Brenda’s Got A Baby

In 2013, the United States had the highest rate of teen births of all developed countries, with 274,641 girls aged 15-19 giving birth in that year alone. Only 38% of women who have a child before 18 years of age finish high school, and the children born to teenage mothers have a higher risk of illness.

However, the long-term consequences of teen pregnancy impact not only the young parents and their children, but the public as well. In 2010, taxpayers spent $9.4 billion on costs associated with teenage childbearing.

These numbers are appalling considering that nearly all of these outcomes could have been prevented.

Long-acting reversible contraception (LARC) options, including intra-uterine devices and sub-dermal implants, are highly effective at preventing pregnancy. Unfortunately, at $500-900, the upfront cost of LARC is much more expensive than other contraceptive methods. Still, a study of over four thousand women found the unintended pregnancy rates for short-acting contraceptives (pills, condoms, or the patch) were 22 times higher than unintended pregnancy rates for LARC. Currently, only 4.5% of women aged 15–19 years who are using a method of contraception use LARC, with most using an IUD.

Secura and colleagues analyzed data from the Contraceptive CHOICE Project to observe whether providing free LARC reduced teenage pregnancy, birth, and abortion. When comparing rates of research subjects to the national teenage population, researchers found that free LARC did indeed reduce rates of all three outcomes.

The Affordable Care Act requires insurance coverage of FDA-approved contraception, including LARC, without co-pays or additional fees. This is an important provision. Delaying motherhood can significantly reduce the costs to the parents, children, and the public.

commentary by May Nguyen, MD, MPH

Abstract

BACKGROUND: The rate of teenage pregnancy in the United States is higher than in other developed nations. Teenage births result in substantial costs, including public assistance, health care costs, and income losses due to lower educational attainment and reduced earning potential.

METHODS: The Contraceptive CHOICE Project was a large prospective cohort study designed to promote the use of long-acting, reversible contraceptive (LARC) methods to reduce unintended pregnancy in the St. Louis region. Participants were educated about reversible contraception, with an emphasis on the benefits of LARC methods, were provided with their choice of reversible contraception at no cost, and were followed for 2 to 3 years. We analyzed pregnancy, birth, and induced-abortion rates among teenage girls and women 15 to 19 years of age in this cohort and compared them with those observed nationally among U.S. teens in the same age group.

RESULTS: Of the 1404 teenage girls and women enrolled in CHOICE, 72% chose an intrauterine device or implant (LARC methods); the remaining 28% chose another method. During the 2008-2013 period, the mean annual rates of pregnancy, birth, and abortion among CHOICE participants were 34.0, 19.4, and 9.7 per 1000 teens, respectively. In comparison, rates of pregnancy, birth, and abortion among sexually experienced U.S. teens in 2008 were 158.5, 94.0, and 41.5 per 1000, respectively.

CONCLUSIONS: Teenage girls and women who were provided contraception at no cost and educated about reversible contraception and the benefits of LARC methods had rates of pregnancy, birth, and abortion that were much lower than the national rates for sexually experienced teens.

PMID: 25271604. Secura, GM et al. NEJM. 2014; 371(14): 1316-23.