Will successful Colorado program to prevent teen pregnancies survive?

Back in 2009, the Colorado Family Planning Initiative started providing free IUDs and other contraceptive implants to low-income women getting care at state Title X family planning clinics. As I described previously, funds from an anonymous foundation supported the purchase of the devices, as well as training for providers and staff and technical assistance – and Colorado teens’ use of these highly effective contraceptives jumped dramatically. The results, Sabrina Tavernise reports in the New York Times, have been startling: “The birthrate among teenagers across the state plunged by 40 percent from 2009 to 2013, while their rate of abortions fell by 42 percent, according to the Colorado Department of Public Health and Environment.” But now the foundation funding has run out, and Colorado’s senate has failed to approve a $5 million expenditure to keep the program running for the next year.

Preventing unplanned pregnancies can save millions of dollars in Medicaid and other public programs; by one estimate, US publicly funded family-planning programs save more than $7 for every dollar spent on them. Investments in long-acting reversible contraceptive, or LARC, methods can be especially helpful for teenagers who don’t want to get pregnant for the next several years. (Last year, the American Academy of Pediatrics advised pediatricians to consider LARC methods as first-line contraceptive choices for adolescents.) And it’s not just about spending money to lessen future Medicaid expenditures – family-planning investments can help reduce poverty and improve women’s economic prospects. Tavernise writes:

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 the women 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. She argues in her 2014 book, “Generation Unbound: Drifting Into Sex and Parenthood Without Marriage,” that single parenthood is a principal driver of inequality and long-acting birth control is a powerful tool to prevent it.

Under the Affordable Care Act, women with private insurance should be able to get any FDA-approved form of contraception, including IUDs, without paying co-payments or co-insurance. As the Kaiser Family Foundation and National Women’s Law Center reported recently, not all plans are complying fully yet. (New HHS guidance spells out requirements in greater detail, which ought to help.) And even if IUD insertion is covered by a woman’s insurance, women in some parts of the country can find it challenging to find a provider who can offer same-day IUD insertion. And, if a young woman is covered under her parents’ insurance plan but doesn’t want them to know about her contraceptive choices, using insurance to receive a copay-free IUD might result in her parents receiving an explanation of benefits statement that spells out which services their daughter received.

Title X helps address these and other barriers to contraception access. Title X providers receive federal grants to provide reproductive-health services to low-income women and men. They are an important source of care for low-income Medicaid beneficiaries and women without insurance; for insured women who want to receive confidential services without alerting their primary policy holders; and for women who live in remote areas or face other barriers to receiving care from non-Title X providers.

Because they offer care on a sliding-scale fee basis to women without insurance (or who don’t want to use insurance for confidentiality reasons), Title X centers’ budgets are limited. They can find it financially difficult to stock IUDs when the devices cost them $300 - $500 and they also need to budget for related provider and staff training. The Colorado Family Planning Initiative helped the state’s Title X providers overcome these barriers and increase access to LARCs.

State-level family-planning initiatives will become increasingly important if the federal government’s Title X spending declines. As I reported earlier this month, the House FY 2016 appropriations proposal includes no money for Title X, while the Senate bill would give it 10% less than FY 2015.

As far as I can tell, neither the federal nor the Colorado legislators refusing these family-planning investments are arguing that they aren’t cost-effective. In a Huffington Post blog post, Jason Salzman summarizes some of the arguments against funding Colorado’s program, and concludes: “Republicans in Colorado still don't know how to talk about birth control in a way that makes sense to normal people. It appears that that's because they don't like birth control, and most people do.”

I realize it’s not uncommon for legislators to deny funding to public-health programs that are demonstrated to be effective and save money over the long run – and that includes programs like poison control centers and lead poisoning surveillance, which have nothing to do with birth control. Those programs often get little public attention, though, and that’s certainly not the case when it comes to the Colorado Family Planning Initiative. A news release from the Colorado Department of Public Health and the Environment reports that the Department continues to seek funding to continue the program. I hope they secure the funding so that Colorado can build on its impressive achievement of reducing teen and other unplanned pregnancies.


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