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The Mirena IUD. Photo courtesy of Sarah Mirk / Flickr via Creative Commons

Is This the End of Free Birth Control?

Colorado’s family planning program cut teen births and abortions by half. Could a new White House rule, accompanied by cuts to Title X funding, reverse that progress?

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As the White House and Congress prepare a tag-team effort to roll back women’s access to birth control, Colorado’s grand experiment in using long-acting contraceptives to prevent unwanted pregnancies, especially among teens, might be at risk.

Long-acting reversible contraceptive (LARC) methods such as IUDs and implants that last up to 10 years are 20 times more effective than birth control pills, according to the American College of Obstetricians and Gynecologists (ACOG). But they’re also more expensive—costing up to $1,000 per device. Currently, women can get LARCs through their insurance under the Affordable Care Act’s mandate that all insurance plans cover contraceptives at no cost. But a new rule put forth by the Trump administration would make LARCs even less affordable, by allowing any employer with a moral or religious objection to withhold birth control coverage from their insurance plans, according to the Wall Street Journal.

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This new rule—which would go into effect as soon as it’s published in the Federal Register (expected any day now)—would move in the opposite direction of Colorado’s nationally recognized progress in family planning. In 2009, Colorado launched a five-year, privately funded program to remove financial barriers for IUDs and other LARC devices for women who requested them, saving the state nearly $70 million in public assistance. The initiative got a boost when the federal government mandated insurance coverage of birth control as a preventative health service in 2011—and again when Colorado’s 2013 Medicaid expansion gave more women insurance.

Colorado’s family planning progress temporarily stalled when the state legislature voted down funding to continue the program in 2015, leading to waiting lists for the devices. In 2016, however, strong bipartisan support drove Colorado to approve $2.5 million to fund family-planning initiatives, including access to LARCs.

New data shows that during the seven-year span from 2009 to 2016, which includes both private and state funding for LARCs, Colorado’s birth rate for young women ages 15 to 19 fell 54 percent, and repeat teen births plummeted by nearly two-thirds, according to the Colorado Department of Public Health and Environment (CDPHE). The abortion rate for Colorado teens fell 53 percent during the same time period.

“Here in Colorado, we have definitely proved that if you make the best birth control method available to a woman, she will pick it, she will use it, and she will be successful with it,” says Planned Parenthood of the Rocky Mountains (PPRM) CEO Vicki Cowart.

Across the country, states such as Virginia, Delaware, and Texas are replicating Colorado’s successful program. By 2015, LARC use increased nearly five-fold nationwide, and the U.S. rate of unintended pregnancy hit a 30-year low with the shift toward long-acting birth control.

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That progress may be in jeopardy under the Trump administration. Currently, 55 million U.S. women receive birth control with no copay. But many conservatives specifically object to the use of IUDs based on religious beliefs that they may be considered abortifacients. (According to physicians at ACOG, IUDs primarily work by preventing eggs from being fertilized, and do not cause medical abortions or harm established pregnancies). While religious groups praise the Trump administration’s rule for restoring the religious freedom rights of employers, advocacy groups such as the National Women’s Law Center says they plan to take legal action if the new rule allows employers to impose their religious beliefs on workers.

In Colorado, about 13 percent of the women currently using CDPHE’s family planning services rely on employer-based insurance, according to Jody Camp, manager of the CDPHE Family Planning Unit. Once the rule is registered, many more Colorado women could find themselves in need of CDPHE’s services. “Women that lose contraceptive coverage due to religious exemption could start coming to CDPHE Family Planning Program clinics for family planning assistance,” says Camp.

Colorado’s progress in ending unplanned pregnancies could also be harmed by a Congressional spending bill that includes eliminating all funding for Title X federal family planning program. The House voted 211-198 on Thursday, September 14 to pass a $1.2 trillion package of spending bills for fiscal 2018 that eliminates all funding for the Title X Family Planning Program. The bills now go the Senate, where they face opposition from Democrats. Colorado’s Family Planning Program primarily serves the state’s Title X population of about 55,000 low-income women and men, and successfully increased the use of LARC devices among Title X patients from 6 percent in 2008 to almost 31 percent by 2015. Beyond birth control, Title X clinics also provide vital health services such as cancer screenings, STD tests, and pregnancy counseling for some 4 million Americans. 

House Republican leaders claim that cutting Title X funding will save nearly $300 million. However, a 2017 study commissioned by the Planned Parenthood Action Fund and compiled by Child Trends, a nonpartisan nonprofit, shows that giving all U.S. women ages 15 to 39 access to all birth control methods, including LARCs, would create $12 billion in savings for public health care costs—about 40 times the savings achieved by cutting Title X.

The spending bill also eliminates future funding to the Teen Pregnancy Prevention Program (TPPP), which was already slashed by the Trump administration in August. Colorado Youth Matter, which provides comprehensive sex education to students in Adams, Arapahoe, and Denver counties, already lost about $1.5 million, or 75 percent of its funding.

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The birth control mandate created a shift to focusing on prevention that’s echoed by other family planning programs and has had an outsized impact in Colorado, says Cowart. “If that’s reversed, then everybody goes back to paying more,” she says. Not just Colorado women and their families—but with millions in public assistance at stakeevery state taxpayer as well. 

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