Acing Unplanned Pregnancy Prevention at College

The state of Arkansas has asked its universities to help discourage unplanned pregnancy among women in college. Universities, taking a variety of approaches to the task, are already at work. There is no funding built into the mandate. Thankfully, the state of Colorado has already figured out how to dramatically reduce unplanned pregnancies—with a cost savings of $5.85 on each dollar invested.

Turns out that when women are offered a low-cost, reversible, long-term, low-maintenance, easy-to-use and extremely effective contraceptive that don’t require partner by-in, they use it.

When Colorado offered women IUDs, women took the state up on the offer—and dramatically decreased unplanned pregnancy and, consequently, abortion in the state. That didn’t stop state Republicans from trying thwart the effort, of course, and members of Colorado’s powerful Religious Right scolded that taxpayers were now being forced to pay for the “Cadillac” of birth control. While IUDs are more expensive than other forms of birth control in terms of initial costs, they are more cost effective than any other contraceptive over the long-term. Indeed, the $5 million cost of the program resulted in an estimated $80 million in reduced Medicaid costs alone. That doesn’t even consider the long term benefits to individual women.

The New York Times called the results “startling,” but that’s only the case if you don’t know the history of contraception: when we can help it, we delay the start of childbearing, have fewer children, and shorten the length of time between our youngest and oldest children so we’re not bearing children from menarche to menopause

Tales of Contraception is available for sale at the Dittrick Medical History Center at Case Western Reserve University.

IUDs are the most effective contraceptive available to women. Worldwide, they are highly popular, but they remain one of the least common forms of birth control used in the US. Falling costs (thanks Obamacare!) are putting them within financial reach for more women, but the initial investment for those whose insurance does not cover the IUD or its insertion—from a few hundred dollars to $1000—remains prohibitive for some women, including many in college. And it’s not a safeguard against STIs/STDs. New research indicates that they do not increase risk for pelvic inflammatory disease (PID). IUDS are lowest-risk for those without STDs/STIs who are in monogamous relationships with partners who do not have STIs/STDs.  And, despite what Hobby Lobby claims, the copper IUD does not prevent the implantation of a fertilized egg, and our best science has not shown that the Mirena, the other top product, does either. Even in the widest sense of the term, then, they do not end pregnancy and are not abortifacients. For women who view pregnancy as beginning at fertilization (rather than implantation, which is the more common medical definition),  the fact that the IUD is as safe for fertilized eggs is important and allows them to choose an effective form of contraception that aligns with their values.

The most significant risk is that, in the very rare cases when pregnancies do occur when an IUD is inserted, miscarriage and poor outcomes for newborns (such as low APGAR scores) are more likely than when other forms of birth control are being used, especially if the IUD is not removed during pregnancy. When women consider all their options and risks, the IUD is a compelling form of birth control. (Side note: it seems that early IUDs were invented by nomadic camel herders in North Africa. They wanted a way to prevent pregnancy in animals they were herding across the desert. Turns out that sticking a peach pit in a female camel’s uterus prevented pregnancy.)

If the state of Arkansas wants to reduce unplanned pregnancy among people in college—and people in their late teens and early twenties in general—then making IUDs widely available (which would also mean getting women’s health care providers in more of locations across the state, which is facing a shortage of ob-gyns) and low-cost (or even free!) IUDs would be a great start.

Right now, A-State’s campus health center does not offer IUDs. The good news is that the Craighead County Health Department does–with NO out of pocket costs to women who use their service. Instead, the health department bills insurance and takes only whatever insurance pays. If that  means a woman’s insurance will not cover an IUD, she has no costs associated with its insertion.

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