February 1, 2013 — Summary of "The Evidence Mounts on the Benefits of Preventing Unintended Pregnancies," Finer/Sonfield, Contraception, December 14, 2012.
"Preventing unplanned pregnancies and enabling women and couples to time their childbearing are central public health goals," write Lawrence Finer, director of domestic research at the Guttmacher Institute, and Adam Sonfield, a senior public policy associate at Guttmacher. To reap the "substantial benefits" of preventing unplanned pregnancy, the authors encourage policymakers to heed lessons from three studies recently published in Contraception: one about the costs of unintended pregnancy in the U.S., a second about the impact of subsidized health insurance coverage, and a third about potential shortfalls of universal contraceptive coverage.
Overview of Three Studies
According to the editorial, the first study found that "imperfect adherence to contraceptive methods" accounts for $2.5 billion (53%) of the estimated $4.6 billion annual cost of unintended pregnancy in the U.S. Finer and Sonfield write that the study "highlights the importance of not merely helping women and couples practice contraception but also helping them identify a method that will best fit their current life circumstances and that they will be able to use consistently and correctly." The study's authors project that $300 million to $400 million of the cost of unintended pregnancy could be avoided if 10% of young women switched to long-acting reversible contraceptive methods, such as intrauterine devices and implants, which are more effective than birth control pills because they require little user intervention. Finer and Sonfield note that these findings are consistent with previous research findings that enabling women to choose long-acting methods leads to reductions in unintended pregnancy.
The passage of the Affordable Care Act (PL 111-148) "bodes well" for wider use of long-acting methods, Finer and Sonfield continue, noting that most private health plans are now required to cover all FDA-approved contraceptives without copayments or deductibles.
The second study forecasts the potential impact of expanded contraceptive coverage "by modeling the impact in Oregon of one part of this expansion: access to subsidized health insurance through the upcoming exchanges." The study found that the state's unintended pregnancy rate would be reduced "by nearly one third" and provide "substantial concomitant savings for public and private insurers." Finer and Sonfield also emphasize that the study's projections did not include "the potential impact of the ACA's elimination of out-of-pocket costs for contraception among people who already are privately insured, a policy that should remove a key financial barrier to couples' choosing methods that they can practice consistently and correctly."
However, as the third study demonstrated, "even universal coverage" could not "completely solve the problem of unintended pregnancy," according to Finer and Sonfield. In the study, researchers found that England's National Health Service spends "roughly US$300 million in public expenditures for medical costs related to delivery, abortion, miscarriage and ectopic pregnancy" from unintended pregnancies, even though far fewer people live in England than in the U.S. and its unintended pregnancy rate is about one-third that of the rate in the U.S.
Finer and Sonfield note that the estimates in all three studies are "conservative" and exclude "numerous potential costs," including the "many longer-term government costs that accrue from unintended pregnancies, such as children's health care costs, welfare payments and food subsidies."
The studies also do not "fully account for the health, social or economic costs of unintended pregnancy to women, couples and families," Finer and Sonfield write, adding that additional research to quantify these costs would be "challenging" but would "provide a fuller picture of the burden of unplanned pregnancy."
While "[n]o single contraceptive method is best for all women and couples, ... the best scientific evidence suggests that we are underutilizing the methods available now," the authors write. They add, "Empowering women and men with the information, advice and options ... they need to make the best use of these methods" -- such as switching to IUDs or using shorter-term methods more consistently -- could "achieve goals at both the individual and family levels."
Additionally, reducing unintended pregnancy "could also reap benefits at the population level by reducing costs to public and private payers," they conclude.
Debra Ness, publisher & president, National Partnership
Andrea Friedman, associate editor & director of reproductive health programs, National Partnership
Melissa Safford, associate editor & policy advocate for reproductive health, National Partnership
Perry Sacks, assistant editor & health program associate, National Partnership
Cindy Romero, assistant editor & communications assistant, National Partnership
Justyn Ware, editor
Amanda Wolfe, editor-in-chief
Heather Drost, Hanna Jaquith, Marcelle Maginnis, Ashley Marchand and Michelle Stuckey, staff writers
Tucker Ball, director of new media, National Partnership