Long-acting reversible contraceptive (LARC) methods (intrauterine devices [IUDs] and contraceptive implants) have demonstrated high effectiveness, safety, and high satisfaction and continuation rates. However, these proven methods are underutilized in the United States. Infrequent use of LARC methods in this country appears to be associated with high rates of unintended pregnancy. In other countries where IUDs are used frequently, unintended pregnancy rates are substantially lower than that in the United States. In a recent report, American women undergoing abortion expressed high interest in LARC methods for postabortion contraception; the majority of these women, however, identified cost as a barrier to using an LARC method. Few studies have investigated whether increasing use of LARC methods would decrease unintended pregnancy rates in the United States.
The aim of this prospective cohort study was to promote the use of LARC methods and provide contraception at no cost to participants who lived in metropolitan St Louis in an effort to reduce unintended pregnancies in this region. Participants were 9256 adolescents and women at risk for unintended pregnancy enrolled into the Contraceptive CHOICE Project. All these women desired reversible contraceptive methods. Between 2007 and 2011, eligible participants were recruited from the 2 main abortion facilities in the St Louis region and by provider referral, newspaper advertisements, flyers, and word of mouth. In-depth contraceptive counseling provided at enrollment to all participants emphasized the effectiveness and safety of LARC methods. All participants were given the reversible contraceptive method of their choice at no cost. The primary study outcomes evaluated were abortion rates, the percentage of abortions that were repeat abortions, and teenage birth rates.
The percentage of abortions that were repeat abortions in the St Louis region were substantially reduced compared with Kansas City and nonmetropolitan Missouri (P< 0.001). Abortion rates were more than 3 times less in the St Louis region than regional and national rates (P< 0.001). The rate of teenage birth within the St Louis CHOICE cohort was markedly lower than the national rate (6.3 vs 34.3 per 1000).
The substantially lower rates of abortions and repeat abortions and the marked reduction in teenage births rates appear to be associated with increased access to contraception, especially highly effective LARC methods. The data suggest that the rate of unintended pregnancy can be lowered by providing effective contraception at no cost.
From the Department of Obstetrics & Gynecology, Washington University in St Louis School of Medicine, St Louis, MO