Subject: Use of Birth Control Pill Surges in U. S. As More Women Take It Later in Life Date: Published: 8/20/91 (147 lines) Source: Wall Street Journal. Copyright Dow Jones & Co. Inc. Technology & Health: Use of Birth Control Pill Surges in U. S. As More Women Take It Later in Life ---- By Ron Winslow Staff Reporter of The Wall Street Journal A new survey of contraceptive practices says that use of the birth control pill is surging among U. S. women and that many are taking it later in their childbearing years. At the same time, women who use IUDs, one of the least popular contraceptive choices, overwhelmingly report satisfaction with the device. And 21% of women who take the pill also have their partners use a condom during intercourse. These and other findings from the survey of more than 7,800 women sponsored by Johnson & Johnson don't reflect any dramatic shift in birth control practices, company officials and other experts say. But they offer persuasive evidence that public concern over health problems linked to early versions of the pill is waning -- especially among women over 35 who have long been considered at increased risk of adverse effects. "It may very well represent an attitudinal change toward the pill and towards contraception," says Anita Nelson, medical director of the Women's Health Care Clinic at Harbor-UCLA Medical Center, Torrance, Calif. "People are beginning to see the benefits of effective contraception and the fear of the risk is subsiding." At the same time, more than 30 years after the pill arrived on the market, women and men have few other options for effective birth control. "Part of it is desperation," says Jeannie I. Rosoff, president of the Alan Guttmacher Institute, a New York organization that conducts research on family planning issues. "You have sterilization. After that you have the pill. Then you go right to methods with relatively high failure rates. There's no other place to go." Johnson & Johnson, the New Brunswick, N. J., health care company whose Ortho Pharmaceuticals unit is the leading maker of birth control pills, is releasing results of the survey today. The company has conducted such a study annually since 1968, but this is the first year it is formally making the results public. News of growing acceptance of the pill could encourage more doctors and patients to reconsider it, increasing sales for Ortho and its competitors, including American Home Products Corp. 's Wyeth-Ayerst Laboratories unit and Warner-Lambert Co. 's Parke-Davis unit. Johnson & Johnson claims 40% of the $1 billion annual oral contraceptives market. The survey, taken in April, found that 16.3 million women, or 29% of those between 15 and 44 years old -- a woman's childbearing years -- are taking the pill. That is an increase of 9.4% over 1990, the biggest annual jump by far in nearly a decade. Moreover, use of the pill among women over 40 years old more than doubled, and a surprising 6% of women between age 45 and 50, years when pregnancy is highly unlikely, report using oral contraceptives. One explanation is the decision by the U. S. Food and Drug Administration last year to revise product labeling to clear the way for doctors to prescribe the pill for healthy, nonsmoking women over 35 -- a group previously considered at increased risk of cardiovascular disease and other pill side effects. The FDA's action "helped physicians and patients to have more confidence" in the pill for older women, Dr. Nelson says. "To have that cloud removed makes the practice much more widespread." She considers broadening use of the pill to older women particularly significant since pregnancies among women aged 40 to 44 are more likely to end in abortion than those in any other age group. Other reasons for the pill's growing acceptance include increased awareness that pill makers have sharply reduced levels of estrogen and progestin, hormones that control ovulation, in their products. Incidence of cardiovascular disease, blood clotting and other side effects have declined as a result, without affecting efficacy, researchers say. And recent studies show that prolonged use of the pill seems to help prevent occurrence of ovarian and endometrial cancer. (Studies exploring links between the pill and breast cancer aren't conclusive.) The aging of the baby boom, for whom the pill fueled the sexual revolution of the 1960s and 1970s, may also play a role, suggests Eric Milledge, Ortho's vice president, sales and marketing. "The baby boomers who grew up with the birth control pill are comfortable in using it." Just 1% of the women surveyed said they used an IUD for birth control and among the rest, 54% said they wouldn't consider using the device under any circumstances. Nevertheless, 98% of those who choose IUDs reported that they were satisfied with the product, an assessment that impressed Ortho officials. "We're certainly going to reassess the potential for re-entering the IUD market," says Mr. Milledge. It would make sense, he adds, if Ortho determines that about 5% of women would use IUDs. Ortho marketed an IUD in the U. S. in the early 1970s, but it was overtaken by competing products before the entire market was devastated by the Dalkon Shielda device that allegedly resulted in sterility and other deleterious effects in so many users that liability forced its maker, A. H. Robins Co., into bankruptcy-law proceedings and then into a merger. IUDs remain popular in other countries, including France and Sweden, where they are used by up to 15% of women. Johnson & Johnson sells an IUD in 40 countries, but introducing one again in the U. S. would probably require FDA approval. The survey also found that 21% of women using the pill and 5% of women reporting that either they or their partners are sterilized also used a condom during intercourse. "We hadn't seen concomitant use of the condom with the pill before," says Richard R. Fordyce, vice president, marketing services and originator of the survey. The practice reflects worries over AIDS and other sexually transmitted diseases rather than a lack of confidence in the pill, experts say. "If a woman has two problems -- preventing pregnancy and preventing sexually transmitted disease -- there's nothing wrong with giving her two solutions," says UCLA's Dr. Nelson. The survey also found that 37% of women reported taking the pill five years or longer, up from 32% the previous year. Acceptance of using condoms, which soared in the late 1980s in response to fear of AIDS, has leveled off at about 65% of women. About 23% of women, including 36% who are single and 11% who are married, said concern over sexually transmitted diseases has prompted them to use a different or additional method of contraception. About 22% of women said they had a favorable opinion of Norplant, a device sold by American Home Products that is implanted in the upper arm and slowly secretes hormones to control ovulation for up to five years. But the device only recently came on the market and few women reported using it. The findings are based on responses to questionnaires sent to 12,500 women, of whom 7,805, or 62%, responded. The mailing was weighted to insure that responses reflect age, income and marital status of the 66.2 million U. S. women between ages 15 and 50. It marked the first time that women over age 44 were surveyed. [This article is made available here by Dow Jones Co. for the personal and non-commercial use of callers to this bbs, in the hope that it will be of some help to those who are suffering from the disease and others who are seeking to help them.]