The XX Factor

St. Louis Study Confirms That IUDs Are the Key to Lowering Teen Pregnancy Rates

Not everyone is convinced that the IUD is the answer.

Right on the heels of the American Academy of Pediatrics recommending the IUD for teenage girls comes a new study that confirms that long-lasting contraception really is the key to reducing teen pregnancy dramatically. St. Louis has, in recent years, hosted an ambitious research project called CHOICE, which offers women and teenage girls free contraception counseling, and then provides them with whatever contraception they want, free of charge. Results from the study show just how far a little counseling and financial assistance can go. As reported by the New York Times:

The yearly pregnancy rate in the study was 34 per 1,000 teenagers, and the abortion rate was 9.7 per 1,000. Pregnancy and abortion rates for sexually experienced teenagers nationally were far higher—158.5 and 41.5 in 2008. For all teenagers, the pregnancy and abortion rates were 57.4 and 14.7 in 2010.

Considering that, by the end of the study, 99 percent of the women and girls enrolled were sexually active, these are dramatically low rates of unintended pregnancy. But the results become even more impressive when we narrow in on the teenagers who were given the copper IUD or the etonogestrel implant: They experienced no unintended pregnancies at all. None. 

In a sense, it’s not surprising, because the whole point of what doctors call LARC, or long-acting reversible contraception, is that it’s nearly foolproof. No ditching the condom in the heat of the moment, no forgetting to take your pill. But it’s nice to have strong, solid numbers to support common sense. That’s doubly true when it comes to teenagers, because the most frequent objection to providing them contraception is that it’s seen as giving them “permission” to have sex. That objection becomes a little harder to stand by once you understand that (a) teenagers are often having sex anyhow, and (b) one major downside to sex is unintended pregnancy, which can be, as we see here, prevented.

Not everyone is convinced. The New York Times reached out to the president of the American College of Pediatricians, a conservative organization that objects to teenage contraception use:

Dr. Den Trumbull, the president of the American College of Pediatricians, which takes an abstinence-only position, criticized the academy’s new guidelines as “another effort to promote the myth of safe sex while ignoring the dire consequences that early sexual activity can have among the young people involved.”

ACP also responded to the AAP’s endorsement of IUDs earlier this week by saying, “Even when contraception is used, early sexual debut has been associated with negative consequences including multiple sexual partners, sexually transmitted infections (STI), increased likelihood of psychological injury (feelings of regret, depression, suicidal attempts), greater substance abuse, and lower academic achievement.” They did not note why adding “unintended pregnancy” to that list of consequences seems like a good idea, nor did they provide evidence for the underlying assumption that simply telling kids not to have sex actually works. That’s likely because it doesn’t: Research shows that kids who pledge to abstain from premarital sex have premarital sex at the same rates as kids who don’t take the pledge.

In contrast, an actual participant of the St. Louis study named Hannah enthusiastically endorsed the IUD she got as a teenager, telling the New York Times: “Having an IUD, it might sound really corny, but I think it’s empowering.” Hannah, who was in a relationship when she got the IUD, is now married at 26.