Free long-term birth control cuts unwanted pregnancies

Women with access to free long-term birth control after an abortion are more likely to use it and avoid future pregnancies, according to a study in Texas.

On the other hand, low-income women who were ineligible for free long-acting reversible contraception (LARC), such as an intrauterine device (IUD) or arm implant, were much more likely to use less effective contraception.

“As a result, these women were more likely to become pregnant again within the year and seek an abortion again,” said study author Vinita Goyal of the University of Texas at Austin. The study was conducted at Planned Parenthood of Greater Texas in Austin.

In Texas, a waiver program of Medicaid, the federally-funded insurance for the poor that is administered by states, uses a combination of federal and local funds to offer free LARC to low-income uninsured women from Travis County, which includes Austin.

“In the absence of state family planning funded programs, or in programs that restrict access and leave certain women out, specialized funding can fill in that gap and play an important role for low-income women,” she told Reuters Health.

Texas legislative policies have cut funding for other abortion clinics in the state, meaning that residents of other counties often seek abortions in Travis County, but if they don’t live in the county, they are not eligible for the Medicaid 1115 program’s free LARC.

Goyal and colleagues recruited more than 500 abortion patients between October 2014 and March 2016 who fell into three groups – low-income uninsured Travis County residents who were eligible for the specialized funding, low-income uninsured non-residents of the county who were ineligible for the funding and high-income insured women who were ineligible for the funding.

The women answered questionnaires about their interest in using long-acting contraception after the abortion, and researchers followed the women for the next year to see what kind of contraception they used and whether they had another unwanted pregnancy.

The study team found that pre-abortion preference for LARC was high among women in all three groups: 64 percent of eligible low-income women, 44 percent of ineligible low-income women and 55 percent of ineligible high-income women.

After abortion, 65 percent of the eligible low-income women received long-term birth control, compared with 5 percent of ineligible low-income women and 24 percent of ineligible high-income women. Among those who received LARC, 90 percent of low-income women still used it a year later.

Ineligible low-income women were also more than three times as likely as eligible women to have another unwanted pregnancy, the researchers report in Obstetrics and Gynecology.

“This highlights what we’ve been learning the past five years about women’s preference for contraception, and access for long-term methods isn’t where it needs to be yet,” said Dr. Colleen McNicholas of Washington University School of Medicine in St. Louis, who wasn’t involved with the study.

“The (Affordable Care Act) contraceptive mandate was a good step forward, but the implementation by the health insurance companies isn’t there,” she told Reuters Health. “Contraceptives are one of the most important preventive measures for women, and access shouldn’t depend on ZIP code or how much you earn.”

If all U.S. women had full access to LARC, the country could see a 64 percent drop in unintended pregnancies, 63 percent drop in unintended births and 67 percent drop in abortions, according to a February analysis from the nonprofit research organization Child Trends. It was based on a simulation model created by Child Trends and the Brookings Institution think tank using data from a 2015 University of California, San Francisco (UCSF) randomized trial.

“It is certainly possible that the contraceptive mandate may end with the current government’s plan to repeal and replace the ACA,” said Corinne Rocca, a researcher on the UCSF trial who was not involved in the current study.

“This week, we are also learning that the ACA replacement plan will likely cut funding to Planned Parenthood because it provides abortion care,” she told Reuters Health by email. “It is really important that people understand the effects that cuts to funding are likely to have on women’s ability to use birth control they want and prevent unwanted pregnancy.”