Pregnancy Is Still Surprising a Lot of Us : Medicine: Thirty years after the legalization of birth control, the rate of unplanned pregnancies remains high. About 60% are unintended.


It's been 30 years since the U.S. Supreme Court said married couples could use birth control. Yet despite numerous legal and contraceptive advancements in three decades, successful family planning still has light-years to go.

"Each advancement seems to be paralleled by challenges still ahead," said Pamela J. Maraldo, president of Planned Parenthood Federation of America, which on Tuesday hosted a family planning symposium here to commemorate the court ruling.

"Sometimes it feels like we're moving backward."

Maraldo noted that in 1965--the year the Supreme Court helped lift state restrictions on birth control--about two-thirds of pregnancies were unplanned. Today, the rate isn't much better: about 60%--or 3.5 million a year--are still unintended.

"Anyone could argue that this is not overwhelming progress," Maraldo said.

And it's not that people aren't using birth control, she added. About half of those unintended pregnancies occur even though some form of contraception is used.

Symposium participants--which included about 40 doctors, researchers and authors--attributed the unplanned pregnancy problem to many factors. Among them: incorrect use of and lack of access to existing methods of precoital birth control--although even when used correctly, no existing birth control method is perfect, they said. U.S. drug companies are also reluctant to risk developing new and potentially better techniques because of tough regulatory approval requirements, fear of litigation and pressure from political forces opposed to family planning, they said.

In addition, there is a lack of awareness about postcoital emergency measures--which by preventing implantation of a fertilized egg could cut in half the whopping abortion rate of 1.6 million a year, experts said.

"We as a society could save billions of dollars by consistently and correctly using effective birth control," said James Trussell, a professor of economics and public affairs at Princeton University and director of its Office of Population Research.

Trussell, acting dean at Princeton's Woodrow Wilson School of Public and International Affairs, told the group that he conducted a recent study in which he and colleagues looked at the economic impact of 15 contraceptive methods, factoring in cost of acquisition, side effects and failures.

The study, published in April's American Journal of Public Health, found that all contraceptives are more cost-effective than no method, with the copper-T IUD and vasectomy plus contraceptive implants and injections all potentially saving managed-care payers more than $13,000 per person over five years.

The study also found that because of high failure rates, barrier methods, spermicides, withdrawal and periodic abstinence were costly but still saved about $9,000 to more than $12,000. Oral contraceptives fell in the middle.

Trussell said that the 3.5 million unintended pregnancies a year--if all treated in managed-care settings--would translate into $13 billion.

"This is a serious piece of change," he added.

Money could also be saved by increasing awareness and use of emergency measures that can be taken when precoital birth control fails or isn't used, said Trussell, who co-wrote the book, "Emergency Contraception: The Nation's Best Kept Secret" (Bridging the Gap Communications, 1995).

Trussell reviewed the three methods of emergency contraception available by prescription in the United States: combined oral contraceptives (ordinary birth control pills containing the hormones estrogen and progestin), mini-pills (birth control pills containing only progestin) and the copper-T intrauterine device.

All three methods are marketed as ongoing regular birth control, but even though they've been used for emergency purposes since the 1970s, such methods are underutilized in this country, Trussell said.

That's primarily because no drug company here has applied to the U.S. Food and Drug Administration to market them for emergency use, unlike in Europe, where they are actively promoted, he said. Therefore, many Americans--including doctors--don't know they can be used.

"Without FDA approval, manufacturers cannot market or advertise these products for postcoital use, so the normal educational function of drug promotion is absent," Trussell said. "However, their use is perfectly legal and most women can use them safely."

In addition, some people perceive postcoital birth control to be the equivalent of abortion.

"Emergency contraception is not abortion--nor is it RU486, the French abortion pill," Trussell stressed. "Emergency contraception simply prevents pregnancy after intercourse."

Still, some people fear that easier accessibility to emergency postcoital contraception would encourage people not to use precoital methods.

"It'd be stupid to use it as an ongoing method because it's not as effective as any regular ongoing contraception," he said. "Also, the nausea associated with its use would not make many people too keen to use it again."

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