Every Saturday, The CSPH highlights news or recent research in the field of human sexuality. This week, we’re discussing a news-worthy study showing that no-cost contraception could lead to a decrease in unintended pregnancy and abortion.
The United States has some of the highest rates of unintended pregnancy in the Western world, with nearly 49% of pregnancies in 2008 reported as unintended. Of these pregnancies, approximately half resulted from non-use of contraception, while the other half came from incorrect use or failure of contraceptive. Study author Dr. Jeffrey Peipert and his co-researchers at Washington University in St. Louis believed that increasing access to contraception would help ameliorate some of these issues with contraception. Furthermore, they believed that IUDs and implants, referred to as long-acting reversible contraceptive methods (LARCs), were especially safe and effective options, yet highly underused in the US.
Researchers designed a two-year long prospective cohort study, named Contraceptive CHOICE Project, with two primary goals: to promote the use of LARCs and to provide free contraception to the nearly 10,000 participants. Participants were recruited from local clinics and abortion facilities in the St. Louis area through advertisements and word of mouth. After being given information on different methods, participants were asked to choose their form of contraception, ranging from condoms to LARCs to pills. Study participants consisted of females ages 14-45, who were all “at risk” for pregnancy and desired a new, reversible contraceptive method. Many of the women were uninsured (40%) and had an education level of “high school or less.” Along with reaching women of lower socioeconomic statuses, the study also involved many racial minorities, with 50% of participants identifying as black, compared to 29% of the local population.
From the results of the study, the researchers were able to draw many interesting conclusions, especially timely considering the current political season. When presented with an educated contraceptive choice, 46% of participants chose a hormonal IUD and 75% chose either an IUD or implant, a much higher percentage than the researchers originally predicted. Additionally, the women recruited at abortion clinics were more likely to choose a LARC method of contraception. Using teenage pregnancy/birth as a measure for unintended pregnancy, the study found that the birth rate among teenage participants was notably lower than that of the country at large (6/1000 compared to 34/1000). Additionally, the rates of abortion were much lower in study participants.
Although these conclusions may seem like a no-brainer to some, they are very important in light of the current political and social conversations around sexual health in general and contraception in particular. This past summer, the mandate under the Affordable Care Act (aka Obamacare) allowing insured women to obtain contraceptives without paying co-pays went into effect for most health insurance plans. By providing free contraception and giving participants the ability to choose and change their contraceptive methods at any time, researchers were hoping to use their study to simulate potential effects of the ACA.
Furthermore, the study serves as an example of the work that still needs to be done to make family planning an accessible option for all. This is especially crucial given that individuals of lower socioeconomic status are disproportionately at risk for unwanted pregnancy. Much of this has to do with cost. Even with new legislation, contraception can be expensive—especially for those who are uninsured—and longer-term treatments like IUDs can cost around $500 up front. Education and awareness are also important factors, as misinformation can lead to people not only misusing contraception, but also choosing options are not the most effective for their bodies, lifestyles, or desires.
In the study, we can see the effects of mitigating these barriers. When presented with information and with cost no longer an issue, participants, especially those of lower socioeconomic class, chose more reliable methods (like IUDs) over more popular ones. This subsequently helped them decrease undesirable reproductive outcomes. With these results, the study speaks to the benefits of accessibility and serves as a major challenge to conservative claims that free contraceptives will lead to riskier behavior.