Freedom to Choose what is Best

About half of pregnancies in the world are unplanned. In the United States, that trend is declining. However, unintended pregnancies are still common among women who are black, Hispanic, and poor.

Women spend much of their lives avoiding pregnancy. Long-acting reversible contraceptive (LARC) methods are very effective in preventing pregnancy likely because they do not require remembering to take a pill every day or go to a clinic every few months for an injection. If a woman later decides to have a child, she can stop using LARC to become fertile again.

After the city of Vantaa, Finland, started providing all women with their first LARC method free of charge in January 2013, researchers studied the monthly abortion rate and the monthly contraception initiation rate.

The program was found to be associated with an increase in the use of LARCs and a decrease in the rate of abortions. The results from this Finnish study are similar to previous U.S. studies that showed the effectiveness of LARCs in reducing teen pregnancy.

Earlier research has shown increased access to LARCs does not make women more promiscuous. In contrast, withholding access to effective birth control and comprehensive sexual education does not prevent pregnancies or sexually transmitted infections. Additionally, the ACA requires insurance plans to cover all FDA-approved methods of contraception at no cost as an essential health benefit. By making LARCs more affordable for patients, the ACA could decrease both unplanned pregnancies and abortions. Nonetheless, not every American has health insurance.

Title X helps low-income people and families access contraception and related preventive health services. However in April, the Trump administration changed Title X funding rules to allow states to block funding for comprehensive family planning services to certain health care providers for political reasons.

People of means always will be able to access the care they desire. Changes to Title X will overwhelmingly hurt the poor. 

A responsible government should provide safe, affordable, and evidence-based options for all. People should have the freedom to make make important life decisions for themselves and their families. 

Abstract

OBJECTIVES: To evaluate whether a public program providing long-acting reversible contraceptive (LARC) methods free of charge increases the LARC initiation rate and reduces the unintended pregnancy rate in the general population.

METHODS: Since 2013, all women in Vantaa, Finland, have been entitled to 1 LARC method free of charge. With time-series analysis between 2000 and 2015, we assessed whether this public program was associated with changes in steady-state mean rates of LARC initiation and abortions.

RESULTS: The initiation rate of LARCs (1/1000 women) increased 2.2-fold from 1.9 to 4.2 after the intervention (P?<?.001). Concomitantly, the abortion rate (1/1000 women) declined by 16% from 1.1 to 0.9 in the total sample (P?<?.001), by 36% from 1.3 to 0.8 among those aged 15 to 19 years (P?<?.001), and by 14% from 2.0 to 1.7 among those aged 20 to 24 years (P?=?.01).

CONCLUSIONS: The LARC program was associated with increased uptake of LARC methods and fewer abortions in the population. Public Health Implications. Entitling the population to LARC methods free of charge is an effective means to reduce the unmet need of contraception and the need for abortion, especially among women younger than 25 years.

PMID: 29470111 

Gyllenberg F, et al. Am J Public Health. 2018 Apr; 108 (4): 538-543.