Simulators and Teen Pregnancy Rates in the USA: A Surprising Connection
January 30, 2018
Though long-acting reversible contraceptives (LARCs) like intrauterine devices, or IUDs, are proven to be the most effective reversible means of preventing pregnancy, by no means are LARCs the most commonly used method of birth control. Yet. While physician and patient education is on the rise, obstacles remain in achieving widespread utilization of LARCs. Simulators have emerged as a factor, and a critical one, in efforts to advance the use and understanding of these devices.
In addition to the demonstrated relationship between increased adoption of LARCs and a decrease in unwanted pregnancies, there is mounting evidence linking simulator training for physicians to an increase in patient use of LARCs. This intersection between simulators, modes of contraception, and pregnancy rates has the potential to change the way medical practitioners approach contraceptive education—for themselves and for their patients.
The University of Oklahoma’s Fall/Winter 2017 publication of OU Medicine includes a feature entitled “College Uses Simulation to Train Physicians on Use of LARCS.” The caption of the accompanying photograph identifies Dr. Bratzler, D.O., MPH, an associate dean at Oklahoma’s College of Public Health, using VirtaMed’s PelvicSim™ to demonstrate the placement of an intrauterine device (IUD).
While the photo was eye-catching, it was the content of the article that truly captured our interest.
A team of physicians at OU campuses in Oklahoma City and Tulsa have collaborated with the Oklahoma Health Care Authority (OHCA) and private donors to implement an initiative that trains community health care providers on the use of LARCs, primarily IUDs. In training that took place over 12 sessions in Oklahoma City and at OU’s Tulsa campus, attendees learned how to insert five IUDs currently on the market by using both low- and high-fidelity pelvic simulators.
The hope shared by the doctors, donors, and state officials behind this collaborative endeavor is that, by educating both physicians and patients on how LARCs work, as well as increasing the number of practitioners trained in their placement, Oklahoma’s uncommonly high rate of unwanted teen pregnancy will go down.
The link between LARCs and pregnancy rates
In research conducted by, among many others, the National Bureau of Economic Research(NBER) and Centers for Disease Control and Prevention (CDC), LARCs are shown to provide the most effective means of preventing unwanted pregnancy. The NBER study goes on to show that when LARCs are more readily available to patients, teen birth rates went down almost 5%. The research clarifies that as of June 2015 when this report was published “…over three- quarters of teen births are unintended at conception and that over a third of unplanned births are to women using contraception.”
Though a correlation between increased use of LARCs and a reduced rate of unwanted pregnancies and births has been proven, affording patients ready access to LARCs comes with its own subset of challenges. The more expensive per-unit cost of LARCs over the incremental fee structure for popular forms of contraception like birth control pills, the patch, or the ring means clinics may not keep the devices stocked, in part because patients may not be inclined to choose the option requiring a higher upfront payment. Furthermore, fewer practitioners are trained in the proper use of LARCs, and thus patients are often required to schedule a follow-up appointment for the IUD or implant to be inserted. In the case of IUDs, this waiting—the simple factor of making a follow-up appointment to have the IUD placed—has resulted in many patients opting out of IUD use altogether. A 2012 study in Contraception Magazine showed that the two-appointment protocol for IUD insertion resulted in only 54.4% of the patients studied following through and having the IUD inserted.
This is where simulation training becomes critical. If more health care providers are well-practiced in the use of IUDs to the point that same-day-insertion of the device is possible, one major hurdle in widespread patient access to IUDs would thus be removed. This training offers a further opportunity to reverse misconceptions around IUDs, allowing the newly trained health care providers to educate the patient population about IUDs in turn.
Other States, Other Rates
This initiative in Oklahoma isn’t without precedent, nor is OU Medicine’s showcasing of simulators’ role in reducing unwanted teen pregnancies and births.
In the spring of 2016, both Cosmopolitan and and Vox featured articles about how simulator training is integral to the same-day IUD-insertion protocol, and the impact this is having on women’s health around the country.
Upstream USA, the nonprofit organization providing simulator training on IUD insertion to healthcare providers around the country, reports an increase in the use of LARCs as a result of their efforts. From Texas, where the teen pregnancy rate is falling at a slower pace than the national average, to Delaware, with the highest rate of unwanted births in the country (ages 15 to 44); in New York City and Northeast Ohio alike, the percentage of women choosing and receiving IUDs is increasing. Considering that, according to the American College of Obstetricians and Gynecologists, LARCs like IUDs are 20 times more effective than other methods of birth control, this increase in IUD use can only have positive implications for a reduced rate of unwanted pregnancies.
Back in Oklahoma
Seeking solutions to a reduced teen pregnancy rate, be it in Oklahoma or anywhere, presents plenty of challenges and requires dynamic thinking and action. As a state with one of the highest rates of unintended pregnancies in the nation, and where public schooling offers no sexual education, Oklahoma seems an ideal place to stage widespread training around LARC use.
It’s too early to know yet what impact this initiative will have on the rate of unwanted teen pregnancies in Oklahoma, or whether a second phase of this training effort will be funded. Lin Goldston, MHA, is the director of Operations and administration for the Clinical Skills Education and Testing Center, where the Oklahoma City portion of the training takes place. As quoted to OA Medicine, Dr. Goldston asserts, “Empowering physicians to use LARCs has the potential to decrease that statistic.” The fact that VirtaMed’s PelvicSim™ is an integral part of this progressive push for a solution is, in our minds, a win-win.