The New England Journal of Medicine is
reporting the results of the Contraceptive
CHOICE project in St. Louis, Missouri. The teenager were
educated about using long-acting contraception such as
intra-uterine devices (IUDs) versus shorter acting contraception
such as the pill. The project enrolled 1404 teenage girls and women
and followed them for two to three years. The pregnancy, birth, and
abortion rates among participants were much lower than the national
average. As the NEJM article notes:
Although it has declined substantially over the past two
decades, the pregnancy rate among girls and women 15 to 19 years of
age remains a stubborn public health problem. Each year, more
than 600,000 teens become pregnant, and 3 in 10 teens will become
pregnant before they reach 20 years of age. Rates are higher
among black and Hispanic teens, with 4 in 10 becoming pregnant by
20 years of age, as compared with 2 in 10 white teens. In
addition to the negative health and social consequences borne by
teenage mothers and their children, the national financial burden
is substantial. In 2010, births involving teenage mothers cost the
United States nearly $10 billion in increased public assistance and
health care and in income lost as a result of lower educational
attainment and reduced earnings among children born to teenage
mothers.
The results as reported in the abstract:
Of the 1404 teenage girls and women enrolled in CHOICE, 72%
chose an intrauterine device or implant (LARC methods); the
remaining 28% chose another method. During the 2008–2013 period,
the mean annual rates of pregnancy, birth, and abortion among
CHOICE participants were 34.0, 19.4, and 9.7 per 1000 teens,
respectively. In comparison, rates of pregnancy, birth, and
abortion among sexually experienced U.S. teens in 2008 were 158.5,
94.0, and 41.5 per 1000, respectively.
The report adds …
… we found that in a cohort of teenage girls and women for
whom barriers to contraception (lack of knowledge, limited access,
and cost) are removed and the use of the most effective
contraceptive methods is encouraged, a large percentage opted to
use LARC methods.
So is unintended pregnancy a public health issue or a private
personal mistake, or both?
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