Colorado cut its abortion and teen birth rates in half over a five-year period by offering teens and low-income women long-acting contraceptives at an affordable price. Long-acting reversible contraceptives (LARCs) are more effective than other methods, such as the pill or condoms, but they can also be expensive, costing up to $1,000 in the US. It is estimated that these results have so far saved the state almost $70 million in public assistance costs.
Results & Impact
From 2009 to 2014, abortion and birth rates fell by 50% among teens and by 20% among women aged 20-24. The changes were starkest in the state’s poorest areas. Approximately 926,200 abortions were carried out in the United States in 2014.
Colorado Department of Public Health & Environment (CDPHE), Susan Thompson Buffett Foundation
Women who want to participate can go to a website, Beforeplay, and enter their address to find the nearest contraceptive provider. The contraceptives - implants and intrauterine devices - are available on a sliding scale of low- to no-cost. To implement the program, the state had to train extra health care providers capable of inserting these devices. The Department of Public Health and Environment also provided funding and operational support to family planning clinics once the program had begun. Clinics have hired more staff, increased hours, and upgraded equipment and billing procedures. A widespread public outreach campaign was also run with the help of the Beforeplay website.
Women and girls
Cost & Value
The program was initially funded with grants of $27 million in 2007. It also receives funding from the state and under Title X, the only federal grant program dedicated to affordable reproductive health and family planning in the US. The declining abortion and unplanned pregnancy rates have so far saved Colorado almost $70 million in public assistance costs.
Running since 2008
One key challenge has been around public outreach and education campaigns to inform women of the effectiveness and availability of LARCs. Colorado built a purpose-designed website and ran a mass public education drive that involved health educators visiting colleges and bars, which required separate funding. Before the program began, Colorado already had a strong network of family planning clinics - yet it still needed to train more providers in how to insert the contraceptive devices. Replication would be more challenging without such a baseline.
The program has not been replicated as yet, but there has been interest from across the country. Colorado’s Department of Public Health is in discussions with lawmakers in New Mexico, Maryland, and South Carolina.
Colorado has cut its teenage birth and abortion rates in half and saved millions in public assistance costs by offering women free or affordable long-acting contraception.
Long-acting reversible contraceptives (LARCs) are intrauterine devices (IUDs) and implants that last between three and 10 years. They are more than 99% effective, higher than other contraceptive methods such as the pill or condoms because women do not need to act after insertion for them to work. However, they can be unaffordable for young and low-income Americans. Without insurance coverage, getting an IUD or an implant can cost up to $1,000.
By enabling women to overcome cost barriers, facilitating access, and running a public outreach campaign, the Colorado Department of Public Health and Environment (CDPHE) produced impressive results. The state offered all its teenagers and some low-income women access to LARCs at no or low cost. From 2009 to 2014, both abortion and birth rates fell by almost 50% among teens aged 15-19 and by 20% among women aged 20-24. These changes were sharpest in the state’s poorest areas. Furthermore, the average age of first birth for all women in the state increased by 1.2 years.
Besides improving choices and access to services for women, there is a strong economic case for making LARCs widely available. “It’s important to frame health and prevention programs like this in economic terms. So we hired a third party to assess the number of public support costs that were avoided by the reductions in unintended pregnancies due to LARCs. The sample focused on women aged 15-24 years, over a four year period,” said Jody Camp, the Director of the CDPHE’s Family Planning Programs.
The decline in abortion rates and unplanned pregnancy rates has so far saved Colorado almost $70 million in public assistance costs. Most of these savings were from the state’s Medicaid program, which covers more than three-quarters of Colorado’s teenage births and pregnancies.
“And we were only able to afford a small sliver of analysis – if we had the resources for more research, that figure would look a lot bigger,” said Camp.
Having children later allows women more educational and employment opportunities. Early childbearing can also increase health risks for both mothers and babies. For example, babies born to adolescent mothers are more likely to have a low birth weight, which can have long-term effects.
By 2015, approximately a fifth of women aged 18-44 in Colorado – about half a million women – were using LARCs, significantly more than the national average. To fulfil increased demand, the CDPHE has funded training for new health care providers in how to insert the devices. It has also provided extra funding and operational support to family planning clinics throughout the state. Clinics hired more staff, increased hours, and upgraded equipment and billing procedures.
The CDPHE also ran a widespread public outreach campaign. “Health educators went to college campuses and to bars to hand out coasters about family planning. The Beforeplay.org initiative put up billboards, commercials, and even Facebook ads,” said Camp.
Beforeplay.org is a purpose-designed website that plays a key role in public outreach efforts. It has information and resources on different birth control methods and details on the locations of reproductive service providers. Women in Colorado can enter their address to find the nearest contraceptive provider.
The LARC provision program was initially funded in 2007 by grants of $27 million, including from the Susan Thompson Buffett Foundation, which has not publicly acknowledged its role. It also receives funding from the state and funds under the national Title X program, and while it is fully funded for the coming year, securing financing remains a challenge. “Running a program like this is not for the fainthearted – it’s the political and administrative side that’s the most challenging,” said Camp. But, in the long term, the economic case for providing teens with LARCs is powerful.
The program has not been replicated as of yet, but there has been interest from across US. The CPDHE’s Family Planning Unit has spoken to lawmakers in New Mexico, Maryland, and South Carolina.
Camp is excited about the program’s future. “What’s happening in Colorado is this movement that will keep on rolling and spreading to other states. No matter what the politics are, if you allow access to the best healthcare available for women, they will choose it.”
(Picture credit: Flickr/Sarah Mirk)