Parks Caitlin, Peipert Jeffrey F
Division of Family Planning, Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University, School of Medicine, St Louis, MO; Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN.
Division of Family Planning, Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University, School of Medicine, St Louis, MO; Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN.
Am J Obstet Gynecol. 2016 Jun;214(6):681-8. doi: 10.1016/j.ajog.2016.02.017. Epub 2016 Feb 12.
Significant public health disparities exist surrounding teen and unplanned pregnancy in the United States. Women of color and those with lower education and socioeconomic status are at much greater risk of unplanned pregnancy and the resulting adverse outcomes. Unplanned pregnancies reduce educational and career opportunities and may contribute to socioeconomic deprivation and widening income disparities. Long-acting reversible contraception (LARC), including intrauterine devices and implants, offer the opportunity to change the default from drifting into parenthood to planned conception. LARC methods are forgettable; once placed, they offer highly effective, long-term pregnancy prevention. Increasing evidence in the medical literature demonstrates the population benefits of use of these methods. However, barriers to more widespread use of LARC methods persist and include educational, access, and cost barriers. With increasing insurance coverage under the Affordable Care Act and more widespread, no-cost coverage of methods, more and more women are choosing intrauterine devices and the contraceptive implant. Increasing the use of highly effective contraceptive methods may provide one solution to the persistent problem of the health disparities of unplanned and teen pregnancies in the United States and improve women's and children's health.
在美国，围绕青少年怀孕和意外怀孕存在显著的公共卫生差异。有色人种女性以及教育程度和社会经济地位较低的女性意外怀孕及由此产生不良后果的风险要高得多。意外怀孕会减少教育和职业机会，并可能导致社会经济贫困和收入差距扩大。长效可逆避孕法（LARC），包括宫内节育器和植入物，提供了将默认状态从意外为人父母转变为计划怀孕的机会。LARC方法无需刻意记着；一旦放置好，它们就能提供高效、长期的避孕效果。医学文献中越来越多的证据表明了使用这些方法对人群的益处。然而，LARC方法更广泛应用的障碍依然存在，包括教育、获取和成本方面的障碍。随着《平价医疗法案》下保险覆盖范围的扩大以及这些方法更广泛的免费覆盖，越来越多的女性选择宫内节育器和避孕植入物。增加高效避孕方法的使用可能为美国意外怀孕和青少年怀孕导致的持续存在的健康差异问题提供一种解决方案，并改善妇女和儿童的健康状况。
