Preface| Volume 42, ISSUE 4, Pxv-xvi, December 2015


      We are thrilled to devote an issue to contraception at this junction in women’s health care. The high rate of unplanned pregnancy that has plagued the United States for decades has started to decline in selected regions. As many are well aware, one-half of pregnancies in the country are unplanned, and 40% of unplanned pregnancies end in abortion. These statistics have remained stable for years. It represents a failure to empower women with the basic right to decide for themselves if and when to have children.
      Several factors have empowered certain groups of women to make health decisions that are consistent with their reproductive life plan. These factors include access to evidence-based reproductive health education and the availability of effective contraception through either the Affordable Care Act’s Contraceptive Mandate or local measures to increase access to contraception. In groups of women with education and access to effective contraceptive methods, we see marked declines in the rate of unintended pregnancy and abortion.
      Intrauterine devices and contraceptive implants are key components of this progress. These methods of long-acting reversible contraception are safe and require little of the user to achieve perfect-use efficacy rates. It is crucial to ensure women have access to these methods, both financially and logistically. Understanding not just who are eligible candidates for these methods, but also when they can be initiated, is important to allow more women to take advantage of them.
      The political, legal, and medical climates in this country affect women’s reproductive options. To elucidate these connections, we have included discussions about the Affordable Care Act and the possibility of over-the-counter access to contraception. Certain vulnerable populations require special attention, and consideration of the specific concerns of adolescents and obese women is addressed. In addition, the family planning experts contributing to this issue provide in-depth information on best practice regarding use of combined hormonal contraception and sterilization, which remain the most commonly used methods of contraception.
      Our goal is to provide readers with up-to-date information on how best to use the spectrum of contraceptive methods across a diverse patient population with respect to patient needs and safety. Ultimately, the best contraceptive method is one that a woman herself feels comfortable with and wants to continue. We aim to empower women and providers to find that method together.