About half of the more than 6.6 million pregnancies in the United States each year are unplanned, according to recent data.
To counteract those numbers, Tessa Madden, MD, associate professor of obstetrics and gynecology at Washington University School of Medicine in St. Louis, and Timothy McBride, PhD, professor at the university’s Brown School, have received a $4 million award from the Centers for Medicare & Medicaid Services to study whether a new model of providing family planning services can reduce unintended pregnancies and births.
As part of the study, they are recruiting 10,000 women of child-bearing age in the St. Louis area to participate.
The model emphasizes the superior effectiveness of long-acting reversible birth control methods such as IUDs and implants over short-term methods such as birth control pills, patches or vaginal rings. However, long-acting methods tend to have higher up-front costs, compared with short-term methods.
Women in the study with health insurance will pay co-pays or deductibles for their contraceptive coverage, depending on their plans. Uninsured women will be eligible for low or no-cost contraceptives, based on their incomes. Researchers will evaluate which methods women choose when the full range of reversible contraception is available.
To enroll in the study, women must be ages 14 to 45 and at risk of pregnancy. Physicians, nurse practitioners and research assistants will provide care to women at the Contraceptive Choice Center, a clinic at 4533 Clayton Ave. in the Division of Clinical Research in the Department of Obstetrics and Gynecology.
Health-care professionals at the clinic will counsel women about all reversible contraceptive methods. In many cases, women will be able to start their contraceptive method the same day they are seen in the clinic. Pregnancy testing, emergency contraception, well-woman exams, and testing and treatment for sexually transmitted infections also will be provided.
The new model of contraceptive care draws on the success of the Contraceptive CHOICE Project at Washington University School of Medicine. The project showed that providing contraceptive counseling and birth control at no cost increased the use of long-acting, reversible methods and reduced unintended pregnancies by almost 75 percent. Most of the women in the study chose an IUD or implant, and women who chose these methods expressed higher satisfaction with and longer use of those methods than women who chose birth control pills.
“Lack of information about IUDs and implants as well as the associated high up-front costs can make it difficult for women who want to use IUDs and implants to obtain them,” said Madden, principal investigator of the new study. “The goal of this project is to remove these barriers in a clinic setting. After increasing access and awareness, we can evaluate whether the model developed is successful and could potentially be implemented in other clinics.”
In the new study, researchers will measure rates of unintended pregnancies and births, the number of women choosing IUDs and implants, the number of women starting a chosen method the day they visit the clinic, and patient satisfaction with the health-care provider and contraception. The researchers will conduct follow-up surveys by telephone after three, six and 12 months.
“Improving contraceptive services reduces unintended pregnancies and births and improves the health of women and families,” McBride said. “Reducing unintended births also has the potential to reduce health-care costs. If this model of contraception delivery improves outcomes and reduces costs, the results could change policy on the national level.”
The Contraceptive Choice Center is a member of the Missouri Title X network. Title X is a federal program that provides low-cost family planning services to uninsured women.
For more information about the study or to make a clinic appointment, call 314-747-0800 or visit C3.wustl.edu.
This project is supported by the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, grant number 1C1CMS331354. The content of this document is solely the responsibility of the author and does not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.