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How Colorado lowered teen pregnancy rate by 40%

Teen birthrates and abortions plummeted in Colorado in the last six years after the state's health department ensured free birth control to more than 30,000 women.

From 2009 to 2015, the Colorado Family Planning Initiative provided women around the state with intrauterine devices (IUDs) or implants, types of long-acting reversible contraceptive (LARC) at little or no cost. During that period, teen births dropped 40 percent and abortions fell 35 percent, according to the Colorado Department of Public Health and Environment.

"Over the last few years, there's been a lot more attention placed on the success of LARC because unlike pills or barrier methods like condoms, LARC has a very high success rate when it comes to preventing unintended pregnancy," Dr. Larry Wolk, executive director and chief medical officer for the department told CBS News. "Specifically for teenage and young adult women who may be in transition periods of their lives, to take the potential for human error out of the equation and provide that level of protection and security is really a significant advantage over other methods."

For comparison, oral contraceptives have a failure rate of 9 percent, while condoms have a failure rate of 18 to 21 percent, according to the Centers for Disease Control and prevention. IUDs and implants, which are effective for five to 10 years, have failure rates below 1 percent.

The use of LARC methods has increased nearly five-fold over the last decade, according to a 2015 report from the CDC. And just last year, the American Academy of Pediatrics updated its recommendations, suggesting IUDs and implants should be the "first line" of contraceptives in preventing teen pregnancy.

"Teens are complicated," said Dr. Jenny Francis, an Adolescent Medicine specialist and Assistant Professor of Pediatrics at Columbia University Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital in New York City. "They're forgetful, nervous, anxious, awkward, transitioning. Give them the option of an IUD or contraceptive implant and now their worries and quirks around sex and preventing pregnancy are taken care of in one setting for the next five to 10 years."

Though the overall upfront cost of receiving an IUD can run from $600 to $1,000, Francis pointed out that overtime, IUDs yield immense savings. "Studies conducted by demographers to evaluate the cost-effectiveness of LARC, consistently shows the same evidence: investing in LARC prevents larger, down-stream expenses associated with unintended pregnancies," she said.

While LARC methods are covered under the Affordable Care Act, several loopholes exist and some insurers may not cover the full cost of the device and its insertion. Experts say confidentiality is also a problem, as teens are less likely to get IUDs when their parents' insurance companies send a letter home explaining the procedure.

"Even though I always encourage parent-adolescent communication about sex, it's the teenager who I see in a private practice setting who will ultimately face breeches in her confidentiality when the insurance company 'spills the beans' to her parents about my ordering an IUD for her," Francis said. "If you want teenagers to seek reproductive healthcare, then cost is not the only factor we need to address. Privacy and confidentiality are just as important to a teenager."

In Colorado, the LARC program helped fill these gaps for the past five years. But the private grant that bolstered it is running out, and the state's health department is seeking more funding to keep the project going.

"We are working closely with our partners who believe in this initiative to find the funding necessary to continue providing contraceptive choices to young women across Colorado," Wolk said in a statement. "Making sure Colorado women have access to safe and effective contraception is an investment in their futures and ours."

Francis hopes the success seen in Colorado will influence broader policies ensuring access to LARC methods for women across the country.

"Colorado's precedence will hopefully persuade federal mandates to ensure all insurance companies (federal and commercial) to provide full reimbursement for LARC, 100 percent of the time for all women," she said.

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