Each Baby: Wanted, Loved And Planned

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We’re doing something wrong, but it’s fixable now.

For years, researchers have said that among industrialized countries, the U.S. has the highest rate of unintended pregnancies, at 49 percent. Such pregnancies are even higher among poor, low-income, and less-educated women.

Intended pregnancies tend to signal a family’s readiness for the huge transition brought by the addition of a new member. Intended pregnancies tend to be healthier, and require less public funds outlay. Intended pregnancies also tend to go full-term.

Of the country’s unintended pregnancies, the Guttmacher Institute says more than four in 10 end in abortion.

The Affordable Care Act, with its much-discussed contraceptive mandate, could have a dramatic effect on those numbers, say two new studies. Washington University’s Contraceptive CHOICE Project found that when birth control is offered free – as specified under Obamacare as of Aug. 1  – 75 percent of women chose more effective, long-acting, reversible contraceptives (known as LARC) such as IUDs, or contraceptive intrauterine devices.

And years after making that choice, the vast majority of women – 86 percent – were still using long-acting contraceptives.

Independent of federal health care reform, more women are choosing long-acting birth control methods, at 8.5 percent in 2009, as opposed to 3.7 percent in 2007, and 2.4 in 2002, according to a recent Guttmacher study.  That increase was pretty much across the board in most every race, age, education, and income group – with slightly more interest among younger women.

Makes sense, doesn’t it? “Isn’t that what we all want?” said Dr. Mary Jane Minkin, clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University. “We want each baby to be a wanted, loved, and planned baby.”

The Washington University study looked at 10,000 women and found that those who used IUDs or the Depo-Provera injection had the lowest unintended pregnancy rates in the first three years of follow-up, while pill, ring, and patch users had unintended pregnancies at more than 16 times that rate.

Removing the cost, women tend to go with methods that don’t require much planning, and so can’t be rendered less effective by user error. Minkin said studies show birth control users might skip three or four pills in a cycle, and “that’s a doomed situation,” she said.

IUDs are becoming popular among younger women, particularly among teenagers where unintended pregnancies are dropping, according to the Centers for Disease Control and Prevention.  But those young pregnancies still account for nearly $11 billion each year in costs to taxpayers for, says the CDC, “increased health care and foster care, increased incarceration rates among children of teen parents, and lost tax revenue because of lower educational attainment and income among teen mothers.”

Minkin said younger women tend to consider IUDs because they don’t have a history with – or knowledge of – devices such as the Dalkon Shield, which in the early ‘70s was purchased by an estimated 2.5 million women, and resulted in hundreds of thousands of lawsuits over a potentially fatal design flaw.  But today’s IUDs are nothing like those of the ‘70s.

Obamacare could affect unintended pregnancy and abortion rates fairly quickly, Minkin said. How long depends on how quickly the message gets out that contraceptives and other preventive health care services for women carry no insurance co-pay under the new health care reform law.

“That’s the variable,” said Minkin. “How quickly can we get the message out: ‘Just go to the clinic for free, and they’ll take care of it. Go to your doctor. This is available.’ If we get the message out, I would say you’ll see differences in two or three years.”



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