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Study Roundup: Free Contraception Prevents Unintended Pregnancy

Researchers in St. Louis provided no-cost contraception to nearly 10,000 women over a four-year period and found that abortion rates dropped dramatically.

-- by Nina Lincoff

The Gist


In the United States, unintended pregnancy rates are higher than in other developed countries and account for almost $11 billion of taxpayer money annually. With nearly 62 million estimated women of reproductive age living in the United States, there will be close to 1 million unintended pregnancies per year. Half of these cases are caused by contraceptive failure, with most women opting to use sometimes faulty oral contraception—the ‘pill’—or condoms.

By providing free birth control and education to women in the Contraceptive CHOICE Project, researchers from the Washington University School of Medicine in St. Louis found that abortion rates dropped by 62 to 78 percent from the national average. And while the reduction in abortion rates provides scientific proof of the effectiveness of contraceptive access and education, the kinds of contraception nearly 4,300 women choose is what’s most exciting to some researchers. 

Of the 9,256 adolescents and women enrolled in the CHOICE study, 75 percent chose long-acting reversible contraceptive (LARC) methods. Forty-six percent chose levonorgestrel intrauterine devices (IUDs), 12 percent chose copper IUDs, and 17 percent chose subdermal implants over the option of oral contraceptive pills (OCPs).

LARC methods—long-term birth control that doesn’t require frequent user action—are more than 20 times more effective than both OCPs and condoms, which have an average failure rate of 8 to 9 percent annually. With proper education and accessibility, a resounding majority of the participants in the CHOICE program chose LARC methods.

The Expert Take

Co-author of the study Gina Secura, PhD, MPH, says she wasn’t surprised about the “big finding.” The correlation between providing no-cost contraception and lower teen pregnancy and abortion rates isn’t shocking, although it’s nice to have scientific backing when making an argument for easier access to contraception. What’s most exciting about the findings is which kinds of contraceptive device women choose in a perfect world—or at least one with access and education.

“What was most surprising to us was that 75 percent of the women choose a LARC method. We saw that really early on, with the first 500 women, and thought that maybe it was just a fluke, that these were women who came to [CHOICE] specifically for these methods,” says Secura. But when those results sustained over nearly 10,000 women, “we were at once surprised and really excited.”

The Bottom Line


Across nearly 10,000 participants in the St. Louis area, the rate of unintended pregnancy dropped due to the no-cost contraception, education, and follow-up that was offered. While that correlation is important when making a case for contraception method accessibility and care, the LARC preference may foreshadow popular birth control methods in the future. With only 9 percent of women opting for OCPs and even less choosing family planning methods, LARCs seem to be what women want. 

LARC methods of birth control require less action on the part of users. Think of ditching the pack of 28 you have to take a daily pill from as an OCP user and knowing that there is a sustainable, safe way to avoid unintended pregnancies. LARC methods have already been proven to be more reliable and effective than OCPs or condoms. The next step, says Secura, is to get the word out there.

The LARC method most commonly chosen in the study was the levonorgestrel IUD, an intrauterine device that releases levonorgestrel, a progesterone hormone into the uterus. 

Source and Method

Between August 2007 to September 2011, 9,256 participants were enrolled in the CHOICE program, either recommended by word of mouth, drawn to the program by flyers and advertisements, or part of the 16 percent that were recruited from two abortion clinics in the area. Of all participants, about 40 percent had their own healthcare coverage, 40 percent had no coverage, and Medicaid covered around 16 to 17 percent, says Secura. 

CHOICE participants were required to meet a set of criteria to be included in the study. Participants from the St. Louis region ranged in age from 14 to 45 years, opted in for contraception, were not using any other contraception during the study period, did not want to be pregnant for at least a year, and planned on being sexually active with a male partner in the six months after starting the program. 

Participants were offered all manner of FDA-approved contraceptive devices and were educated about each option, in a way simulating Obamacare’s birth control provision that requires healthcare to cover basic birth control services for women. 

Other Research

Earlier this year, the New England Journal of Medicine published a study from Secura and a team of researchers reporting the effectiveness of LARCs on reducing the rate of unintended pregnancies. 

study earlier this year examined the likelihood of healthcare services offering LARC methods when given federal funding. The study found that doctors and clinics were more likely to offer LARC options when they received Title X funding, the family planning initiative enacted under president Richard Nixon.

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Tags: Public Health & Policy , Health Insurance Issues , Latest Studies & Research

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