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On LARCs: The St. Louis Study, Colorado, and Political Will

Not sure what a LARC is? We didn't know, either, until the St. Louis Study came out in 2010.

LARCs are long-acting reversible contraceptives - like IUDs - and they are considered exceptionally effective at preventing unintended pregnancies. Unfortunately, the barrier to entry is the upfront cost which is often in excess of $700. Over the life the LARC, that cost amortizes down to be less than birth control pills. But most women don't have $700 lying around.

So researchers set out to see what the impact on unintended pregnancies would be if they removed that financial barrier. Let's take a look at what they did. (Full paper here.)



To introduce and promote the use of long-acting reversible methods of contraception (LARC; intrauterine contraceptives and subdermal implant) by removing financial and knowledge barriers.


The Contraceptive CHOICE Project is a prospective cohort study of 10,000 women 14-45 years who want to avoid pregnancy for at least one year and are initiating a new form of reversible contraception. Women screened for this study are read a script regarding LARC to increase awareness of these options. Participants choose their contraceptive method that is provided at no cost. We report the contraceptive choice and baseline characteristics of the first 2,500 women enrolled August 2007 through December 2008.


Sixty-seven percent of women enrolled (95% confidence interval: 65.3, 69.0) chose long-acting methods. Fifty-six percent selected intrauterine contraception and 11% selected the subdermal implant.


Once financial barriers were removed and LARC methods were introduced to all potential participants as a first-line contraceptive option, two-thirds chose LARC.


Ok. A couple of key things that this paper discusses and addresses that simply don't get enough airtime in any debates on abortion or family planning.

First, of the approximately 6M pregnancies that occur annually in the US, about 50% are unintended. And, *half* of those women report having used contraceptive in the month in which they got pregnant. As the study's authors write, "Because most women use a contraceptive method with adherence requirements, the majority of pregnancies result from incorrect or inconsistent method use rather than from method failure." The study's authors are in no way trying to place further burdens on women - who are already disproportionately burdened with the responsibility of pregnancy prevention and family planning - they are simply trying to explain the real efficacy and potential impact of a method of birth control that has no adherence requirements.

Second, only 3% of all women were using LARCs at the time of the study - a figure that has increased to nearly 8% in subsequent years. Yet, this is a family planning tool that is incredibly effective at doing its job and has no adherence requirements! Why not make it widely available? For those lawmakers who claim to care about women's reproductive health, why not invest heavily in LARCs and increase access to this most effective contraceptive method?

Colorado saw that data and made that choice. Colorado instituted a statewide public health program - with the support of private grants - and removed the financial barrier to LARCs. They made IUDs widely accessible. (There were even IUD pins worn by lawmakers who supported the effort.)

And watch what happened: "The steep drop in teen pregnancies and abortions in Colorado since 2009 is mainly due to one thing: free, low-cost access to IUDs. Intrauterine devices — tiny, T-shaped pieces of plastic placed in the uterus — are the main reason Colorado’s teen birth rate fell 54 percent and the teen abortion rate declined 64 percent," between 2009 and 2017.

This is well within the realm of possibility for Wyoming, a state with a small population and a robust State Public Health Department. What we need now is the will to do it.

Ladies, let's help our lawmakers work up their will.

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