Here are two facts that don’t seem to jibe: Birth control is widely available. And about half of the 6 million pregnancies in the United States each year are accidents. Contraception experts have long known that even couples who want to avoid pregnancy can be strikingly lax about preventing it. This month, a survey from the Guttmacher Institute, a think tank on reproductive issues, casts new light on the whys.
What the survey found
*Nearly two-fifths of women on the pill miss a daily dose at least once in the course of three months, raising their pregnancy risk.
*About three-fifths of women who rely on their partners to use condoms reported that a condom was skipped or put on late at least once in the previous three months.
*Nearly 4 in 10 women using birth control do not much like their method, and such dissatisfaction also significantly raises the risk of pregnancy.
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*About 5 percent of the women said they used their birth-control method reliably, but it had failed — possibly because of a break in a condom or, rarely, pills that don’t work — allowing them to get pregnant.
What happened next
The survey did not determine how many of the unplanned pregnancies led to births, though previous Guttmacher research has suggested that 42 percent end in abortion, 14 percent in miscarriage and the rest in births.
The myths
Karen Caponi, a nurse-practitioner at the Worcester Health Center of Planned Parenthood in Massachusetts for 22 years, said accidental pregnancies often come from misinformation. A classic myth, she said, “is that you can only stay on the pill for two years, and then you have to come off it, your body needs a rest. It doesn’t need a rest!” Among others cited by birth-control providers:
*The belief that you can’t get pregnant over age 40.
*The myth that you can’t get pregnant during your period.
*The idea that you can’t get pregnant in a first sexual encounter.
*The notion that you can’t get pregnant while breast-feeding.
Wrong, wrong, wrong and wrong.
The pill problem
Even for those who aren’t fooled by old wives’ tales, pitfalls of human nature can lead to unplanned pregnancies, experts say. For example, studies have shown it is a huge challenge for people without immediate symptoms to take a pill every day, whether it is birth control or blood pressure medication. “Everyone always wants to indict young, sexually active women, and this is a behavior that is a human nature problem” not specific to them, said Dr. Katharine O’Connell of Columbia University Medical Center in New York. Researchers are looking into methods to prompt regular pill-taking, she said, such as text messages on a woman’s cell phone daily.
The image problem
Another persistent challenge, providers say, is that societal attitudes about sex often make women who are not in steady relationships reluctant to prepare in advance for sexual encounters, for fear that will make them seem promiscuous. Dr. Moira Cunningham, chief of the internal medicine practice at the Copley, Mass., office of Harvard Vanguard Medical Services, routinely advises female patients to buy their own condoms and to keep a supply of Plan B, the emergency “morning after” pill, at home.
The access problem
Yet another barrier is trouble gaining access to birth control, whether because of cost, insurance changes, or problems getting to the doctor for a new prescription or method. “A fairly common scenario is that patients take their pills, and then their prescription runs out,” said Dr. Alisa Goldberg of Planned Parenthood in Boston. “They just can’t get in on time, and so they have a gap, and eventually they come back, but maybe they come back pregnant.” According to the Guttmacher report, more than half of women who have a gap of at least one month in birth control are in the midst of an “important life event,” whether a job change, a move, a break-up, a new love, or some kind of crisis.
Longer-term options
Given the “human error” problems with pills and condoms, some providers say they encourage patients to give added consideration to long-term methods:
*The intrauterine device, or IUD, which can stay in for up to five years and has recently been approved for women who have not had children
*The NuvaRing, which stays in the vagina for three weeks
*Hormonal implants such as Implanon that last three years.
About the survey
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The Guttmacher survey was released this month but was conducted in 2004. It included 1,978 American women age 18 to 44 who were sexually active, not sterile, not pregnant and not trying to become pregnant. They were asked about contraceptive use in the previous year.