The potential of long-acting reversible contraception to decrease unintended pregnancy.

The 80 million unintended pregnancies that occur worldwide each year (38% of all pregnancies) can justifiably be deemed an “epidemic.” These pregnancies result in 42 million induced abortions and 34 million unintended births — births that contribute substantially to the annual world population growth of 78 million [1,2]. Among developed countries, the US record of family planning is uniquely deficient. Of 6.1 million pregnancies in 2001, half were unintended (as were more than 80% of the 800,000 annual teen pregnancies), resulting in 1.3 million abortions, 4 million births (of which one-third were unintended) and 800,000 miscarriages [3]. As Frost et al. [4] noted in a recent study published by the Guttmacher Institute: “Unintended pregnancy can force women and their families to confront difficult abortion decisions or the potentially negative consequences associated with unplanned childbearing—including child health and development issues, relationship instability, and compromises in education and employment that may exacerbate ongoing poverty.” This same study attributes 52% of unintended pregnancies in the USA to nonuse of contraception, 43% to inconsistent or incorrect use, and only 5% to method failure [4]. Leading causes of unintended pregnancy are closely related to contraceptive method choice. In 2002, more than half of contraceptive users relied onmethods with high failure rates under typical use: 31% used the pill, 18% the male condom and 5% the 3-month injectable [5]. While with perfect use these methods are highly effective, 9% of pill users, 17% of condom users and 5% of injectable users will become pregnant during the first year of typical use [5,6]. To make matters worse, about half of condom and injectable contraception users — and almost one-third of pill users — will discontinue within a year [6].