In 1970, Congress amended the Public Health Service Act, initially passed in 1944, to include a program known as Title X: The National Family Planning Program. Through this initiative, the federal government helped fund free or heavily discounted family-planning services, which were available for low-income women at regional health clinics. The strategy has been incredibly effective: According to the Centers for Disease Control (CDC), the birth rate to teenagers in the U.S. plunged 43 percent between its peak in 1970, when Title X was enacted, and 2010.
Over the years, though, coffers began to close, and states needed to find other ways to support women and teens in rural and impoverished areas. So in 2007, Colorado’s Department of Public Health and Environment (CDPHE) decided to try an experiment. It used a private grant from the Susan Thompson Buffett Foundation—named for Warren Buffett’s late wife—to offer free long-acting reversible contraception methods, such as intrauterine devices (IUDs) and implants, through existent Title X health centers. (Twenty-eight of the 68 clinics in Colorado agreed to participate. You can search for a clinic in your area on BeforePlay.org)
“The way that we’ve evolved, if we don’t do something every single time [we have sex], we [can] get pregnant—and fast,” says Stephanie Teal, CDPHE’s medical director of family planning and an OB/GYN at University of Colorado Hospital. “What if we could change that default?”
Years later, it appears that Colorado is making progress. From 2009 to 2013, while the program was in effect, teen birthrates in Colorado plummeted by 40 percent, and the abortion rate dropped by 42 percent. Even more impressive, the repeat pregnancy rate for adolescent moms dropped by 53 percent. (CDPHE also supplied patients who had just delivered babies at Denver Health Medical Center and University of Colorado Hospital with IUDs or implants if they were interested, according to Teal.) In fact, teen birthrates in Colorado have decreased faster than any other state, and our country as a whole.
Because of the program’s widely publicized outcomes, researchers and doctors from Salt Lake City to Chicago are now looking to the Centennial State for help in replicating the experiment, and Kaiser Permanente is said to be considering implementing a program for long-acting contraceptives.
But as more states look to Colorado as an example, the future of our family planning program could be in jeopardy. State legislators voted in April not to allocate funding for the program, and the grant money is quickly running out. Critics’ reasoning for opposing the initiative range from religious motivations to cost concerns. (Theoretically, the Affordable Care Act is supposed to already fund long-acting contraception, but many insurance companies have refused to pay for it.)
Teal hopes the introduction of Liletta, a new IUD developed by nonprofit pharmaceutical company Medicines360, which was approved by the FDA in February, will offer an alternative solution to women in need of long-acting contraception if state funding remains low. Although it’s similar to Mirena (the most popular IUD on the market right now), one Liletta unit costs $50 for federally qualified health centers like Title X clinics—in comparison to $800 commercially.
“We need to help our legislators understand that their constituents do want things that will save Coloradans money,” Teal says of the program. “But the second part is driving the prices of these devices down to a place where it’s just not as difficult for payers—whether it’s the woman herself or health insurance companies or Medicaid—to afford them.”
Follow editorial assistant Mary Clare Fischer on Twitter at @mc_fischer.