Position Statement from the European Board and College of Obstetrics & Gynaecology (EBCOG)
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nCall for Action for the prevention of unintended pregnancies by promoting wider use of Long Acting Reversible Contraceptives (LARC)
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WHO has estimated that at present, there are some 222 million women worldwide with unmet contraceptive needs and these results in about 80 million unintended pregnancies per annum and 20 million unsafe abortions especially among young women, with the significant mortality and morbidity. The ability of individual women and couples to regulate their fertility is a fundamental human right.nnIn 1965, Professor Sir Dugald Baird of the United Kingdom emphasised the need for a “fifth Freedom” in addition to the four important freedoms outlined by the President of USA, Franklin D. Roosevelt. Professor Baird’s fifth Freedom was Freedom from unwanted and uncontrolled fertility. Over the past twenty years significant developments have taken place in the area of contraceptive preparations which are available to women of all ages.nnnAmong various preparations of contraceptives, Long acting reversible contraceptives (LARC) offer huge range of choices: including various Copper IUDs, LNG IUS (Mirena and Jadesse) and Implants (Implanon and Jadelle). These methods are user independent, with no age barrier and estrogens free.nnnThe number of unintended pregnancies during the first use are: Implants (perfect use 0.05; typical use 0.05) ; LNG IUS (perfect use 0.2-;typical use 0.2) Copper IUDS ( perfect use 0.6; typical use 0.8) . These data are in strong contrast to short acting methods like Combined Oral Contraceptive pill users where the difference between perfect use 0.2 and typical use 8 is much higher.nnnLong acting reversible contraceptives have proved to be most effective methods in reducing the incidence of unwanted pregnancies as reported in the “CHOICE STYDY”, where 9256 adolescents were enrolled. There was a significant reduction in the percentage of repeat abortions in the St. Louis region compared with Kansas City and the nonmetropolitan Missouri (p<0.001). Abortion rates in the choice cohort were less than half the regional and national rates (p<0.001) The rate of teenage birth within the CHOICE cohort was 6.3 per 1.000 compared with the US rate of 34.5 per 1.000. Intrauterine devices and the implant had the highest rates of continuation at 24 months (74{075882304f93d2f093df74f612da8d0297629e88d069379dcdc33b2e8dd99ac8}).nnnFurthermore pProgestogens imbedded devices also offer non-contraceptive benefits such as reduction in menstrual blood loss, dysmenorrhoea and the treatment of pelvic endometriosis.nnnEBCOG launched its European Wide Standards of Care for Gynaecology Services at the European Parliament in November 2014, under the auspices of the Presidency of Italian Government. In this document, EBCOG has described at length “Standards for Contraception and Sexual health” services. We are fully supportive of the provision of services offering a wide range of contraceptive methods. Considering the published evidence of the effectiveness and health benefits, EBCOG endorses that LARCs should be recommended as first choice method for adolescents.nnnEBCOG will be looking forward to working with any organisation who is working towards prevention of unwanted and untimed pregnancies.nnnDr Tahir Mahmood, Professor Chiara BenedettonnPresident EBCOG Past President EBCOG ( 2011-14)
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