Association for Public Policy Analysis & Management

Background. The Contraceptive CHOICE Project is one of the most influential studies of long-acting reversible contraception to date.  CHOICE was credited with substantially lowering participants’ risk of unintended pregnancy by increasing their use of long-acting methods, a conclusion that has generated enthusiasm about the potential benefits of expanded use of intrauterine devices and subdermal implants.  However, it is unclear to what degree CHOICE’s effects were due to enrollees’ selection of long-acting methods over other forms of female-controlled contraception.  Because participants’ rates of noncontraception and condom use fell to zero at the outset of the intervention, it is possible that sizeable pregnancy reductions could still have been achieved if enrollees had adopted shorter-acting female-controlled methods, such as oral contraception.

Methods. We used the FamilyScape 3.0 microsimulation model to estimate the CHOICE Project’s impact on participants’ pregnancy rates.  We then simulated the counterfactual effect of moving all noncontraceptors and condom users onto shorter-acting female-controlled methods.

Results. CHOICE reduced subjects’ pregnancy risk by more than 80%.  However, more than 70% of this effect could have been achieved if participants who were using condoms or no method prior to enrollment had adopted shorter-acting female-controlled methods.

Conclusions. The bulk of the CHOICE intervention’s impacts could have been realized without any increase in long-acting method use. Medical practitioners and policymakers should not assume that expanded use of long-acting methods will necessarily yield large reductions in unintended pregnancy; rather, the most impactful interventions will likely be those that increase the use of female-controlled methods – long-acting or otherwise.