Contraception

Study: Providing Teens With Free Long-Acting Contraception Dramatically Lowers Births and Abortions

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Pregnant and 16
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The New England Journal of Medicine is reporting the results of the Contraceptive CHOICE project in St. Louis, Missouri. The teenagers were educated about using long-acting contraception such as intra-uterine devices (IUDs) versus shorter acting contraception such as the pill. The project enrolled 1404 teenage girls and women and followed them for two to three years. The pregnancy, birth, and abortion rates among participants were much lower than the national average.  As the NEJM article notes:

Although it has declined substantially over the past two decades, the pregnancy rate among girls and women 15 to 19 years of age remains a stubborn public health problem. Each year, more than 600,000 teens become pregnant, and 3 in 10 teens will become pregnant before they reach 20 years of age. Rates are higher among black and Hispanic teens, with 4 in 10 becoming pregnant by 20 years of age, as compared with 2 in 10 white teens. In addition to the negative health and social consequences borne by teenage mothers and their children, the national financial burden is substantial. In 2010, births involving teenage mothers cost the United States nearly $10 billion in increased public assistance and health care and in income lost as a result of lower educational attainment and reduced earnings among children born to teenage mothers.

The results as reported in the abstract:

Of the 1404 teenage girls and women enrolled in CHOICE, 72% chose an intrauterine device or implant (LARC methods); the remaining 28% chose another method. During the 2008–2013 period, the mean annual rates of pregnancy, birth, and abortion among CHOICE participants were 34.0, 19.4, and 9.7 per 1000 teens, respectively. In comparison, rates of pregnancy, birth, and abortion among sexually experienced U.S. teens in 2008 were 158.5, 94.0, and 41.5 per 1000, respectively.

The report adds …

… we found that in a cohort of teenage girls and women for whom barriers to contraception (lack of knowledge, limited access, and cost) are removed and the use of the most effective contraceptive methods is encouraged, a large percentage opted to use LARC methods. 

So is unintended pregnancy a public health issue or a private personal mistake, or both? 

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  1. Where do you even begin with this one?

    1. One: did I misread the title? Study: Providing Teens With Free Long-Acting Contraception Dramatically Lowers Births and Abortions. Really? Secondly What was the point of the study?

      Of the 1404 teenage girls and women enrolled in CHOICE, 72% chose an intrauterine device or implant (LARC methods); the remaining 28% chose another method. During the 2008?2013 period, the mean annual rates of pregnancy, birth, and abortion among CHOICE participants were 34.0, 19.4, and 9.7 per 1000 teens, respectively. In comparison, rates of pregnancy, birth, and abortion among sexually experienced U.S. teens in 2008 were 158.5, 94.0, and 41.5 per 1000, respectively

      So they gave a bunch of teenagers birth control and were shocked they were smart enough to use it?

      1. Lowering the cost of something increases its frequency. Shocking.

        1. But free condoms and the Pill are relatively not as effective, because:

          1) Condoms and the Pill are cheap to start with, and
          2) A pain to remember to use.

          With condoms and the Pill it’s not the cost that’s the barrier to people using them every time. Seriously, go and check the “actual failure rate” of condoms (and to a lesser degree the Pill)– it’s basically the same as people who use the rhythm method or withdrawal, because tons of people who say that they use condoms as their primary method don’t always use them.

      2. Not only that, but they compared the girls in CHOICE with sexually experienced US teens, not all teens.

        Is there any reason to assume the participants in the program were sexually experienced?

        1. r: Yes, the participants were mostly sexually experienced.

          1. Ron, you sly dog you!

          2. So the girls elected to participate in the program specifically, or were randomly assigned to it? If not randomly assigned, the whole study is worthless as you can’t distinguish between the effect and selection bias.

        2. Yes, according to the article “the vast majority of the girls enrolled were already sexually active” when the study began. In this way they are comparing like things. It would make no sense to compare groups of girls who are and are not having sex.

      3. So they gave a bunch of teenagers birth control and were shocked they were smart enough to use it?

        No, note that most of them chose IUDs or implants that don’t require being “smart enough to use it.”

        I think the point of the study is supposed to be “things like IUDs and implants that you don’t have to remember to use each time are way more effective for teenagers than things like the Pill or condoms that you have to remember to use.”

        1. Correct me if I’m wrong but they just gave the majority 72% IUD not the entire group, 28% used “other” unspecified methods and they never separate that out. So that kind of comes with a caveat.

          1. The comparison is to other studies and status quo in many districts, which have found much smaller effect sizes.

  2. Study: Providing Teens With Free Long-Acting Contraception Dramatically Lowers Births and Abortions

    And if they were sterilized altogether, it would dramatically lower births and abortions to zero.

    In other news…

    1. And also, it’s not FREE! It is paid for by someone else.

      1. Ya but when the state holds a gun to your head and asks where you’d like your wallet to be sent. This is far better than the alternative

  3. “So is unintended pregnancy a public health issue or a private personal mistake, or both?”

    A personal mistake, which need not burden the public fisc if the mothers allow the many stable married couples begging for the chance to adopt a child, to adopt their baby.

    Of course, it would nice if adoption were made easier – even easier than abortion.

    Now, the study compares “CHOICE participants” to sexually-active teens. I assume the CHOICE participants are all sexually active, so that we can have an apples-to-apples comparison?

    1. More pregnant teens would probably choose to give birth over abortion if they were allowed to sell the child. Would you be good with that Eddie?

      1. I’m not Eddie, but I’m fine with that so long as prospective buyers are bound by the same laws as any other parental guardian would be RE: care and non-abuse of the child.

        1. I don’t have a problem with it either. Market forces. People want babies and are willing to pay. Assume parenting responsibilities and have a nut.

          I’m sure there would be fewer abortions.

      2. There’s a slight legal difficulty with formally selling children, known as the 13th Amendment. Selling a human being strikes me as one of the “badges or incidents” of slavery, as the jurists call it. If you want to amend the 13th amendment you’re welcome to try.

        Plenty of people put their children up for adoption without selling them. These are not equivalent concepts.

        1. Except the babies are not being forced into involuntary servitude. The mother is merely being compensated for her labor and loss.

        2. Have you read the 13th Amendment? Says nothing about selling children. It abolished slavery:

          Amendment 13 – Slavery Abolished

          1. Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.

          2. Congress shall have power to enforce this article by appropriate legislation.

          1. That’s why I said sale of a human being is a badge or incident of slavery.

            It presupposes that the parent actually *owns* the child, and can transfer that ownership to someone else for pay. Now, if that’s not a badge or incident of slavery, I’m not sure what would be.

            But the parent-child relationship is not one of ownership. I support adoption of infants, not under any ownership theory, but because if the mother* wants to give up the child that’s a sign that it’s in the child’s interest to be raised by someone else.

            If the mother gives the child for adoption, she gets “financial compensation” in the form of no child-care expenses. No need to sign a contract of sale giving her the savings she’s going to get in any case.

            *I’m assuming a single-mother scenario here.

            1. Parent doesn’t own the child, but he/she does own exclusive guardianship rights/privileges. That has to be worth something to someone, and the right is already transferrable — why not make it transferrable contingent on incentives? I’m sure there are plenty of parishes and churches that would fundraise to meet these costs for eligible parents in their congregations, or even to put the child up in an orphanage over the possibility of abortion.

              Seems to me that the willingness of a prospective adoptive parent to pay for a child of their own (and the willingness of a biological parent to sell the child) is an indicator that the adoptive parent will value the child more than the biological parent, and that the child will accordingly have a better upbringing. Indeed, if one is a Christian is not God considered the ultimate adoptive father on account of His paying the ultimate price for that status?

              1. “Indeed, if one is a Christian is not God considered the ultimate adoptive father on account of His paying the ultimate price for that status?”

                That is certainly a good point. Now, I think the “bought at a price” metaphor is not strictly literal, but an attempt to capture a great mystery about redemption. But certainly there’s plenty of “redemption” (in the literal sense) and “bought at a price” language in the scriptures.

                But I guess where I draw the line is the idea that you can buy and sell human beings. Compensating a mother who decides to put her child up for adoption could *sometimes* be justified, and there’s plenty of borderline cases, but I’m not treating this like a law professor posing clever hypotheticals to challenge his students, but as someone who doesn’t want to establish any principle which could put human beings up for bargain and sale.

                If you admit the principle that human beings can be bought and sold, what’s to stop a parent from selling their child to a cotton planter for perpetual servitude? It’s better than being aborted!

                1. The abolition of slavery was a gradual process – the Church didn’t wave a want and get rid of it, but instead created a process of erosion by which the force of Christian principles gradually wore away slavery, first establishing the right of slaves to stay on their own property and not be sold down the river, then letting the ex-serfs enjoy full freedom.

                  To me, the erosion of slavery is a one-way process – moving from slavery to freedom. Moving in the other direction is out of the question.

                2. But I guess where I draw the line is the idea that you can buy and sell human beings.

                  So if we simply call it “a woman selling her reproductive services”, you’re good with it?

                  If you admit the principle that human beings can be bought and sold, what’s to stop a parent from selling their child to a cotton planter for perpetual servitude?

                  The 13th Amendment…see above.

                  1. I react very strongly to your endorsement of the idea of “sell[ing] the child.” I don’t think a child *can* be sold.

                    Letting women give up their infants for adoption is a recognition that it’s not a good idea to have a child reared by a single mother who doesn’t have the will or resources to raise it.

                    But just because a single mother can give up her parental rights doesn’t mean she can transfer those rights to whomever she chooses, like the cotton plantation owner who offers her the best price.

                    Once she gives up her rights, then the govt can at least inquire into the qualifications of the adoptive couple – and for practical reasons, I don’t think the government should do too much meddling so long as the adoptive couple are regular people who just want a kid (as opposed to a plantation owner seeking slave labor).

                    I don’t consider this the same as the sale of a human being.

                    1. I react very strongly to your endorsement of the idea of “sell[ing] the child.” I don’t think a child *can* be sold.

                      You’re not selling the child. You are selling the services and the rights/responsibilities of the birth mother.

                      But just because a single mother can give up her parental rights doesn’t mean she can transfer those rights to whomever she chooses, like the cotton plantation owner who offers her the best price.

                      Why not? When I sell my services, do I not do so for the best price? And they are MY rights/responsibilities. Who better to decide who I give them to than me? Why is the government better. I can show you a thousand examples of how adoption agencies are worse.

                      (as opposed to a plantation owner seeking slave labor).

                      Stop saying this. We are not talking about selling anyone into slavery. Not the issue being discussed. Even if you were selling the baby, as property, as opposed to the services of the mother, it still has nothing to do with slavery. One may not legally or morally own a slave.

                    2. “You’re not selling the child.”

                      I don’t want to get all technical, but you said above that “More pregnant teens would probably choose to give birth over abortion if they were allowed to sell the child. Would you be good with that Eddie?”

                      Was that simply a taunt of the “if you’re *really* prolife you’d want to sell babies” variety? Because if so, I’m sorry I spent more than a token amount of time rebutting it.

                    3. Reread my 12:52

                      The topic shifted.

                      You said:

                      But I guess where I draw the line is the idea that you can buy and sell human beings.

                      To which I asked:

                      So if we simply call it “a woman selling her reproductive services”, you’re good with it?

                      So yes, you are correct, but the follow-up question was different than my original question. You’ve convinced me that the child is not property. But I see nothing wrong with selling the service and time required to produce a child.

                      My premise was that selling the child (originally, now selling the service to make a child) would provide a profit motive and incentivise the birth mother to deliver rather than abort. And knowing you are pro-life, wondering where you would stand with monetarily incentivising the woman to deliver?

                      And checking your libertarian cred. 😉

        3. There’s a slight legal difficulty with formally selling children, known as the 13th Amendment. … Plenty of people put their children up for adoption without selling them. These are not equivalent concepts.

          One would think that. But then again, one would be wrong.

          1. You mean there are people who break the law? That doesn’t invalidate my point.

            From the linked article:

            “the Orphan Train Project gathered children and transported them for resettlement under farmers needing labor, using a procedure akin to a slave auction.”

            I’m guess that wasn’t legal. Lots of things happen that aren’t legal.

            1. Please tell me you read past the 2nd paragraph.

              1. OK, help me out here. Maybe I’m slow. What’s your bottom-line point? Then maybe I can give a better response.

                1. 1.) If the argument for the illegality of the activity under the 13th was a strong as you say, then why, in 1955 did Congress think it necessary to propose legislation to ban it…much less to see the bill fail to pass?

                  2.) If the activities aren’t equivalent, then why did the peak of adoption in the United States coincide with baby-selling practices?

                  1. The article you linked to in #2 starts off by saying mothers “had newborns stolen from them,” which is a Very Bad Thing, though I don’t see what this has to do with *sale* of babies.

                    The article goes on to blame Society and social workers for guilt-tripping single mothers into giving up their babies, which, to me may or may not be a Bad Thing but in any even isn’t the same as selling babies.

                    And I’d like to see the baby-selling bill from 1955 to see what was in it. Though it’s possible Congress ignored its duties to enforce the 13th Amendment, just as for a long time it ignored its duties to enforce the 14th and 15th*

                    *For that matter, it *still* ignores its duty to enforce the 14th. More on that in the next abortion thread.

                    1. The article you linked to in #2 starts off by saying mothers “had newborns stolen from them,” which is a Very Bad Thing, though I don’t see what this has to do with *sale* of babies.

                      Because the adopting families weren’t stealing the babies, adoption agencies were. And they made quite a profit doing so.

                    2. OK, but FdA’s initial remark, to which I was responding, was about teenage single moms “sell[ing]” their children.

                      I don’t think moms can sell children, much less adoption agencies who kidnapped* the child from its mother.

                      *”Stole” implies ownership, so I steer clear of that word.

        4. Most adoptions are a purchase. Just the money goes to third parties (brokers, lawyers, govt.) and the mother gets nothing.

          1. I focus on the idea that, to sell a baby, you first have to have some kind of property interest in its *person* or its *labor.*

            1. Which I deny, in that property in human beings is way out.

            2. She’s not selling the baby. She’s selling her signature. That signature just so happens to go on a legal document waiving all the rights the law afforded her as the child’s mother.

          2. She doesn’t get “nothing.” She gains the present value of all the future money amounts she would have had to spend in order to feed and clothe the kid.

    2. Now, the study compares “CHOICE participants” to sexually-active teens. I assume the CHOICE participants are all sexually active, so that we can have an apples-to-apples comparison?

      I noticed the same thing. Posted above before I saw this.

      It stands out like a huge red flag, I hope they got it right.

    3. Folks: Study participant criteria:

      Women and adolescent girls were eligible to participate in CHOICE if they were English-speaking or Spanish-speaking, resided in the St. Louis region or sought contraceptive services in selected community clinics, had no desire for pregnancy for at least 12 months, were sexually active or planning to be sexually active with a male partner during the next 6 months, and were not using a contraceptive method or were willing to switch to a new, reversible contraceptive method. Women and adolescent girls were ineligible if they had undergone a hysterectomy or sterilization procedure.

      1. “were sexually active or planning to be sexually active with a male partner during the next 6 months”

        OK, thank you, that clarification helps a lot!

      2. Folks? FOLKS?!?!

        How dare you?

    4. Here I am, on a libertarian site, in a lonely crusade to oppose the sale of children!

    5. Do you honestly think that there are enough “stable married couples” out there to adopt all of the results of unwanted pregnancies in America? Really? Let’s look at some numbers –

      Number of US women 19 and under who had an abortion in 2008 (the last year for which full statistics are available) (According to the Guttmacher Institute): 198,100

      Number of children adopted in the US in 2008 (US Dept of Health and Human Services): 135,813

      Number of children eligible for adoption in foster care last year (Congressional Coalition on Adoption): 101,666

      Now the numbers for children adopted and in foster care are kids of all ages – not just infants. And the number of adoptions include international adoptions.

      If there were really SO MANY couples out there dying to adopt, there wouldn’t be a hundred thousand kids in foster care. The number of abortions is substantially higher than the number of adoptions. Do you really think we can find this many more couples who want to adopt? Really? You think the number of adoptions in the US can more than double?

      Maybe there are a lot of couples waiting to adopt healthy white babies. But what about an African-American baby with special needs? Do you really think there are enough homes to go around for them? It is depressingly naive to think that every single teenager who decides to have an abortion could have reasonably put their child up for adoption.

  4. But using IUDs is murder!

    /Eddie

    1. “I don’t know the details of IUDs, which is why I haven’t commented on the subject.”

      /The Eddie who exists in reality, outside FdA’s brain

  5. IUDs cause abortions, if you think human life begins at conception rather than implantation.

    1. Re: SugarFree,

      IUDs cause abortions, if you think human life begins at conception rather than implantation.

      IUDs are like not answering your door. If the zygote can’t implant itself, then there’s no tenancy. It is not murder if you do not open your door.

      1. I think you “open your door” a trifle earlier than implantation of the zygote, OM.

        1. Re: MegaloMonocle,

          I think you “open your door” a trifle earlier than implantation of the zygote, OM.

          The point is that if the zygote does not implant, then there was no act of aggression on your part. If this was because nature didn’t intend it or because you have an IUD, the result is the same: it is the same as not opening your door to let someone in. Instead, implantation is the same as inviting that someone into your house. Abortion is murdering that someone you invited into your house.

      2. The logic of the entire Hobby Lobby case rested on what I stated above, for both IUDs and emergency contraception. They had no issue with paying for contraception that prevented fertilization.

        1. Re: SugarFree,

          The logic of the entire Hobby Lobby case rested on what I stated above

          Well, they chose to choose their battle. Arguing their case on NAP grounds would have meant being laughed out of the courtroom by the statists in robes.

          1. There were plenty of people on the board that agreed with Hobby Lobby. And human life beginning at fertilization is not exactly an uncommon position in the pro-life crowd.

  6. You just want to turn these precious delicate blossoms of American womanhood into whores.

    WHORES, I SAY!

    1. Don’t encourage them

    2. WHORES, I SAY!

      Would have been a good alt text.

    3. At least there is always a market for whores. /evil libertarian

  7. The premise is of course false (not entirely shocking considering NEJM’s track record when medical intersects with political) when they say

    ‘Although it has declined substantially over the past two decades, the pregnancy rate among girls and women 15 to 19 years of age remains a stubborn public health problem. Each year, more than 600,000 teens become pregnant, and 3 in 10 teens will become pregnant before they reach 20 years of age. Rates are higher among black and Hispanic teens, with 4 in 10 becoming pregnant by 20 years of age, as compared with 2 in 10 white teens.’

    Unless all those teens are unmarried and all the births unintentional there is no public health problem if for example an 18-year-old girl who is married has an intended pregnancy. Are they distinguishing between 18-year-old married girls, or even 16 yr old ones and those that are unmarried and have unintended pregnancies ?

    Also clearly they are racist just like cops are since there’s no way that any sort of racial disparity can ever mean anything but racism

    1. Married or not it isn’t a public health problem unless the public is forced to subsidize it.

      1. In our system, it’s clear that births by unwed teenagers tend to rack up costs incurred by the public. Obviously your average unwed teen mother is more likely to be receiving public assistance etc

        Also criminologists are near unanimous in concluding that there are few factors more likely to be able to predict future criminality sociopathology etc that being the product of an out of wedlock birth

        So not only is the mother going to be likely to cost society but the kid is way more likely to be a burden on society both by the crimes he commits and the costs of prosecuting incarcerating and

    2. TakD: Currently, about half (51%) of the 6.6 million pregnancies in the United States each year (3.4 million) are unintended.

  8. Why 20? If you are 18 or 19, out of school and married (that actually still happens once in a while) why would having a kid be a “public health problem” or whatever?

    1. Why is in school even a problem?

      I knew married college students who had kids.

  9. Question: does Reason post these threads so often specifically because they know that abortion is a decisive issue among libertarians and they love seeing us flame each other instead of flaming them? or am I a crazy tin foil wearing conspiracy theorist?

    1. decisive

      Thats lacist.

      1. *divisive.

  10. You know what else is a contraceptive?

    Facials.

    We need to heavily feature the money shot in high school sex ed. curricula.

    Let’s open a Kickstarter.

    1. Also as a follow-up blow jobs and anal seem to be effective as well.

      1. Someone should do a study.

        1. Go on.

          1. I’m incapable as I already came.

            1. Come again?

      2. I never understood why the phrase “technical virgin” needed the first word.

        1. Because there are many kinds of virginity. Getting to fifth base is a special moment in a Catholic schoolgirl’s life and it should be recognized.

          1. Is that potato growth?

            1. When a girl gets her first potato is often a joyous time. Many cultures celebrate with a special party.

    2. Damn right.

      Ditto anal.

    3. Is THIS why there are no female libertarians?

      1. ENB has an entire article on the interwbebz on the health benefits of swallowing.

  11. What percentage of Millenials use potatoes as contraceptives? I demand a poll.

  12. the pregnancy rate among girls and women 15 to 19 years of age remains a stubborn public health problem.

    Because reproduction is a sickness. Especially when the ‘undesirables’ do it.

    /Margie Sanger.

  13. Study: Providing Teens With Free Long-Acting Contraception Dramatically Lowers Births and Abortions

    or

    Study: Providing Teens (and adults up to 19) With Free (money coerced from citizens) Long-Acting Contraception (and lessons about personal responsiblity) Dramatically Lowers Births and Abortions.

  14. http://m.nydailynews.com/news/…..1235#bmb=1

    Woman with protective order (press says restraining order which is almost certainly wrong since in most jurisdictions restraining orders are issued in cases of marriage dissolution) Shutes her stalker after he kicks her Door in. She is completely unharmed and fine and he is in hospital with gunshot wounds and has been charged with multiple felonies. As an added bonus the reporting of this case in the media could possibly even have a deterrent effect on some futures talkers

    Regardless he is deterred as fuck since he is both perforated and in custody

    I am confident that the empowerment mavens at feministing and Jezebel will be celebrating this case is a great example of the benefits of firearm rights and real gun-control which means proper aiming and trigger control. She is a REAL feminist hero

  15. This is stylish and sexy!

    I need to add a ‘glamlet’ to my collection of singlets. Spanking anticop bigots is part of living well, but so is being damn sexy ™

    Glamlet and pro-USA socks = win

  16. No abortion, no contraception, no welfare state. One gets the impression that the motivation here might just be trying to force females to keep their legs together and not at all the protection of precious baby zygote lives.

    1. no contraception

      Did you mistakenly think you were posting on CatholicStuff.org or are you willfully and mendaciously misrepresenting the arguments of your ideological opponents, yet again?

      1. I think they are misrepresenting their own arguments to themselves. People genuinely motivated by protecting innocent baby fetus lives are a couple generations removed from the people who started the movement as a sexual purity thing and used baby fetus lives as a rhetorical device.

        1. So, by that logic, Planned Parenthood, and other Progressive reproduction-rights groups are just in denial that they are pro-eugenics organizations. Are you prepared to bite that bullet?

          1. Word

            And not surprising Tony would devolve to the typical ploy he just did

  17. And now. our 1,000,000th unnecessary study with a completely obvious result! What does the lucky winner get???

  18. That explains the high teen pregnancy rate among the Amish, I suppose.

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