The mother was in her late 20s and stated she wanted to get her tubes tied after her second child but “her doctor didn’t do it.” She asked for this surgical procedure after her 3rd and 4th child to no avail either. She said she wasn’t sure what else to do as “condoms don’t work for me and my partner and there’s no way I can remember to take a pill every single day.”
The contrast of two very different realities, only 6 physical miles apart within the city of Chicago, baffles me. Inequities exist in every facet of life, yet even in our world class city, access to basic preventive services still presents a seemingly insurmountable challenge. Aside from the devastation of sexual assault, pregnancy is 100% preventable! Globally, we know that when women have the tools to plan if/when they become pregnant or parent, they have more opportunities; opportunities that correlate with higher educational and professional achievements and, ultimately, more parity and equality with the biological gender lacking a uterus. To be clear, unplanned pregnancies can be joyous news for some, but devastating for others. It’s not a binary issue of planned is good, unplanned is bad. It’s about having the personal choice.
Of women contracepting, about 12% use an IUD or contraceptive implant (Implant), with the majority still choosing either oral contraceptive pills, tubal ligations or condoms. Less than one-half (45%) of all pregnancies in the USA are unplanned or mistimed, an improvement from a decade ago at 52%. In Illinois, one-half of all pregnancies continue to a birth, while about 30% end in abortions and 18% end in miscarriages or a failed pregnancy.
The IUD is a t-shaped device about the size of a quarter that is effective for 3 to 12 years. Implants consist of a single match-sized rod placed on the underside of the upper arm that is effective for 4 years. Collectively termed long acting reversible contraception (LARC), these 2 types of modern birth control are known as the most effective methods for pregnancy prevention with the same efficacy as a tubal ligation or a vasectomy, but completely reversible and requiring only a 30 minute office visit. Aside from the highly touted efficacy rates, LARCs do not contain estrogen, often the culprit for concerns and serious side effects from hormonal birth control. Moreover, the IUD is approved for treatment of heavy uterine bleeding. What once required a hysterectomy can now be alleviated with a simple office visit.