Abortion rates fall with free contraception
Abortion rates fall with free contraception
Just-published data from the Contraceptive CHOICE Project, conducted by researchers at Washington University School of Medicine at St. Louis, confirms that provision of contraception at no cost substantially reduced unplanned pregnancies and cut abortion rates by 62-78% over the national rate.1
The CHOICE Project enrolled 9,256 adolescents and women at risk for unintended pregnancy to perform a prospective cohort study of adolescents and women desiring reversible contraceptive methods. Females were recruited from the two abortion facilities in the St. Louis region and through provider referral, advertisements, and word of mouth. Contraceptive counseling included all reversible methods but emphasized the superior effectiveness of intrauterine devices (IUDs) and implants, known collectively as long-acting contraceptive (LARC) methods. All participants received the reversible contraceptive method of their choice at no cost. Three-quarter of the women chose LARC methods: 46% levonorgestrel IUD, 12% copper IUD, and 17% subdermal implant.
From 2008 to 2010, annual abortion rates among study participants ranged from 4.4 to 7.5 per 1,000 women, representing a 62-78% drop over the national rate of 19.6 abortions per 1,000 women in 2008, the latest year for which figures are available, researchers note.1 The lower abortion rates among study 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.1
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.
"Unintended pregnancy remains a major health problem in the United States, with higher proportions among teen-agers and women with less education and lower economic status," says Jeffrey Peipert, MD, MPH, MHA, Robert J. Perry professor of obstetrics and gynecology and vice chair for clinical research at Washington University School of Medicine. "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."
Births to teen-agers and abortions are clearly a concern to society, observes Robert Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta. The "get it and forget it" contraceptives, also known as the LARC methods, have been shown by the research group at Washington University in St. Louis to be popular among women and effective at preventing both abortions and births to teen-agers, he states. "If a community wants to approach the issues of abortion prevention and prevention of teen births, the provision of IUDs and implants at no cost must become high priority," says Hatcher. "The same holds for societies around the world."
What drives use?
Few studies in the United States have asked women directly why they use contraception and what benefits they expect or have achieved from its use. Researchers at the Guttmacher Institute in New York City surveyed 2,094 women receiving services at 22 family planning clinics nationwide to fill in this information gap.2
Most women participating in the survey said that contraception has had a significant impact on their lives. They said it allowed them to take better care of themselves or their families (63%), support themselves financially (56%), complete their education (51%), or keep or obtain a job (50%).
When asked why they were currently seeking birth control, women expressed concerns about the consequences of an unintended pregnancy on their families' and their own lives. Sixty-five percent of women said they were using contraception because they could not afford to take care of a baby; nearly one in four women said they or their partners were unemployed. Among women with children, nearly all reported that their desire to care for their current children was a reason for contraceptive use.
Women need continued access to a wide range of contraceptives so they can plan their families and determine when they are ready to have children, observes Laura Lindberg, PhD, senior research associate at the Guttmacher Institute and coauthor of the research paper. Many of the most highly effective methods have high up-front costs, which can be a barrier to women seeking to prevent an unintended pregnancy, she notes.
"The findings of our study point to the critical role of contraception in the lives of women and their families, and reinforce the need to ensure that women have access to the contraceptive methods that best meet their needs, at low cost, and without having to jump through bureaucratic hoops," states Lindberg.
References
- Peipert JF, Madden T, Allsworth JE, et al. Preventing unintended pregnancies by providing no-cost contraception. Obstet Gynecol 2012. Doi: 10.1097/AOG.0b013e318273eb56.
- Frost JJ, Lindberg LD. Reasons for using contraception: perspectives of US women seeking care at specialized family planning clinics. Contraception 2012. Doi:10.1016/j.contraception.2012.08.012.
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