Giving teenagers access to free, long-term contraception can dramatically reduce rates of unintended pregnancy and abortion. That's according to new research out of Washington University in St. Louis.
The study is part of a larger effort called the Contraceptive CHOICE Project, whose goal is to promote long-acting forms of birth control like intrauterine devices (IUDs) and contraceptive implants in order to reduce unplanned pregnancies in the St. Louis region.
This component of the project focused on 1,404 St. Louis-area women between the ages of 14 and 19.
The researchers provided the teenagers with contraceptive counseling, including information about the effectiveness, risks, and potential side effects of each birth control method. The young women could choose any method they wanted, at no cost.
Once the women enrolled in the study, they were interviewed by phone at three and six months, and then again every six months after that, for two to three years.
The researchers then compared the St. Louis teens’ average annual rates of pregnancies, births, and abortions to the rates for other sexually-active teenagers, nationwide. Here’s what they found:
The Washington University study is published in the New England Journal of Medicine.
Senior author Dr. Jeffrey Peipert attributes the much lower rates of unintended pregnancy, birth and abortion among study participants to their having access to free birth control ― in particular, long-acting, reversible contraception, or LARC methods, like IUDs and implants.
“Pills and condoms are the most commonly used methods in the U.S.,” Peipert said. “But these LARC methods are over 20-fold more effective.”
Peipert said even so, less than five percent of U.S. teens choose them.
In contrast, more than 70 percent of the teenagers enrolled in the Contraceptive CHOICE Project selected IUDs or implants. “That, in and of itself, may account for the real reductions we saw in unintended pregnancies,” Peipert said.
In spite of their effectiveness, LARC methods haven’t caught on in the U.S. with teens or adults.
Peipert said that’s in part because there are a lot of lingering myths about intrauterine devices. “The Dalkon Shield, which was marketed in the 1970s, gave IUDs a very bad name,” Peipert said. As a result, some women ― as well as health care providers ― still believe they can cause infections and infertility, even though studies have shown that is no longer the case.
Peipert said another major barrier to IUD use is the up-front cost, which can be prohibitive for women without contraceptive health insurance coverage.
“An IUD might cost $700, not including the insertion fee,” Peipert said. That could bring the total cost of an IUD to over $1,000. “But as methods of contraception, they’re among the most cost-effective, because they’re good for so long.”
Hormonal IUDs can last for five years; copper IUDs for ten.
Contraceptive implants are still relatively new to the U.S. market, so many women may not be aware that they are even an option. They’re about the size of a match stick and are inserted just under the skin of a woman’s upper arm. They work for three years, but Peipert said they can cause irregular bleeding, which may not make them a good choice for some women.
Overall the health risks associated with LARC methods are very low. “In general, what people fail to recognize is that almost every contraceptive method is safer than pregnancy,” Peipert said.
Getting pregnant as a teenager can be especially problematic. “These are often high-risk pregnancies,” Peipert said. “Pregnancies that could end in pre-term birth, or have complications.”
In addition, Peipert said many women who become pregnant as teenagers do not finish school, limiting their job opportunities and creating what he termed a “cycle of poverty.”
Although nationally the teen birth rate has declined by more than 50 percent over the past two decades, it is still higher than that of many other developed countries, including Canada and the United Kingdom.
In the U.S., close to 80 percent of teen pregnancies are unplanned, and almost a third end in abortion.
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