Contraception – Page 6 – Population Matters-USA

Advocate for LARC (Long Acting Reversible Contraception)

This is a picture of an IUD in a mockup of a uterus.

The potential of LARCs (Long Acting Reversible Contraception) is so great that I am advocating that all voters advocate for them to be paid for by government. The savings–both financial and in terms of human potential–are enormous!

Your doctor tells you that she can prescribe either of two treatments, but that one is 20 times as likely to fail as the other. Which would you choose?

Over a quarter of women in the USA use birth control pills, which fail much more frequently than Long Acting Reversible Contraception. LARCs, as they are nicknamed, are amazingly effective yet not used as frequently as one might hope.

IUDs (Intrauterine Devices) are the most commonly used LARCs. There are four available now; they are all made out of flexible plastic in the shape of a â€œTâ€. Three emit a tiny amount of hormone into the womanâ€™s uterus, where it is most effective. The fourth IUD uses copper to gain effectiveness. IUDs are usually well tolerated, although sometimes they can increase cramps or change menstrual flow. The best medical knowledge is that IUDs do not work by aborting pregnancies.

IUDs can stay in place for a maximum of 3 to 10 years, depending on which type. Since there is a string attached, they are usually easy to remove. The string also allows the woman to check that it is in the correct place. The pregnancy rate is vanishingly smallâ€”only a couple of LARC users in 1,000 will conceive each year. This statistic for â€œthe pillâ€ is much higherâ€”almost 50 per thousand will experience an unplanned pregnancy. Apparently the high failure rate of oral contraceptives in the USA is due to noncompliance. In Europe the failure rate is significantly lower; European women take their birth control pills more regularly.

There are two major drawbacks to both IUDs and the implant: they are expensive and they need to be placed by an experienced clinician. IUDs have a further drawbackâ€”bad press.

It used to be that only women with health insurance or a plump checking account could afford LARCs, but that is changing. Thanks to the Affordable Care Act (â€œObamacareâ€), any woman with insurance, including Medicaid, can get her chosen birth control without copay. In addition, one IUD, Liletta^Â®, is priced much lower than the others. Here in Colorado there is a program that provides contraception, including LARCs, at little or no cost.

Placing an IUD is not difficult for a trained practitioner. The opening of a womanâ€™s cervix may be tight is she hasnâ€™t borne a child, but a little local anesthesia and gentle dilatation will help with the insertion.

The other type of LARC is the implant, Nexplanon^Â®, which is as effective as an IUD. It is a thin plastic rod that is inserted under the skin of the womanâ€™s arm, where it can stay for up to 3 years. It emits a hormone that is very effective in preventing pregnancy. Although it is in a very low level in the womanâ€™s blood, it is sufficient to change menstrual patterns; most women with Nexplanon^Â® will have spotting or breakthrough bleeding. Perhaps this is why less than 1% of women in the USA choose an implant, whereas about 6% use an IUD.

Unfortunately, reproductive health has become a political football. Here in Colorado a grant demonstrated that access to LARCs can give young women a better chance in life by decreasing teen pregnancies. By taking away the consideration of expense, the use of LARCs expanded 4 fold. Nevertheless, the false fear that IUDs might abort pregnancies kept our legislators from continuing funding to provide this effective contraception. The best way to prevent abortions is with effective birth control!

Ohio took a tip from Colorado with a program to provide LARCs. Part of that stateâ€™s motivation is to lower their infant mortality rate. They are targeting young teens and women who have just had a child, since these two groups are at high risk of having an infant die if they were to get pregnant. They also note that the state saves almost $6 for every dollar invested in LARCs.

Ohio has been proactive in another way. Some healthcare providers have misconceptions about IUDs. They think that they should only be used if a woman already has delivered a baby, or that an IUD makes a woman more susceptible to sexually transmitted infections, or teens shouldnâ€™t use IUDs, or that IUDs can lead to sterility. All of these perceptions are wrong! Indeed, almost every woman can safely use an IUD, and start her family as soon as it is removed.

Safe, effective contraception is an important step in empowering women. We should advocate for making LARCs available to all women!

Listen to Representative Coram

A recent Durango Herald article detailed the â€œNew Yearâ€™s resolutionsâ€ of three Southwest Colorado lawmakers. There is an important issue that was not mentioned in this article, and Rep. Coram may have part of its solution.
Let me start by trying to summarize what is on each of the legislators has said. State Senator Ellen Roberts is focusing on rural healthcare costsâ€”for good reason! Although we in the USA spend the mostÂ per capitaÂ of any country in the world, our health statistics lag behind many other countries. Senator Roberts is also concerned about problems brought up by the Gold King Mine spill. I am confident that her excellent legal mind can help pass a â€œgood Samaritanâ€ law for mine mitigation, and decrease barriers between states in dealing with emergencies. Finally, she is concerned about the monstrous wildfires we have experienced recently.
J. Paul Brown, our Representative in the Colorado House, rightly picks transportation and water as key issues for the legislative session that has just begun. He and I probably disagree about transportation because I support public transportation as well as highway improvement. But we definitely agree about water! J. Paulâ€™s website states: â€œWater is the most precious resource on Coloradoâ€™s West Slopeâ€¦. As your State Legislator, I will work tirelessly to protect our water.â€ Globally, waterÂ isÂ the most precious resource.
Don Coram represents people a bit to the north and west of La Plata County, nevertheless he was included in this article. The only issue mentioned is voter registration, but I admire him for another topic. In 2015 he was one of the sponsors of a bill to provide safe, effective contraception to low-income women. A Republican, the bill had a Democratic cosponsor. Unfortunately, the bill failed. Fortunately, however, a coalition of private donors has temporarily picked up part of the slack.
You probably recall that a foundation funded provision of Long Acting, Reversible Contraceptives (LARCs) here in Colorado. LARCs consist of IUDs and a hormonal implant, all of which are safe and appreciated by women, but are usually out of the price range of those who donâ€™t have insurance. They are much more effective than over-the-counter methods such as condoms, and are even 20 times as successful at preventing pregnancy as â€œthe pillâ€. That grant was for a 5-year period which ended in 2015. This funding had a remarkable effect! There were fewer abortions in Colorado, and our teen pregnancy rate dropped by 40%.
Despite Representative Coramâ€™s best efforts, the legislature would not approve funding to continue the program. The reason given for disapproval by other legislators was that IUDs sometimes cause abortions. The best medical knowledge is that IUDs doÂ notÂ cause abortionsâ€”but it is well known that unplanned pregnancies often end up being aborted.
Public health sources state that each dollar spent on family planning saves from 4 to 7 healthcare dollars. This is a better return on investment than just about anything else! Personal benefits, such as allowing a young woman to finish college are of even greater value. Other advantages, however, go beyond the obvious. The cost of insurance is lower if there are fewer unplanned pregnancies, Senator Roberts. Some of the highest healthcare costs are those associated with premature birth. The pregnancies that LARCs prevented in this study would have likely been to the women most likely to give birth prematurelyâ€”young and poor.
What is causing those terrible wildfires that we are having trouble paying for? Climate change is a major factor. What is the least expensive way to slow greenhouse gas emissions? You guessed itâ€”family planning! Fewer people mean fewer emissions. LARCs wonâ€™t provide a short-term solution for either climate change or wildfires, but they can help in the long term.
Representative Brown, please remember that the more people who drive on our highways, the more costly they are to maintain. Likewise, the more people there are in Colorado, the greater the need for water. Most of the growth is on our stateâ€™s Eastern Slope. As its population increases, the pressure for them to get our Western Slope water will increase. Again, LARCs wonâ€™t solve transportation or water problems right away, but funding them can reduce the size of the problems that our children and grandchildren have to deal with.
Thank you for your courageous stand, Representative Coram. I am sorry that I cannot vote for you, but hope that you will find new allies in support of another bill to pay for LARCs.