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Abortion Rates Plummet With Free Birth Control—New Study

Wednesday, October 17, 2012


When birth control is free or very inexpensive, rates of abortion plummet, according to new research. Methods such as IUDs and implants are the most effective.

Providing birth control to women at no cost substantially reduced unplanned pregnancies and cut abortion rates by 62 percent to 78 percent over the national rate, a new study shows. The research, by investigators at Washington University School of Medicine in St. Louis, is published online in Obstetrics & Gynecology.

Women's choices

Among a range of birth control methods offered in the study, most women chose long-acting methods like intrauterine devices (IUDs) 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 aren't 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,” says lead author Jeff Peipert, MD, PhD, the Robert J. Terry Professor of Obstetrics and Gynecology. “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.”

Planned Parenthood's Paula Hodges

The Washington University study "reaffirms what Planned Parenthood of Southern New England (PPSNE) has been advocating for years," said Paula Hodges, Rhode Island Director of Public Policy & Advocacy at PPSNE. "Providing women equal access to long lasting reversible contraceptive (LARC) options prevents unintended pregnancies and therefore reduces abortion rates." Hodges said that Rhode Island elected officials "should do everything in their power to ensure our state adopts a family planning expansion as part of the Affordable Care Act that will allow low income Rhode Islanders to have access to the same forms of contraception available in the study."

Unintended pregnancies

Unintended pregnancies are a major problem in the United States. Each year, about 50 percent of all U.S. pregnancies are unplanned, far higher than in other developed countries. About half of these pregnancies result from women not using contraception and half from incorrect or irregular use. The Guttmacher Institute estimates that as of 2008, there are 62,700 women in Rhode Island in need of publicly supported contraceptive services and supplies.

The study

The Contraceptive Choice Project enrolled 9,256 women and adolescents in the St. Louis area between 2007 and 2011. Participants were 14-45 years of age, 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 like 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 percent) of IUDs and implants over that of shorter-acting forms (8 percent to 10 percent) was emphasized. In all, about 75 percent 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. This is a substantial drop (62 percent to 78 percent) over the national rate of 19.6 abortions per 1,000 women in 2008, the latest year for which figures are available.

The lower abortion rates among CHOICE participants also is considerably less than the rates in St. Louis city and county, which ranged from 13.4 to 17 per 1,000 women, for the same years.

Among girls ages 15-19 who had access to 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.

Methods matter

While birth control pills are the most commonly used contraceptive in the United Sates, their effectiveness hinges on women remembering to take a pill every day and having easy access to refills.

In contrast, IUDs and implants are inserted by health-care providers and are effective for 5 to 10 years and 3 years, respectively. Despite their superior effectiveness over short-term methods, only a small percentage of U.S. women using contraception choose these methods. Many can’t afford the cost of IUDs and implants, which can cost more than $800 and may not be covered by insurance.

Level the playing field

Planned Parenthood's Hodges said that the research demonstrates that "if we can level the playing field and remove cost as a factor for low income women, they will choose methods that are more effective and that last over the course of months and even years."  However, she added, "when women living paycheck to paycheck do not have the ability to pay hundreds of dollars up front for an IUD and have to pay $20 per month for the pill, they will choose the latter. This goes to the very heart of reproductive justice within healthcare delivery."

At Planned Parenthood's clinic in Providence a wide array of contraception is available, including intrauterine devices (IUDs), Implanon or implants, Depo-Pravera shots, Nuva Ring, Ortho Evra Patch and the Pill.  

“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 says. “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.”

"We need to bring lawmakers, advocates and providers together to recognize that family planning programs and educating women about birth control is integral," said Hodges. "For every $1 we invest in family planning programs, the state will save $3.74 by keeping women healthy and allowing them to become pregnant when the time is right.  Instead of politicizing women’s health and restricting access to abortion, we should all be working toward programs and education to help women prevent unintended pregnancies in the first place."


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