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Reviewed by Louise Chang, MD
Oct. 4, 2012 -- Abortions and unplanned pregnancies dropped dramatically in a new study when women and teenaged girls were provided birth control at no cost.
The women and girls were also more likely to choose IUDs or contraceptive implants when cost was not an issue.
Family planning advocates say the study shows the potential of the health reform law (now known by both supporters and opponents as Obamacare) to reduce unplanned pregnancies nationwide.
‘Cost Has Been Barrier to IUD, Implant Use'
The law requires health insurers to provide all FDA-approved forms of contraception without charging a co-pay.
They say cost has been a big barrier to the use of IUDs and implants, which have a much lower rate of failure than other reversible birth control methods.
“This study reinforces what I have seen in my own practice,” says Yale School of Medicine ob-gyn Nancy Stanwood, MD, who is chair-elect of the group Physicians for Reproductive Choice and Health.
“When women have access to all methods of birth control and cost is not a barrier, they prefer the highly effective methods."
Half of Pregnancies in U.S. Unplanned
About half of all pregnancies in the U.S. are unplanned, and about half of these pregnancies happen when birth control is not used.
The rest happen when contraception is used only some of the time or is used incorrectly.
The new study, published online today in the journal Obstetrics & Gynecology, included close to 9,300 sexually active women and teen girls at risk for having an unplanned pregnancy.
While the women were offered any FDA-approved method of contraception at no cost, the researchers made sure they knew that IUDs and implants were the most effective.
Researcher Jeff Peipert, MD, of Washington University in St. Louis, says around 3 out of 4 study participants opted for the long-acting methods.
“That was a shocker,” he says. “We had hoped to get maybe 15% of the women to choose IUDs or implants, but it was closer to 75%. That made all the difference.”
Abortion rates among the women and teens ranged from 4.4 to 7.5 per 1,000 during the time they were enrolled in the study -- far lower than the national rate of close to 20 abortions for every 1,000 women.
And the birth rate among the teen girls in the study was almost six times lower than the national average.
The researchers estimated that providing no-cost contraception and promoting long-acting birth control methods nationwide could reduce abortions by 41% to 71% annually.
That's because the failure rate for IUDs and implants is less than 1% per year, compared to closer to 8% with typical pill use.
IUDs, Implants, and Teens
While cost has been a significant barrier to the use of IUDs and implants, it is not the only one, says Adam Sonfield, of the nonprofit reproductive health advocacy group Guttmacher Institute.
He says many health providers have not offered long-acting reversible birth control methods to teenagers in the past, but this is changing.
Just this month, the nation's largest group of obstetricians and gynecologists published an opinion on the subject, concluding that IUDs and implants are both safe and appropriate methods of contraception for teens.
Sonfield points out that the average age for starting sexual activity is about 17, and many women now want to delay having children until their late 20s or early 30s.
“The gap is close to 10 years, so it makes sense that women would want a long-acting birth control method that they don't have to think about every day,” he says.
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SOURCES: Peipert, J.F. Obstetrics & Gynecology, published online Oct. 4, 2012. Jeffry F. Piepert, MD, PhD, department of obstetrics and gynecology, Washington University in St. Louis. Adam Sonfield, senior public policy associate, Guttmacher Institute. Nancy Stanwood, MD, MPH, Yale School of Medicine, New Haven, Conn.; chair-elect, Physicians for Reproductive Choice and Health. News release, Washington University in St. Louis. American College of Obstetricians and Gynecologists: "Committee Opinion on Long-acting Reversible Contraception."
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