PHS 795 student Kali Boldt points us to an NPR article on increasing use of long-acting reversible contraceptives (LARC) among young women. US rates of adoption have been lower than elsewhere; what determinants might underlie that fact? Kali writes:
I feel this is very relevant to the lecture we just had about the “pleasure deficit”. There are many reasons why using contraception has a large benefit for individual health, but also population health outcomes. Using contraception prevents premature births and low birth weights, but also planning pregnancy can have great benefits for physical and emotional well-being down the road for moms. Many issues were raised in the article describing ideas that could be better explained from the “pleasure deficit.” Many young ladies know about the pill. Because of this, they are more likely to use this contraception method. They hear about the bad reputation/history surrounding IUDs and implants, which makes them weary of using this type of contraception. This history includes, high rates of pelvic inflammatory disease and septic miscarriages in cases when the IUD failed to prevent pregnancy. This history carries into the current use of IUDs and implants. If these failings continued in new models, when women start to use the device as contraception this would greatly decrease their pleasure. However, these are long-acting methods that have been improved drastically since past devices. This type of device would address many factors of the “pleasure deficit” in a positive way. The power of choice when to have children, ability for spontaneity, effective prevention making sex more pleasurable, etc. In Gaston County, they have increased the rate of use of these long term contraception methods, resulting in a decrease in teen pregnancy and reducing the disparity seen between white and African Americans. This does away with the responsibility of taking a pill each day. Many moms on Medicaid were not coming for their post-partum appointments, so right after giving birth, providers started offering an IUD or implant to prevent another pregnancy. In this way, they reach more moms on Medicaid to offer contraception. Before this, many mothers came back soon after their previous birth pregnant again.
While this article highlights many great ideas about contraception use, the article may be more impacting if it addressed the “pleasure deficit” directly. Simply offering more methods and more access to these methods may not be enough to warrant their usage to many moms. If providers were trained how to talk with their patients about factors surrounding the “pleasure deficit” many women may be more inclined to use IUDs or implants. As noted above, these long-acting methods are a great way to prevent pregnancy without much responsibility to the user. With increased use of these methods, we’ve already seen decreases in teen pregnancy rates and disparities among these rates in Gaston County. To increase their use, providers need to discuss with their patients the history of old models to the new improved models. Training programs for providers should include practice in discussing the “pleasure deficit” to increase IUD and implant use to further decrease high teen pregnancy rates and disparities within these rates.