Unintended pregnancies continue to be an issue in many areas of the U.S., the authors noted. "U.S. taxpayers pay approximately $11 billion annually in costs associated with 1 million unintended births," they wrote, adding that the U.S.'s unintended pregnancy rate is "significantly higher than in other developed countries."
So Peipert and colleagues designed a prospective cohort -- the Contraceptive CHOICE Project --
"to promote the use of the most effective contraceptive methods (intrauterine devices [IUDs] and implants) and provide contraception at no cost to 10,000 female participants" in the St. Louis region who were at risk for unintended pregnancy "in an effort to reduce unintended pregnancies."
The study measured teen birth rates and percentages of repeat abortions in a population of 9,256 females ages 14 to 45 (mean age 25) recruited at two abortion facilities in the St. Louis region and through healthcare provider referral, advertisements, and word of mouth, and compared these data against regional and national statistics from 2008 to 2010.
The study population was 51% black, 35% had a high school or less education, 37% lived on public assistance, 39% had difficulty paying for basic expenses, and 63% had a prior unintended pregnancy, they wrote.
Participants desired a LARC and were not currently using one or were willing to switch to a new LARC, had no desire for pregnancy for at least 12 months, planned to be sexually active with a male partner within 6 months of baseline, and spoke English or Spanish.
The women and teens received the reversible contraceptive method of their choice at no cost for 3 years in the first 5,090 participants, and 2 years for the remaining patients. Patients could continue their LARC method after the study conclusion, but would no longer be given free treatment or be offered a free alternative contraceptive.
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Compared with regional and national data,
St. Louis adolescents and women given free long-acting reversible contraceptive (LARC) methods
had nearly four times fewer abortions --
a proxy measure of unintended pregnancies --
than the regional rate (4.4 versus 17.0 per 1,000 women),
and nearly five times fewer abortions than the national rate
(4.4 versus 19.6 per 1,000 women) in 2008 (P<0.001 for both), according to Jeffrey Peipert, PhD, and colleagues.