Free IUDs, hormonal implants slash teen pregnancy rate, study finds

Teen girls educated about different types of birth control and offered free access to every method available have drastically lower pregnancy and abortion rates compared to the national average for similarly sexually active teens, according to a study published Wednesday.

In the face of ongoing debate over whether sex education should be taught in U.S. schools — just 22 states plus the District of Columbia require public schools to teach it — the report may vindicate those who insist that arming teens with comprehensive information about birth control, safe sex and STDs is smart, not salacious.

In the study, which was published in the New England Journal of Medicine, researchers from the Washington University School of Medicine in St. Louis counseled more than 1,400 teen girls between the ages of 15 and 19 about various types of birth control and their effectiveness at preventing pregnancy. It was part of the university’s Contraceptive CHOICE Project, which recruited 10,000 St-Louis area women and teens that were deemed to be at high risk of unintended pregnancy.

During the study, researchers emphasized to the teens the effectiveness of long-acting, reversible contraceptives such as IUDs and hormonal implants, which are almost 100 percent effective at preventing pregnancy. Then, on the same day, the teens — a significant portion of whom had already had unintended pregnancies — were given the free birth control of their choice. They were also given free condoms to protect them from STDs.

The researchers, who say theirs is the first major study to educate women about all available types of contraceptives rather than focusing on one or two types — said they were surprised that 72 percent of the teens participating in the study selected IUDs or implants. On a national level, fewer than 5 percent of teens use those methods and instead favor birth control pills or condoms — which are less effective, particularly because they are often used incorrectly.

And when the researchers followed up with the teens every few months for the next two to three years, they found them far less likely to have gotten pregnant or had abortions than other sexually experienced teens. The average pregnancy rate among the teens involved in the study was 34 for every 1,000, versus the national average of 158.5 per 1,000 sexually active U.S. teens.

The average abortion rate was 9.4 per 1,000, while the average abortion rate among sexually active teens in the United States is 41.5 per 1,000.

Also, while the study cited data showing black teens on average get pregnant at nearly twice the rates that white teens do — at 253 versus 137 pregnancies per 1,000 women, respectively — that disparity all but disappeared among the study participants. There were 31.8 pregnancies per 1,000 among the black teens and 26.9 per 1,000 among the whites, according to the study.

“If we provide great contraceptive care and access to all of our teens in the U.S., this is what we could see,” said Gina Secura, lead author of the study and a senior epidemiologist with the Washington University School of Medicine’s Department of Obstetrics and Gynecology.

“We are still in a country where it just makes us skeevy to talk about sex, especially with young folks,” she added. “It’s a real bummer because we actually have a medical intervention that will work, and we just need to be better about talking about it.”

Steadily declining teen pregnancy rates in the U.S. have been seen as a public health victory. After peaking in 1990 at 116.9 teen pregnancies for every 1,000 women, in 2010 the rate plummeted to 57.4 per 1,000, or about 6 percent of teens, according to the according to the Guttmacher Institute (PDF).

But teen pregnancy rates in the U.S. are still higher than they are in other industrialized countries, according to the study, and teen births cost the U.S. nearly $10 billion annually in public assistance, according to The National Campaign to Prevent Teen and Unplanned Pregnancy.

The major barrier teens face in getting birth control — especially the long-acting methods — has often been lack of awareness. Secura said the CHOICE Project was originally set up with the assumption that the young women would come in knowing exactly which method they wanted to use.

But they didn’t. The teens wanted more information about options, so the project quickly created a “script” for staff to counsel teens about each contraceptive. Each would sit down at a desk with a counselor and samples of all the different options on the desk in front of her, and they would discuss each one, starting with the one most effective at preventing pregnancy.

“She could see that the IUD wasn’t as big as her hand — it was actually very small,” Secura said. “That was really, really helpful, because a lot of the kids had no idea. They only knew about pills and the shot.”

Even more often, cost and availability are barriers to teens using long-acting contraception, researcher say. Although many young women can get reduced-cost contraceptives at clinics such as Planned Parenthood, Secura says clinicians often worry that the teens will change their minds about IUDs or implants and want to have them taken out, and so the cost won’t be worth it. Or, she said, providers will ask women to wait until they have their periods for insertion, which requires a follow-up appointment that teens may not end up making.

IUDs can cost between $600 and $800 for the device alone, plus between $100 and $300 to implant, so if a patient doesn't have health insurance coverage, costs can be insurmountable. The Affordable Care Act calls for insurance coverage to include all FDA-approved contraceptives, but some private companies and universities have pushed back on that provision based on religious grounds.

“There are these barriers that get put into place, and then it makes it that much harder for a teen who decides that she wants it to actually get it,” Secura said.

Just last week, the American Association of Pediatricians issued a new position statement suggesting that sexually active teen girls should use IUDs or hormonal implants as a first line of defense against pregnancy, in a recommendation echoing the American College of Obstetricians and Gynecologists’ 2012 statement.

IUDs and hormonal implants have historically been thought of as contraceptives for women who have already had kids and are trying to space out the birth of additional ones, said Megan Kavanaugh, a senior research associate at the Guttmacher Institute.

But she says that perception is changing — use of IUDs among teens tripled between 2007 and 2009. And with 17 as the average age that American women first have sex, but 25 as the average age they first have children, long-acting contraceptives are a great choice for young women, according to Kavanaugh.

“There’s this long time window in which women need protection from unintended pregnancy, and these [long-acting, reversible contraceptive] methods are rather appropriate to cover them for that period of time,” she said.

“We do expect to see a continued increase in the use of these methods by all women, but particularly in young women.”