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Special Edition - EPRExpand Special Edition - EPR

 Making the Case for LARC as a Tool to Prevent Teen Pregnancy

By Emily Eckert
Program Associate, Health Reform Implementation, AMCHP

There are 43 million women (aged 15-44) at risk of having an unintended pregnancy in the United States. Upwards of 99 percent of these women have used contraception in their lifetime, but many of these women use contraception imperfectly or inconsistently, common behaviors that can lead to an unplanned pregnancy. Though there has been an overall decline in unintended pregnancies since 1990, the United States continually ranks highest in teen birth rates among other developed nations.

The simple reality is that many women struggle with timing and spacing pregnancies, especially teens. Though the vast majority of teens report using some form of birth control the last time they had sex, less than 5 percent are using the most effective methods. Numerous recent reports have found that long acting reversible contraceptives (LARC), which are typically intrauterine devices or implants, are the most effective method for preventing unplanned pregnancy. These methods merit strong consideration in policy discussions on reducing the national teen pregnancy rate.

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Unplanned pregnancies contribute substantial costs to the health care system, with teen pregnancy alone costing $9 billion in taxpayer money. Investing early in preventive methods to help teens avoid unplanned pregnancies can help save billions of dollars down the road while creating healthier generations of Americans. Numerous health care organizations are advocating for LARC use among teens to help curb the cycle of poverty that teenage pregnancy supports.

The American Academy of Pediatrics (AAP) has recommended that LARC methods be considered "first-line contraceptive choices for adolescents." The AAP report concludes that the "effectiveness and safety of LARCs, coupled with anticipated cost savings to patients, their families, and society, should stimulate pediatricians to take on this challenge to prevent unintended pregnancies," and encourage politicians to enact effective policies. Similarly, the American College of Obstetricians and Gynecologists (ACOG) describes LARC as a "first-line" options for adolescents based on their "top-tier effectiveness, high rates of satisfaction and continuation, and no need for daily adherence."

In addition to these national recommendations, some states are already reaping the health and financial benefits of investing in teen LARC programs. Arguably the most successful example comes from Colorado, where the state Family Planning Initiative succeeded in using private funds to provide LARC methods free of charge to young, low-income women. This program, present in 28 Title X-funded health centers across the state, increased LARC use among 15-24 year olds by 14.9 percent. This increase in LARC use led to a 39 percent reduction in the Colorado teen birth rate, and a 42 percent reduction in abortions for women ages 15-19. Similar statistics are found in the St. Louis Contraceptive CHOICE Project, which offered adolescents age 15 to 19 years of age their choice of contraceptive method at no cost. Seventy-five percent chose a LARC. Young women who chose the pill, patch or ring had pregnancy rates 20 times higher than that of the LARC users. These two state examples demonstrate that removing financial and other access barriers to LARCs can help reduce abortion and teen pregnancy.

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MCH professionals have a special role to play in this work. Title V staff can connect women of reproductive age with providers that offer the full range of contraceptive services. Title V staff also can help women navigate their insurance options to reduce the cost of accessing LARC and other forms of birth control. The Affordable Care Act (ACA) and other insurance reforms have the potential to make contraceptives available to more women without cost sharing. Expanding access will in turn reduce the number of unintended pregnancies and improve the health of women of reproductive age. For more information on contraceptive coverage and the health care law, visit the National Women’s Law Center website.