After Gov. John Hickenlooper announced a significant drop in the state’s teen birth rate on July 3, local family planning providers heralded similar statistics in Summit County.
From 2009 to 2013, teen births declined by 40 percent across the state, and the Colorado Department of Public Health and Environment attributed most of that drop to a five-year initiative that has helped low-income women get long-acting reversible contraceptives.
Long-acting reversible contraceptives, which include intrauterine devices (IUDs) and hormonal implants, are recommended for young women by organizations including the American Academy of Pediatrics and the Centers for Disease Control and Prevention, said Molly Lee, a nurse practitioner and director of programs at the Summit Community Care Clinic.
“It really is a genius thing,” she said. “Family planning is all about making sure that you’re getting pregnant when you want to get pregnant.”
AFFORDABLE BIRTH CONTROL
However, before the initiative, many Colorado women couldn’t afford those birth control methods. The devices often cost $400 to $500 and doctor visits cost around $400, Lee said, pushing the whole bill close to $1,000. It was frustrating to know those methods were available, she said, but the clinic’s patient population, mainly low-income and uninsured residents, didn’t have access to them.
Starting in 2009, the Colorado Family Planning Initiative aimed to show that making those contraceptives available to women who wanted them but couldn’t afford them would lower pregnancy rates. The initiative, funded by an anonymous private donor, addressed barriers to access by training providers and paying for contraception methods at Title X-funded clinics.
The Title X Family Planning program, enacted in 1970, is the federal grant program dedicated to providing comprehensive family planning and related preventive health services. The Summit Community Care Clinic is a Title X clinic.
‘RIDICULOUSLY SUCCESSFUL’ RESULTS
After five years of the initiative, the state health department has collected and analyzed enough data to confidently speak about results, which before health care providers could only talk about anecdotally.
In Summit County, the rate of live births among 15- to 19-year-olds dropped from 54 per 1,000 in 2008 to 10.3 per 1,000 in 2013. In those same years, the clinic saw the percentage of teens using long-acting reversible contraceptives triple from 4 percent to 14 percent.
“That is hugely, enormously, gigantically substantial,” Lee said. “That’s ridiculously successful. It’s so great.”
The initiative has provided more than 30,000 intrauterine devices (IUDs) or implants at low or no cost to low-income women at 68 family planning clinics across Colorado.
By 2011, use of long-active reversible contraceptives by 15- to 24-year-olds statewide increased from 5 percent to 19 percent, according to a Colorado Department of Public Health and Environment study that will be published in the journal Perspectives on Sexual and Reproductive Health this fall. One in 15 young, low-income women had received one of those contraceptives, up from one in 170 in 2008.
While the family planning initiative helped thousands of young women avoid unintended pregnancy, it also helped reduce social and economic costs to Colorado.
The teen abortion rate dropped 35 percent from 2009 to 2012 in the counties served by the initiative. The infant caseload for Colorado WIC, a program that provides nutrition education and support to low-income women and their babies, fell 23 percent from 2008 to 2013.
And Colorado saved millions in health care expenditures associated with teen births — $42.5 million in public funds in 2010 alone based on the latest available data.
“This initiative has saved Colorado millions of dollars,” Gov. Hickenlooper said. “But more importantly, it has helped thousands of young Colorado women continue their education, pursue their professional goals and postpone pregnancy until they are ready to start a family.”
The program’s overall success is proof that health insurance plans should cover family planning services, said Amy Wineland, the director of Summit County’s Public Health Department.
“Unplanned pregnancies certainly carry health risks for both the mom and baby,” she said, which include birth defects, low birth weight, elective abortions, maternal depression, reduced rates of breastfeeding and increased risk of physical violence during pregnancy.
Children born to mothers who didn’t plan to have children are more likely to experience child abuse, poor health and educational challenges. Teen mothers are less likely to graduate from high school or earn as much as women who wait to have children.
Seven of 10 teen pregnancies in Colorado are unintended, and unintended pregnancy is considered one of the state’s top 10 winnable battles in public health and environment issues.
In Summit County, Wineland said, unintended pregnancy isn’t a top priority because rates aren’t as high as in larger urban areas. Summit residents have access to the county’s nurse-family partnership program for low-income pregnant women and new parents, she said, and the Community Care Clinic and its school-based health clinics do an amazing job of educating teens in safe sex.
The state initiative has certainly helped the clinic’s efforts, Lee said, but the clinic also has a long history of making sure teens and all patients are well educated about their birth control options.
“Education is the biggest thing,” she said.
PROVIDING SEX ED
Teen program coordinator Shawna Lane said she teaches 15 girls while a male coworker teaches 15 boys. They focus on healthy decision making in general, she said, and cover friendships, puberty, social media safety, dating, consent, abstinence, contraception, STIs, sexual harassment, rape, stalking and threats. They also visit the Community Care Clinic and talk to a nurse about sexual health.
“We talk about things across the board, and it’s really discussion-based,” said Lane, who has been teaching the class for the last four years. She said the program aims to walk alongside youth as they learn and go through new experiences. “From my perspective that’s what makes the biggest change.”
The initiative only funded Title X clinics, so Planned Parenthood of the Rocky Mountains was not involved, said Alison Macklin, director of the organization’s Responsible Sex Education Institute, but the organization supported the initiative.
“We’re really excited because this drop in teen pregnancy is related not only to access to contraception but also to comprehensive sex education,” she said, “one of the key factors in preventing unintended pregnancies.”
The closest Planned Parenthood office to Summit County is in Granby. The organization emphasizes not only educating youth but also giving parents and guardians resources for talking with kids and teens about sex, she said. “We know that youth primarily want to hear this information from parents or trusted adults.”
Funding for the Colorado Family Planning Initiative is expected to run out in the next year.
As the initiative ends, Wineland said, “it’ll be really interesting to see what’s going to happen next.”
State and local health care providers are still figuring out how family planning services and contraceptive methods are covered under the Affordable Care Act.
At the Community Care Clinic, Lee said, “we’re in a little bit of a limbo right now.”
When the clinic can no longer provide long-acting reversible contraceptive for little to no cost, she said, “what we hope is there is a good chunk of our patient population that will be eligible for Medicaid.”
She said every dollar Medicaid pays for family planning services saves $5 later of government money that would go toward keeping moms and children healthy.