We’ve been reading a lot in the press lately about Colorado’s success bringing a dramatic decline to its teen birth rate. This decline mirrors the national trend in declining teen pregnancy rates. As with most public health issues, but especially those that relate to sexual and reproductive health, there are a myriad of potential explanations for the decline. The most important questions we need to ask now are: Does the decline in teen pregnancy rates indicate better reproductive health choices and outcomes for women? And if so, how do we continue to build on this success?
The decline is, in part, due to more effective contraception and increased access to and use by women. A study from the journal Fertility and Sterility supports this view with the finding that use of long-acting contraceptives such as intrauterine devices (IUDs) had tripled between 2009 and 2013, with most of this increase happening within the last two years. These data suggest that our efforts in primary prevention are paying off, which is, to us, perhaps the most hopeful explanation.
Given these remarkable outcomes in Colorado, we were disappointed to see that the effort to make the most effective birth control methods available to the state’s most vulnerable was not successful in getting public funds—despite potentially saving taxpayers nearly $6 for every $1 spent on the program and shrinking the abortion rate by 42 percent and the teen birth rate by 40% between 2009 and 2013.
We attribute some of this success to new technology—long active reversible contraception that enables women to “get it and forget it.” But no technology can be successful without the expertise needed to make it effective. More than 40 years ago, under the Title X program, Congress established a network of safety net family planning clinics for people who want family planning services but cannot afford them. This network and their staff in local communities formed the backbone of Colorado’s successful efforts with CFPI, the Colorado Family Planning Initiative which led the charge to get the most effective methods into the hands of women most in need.
JSI has worked closely with many of these local players in assessing and achieving their goals for teen pregnancy prevention within the community. From 2009 -2011, we worked closely with both Pueblo and Boulder counties on teen pregnancy studies designed to explore issues and factors associated with choosing birth control methods and unintended pregnancy. Two key messages came out of these studies: The first is that young women (and men) want information about making healthy choices if they decide to become sexually active; and secondly, their parents and health care providers are their most trusted sources of information. Participants in the JSI studies underscored the value of providers. The information imparted during a contraceptive method visit is very important, as it enables women to choose and employ contraception with satisfaction and technical competence. A long-running quality improvement project with Title X Family Planning clinics found that a lack of information is a reason for discontinuing method use, and belief in rumors may be a deterrent to use altogether. The common response in this study was that women would like more information about the method that they are going to use so that they can make sure that it will fit into their lifestyle, among other considerations.
At JSI, we feel honored to work closely with Title X programs at the local, state, and national levels. Title X standards of evidence-based care are documented in the Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs. We work closely with Title X agencies and other safety net providers to help them deliver high quality care and remain sustainable in the changing health care landscape. What we see is a strong network of committed professionals striving to ensure that people are able to choose when and how many children to have.
From our decades of experience working with the Colorado Department of Public Health and Environment and other local agencies focusing on population health issues, including reproductive health, we recognize that CFPI hit on something important. Although the Affordable Care Act ensures that health plans cover free contraception to women, access to affordable, effective methods remains elusive to low-income women who remain uninsured, and for some communities, finding a health care provider with the expertise to offer this new contraceptive technology can be a challenge. Programs such as CFPI eliminates barriers low-income women often face to accessing the most effective contraceptives, and the Title X provider network ensures that communities have a trusted resource for these services when needed.
The staff at the Colorado Department of Public Health and Environment are thought leaders, not just on this topic, but also on other aspects of ensuring that men and women are able to choose the number and spacing of their children. We are grateful for the opportunity to work so closely with the local Title X family planning providers and other reproductive health organizations on the front lines of what we believe is a most fundamental aspect of public health: family planning, which impacts poverty, housing, environment, education, and many other social determinants of health.
The Colorado Title X network took a very measured and thoughtful approach to how they implemented the program. Armed with evaluation data and cost-effectiveness analyses, now they have a value proposition to make the case to private foundations for continued funding for this important program—at least until the Colorado Senate realizes: this new contraceptive technology does not cause but prevents abortions; this technology is actually less costly in the long-run than other methods; and this technology is just another (albeit more effective) option that does not influence levels of parental involvement.
We have much to learn from our colleagues in Colorado who are navigating this important program for young Coloradans in support of their bright futures. At the state level, their approach was clearly for the long haul—gathering the data needed to demonstrate impact and tackling this issue on multiple fronts. At the local level,Title X providers were at the ready—thoughtfully and skillfully providing the information and services their patients requested. Other states could also benefit from Colorado’s playbook and lessons learned.
We wish every success to our Colorado colleagues as they continue their journey to ensure that men and women have the freedom to choose the number and spacing of their children. We are hopeful that Colorado lawmakers will eventually see how this program is not only good for Colorado’s bottom line, but it can also strengthen the social fabrics of communities and improve the lives of the people who live here.