No-Cost Contraception May Reduce Abortion Rates and Teenage Pregnancies

Although the teenage birth rate has decreased in the United States in recent years, the percentage of teen girls giving birth is still higher here than anywhere else in the developed world. Likewise, while the U.S. abortion rate has also fallen, the number of abortions performed in this country each year is higher than it is in Canada, Europe, and a number of other countries. In order to address these issues, some doctors and sexual health experts have proposed making free or low-cost contraceptives more widely available. And, in fact, as of August 1, 2012, the Affordable Care Act now makes contraceptives available without a copay for women who begin new insurance plans or renew their old plans. But will greater access to contraceptives actually reduce abortion and teen pregnancy rates? According to a new study published in the journal Obstetrics & Gynecology, the answer is a resounding yes.

In this study, 9,256 women and adolescent girls who were at high risk for unwanted pregnancy enrolled in a longitudinal contraceptive study that took place between 2008 and 2010. All participants were recruited through abortion clinics and targeted advertisements in St. Louis, Missouri. The average age was 25, and about one-third of the sample consisted of women with low levels of educational and economic attainment. All of the women were provided with contraceptive counseling in order to help them determine which method would work best for them. Afterward, each participant received their choice of contraceptive for free. The vast majority of women opted for an intrauterine device (IUD) or subdermal implant, both of which were emphasized in counseling for their superior effectiveness and long-acting abilities (you can read more about effectiveness rates for these and other forms of contraception here).

Results indicated that there was a dramatic difference in abortion and teen pregnancy rates for women involved in the study compared to both the overall rates in the local area as well as the national rates. For instance, the teenage birth rate for participants in this study was 6.3 per 1,000 girls, dramatically lower than the national rate of 34.3 per 1,000 girls. Likewise, the abortion rate for study participants fluctuated between 4.4 and 7.5 per 1,000 across the three years of the study, which stands in stark contrast to the overall national rate of 19.6 per 1,000.

These findings indicate that the key to reducing high levels of teen pregnancy and abortions in the United States may reside in increasing access to no-cost contraceptives, particularly long-acting reversible methods such as IUDs and subdermal implants. In fact, the study’s authors estimate that if the same changes in contraceptive behavior occurred nationally, the abortion rate could fall up to 78%. Whether such a dramatic effect will ever occur remains to be seen and it is certainly unlikely any time in the near future, given how rarely IUDs and implants are currently utilized in the U.S. market (birth control pills, which are significantly less effective when looking at typical use rates, are used far more frequently). At the very least, these findings suggest that the recent changes to U.S. contraceptive policies are likely to spur at least some positive change in teen pregnancy and abortion rates.

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To learn more about this research, see: Peipert, J. F., Madden, T., Allsworth, J. E., & Secura, G. M. (in press). Preventing unintended pregnancies by providing no-cost contraception. Obstetrics & Gynecology. doi: 10.1097/AOG.0b013e318273eb56

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