Long-acting reversible contraception (LARC) offers many safety and efficacy benefits. But there remain barriers in cost and the need for in-person clinic visits.
The results of recent research show that as the cost is decreased, the percentage of women using IUDs increased.1
“What we’ve shown is that cost is a huge barrier to people to get the method of their choice,” says David L. Eisenberg, MD, MPH, FACOG, study co-author and associate professor and associate director in the division of family planning, department of obstetrics and gynecology at the Washington University in St. Louis School of Medicine. “Many times, they’re choosing contraceptives they might not pick if cost were no concern.”
LARC has many benefits for women who choose that method. “LARC is tied to better health outcomes for families,” Eisenberg says. “They can space appropriately for their desired family size.”
Cost Is a Major Barrier
One major barrier to obtaining IUDs is the cost, despite the Affordable Care Act’s (ACA) contraceptive mandate.2 Although many insurers cover the cost of LARC, there still are too many people who do not receive that coverage. Women who are not insured through employers or the ACA marketplace and people who are undocumented may have to pay out of pocket for IUD placement.
However, LARC is popular when the financial barrier is removed and people receive medically accurate contraceptive counseling. The Contraceptive CHOICE Project in Missouri revealed that eliminating the cost and information barriers resulted in 46% of women choosing a hormonal IUD and three in four choosing some method of LARC.1,3
Eisenberg and co-authors wanted to know if the percentage of people choosing a hormonal IUD increased after the introduction in 2014 of the low-cost Liletta, a levonorgestrel-releasing intrauterine system. They found that the low-cost hormonal IUD was associated with more low-income and self-pay women accessing this method. There was a 7% increase in hormonal IUD uptake among privately insured women. Uptake in women with a family income greater than 200% of the federal poverty level (FPL) increased 13.9%.1
A large percentage of study participants did not have contraceptive coverage, and they would have excessive out-of-pocket costs, Eisenberg notes. For families living on 200% of the federal poverty level, an out-of-pocket contraceptive cost of even $50 would be the difference between someone accessing an IUD or implant and someone not being able to afford it.
In 2014, 30 health centers included in the study bought Liletta at $50 per unit, a huge cost savings compared with a similar contraceptive product available at that time. The low cost made it possible to offer the IUD to people without insurance coverage or with high-deductible expenses.
Also, lower costs for IUDs enable reproductive health centers to stock IUDs so they are available when patients ask for one.
“Without a doubt, in not only research, but also in my practice, this has been a game-changer for people,” Eisenberg says.
Teens Benefit from Program
A study of the no-cost IUDs from the Contraceptive CHOICE Project revealed that teenagers enrolled in the program had much lower rates of teen pregnancy, births, and induced abortion.3 When comparing sexually active teens, ages 14-19 years, researchers noted CHOICE teens’ pregnancy rates were 34 per 1,000; birth rates were 19.4 per 1,000; and abortion rates were 9.7 per 1,000. This compares to the national average of 158.5 pregnancies per 1,000, 94 births per 1,000, and 41.5 abortions per 1,000.
“The Contraceptive CHOICE Project proved that when people are given comprehensive counseling and we remove the cost factor as a barrier and [address] logistical barriers, we make it possible for people to get the contraceptive care that they need on their own terms,” Eisenberg explains. “They have better health outcomes for themselves and for their families.”
When public health policies and the healthcare industry make it easier for people to obtain the contraceptive that is right for them at an affordable cost or no cost, then people are more likely to be satisfied, use it correctly, and have lower rates of unintended pregnancy.
“Contraception is one of those key preventive health services, like vaccination and safe drinking water,” Eisenberg says.
REFERENCES
- Ruhr LR, Grossman J, Odendahl R, Eisenberg DL. Contraceptive utilization at publicly funded clinics before and after introduction of low-cost levonorgestrel intrauterine system: A retrospective case study analysis. Women Health 2022;62:75-84.
- HealthCare.gov. Birth control benefits.
- McNicholas C, Madden T, Segura G, Peipert JF. The contraceptive CHOICE project round up: What we did and what we learned. Clin Obstet Gynecol 2014;57:635-643.
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