate study by the Guttmacher Institute, researchers found that “every dollar invested in providing publicly funded contraceptive services in 2010 saved $5.68 in Medicaid costs for pregnancy and infant care,” higher than prior estimates.

“We also see women who normally go to private OB/GYN offices, but because of their insurance it can be cheaper to come to us than to go to private practitioners,” Taormina said. “There are three other practices in the county and they’ll send those patients over to us if the costs are prohibitive.”

But Taormina’s biggest concern is the teens she sees.

“I know one pediatrician who said that in her four-doctor group she’s the only one offering contraception to teens in her practice.

“She gives them all pills.”

Correction: This story originally identified Velma Taormina as the Health Director in Gaston County. She is the Medical Director.

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