What would happen if women at risk for unintended pregnancies received the birth control of their choice — especially the more effective kinds — at no cost?
The national abortion rate would plummet, according to a study conducted by researchers at the Washington University School of Medicine in St. Louis and published in the journal Obstetrics & Gynecology on Thursday.
The researchers enrolled 9,256 women from the St. Louis region into the Contraceptive Choice Project between August 2007 and September 2011. The women were aged 14 to 45, with an average age of 25, and many were poor and uninsured with low education. Nearly two-thirds had had an unintended pregnancy previously. Participants were either not using a reversible contraception method or willing to switch to a new one.
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Researchers provided free, FDA-approved birth control to the women for three years. The women were given their choice of contraception, including oral birth control pills and long-acting reversible contraceptive (LARC) methods like implants and IUDs. The researchers specially briefed the participants on the “superior effectiveness” of LARC methods — the T-shaped IUD, or intrauterine device, has close to 100% effectiveness and can last five to 10 years, for instance — and 75% of women chose those devices over the pill, patch or ring.
Over the course of the study, which lasted from 2008 to 2010, women experienced far fewer unintended pregnancies than expected: there were 4.4 to 7.5 abortions per 1,000 women in the study, after adjusting for age and race — much fewer than the national rate of 19.6 abortions per 1,000 women and lower also than the rate in the St. Louis area of 13.4 to 17 abortions per 1,000 women.
The effect of free contraception on the teen birth rate was remarkable: there were 6.3 births per 1,000 girls aged 15 to 19 in the study, compared with the national rate of 34.3 births per 1,000 teen girls.
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The findings come amidst contention over President Obama’s health-care law, which offers women FDA-approved birth control without a copay. As of August 1, contraception is covered for women signing up for new health insurance plans or renewing their existing plans.
“[C]hanges in contraceptive policy simulating the Contraceptive Choice Project would prevent as many as 41% to 71% of abortions performed annually in the United States,” the study’s authors wrote.
Nearly half of the more than 6 million pregnancies that occur each year are unintended, and about 43% of them end in abortion. Further, about 1 million births are unintended, costing U.S. taxpayers about $11 billion a year in associated expenses. Low-income women with less education are far more likely to have an unintended pregnancy than their wealthier, educated peers.
About half of unplanned pregnancies occur in women who are using no contraception; in other cases, women may be using short-acting contraception, like condoms or pills, which can fail if not used properly. In contrast, methods like IUDs, which are fitted into the uterus, or hormonal implants, which are surgically placed under the skin of the upper arm, can be placed and then forgotten about — no need to remember to refill a prescription or take a pill at the same time each day.
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Women who choose long-acting contraception are more likely to stick with it as well: in the study, 85% were still using it a year later, compared with 35% of those choosing pills or other short-acting forms of birth control. “Because LARC methods have been shown to have higher continuation rates than other reversible methods, the number of adolescents and women using no contraception would decline, further decreasing the unintended pregnancy rate,” the authors conclude.
Yet American women use LARC methods at far lower rates than in other countries. In large part, that’s because of cost: upfront costs to implant an IUD, which requires a doctor visit, can total $500 to $1,000, for example. Over a decade, however, birth control pills can cost just as much. American doctors also tend not to recommend long-acting birth control to women as often as they do the pill or patch, though IUDs and implants may be up to 20 times more effective.
That’s why the American College of Obstetricians and Gynecologists is now urging doctors to recommend IUDs and implants as “first-line” contraceptive choices to their teen patients.