TIME republicans

Most Young Republicans Support Birth Control, Poll Says

TIME.com stock photos Birth Control Pills
Elizabeth Renstrom for TIME

But 60% don't think it's a health care need

A majority of young Republicans believe every woman should have access to affordable birth control, according to a new poll.

The survey, by The National Campaign to Prevent Teen and Unplanned Pregnancy, found that 57% of Republicans aged 18-34 said they had a positive view of birth control, and two-thirds of them agreed that “every adult woman should have access to affordable, effective birth control because it gives people a chance to build families on their own terms.”

“Young Republicans don’t leave their ideology behind when thinking about expanding contraceptive access, and they certainly favor limited government,” said Kristen Soltis Anderson, a Republican pollster who conducted the survey. “However, within that context, they want to know how to make sure that the most effective methods of birth control are available to those who want them.”

Despite largely believing birth control should be covered by insurance, a majority of those surveyed, including 55% of young Republican women, supported the Supreme Court’s decision in the Hobby Lobby case, which allowed an employer to deny contraceptive coverage to employees on religious grounds. And while a majority support birth control generally, 60% of respondents, including a majority of women, consider birth control “more of a personal convenience than a health care need for adult women.”

TIME Iran

Iran Mulls Laws That ‘Reduce Women to Baby-Making Machines,’ Says Amnesty

Tehran plans to outlaw vasectomies and reduce access to birth control

Amnesty International has slammed Iran for proposing two draft laws aimed at boosting the country’s population, saying the legislating would “reduce Iranian women to ‘baby-making’ machines.”

One proposal would ban voluntary sterilization and restrict access to contraceptives, while the other would make it harder for women without children to get jobs.

In a report released Wednesday, Amnesty says the laws, if approved by Tehran’s parliament, would “set the country back by decades” and have serious consequences for women and girls. (For the past two decades, Iran has had an effective birth control program in place that provided affordable contraception, subsidies for vasectomies, and education on family planning and sexual health, with the aim of reducing the population.)

“By abolishing family planning programs and blocking access to vital sexual and reproductive health services, the authorities would be exposing women to serious health risks, and violating their human rights,” said Hassiba Hadj Sahraoui, Amnesty’s deputy director for the Middle East and North Africa.

The second bill would instruct workplaces to prioritize employing men with children, married men with children and married women with children when hiring for certain jobs. The new legislation would also make obtaining a divorce more difficult, which Amnesty says would have “devastating consequences” for women in abusive relationships.

“The bills send a message that women are good for nothing more than being obedient housewives and creating babies and suggests they do not have the right to work or pursue a career until they have fulfilled that primary role and duty,” said Sahraohi, adding that without access to contraceptives more women would risk their lives and health by undergoing unsafe abortions.

TIME Sex/Relationships

IUDs Are Getting More Popular With American Women

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Getty Images

More U.S. women are using the IUD or implant

American women are increasingly opting for longer-lasting and highly effective forms of birth control, according to new federal data released on Tuesday.

New numbers from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) show women are choosing long-lasting reversible contraceptives (LARC) like the intrauterine device (IUD) and the implant more than they have in the past. According to the numbers, IUD use increased 83% from 2006–2010 to 2011–2013 and implants tripled in use during the same time period. Both methods are approximately 99% effective at preventing pregnancy.

“I am delighted LARC use is rising. It’s terrific and I would like to see even more,” says Dr. Mary Jane Minkin, professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine.

Overall, the use of LARC has increased fivefold in the past decade among women between the ages of 15 to 44, though overall usage remains low. Use spiked from 1.5% in 2002 to 7.2% in between 2011 and 2013. Women ages 25 to 34 are the most likely to choose LARC at 11% compared with 5% of women ages 15 to 24 and around 5.3% of women ages 35 to 44.

As TIME previously reported, one reason for the slow uptake among American women is that older versions of the IUDs from the 1970s and ’80s were plagued with problems. The new CDC data shows that LARC use declined between 1982 and 1988 and remained stable from 1988 to 1995. Today, IUDs are considered very safe and effective. Planned Parenthood told TIME it has experienced a 75% increase in IUD use among its patients since 2008.

“I think the current generation of women haven’t heard about the errors of the past, which is good,” says Minkin. “They are looking anew at LARC and looking at them for the value they have. People can forget their pills. These other methods take the human variable out of it, and they work very nicely.” (Minkin was not involved in the new study.)

MORE: Why the Best Form of Birth Control Is the One No One Is Using

New, separate data published Monday in the journal Contraception showed that among 500 female health care providers, 42% used LARC, which is significantly higher than the general population.

Women in other countries are significantly more likely to use LARC, especially the IUD. Separate research has shown that 23% of French women using contraception use an IUD as well as 27% of Norwegian women and 41% of women in China. In the U.S., cost may be a factor: the Guttmacher Institute, a reproductive-health nonprofit, reports that their research shows sharp increases in the numbers of women who don’t have to pay out of pocket for LARC thanks to the Affordable Care Act. Without insurance coverage, LARC can be prohibitively expensive for some — around $900 for an IUD, for instance.

“If you have contraceptive coverage that makes it much more doable,” says Minkin, “I think it increases the availability and viability for women.”

MONEY Health Care

Why You’re Still Paying for Birth Control Even Though It’s “Free” Now

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Laura Johansen—Getty Images

Most women with private health insurance can get contraception for free, but a lack of information means some are still paying out of pocket—even when they shouldn't be.

A record scratch sounded in my head one weeknight this January, when a pharmacist at my local drugstore told me my birth control pills would—for the first time—cost more than $50 a month.

Strange, I thought, since I could have sworn I heard contraception was one of the preventive health services that are free under the Affordable Care Act, and that the law was rapidly expanding access for most women, with at least 67% of insured women on the pill paying $0 (up from only 15% in 2012), according to a recent study by the Guttmacher Institute. Perplexing.

After all, I don’t work for an exempted religious organization or a company such as Hobby Lobby, which in a Supreme Court case last year won the right to deny contraceptive coverage because of conflicting beliefs. And the same pills—Ortho Tri-cyclen Lo—cost me nothing under my old health plan. Sure, I had switched insurance companies in the new year (to Aetna, the third largest in the country), but I’d opted for a high-premium Gold plan. A monthly copay on par with the cost of an iPod shuffle seemed hefty and unfair.

So I left the pharmacy empty handed and went home to call Aetna.

My happiness was brief when a customer service agent informed me that—while most brand-name pills had a copay—I could simply switch to a free generic version of the same compound. The problem? Turns out there is no generic version of Ortho Tri-cyclen Lo yet. So I was trapped, much like women whose insurance companies have denied them coverage for the NuvaRing, reasoning that they can take generic pills with the same hormones—even though the Department of Health and Human Services has been clear that the ring is a distinct form of contraception (and should therefore be free).

I hesitated to simply choose a different generic for a reason that should not surprise the many other women who have tried multiple birth control methods: Switching from pill to pill in the past caused me side effects, which thankfully subsided once I finally found one that worked for me.

“People respond differently to different pills and a change can cause side effects like irregular bleeding and headaches,” says Jill Rabin, an ob-gyn and professor at Hofstra North Shore-LIJ School of Medicine. “There’s no predicting how someone will do unless they try it.”

The pressure I felt to switch seemed especially unjust given this aspect of the law: While women can be charged a copay for brand name drugs when an equivalent generic is available, this Department of Labor FAQ explains, “if, however, a generic version is not available, or would not be medically appropriate for the patient” as determined by her doctor, “then a plan or issuer must provide coverage for the brand name drug … without cost-sharing.”

When I brought my dilemma (and the fact that I was a journalist planning to write about it) to Aetna’s director of communications, Susan Millerick, she took swift action. Within a week, I had my Ortho Tri-cyclen Lo, free of copay.

“It is always Aetna’s intent to abide by the laws that govern our health benefits coverage, and to fairly interpret and apply all laws and regulatory guidance on behalf of our customers and members,” Millerick wrote in an email.

Millerick’s explanation for what had happened suggests any woman would be wise to question any insurer denial for contraceptive; she said Aetna’s “service reps erred” in not telling me about the option to appeal the copay. I should have been told that I could just ask my doctor to call and verify that I really needed my pill and that a different generic would not suffice.

The good news for many women is that simply being informed of your options—and getting your doctor on your side—may be enough to go from paying a wallet-draining copay to nothing at all, says Rabin.

“Figuring out the best contraception that minimizes cost and maximizes efficacy is a conversation that should be between doctor and patient,” Rabin says. “Most doctors don’t want that decision taken out of their hands and would be happy to help make that call for their patients.”

For those women who encounter more resistance than I did—or find, as Kaiser Health News reported, that certain insurers are even trying to wriggle out of covering generics—there are other resources to turn to, like the National Women’s Law Center. Their website has clear instructions on how to fight back if you think your insurer is unfairly denying you free birth control, with templates for appeal letters and a free hotline (866-745-5487) for additional assistance.

Even with all the progress, thousands of women have been contacting the NWLC’s hotline in recent months after running into problems getting free contraceptives, says Mara Gandal-Powers, a lawyer at the NWLC.

Generally, the biggest obstacle to free birth control access right now is ignorance, she says. Many women—and their insurance representatives, doctors, and pharmacists—aren’t on the same page about whether their particular contraception should have a copay or not. Instead of doing a double take at the cost of their contraceptives, Gandal-Powers says, some women never question the charge.

That’s a compelling reason to double check your insurer, pharmacist, and even doctor’s assumptions.

“There is definitely a lot of education that still needs to happen,” says Gandal-Powers, “not just among women themselves but also among health care providers and pharmacists.”

Beyond a lack of education, a few more obstacles to universally free birth control remain. Besides the religious exemption, there’s also a subset of insurance plans that are “grandfathered” in such a way that they don’t have to cover contraception right away—though they will in coming years. Enrollment in grandfathered plans is dropping, with only 26% of covered workers enrolled in a grandfathered health plan in 2014, down from 56% in 2011, according to the Kaiser Family Foundation. Another exception is self-funded student plans.

The takeaway? If you’re paying more than $0 for birth control, it can’t hurt to do a little digging. If you are lucky (and persistent), you could end up pushing your insurer to better comply with the law—and save hundreds of dollars a year, to boot.

TIME Sex/Relationships

Your IUD and Implant Last Much Longer Than They Claim, Study Says

IUD birthcontrol
Photo Illustration by Mia Tramz for TIME; Corbis

These long-acting contraceptives might last even longer than you think

Two highly effective contraceptives—the intrauterine device (IUD) and the implant—actually last much longer than they are currently recommended, according to new research.

In a new study published in the journal Obstetrics & Gynecology, researchers discovered that the hormonal IUD and the implant are highly effective a year after they are currently approved for use.

MORE: The IUD Answer: Why The Best Form of Birth Control is the One No One Uses

The researchers followed 237 women who were using an implant like Implanon and Nexplanon and 263 women using the Mirena hormonal IUD. The implants are currently approved for three years, and the hormonal IUD used in the study is approved for five. (There is also a non-hormonal IUD that is approved for 12 years, but it was not included in the current study.)

All the women were between the ages of 18 and 45 and their contraceptives were within six months of expiring before they enrolled in the study. The women were informed of the pregnancy risk associated with using their device longer than recommended, and the researchers called them for followup every 6 months for 36 months or until the women had their device removed.

By the end of the trial period, none of the women using the implant were pregnant and there was one pregnancy among the women using the IUD. Still, the failure rate was similar to the failure rate of the IUD when used during the five-year period (which is under 1%). The study is still ongoing, and the researchers plan to recruit up to 800 women and ultimately test whether the IUDs and implants were effective for up to three years after their current FDA-approved duration.

The benefit of being able to use the implant and IUD for a longer period of time is that it could reduce costs for individuals and insurance. The longer use also makes the IUD and implant more convenient for women, since maintenance is reduced.

Though the data is preliminary, the researchers say they believe that the hormonal IUD and the implant can both be used for an additional year longer than the FDA recommends. That doesn’t mean you should extend your own use of the contraceptives without talking to your doctor. The study is still continuing, and it could be quite a long time before any changes to clinical recommendations are considered.

TIME health

The Long, Strange History of Birth Control

TIME.com stock photos Birth Control Pills
Elizabeth Renstrom for TIME

The father of the birth control pill — who died Jan. 30 — was part of the extensive history of people trying to prevent pregnancy

Writing in the New York Review of Books last year, Carl Djerassi declared that with the invention of the birth control pill, “sex became separated from its reproductive consequences” and “changed the realities of human reproduction.” Djerassi would know. The pioneering chemist, who died on Jan. 30 of complications from liver and bone cancer at the age of 91, was dubbed the father of the birth control pill after he created the key ingredient used in oral contraceptives.

The importance of his discovery — and the dogged research of numerous other scientists — can’t be understated. Today, a staggering 99% of American women of childbearing age report using some form of contraception at one time or another.

Yet while Djerassi’s discovery and other modern advancements have led to the ubiquitous use of safe and effective contraception, pregnancy prevention has a long and determined history. As Jonathan Eig writes in his book The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution, “For as long as men and women have been making babies, they’ve been trying not to.”

Proto-Prophylactics

Not that every historical effort was all that effective. Some methods are still used today, such as coitus interruptus — or “pulling out” — which was referenced in the Old Testament, but have never been a reliable form of pregnancy prevention. And other methods seem, by today’s standards, straight-up bizarre. In ancient Egypt, for example, around 1500 BC, women would mix honey, sodium carbonate and crocodile dung into a pessary — a thick, almost solid paste — and insert it into their vaginas before sex. (Crocodile dung was later found to possibly increase the likelihood of getting pregnant, due to its effects on the body’s pH levels.) In ancient China, concubines are thought to have used a drink of lead and mercury in order to prevent pregnancy. (Possible side effects: sterility, brain damage, kidney failure and death.) In the year 200, the Greek gynecologist Soranus advised women to abstain from sex during menstruation, which he mistakenly believed to be their most fertile time of month. (Not true.) He also recommended that women hold their breath during intercourse, followed by sneezing afterwards to prevent sperm from entering the womb. (Just silly.) In 10th-century Persia, women were told to jump backwards seven or nine times after intercourse to dislodge any sperm, as those were believed to be magical numbers. And in the Middle Ages in Europe, women were advised to tie the testicles of a weasel to their thighs or around their necks during intercourse. (Really.)

Yet it wasn’t all a shot in the dark. Many researchers today believe that several archaic methods of birth control actually had the dual perks of being somewhat effective and not lethal. This is perhaps not so surprising considering that certain methods were passed along from one woman to another. For instance, the ancient Egyptians weren’t completely off the mark with their pessaries: some documents reveal that women would also use pessaries made with acacia gum, which was later found in 20th-century studies to have spermicidal effects. Several other plants used in the ancient world were later found to have contraceptive qualities as well.

And it wasn’t just plants. A cave painting that researchers believe could be 15,000 years old, found in France, depicts what some think is the first illustration of a man wearing a condom. The condom also shows up in legends that date back to 3000 BC, in which King Minos of Crete — son of Zeus and Europa — would use goat bladders for that purpose.

Later, the European doctor Gabriel Fallopius, for whom the fallopian tubes are named, suggested a linen version, prompted by a syphilis epidemic that spread across the continent in the 1500s. In Giacomo Casanova’s memoirs, written in the late 18th century, he takes credit for inventing a primitive version of the cervical cap, when he describes using partly squeezed lemon halves during sex. (A painting of the Italian writer also exists where he appears to be blowing into a condom-like prophylactic, but researchers believe that Casanova’s covers were for protection from venereal disease, not pregnancy.)

Condoms turned another technological corner in the year 1844, when American manufacturing engineer Charles Goodyear patented the vulcanization of rubber, which he had invented five years earlier. The move led to the mass-production of rubber condoms and the appearance of rubber cervical caps. It would be several decades before cervical caps — and later diaphragms — would catch on in the U.S., where the earliest rubber diaphragms were known as “womb veils.” Condoms caught on much more quickly. The first advertisement for the condom appeared in The New York Times in 1861, for a brand called Dr Power’s French Preventatives. The advertisement’s tagline read: “Those who have used them are never without them.”

Birth-Control Backlash

But just when it looked as if contraceptives were taking off — becoming not only safe and effective, but also more widely available — an American post inspector named Anthony Comstock began crusading against obscenity. His campaign led to the Comstock Act, passed in 1873, which banned the spread of information about contraceptives in the United States — even from doctors.

The 20th century would eventually see the most advanced and revolutionary development of birth control in history, but at the start of the century the phrase “birth control” wasn’t part of the common parlance. Margaret Sanger — a determined nurse and activist who would revolutionize reproductive rights in America — first coined the phrase in 1914 with the launch of a monthly newsletter called The Woman Rebel. The newsletter offered information about birth control and was a flagrant challenge to the country’s obscenity laws. It wasn’t long before Sanger was indicted for breaching the obscenity laws and fled the country to avoid trial. By 1916, Sanger was back and opening the first family-planning clinic in the U.S. It was shut down within a week and a half. Five years on, Sanger founded the American Birth Control League, which would later become the Planned Parenthood Federation of America.

Neither legal restrictions, nor religious condemnation—during the 1930s, Pope Pius XI declared that using birth control was a “grave sin”—could actually stop women from trying to prevent pregnancy. In 1935, TIME reported that “[d]espite furtiveness, commerce in contraceptives has become big business. More than 300 manufacturers today are engaged in it…. Three ‘feminine hygiene’ manufacturers last year spent $250,000 advertising in general magazines alone.”

Some advertisements for products marketed to women emphasized their “feminine” uses, with obvious euphemisms for contraceptives. Throughout the 1920s, even Lysol was advertised as a product that could “protect your married happiness” with a series of terrifying ads, depicting desperate women trying to keep the family harmony—so desperate, in fact, they were willing to use a household cleaner as a douche. Lysol didn’t have any contraceptive qualities—and could actually be quite harmful when inserted into the body—but that wasn’t the impression given by the company‘s marketing campaign. Another household product that many believed could prevent pregnancy was Coca-Cola. (Unsurprisingly, it did not actually prevent unwanted pregnancies: though later research suggested that a douche of cola did kill sperm, it didn’t work fast enough.)

In 1937, headway in Sanger’s fight was made when the American Medical Association officially recognized birth control as a legitimate part of doctors’ practice. A year later a judge lifted the federal obscenity ban on birth control, though laws against contraception remained on the books in most states. America went from 55 birth control clinics in 1930 to more than 800 in 1942.

The Pill Arrives

By the 1950s, Sanger landed on a better way to serve that demand. She approached biologist Gregory Pincus — who had something of a reputation as a Dr. Frankenstein-like character, due to his experiments with in-vitro fertilization of rabbits — and asked him to conduct research on the use of hormones for contraception. Unbeknownst to Sanger and Pincus, a scientist in Mexico City had already had success creating a progesterone pill, synthesized from wild yams, which could block ovulation. That scientist was Carl Djerassi, then just a twenty-something but already the associate director of research at the pharmaceutical company Syntex.

With funding from Katherine McCormick, a wealthy widow and dedicated feminist, Pincus had also begun developing and testing a synthetic hormone and found that it could suppress ovulation in animals. A gynecologist named John Rock then began testing the hormone on women. In 1956, the United States Food and Drug Administration (FDA) approved the hormone pills for menstrual disorders, such as irregular periods or PMS. Promoting birth control was still illegal in many states, but as TIME winkingly noted in 2010, the late ’50s tellingly saw “a sudden epidemic of menstrual irregularity among women across the U.S.”

Then came the landmark date, marking the biggest change to America’s contraceptive potential in history. On May 9, 1960, the FDA approved Enovis, an oral contraceptive pill released by G.D. Searle and Company. By 1965, almost 6.5 million American women were on “The Pill,” the oral contraceptive’s enduring vague nickname, which is thought to have stemmed from women requesting it from their doctors as discreetly as possible. That same year, the Supreme Court struck down state laws that prohibited contraception use, though only for married couples. (Unmarried people were out of luck until 1972, when birth control was deemed legal for all.)

Even by 1966 the Pill’s effects were apparent. That year, TIME wrote, “No previous medical phenomenon has ever quite matched the headlong U.S. rush to use the oral contraceptives now universally known as ‘the pills.’” Indeed, by the time 1973 rolled around, a whopping 70% of married women between the ages of 15 and 44 were using some form of contraception.

The Pill was an international revolution as well. In 1967, TIME reported that despite the Pill’s necessarily strict routine, uneducated women could still manage: “[The] latest reports show that illiterate women who can’t count can still take their pills on schedule. In Pakistan, Denver’s Dr. John C. Cobb got dozens of them to do it, simply by starting them on the night of the new moon. In semiliterate Taiwan, where IUDs have won wide acceptance, more and more women are switching to the pills. The number of users outside the U.S. is about 5,000,000, and the figure is rising.”

Not that the Pill was without critics. The fact that its rise coincided with second-wave feminism and the sexual revolution meant that many people pointed to the contraceptive as the trigger that changed society. (Many researchers have pointed out that cultural views on sexuality and women’s roles were shifting well before the Pill was introduced.) Some African-American leaders were especially critical of the Pill, claiming that it was being peddled in their community for the purpose of a “black genocide.” But nothing stopped the Pill from catching on. Today, more than 100 million women around the world use the Pill in order to prevent pregnancy. And that’s not counting the women using other safe and effective forms of birth control, from DepoProvera and the NuvaRing to the contraception patch and the intrauterine device (IUD), which is considered by many health care experts to be one of the best forms of birth control available.

The Future of Birth Control

Yet access to safe and effective birth control still isn’t a universal privilege. A report from the Guttmacher Institute in 2012 found that around 222 million women in developing countries want to use birth control but aren’t currently able to access modern contraceptives.

Even in the U.S., there has been a political push to restrict access. The rise of “conscience clauses” has also meant that hospital employees, pharmacists and employers with religious views on birth control can refuse to fill prescriptions or cover employees’ coverage for contraception.

History — both ancient and more recent — has shown that women (and men) will risk their lives or reputations for effective birth control. Restricted access to contraceptives doesn’t necessarily mean that women won’t be able to prevent pregnancies, but, like the ancient Egyptians and Chinese, they just might resort to methods that could be harmful. That hasn’t changed, but thanks to the dogged determination of activists, such as Sanger, and the pioneering research by scientists and physicians, such as Djerassi, that level of risk seems like the most preventable thing of all.

TIME Chemistry

The Chemist Who Helped Develop the Pill Has Died

Carl Djerassi
Boris Roessler—AP Scientist and patron of the arts Carl Djerassi sits during an interview with the DPA German Press Agency at the university in Frankfurt Main, Germany, 29 October 2013.

His scientific work led to the world's first oral contraceptive in 1952

Carl Djerassi, a 91-year-old Stanford chemist who helped to develop the birth control pill, passed away from cancer Friday in San Francisco.

Djerassi’s scientific work led to the world’s first oral contraceptive in 1952, which gave women the option to control pregnancies. He developed a synthetic molecule called norethindrone, the effects of which simulated, in stronger form, those of progesterone. For his work, he earned an induction into the National Inventors Hall of Fame and received the presidential National Medal of Science, which only a few hundred scientists have received since its creation.

“Carl was interested particularly in individual freedom and self-determination, and believed that all of us, women included, should have that opportunity,” said Dr. Philip Darney, the director of UCSF’s Bixby Center for Global Reproductive Health. “He saw birth control and access to abortion as agents of that opportunity.”

Djerassi, a polymath, penned three biographies The Pill, Pygmy Chimps and Degas’ Horse, In Retrospect: From the Pill to the Pen and This Man’s Pill, and founded a free art residency program called the Djerassi Resident Artists Program, funded by earnings from the birth control pill.

[SF Gate]

TIME Sex/Relationships

Unintended Pregnancies Decline Across the U.S.

TIME.com stock photos Pregnancy Test
Elizabeth Renstrom for TIME

Though some states are doing better than others

The rates of unintended pregnancies have fallen in most U.S. states since 2006, according to a new report — though rates remained steady in a dozen states.

Between 2006 and 2010, 28 states out of 41 with data available experienced a drop in their unintended pregnancy rate of 5% or more, according to a new report from the Guttmacher Institute. Twelve states’ rates remained unchanged, and one state—West Virginia—had an increase of 5% or more.

MORE: The IUD: Why The Best Form of Birth Control is One No One is Using

The report notes that in 2010, more than half of all pregnancies in 28 states were unintentional and that the minimum rate for any state was 36%.

The states with the highest unintended pregnancy rates were Delaware, Hawaii, and New York, though the South tended to have higher rates in general. New Hampshire had the lowest rates.

“The decline in unintended pregnancy rates in a majority of states since 2006 is a positive development,” study author Kathryn Kost, a senior research associate for Guttmacher said in a statement. “However, rates remain twice as high in some southern and densely-populated states compared with those in other states—a variation that likely reflects differences in demographic characteristics and socioeconomic conditions across states.”

MORE: Why Schools Can’t Teach Sex Ed

There’s been an increased use of the most effective contraceptives, like the intrauterine device (IUD), which has contributed to the drop in pregnancies. The report underlines double-digit drops in unintended pregnancy rates in Colorado, Iowa and Missouri, after conducting campaigns to promote the use of long-acting methods like the IUD and implant.

In 2010, publicly-funded family planning services also helped prevent 2.2. million unintended pregnancies, according to prior Guttmacher research.

TIME Sex

How Birth Control Has Changed Over the Centuries

A history of contraception, in all its many forms

Birth control may still be a hot button issue today in some countries, but men and women have been using contraceptives for thousands of years, albeit with varied results.

In ancient China, a popular remedy involved drinking a cocktail of lead and mercury. In ancient Egypt, a paste made out of honey, sodium carbonate, and crocodile dung was a popular form of contraception.

However, not all historic forms of contraception were based on superstition. A prototype of the cervical cap has been in use since the 18th century, and cave drawings in France appear to show a version of a condom.

For much of the 19th and early 20th centuries women in the U.S. had a hard time getting their hands on effective contraception. Due to anti-obscenity laws, doctors were not allowed to spread information about birth control.

To compensate for the lack of official methods, household products like Lysol and Coca-Cola were often used, as they were believed to kill sperm.

In 1960 modern birth control was born, when the FDA approved the first oral contraceptive pill for women. Within 5 years, millions of American women had prescriptions for the pill. Today, 99% of women of child-bearing age say they have used some form of birth control.

However, universal access to birth control still does not exist worldwide. Some 220 million women from developing countries say they want to use birth control but don’t have access.

TIME Reproductive Health

Birth Control Pill Risks May Now Include Brain Cancer

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Raymond Forbes—Getty Images/age fotostock RM

Certain forms of birth control may promote growth of a rare brain tumor

Taking any drug is a matter of weighing the benefits and risks, and when it comes to birth control, women may now have one more factor to consider.

Dr. David Gaist, a neurologist at Odense University Hospital and the University of Southern Denmark, and his colleagues found that women taking hormonal contraceptives — those containing estrogen, progestin or a combination of both — showed higher rates of a rare brain tumor known as glioma. Their results, published Thursday in the British Journal of Clinical Pharmacology, raise questions about the connection between oral contraceptives and brain cancer, but shouldn’t yet be interpreted as a reason to stop taking birth control, says Gaist.

MORE: This Contraceptive Is Linked to a Higher Risk of HIV

Using data from Denmark’s national registries of health records, cancer cases and prescriptions, Gaist zeroed in on the women aged 15 years to 49 years diagnosed with glioma, and then analyzed whether they were prescribed contraceptives and for how long. Overall, women who had used hormonal contraceptives at any point in their lives showed a 50% higher risk of developing the brain tumors compared to those who had not used them. And women who used the birth control for more than five years nearly doubled their risk of the cancer. Still, Gaist says, since gliomas are rare, even a doubling of a rare event is still a small risk.

MORE: Which Birth Control Works Best? (Hint: It’s Not the Pill)

“If you look at women in Denmark aged 15 to 49, about five in 100,000 experience that terrible diagnosis in a year, and that figure includes women on hormonal contraceptives, so it’s a very rare event.”

But he admits he was “a bit surprised” by the results, since previous studies suggested that the sex hormones estrogen and progestin might be protective against the gliomas. But those studies primarily included women past menopause, who self-reported their use of contraceptives. In his study, the women were at the age where they would be taking contraceptives, and the data came directly from medical records and registries and therefore more likely to be accurate.

MORE: Take a Look at History’s Worst Contraceptives for Women

Interestingly, Gaist found that women using progestin-only birth control showed slightly higher risk of developing gliomas. While it’s not clear why, he suspects that obesity may be playing a role. In Denmark, regulations require that doctors avoid prescribing estrogen-based contraceptives to obese women, since estrogen can increase risk of blood clots.

Dr. Santosh Kesari, director of neuro-oncology at University of California San Diego and a member of the American Academy of Neurology, notes that rates of gliomas have not spiked since the introduction of hormonal contraceptives, but agrees that the correlation deserves discussion and more study. “It’s something women should be aware about, but I don’t think there is enough evidence to say don’t use it. But the discussion about this potential risk needs to happen,” he says.

Until more research is done to tease apart how the hormones in contraceptives are influencing cells in the brain, Gaist agrees that there isn’t any reason for women to stop using such birth control methods. “With the present knowledge we have, I would still favor using contraception in eligible women,” he says. “But we need to do more research to get a better handle on the issues.”

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