Here's why this is a public health issue: Nearly half of the nation's 6 million-plus pregnancies each year are unintended. An estimated 43 percent of them end in abortion. Low-income women are far more likely to have an unplanned pregnancy than their wealthier counterparts.
"We shouldn't have, in my view, a tiered system where the women with money can get family planning and the women without cannot," said Peipert, noting that 39 percent of the women in his study had trouble paying basic expenses.
About half of unplanned pregnancies occur in women who use no contraception. As for the other half, condoms can fail and so can birth control pills or other shorter-acting methods if the woman forgets to use them or can't afford a refill.
In contrast, you can forget about pregnancy for three years with Implanon, the implant inserted under the skin of the arm. An IUD, a tiny T-shaped device inserted into the uterus, can last for five to 10 years, depending on the brand. Change your mind, and the doctor removes either device before it wears out.
Only about 5 percent of U.S. women use long-acting contraceptives, far fewer than in other developed countries. Peipert said insurance hasn't always covered the higher upfront cost to insert them, even though years of birth control pills can add up to the same price.
Yet three-quarters of his study participants chose an IUD or Implanon, and a year later 85 percent were sticking that choice — compared to about half who had initially chosen the pill, patch or other shorter-acting method.
Cost isn't the only barrier. Doctors don't always mention long-acting methods, maybe because of a long-outdated belief that IUDs aren't for young women or just because they assume women want the most commonly prescribed pill.
That was the case for Ashley England, 26, of Nashville, Tenn., who enrolled in the study while in graduate school in St. Louis. She had taken birth control pills for years but struggled with a $50 monthly copay. She switched to a five-year IUD, and loves that she and her husband don't have to think about contraception.
"No one had ever presented all the options equally," England said. "It's not telling you what to do. It's giving you a choice unhindered by money."
EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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