The Nexplanon hormonal implant is for long-lasting birth control. Free birth control has been linked to a decrease in teen pregnancies.(Photo: Merck via AP)
An experimental project that gave free birth control to more than
9,000 teen girls and women in one metropolitan area resulted in a
dramatic decrease in abortions and teen pregnancies, a new study shows.
wasn't just the "free" part that led to rates far below national
averages, researchers say. They also credit the long-acting highly
effective methods of contraception chosen by 75% of the participants -
namely intrauterine devices (IUDs) and hormonal implants.
findings come as cost-free birth control is becoming available to more
women under a much-debated provision of the federal health care law. The
provision was supported by many women's health advocates but strongly
opposed by the Catholic Church and many social conservatives. Dozens of
lawsuits have been filed around the country. The study also comes weeks
after the American College of Obstetricians and Gynecologists declared
IUDs and implants front-line contraceptive choices for sexually active
The study, published online in Obstetrics & Gynecology,
was carried out in the St. Louis area from 2007 to 2011 and included
participants ages 14 to 45 who said they wanted to avoid pregnancy for
at least a year.
All were told about various methods of birth
control and allowed to choose among them - but they did get counseling
that stressed that IUDs and implants are much more effective than birth
control pills and other methods, says lead researcher Jeffrey Peipert,
professor of obstetrics and gynecology at Washington University School
Data suggest IUDs and implants fail up to 20 times
less often than pills, which failed at a rate of about 4.5% in this
study. Yet just 8.5% of U.S. women used IUDs and implants in 2009, says
Megan Kavanaugh, senior research associate at the Guttmacher Institute
in New York.
So the St. Louis researchers were stunned when
58% of the participants chose IUDs and 17% chose implants, Peipert
says: "We found that when cost is not an issue, what is really important
to women is that a method work really well."
Among the results:
-- A teen birth rate of 6.3 per 1,000 in the study, compared with 34.3 per 1,000 nationwide.
Annual abortion rates ranging from 4.4 to 7.5 per 1,000 women in the
study vs. 13.4 to 17 per 1,000 in the region and to 19.6 per 1,000
nationwide in 2008, the most recent national data available.
Falling rates of repeat abortions in the entire St. Louis region but not
nearby Kansas City. The researchers say this is linked to their study,
which recruited some women from abortion clinics.
really show promise for what could happen on a national level," with a
combination of free birth control and promotion of the most effective
methods, Kavanaugh says.
Jeanne Monahan of the conservative Family
Research Council suggested contraceptive use can encourage riskier
sexual behavior. "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.
devices and insertion can cost several hundred dollars. An IUD, which
contains copper or a progestin hormone, is inserted in the uterus and
lasts five to 10 years. Hormone implants, the size of a matchstick, are
placed in the arm and last three years.
Cost is not the only
barrier to more widespread use, says Tina Raine-Bennett, research
director at the Women's Health Research Institute at Kaiser Permanente
Northern California. Many doctors don't suggest the long-acting
methods, she says, because they are not trained to insert them or
remember outdated information about a faulty IUD discontinued decades
Raine-Bennett led the committee of obstetricians and
gynecologists that recently recommended IUDs and implants for teens.
"They are as effective as sterilization, but they are reversible," she
Under provisions of the Affordable Care Act that went
into effect in August, insurers must cover birth control as well as many
other preventive health services for women. Colleges, non-profits and
other employers affiliated with religious organizations that object to
the rule have been given an extra year to comply. A number of legal
challenges by states and employers are underway; one was dismissed this