Does the use of long-acting contraceptives reduce the birth rate among teenagers?

Responsible researcher: Adriano Valladão Pires Ribeiro

Article title: HOW MUCH CAN EXPANDING ACCESS TO LONG-ACTING REVERSIBLE CONTRACEPTIVES REDUCES TEEN BIRTH RATES?

Article authors: Jason Lindo and Analisa Packham

Intervention location: Colorado, USA

Sample size: 20,376 observations

Big topic: Health

Type of Intervention: Expanding access to long-acting reversible contraceptives

Variable of main interest: Adolescent birth rate

Assessment method: Differences in Differences

Policy Problem

The teenage pregnancy rate in the United States has been falling over the years, but is still higher than the average for other developed countries, according to data from the World Bank. Public policies to reduce the number of unwanted pregnancies focus on reducing the frequency of sexual intercourse, increasing the use of contraceptives and the use of more effective contraceptives. Long-acting reversible contraceptive methods, such as intrauterine devices (IUDs), are more effective in preventing pregnancy and do not require any attention for a few years compared to inconsistent use of birth control pills, rings and condoms. Therefore, it remains to be seen how much expanding access to long-acting contraceptive methods would reduce the birth rate among adolescents.

Assessment Context

Despite the ease and benefits of long-acting contraceptives, in 2013 only 5% of teenagers in the USA opted for an IUD and only 8.5% of all women chose this method. Among the factors that explain these low numbers are the lack of knowledge about long-term methods, misinformation about their safety, the discomfort of the implant and possible side effects, in addition to a high initial cost of acquisition and implementation. On the health clinics side, the two main barriers would be the lack of knowledge and misinformation of some doctors and nurses. In the case where clinics provide the methods free of charge, there is a limited capacity to provide the service to many clients.

Intervention Details

In January 2009, the Colorado Department of Public Health (DPHE) implemented the Colorado Family Planning Initiative (CFPI) with the goal of reducing unplanned pregnancies by increasing the availability of long-term reversible contraceptive methods. duration. An anonymous donation of $23 million funded free contraception for low-income women at Title

The money was distributed to Title Additionally, CFPI provided the IUDs, advice and knowledge on implementing long-acting contraceptive devices, and technical assistance for clinic management.

In Colorado, people below the poverty level are not charged for any services at Title X , people above that level would receive a discount or have to pay for the entire service depending on their income level. Clinics must accept verbal reporting of income and no verification is required. It is noted that 90% of clients meet the income criteria and do not have to pay anything for contraceptives or for going to the doctor. The program was highly successful and directly addressed some of the barriers that limit access to long-acting contraceptive methods, such as supply of devices and reducing the cost of implantation. Despite not being focused on adolescents, they represented an important part of the Title X . In the state, in 2008, the use of long-term methods by young people was less than 3% and jumped to almost 25% in 2014. Finally, in the years following the program, the teen pregnancy rate in Colorado reduced by 40%. %, it should be noted, however, that the rate was already decreasing throughout the country, and it is not possible to attribute all this difference solely to the CFPI.

Methodology

To evaluate the effect of the CFPI on the teenage birth rate in the state of Colorado, all counties in the state that had a Title The National Center for Health Statistics contains information on all births between 2002 and 2013 in the US, including the mother's age and county of birth. In addition, demographic information about young women over this period was used, unemployment in the county as an index of economic activity and indicators on the legalization of contraceptives and the need for prescriptions to purchase contraceptives.

The way to measure the effects of the program is by comparing the trajectory of the average birth rate of teenage mothers in counties in Colorado that had a Title X (treatment group) with the trajectory of the other counties (control group). Note that when using all the information described in the previous paragraph, and considering the fact that the birth rate among teenagers was similar for the USA and the state of Colorado between 2003 and 2008, it is clear that the control group would be a good counterfactual, that is, what the number of births in counties in Colorado would be like if it were not for the CFPI.

Finally, as the program was intended to help low-income women access long-acting contraceptive methods, we also investigated whether the effects of the CFPI were greater in counties where a larger portion of the population was low-income.

Results

The result of the measurement exercise shows that, on average, the program reduced the birth rate among teenagers by 6.4% per year. The effect is close to 1% in the first year, increasing from the second to the fifth year, with emphasis on a 10% drop in the third year. When targeting the exercise to counties with incomes below the state median income, the average effect was even greater, approximately 8% per year. Again, the effect of the program in the first year was small, but it reached an average of over 10% in reducing birth rates among adolescents in the last three years evaluated.

Public Policy Lessons

The CFPI was the first major program to encourage the use of long-acting reversible contraceptives in the US, and although teenage girls were not the main focus, the program helped reduce the birth rate among young women in Colorado. The reason for the success lies both in reducing the cost of inserting contraceptive devices and in reducing misinformation about the methods. The fact that the program had even greater results in lower-income counties corroborates this learning.

Reference

Beautiful, Jason M.; Packham, Analisa. “How Much Can Expanding Access to Long-Acting Reversible Contraceptives Reduce Teen Birth Rates?.” American Economic Journal: Economic Policy, vol. 9, no. 3, p. 348-76, 2017.