Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review

Natalia E Birgisson, Qiuhong Zhao, Gina M Secura, Tessa Madden, Jeffrey F Peipert, Natalia E Birgisson, Qiuhong Zhao, Gina M Secura, Tessa Madden, Jeffrey F Peipert

Abstract

The Contraceptive CHOICE Project (CHOICE) sought to reduce unintended pregnancies in the St. Louis Region by removing cost, education, and access barriers to highly effective contraception. CHOICE was a prospective cohort study of over 9,000 women 14-45 years of age who received tiered contraceptive counseling to increase awareness of all reversible methods available, particularly long-acting reversible contraceptive (LARC) methods. Participants were provided with contraception of their choice at no cost for 2-3 years. We studied contraceptive method choice, continuation, and population outcomes of repeat abortion and teen pregnancy. Seventy-five percent of study participants chose one of the three LARC methods (46% levonorgestrel intrauterine system, 12% copper intrauterine device, and 17% subdermal implant). LARC users reported greater continuation than non-LARC users at 12 months (87% versus 57%) and 24 months (77% versus 41%). In our cohort, LARC methods were 20 times more effective than non-LARC methods. As a result, we observed a reduction in the percent of repeat abortions from 2006 to 2010 in St. Louis compared with Kansas City and nonmetropolitan Missouri and found substantial reductions in teen pregnancy, birth, and abortion (34.0, 19.4, and 9.7 per 1000 teens, respectively) compared with national rates among sexually experienced teens (158.5, 94.0, and 41.5 per 1000, respectively). Improved access to LARC methods can result in fewer unintended pregnancies and abortions and considerable cost savings to the health care system.

Figures

FIG. 1.
FIG. 1.
Twelve- and twenty-four-month continuation by contraceptive method. IUD, intrauterine device; LARC, long-acting reversible contraceptive; LNG-IUS, levonorgestrel intrauterine system; OCP, oral contraceptive pill.
FIG. 2.
FIG. 2.
Cumulative failure rates at 1, 2, and 3 years for LARC and non-LARC methods.
FIG. 3.
FIG. 3.
Change in LARC use from 2006 to 2013 in two St. Louis family planning clinics.

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Source: PubMed

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