What happens when women are given free birth control, and contraception education on top of that? Something of a "duh," but a stunning "duh": the number of unplanned pregnancies and abortions don't just go down, they plummet.
Researchers involved in the Contraceptive Choice Project to test the effects of free contrception say the impact of the project was even greater than they predicted.
Here's how it went: Free birth control was offered to more than 9,000 St. Louis teens and adults who were also educated about their options. The study subjects were aged 14 to 45 and were enrolled in the program between 2007 and 2011. All were considered at risk of unplanned pregnancies and were willing to try a new birth control method.
After hearing about their options, and the pros and cons of each, women picked from a list including birth control pills, intrauterine devices (IUDs), implants and other methods.
For the project, Secura's team promoted the use of long-acting reversible contraceptive methods, such as IUDs and implants, over short-term methods such as the pill. IUDs and implants are more than 20 times more effective at preventing pregnancy than the birth control pills, patch or vaginal ring, the Washington University researchers said. The birth control pill is the most commonly used reversible method in the U.S., but with typical use it fails 8 percent to 9 percent of the time each year. IUDs are effective for five to 10 years and implants for three years.
Drum roll: The free birth control program reduced unplanned pregnancies substantially and cut the abortion rate by 62 percent to 78 percent over the national rate, Gina Secura, an epidemiologist at the university and the project's director, told TakePart.
When Secura's team tracked the results, published online recently in the journal Obstetrics & Gynecology, they found that from 2008 to 2010, the abortion rate ranged from 4.4 to 7.5 for every 1,000 women. For 2008 (the last year calculated) the national abortion rate was 19.6 per 1,000 women.
The birth rate among the girls aged 15 to 19 in the study was 6.3 per 1,000. That's far below the U.S. rate of 34.3 for every 1,000 girls of that age range.
What worked? "It's not only the free component but also education and what we call access," Secura says. "Knowing all the options is really valuable. That's what we heard over and over again from our participants."
In the study, about 75 percent of the women chose IUDs or implants. In the population as a whole, a low percentage of women actually use these methods. Secura says many can't afford the costs, which can be more than $800 and not always covered by insurance plans.
Some women may not be aware of the option if their doctors don't discuss them, Secura says: "It's easier for a doctor to hand over a prescription [for birth control pills] than do an insertion [for an IUD]."
The study results could have huge implications, considering that about half of all U.S. pregnancies are accidental. That amount is far higher than in other developed countries. About half of the unplanned pregnancies are the result of no contraceptive use, and the other half occur when contraception is used incorrectly or irregularly.
Secura estimates that programs like the Contraceptive Choice could prevent 41 percent to 71 percent of abortions performed each year in the U.S.
Reducing unplanned pregnancies doesn't only benefit individuals--unplanned pregnancies cost U.S. taxpayers about $11 billion a year for costs linked with the one million unintended births, the researchers say.
Free contraceptive counseling and methods are part of the Affordable Care Act. As of August 1 this year, new insurance policies are required to include preventive health care packages that include no-cost birth control.
The new research supports the ACA's birth control provision, according to Planned Parenthood, which assisted with the project. In a statement, Dr. Vanessa Cullins, Planned Parenthood's vice president of external medical affairs said, "Increasing access to birth control will improve the health of women, families and communities across the country."
Do you think free contraception for women is an important part of the Affordable Care Act? Let us know in the comments.
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Kathleen Doheny is a Los Angeles journalist who writes about health. She doesn't believe inmiracle cures, but continues to hope someone will discover a way for joggers to maintain their pace.