By Katie Kerwin McCrimmon
Colorado’s top doctor is refusing to give up on a birth control program that is leading the nation in reducing teen pregnancies and cutting abortions.
Last week, Republicans in the Colorado Senate killed a bill that would have allocated $5 million in taxpayer funds to provide IUDs and other long-acting removable contraceptive devices (known as LARC) for low-income teens and young women in Colorado.
Dr. Larry Wolk, executive director and chief medical officer at the Colorado Department of Public Health and Environment, fought hard for the new funding along with health officials from across the state. The measure passed with bipartisan support in the House, but failed when several Republicans said they intended to fight it and leaders sent the bill to a “kill committee” where the measure was doomed. Despite the loss, Wolk plans to press forward with the program.
“Where there’s a will, there’s a way,” said Wolk, a pediatrician with specialty training in adolescent medicine. “We are going to go out and see if we can raise the money through private foundations. We already have some preliminary interest. We’re going to pull together a group of interested supporters in the next month and see what we can do.”
Wolk said leaders of foundations both in Colorado and around the country have approached him and want to join local health officials in preserving the program.
That’s because Colorado has attracted attention from the U.S. Centers for Disease Control and Prevention for a remarkable drop in teen pregnancies.
In a report that the CDC released this spring, Colorado was the only state in the U.S. where more than 20 percent of young women ages 15 to 19 who sought help at Title X clinics chose long-acting contraceptives. The LARC devices are the most effective forms of birth control, especially for teens and young women who sometimes forget to take a daily birth control pill or have trouble getting new prescriptions each month.
According to the CDC, the failure rate with LARC is less than 1 percent, while birth control pills fail at a 9 percent rate and condoms don’t work 18 percent of the time.
Nationally, only 7 percent of women use IUDs or other long-acting devices. They cost more up front to purchase and insert, but are highly effective in helping women prevent unplanned pregnancies.
Wolk told lawmakers during various hearings that STDs, abortions and teen birth rates all have declined sharply in Colorado over the past six years since a private donor funded a pilot program that has given the free or low-cost IUDs to teens and young women. At the same time, Colorado lawmakers also funded programs that encouraged teens to wait to have sex. For those who do become sexually active, public health clinics across Colorado have over the past six years been offering long-acting birth control.
Since 2009, the Susan Thompson Buffett Foundation https://buffettscholarships.org/ has funded the Colorado Family Planning Initiative with a $25 million grant that helped Colorado officials provide more than 30,000 long-acting birth control devices that they say cut the teen birth rate in the state by 40 percent.
State Medicaid programs pay for many teen births — at an average cost of about $11,000 per birth — and health officials estimate that prevention of unwanted pregnancies saved the state between $49 million and $111 million in Medicaid costs from 2010 through 2012. They say every dollar spent to help low-income teens and young women get IUDs or similar long-acting implants will save $5.85.
The long-acting contraceptives not only save money, but also can change lives, allowing young women to finish school and start their careers while waiting to have children until they are ready.
Corrine Rivera-Fowler, deputy director of the Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR), was among those who testified at the legislature.
She said young Latinas are twice as likely to get pregnant by accident compared to other girls and young women. When they do, it can derail their educational and career goals.
“I know first hand how important it is to provide long-acting contraception,” Rivera-Fowler testified.
“As a teen, I was sexually active. My family did not have health insurance. I had no primary care doctor. I learned I could go to Tri County Health. I would take multiple buses (to get there),” she said.
But she wasn’t always able to get her pills.
“When I was 18, I experienced an unplanned pregnancy and I gave birth to my son. This week, he will finish his junior year at Boulder (at the University of Colorado).
“It has been a long, tough road these past 20 years,” Rivera-Fowler said.
While she said she loves her son and is proud of his accomplishments, she wishes she could have had access to long-acting birth control at a young age, so she could have become a mother when she was ready.
“We know it is better when people are able to plan and space their pregnancies. It improves health outcomes when they have the support they need,” she said. “This program has made real changes.”
Officials at the Buffett Foundation declined to discuss the Colorado program since foundation leaders don’t talk about their work. But, it’s unlikely they will continue to fund the Colorado program since it was a demonstration project.
Along with seeking support from other foundations, Wolk said he will also press insurance carriers to do a much better job of covering long-acting birth control for patients.
The trend is going in the right direction. In 2011, Colorado’s Medicaid program funded about $465,000 for LARC while private insurance paid about $53,000 for the devices. As of 2014, reimbursements had grown to $2.3 million for Medicaid patients and $547,000 for those with private insurance.
The Affordable Care Act was supposed to guarantee women access to birth control, but studies have shown that insurance carriers often don’t provide access to all types, especially LARC.
“One of the strategies is to come down harder and heavier on insurance companies that aren’t complying with coverage (requirements) and making sure that reimbursements are adequate,” Wolk said
He also said Colorado can do more to train young health workers on how to insert IUDS or other LARC devices.
“One of the ideas is that if we’re doing loan forgiveness programs for primary care providers in areas of the state that meet the medically underserved criteria, we can provide some sort of training to these folks so we can expand the reach and comfort level (of providers),” Wolk said.
In general, health providers have felt more comfortable writing a prescription for birth control than learning how to insert long-acting devices.
Without a concerted effort to continue driving down teen births, Wolk said Colorado could easily slide back.
The day before he testified in the Colorado legislature last week, Wolk traveled to Washington, D.C., to receive a national award for the accomplishments in Colorado.
“It’s ironic to receive national recognition from folks outside the state while we can’t get the same recognition inside the state,” Wolk said.