The ST LOUIS CHOICE STUDY

· Almost 7500 sexually active women in St. Louis could have their choice of free contraception for up to 3 years (1) 

· They only had to not want to get pregnant for at least one year and be willing to listen to all the risk and benefits of all available common contraceptives 

· They could then have their choice of all the methods and switch if they were unhappy with their choice

 · This was the first prospective large US multi-year study that compared the outcomes of the pregnancy rates and satisfaction with the most popular contraceptive methods currently available with no cost consideration

 · The main author was Dr Jeff Peipert and was paid for by the Susan Buffett Foundation

 · The average US teen has sex for the first time when they are 18 years old (2) 

· This is no different than Europe, Canada, and Mexico

 · The only difference is that US teens have a much higher unplanned pregnancy and abortion rate (3,4)

 · Lack of adequate sex education in US schools is one of the major differences

· Failure rates of long-acting reversible contraception [LARC] (intrauterine devices [IUDs] and implants) were compared to the most commonly used contraceptive, “the pill” 

· One half of failures causing unplanned pregnancies is the incorrect or inconsistent use of the method (5)

 · “Forgettable contraception” like LARC takes these failures “off the table”

 · The implant (Nexplanon) and IUDs do not require you to remember anything

 · The failure rate for the pill, patch, or ring was 20 times higher than LARC (1) 

· LARC users had over 80% continuous use at 12 months compared to 50% for the pill (6)

 · Satisfaction with the two groups was also similar (IUDs 80%; the pill 54%) (6)

 · For a more detailed description of individual methods please see Bedsider (7) 

References 

1. Effectiveness of Long-Acting Reversible Contraception BrookeWinner,M.D., JeffreyF.Peipert, M.D., Ph.D., Qiuhong Zhao, May 24, 2012
N Engl J Med 2012; 366:1998-2007 DOI: 10.1056/NEJMoa1110855

 2. http://chartsbin.com/view/xxj 

3. Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011;84:478-485 

4. Ventura SJ, Abma JC, Mosher WD, Henshaw SK. Estimated pregnancy rates for the United States, 1990-2005: an update. Natl Vital Stat Rep 2009;58:1-14 

5. Kost K, Singh S, Vaughan B, Trussell J, Bankole A. Estimates of contraceptive failure from the 2002 National Survey of Family Growth. Contraception 2008;77:10-21 

6. Obstet Gynecol. 2011 May;117(5):1105-13. doi: 10.1097/AOG.0b013e31821188ad. 

7. www.bedsider.org