Colorado contraception program was a huge success – but the GOP is scrapping it

Over the past seven years, Colorado has run an experiment to see if it could lower the rate of unintended pregnancies, cut abortions – and save the state government some money, too.

The Colorado Family Planning Initiative (CFPI) offered low-income women and teenagers access to low or no-cost contraceptive devices, including IUDs and implants, and trained providers in insertion and counselling techniques. Last year, researchers reported significant drops in the birth rate among teens and young adult women in participating counties. The abortion rate among women between 15 and 19 years old dropped by more than a third; high-risk pregnancies by a fourth.

In July the governor’s office issued a glowing press release, crediting the program with a 40% statewide drop in teen birth rates between 2009 and 2013 – and a 35% drop in abortions.

But, despite the program’s widely reported successes, last Wednesday Colorado’s Republican-controlled senate killed a bill that would sustain and expand CFPI services.

“Unfortunately, family planning is a political issue and science and data gets trumped by ideology,” Greta Klingler, who works for the Colorado department of public health and environment, and who authored the CFPI report, told the Guardian.

“It’s a missed opportunity for the people of Colorado, many of whom still don’t have access to the best most effective methods and services out there,” she said. The program has also been “shown to save the state an enormous amount of money, so there’s the economic piece of this too”.

The CFPI was set up in 2009 with funding from the Susan Thompson Buffett Foundation. The program paid for IUDs and birth control implants – together known as long-acting, reversible contraceptives, or Larcs – at 68 low-income Title X clinics across the state. Without the funding, these highly effective birth control methods have a high up-front cost – between $500 and $1,000 each.

Since it started, CFPI has distributed more than 30,000 Larc devices. Researchers reported that between 2009 and 2011, Larc use among 15-24 year-old Colorado women using Title X clinic services rose from fewer than 5% to 19%. By 2013, that number climbed to 26%.

With foundation money set to run out this year, supporters of the initiative turned to the state for funding to sustain and expand the program. Governor John Hickenlooper and other Democrats threw their support behind a bill that would put $5m towards continuing the Larc program.

Last Monday, the bill passed the Colorado house with bipartisan support.

“If you’re anti-abortion and also a fiscal conservative, I think this is a win-win situation for you,” Don Coram, a conservative Republican in the Colorado House who supported the bill, told NPR.

But, two days later, the bill was shut down in senate committee.

Republican senators expressed concern over funding the program on various grounds, including redundancy – arguing that state and federal money already goes to general family planning services, so there’s no need to fund a specific program, Klingler said. Others raised the disputed concern that IUDs themselves can cause abortions.

“It basically comes down to political positions – what people support and don’t support ideologically. And women’s health is a big point of contention,” Klingler wrote in an email to the Guardian after the bill’s defeat.

Experiments in other states

The CFPI may currently have the spotlight, but it’s not the first program to test whether removing cost barriers to the most effective contraceptives – and educating women and providers – might reduce unwanted pregnancies and improve health outcomes.

In Iowa, a similar program ran between 2007 and 2012, and yielded positive, though more modest, results. (Funding for that program, which also came from the Buffett Foundation, ran out in 2011, but data was collected through the next year.)

St Louis’s Contraceptive Choice Project, which also ran from 2007-11, introduced an innovative educational model, counselling women on contraceptives starting from the most effective methods – IUDs and implants – to the least. 72% of Choice Project participants chose Larc methods as their primary form of birth control – compared to around 5% nationally. The project also reported one-third fewer births compared to the national average.

“What happened in Colorado is disappointing,” said Dr Jeffrey Peipert, professor of obstetrics and gynecology at Washington University in St Louis, and a lead researcher on the Choice project, but each of these programs “have played a big role in making Larcs more mainstream,” he added.

Indeed, IUDs and birth control implants have gained in popularity over the past decade, according to the CDC. IUDs, especially, have rebuilt their reputation, long scarred by a poorly designed device called the Dalkon Shield which left many women infertile during the 1970s.

A new generation of Larcs has proven safe for women of all ages and highly effective at preventing unintended pregnancies. Now, many researchers, healthcare providers and even lawmakers hope Larcs can help bring down America’s high rates of unintended pregnancy, especially among teens.

“We’ve shown over and again that we can reduce the need for abortion and we can reduce unplanned pregnancies and improve health outcomes for young women at the same time” by making Larcs more accessible to young women, Peipart said.

“I think legislators will realize these are positive, cost-saving programs over time. But there are a lot of pieces to this: we need state support, but we also need insurance support, provider support, and patient knowledge and demand – to have people asking about Larc methods. Many of these fall a little short right now, but we’re seeing changes,” he said.