Fort Worth Obstetrician-Gynecologist
Member, TMA Committee on Maternal and Perinatal Health
There was such excitement in the office this week. The resident I was working with had just found out she was pregnant. She had done all the right things, getting her medical problems controlled and changing her medications to ones that are safe in pregnancy; she had even started taking her prenatal vitamins. She was a little nervous about the prospect of being pregnant, but she and her husband were very happy with the new path their life was taking.
Now imagine being a single mom with two kids, barely keeping things together in your one-bedroom apartment, and discovering that you are pregnant, again. You had been on the pill; it was the only thing you could afford. But with the day-to-day rush of life, it was hard to keep track of the pills and when you had taken them, and you may have missed one here and there.
Unfortunately, the second story is the one I see all too often. In the United States, we have an unintended pregnancy rate of 51 percent, and in Texas it is 54 percent. Despite the wide variety of contraceptive options available as well as some very effective forms of contraception, there has not been much change in this number over the past 20 years. While some might think this is simply due to women not using contraception, that only accounts for half; the other half of unintended pregnancies are due to incorrect use of contraception or use of ineffective forms of contraception.
Fortunately, there is hope. The contraceptive Choice project out of Washington University School of Medicine in St. Louis showed us that when women are provided accurate, comprehensive contraceptive counseling as well as contraception at no cost, they often choose the most effective forms of contraception, the IUD and the implant (also known as long-acting reversible contraception or LARC) and continue to use them long term. From this study, it was shown that women had a decrease in the unintended pregnancy rate. We have also learned from Colorado that when women have access to low-or no-cost contraceptive devices (including IUDs and implants), LARC use increases, and the number of unintended pregnancies and abortions decrease. Lastly, for women whose insurance is following the mandate from the Affordable Care Act and covering contraception, there is significant cost savings on contraception, and the hope is that by no longer having the high up-front cost for LARC (sometimes a few hundred dollars), women will be more likely to choose this very effective form of contraception.
Unfortunately, not all insurance companies are following the mandate for contraceptive coverage, and many women still remain uninsured, especially in states that have not expanded Medicaid. The evidence is there that low-cost or free access to LARC increases its usage and decreases unintended pregnancies. We need to get insurance companies to realize this so that our patients can prepare for a pregnancy when they are ready and avoid one when it is not the right time.
Dr. Combs is a Fort Worth obstetrician-gynecologist and assistant professor at the University of North Texas Health Science Center.