Though Utah has the highest birth rate of any state, it also has one of the highest numbers of intrauterine device (IUD) and contraceptive implant users in the nation. Taken together, those two facts suggest that many Utahns are invested in their reproductive health and fertility.
A partnership between the University of Utah Family Planning Research Group and Planned Parenthood Association of Utah (PPAU) has two goals that mirror the needs of many states: empowering women by reducing unintended pregnancy rates and, second, reducing public spending on unintended pregnancy and birth costs. The partners formed the HER Salt Lake Contraceptive Initiative to achieve these goals through free contraception.
From March 2016 to March 2017, HER Salt Lake is providing an estimated 7,000 women at participating PPAU health centers with any contraceptive method they want, for free. In the first six months of the initiative, more than 3,100 women got the contraceptive method of their choice at no cost to them. That included the birth control pill; the ring; hormonal shots; and IUDs and implants, also called highly effective reversible (HER) contraceptives.
IUDs and the implant have high upfront costs and are often inaccessible to many women without insurance or with limited insurance coverage. In Utah, where 16 percent of women ages 15 to 44 are uninsured, 207,350 were in need of publicly funded contraceptive services and supplies in 2014.
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Women without private insurance or Medicaid often rely on Title X-funded or other safety-net health centers to provide family planning services. Even with Title X funding and sliding-scale fees, some health centers are unable to reduce costs on all methods all of the time. Despite reduced out-of-pocket costs, the most desirable methods for some women may still be out of reach, defaulting their contraceptive decision to cheaper, less effective methods.
But once HER Salt Lake provided birth control for free, more than twice as many women left the health centers with an IUD or implant, compared to the six months before the initiative.
Additionally, it’s important to help women find the best method for them, which also includes helping them switch methods. HER Salt Lake is making that possible too. Birth control is not one-size-fits-all, so women benefiting from HER Salt Lake can switch methods in the first three years, for free, until they find the perfect fit for themselves.
Soon, it’s likely that more U.S. women will be using IUDs and implants than the pill. Among women benefiting from the HER Salt Lake Initiative, 46 percent are choosing an IUD or implant compared with 30 percent choosing the pill. The pill revolutionized life for women in the United States and directly contributed to a reduction in unplanned pregnancies and an increase in women graduating from college and entering the paid labor force. If the IUD and implant are dramatically more effective methods of contraception, what kind of result will they have on women’s lives?
The HER Salt Lake Contraceptive Initiative intends to find out and is conducting a longitudinal study to examine the social, educational, economic, and health outcomes associated with free birth control, distinguishing the HER project from other community-level initiatives. The HER Salt Lake research team is enrolling women at participating clinics and following them for three years through surveys.
The team is studying the impact of free birth control on women’s lives. Does free birth control contribute to women’s empowerment and help them reach their educational goals? Improve their economic status? And result in more planned pregnancies and healthy babies? These are a few of the many questions HER Salt Lake strives to answer.
The initial finding that women will choose the most effective methods is more proof that cost is a barrier for women trying to access IUDs and implants. Removing the costs of contraception allows women to choose the method they prefer, which is often an IUD or implant. In turn, women’s risk of experiencing an unintended pregnancy is reduced.
Unintended pregnancies can be costly for women and public systems. Publicly funded family planning services have been shown to save $7.09 for every public dollar spent, according to the Guttmacher Institute. Providing 7,000 women in Utah with contraception is projected to prevent 1,750 unintended pregnancies; 870 unplanned births; 600 abortions; 290 miscarriages from unintended pregnancies; 230 unplanned, short-interval births, meaning a woman gave birth then conceived again within 18 months; and 120 unplanned preterm or low-birth weight births. In addition to the public health investment, the HER Salt Lake Contraceptive Initiative is well on its way to saving the state and federal governments more than $8.5 million dollars from prevented miscarriage, ectopic pregnancy, and maternal and birth-related costs.
Community-level contraceptive access projects like the Contraceptive CHOICE Project and the Colorado Initiative to Reduce Unintended Pregnancy have demonstrated that increasing access to contraception reduces rates of unintended pregnancy and abortion. We know that increased access to contraception reduces the negative social and health impacts of unintended pregnancy.
However, the potential, long-term positive impacts of free IUDs and implants, specifically, are not yet clear.
While oral contraception is effective and popular, IUDs and implants remove user error, are more effective, and may be easier to use correctly and consistently for many women. Additionally, as of 2012, the national rate of women using an IUD or implant (12 percent) was slowly but surely catching up to pill users (26 percent). Since 2014 and the introduction of the Affordable Care Act, private health insurance, Medicaid, and plans in the Health Insurance Marketplace cover contraceptive methods with no out-of-pocket costs for the insured.
Helping women control if and when they get pregnant is a win-win for women, families, and states. Planning and spacing pregnancies improves women’s odds of completing high school and college. Empowering women through contraceptive access allows women to focus on their careers without worrying about an unintended pregnancy. Free birth control is a win for relationships—which are more enduring when women have the ability to control their fertility. States benefit from providing family planning services and supplies. Investing in residents’ family planning goals not only saves money, but also improves people’s lives, autonomy, and social mobility. HER Salt Lake hopes to share Utah’s wins with women, families, and states across the nation.
The views expressed in this article are the views of the author and do not reflect the views of the University of Utah.