Another reason LARCs should be offered in public schools is that it makes birth control more accessible and, as public schools are state-funded, it can make birth control easily affordable or even free to teens. One great contributor to teen pregnancy rates is income. The rate of unplanned pregnancy is disproportionally higher in economically disadvantaged communities, which may be due to a lack of access to affordable birth control. This is doubly a problem for teens who often do not have their disposable income for use outside of housing, food, and other necessities. The birth control pill, the most common method used by teens, can cost upwards of $50 per month for the uninsured or underinsured. The American Pregnancy Association notes that on top of the cost of one month of pills, the initial physician visit can cost up to $200 (2012). That means that only one year of birth control could end up costing $800. In contrast, LARCs can cost anywhere from $200 to $1500 but are effective for up to seven years. That would be the equivalent of paying $17 a year for birth control, which is much more cost-effective in the long run. Also, thanks to the Affordable Care Act, teens now have private and state insurance coverage that funds the complete cost of LARC placement and removal. One public school in Seattle, Washington sparked controversy by offering free placement of contraceptive devices in their high school health center. The program allows girls under 19 to get LARCs at no cost with full confidentiality, and no parental consent or insurance required. It is no surprise that, with the increase in access, Washington’s teen pregnancy rate is lower than the national average. In some counties, rates have even dropped as much as fifty percent.
The addition of LARCs as a contraceptive option in public schools can also decrease teen pregnancy rates overall. The American Congress of Obstetricians and Gynecologists, in the Committee Opinion on Intrauterine Device and Adolescents, concluded:
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“Because adolescents contribute disproportionately to the epidemic of unintended pregnancy in this country, top-tier methods of contraception, including IUDs and implants, should be considered as first-line choices for both nulliparous and parous adolescents. After thorough counseling regarding contraceptive options, health care providers should strongly encourage young women who are appropriate candidates to use this method”
Pediatricians are only now encouraged to counsel adolescent patients on all contraceptive methods, starting with LARC methods due to their ease of use and effectiveness. While still small, the proportion of teens using LARC methods is growing: Among women aged 15–19, usage of IUD and contraceptive implants increased between 2002 and 2009 from 1 percent to 4.5 percent. After the introduction of a program in Colorado offering free placement of birth control devices, both teen birth and abortion rates dropped 48 percent over five years. A similar program in St. resulted in a 25 percent decrease in birth and abortion among sexually active teens (McClain 2015). These numbers suggest a clear positive correlation between access to LARCs and teen pregnancy rates.
The decline in teen pregnancy rates nationwide is cause for celebration, but it's still too early to believe there is no more to be done. Further progress can be made by bringing contraceptive care directly to teens and by adding LARCs as a birth control option in reproductive counseling. It is well understood that the more children a woman has during her teen years, the less likely she is to complete high school, obtain a college degree, or maintain employment. One action we can take to address this still very real social issue and improve outcomes would be to fund the creation of more public school-based family planning or contraceptive healthcare services. Such entities would offer shining examples of how access to all contraception, including LARCs, is critical to teen pregnancy rate reduction.
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