Startling Proof That Teen Pregnancies Drop When Birth Control Is Free

If birth control were free, there would be fewer unwanted pregnancies. This is the longstanding hypothesis put forth by women’s health advocates (and correspondingly written into the Affordable Care Act). Over the last six years, a private grant fund from the Susan Thompson Buffett Foundation (billionaire investor Warren Buffett’s late wife) has given Colorado a unique opportunity to test this hypothesis. The results are significant.


When teenagers and poor women in the state were offered free, long-acting contraceptives—i.e. intrauterine devices (IUD) and implants—they overwhelmingly accepted, and the rate of teen pregnancies has plunged. Teen births in Colorado dropped by 40 percent between 2009 and 2013 and the number of abortions in the state decreased by 42 percent, according to the Colorado Department of Public Health and Environment.

The New York Times called the results of the experiment “startling,” in a cover story this week, noting that while teenage births “have been declining nationally, experts say the timing and magnitude of the reductions in Colorado are a strong indication that the state’s program was a major driver.”

The impact of the program has been most noticeable in the poorest parts of the state, where the rates of unplanned teenage pregnancy have historically been highest. As the Times piece explains,

“In 2009, half of all first births to women in the poorest areas of the state happened before they turned 21. By 2014, half of first births did not occur until the women had turned 24, a difference that advocates say gives young women time to finish their educations and to gain a foothold in an increasingly competitive job market.”

The Times article also notes that the number of women using long-term birth control methods in Colorado is much greater than the use of those methods nationally.

About 7 percent of American women ages 15 to 44 used long-acting birth control from 2011 to 2013, the most recent period studied, up from 1.5 percent in 2002. The figures include all women, even those who were pregnant or sterilized. The share of long-acting contraception users among just women using birth control is likely to be higher.”

While the Affordable Care Act mandates “free contraception” for many in the US, not all insurance coverage is panning out equal. Some plans include a required payment for birth control, and others only offer a limited selection of birth control methods free of charge. And, as the Times notes:

“Only new plans must provide free contraception, so women on plans that predate the law may not qualify. (In 2014, about a quarter of people covered through their employers were on grandfathered plans, according to the Kaiser Family Foundation.)

Advocates also worry that teenagers — who can get the devices at clinics confidentially — may be less likely to get the devices through their parents’ insurance. Long-acting devices can cost between $800 and $900.”

Meanwhile, Colorado’s program is beginning to run low on funding, but for now continues to save the state money and time. The Colorado Department of Public Health and Environment estimates that the birth control initiative has saved the state’s Medicaid program (which covers more than three-quarters of teenage pregnancies and births) $5.85 for every dollar spent.

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