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Life is complicated; birth control doesn't have to be.

Nurses are the health care professionals who most often provide patient education. That's why they work so hard to keep up with the latest in research and best practice. And, when it comes to reducing unintended pregnancies, here is information nurses will welcome, because Iowa is leading the way with important new findings.

Increasing women's access to Long-Acting, Reversible Contraceptives (LARC) has helped reduce both unintended pregnancies and abortions in Iowa, according to a preliminary independent analysis commissioned by the Iowa Initiative to Reduce Unintended Pregnancies.

The evaluation by Philliber Research Associates and the Bixby Center for Global Reproductive Health, University of California, San Francisco found that since 2006, unintended pregnancies and abortions in Iowa have decreased by 8 percent and 24 percent, respectively. Use of LARCs in Iowa more than quadrupled between 2007-2011, increasing at a faster pace than the national rate.

The Iowa Initiative to Reduce Unintended Pregnancies is a privately funded five-year demonstration project committed to reducing the high rate of unintended pregnancies in Iowa. We work in partnership with the Iowa Department of Public Health, the Family Planning Council of Iowa, Planned Parenthood of the Heartland, and the Center for Social and Behavioral Research at the University of Northern Iowa.

In 2006, about one-half of all of the pregnancies in the U.S. and in Iowa were unintended, one of the highest levels in the developed world. In Iowa, among women ages 18-30, fully 47% of all pregnancies were unintended; for those ages 18 & 19, that figure rose to 79%.

The high rate of unintended pregnancy hasn't really changed in 30 years, despite the development of more advanced methods of contraception. The reason is that the most commonly used forms of birth control--pills and condoms--require correct and consistent use.

Over the past five years, our work has focused on helping women learn about and get access to affordable, safe, long-acting reversible contraceptives through Family Planning Clinics that serve low-income women. Iowa Initiative grants have allowed clinics to expand hours and locations, to train clinic nurse practitioners and physicians on the benefits of LARCs and how they are used, and to purchase LARCs so clinics can offer them at low cost, or no cost, to their patients. Prior to this initiative clinics could not afford to offer LARCs to their patients due to the high cost.

These efforts have made a real difference! During the past four years the use of LARCs by women served by Title X clinics in Iowa has grown significantly. The number of women using IUDs increased from 1,833 in 2007 to 5,352 in 2011. During that same period, the number of women using implants increased from 411 to 4,413. Total LARC use quadrupled.

So what has been the impact on unintended pregnancies and abortions?

The rate of unintended pregnancies has declined from a peak of 47.6 % of all Iowa pregnancies in 2006, to less than 44% in 2011. During that same period, the percentage of pregnancies that were terminated by abortion declined by 24% from 14% to less than 11%.

In short, providing women with access to LARCs leads to not only fewer unintended pregnancies, but also to fewer abortions.

This has important implications for individual lives and for society as a whole: Reducing unintended pregnancies means more women are able to pursue their education. Six of every 10 community college students who have a child after enrolling don't complete their education. Preventing unintended pregnancies means that many of these women can remain in school, get their degrees, establish successful careers and have families when they are ready.

Reducing unintended pregnancies also generates an impressive return on investment for all Iowans. Every dollar invested in helping women prevent an unintended pregnancy saves taxpayers almost $4 in prenatal and delivery costs in the first year and $15 in public assistance costs over five years.

In 2006, births resulting from unintended pregnancies cost Iowa taxpayers $44 million in Medicaid funding alone.

Iowa's experience can be a model for the nation and provide policymakers and health care professionals important data to guide future decision-making.

The Iowa Initiative recommends moving forward in four key areas to continue to bring down the rates of unintended pregnancies and abortions.

1. Enhance investments in public-funded family planning services so clinics can educate patients, through outreach and advertising, about the most effective birth control options and offer those options at little or no cost.

2. Educate obstetricians and gynecologists, family practice physicians, nurse practitioners, nurse mid wives and physician assistants about the safety and efficacy of LARCs and provide training on their use.

3. Encourage health care professionals, non-profit human services organizations, civic organizations, foundations, advocates and public officials to work together to reduce unintended pregnancies and abortions through better access to the most effective contraception.

4. Institute programs at community colleges, private colleges and universities to help students avoid unintended pregnancies and thereby improve academic success.

The five-year project is coming to completion. On December 31 we will close our doors, but Philliber & Associates and the Bixby Center will continue to gather and analyze data for the next 12-18 months. You can learn more and follow the research on our website,, through 2013.

By Sally Pederson

Executive Director

Iowa Initiative to Reduce Unintended Pregnancies
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Author:Pederson, Sally
Publication:Iowa Nurse Reporter
Geographic Code:1U4IA
Date:Dec 1, 2012
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