Study: Free birth control leads to fewer abortions

LAURAN NEERGAARD

AP Med­ical Writer

WASHINGTON — Free birth con­trol led to dra­mat­i­cally lower rates of abor­tions and teen births, a large study con­cluded Thurs­day, offer­ing strong evi­dence for how a bit­terly con­tested Obama admin­is­tra­tion pol­icy could ben­e­fit women’s health.

The project tracked more than 9,000 women in St. Louis, many of them poor or unin­sured. They were given their choice of a range of con­tra­cep­tive meth­ods at no cost — from birth con­trol pills to goof-proof options like the IUD or a matchstick-sized implant.

When price wasn’t an issue, women flocked to the most effec­tive con­tra­cep­tives — the implanted options, which typ­i­cally cost hun­dreds of dol­lars up-front to insert. These women expe­ri­enced far fewer unin­tended preg­nan­cies as a result, reported Dr. Jef­frey Peipert of Wash­ing­ton Uni­ver­sity in St. Louis in a study pub­lished Thursday.

The effect on teen preg­nancy was strik­ing: There were 6.3 births per 1,000 teenagers in the study. Com­pare that to a national rate of 34 births per 1,000 teens in 2010.

There also were sub­stan­tially lower rates of abor­tion, when com­pared with women in the metro area and nation­ally: 4.4 to 7.5 abor­tions per 1,000 women in the study, com­pared with 13.4 to 17 abor­tions per 1,000 women over­all in the St. Louis region, Peipert cal­cu­lated. That’s lower than the national rate, too, which is almost 20 abor­tions per 1,000 women.

In fact, if the pro­gram were expanded, one abor­tion could be pre­vented for every 79 to 137 women given a free con­tra­cep­tive choice, Peipert’s team reported in the jour­nal Obstet­rics & Gynecology.

The find­ings of the study, which ran from 2008 to 2010, come as mil­lions of U.S. women are begin­ning to get access to con­tra­cep­tion with­out copays under Pres­i­dent Barack Obama’s health care law. Women’s health spe­cial­ists said the research fore­shad­ows that policy’s poten­tial impact.

“As a soci­ety, we want to reduce unin­tended preg­nan­cies and abor­tion rates. This study has demon­strated that hav­ing access to no-cost con­tra­cep­tion helps us get to that goal,” said Alina Sal­gan­i­coff, direc­tor of women’s health pol­icy at the Kaiser Fam­ily Foundation.

“It’s just an amaz­ing improve­ment,” Dr. James T. Bree­den, pres­i­dent of the Amer­i­can Col­lege of Obste­tri­cians and Gyne­col­o­gists, said of the results. “I would think if you were against abor­tions, you would be 100 per­cent for con­tra­cep­tion access.”

The law requires that Food and Drug Administration-approved con­tra­cep­tives be avail­able for free for women enrolled in most work­place insur­ance plans, a change that many will see as new plan years begin on Jan. 1.

The pol­icy is among the law’s most con­tentious pro­vi­sions because it exempts churches that oppose con­tra­cep­tion but requires religious-affiliated orga­ni­za­tions, such as col­leges or hos­pi­tals, to pro­vide the cov­er­age for their work­ers. The U.S. Con­fer­ence of Catholic Bish­ops and many con­ser­v­a­tive groups say that vio­lates reli­gious free­dom, and Repub­li­can pres­i­den­tial nom­i­nee Mitt Rom­ney has voiced sim­i­lar criticism.

This week, a fed­eral judge in St. Louis dis­missed a law­suit chal­leng­ing the con­tra­cep­tion man­date; nearly three dozen sim­i­lar suits have been filed around the country.

Thursday’s data didn’t sway the critics.

Jeanne Mon­a­han of the con­ser­v­a­tive Fam­ily Research Coun­cil sug­gested con­tra­cep­tive use can encour­age riskier sex­ual behavior.

“Addi­tion­ally, 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.

Here’s why this is a pub­lic health issue: Nearly half of the nation’s 6 million-plus preg­nan­cies each year are unin­tended. An esti­mated 43 per­cent of them end in abor­tion. Low-income women are far more likely to have an unplanned preg­nancy than their wealth­ier counterparts.

“We shouldn’t have, in my view, a tiered sys­tem where the women with money can get fam­ily plan­ning and the women with­out can­not,” said Peipert, not­ing that 39 per­cent of the women in his study had trou­ble pay­ing basic expenses.

About half of unplanned preg­nan­cies occur in women who use no con­tra­cep­tion. As for the other half, con­doms can fail and so can birth con­trol pills or other shorter-acting meth­ods if the woman for­gets to use them or can’t afford a refill.

In con­trast, you can for­get about preg­nancy for three years with Implanon, the implant inserted under the skin of the arm. An IUD, a tiny T-shaped device inserted into the uterus, can last for five to 10 years, depend­ing on the brand. Change your mind, and the doc­tor removes either device before it wears out.

Only about 5 per­cent of U.S. women use long-acting con­tra­cep­tives, far fewer than in other devel­oped coun­tries. Peipert said insur­ance hasn’t always cov­ered the higher upfront cost to insert them, even though years of birth con­trol pills can add up to the same price.

Yet three-quarters of his study par­tic­i­pants chose an IUD or Implanon, and a year later 85 per­cent were stick­ing that choice — com­pared to about half who had ini­tially cho­sen the pill, patch or other shorter-acting method.

Cost isn’t the only bar­rier. Doc­tors don’t always men­tion long-acting meth­ods, maybe because of a long-outdated belief that IUDs aren’t for young women or just because they assume women want the most com­monly pre­scribed pill.

That was the case for Ash­ley Eng­land, 26, of Nashville, Tenn., who enrolled in the study while in grad­u­ate school in St. Louis. She had taken birth con­trol pills for years but strug­gled with a $50 monthly copay. She switched to a five-year IUD, and loves that she and her hus­band don’t have to think about contraception.

“No one had ever pre­sented all the options equally,” Eng­land said. “It’s not telling you what to do. It’s giv­ing you a choice unhin­dered by money.”

Posted by AP News on Oct 4 2012. You can follow any responses to this entry through the RSS Feed. Comments can be made below.