Six years ago, the Colorado Department of Public Health and Environment launched a new program to reduce unwanted pregnancies.
It handed out long-term birth control to women.
As a result, teenage pregnancies in the state decreased 40 percent from 2009 to 2015. Abortion rates plummeted by about 35 percent.
The success of the program has thrown a spotlight on the efficiency of using long-acting reversible contraceptives (LARCs) — namely, intrauterine devices (IUDs) or implants — to combat unwanted pregnancies.
Greta Klingler, who supervises the Colorado department’s family planning unit, said the privately funded program was built upon the existing family planning program, which incorporated state and federal funding for more than 40 years.
It allowed the state to expand birth control methods the same way it has done previously with pills, patches, and other forms of birth control.
Before offering the free and low-cost devices, Klingler said there had been efforts to disperse them after delivery at University Hospital and Denver Health. She said the hospital and Boulder Valley Women's Health Center also provided free devices after abortion procedures.
Klingler noted that Planned Parenthood did not distribute free devices, though some of their clinics provided low-cost items.
The Cost of Long-Term Birth Control
The cost of long-term devices remains prohibitive for a lot of women. Monthly birth control pills, patches and rings — as well as condoms — are less expensive.
While costs vary, IUDs typically cost about $300 and implants are about $400. At the end of April, a new device came on the market that was available to the state’s clinics for about $50.
Klingler said the program’s clinics qualify for the 340b/Prime Vendor discount program. This enabled them to purchase devices at a discounted price.
To get the devices, women had to go to one of the state’s 69 Title X family planning clinics. Klingler noted that about two-thirds of the clinics are in county health departments. The rest are private clinics, community health centers, or located in hospitals.
In a news release, Dr. Larry Wolk, executive director and chief medical officer for the department, said they are working with partners to secure the funding needed to continue the program.
“Making sure Colorado women have access to safe and effective contraception is an investment in their futures and ours,” he said in a statement.
Klingler notes that a bill went through some state legislative bodies but never got final approval. She said insurance revenue is helping to keep the program floating in place of the grant funding that started it.
Should You Skip the Pill?
A recent report from the U.S. Centers for Disease Control and Prevention (CDC) stated that 90 percent of teens are using birth control.
Ileana Arias, principal deputy director at the CDC, said teens are still mostly relying on condoms and birth control pills. Those are two of the least effective methods. The CDC said that implants and IUDs are the most effective.
Long-term birth control usage among teens has surged from 0.4 percent in 2005 to 7.1 percent in 2013, the CDC report stated.
Another published last month in The Lancet found that more people used LARCs and pregnancies dropped when users were given training.
In that study, researchers placed 40 Planned Parenthood centers into two groups: They trained one group on LARC use and had the other group continue to counsel patients as they had previously been doing.
Researchers found that 71 percent of the providers who received the training discussed IUDs and implants with their patients, compared to 39 percent in a group that did not receive the training.
As a result, 28 percent of women in the intervention group chose IUDs or implants, compared with 17 percent in the group without training.
Unintended pregnancies went from 15 per 100 women to 8 per 100 women over a year among women who went to Planned Parenthood.
Researchers said that restrictions on using public funding for contraception in offices that provide abortions may have discouraged many women from using LARCs.
In addition, 38 percent of the women in the study had no medical insurance. Over time, though, using a LARC can be cheaper than regular birth control because a woman does not have to refill a prescription.
“There has been heavy reliance in the United States on the pill and condoms for young people. It’s easy for people to forget to use these methods, which can lead to accidental pregnancies,” said Dr. Cynthia Harper, a professor at the University of California, San Francisco, Bixby Center for Global Reproductive Health and study author.
“It’s important that women also learn about methods that give a higher level of protection against pregnancy when they seek contraceptive care. Women consider healthcare providers a highly-trusted source of information on birth control, so it’s especially important that providers tell women about all of the methods they can use,” she added, in a statement.
Dr. Jeff Peipert, who ran the Contraceptive Choice Project, also published a study on using LARCs. In his project, 9,256 women and adolescents in the St. Louis area were enrolled. The women were 14 to 45 years old, and willing to begin using a new contraceptive method.
They could choose shorter-acting methods such as the pill, patches, and rings. They also could choose to use a LARC. About 75 percent of the women chose an IUD or implant.
The women were counseled about the different methods, including their effectiveness, risks, and benefits. The low failure rate (less than 1 percent) of IUDs and implants over that of shorter-acting forms (8 to 10 percent) was emphasized.
As a result, Peipert found that abortion rates from 2008 to 2010 among study participants dropped from the annual rate nationally. Nationally, there were 19.6 abortions per 1,000 women in 2008. Among his group, there were anywhere from 4.4 to 7.5 per 1,000 women.
Why Devices Aren’t as Popular
Peipert noted that the LARC methods, which last longer than monthly birth control, require trained providers to complete the insertion procedure. Many general practitioners and primary care providers do not have this training.
“There are also knowledge barriers,” Peipert added. “Many providers and patients are worried about infection and infertility with the IUD. These are myths that need to be dispelled.”
Some people are opposed to giving away free or low-cost birth control. One of their arguments is they feel it encourages young women to have sex. Another is the cost to taxpayers.
For Klingler, the programs are worth the investment.
It’s estimated that for every public dollar that is invested in family planning services, more than $7 is saved in future Medicaid and public assistance costs, she said.
“Access to family planning services are key to protecting public health. They are not only important to health indicators, but it is cost effective,” she said.
Dr. Serena Chen, a reproductive endocrinologist at The Institute for Reproductive Medicine and Science in Livingston, New Jersey, said the Colorado program worked well.
“Seems like this is a great program that actually would reduce healthcare costs and the burden to taxpayers of unwanted pregnancy, which in the long run is much more costly than birth control,” Chen said.
“I believe we should use our tax dollars for important preventive healthcare such as vaccinations and contraception,” said Peipert. “If we choose not to pay for contraception, we will pay for the consequences.”