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Obamacare Simulation's Dramatic Effect on Teen Pregnancy Really a Technology Tipping Point

What got triggered when 9,000 women were offered free birth control in a recent study was a technology shift in a microcosm.

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1. Traditional contraceptives have a big gap between “perfect use” and “real world.” Short acting hormonal methods like pills and patches, and barrier methods like diaphragms and condoms all have major gaps between how well they work under “perfect use” or laboratory conditions, and how well they work in the real world. For timing methods like Natural Family Planning, withdrawal, and abstinence the gap can be enormous, because they require a level of knowledge, self-awareness, control and communication that is beyond most people.  By contrast, with a LARC, what you see is what you get. Once a LARC is in place, it works in the real world just like it works in the research. 

2. LARCS are better at blocking pregnancy. If you keep in mind that 85 women out of 100 will get pregnant in a year of unprotected sex, the contraceptive effect of the Pill is dramatic. In a perfect world where pill-taking never got disrupted by bounced checks, marital disputes or forgetfulness only two women out of every hundred would get pregnant on the Pill. Not bad, unless you’re one of the two.  Even so a well settled LARC leads to far fewer.  It’s anywhere from 2/800 (copper IUD) to somewhere around 2/4000 (implant).         

3. Fewer side effects means higher continuation. In the St. Louis study, 85 percent of the women who chose a LARC were still using it a year later, compared with about half of those who had chosen a short acting method like the Pill or ring or patch. Part of the difference may be the hassle factor, but also short acting methods like the Pill or ring or patch require a larger dose of hormone than an IUD. No contraceptive works the same for everyone, but on average a lower dose means fewer side effects. And fewer side effects means women are less likely to go through risky gaps when they are changing methods.    

4. LARCs toggle the fertility default. Imagine if the light switches in your house all turned themselves back on after a certain amount of time whether you wanted them on or not.  That’s how fertility works. It turns on at adolescence and stays on for the next forty years whether a woman wants it on or not. During that time she may want to have one child or four or none. The rest of those forty years, some 400 reproductive cycles, she has to either switch it back off or avoid having a fertile egg come in contact with sperm. The Pill requires her to flip the switch off every day.  A LARC means she can hit it as infrequently as once every twelve years –and still flip it back on when she wants to have a child. In recent years, behavioral scientists have learned quite a bit about default effects—how much human behavior is driven, not by choice but by indecision or inattention or inconvenience or inertia or impulse. LARCs take these factors out of the equation for long periods of time, making pregnancy an active and more often mutual decision.

It all adds up to a technology leap that is huge, especially for people who are already up against the hard edges of life: teenage girls who haven’t quite figured out what they want for themselves, or how to say no; families that are struggling to make ends meet; fundamentalist women for whom either another baby or an abortion would feel like a nightmare; tired moms who just want to relax about sex, confident that intimacy won’t mean another 6000 diapers. 

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