October 5, 2012
Free Birth Control Reduces Abortion Rates, But May Lead To More Sex
Lawrence LeBlond for redOrbit.com - Your Universe Online
A new study published online in Obstetrics & Gynecology shows that abortions and unplanned pregnancies have dramatically dropped after adult and teenage women were offered birth control at no cost. Women and girls were also more likely to choose IUDs or contraceptive implants when cost was not an issue.
Providing free birth control options substantially reduced the number of unplanned pregnancies and abortion rates by 62 to 78 percent over the national rate, according to the study from researchers at Washington University School of Medicine in St. Louis.
The study of St. Louis women and teen girls showed a dramatic drop over national unplanned pregnancy and abortion rates during the study period. Long-acting reversible contraceptive (LARC) offered free by the researchers led to four times fewer abortions than the regional rate, and five times fewer abortions than the national rate.
“The impact of providing no-cost birth control was far greater than we expected in terms of unintended pregnancies,” said Jeffrey Peipert, professor of Obstetrics and Gynecology at WU School of Medicine. “We think improving access to birth control, particularly IUDs and implants, coupled with education on the most effective methods has the potential to significantly decrease the number of unintended pregnancies and abortions in this country.”
Peipert and colleagues found that among the birth control methods offered in the study, most women chose long-acting methods like IUDs and implants, which have lower failure rates than commonly used birth control pills. In the US, IUDs and implants have steep up-front costs that most women cannot afford, as they are not covered under most health insurance plans.
Unintended pregnancies are a major problem in the US, accounting for roughly 50 percent of all pregnancies, far higher than in other developed countries. And nearly half of all unintended pregnancies come from incorrect use of contraception or no use at all.
“US taxpayers pay approximately $11 billion annually in costs associated with 1 million unintended births,” the researchers wrote.
Because of this burgeoning national epidemic, Peipert and colleagues designed the Contraceptive CHOICE Project “to promote the use of the most effective contraceptive methods (intrauterine devices [IUDs] and implants) and provide contraception at no cost to 10,000 female participants.” The free contraceptives were offered to women and teen girls in the St. Louis area who were at highest risk for unintended pregnancy.
Peipert and his team enrolled nearly 10,000 women and teens in the program between 2007 and 2011. Participants were between 14 and 45 years of age, at risk for an unintended pregnancy and willing to use contraceptives.
The researchers gave the participants their choice of birth control methods, which included the LARCs, pills, patches and rings. The participants were counseled about the effectiveness, risks and benefits of all forms, and after lectures were given, 75 percent of all participants chose the IUDs or implants.
During the study period, the team found lower abortion rates among CHOICE participants that were considerably less (4.4 to 7.5 per 1,000) than the rates for non-participants in St. Louis city and county, which ranged from 13.4 to 17 per 1,000 women, for the same years. The abortion rate of study participants was also far lower than the national rate of 19.6 per 1,000 women for the same years of the study.
For teen girls ages 15 to 19 who had access to the birth control provided in the study, annual birth rate was 6.3 per 1,000, more than five times lower than the national rate of 34.3 per 1,000.
“This study reinforces what I have seen in my own practice,” Yale School of Medicine ob-gyn Nancy Stanwood, MD, told WebMD´s Salynn Boyles. “When women have access to all methods of birth control and cost is not a barrier, they prefer the highly effective methods.”
Cost of IUDs and implants has been a significant deterrent for women and teens looking for birth control methods, but cost is not the only barrier for these women, noted Adam Sonfield, of the nonprofit reproductive health advocacy group Guttmacher Institute. Many health providers have opted to not offer these long-acting methods to teens in the past, because of potential side effects.
But times are changing, and a recent report by the US´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, said Sonfield.
He pointed 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. “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.”
The findings of Peipert´s study come as millions of US women are now beginning to get access to more contraceptive options without co-pays under President Barack Obama´s new Obamacare health care reform law.
Obamacare requires that Food and Drug Administration (FDA)-approved contraceptives be available for free to women enrolled in most workplace insurance plans. Most plans will take effect beginning on January 1, 2013.
The measure has sparked outrage from the U.S. Conference of Catholic Bishops and many other conservative groups, who state the law violates religious freedom by offering controversial birth control to employees of religious-affiliated organizations, such as colleges and hospitals. The law states that these organizations are not exempt from the law and must offer the plans. US Republican presidential nominee Mitt Romney has voiced similar criticism over the bill.
A St. Louis federal judge this week dismissed a possible lawsuit challenging the contraception mandate; just one of more than three dozen similar lawsuits that have been filed around the country.
Yet, the recent lawsuit dismissal is not deterring opponents of the measure.
Jeanne Monahan of the conservative Family Research Council suggested contraceptive use may actually encourage more teens to partake in risky sexual behavior.
“Additionally, one might conclude that the Obama administration's contraception mandate may ultimately cause more unplanned pregnancies since it mandates that all health plans cover contraceptives, including those that the study's authors claim are less effective,” Monahan said.
Nearly half of the country´s 6 million-plus pregnancies each year are unplanned, with an estimated 43 percent of those ending in abortion. Low income women are far more likely to have unplanned pregnancies than those who are wealthier.
Peipert said in the US there shouldn´t be a “tiered system where the women with money can get family planning and the women without cannot.” He noted that 39 percent of the women in his study had trouble just paying their basic expenses.
About half of the unintended pregnancies in the US occur in women who use no contraceptives; those who rely on condoms or other short-acting methods make up the other half.
But with LARCs, such as Implanon, an implant inserted under the skin of the arm, women can forget about unintended pregnancies for up to three years. And an IUD inserted into the uterus can last for five to ten years, depending on the brand. And theses devices can be removed at any time if the user has a change of heart.
But currently, in the US, only 5 percent of women use LARCs, far fewer than in most other developed countries. Insurance is the main thing holding women back here, said Peipert. Obamacare should change that.