Reasons for Choice (in depth)

Having a child is one of the most significant and special events in a person's life. You want a child to be born when it is most welcome. At the same time, you don't want to think about birth control all the time. That is why we developed Choice. Choice is a new contraceptive that offers lifelong protection after insertion. Choice offers women* a hormone-free alternative to existing contraceptives.

 

Here you can find out more about the technical details of Choice. In this article we highlight the relevance and background.

 

Unintended pregnancies

Although there are already many contraceptives on the market, women still get pregnant unwanted or unplanned every day. About half of all pregnancies that take place worldwide are unintentional (3). An unintended pregnancy is a pregnancy that is either undesirable: the woman becomes pregnant while she does not want to have children (anymore). Or an unintended pregnancy can be a wrongly timed pregnancy: the woman becomes pregnant earlier than desired. A desired pregnancy is one that occurs at the right time or later, because of infertility or difficulties with conception (18).

 

Causes Unintended Pregnancies

Why do women still get pregnant unintentionally despite all the existing contraceptives? One cause of unintended pregnancies is the non-use of contraceptives. Although the number of women using contraceptives has increased, there are still many women who do not use contraceptives. It is estimated that 10 percent of women of childbearing age worldwide do not use a method of contraception (22). In some developing countries this percentage even rises to 38 percent (19). Although contraceptive use is high in the Netherlands, 8 percent of women (18-49 years old) are at risk of an unplanned pregnancy because they have sexual intercourse, are not using contraception, are fertile and do not want to become pregnant (6,15).

Women do not use contraceptives for a variety of reasons. There is no main reason why women who want to avoid pregnancy are not using a contraceptive. The reasons can be found on an individual, interpersonal and societal level. Individual reasons include underestimating the risk of pregnancy from unprotected sex, concerns about contraceptive side effects, or lack of knowledge. Interpersonal reasons are partners, family or friends who discourage the use of contraception. Social reasons concern, for example, the accessibility and costs of contraception. There are often several reasons why women have unprotected sex. However, one of the most common reasons is underestimating the risk of pregnancy from unprotected sex (1,13,19,23).

Another cause of unintended pregnancies is misuse or failure of a contraceptive. Research in America shows that in about half (48%) of unintentional pregnancies, women used a method of contraception and still got pregnant (20). In the Netherlands, two thirds of women who underwent an abortion did use a contraceptive method. In most cases, therefore, something went wrong with the use of the contraceptive (16). Especially condoms and coitus interruptus have a high failure rate. Things also go wrong with hormonal methods such as the pill (20). For example, 21 percent of the pill users in the Netherlands have forgotten one or more pills from the same strip in the past 6 months. This concerns approximately 300,000 women in the Netherlands (15).

 

Consequences of unintended pregnancies

The consequences of an unintended pregnancy are major. In many developing countries, unintended pregnancy has far-reaching consequences for the health of women and their families and contributes to poverty, malnutrition, lack of sanitation and education (10). An unintended pregnancy also has undesirable consequences outside developing countries. Although little research has been done, unintentional pregnancy appears to be a risk factor for the mental health of the mother herself. Women who become pregnant unintentionally, for example, are more likely to suffer from depression during and after pregnancy (7,11,14). However, the degree to which a woman suffers from mental complaints appears to be related to external factors such as the quality of the relationship with her partner and the degree to which the woman is supported by her environment (2). In addition, an unintended pregnancy is also a risk factor for the health of the child. For example, women who become pregnant unintentionally seek prenatal care later and give up harmful habits such as smoking, drinking or drugs later. In addition, children born after an unintended pregnancy are breastfed less often. An indirect consequence is that, because of the higher health risks, there are also higher healthcare costs for society (9,13). In the longer term, there are also consequences for the child: for example, they have increased risks in terms of psychosocial development and mental well-being as adults. Children born after an unintended pregnancy are less likely to excel academically, job satisfaction and parenthood (5).

 

A woman can also choose to have an abortion if she has accidentally gotten pregnant. Many unintended pregnancies end in abortions. It is estimated that approximately 61 percent of all unintended pregnancies worldwide end in abortion (3). In countries where abortion is illegal and unsafe, unintended pregnancies are a major contributor to morbidity and mortality in women (18). An estimated 68,000 women die each year from unsafe abortions (24). In countries where abortion is legal and safe, opting for an abortion is drastic and emotionally taxing (17).

 

Current contraceptives

As described above, the consequences of an unintended pregnancy are major. Many women therefore find it important to use reliable contraceptives. The contraceptive pill is the most widely used contraceptive method in Europe (22). In recent years a lot of research has been done into the side effects of the pill. The pill appears to not only prevent pregnancies, but also to have physical and psychological side effects. Women who take the pill, for example, have an increased risk of thrombosis, can have less sex drive, more frequent mood swings and their body reacting differently to stress (9,12). Pill use among women in the Netherlands has been declining for years (4). Many women are looking for a hormone-free alternative. Of non-hormonal methods, the condom is the only method used by a larger group. However, this group is significantly less satisfied with the use than users of another method (15). For example, many people who use a condom find sex less pleasant or they experience putting on the condom as an interruption of sex. In addition, there are often problems using condoms, which can lead to an unintended pregnancy (20). Another alternative to hormone-free birth control is the copper IUD. However, the copper IUD is not suitable for everyone and some women suffer from side effects such as heavier periods or stomach cramps (21).

 

Freedom of choice for women

Choice offers women a choice for a safe and reliable contraceptive, so that they can take control of their fertility without affecting the rest of their body. We focus on contraception for women, because women often suffer the consequences of an unwanted pregnancy. Good contraception helps women to participate fully in society, without having to worry about the consequences of an unwanted pregnancy. With Choice we want to reach all women on earth to make unwanted pregnancies a thing of the past. At Choice, we strive to make sure that every child on earth is desired, so that the children who are born have the best possible start in life.

 

A number of starting points were important while designing Choice. First of all, we wanted Choice to be a carefree contraceptive. After a one-off outpatient procedure, you no longer have to worry about it, while being protected against unintended pregnancies. Choice is discipline-free (I) and also protects you at times when you don't want to think about contraception: it is passion proof (II). Finally, we wanted Choice to do only what it is intended to do: protect your body against unwanted pregnancies when necessary. Hormones are increasingly known to not only affect your fertility, but also affect the rest of your body and mind. That is why we made the choice to make Choice hormone-free (III).

 

* This includes people who do not identify as women, such as transgender men or non-binary people. They can also have a uterus and thus become pregnant.

 

References

 

1. Ayoola, A., Nettleman, M., & Brewer, J. (2007). Reasons for Unprotected Intercourse in Adult Women. Journal of Women’s Health, 16(3), 302-310.

2. Barton, K., Redshaw, M, Quigley, M., & Carson, C. (2017). Unplanned pregnancy and subsequent psychological distress in partnered women: a cross-sectional study of the role of relationship quality and wider social support. BMC Pregnancy and Childbirth, 17(44), 1-9.

3. Bearak, J., Popinchalk, A., Moller, A., Tunçalp, O., Beavin, C., Kwok, L., & Alkema, L. (2020). Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990-2019. www.thelancet.com/lancetgh, Vol 8, e1152-e1161.

4. CBS (2014). Gebruik pil daalt, spiraaltje wint terrein. Retreived from: https://www.cbs.nl/nl-nl/nieuws/2014/25/gebruik-pil-daalt-spiraaltje-wint-terrein

5. David, H. (2006). Born Unwanted, 35 Years Later: The Prague Study. Reproductive Health Matters, 14(27), 181-190.

6. Graaf, H. de, & Wijsen, C. (red.) (2017). Seksuele gezondheid in Nederland 2017. Delft: Eburon.

7. Herd, P., Higgins, J., Sicinski, K., & Merkurieva, I. (2016). The Implications of Unintended Pregnancies for Mental Health in Later Life. Perspectives From the Social Sciences, 106(3), 421-429.

8. Hill, S. (2019). This Is Your Brain on Birth Control. The Surprising Science of Women, Hormones, and the Law of Unintended Consequences. New York: Avery Publishing Group.

9. Joyce, T.J., Kaestner, R., Korenman, S. (2000). The effect of pregnancy intention on child development. Demography, 37(1), 83-94.

10. Klima, C.S. (1998). Unintended pregnancy. Consequences and solutions for a worldwide problem. J Nurse Midwifery, 43(6), 481-491.

11. Maxson, P., & Miranda, M.L. (2011). Pregnancy Intention, Demographic Differences, and Psychosocial Health. Journal of Women’s Health, 20(8), 1215-1223.

12. Montoya, A., & Bos, P. (2017). How Oral Contraceptives Impact Social-Emotional Behavior and Brain Function. Trends in Cognitive Sciences, 21(2), 125-136.

13. Mosher, W.D., Jones, J., & Abma, J.C. (2012). Intended and Unintended Birth in the United States: 1982-2010. National Health Statistics Reports, 55, 1-27.

14. Orr, S., & Miller, C. (1997). Unintended pregnancy and the psychosocial well-being of pregnant women. Women’s Health Issues, January-February 1997, 38-46.

15. Picavet, C. (2012). Zwangerschap en anticonceptie in Nederland. Tijdschrift voor Seksuologie, 36(2), 121-128.

16. Rutgers (2020, September 11). Enkele feiten over abortus. Retrieved from https://www.rutgers.nl/wat-wij-doen/anticonceptie-en-abortus/enkele-feiten-over-abortus

17. Rutgers (2020, October 2). Anticonceptie en abortus – Regie over kinderwens. Retrieved from https://rutgers.nl/wat-wij-doen/anticonceptie-en-abortus-regie-over-kinderwens

18. Santelli, J., Rochat, R., Hatfield-Timajchy, K., Colley Gilbert, B., Curtis, K., Cabral, R., Hirsch, J., & Schieve, L. (2003). The Measurement and Meaning of Unintended Pregnancy. Perspectives on Sexual and Reproductive Health, 35, 94-101.

19. Sedgh, G., Ashford, L., & Hussain, R. (2016). Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method. New York: Guttmacher Institute.

20. Sundaram, A., Vaughan, B., Kost, K., Bankole, A., Finer, L., Singh, S.,& Trussell, J. (2017). Contraceptive Failure in the United States: Estimates from the 2006–2010 National Survey of Family Growth, Perspectives on Sexual and Reproductive Health, 497-16.

21. Thuisarts (2020). Ik kies voor een koperspiraaltje. Retrieved from: https://www.thuisarts.nl/spiraaltje/ik-kies-voor-koperspiraaltje

22. United Nations (2019). Contraceptive Use by Method 2019. Data Booklet. United Nations.

23. Westoff, C.F. (2001). Unmet Need at the End of the Century. DHS Comparative Reports I. Calverton: ORC Macro.

24. World Health Organization (2005). The World Health Report 2005. Make every mother and child count. Geneva: World Health Organization.