Providing birth control to women at no cost substantially reduced unplanned pregnancies and cut abortion rates by 62% to 78% over the national rate, researchers reported.
Among a range of birth control methods offered in the study, most women chose long-acting methods such as intrauterine devices or implants, which have lower failure rates than commonly used birth control pills. In the United States, IUDs and implants have high up-front costs that sometimes are not covered by health insurance, making these methods unaffordable for many women.
“The impact of providing no-cost birth control was far greater than we expected in terms of unintended pregnancies,” Jeff Peipert, MD, PhD, the studys lead author and a professor of obstetrics and gynecology at the Washington University School of Medicine in St. Louis, said in a news release. “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.”
The Contraceptive Choice Project enrolled 9,256 women and adolescents in the St. Louis area between 2007 and 2011. Participants were ages 14 to 45, at risk for unintended pregnancy and willing to start a new contraceptive method.
Participants had their choice of birth control methods, ranging from long-acting forms such as IUDs and implants to shorter-acting methods such as birth control pills, patches and rings.
The women were counseled about the different methods, including their effectiveness, risks and benefits. The extremely low failure rate (less than 1%) of IUDs and implants compared with shorter-acting forms (8% to 10%) was emphasized. In all, about 75% of women in the study chose IUDs or implants.
From 2008 to 2010, annual abortion rates among study participants ranged from 4.4 to 7.5 per 1,000 women. Those rates represented a substantial drop (62% to 78%) over the national rate of 19.6 abortions per 1,000 women in 2008, the latest year for which figures are available.
Among girls ages 15 to 19 who had access to the free birth control provided in the study, the annual birth rate was 6.3 per 1,000, far below the U.S. rate of 34.3 per 1,000 for girls the same age.
Although birth control pills are the most commonly used contraceptive in the United States, their effectiveness hinges on remembering to take a pill every day and having easy access to refills.
In contrast, IUDs and implants are inserted by healthcare providers and are effective for five to 10 years and three years, respectively. Despite their superior effectiveness over short-term methods, only a small percentage of U.S. women using contraception choose these methods. Many cannot afford the cost of IUDs and implants, which can cost more than $800 and may not be covered by insurance.
“Unintended pregnancy remains a major health problem in the United States, with higher proportions among teenagers and women with less education and lower economic status,” Peipert said. “The results of this study demonstrate that we can reduce the rate of unintended pregnancy and this is key to reducing abortions in this country.”
The study appeared Oct. 3 on the website of the journal Obstetrics & Gynecology. A PDF of the study is available at http://bit.ly/SGbbq3.