Family Matters

To Slash the Abortion Rate, Dole Out Birth-Control Pills a Year at a Time

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Abortion is one of those topics that gets people fired up. Everyone’s got an opinion, but one thing pretty much everyone agrees on is that it would be great if the abortion rate were lower. One thing that may help: call it the Costco effect — when women are allowed to stockpile contraceptives, a new study shows the rates of accidental pregnancies and abortions go way down.

The study’s publication online this week in the journal Obstetrics and Gynecology is timely; it comes out as the U.S. Congress is debating the Title X program, the federal family planning program that serves millions of low-income women each year. Last week, House Republicans voted to cut off Planned Parenthood — many low-income women’s source for reproductive health care — from federal funding. (More on House Votes to Deny Federal Funding to Planned Parenthood)

Researchers at the University of California, San Francisco (UCSF), saw a 46% decline in the odds of an abortion and a 30% decrease in the odds of pregnancy when low-income women who relied on public programs for contraception received a one-year supply of birth control pills instead of the usual one- or three-month stash.

Picking up a 12-month supply in one clinic visit does away with the need for multiple clinic visits, making it easier for women to stick to their birth-control regimen. Because let’s face it: schlepping to a clinic or pharmacy each month for a new pack of pills is a pain.

It’s actually more than an inconvenience, argues lead author Diana Greene Foster; it’s dangerous, akin to not wearing seatbelts.

“Having sex without using a method of birth control is one of many kinds of risks people take in their lives, like driving too fast or driving without a seatbelt,” says Foster, associate professor in UCSF’s department of obstetrics, gynecology and reproductive sciences. “If seatbelts were given out as piecemeal as contraception, few people would use them.”

Nearly half of women who rely on oral birth control receive just one month of pills at a time; most get less than a four-month supply at once, according to a 2010 study published in Contraception. In California, however, some family-planning clinics dispense a full year’s supply of oral contraceptives. (More on Time.comThe Future of Birth Control)

The UCSF researchers looked at close to 85,000 women who got birth-control pills in Jan. 2006 through Family PACT (Planning, Access, Care, Treatment), a California family planning program. Then they cross-referenced those figures with birth records and other data from Medi-Cal, the state’s version of Medicaid.

About 1,300 pregnancies and 300 abortions would have been avoided had the 65,000 women in the study who got either one or three packs of pills at a time experienced the same number of pregnancies and abortions as those who got a year’s supply.

“It’s a cost-savings thing, but it’s also a quality-of-care issue — and it’s the right thing to do,” she says. “People don’t stop having sex when their pills run out.”

Health plans may think they’re saving money by doling out supplies on a monthly basis, but Foster’s data shows they likely could save money by authorizing a year’s supply and preventing unwanted pregnancies and abortions. After all, having oral contraceptives on hand means less unprotected sex — provided they’re taken as directed, of course. (More on Time.comAre Doctors’ Exams a Barrier to Birth Control?)

Birth-control pills are the most commonly used method of “reversible contraception” in the United States, according to the study. But their high rate of effectiveness — three pregnancies per 1,000 women in the first year — is contingent upon taking the pills correctly each day. Half of women forget to take at least one pill each cycle, which makes the pills much less reliable: 80 pregnancies per 1,000 women in the first year.

The idea of doling out multiple cycles of pills at once is a “long-standing, well-established tactic” of publicly funded family-planning clinics, which typically provide contraception on-site, says Adam Sonfield, a senior public policy associate with the Guttmacher Institute, a reproductive health care think tank.

“It’s definitely one of the things that public clinics do that you don’t normally see from private clinics,” says Sonfield. “It’s been shown to be pretty successful.”