Association for Public Policy Analysis & Management

Many have argued that leveraging recent advances in contraceptive technology could be key to reducing unintended pregnancies and improving women’s outcomes. In particular, long-acting reversible contraceptives (LARCs), which include implants and intrauterine devices, are extremely effective at preventing pregnancy. Unlike birth control pills, injectables, patches, rings, and condoms, which have failure rates of 6-18%, LARCs have failure rates of less than 1% because they are not user-dependent and thus eliminate user-compliance errors.

Despite the effectiveness of LARCs, take-up is low. This project investigates the degree to which policies that expand access to LARCs, such as the Colorado Family Planning Initiative, affect different age groups and outcomes to provide a more comprehensive picture of the benefits of expanding access to these contraceptives. The Colorado Family Planning Initiative was a statewide program intended to help low-income women gain access to LARCs through Title X clinics. In the five years following its implementation (2010-2014), LARC use increased from 10.1 to 24.2 percent among women visiting these clinics. We will use zip code-level data from Colorado to estimate the causal effects of expanding access to LARCs on contraception use, abortion, pregnancy, childbearing, and newborn health among various subgroups. Preliminary estimates indicate that improved access to LARCs substantially reduces births to young women living in zip codes closest to Title X clinics.

Our findings will contribute to discussions about future interventions that could be conducted and to broader considerations about removing financial and information hurdles that often prevent women from obtaining LARCs. These barriers continue to be significant even with the extensive changes in health care policy that have occurred in recent years. Even with the Affordable Care Act’s current mandate that insurers cover some forms of LARCs without cost sharing, many women remain uninsured or on exempted plans—and the recent repeal of the individual mandate means that the population of women relying on state-sponsored family planning programs is likely to increase in the coming years. Moreover, a large majority of individuals report that they know little or nothing about LARCs. As such, there remains considerable scope for policymakers to improve access to LARCs. This study takes an important step toward understanding the potential for such efforts to improve women’s outcomes by documenting the effects of a large-scale policy intervention in the United States.