Cervical cap: a birth control method most likely to be overlooked by ob/gyns

We in the U.S. are reproductively illiterate. More than half of U.S. pregnancies are unintended, the highest rate in the developed world. Each year the U.S. has about 6.3 million pregnancies; 3.5 million (56.5%) are unintended; resulting in about 1.5 million unintended births, about 1.6 million legal abortions and about 440,000 miscarriages.

Also, we are among the developed world's poorest contraceptors. We have one of the western developed world's highest abortion rates, about 325 per 1,000 live births, much of it for unintended pregnancy.

Conspicuously absent from the AMA's press briefing on contraception methods, both available and still-in-the-research stage, was any mention of the cervical cap. This simple barrier method was promoted by women's health activists in the 1970s and approved by the FDA in 1988.

The gynecologists who spoke at the AMA's briefing, financed in part by pharmaceutical companies, emphasized--and extolled the virtues of--birth control methods involving hormone drugs, such as oral contraceptives and Norplant.

Unintentionally, the press briefing symbolized the way information is dispensed to women seeking birth control advice from the average gynecologist. All birth control methods with their respective pros and cons should be discussed. But proponents of the cervical cap say it is likely to be mentioned only by other health care providers, such as family practitioners, physician's assistants, nurse practitioners, and nurse midwives.

The cervical cap is obtained by prescription after a fitting by one of the above health care providers. It fits snugly over the cervix, or neck of the uterus, and differs from the diaphragm in several ways. The cap is smaller, thicker, and can be worn for 48 hours. About 80% of the women who want a cervical cap are able to use this method. (The rest cannot because of anatomical anomalies, such as an angled uterus.) Like the diaphragm, it is reportedly 96% effective in preventing pregnancy.

In a telephone interview, Liz Summerhayes, R.N., of Cervical Cap Ltd., was asked about gynecologists' reluctance regarding this contraceptive option. "The obstetrician/gynecologists have a certain amount of caution because it's easier to write a prescription than to fit and educate a woman about any barrier method," responded Ms. Summerhayes, whose company imports cervical caps from England and sells them to health care providers in the U.S. and Canada.

"Their medical education was prior to the introduction of the cap so it's easier for ob/gyns to continue what they have been doing rather than look at a new method." But she quickly noted the exception to her own statement. Norplant, the new contraceptive method of implanting hormone capsules in the arm, is more attractive to ob/gyns, she explained, because there's a definite bias in favor of using their surgical skill.

"Part of the [ob/gyns'] anxiety over the cervical cap comes from a lack of knowledge and an unwillingness to admit it," said Ms. Summerhayes. She singled out another medical specialty, family practice, as a "totally different breed" of physicians.

"Family practitioners are hungry for information and tend to listen to the woman, educate her about all alternatives, and then let her make the decision," observed Ms. Summerhayes, who as a nurse practitioner and midwife has worked with many family practitioners.