Program reduces teen pregnancies

WALSENBURG, Colo. -- Over the past six years, Colorado has conducted one of the largest-ever real-life experiments with long-acting birth control.

If teenagers and poor women were offered free intrauterine devices and implants that prevent pregnancy for years, state officials asked, would those women choose them?

They did in a big way. The birthrate for teenagers across the state plunged 40 percent from 2009 to 2013, and their rate of abortions fell 42 percent, according to the Colorado Department of Public Health and Environment.

There was a similar decline in births for unmarried women younger than 25 who have not finished high school.

"Our demographer came into my office with a chart and said, 'Greta, look at this, we've never seen this before,'" said Greta Klingler, the family-planning supervisor for the public health department.

Hope Martinez, a 20-year-old nursing home receptionist, recently had a small metal rod implanted under the skin of her upper arm to prevent pregnancy for three years.

"I don't want any babies for a while," she said.

More young women are making that choice. In 2009, half of all first births to women in the poorest areas of the state happened before they turned 21. By 2014, half of first births did not occur until they had turned 24, a difference that advocates say gives young women time to finish their educations and to gain a foothold in an increasingly competitive job market.

"If we want to reduce poverty, one of the simplest, fastest and cheapest things we could do would be to make sure that as few people as possible become parents before they actually want to," said Isabel Sawhill, an economist at the Brookings Institution.

Teenage births have been declining nationally, but experts say the timing and magnitude of the reductions in Colorado are a strong indication that the state's program was a major driver.

But the experiment in Colorado is entering an uncertain new phase that will test a central promise of the Patient Protection and Affordable Care Act: free contraception.

The private grant that funds the state program has started to run out, and while many young women are expected to be covered under the health care law, some plans have required payment or offered only certain methods.

What is more, only new plans are required to provide free contraception, so women on plans that predate the law may not qualify.

Advocates also worry that teenagers may be less likely to get the devices through their parents' insurance. Long-acting devices can cost between $800 and $900.

Women's health advocates contend that long-acting birth control is giving U.S. women more say over when they have children. About half of the 6.6 million pregnancies a year in the United States are unintended. Teenage births may be down, but unplanned births have simply moved up the age scale, Sawhill said.

Proponents say the program is working. The state health department estimated that every dollar spent on the long-acting birth control initiative saved $5.85 for the state's Medicaid program, which covers more than three-quarters of teenage pregnancies and births. Enrollment in the federal nutrition program for women with young children declined nearly a quarter between 2010 and 2013.

A Section on 07/07/2015

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