Clinical Question

Does providing contraception at no cost and educating teenage girls about long-acting reversible contraceptives (LARCs) reduce pregnancy rates compared to national rates among sexually experienced teens?

Bottom Line

Teenage girls who were provided contraception at no cost and educated about LARCs had substantially lower rates of pregnancy, birth, and abortion compared to national rates for sexually experienced teens.

Major Points

Guidelines

No specific guidelines were stated, but the study suggested that comprehensive contraceptive education and free access to LARCs could be effective strategies in reducing teenage pregnancy, which align with the CDC's Winnable Battles initiative's goals.

Design

- Prospective cohort study
- Participants: 1404 teenage girls and women aged 15 to 19
- Intervention: Free contraception and education on reversible contraception with an emphasis on LARCs
- Time Period: Enrolled from 2007 through 2011, followed for 2 to 3 years
- Primary Outcomes: Rates of pregnancy, live birth, and induced abortion among participants

Population

- Inclusion Criteria: English-speaking or Spanish-speaking, St. Louis region residents, no pregnancy plans for at least 12 months, sexually active or planning to be active
- Exclusion Criteria: History of sterilization or hysterectomy
- Baseline Characteristics: Nearly half reported a previous unintended pregnancy and 18% had a history of abortion

Interventions

Participants were offered free contraception of their choice after receiving standardized contraceptive counseling emphasizing the efficacy of LARC methods.

Outcomes

- Birth rates were 19.4 per 1000 compared to 94.0 per 1000 sexually experienced U.S. teens nationally
- Abortion rates were 9.7 per 1000 compared to 41.5 per 1000 sexually experienced U.S. teens nationally

Criticisms

- Self-reported data may underestimate pregnancy numbers
- Regular surveys may have influenced method adherence
- Questionable generalizability due to study's design and approach to counseling
- Majority were black, sexually experienced, and at greater unintended pregnancy risk

Funding

The study was funded by the Susan Thompson Buffett Foundation and others.

Further Reading