Researchers at Washington University School of Medicine in St. Louis want to know whether they can reduce the rate of unintended pregnancies at community clinics by providing contraceptive counseling that emphasizes the benefits of long-acting birth control, like IUDs and implants, and by making these methods available to women at sharply reduced costs or free of charge.
About half of all pregnancies in the United States — some 3 million a year — are unplanned. While intrauterine devices (IUDs) and under-the-skin implants are most effective at preventing pregnancies, many U.S. women still choose birth control pills and condoms, which have higher failure rates.
Some also are deterred by the high up-front costs of IUDs and implants, which are not always covered by insurance.
“We suspect that contraceptive counseling alone is not enough to increase the use of long-acting birth control,” said Tessa Madden, MD, assistant professor of obstetrics and gynecology and principal investigator of the study. “Factors such as cost and lack of information from health-care providers may make it difficult for women to get IUDs and implants, and we want to see what happens when we remove those barriers in community clinics.”
The new initiative is a follow-up to a study reported in 2012 in The New England Journal of Medicine by the same team of researchers. That study, known as the CHOICE project, found a clear benefit to providing contraceptive counseling and free birth control to more than 9,000 St. Louis-area women. Those who opted for birth control pills or other short-term methods like the patch or vaginal ring were 20 times more likely to have an unintended pregnancy than women who used IUDs or implants.
The researchers want to see whether they can match results from the CHOICE project at two community clinics in St. Louis and two in Memphis, Tenn.
The researchers will enroll 800 women who will be divided into two groups. Half will receive contraceptive counseling, including information about all forms of birth control and a visit with a health-care provider. And the other half will receive the same counseling and a visit with a health-care provider who has received special training in IUDs and implants. Participants in this group also will receive help paying for IUDs or implants if they do not have health insurance or their insurance does not cover these methods.
Women in both groups will complete surveys after visits with their health-care providers and later at six weeks, six months and 12 months. Researchers then will compare how many women had unplanned pregnancies. They also will evaluate which birth-control method women chose and how satisfied they were with their birth control and counseling.
“If this research leads to changes in how we deliver contraceptive services, we could reduce the rate of unintended pregnancy in the United States,” Madden said. “Fewer unintended pregnancies will lead to better health for women and their families.”
The research will be funded by a federal Patient-Centered Outcomes Research Institute (PCORI) award. All awards in this most recent round of funding were approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.
PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health-care decisions. PCORI is committed to continuously seeking input from a broad range of stakeholders to guide its work. More information is available at www.pcori.org.
Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s
hospitals. The School of Medicine is one of the leading medical
research, teaching and patient care institutions in the nation,
currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.