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Study finds that access to free contraception would dramatically lower unwanted teen pregnancies

Educating teenage girls thoroughly about all forms of contraception and then providing that contraception at no cost would significantly reduce unwanted teenage pregnancies, births and abortions in the United States, according to a study published Thursday in the New England Journal of Medicine.

That would be a much-needed development. Although the U.S. teen pregnancy rate has fallen substantially over the past two decades, it’s still among the highest in the world and represents, as this study notes, “a stubborn public health problem.” Each year, more than 600,000 American girls between the ages of 15 and 19 become pregnant, and three in 10 girls become pregnant before their 20th birthday.

Teen pregnancies are associated with higher rates of medical problems for both mother and child. In addition, children born to teenage mothers are more likely to have developmental problems and to grow up in poverty. The economic burden of teen pregnancies on the U.S. economy is significant, costing about $10 billion a year in public assistance, health care and lost income.

Study details

For this study, researchers at Washington University School of Medicine in St. Louis used data collected from 1,404 teenagers, aged 15 to 19, who were participating in the Contraceptive CHOICE Project, a large study designed to reduce unintended pregnancy in the St. Louis region by promoting the use of two long-acting, reversible contraceptive methods, intrauterine devices (IUDs) and implants (small devices implanted under the skin, usually in  the upper arm, that release pregnancy-preventing hormones).

About 97 percent of the teens in the Contraceptive CHOICE Project were sexually active at the time they enrolled in the study. The others said they intended to become sexually active within the next six months. Nearly half reported a previous unintended pregnancy, and 18 percent had a history of abortion.  Almost 500 were minors (aged 17 or younger). The minors had to provide the written consent of their parents or guardians to be in the study. They could enroll under a waiver of that consent if they didn’t know where their parents were or if they didn’t want their parents to know that they were seeking contraception. Four minors enrolled using the waiver.

All participants in the Contraceptive CHOICE Project were given contraceptive counseling about commonly used reversible contraceptive methods. The methods were presented in order of their effectiveness, and potential side effects were reviewed. The young women were told that they would be given immediate and free access to the contraceptive method of their choice (barring any medical contraindications), including same-day insertion of an IUD or implant.

After this counseling, a significant majority of the teens  — 78 percent of those aged 14 to 17 and 68 percent of those aged 18 and 19 — chose the IUDs or implants.  The younger teens tended to prefer the implants, while the older ones opted most often for an IUD. The remaining 28 percent of the study’s teen participants chose another method of birth control.

Mirena IntraUterine System
Wikimedia Commons
Mirena IntraUterine System

Study results

The young women were then followed for two to three years to see how many became pregnant. The results were remarkable. During the five years (2008-2013) of the study, the average annual birth rate among its teenage participants was 34 per 1,000 teens. By comparison, the national teen pregnancy rate in 2008 was 158.5 per 1,000 teens  — more than four times higher.

The results were similar for births and abortions. The average annual birth rate among the teens in the study was 19.4 per 1,000, which compares with 94 per 1,000 in 2008 for sexually active U.S. teens. And the average annual abortion rate among the teens in the study was 9.7 per 1,000 — much, much lower than the 41.5 per 1,000 rate reported nationally in 2008 among sexually active teens.

Interestingly, two-thirds of the teens in the study who had chosen IUDs and implants were still using those devices two years later, while that was true for only a third of the teens who had chosen shorter-acting methods, such as birth control pills.

Key to reducing teen pregnancies

As the authors of the NEJM study point out, the U.S. Centers for Disease Control and Prevention has set a goal of reducing teenage births to 30.3 per 1,000 teens by 2015. This study achieved a much lower rate than that.

Indeed, the findings demonstrate that full and detailed contraception education, coupled with free and easy access to all available methods of birth control, but especially long-lasting ones such as IUDs and implants, are key to reducing teenage pregnancies.

On Monday, before the NEJM study was published, the American Academy of Pediatrics published new practice guidelines in which they recommended that long-lasting contraceptive devices should be the first choice of birth control for teenage girls.

Let’s hope that our politicians and policymakers are listening.

You can read the study in full on the NEJM website.

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Comments (14)


“…Let’s hope that our politicians and policymakers are listening.”

Sadly, "listening" and "acting" are not at all the same thing, and resistance to the sort of information this column presents will continue to be a factor with mostly (but not entirely) right-wing voters and others who like to call themselves "conservative."

That the emotional, financial and social costs to both society and individuals of providing contraception would be far, far less than our current faux-Puritanical approach to sexuality doesn't seem to matter to zealots.

Why adults?

I wonder why the 18-year and 19-year-olds were included in this study. They are adults. Less than half of the girls in the study were minors. Did the researchers have problems finding enough girls who fit the criteria?
Also, isn't it obvious that the results showed the majority of users wanted long-lasting birth control? It's like doing a study to see if people like ice cream. Of course, they do. I hope the researchers didn't use taxpayer money for this study. What a waste of time.

Reading comprehension is a gift.

You did happen to see that girls under 17 needed permission from their parents to take part in the study? And last I heard, 18 and 19 year olds are still teens. I guess when you don't like the results of something that goes against your ideology, it's just easier to lean on false equivalence to justify your denial of facts.

"I wonder why the 18-year and

"I wonder why the 18-year and 19-year-olds were included in this study. They are adults"

-Because the study was of teenage girls. 20 and up doesn't qualify as 'teenager.' 18 and 19 does.

"Did the researchers have problems finding enough girls who fit the criteria?"

-It's entirely probable that parents, possibly with world-views such as yourself, would not allow their children to participate in the study. Or that the children of parents with such world views would self-censor themselves away from the study.

And no, the results may not be obvious. That's why people ask the question, and then go through a process by which they record facts and use them to hopefully better answer the question. Maybe you think that a 30% pregnancy rate for women under 20 in American society is a good thing,

But I doubt the people doing the study thought it was a waste of time... I don't. In fact, it just adds another layer of evidence to something that has been a known for a long time: giving women access to birth control methods decreases unplanned teen pregnancies and lowers the abortion rate.

So you agree that making it

So you agree that making it over the counter easy is the right thing to do, right?

As you should know, Mr. Swift

neither implants nor IUDs - the method of choice of the majority of study participants - is available over the counter.

Opinions versus Facts

"Also, isn't it obvious that the results showed the majority of users wanted long-lasting birth control?"

That's an opinion. Research needs to be done to make it into a fact. And, even then, the results need to be carefully reviewed to determine their true meaning.

Policies and legislation should be based on facts, not on opinions.

Anti-abortion usually also means anti-contraceptive

Unfortunately those who are anti-abortion are also often anti-contraceptives - especially for teens. History has overwhelmingly demonstrated that the only effective means of preventing abortion it to prevent unwanted pregnancies. If only we could convince public policy makers of this truth. Education and easy access to effect means of contraception should be the norm.

education fails?

We were told for years that all we needed was "more money for sex education" and this problem would be solved.

However, it sounds to me that the public education route has failed and now "free stuff" is the solution.

Maybe we have a "public education problem" that eventually leads to this "public health problem."

Au contraire, Mr. Gotzman

Abortion Rate Hits Record Low. Thanks, Birth Control Advocates!

Falling behind???

" U.S. teen pregnancy rate has fallen substantially over the past two decades, it’s still among the highest in the world and represents, as this study notes, “a stubborn public health problem.”

I guess this is your definition of success?

If the goal is to reduce the number of teen pregnancies,

Mr. Gotzman, then yes, we are moving in the right direction.

As to the larger question of why the rates in the US are so high, relative to other developed countries, then I draw your attention to an excellent paper:

Why is the Teen Birth Rate in the United States so High and Why Does it Matter?


"This paper examines two aspects of teen childbearing in the United States. First, it reviews and synthesizes the evidence on the reasons why teen birth rates are so uniquely high in the United States and especially in some states. Second, it considers why and how it matters. We argue that economists' typical explanations are unable to account for any sizable share of the geographic variation. We describe some recent analysis indicating that the combination of being poor and living in a more unequal (and less mobile) location, like the United States, leads young women to choose early, non-marital childbearing at elevated rates, potentially because of their lower expectations of future economic success. Consistent with this view, the most rigorous studies on the topic find that teen childbearing has very little, if any, direct negative economic consequence. If it is explained by the low economic trajectory that some young women face, then it makes sense that having a child as a teen would not be an additional cause of poor economic outcomes. These findings lead us to conclude that the high rate of teen childbearing in the United States matters mostly because it is a marker of larger, underlying social problems."

As opposed to republican solutions?

Like women holding an aspirin between their knees? That is what's so funny about you folks popping your head out of your bunker to complain about teenage pregnancy. You have absolutely no solutions of your own other than abstinence...which has never worked and will never work.


I have no problem at all with my tax money going to pay for free contraception. As a matter of fact, I'd willingly pay more for that. Much more prudent than waiting and then paying to feed, house, supervise and educate unwanted children at public expense. ALL babies should be WANTED.