Maxine's Journal

I have lots of other things to catch up with, but it seems I'm most productive when I'm angry - and this idiotic article (and a swathe of similar ones) makes me EXTREMELY angry.

So what's wrong with it?

Here's the headline: "Failure of contraceptive implants sets back battle against teen pregnancies"
and the subtitle: "Bad press surrounding 584 cases in which women trusting in Implanon implants fell pregnant is a blow to family-planning advisers"

Terrifying - 584 failures - that's got to be bad, right? Well, no.

Why not?

Because statistically, that number of 584 failures makes Implanon an AMAZINGLY EFFECTIVE contraceptive.

Let's take a look at a table of statistics about contraception - I've taken my stats from here

Type of contraception	Implanon Hormone Implant: 0.05% failure rate.	Condom: 2-15% failure rate.	Crossed Fingers (no contraception): 85% failure rate.
Number of women expected to become pregnant during one year (out of 100)	0.05	2 to 15	Around 85
Number of women expected to become pregnant during one year (out of 82,000)	41	1640 to 12,300	Around 69,700
Number of women likely to become pregnant over 11 years (out of estimated 1,000,000)	584*	20,000 to 150,000**	Around 850,000**
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*actual statistic
**this is a low estimate - stats are based on only one year of use.

Contraception failure rates are measured by the number of women out of 100 who would get pregnant over a year using that contraceptive. So as you can see above, using no contraception at all, 85% of women WOULD get pregnant. Condoms have between a 2 and 15% failure rate. That means between two and 15 women will pregnant over a year whilst relying on condoms for contraception. So if 82,000 women were using condoms for contraceptive protection for a year, between 1640 and 12300 of those women would get pregnant.

So let's just compare those condom statistics back to the headline: We are told in the article that 82,000 women per year are fitted with an Implanon implant. Compared to condoms, 584 failures out of 82,000 women is very low - far less than 1%.

But that's not the end of the story.

It's not the end of the story because the 584 pregnancies they're talking about in this article weren't over one year. They were over ELEVEN YEARS. We're talking about barely one twentieth of a percent, 0.06%.
If all of these women had used condoms instead, we'd be looking at an extra 11,716 women who would likely be pregnant due to contraceptive failure - not just once either, that's every year.
That's ELEVEN THOUSAND WOMEN! Eleven thousand lives that *haven't* been disrupted by unwanted pregnancy, because they were relying on a more effective form of contraception. If they hadn't used any contraception at all? 69700 unwanted foetuses PER YEAR. This is what happens when you put people off using safe contraceptives with idiotic scare tactics.

Yes, these women "thought they were 99% safe" - based on the number of women who have actually had Implanon fitted, they were actually 99.94% safe (equivalent to one in about 2000, vs. one in 100). I'm sure it's not much of a comfort to the women who have experienced a failure (after all, on an individual level it's no longer a statistic - you're either pregnant or you're not), and of course it would have been wonderful if they could have been 100% 'safe', but compared to around 70,000 of those same women each year who would have been pregnant if they had no contraception, that's a vanishingly small number.

It's not perfect. No method of contraception is perfect, and not everyone gets on with hormone based contraception, but it's by far the best out there. And it makes me sick with anger that scare tactics like these stupid headlines are being used to trash what is clearly the most reliable means we have of preventing unwanted pregnancy.

What's the real agenda here? I have no idea. Maybe some crazy idea that that declaring contraception 'unsafe' will put teenage girls off from having sex? Maybe a complete lack of understanding of statistics. Perhaps a misunderstanding of how contraception really works - and a belief that there's a better method out there? Currently, there isn't a better option - unless you combine several at once, eg. condoms *and* an implant, or a coil, or or whatever (and of course, implants and coils don't protect from STIs, so that's an excellent idea anyway). Sadly real science doesn't give us perfect answers, it just gives us better ones. And they're getting better all the time - or they would be, if only journalists would actually understand the information they're presented with.

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Additional information:

If you have an implant and you're worried if it might be incorrectly fitted:

What to do if you are worried?
If you are already using the Contraceptive Implant and are not experiencing any problems you probably don’t need to worry. However if this coverage has concerned you then you can speak to your GP, Reproductive Health Clinic or call the Family Planning Association (in the UK) on 0845 122 8690.

Remember this form of contraception is more than 99% effective and for the majority of women who opt to use it they experience no problems and are happy with it as their contraceptive choice.

--from Dr. Petra Boynton's blog entry, Contraceptive Implants and Media Panics – what you need to know (click for more details)

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Update two:

There's some more decent information at these sites (though many of them still fail to compare with failure rates for other contraceptives):

http://bishuk.com/2011/01/06/contraceptive-implant/
http://www.bbc.co.uk/journalism/blog/2011/01/contraceptive-failure-figures.shtml
http://dianthus.co.uk/implanon-and-contraceptive-failures
http://www.nhs.uk/news/2011/01January/Pages/info-implanon-contraceptive-implant.aspx

I have just been reminded by a post of Joreth's, that this tab has been open in my browser for a couple of weeks now: Reuters article on incidence of STIs in prostitutes, swingers and 'straight' population.

Possibly the most poorly titled piece of science journalism EVER.

Take a look at the statistics quoted in the article: "Overall, combined rates of Chlamydia and gonorrhea were just over 10 percent among straight people, 14 percent among gay men, just under 5 percent in female prostitutes, and 10.4 percent among swingers, they found. And female swingers had higher infection rates than male swingers."

What Reuters managed to read from that: Shock, horror! Swingers have TWICE the infection rate of prostitutes!

With a more sex-positive eye, however, let's re-read that. Swingers overall had an infection rate of 10.4% over the period of the study. that's just 0.4% more than 'straight' (I assume this means heterosexual, serially monogamous - it's never actually defined in the article) people. So the straight folk and swingers had very similar infection rates, which were both DOUBLE the infection rate of the prostitutes.

What does this tell us?

First it tells us that Reuters journalists are so biased against sex-positive folk that they have to ignore an amazing statistic to twist their headline into something with enough shock value to please their readers.

Second, it tells us that monogamous people don't have all the answers on safety... who would have thought?

joreth hits the nail on the head: "The number of sexual partners is not the most important factor in a person's health risk profile. Using proper safety procedures, and exchanging accurate medical information between partners and with medical practitioners are more likely to keep you safe than just reducing the number of partners."

The take-home piece of information from this study is NOT that being a swinger is inherently unsafe, but that being 'straight' does not keep you safe.

Clearly the prostitutes in this study, working in a legal profession (bless the Netherlands for being open-minded enough for that) by being aware of risk and observing safer sex methods managed to reduce their risk to a level far below the general population. What might they be doing to reduce their risk? Getting checked regularly and using barrier protection are the most obvious. Being aware of how, for example, different lubricants can alter your risk of infection is another. Another less obvious one is this: not automatically assuming that your partner is clear of infection.

Assuming that your partner is clear of infection because they have slept only with one person at a time is a mistake made by so many of the straight, monogamous community – I mean come on guys, you're in the majority (for now). If it actually kept you safe, these diseases wouldn't exist! You don't have to assume that your partner is cheating on you for them (and you) to be at risk of having an STI – they may well have contracted something before you met. Sexual health clinics in the UK generally won't offer certification, but are you certain that every one of your partners had the all-clear before you played together? If you're monogamous and haven't done testing, are you certain that your partners exes had the all-clear before THEY slept together? Or if not, what precautions did/do you take? Crossing your fingers, closing your eyes and singing 'la la la' is not a precaution, by the way. Nor is a wedding ring.

Out of interest, I've visited one swing club in the netherlands, and would go so far as to hazard a guess that the reason why the infection rate was so similar between 'straight' folk and swingers would be because generally the swingers are using barrier methods with randoms they play with at clubs, but where it comes to their usual partner, make pretty much the same assumptions about safety that the general 'straight' population do – “well he/she uses barriers with everyone else, so we don't need to get tested”.

I'd love to see a study like this comparing mono and poly folk. My hunch is that the poly community in general has a % that's even lower, since there is a high level of safety-consciousness combined with a relatively small number of partners, at least as compared to Dutch prostitutes.

Now there's a line I never thought I'd use!