This opinion piece was originally published in the Washington Post.
A privately funded initiative in Colorado that drastically reduced teen pregnancy and abortion rates has recently been lauded by public health officials, policymakers and editorial boards alike. As a physician, I’ve been closely following the outcomes and results of this public health initiative. As Virginia’s lieutenant governor, I genuinely believe that Democrats and Republicans should be able to agree that reducing unintended pregnancies, decreasing abortion rates and improving the health of mothers and infants are important public health goals that should be carefully considered and debated.
Over the past six years, Colorado observed a 40 percent decline in teen birthsand a 42 percent decline in teen abortions based on an innovative program that provided education, counseling, administrative support and long-acting, reversible contraceptives (LARCs) to providers and patients upon request. These long-acting birth control methods, which include intrauterine devices (IUDs), injectables and implants, can last up to 10 years. They have a failure rate of less than 1 percent compared with condoms and the pill, which have failure rates of around 18 percent and 9 percent respectively.
This is an issue Virginia needs to consider for the health of women of all ages, the health of our infants and the fiscal well-being of our commonwealth. Virginia’s teen pregnancy rates have fallen in recent years in line with national trends, but many states still do far better than us in this regard. In 2013, the birth rate for Virginia teens was 20.1 per 1,000 females aged 15 to 19.
Provider and patient education about the safety and effectiveness of productsis a key component in the success of such efforts. Unfortunately, myths also abound with regard to LARCs and the safety of IUDs, in particular. TheAmerican Academy of Pediatrics calls them a “first line” form of birth control for adolescents, and the American Congress of Obstetricians and Gynecologists has recommended the use of LARCs to reduce the number of unintended pregnancies.
Not only did making the most effective forms of birth control more accessible reduce unintended pregnancies and abortions in Colorado, but also it saved taxpayer dollars and demonstrated a clear return on investment. For every $1 invested in educating women and providing LARCs, the program saved the state more than $5 in Medicaid costs.
While the Colorado initiative was focused on reducing teen pregnancy, we know that LARC use between pregnancies also helps improve the health of infants. Pregnancies spaced too closely together lead to increased rates of infant mortality. Although Virginia has reduced infant mortality rates in recent years, there is room for improvement. Helping women make informed decisions about the best contraceptive methods for their families would also help us ensure that more infants are celebrating their first birthdays.
While the outcomes of this pilot program are dramatic, many women and families do not always have access to such options. The Affordable Care Act mandates that insurance plans cover every type of contraceptive, including LARCs, but various loopholes mean that some women have plans that do not cover LARCs. The average out-of-pocket cost for LARCs is roughly $800, making them prohibitively expensive for many.
Unfortunately, there are hundreds of thousands of women in Virginia without health insurance or access to affordable care. If we are serious about reducing abortions and addressing the costs associated with unintended pregnancies, then affordable access to LARCs for these women must be a prominent part of the discussion.
Because many Virginians have access to LARCs for the first time through their insurance under the Affordable Care Act, we need a concerted effort to work with physicians and clinics to educate women on all of their options. Despite LARCs’ safety and effectiveness, only 7 percent of women use them, but according to one study, when appropriately educated on all of their options and cost is not a factor, teens chose LARCs 72 percent of the time.
As a physician and a policymaker, I believe all Virginia women should be informed about and have access to all possible reproductive health-care options so they can make the best decisions for their families. That includes the most effective forms of contraception, LARCs, which have clear potential to help us achieve shared goals of decreasing unintended pregnancies, reducing abortions and improving health outcomes for infants.
Virginia should carefully evaluate the results of Colorado’s program and seriously consider our policies and investments in family planning methods and education efforts for providers and families alike.
The writer, a pediatric neurologist, is lieutenant governor of Virginia and a Democrat.