Free Highly Effective Reversible Contraception: Conquering a Barrier

　　Providing such contraception at no cost significantly reduced abortion rates.

　　The Institute of Medicine recently recommended that, in keeping with the Patient Protection and Affordable Care Act of 2010, reliable contraception be provided at no charge. The Contraceptive CHOICE Project was designed in part to provide insight into how such an objective could change the face of U.S. family planning services. The goal of this prospective cohort study was to promote use of effective contraceptives (with emphasis on highly effective reversible contraceptive methods) by providing them for free to women at high risk for unintended pregnancy in greater metropolitan St. Louis (JW Womens Health May 24 2012). Teen births and repeat abortions were selected as surrogates for unintended pregnancies. Between August 2007 and September 2011, 9256 participants (age range, 14–45; 51% black; 35% with high school education or less; 37% on public assistance) were enrolled. Highly effective reversible contraceptive methods were chosen by 75% of women (most commonly the levonorgestrel intrauterine device).

　　Between 2008 and 2010, the number of abortions in the St. Louis area fell by 20.6% (P<0.001) but did not change in the rest of Missouri. Among CHOICE participants during this period, abortion rates did not exceed 7.5/1000, whereas the national rate was 19.6/1000 women aged 15 to 44. The proportion of repeat abortions in the St. Louis area also declined (P=0.002). The teen birth rate among CHOICE participants aged 15 to 19 was 6.3/1000 versus the national rate of 34.3/1000.

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