Pill Misuse Leaves Millions Pregnant

B O S T O N, Aug. 14 -- Why do women in Bangladesh, Zimbabwe and Thailand have more success using the birth control pill to ward off pregnancy than the 10.6 million women taking the pill in the United States?

Perhaps because they have better access to counseling and receive clearer instructions on how to use the pill, researchers at Johns Hopkins’ University say in a new report titled “Helping Women Use the Pill.”

The study compared success rates for the 106 million women using birth control pills worldwide, and found that the first-year failure rate of pill users in the United States was 6.9 percent — higher than several other, less developed, countries.

Puzzling Differences

The failure rate worldwide ranged from a low 1.7 percent failure rate in Bangladesh to as high as a 10.5 percent failure rate in Bolivia. The pill has a 99.9 percent effectiveness rate with “perfect world” usage, but actual success rates are lower.

“You have to ask, ‘why the difference?’” says lead author Vera Zlidar, a research analyst for Johns Hopkins’ Population Information Programs, which published the findings in itsquarterly Population Reports.

One explanation she gives is that some countries have nationalized family planning services.

“In certain communities, people have health workers who visit their house once a month and ask, ‘How are you doing?’” she says. “They have constant reinforcement and help in using the pill.”

By comparison, she says, “in the U.S., the gynecologist says, ‘Here’s the pill,’ and when a patient asks, ‘How do I use it?’ the physician tells them, ‘Read the insert.’”

Dumbing Down Instructions? The pill’s insert is written at a college level, rather than at the high school level most Americans can comprehend, researchers say.

That might be a main cause of improper usage both in the United States and around the world. Researchers estimated incorrect use causes 2 million women worldwide to become pregnant each year.