Colorado's Long-Lasting Birth Control Program For Teens May Not Last Long
The shelf of long-lasting birth control at Children's Hospital outside Denver. The clinic's director said having the devices on hand is crucial, so young women don't have to make a second visit. But that costs money.
When President Obama spoke to the Democratic National Convention in Colorado seven years ago, he tried to call a truce in one of the nation's long-running social debates.
"We may not agree on abortion. But surely we can agree on reducing the number of unwanted pregnancies in this country," he said to applause.
Not long after that, Colorado launched an experiment aimed at doing just that. The results have been dramatic — but efforts to expand the program using taxpayer money have hit a political roadblock.
Six years ago Children's Hospital Colorado, outside Denver, and dozens of clinics around the state began focusing on long-acting forms of contraception, such as IUDs and hormonal implants.
Research shows they're much more reliable at preventing pregnancy than the pill or condoms. Liz Romer, who runs the clinic at Children's, where teenagers and young women can get free and confidential birth control, said that's in part because they're less subject to human error.
"It gives them something that is a very effective method that doesn't require a daily decision not to get pregnant and gives them the freedom then to think about other things," she said.
Despite the effectiveness of the long-acting methods, less than 5 percent of teenagers on birth control nationwide use them. Implants and IUDs require a health care provider to put them in place. And the up-front cost can be high: hundreds of dollars apiece. At the Children's Hospital clinic, supplies are kept behind a locked door.
Romer unlocks the door and points out her clinic's "device shelf."
"We've got to be able to come in, grab this, and be able to deliver to a patient at that moment," she said.
Romer said having the devices on hand is crucial, so young women don't have to make a second visit. But that costs money. And so does training the health care providers.
Larry Wolk, who directs Colorado's public health department, wore an IUD as a lapel pin during this year's legislative debate. He said people would remark on how small and lightweight it was. "It's not you're mother's IUD, for sure," he said, chuckling.
Colorado's experiment was funded with a $23 million grant from the Susan Thompson Buffett Foundation, named for the late wife of billionaire Warren Buffett. And the results are striking: By 2013, teen births in Colorado had dropped 40 percent — compared with a 30 percent decline nationwide. The steep drop continued last year. Abortions among teenagers in Colorado were also down. Democratic Gov. John Hickenlooper said the savings in Medicaid and government assistance far outweigh the up-front costs.
"What greater gift can you give to a teenaged potential mother than the opportunity to plan her family so when she has children, it's when they're wanted, when she can afford to care for them ... and to do it in such a cost-effective way in terms of government spending? It dramatically reduces government spending," he said.
When seed money from the Buffett foundation ran out this summer, Hickenlooper asked for state funding to continue the program. But Republican state lawmakers like Rep. Kathleen Conti said no. Conti complains that the long-acting birth control is too expensive and sends the wrong message to teenagers who should instead be taught to refrain from sex.
"Don't get me wrong. I don't think the doctors encouraged the kids: 'Now that you've got this, feel free to have sex with everybody.' But I think it, by default, takes away one more intimidating problem."
Conti also worries about an increase in sexually transmitted diseases, though there's been no evidence of that in Colorado. Other critics complain that the program doesn't require enough parental involvement.
"There's a history of politics as it relates to anything family planning-related," said pediatrician Larry Wolk, who directs the public health department in Colorado . The fight for state funding is not over, he added. Wolk wore an IUD as a lapel pin during this year's legislative debate.
"I was just amazed at how many people said, 'What is that?' I'd say, 'It's an IUD.' And they're like, really? It's so small, it's so lightweight. ... It's like the Buick commercials that are out there. It's not your mother's IUD, for sure," he said, chuckling.
For now, Colorado is relying on a patchwork of private grants to continue its family planning initiative. At the Children's Hospital clinic, Romer said it's gratifying to see young women who got their first long-acting birth control three years ago and are now coming back for more.
"Just to watch their eyes beam and say, 'I graduated. And I'm one of the only people in my circle of friends who doesn't have a child. And now I'm managing this,' or, 'I'm in this job.' And to see that they're still dreaming big," she said.
Romer said she can't imagine turning those young women away for lack of funding. "The numbers speak so clearly," she said. "It's time to listen."
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Transcript
RACHEL MARTIN, HOST:
When Barack Obama spoke to the Democratic National Convention in Colorado seven years ago, he tried to call a truce in one of the nation's long-running social debates.
(SOUNDBITE OF ARCHIVED RECORDING)
BARACK OBAMA: We may not agree an abortion, but surely we can agree on reducing the number of unwanted pregnancies in this country.
MARTIN: Soon after that speech, Colorado launched an experiment aimed at doing that. The results have been dramatic. But as NPR's Scott Horsley reports, efforts to expand the program using taxpayer money have hit a political roadblock.
LIZ ROMER: We're really sitting in the middle of the clinic, here. So this is our family planning area.
SCOTT HORSLEY, BYLINE: Liz Romer runs a clinic at Children's Hospital outside Denver, where teenagers and young women can get free and confidential birth control. Six years ago, this clinic and dozens of others around the state began focusing on long-acting forms of contraception, such as IUDs and hormonal implants. Research shows they're much more reliable at preventing pregnancy than the pill or condoms in part, Romer says, because they're less subject to human error.
ROMER: It gives them something that's a very effective method that doesn't require a daily decision not to get pregnant.
HORSLEY: Despite their effectiveness, less than 5 percent of teenagers on birth control nationwide use the long-acting forms. Implants and IUD's require a health care provider to put them in place, and the upfront cost can be high - hundreds of dollars apiece. At the Children's Hospital clinic, supplies are kept behind a locked door.
ROMER: This is an example. This is our device shelf. We've got to be able to come and grab this and be able to deliver it to a patient at that moment.
HORSLEY: Romer says having the devices on hand is crucial so young women don't have to make a second visit. But that costs money, and so does training the health care providers. Colorado's experiment was funded with a $23 million grant from the Susan Thompson Buffett foundation, named for the late wife of billionaire Warren Buffett.
The results are striking. By 2013, teen births in Colorado had dropped 40 percent, compared to a 30 percent decline nationwide. Abortions among teenagers in Colorado were also down, and the steep drop continued last year. Democratic governor John Hickenlooper says the resulting savings in Medicaid and government assistance far outweigh the upfront costs.
JOHN HICKENLOOPER: What greater gift can you give to a teenage potential mother than the opportunity to plan her family so that when she has children, it's when they're wanted, when she can afford to care for them. And to do it at such a cost-effective way in terms of government spending dramatically reduced government spending.
HORSLEY: When seed money from the Buffett Foundation ran out this summer, Hickenlooper asked for state funding to continue the program. But Republican state lawmakers like Kathleen Conti said no. Conti complains the long-acting birth control is too expensive and sends the wrong message to teenagers who should instead be taught to refrain from sex.
KATHLEEN CONTI: Don't get me wrong. I don't think the doctors encourage the kids - now that you've got this, feel free to have sex with everybody. But I think it, by default, takes away one more intimidating problem.
HORSLEY: Conti also worries about an increase in sexually transmitted diseases, though there's been no evidence of that in Colorado. Other critics complain the program doesn't require enough parental involvement.
LARRY WOLK: There is a history of politics as it relates to anything family-planning related.
HORSLEY: Pediatrician Larry Wolk directs the public health department in Colorado. He says the fight for state funding is not over. Wolk wore an IUD as a lapel pin all during this year's legislative debate.
WOLK: I was just amazed at how many people said, what is that? And I said, it's an IUD. And they're like, really? It's so small. It's so lightweight. It's not your mother's IUD, for sure (laughter).
HORSLEY: For now, Colorado's relying on a patchwork of private grants to continue its family planning initiative. At the Children's Hospital clinic, Liz Romer says it's gratifying to see young women who got their first long-acting birth control three years ago now coming back for more.
ROMER: Just to watch their eyes beam and say, yeah, I graduated, and I'm one of the only people in my circle of friends who doesn't have a child; and now I'm managing this, or, I'm in this job, and to see that they're still dreaming big.
HORSLEY: Romer says she can't imagine turning those young women away for lack of funding. The numbers speak so clearly, she says. It's time to listen. Scott Horsley, NPR News. Transcript provided by NPR, Copyright NPR.
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