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The HHS mandate requiring employers to provide coverage for contraceptive services is based on recommendations in the 2011 report, Clinical Preventive Services for Women: Closing the Gap, from the Committee on Preventive Services for Women of the Institute of Medicine of the National Academies (IOM, 2011).
The report includes a table of methods of contraception effectiveness (Table 5-3) based on a report by Ardent Media, an organization associated with the Guttmacher Institute. Table 5-3 lists the reference on which it’s based: “SOURCE: © 2007 by Contraceptive Technology Communications Reprinted by permission of Ardent Media, Inc.”
Here’s what the table presents, which I’ve reformatted to show up properly here. The format is as follows:
Method
“Typical Rate” / “Perfect Rate”
TABLE 5-3 Percentage of U.S. Women Experiencing an Unintended Pregnancy During First Year of Typical Use and First Year of Perfect Use, by Contraceptive Method
None
85 / 85
Spermicides (foams, creams, gels, vaginal suppositories, and vaginal film)
29 / 18
Withdrawal
27 / 4
Fertility awareness-based methods
25 / BLANK
Standard days method
BLANK / 5
Two-day method
BLANK / 4
Ovulation method
BLANK / 3
Sponge in Parous women
32 / 20
Sponge in Nulliparous women
16 / 9
Diaphragm (with spermicidal cream or jelly)
16 / 6
Condom (without spermicides)
Female
21 / 5
Male
15 / 2
Combined pill and progestin-only pill 8 0.30
8 / 0.30
Evra patch
8 / 0.30
NuvaRing
8 / 0.30
Depro-Provera
3 / 0.30
Intrauterine Device: ParaGard (copper T)
0.80 / 0.60
Intrauterine Device: Mirena (LNG-IUS)
0.20 / 0.20
Implanon
0.05 / 0.05
Female sterilization
0.50 / 0.50
Male sterilization
0.15 / 0.10
Table 5-3 includes a footnote for the rates reported for “typical use”:
“Among typical couples who initiate use of a method (not necessarily for the first time), the percentage who experience an accidental pregnancy during the first year if they do not stop use for any other reason.”
Table 5-3 includes a footnote for the rates reported for “perfect use”:
“Among couples who initiate use of a method (not necessarily for the first time) and who use it perfectly (both consistently and correctly), the percentage who experience an accidental pregnancy during the first year if they do not stop use for any other reason.”
Table 5-3 includes a footnote for “Fertility awareness-based methods”:
"The ovulation and 2-day methods are based on evaluation of cervical mucus. The standard day method avoids intercourse on cycle days 8 through 19.
What’s odd about the IOM report is that it references studies published up to 2011. However, the report does not reference other review studies that were published in the peer-reviewed literature prior to that date. Notably, it excludes the following review article: **Pallone, S.R. and Bergus, G.R. **(2009) Fertility awareness-based methods: another option for family planning. Journal of the American Board of Family Medicine 22(2):147-57.
Pallone and Bergus also include the table from the 2007 publication included in the IOM report. However, it also reviews newer studies on the effectiveness of natural family planning methods. I’ve attached a file (CSV format) that includes all the “failure rates” for both NFP methods as well as artificial contraception.
What you can see is that the failure rates for the Symptothermal method, in particular, are very similar to those found in common artificial contraception methods. Statistically, they’re probably the same.
This suggests to me that NFP science was ignored by the IOM committee. The review by Pallone and Bergus was published in 2009, which gave the committee enough time to read it. Did they read it at all? Or were they captured by their desire to advocacy?
Looking at Appendix D of the document (p. 231 and following), how that happened seems to pop right out:
The view of this dissent is that the committee process for evaluation of the evidence lacked transparency and was largely subject to the preferences of the committee’s composition. Troublingly, the process tended to result in a mix of objective and subjective determinations filtered through a lens of advocacy. An abiding principle in the evaluation of the evidence and the recommendations put forth as a consequence should be transparency and strict objectivity, but the committee failed to demonstrate these principles in the Report. T*his dissent views the evidence evaluation process as a fatal flaw of the Report *particularly in light of the importance of the recommendations for public policy and the number of individuals, both men and women, that will be affected.
The report includes a table of methods of contraception effectiveness (Table 5-3) based on a report by Ardent Media, an organization associated with the Guttmacher Institute. Table 5-3 lists the reference on which it’s based: “SOURCE: © 2007 by Contraceptive Technology Communications Reprinted by permission of Ardent Media, Inc.”
Here’s what the table presents, which I’ve reformatted to show up properly here. The format is as follows:
Method
“Typical Rate” / “Perfect Rate”
TABLE 5-3 Percentage of U.S. Women Experiencing an Unintended Pregnancy During First Year of Typical Use and First Year of Perfect Use, by Contraceptive Method
None
85 / 85
Spermicides (foams, creams, gels, vaginal suppositories, and vaginal film)
29 / 18
Withdrawal
27 / 4
Fertility awareness-based methods
25 / BLANK
Standard days method
BLANK / 5
Two-day method
BLANK / 4
Ovulation method
BLANK / 3
Sponge in Parous women
32 / 20
Sponge in Nulliparous women
16 / 9
Diaphragm (with spermicidal cream or jelly)
16 / 6
Condom (without spermicides)
Female
21 / 5
Male
15 / 2
Combined pill and progestin-only pill 8 0.30
8 / 0.30
Evra patch
8 / 0.30
NuvaRing
8 / 0.30
Depro-Provera
3 / 0.30
Intrauterine Device: ParaGard (copper T)
0.80 / 0.60
Intrauterine Device: Mirena (LNG-IUS)
0.20 / 0.20
Implanon
0.05 / 0.05
Female sterilization
0.50 / 0.50
Male sterilization
0.15 / 0.10
Table 5-3 includes a footnote for the rates reported for “typical use”:
“Among typical couples who initiate use of a method (not necessarily for the first time), the percentage who experience an accidental pregnancy during the first year if they do not stop use for any other reason.”
Table 5-3 includes a footnote for the rates reported for “perfect use”:
“Among couples who initiate use of a method (not necessarily for the first time) and who use it perfectly (both consistently and correctly), the percentage who experience an accidental pregnancy during the first year if they do not stop use for any other reason.”
Table 5-3 includes a footnote for “Fertility awareness-based methods”:
"The ovulation and 2-day methods are based on evaluation of cervical mucus. The standard day method avoids intercourse on cycle days 8 through 19.
What’s odd about the IOM report is that it references studies published up to 2011. However, the report does not reference other review studies that were published in the peer-reviewed literature prior to that date. Notably, it excludes the following review article: **Pallone, S.R. and Bergus, G.R. **(2009) Fertility awareness-based methods: another option for family planning. Journal of the American Board of Family Medicine 22(2):147-57.
Pallone and Bergus also include the table from the 2007 publication included in the IOM report. However, it also reviews newer studies on the effectiveness of natural family planning methods. I’ve attached a file (CSV format) that includes all the “failure rates” for both NFP methods as well as artificial contraception.
What you can see is that the failure rates for the Symptothermal method, in particular, are very similar to those found in common artificial contraception methods. Statistically, they’re probably the same.
This suggests to me that NFP science was ignored by the IOM committee. The review by Pallone and Bergus was published in 2009, which gave the committee enough time to read it. Did they read it at all? Or were they captured by their desire to advocacy?
Looking at Appendix D of the document (p. 231 and following), how that happened seems to pop right out:
The view of this dissent is that the committee process for evaluation of the evidence lacked transparency and was largely subject to the preferences of the committee’s composition. Troublingly, the process tended to result in a mix of objective and subjective determinations filtered through a lens of advocacy. An abiding principle in the evaluation of the evidence and the recommendations put forth as a consequence should be transparency and strict objectivity, but the committee failed to demonstrate these principles in the Report. T*his dissent views the evidence evaluation process as a fatal flaw of the Report *particularly in light of the importance of the recommendations for public policy and the number of individuals, both men and women, that will be affected.