SALT LAKE CITY — Researchers from the University of Utah reported findings from the HER Salt Lake Contraceptive Initiative on June 16 in JAMA Network Open. The study found that patient-centered counseling and immediate access to chosen methods improved contraceptive effectiveness across all methods.

The initiative provided participants with counseling focused on their needs and values, along with their chosen contraceptive method immediately, refills, and other support. Jessica Sanders, a reproductive health researcher at University of Utah Health, said, "Patients received their preferred method, had timely access, felt respected and could stop and switch methods at any time." She added, "A missed refill, a delayed appointment, out-of-pocket costs or an unavailable method creates that gap — it's not necessarily on the person." Sanders stated, "The small disruptions matter." She also said, "These are all effective methods at preventing pregnancy," and "People should feel really valid in whatever decision they make."

The study was conducted at four Salt Lake City family planning clinics and included more than 4,000 participants who could become pregnant, were aged 16 to 45, and had incomes below the federal poverty line. Participants planned to avoid pregnancy for at least one year and were either new patients seeking contraception or established patients looking for a new method. The study offered a choice of seven reversible birth control methods: copper intrauterine device (IUD), hormonal IUD, contraceptive implant, contraceptive injection, pill, vaginal ring, or male condoms. Medical providers placed copper IUDs, hormonal IUDs, and contraceptive implants, while medical offices administered contraceptive injections. Pills, vaginal rings, and male condoms are user-controlled methods. Eighty-two percent of participants completed the full three years of follow-up. The research team tracked how long participants continued with their original method and defined contraceptive failure as a pregnancy despite using the original method in the four weeks prior. The study recorded 96 pregnancies.

Over three years, the study found approximately one pregnancy per 100 participants per year among users of all methods except male condoms. This failure rate ranged from 0.7 per 100 per year for hormonal IUD users to 1.6 per 100 per year for pill users. The failure rate for hormonal IUDs was 0.7 pregnancies per 100 users, for birth control implants it was 0.8 pregnancies per 100 users, for copper IUDs it was 1.1 pregnancies per 100 users, and for injectable contraceptives it was 1.1 pregnancies per 100 users. The failure rate for vaginal rings was 1.4 pregnancies per 100 users, and for pills, it was 1.6 pregnancies per 100 users. The estimated failure rate for condom users was 2.6 pregnancies per 100, though this estimate is limited by a small sample size.

Katharine White, chief of obstetrics and gynecology at Boston Medical Center, said, "This shows that patients actually don't have to choose between something that they like and something that need — very often, one method can be both." She added, "This is not trying to put down any method." White said, "It's about opening the scope and expanding our view of options that meet people's values." She also stated, "When people feel heard, they are more likely to have trust in the care they are getting [and] to reach back out if they have any problems." Anu Manchikanti Gómez, a sexual and reproductive health equity researcher at the University of California, Berkeley, said, "What HER Salt Lake adds is incredible evidence that having the ideal access and support to use [preferred] methods actually increases the effectiveness of shorter-term methods for preventing pregnancy."