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Free, Long-Acting Contraceptives May Greatly Reduce Teen Pregnancy Rate
Study findings also showed abortion rate was three-quarters lower than the national norm in this age group
WEDNESDAY, Oct. 1, 2014 (HealthDay News) -- Giving teenage girls free birth control -- especially long-acting implanted devices -- could slash pregnancy and abortion rates to well below the current U.S. average, new findings suggest.
In a study of 1,400 teenage girls, researchers found that counseling and free contraceptives substantially cut the girls' rates of unplanned pregnancy and abortion. Over three years, their annual pregnancy rate averaged 34 per 1,000 girls -- versus a rate of 158 per 1,000 among all sexually active teenage girls in the United States.
Meanwhile, the abortion rate was 9.7 per 1,000 girls in the study, compared to a national abortion rate of 41.5 per 1,000 sexually active girls, the researchers report in the Oct. 2 issue of the New England Journal of Medicine.
"What we're seeing here are extraordinary declines," said Bill Albert, chief program officer for the Washington, D.C.-based National Campaign to Prevent Teen and Unplanned Pregnancy.
Albert, who was not involved in the research, pointed to a key element of the study: Girls received counseling that emphasized the safety and effectiveness of intrauterine devices (IUDs) and contraceptive implants -- and most of the teens opted for those types of birth control.
IUDs and implants are substantially more effective than the Pill or condoms, which are currently the top birth control choices among U.S. teens, according to the American Academy of Pediatrics (AAP).
The "magic" of IUDs and implants, according to Albert, is that they are put in place and then last for years -- or until a woman decides to remove them. "These types of birth control are 'set it and forget it,'" Albert said. "They don't rely on perfect use."
And from the standpoint of preventing unplanned pregnancies, the devices "have the potential to be game-changing," Albert said.
The new report comes on the heels of new recommendations from the AAP, advocating IUDs and implants as the first-choice contraceptives for teenagers.
Gina Secura, the lead researcher on the new study, welcomed the AAP guidelines, which came out this week.
"For so long we've dismissed these types of contraceptives for teenagers, thinking girls won't want them or will find them too complicated," said Secura, a researcher at Washington University School of Medicine in St. Louis.
But, she said, her team's findings show that teenagers are willing to use IUDs and implants. Even more importantly, she added, the benefits are clear.
According to Planned Parenthood, IUDs are implanted in the uterus, where they release small amounts of either copper or the hormone progestin. The contraceptive implant, about the size of a matchstick, is inserted under the skin of the arm, where it releases controlled amounts of progestin.
The hormonal IUD (sold under the brand name Mirena) can prevent pregnancy for five years, while the copper version (ParaGard) works for about 10 years. The contraceptive implant (Implanon, Nexplanon) lasts for three years, according to Planned Parenthood.
According to the U.S. Centers for Disease Control and Prevention (CDC), between 0.2 percent and 0.8 percent of women who use an IUD will have an unplanned pregnancy within a year. That rate is just 0.05 percent with an implant.
In contrast, about 9 percent of women on the Pill have an unintended pregnancy each year. Condoms, as people typically use them, are even less effective -- with a pregnancy rate of 18 percent to 21 percent, according to the CDC.
Still, only about 5 percent of U.S. teens currently use IUDs or implants, according to background information in the study. Secura said that going into this study, her team thought price was the major obstacle: IUDs cost $500 to $1,000 upfront, while contraceptive implants range from $400 to $800.
But the researchers quickly found out that many young women simply don't know much about the devices.
Albert said that to translate these study findings to the real world, doctors and other providers are going to have to get up-to-date with the evidence for IUDs and implants -- and either become comfortable with offering the devices, or be able to refer girls to a provider who is.
Planned Parenthood welcomed the new findings.
"This study shows that the IUD and implant help reduce teen pregnancy," said Dr. Vanessa Cullins, vice president of external medical affairs for Planned Parenthood Federation of America. "IUDs and implants are safe for most women, including adolescents and women who have not yet children, and they are an especially good option for young women who want to delay starting their families for a few years, so they can be the best parents they can be."
As for cost, under the Affordable Care Act, many insurers have begun covering prescription birth control methods without copays.
"Hopefully," Albert said, "the cost of IUDs and implants will become less of a concern."
Still, Secura said, teens can face an extra obstacle: wanting to keep their contraception choice private. State laws on minors' access to contraception vary. But even when teens can get it on their own, their parents will probably find out when they receive their insurer's explanation of benefits, Secura pointed out.
Albert said that ideally, kids should feel they can talk to their parents. "Parents and kids should have discussions about relationships, sex and contraception -- early and often," he said.
He added that, despite some parents' worries, those talks do not end up encouraging kids to have sex. "Research shows that's a myth," Albert said. "When parents discuss these issues, their kids tend to delay sex. And when they do have sex, they're more likely to use contraception."
SOURCES: Gina Secura, Ph.D., M.P.H., senior scientist, obstetrics and gynecology, Washington University School of Medicine, St. Louis, Mo.; Bill Albert, program director, National Campaign to Prevent Teen and Unplanned Pregnancy, Washington, D.C.; Oct. 2, 2014, New England Journal of Medicine
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