Contraception and disease protection

Unintended pregnancies and sexually transmitted infections (STIs) are two serious public health concerns, University of Delaware researchers point out in a paper that has been selected as the Editor’s Choice in the current issue of the journal Women’s Health Issues.

The problem, they say, is that the most effective ways of addressing one of those concerns might end up increasing the risk of the other.

“We focused on long-acting reversible contraception [LARC] because there’s been a big increase in the use of those methods in recent years,” said Mieke C.W. Eeckhaut, associate professor of sociology. “There are also historically high rates of STIs in the United States, and in Delaware, right now, so we wondered about possible unintended conseq​uences of increased use of these highly effective means of contraception.”

The researchers compared women using the highly effective LARC methods with those using moderately effective contraception such as the pill or a patch to determine if there were differences in their use of condoms. They compared the two groups overall and also within various age categories.​

LARC methods, which don’t require regular actions by the user or annual doctor visits, are sometimes considered “forgettable” forms of contraception, Eeckhaut said, adding, “We wondered if they’re so effective that women using them don’t feel the need for a backup, such as condoms.”

She and Fitzpatrick concluded that this was the case, with women who use LARC reporting less condom use. When the researchers controlled for other factors associated with STI risk — sociodemographic and the number of sex partners — they found that the difference in condom use occurred only among women ages 20-34.​

Women in this age group are at high risk for STIs, so their lower rate of condom use can be especially problematic, Fitzpatrick said.

“This shows the need for a more integrated method of protection,” she said. “I think this data is useful for clinicians,” who might put additional emphasis on the need for STI protection when they prescribe LARC methods of contraception.

For individual women making decisions about their health, it’s a problem of balancing their various needs, the researchers said.

Moreover, current policies tend to focus on the effectiveness of LARC in avoiding pregnancy. In their conclusions in the paper, the researchers write that, “A more promising approach would be for contraceptive counseling to center clients’ needs, preferences and concerns during method selection, in addition to providing comprehensive information about a method’s side effects and risks (including risks and trade-offs related to STIs).”​​

​Eeckhaut is a family sociologist interested in social stratification and health. Her current work focuses on inequalities in U.S. contraception use.

Fitzpatrick’s research interests are in health policy and consumer financial protection. She is currently studying Medicaid and household well-being.

For the research on LARC, they examined data from the National Survey of Family Growth, focusing on participants who began using LARC or other contraception between 2008 and 2018.

They are also examining other issues, including how Medicaid clients are using health care services in Delaware and whether LARC users, who aren’t required to see a doctor frequently for prescription refills or monitoring, are accessing preventive care less often.

Their article, “Are LARC Users Less Likely to Use Condoms?” is available in Women’s Health Issues, the official journal of the Jacobs Institute of Women’s Health at George Washington University.​​

​ Article by Ann Manser,illustration  ​by Jeffrey C. Chase 

Originally published October 11, 2022​