Long-acting reversible contraceptives, known as LARCs, are revolutionizing American birth control. Pilot programs in St. Louis, Missouri, and in Colorado, where healthcare providers and researchers have made the IUD and hormonal implants available at low or no cost and educated potential users about their nearly foolproof effectiveness, have shown astounding results. In Colorado, the teen birth rate and teen abortion rate both dropped 48 percent over five years. At the start of the study, half the women in the poorest parts of the state gave birth before the age of 21. Five years later, half the women in the same group were over the age of 24 when first giving birth. And in St. Louis, pregnancy and abortion rates among sexually active teens studied dropped to less than a quarter of the rates for their peers nationwide.
Statistics like these, along with new recommendations from major medical organizations, suggest that it’s time for American women to recognize what Europeans have known for years: that IUDs and implants—birth-control devices that, once inserted, are 99 percent effective for three to 10 years—are the most reliable way to prevent unintended pregnancies. Recently, the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists recommended that long-acting contraception be considered a safe and effective option for adolescents, and new programs have made IUDs and implants available to teenagers as young as 14. Unlike the pill, which must be taken daily, and shorter-term birth-control methods such as the Depo-Provera shot, which lasts a few months, LARCs are considered a “set it and forget it” method—something that’s particularly important for teenagers, who tend to be less conscientious in their use of any contraceptive method that they control.
But not everyone is receptive to this message. When considering long-acting methods, many women remember or hear stories about the Dalkon Shield, an early version of the IUD that caused infections and infertility and was linked to more than a dozen fatalities before it was pulled off the market in 1974. Since the mid-1980s, new and improved IUDs have been released, but the cost of these devices—upward of $800 apiece—put them out of reach for all but the well-off or well-insured. The Affordable Care Act requires that new insurance plans cover all FDA-approved birth-control methods without a co-payment, but the National Women’s Law Center, which operates a hotline to advise women on birth-control coverage, has received complaints from every state in the country that plans are refusing to comply. And teenagers may not feel comfortable using a parent’s plan to access contraception, even if it does cover long-acting methods. So philanthropists have stepped in, including the Omaha-based Susan Thompson Buffett Foundation, which has given hundreds of millions of dollars per year to organizations working on reproductive health. A recent Bloomberg investigation found that the foundation has anonymously pledged at least $200 million to promote the use of LARCs in the United States; it has also funded both the St. Louis and Colorado programs. According to the Bloomberg report, the foundation hoped that an infusion of dollars into public-health clinics would “change the perception of IUDs and build political support for the devices,” ultimately convincing state and local legislators to fund LARC programs themselves.