Archive for October, 2015

Contraception Saves Lives and Money

Sunday, October 4th, 2015

I suggest going to an article in the Washington Post that not only compliments this column, but also has an excellent graphic showing the effectiveness of the Colorado experiment. Here’s the link:

www.washingtonpost.com/news/morning-mix/wp/2014/08/12/how-colorados-teen-birthrate-dropped-40-in-four-years/

Can you think of any state-funded program that can save seven dollars for every dollar spent? Voluntary family planning programs for teens and young women offer that wide a margin of benefit!

Indeed, family planning can do much more than just save money. It has the ability to change the prospects for people, especially young women. By allowing people to postpone parenthood, they have the opportunity to mature emotionally, complete their education and improve job skills. An experiment, the Colorado Family Planning Initiative (subsidized by a generous grant) has shown the benefit of making effective contraception available to all women.

OK, I have to admit, women bear an unjust proportion of responsibility for family planning. That is the way it is now; I hope that the future will hold more in the way of birth control for men other than just condoms and vasectomy.

An anonymous donor (reported to be the Susan Thompson Buffet Foundation) gave money to fund contraception for women who otherwise couldn’t afford it. This program started in 2009 and finished this summer. It paid about $5 million each year for more than 36,000 women to receive contraceptive information, services and supplies.

Fortunately, during this interval the need for funding decreased because the Affordable Care Act (Obamacare) picked up perhaps 25,000 Colorado women who didn’t have prior coverage. Unfortunately there are still many people who don’t have any insurance coverage and cannot afford contraception. They are especially unable to pay for Long-Acting Reversible Contraceptive (LARC) methods that are so effective, but have an initial cost of about $1000. LARCs include four IntraUterine Devices (IUDs) and one hormonal implant.

In the long run, LARCs are actually less expensive than less reliable methods if you look at the monthly cost over their lifespan of 3 to 10 years. DepoProvera® is almost as effective, but this shot has to be administered every three months, so requires more action on the user’s part.

How did this program save money? If they had gotten pregnant, many of these women would have been on Medicaid or other state-supported programs. Their children would also likely be on taxpayer-funded programs, including children of undocumented women who are citizens as soon as they are born in the USA. The estimate of the amount of money the grant saved just for obstetrical services is $79 million.

The most important savings is in the decrease in the teen pregnancy rate. It is true that all over the country fewer teens became pregnant during the past few years, so not all of the decrease in our state is due to the Initiative. However, Colorado’s teen pregnancy rate dropped an outstanding 40% from 2009 to 2013, largely because of this Initiative.

No one is in favor of unintended pregnancies. This Initiative illustrates what we have known all along: the best way to prevent abortion is with good contraception—and this has been proven over the past 5 years. From 2009 to 2013 the abortion rate for Colorado teens fell 42%, and for women aged 20 to 24 it also dropped significantly.

Good things come to an end, and the Initiative’s grant ended in July. Don Coram, a Republican state representative from Montrose, tried to garner support to continue the program—but unfortunately failed. In stepped private foundations to assure that funding is available.

So far 12 foundations have collaborated to pay $2 million during the next year to continue the Initiative. It remains to be seen whether this will be enough to provide services to all who need them, but it is hoped that more funding will follow. Optimistically the State Legislature will see that this program is saving money and empowering young women to become healthier, more productive citizens and will finally fund this program. And maybe then other states will then get on the bandwagon to follow Colorado’s lead by funding similar programs.

Dr. Eve Espey is chair of the department of OB-GYN in Albuquerque where I trained many years ago. Her paper “Feminism and the Moral Imperative for Contraception” documents the importance of contraception in the modern world. Not only does family planning provide social benefits to individuals and to their societies, but also it saves lives. Spacing the births of babies promotes healthier children and decreases infant deaths. “It is estimated that, in 2008,” she writes “44% (272,040) of maternal deaths were prevented in 172 developing countries owing to use of contraceptives….” Not only does contraception save money; globally it saves a quarter million women’s lives yearly!

© Richard Grossman MD, 2015

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Sunday, October 4th, 2015

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Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.