Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review

Abstract

The Contraceptive CHOICE Project (CHOICE) sought to reduce unintended pregnancies in the St. Louis Region by removing cost, education, and access barriers to highly effective contraception. CHOICE was a prospective cohort study of over 9,000 women 14-45 years of age who received tiered contraceptive counseling to increase awareness of all reversible methods available, particularly long-acting reversible contraceptive (LARC) methods. Participants were provided with contraception of their choice at no cost for 2-3 years. We studied contraceptive method choice, continuation, and population outcomes of repeat abortion and teen pregnancy. Seventy-five percent of study participants chose one of the three LARC methods (46% levonorgestrel intrauterine system, 12% copper intrauterine device, and 17% subdermal implant). LARC users reported greater continuation than non-LARC users at 12 months (87% versus 57%) and 24 months (77% versus 41%). In our cohort, LARC methods were 20 times more effective than non-LARC methods. As a result, we observed a reduction in the percent of repeat abortions from 2006 to 2010 in St. Louis compared with Kansas City and nonmetropolitan Missouri and found substantial reductions in teen pregnancy, birth, and abortion (34.0, 19.4, and 9.7 per 1000 teens, respectively) compared with national rates among sexually experienced teens (158.5, 94.0, and 41.5 per 1000, respectively). Improved access to LARC methods can result in fewer unintended pregnancies and abortions and considerable cost savings to the health care system.

Short-Term Treatment of Bothersome Bleeding for Etonogestrel Implant Users Using a 14-Day Oral Contraceptive Pill Regimen

“…5,6 Although the overall continuation rates of implants are very good compared with short-acting methods, continuation beyond 1 year of use appears lower for implants than other long-acting methods, often secondary to unacceptable bleeding. 3,16 Interventions such as the one tested in this study may be of benefit to women seeking temporary cessation of bleeding episodes and possibly avoid early removal.…”

“…It is one of the most effective forms of contraception available with a failure rate of 0.05% 1,2 and 2-year continuation rates are high ranging from 53% to 90%. 3,4 Like other contraceptive methods, many implant users discontinue before the 3 years of intended use for reasons other than desiring pregnancy. One of the most common reasons for lower contraceptive satisfaction is "bleeding problems" such as prolonged bleeding and frequent episodes, which may be termed "bothersome bleeding."…”

Investigational hormone receptor agonists as ongoing female contraception: a focus on selective progesterone receptor modulators in early clinical development

“…While these products are considerably less hazardous to a woman's health than pregnancy, they do increase the risks of venous and arterial thromboembolism [84]. Progestin-only methods, which provide even better pregnancy protection without any pro-thrombotic impacts, have increased in use.…”

Estimated disability-adjusted life years averted by free-of-charge provision of the levonorgestrel-releasing intrauterine system over a 9-year period in Brazil

“…A previous study that was part of the US-based contraceptive CHOICE project reported a reduction in abortion rates with the use of LARC methods among participants who were recruited mainly from two abortion facilities in St Louis, MI, USA. At the end of that study, abortion rates in this group were less than half the regional and national rates 13. According to the results of the present study, an estimated total of 410 unsafe abortions were averted over the 9 years of evaluation.…”