Roughly two in five women in the United States do not use any form of birth control and many underestimate their risk for pregnancy, according to a recent survey about contraceptive practices in the United States.

The survey, Contraception in America: A National Landmark Survey of Women of Reproductive Age and Physicians Treating Women, included 1,000 women ages 18-49 and a parallel survey of physicians (100 Ob/Gyn physicians and 101 primary care physicians). The survey was designed to reveal the current state of contraception use and preferences from the perspective of women and the physicians treating them.

"While contraception is widely available, women don't access clinics or health care providers," said Rebecca Brightman, MD, a clinical instructor of Obstetrics, Gynecology and Reproductive Science at the Mount Sinai School of Medicine in New York City. "Women who are uninsured frequently don't seek the attention of a health care provider until it is too late."

Aside from not seeking proper health care, there were several other findings in the survey of note. With regard to accidental pregnancies and the role of birth control failure:

•Almost half of the women surveyed (43%) who had ever been pregnant report that they had one or more accidental or unintended pregnancies. Roughly 50% of those women report that at least one of these pregnancies may have been caused by birth control failure, such as a broken condom or missing a scheduled birth control pill.

•One in 10 women on birth control reported a perceived failure in the past year.

•There is confusion on how long an intrauterine device (IUD) lasts even among women who use them. One in three women say an IUD lasts less than five years (in fact it lasts 5-10 years depending on the device).

The use of IUD's has increased significantly over the past few years. "Several recent articles in well-respected medical literature have confirmed the safety and efficacy of IUDs even in women who have not yet had children," said Brightman. As a result, more IUDs are being placed in younger women who as a group have the highest risk of accidental/unintended pregnancy. Depending on the type, an IUD can be inserted by a health care provider and used for five to 10 years on average. It is important "for patients to understand that while IUDs are extremely effective in terms of pregnancy prevention, they will not prevent STDs."

In addition to IUDs, there are many other options available to women. Women should first determine their stage of life and understand their purpose for using contraception in order to make more informed decisions on which methods will be most beneficial and appropriate. For example, women who plan on having children can choose from a variety of birth control pills, the shot, the patch, diaphragms, caps, shields, and rings. Women who want to fully prevent pregnancy in the short-term but not permanently may choose to use an IUD. If a woman wants to permanently prevent pregnancy, her options include, tubal ligation, and a newer procedure in which tiny metal coils are inserted into the fallopian tubes, which scar over, and leave the passage blocked, making it impossible for sperm to enter. Finally, men have the option of a vasectomy, which prevents sperm from leaving the man's body.

In addition to confusion over contraception, the survey also revealed that women underestimate their risk of pregnancy. Among the sexually active women surveyed, many reported they are not trying to get pregnant, and a majority perceive that they are at "low or no risk" for accidental pregnancy. Incidentally, more than two in five women ages 18-49 report that they have used no method of birth control in the past 30 days.

The survey showed that women may not fully understand their options or how certain contraception methods work. One in five women did not know which methods would be considered hormonal (hormonal contraception contains forms of the hormones estrogen and/or progesterone, examples include: birth control pills, patch, a shot, implant, or ring).

A parallel survey revealed that the vast majority of Ob/Gyn and family practitioners who were questioned say that they routinely discuss contraception with women of reproductive age. However, the women report that they initiate the conversation much more frequently than their doctors.

"Many health care providers are under tremendous time constraints with their patients and it is difficult to sometimes convey all of the information necessary regarding contraception options during the course of an office visit," said Brightman.

According to this survey, there are large gaps in information and understanding among women of reproductive age when it comes to contraception. Women should begin the contraception conversation with their health care providers at their wellness visits to see what is right for them. An open dialogue between the patient and doctor is a great way to ensure the exchange of information necessary to empower women to make the best decisions.