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Sixty seconds on . . . teen pregnancies

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1888 (Published 18 April 2017) Cite this as: BMJ 2017;357:j1888

Re: Sixty seconds on . . . teen pregnancies - how about the success being through more use of the LARCs?

Long-acting reversible contraceptives (LARCs) - the injectables, implants, intrauterine devices and systems - received a boost when the NICE guideline came out in 2005, which would be time-related, certainly, to the decline in teen pregnancies from 2007 onwards. The relevant UK Pharma companies have data that show an associated increased uptake in the LARCs. This explanation is reinforced by the experience in the US tha Hawkes quotes, where, for example in Colorado, the decline in teen pregnancy has been massive and causally attributed to greater use of LARCs (www.colorado.gov/pacific/cdphe/news/teenbirthrate). Though funding continues to be threatened by the Republican party (www.theguardian.com/us-news/2015/may/06/colorado-contraception-family-pl...), other States have to a greater or lesser extent also increased LARC usage especially at young ages.

The benefit of promoting LARCs is two fold: they are the most effective reversible methods with highest continuation rates, but they also imply less reliance on the combined oral contraceptive, which Trussell has shown is vastly less effective in typical use (9 failures per 100 users in the first year) than the less than 1 % failure rate still wrongly quoted by so many providers (www.contraceptivetechnology.org/wp-content/uploads/2013/09/CTFailureTabl...). This dire real-world failure rate is reducible, by explaining to users the crucial importance of never lengthening the PFI or pill-free interval ("Never be a Late Re-starter") and even better by proposing the more effective and SRH Faculty-approved extended-use systems such as tricycling, that eliminate most or all of the contraceptively risky PFIs (file:///C:/Users/John/Downloads/ceuguidancecombinedhormonalcontraception%20(3).pdf); but even so the LARCs are in a different league.

Competing interests: No competing interests

21 April 2017
JOHN GUILLEBAUD
Emeritus Professor of Family Planning and Reproductive Health
UCL
Oxford
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