Abstract
“Empowering women to achieve their desired family size should be the focus of global public health policy in the 21st century.”
Unintended pregnancy is one of the main causes of maternal morbidity and mortality worldwide. Consequences of unintended pregnancy have an enormous financial and societal impact resulting in high medical costs, a reduction in the female workforce, and a threat to families and children. Empowering women to achieve their desired family size should be the focus of global public health policy in the 21st century.
One of the major mechanisms toward achieving a desired family size is through enhanced contraceptive access and safe abortion. Currently there is an unmet global need for contraception in excess of 200 million women. This need can best be met by educating more women regarding all contraceptive options, development of diverse contraceptive options that address the needs of women from different cultural and ethnic backgrounds, and promotion of long-acting reversible contraception. Additionally, contraceptive methods that have additional medical benefits such as reducing the incidence of certain cancers and preventing the transmission of HIV are important considerations.
The following themed section of this Women's Health issue includes articles that provide the most current and evidence-based approaches toward achieving the goal of reducing the global burden of unintended pregnancy. ‘Addressing gaps in the contraceptive method mix: methods in development’ by Nanda et al. [1] highlights the importance of novel contraceptive development. New contraceptive methods aim to increase the number of contraceptive users through nontraditional approaches while maintaining or improving contraceptive efficacy. Another equally important strategy toward reducing unintended pregnancy is by reducing the incidence of teenage pregnancy. ‘Contraceptive counseling for adolescents’ by Potter and Santelli [2] focuses on key strategies for healthcare providers to increase the uptake of highly effective contraception for this patient population.
'Oral steroid contraception’ by Sech and Mishell [3] aims to dispel certain myths attributed to the use of oral contraceptives that may prevent their current widespread global use. Oral steroid contraception continues to be a popular form of family planning with many additional and important health benefits. Knowledge of the true adverse event risk of oral steroid contraception will help to improve access to this highly desired form of contraception. The articles ‘Long-acting hormonal contraception’ (Benagiano et al.) [4] and ‘Intrauterine contraception’ (Whaley and Burke) [5] address the use of long-acting reversible contraception such as injectables, implants and IUDs, all of which can be used with safety in a wide variety of patient populations including adolescents. These forms of contraception have the highest contraceptive efficacy in addition to being completely reversible.
'Permanent contraception for women’ by Micks and Jensen [6] addresses the available options for women who have definitively achieved their desired family size. It is important that these procedures are offered to women during pregnancy since the great majority of female permanent contraceptive procedures are performed in the immediate postpartum period. There is an ongoing need to ensure appropriate access to permanent contraception particularly for women in the developing world. Development of innovative approaches to permanent contraceptive methods that are both effective and inexpensive will be an important advancement for global reproductive health.
Lastly, the global cost of unintended pregnancy can be lessened by reducing the incidence of unsafe as well as repeat abortion. Initiation of immediate postabortion contraception is addressed in the article ‘Postabortion contraception’ by Gemzell-Danielsson and Kopp Kallner [7], and has been shown to reduce repeat abortion rates at 1 year. The practice of immediate postabortion contraception is particularly important in developing countries where access to a healthcare provider is limited.
Continued dedication to reduce the unintended pregnancy rate will serve to strengthen the global economy and provide women with an opportunity to assert their equitable position in society. Moreover, it will reduce the incidence of maternal morbidity and mortality. This, in turn, will improve the status of women and improve society as a whole.
Footnotes
DR Mishell Jr serves on advisory board for Agile Pharmaceuticals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.