The Our Moment of Truth campaign of the American College of Nurse Midwives (ACNM) has released survey results revealing that despite the fact that 99% of sexually active American women of childbearing age have used birth control, many of them don’t know much about it. Fewer than half of women surveyed felt knowledgable about a majority of contraceptive methods, and fewer than a quarter felt knowledgable about the most effective long acting reversible methods, IUDs and implants.
As part of my work, I went to three states in the South and talked to women’s reproductive health care providers at more than a dozen sites. Providers consistently said that most women are not aware of most contraceptive options, and that the main options women know are the Pill, the Shot (Depo Provera) and getting their tubes “tied.” Interestingly, in the ACNM survey, women consistently rated the pill as the most effective form of birth control (9% of women using become pregnant per year)–ahead of tubal ligation, vasectomy, and IUDs (less than 1%) and implants (less than 2%).*
Providers I met also said that women (especially in Catholic areas) had been told that the IUD is an abortifacient. While there are numerous religiously-oriented groups that assert this idea, the IUD is actually a contraceptive (prevents conception). Some groups also assert that the Pill is an abortifacient (though the providers did not mention this), and the providers said that women were not aware of contraceptive implants (which some groups also consider an abortifacient).
Most disturbingly, about 40% of women said they were not counseled sufficiently about how to use their chosen method, and 10% felt their provider pressured them to choose a particular method. About a third of women are seeing a provider based solely on insurance coverage, not on research about the provider’s practice norms, qualifications or values. Most women do not know that midwives can prescribe birth control.
How is this lack of information propagated? And if women don’t know they have options, what options do they really have?
*Effectiveness is calculated by a woman’s likelihood of getting pregnant during a year of typical use. In the case of the Pill, about 9 women out of every 100 using the Pill become pregnant each year. Among those using an IUD, fewer than 1 out of every 100 become pregnant–it’s more like 2 out of every 1000.