There's Nothing 'Startling' About the Success of Colorado's IUD Program

Colorado, in the past six years, has run an incredibly successful initiative in reproductive health: by providing free long-acting birth control to teens and low-income women starting in 2009, the state slashed the teen pregnancy rate by 40 percent by 2013, and the teen abortion rate by 42 percent.

The New York Times describes this program’s success as “startling,” but is it really so startling that making the most reliable form of birth control available to women today free to your state’s most vulnerable populations would have a dramatic public health outcome? From the Times article:

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. About one-fifth of women ages 18 to 44 in Colorado now use a long-acting method, a substantial increase driven largely by teenagers and poor women.

The surge in Colorado has far outpaced the growing use of such methods nationwide. About 7 percent of American women ages 15 to 44 used long-acting birth control from 2011 to 2013, the most recent period studied, up from 1.5 percent in 2002. The figures include all women, even those who were pregnant or sterilized. The share of long-acting contraception users among just women using birth control is likely to be higher.

For many years now, long-acting reversible contraceptive methods (LARCs) have been repeatedly shown to be much safer, more reliable, and more effective than the percentage of American women who use them would imply. LARCs are not ideal for everyone, but they’re ideal for many people, including many teens. In Colorado, IUDs and implants also had a significant impact on unmarried women under 25 who hadn’t yet graduated high school—particularly those living in regions of the state where jobs were hard to come by.

“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.

But of course, the program—formerly funded by a private grant from the Susan Thompson Buffett Foundation, which is about to run out—worked so well that Republican legislators had to refuse to help fund it with public money. Furthermore, Colorado women on health care plans that predate Obamacare will be exempt from new provisions mandating that birth control be free. It’s a regrettable future for the state, as the effects of having women not be pregnant when they didn’t want to be were already vast:

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 by nearly a quarter between 2010 and 2013.

But, just like IUDs themselves, all this good news is reversible—startlingly so. Here’s to hoping other states find it in them to try out Colorado’s program soon.