IUDs & Other LARCS Can Transform the Futures of America's Poor Women

Drop in Unintended Pregnancies Accompanies Drop in US Abortions

The rate of unintended pregnancies in America has experienced a steady drop since 2008, reversing a trend of climbing unintended pregnancies in the period from 2001-2008. The 18% drop in unintended pregnancies in America since 2008 has also impacted a reduction in the abortion rate. 

Sponsored by the Guttmacher Institute, the study published in the New England Journal of Medicine (NEJM) provides clarity around the US abortion debate, says Joerg Dreweke, author of the accompanying policy analysis. “We now know that abortion declined primarily because of fewer unintended pregnancies, and not because fewer women decided to end an unwanted pregnancy. Improved contraceptive use is likely the key driver of the decline.”

Anti-abortion advocates have argued that the decline in abortions is due to stricter laws in many states and intense public activism against abortion providers like Planned Parenthood. The hideously manufactured lies contained in the 2015 anti-abortion, fetal-tissue videos are an example of this activism.

While certain drops in abortion rates in specific states may be tied to the most restrictive laws, it's the availability of reliable contraception that has the greatest aggregate impact on women's well-being and abortion rates at a national level.

Lawrence Finer, a co-author of the study and the director of domestic research at the Guttmacher Institute says that these results are part of the reality that women are picking more reliable and statistically effective birth control. Since 2007, many women have turned to using an intrauterine device (IUD) or other long-acting reversible contraceptives (LARCS). Unlike birth control pills, patches or diaphragms, LARCS are not subject to human error. Once inserted, they last for a minimum of three years with no maintenance.

LARCs still aren't the most popular type of birth control in the United States. But usage has increased significantly, from 3.7 percent of birth control users choosing IUDs or implants in 2007 to 11.6 percent in 2012.

A deterrent to IUD usage has been the price.

Planned Parenthood has estimated that IUDs can cost between $500 and $900 to the patient. Prior to Obamacare, Insurance plans tended to charge patients more for IUDs than for birth control pills, due to the high upfront costs.

Obamacare has changed the costs of IUDs to women. The ACA's insurance expansion gives coverage to millions more American women. now have coverage. Additionally, Obamacare mandates that insurers cover all contraceptives at no extra cost to patients. This means that insurers can't charge patients more for an IUD because the device costs more As a result, women can use the birth control method recommended by physicians.  Professional medical groups like the American College of Obstetricians and Gynecologists endorse LARCs as the best birth control in official policy statements.

IUDs & Pregnancy Reduction in Colorado

One of the most successful public policy studies around the use of IUDs happened in Colorado, where the price of success caused the Republican state government to pass legislation to end the program.

Colorado offered free IUDs and implants to teenagers and poor women in a massively publicized program. "The birthrate among teenagers across the state plunged by 40 percent from 2009 to 2013, while their rate of abortions fell by 42 percent, according to the Colorado Department of Public Health and Environment. By 2014, the decline was 48%. There was a similar decline in births for another group particularly vulnerable to unplanned pregnancies: unmarried women under 25 who have not finished high school," wrote the New York Times in July, 2015.

Colorado's state health department estimated that for every dollar spent on LARCS, taxpayers saved $5.85 in the state's Medicaid program, which covered more than three-quarters of teen pregnancies and births in the state. Enrollment in federal nutrition programs for women with young children also declined by about 25% between 2010 and 2013.

The program in Colorado was funded by a private $23 million grant from the Susan Thompson Buffett Foundation.  With the grant due to expire, policymakers assumed that the staggering success of the study would easily prompt lawmakers to assume funding for the program.

"What greater gift can you give to a teenaged potential mother than the opportunity to plan her family so when she has children, it's when they're wanted, when she can afford to care for them ... and to do it in such a cost-effective way in terms of government spending? It dramatically reduces government spending,"  said Democratic Colorado Gov. John Hickenlooper. The state funding measure passed the Democrat-controlled House of Representatives but failed in the Republican-controlled Senate.

Republican state lawmakers in the Senate like Rep. Kathleen Conti said 'no deal'. Conti complained that the long-acting birth control is too expensive and sends the wrong message to teenagers, who should be practicing abstinence. The program fundamentally promotes promiscuity, argued Republicans, even though all current research confirms that teen girls are delaying sexual activity.

Conti also expressed concerns about an increase in STDs and a lack of parental involvement. Note that under Obamacare, teens would be covered on their parents' plans and therefore more likely to be involved in the decision to use the long-acting methods of birth control.

IUDs and the False Science of Abortifacients

Most doctors agree that only when a fertilized egg attaches -- or implants -- to a woman's uterus, has a pregnancy occurred. The radical wing of the pro-life crowd doesn't agree. To them, if something interferes with a fertilized egg’s assemblé to the uterus, it’s an abortion, wrote The Atlantic, in March 2014.  Hobby Lobby brought this issue before the Supreme Court -- not asking the justices to rule on exactly when conception occurs -- arguing that the Supreme Court take a position most definitely at odds with the bible.

Hobby Lobby claims that IUDs and morning-after pills are more like abortifacients, meaning they kill fertilized embryos, than they are like contraceptives. And their reasoning rests on the fact that, with the exception of condoms, we don’t know exactly how most forms of birth control work, every time they work.

The Hyde Amendment -- the law preventing the use of federal funding for abortions -- currently does not block funding for at least four of the FDA's approved contraceptives including IUDs and morning after pills.

But the argument among the radical wing of the pro-life moments argues that an IUD is an abortifacient and therefore, the Colorado legislature cannot provide funding to the most successful life-management tool for poor women in the history of America. 

The Colorado program was saved with the support of private foundations, and the governor plans to launch a new fight for state-supported funding for the program. As difficult as the challenges are, other states are joining the support of long-acting birth control initiatives because they provide great outcomes for poor women and taxpayers both. Five states initially joined the Colorado project: Georgia, Iowa, Massachusetts, New Mexico and South Carolina.

The CDC federal research program now includes California, Illinois, Louisiana, Maryland, Montana, New York and Oklahoma.  A comprehensive review of the current research update on the amazing results associated with this program are included in The 6/18 Initiative: Evidence Summary: Prevent Unintended Pregnancy.

Suffice it to say that this CDC research at a federal level NEVER would have been launched in a Republican administration.  It's the kind of public policy research associated with the European countries. ~ Anne