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The New England Journal of Medicine is reporting the results of the Contraceptive CHOICE project in St. Louis, Missouri. The teenagers 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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