Life is complicated; birth control doesn’t have to be

Callie Waller, D.O., a 2011 DMU graduate, chose to be a primary care physician because she wanted to be closely connected to patient care. Now in her second year of residency at Lutheran Hospital in Des Moines, she is gaining experience that helps her apply her knowledge and skill in the real world.

“I was in medical school when I first learned that almost 50 percent of all pregnancies are unintended,” Callie told me. “That surprised me and made me curious about why this happens.”

Callie is not the only one surprised about why this happens.

Almost half of all pregnancies in Iowa and across the U.S. are unintended, one of the highest levels in the developed world. Unintended pregnancy is especially a problem for young adults, according to studies by Mary Losch, Ph.D., assistant director of the Center for Social and Behavioral Research at the University of Northern Iowa: Among Iowa women ages 18 to 30, 47 percent of pregnancies are unintended; for those ages 18 and 19, that figure soars to 79 percent.

This high rate of unintended pregnancy hasn’t really changed in 30 years, despite the development of more advanced methods of contraception. Yet in those same three decades, the average age at marriage has risen from 24.8 years to 28.7 years for men, and from 22.3 years to 26.5 years for women. And since the typical woman wants only two children, she spends approximately three decades trying to avoid pregnancy. The most common forms of birth control – pills and condoms – require correct and consistent use. That means never missing a pill or never breaking a condom. That kind of perfection turns out to be pretty rare.

But what would happen if women had access to the least complicated, most effective contraceptives – Long Acting Reversible Contraceptives (LARCs) – that, once inserted, protect against pregnancy until removed? Would unintended pregnancies and abortions decrease?

That was the question we hoped to answer through the work of the Iowa Initiative to Reduce Unintended Pregnancies. The Iowa Initiative began in 2008 in partnership with the Iowa Department of Public Health, the Family Planning Council of Iowa, and the Center for Social and Behavioral Research at the University of Northern Iowa.

Over the past five years, this privately funded nonprofit has invested millions of dollars in grants to family planning clinics throughout the state to increase access to services. Through outreach and marketing we have increased women’s awareness of the most effective methods of contraception, like intrauterine devices (IUDs) and implants, and made them available at little or no cost through Title X health clinics.

In order to accurately measure the effects of this project, independent evaluators have been gathering the data reflecting changes in the use of IUDs and implants and the rates of unintended pregnancies and abortions. Those data will be shared at a conference this fall and made available to medical professionals, policymakers and the public. Preliminary findings show an increased use of IUDs and implants, and a reduction in unintended pregnancies and abortions. This is certainly good news for everyone.

Unintended pregnancies increase the risk of unhealthy outcomes for children and families, and cost taxpayers millions of dollars for prenatal and delivery costs and maternal and pediatric care. So a successful demonstration of how to reduce unintended pregnancies could have a huge impact on reducing health care costs.

Studies have shown that for every $1 invested in publicly funded family planning, almost $4 is saved in averted Medicaid birth costs. Implants, for example, can cost less than $400 and are good for three years, and IUDs may cost up to $900 and are good for five to 10 years, while the costs of labor, delivery and first-year baby care exceeds $12,000.

The Iowa Initiative is working with community leaders and health care providers statewide to build support for family planning services and the most effective birth control options – services and options that will reduce significant social and economic costs to women, taxpayers and communities.

Iowa’s experience can be a model for the nation and provide health care professionals and policymakers evidence-based information to guide future decision-making and practice.

Iowa’s experience can be a model for the nation and provide health care professionals and policymakers evidence-based information to guide future decision-making and practice. (Federal law now requires most insurance plans to provide these options without a patient co-pay.)

Health care professionals, like Callie and her colleagues, are key players in this critical effort. She shared with me her eye-opening experience of congratulating a newly pregnant patient, only to realize the pregnancy was not good news to this woman. Callie said she has met patients who have suffered from depression, dropped out of school or were otherwise emotionally and economically devastated by becoming pregnant.

“As providers, we need to talk about birth control and not be shy about it. We need to educate patients so they have the control and the choice,” Callie told me. “There’s a bottom line to this issue that goes beyond the individual. It’s an issue for communities, the state and for society.”

We’ve learned something important in Iowa, and we need to share it widely: Access to family planning services with a full range of contraceptive options can reduce unintended pregnancies and abortions – saving money and improving lives.

Sally Pederson is executive director of the Iowa Initiative to Reduce Unintended Pregnancies and an adjunct assistant professor of global health at DMU. As Iowa’s lieutenant governor from 1999 to 2007, she led successful efforts to expand access to health care for children, require insurance coverage for mental illness, and create 1,000 new units of affordable housing for people with disabilities. Yogesh Shah, M.D., DMU’s associate dean of global health, serves on the board of directors of the Iowa Initiative. To learn more about the organization, visit www.iowainitiative.org.