LARCs: A Better Way to Reduce Abortions

Could long-acting reversible contraceptives (LARCs) provide the much needed middle ground in the contentious abortion debate?

Young doctor holding a LARC IUD (1500 x 1000 px)

Is it better to ban abortions as the anti-abortion crowd wants to do? Or prevent unwanted pregnancies in the first place? Hmmm…let me think about that for about 2 seconds.

The former approach is grounded in the “I am not going to give you what you need because it is bad, bad, bad” school of thought. The latter is based on understanding the sociology of unplanned pregnancies and coming up with an approach that works. That is what the great state of Colorado just did.


The Colorado experiment

Thanks to a grant from the Susan Thompson Buffett Foundation (named after Warren’s late wife), Colorado was able to provide free long-acting birth control to women across the state. According to a July 5, 2015 article in the New York Times, the birthrate for teens dropped an astounding 40% from 2009 to 2013. Equally important, the rate of abortions fell by 42%.

Although teen births across the country have been declining for some time, the New York Times story states that “experts say the timing and magnitude of the reductions in Colorado are a strong indication that the state’s program was a major driver.” Wow! If LARCS not only reduce pregnancies, but also reduce abortions, this could provide the much needed middle ground in the contentious abortion debate.


So, what are LARCs anyway?

Dalkon Shield via
Dalkon Shield via

Long-acting reversible contraception (LARC), such as IUDs and contraceptive implants, are the most effective forms of reversible birth control available today. That is because they eliminate user compliance issues—once inserted, LARCs are effective for years. The woman doesn’t have to do anything to remain protected—no remembering to take the pill, no fussing with condoms (although these have the advantage of preventing transmission of sexually transmitted diseases), and no shots. Best of all, there are no unwanted pregnancies.

For those of you old enough to remember the first iterations of the IUD, including the infamous Dalkon shield, you may be thinking, geez, aren’t those things dangerous. But, my friends, today’s IUDs are not the same as your Grandma’s IUDs. They are safe with a negligible risk of serious complications, such as pelvic inflammatory disease or uterine perforation. Furthermore, they have a failure rate of <1% per year; they are more effective than birth control pills.


Breaking the deadlock

The remarkable 42% decline in the rate of abortions was accomplished by giving women what they wanted and needed—access to a highly effective means of birth control that does not require the user to do anything to be protected once the device is inserted. This approach is so much better than passing ridiculous laws requiring women to be counseled about dubious “facts,” such as a purported link between abortion and breast cancer or the reversibility of pharmaceutically-induced abortions. It is better than needlessly requiring abortion providers to have admitting privileges or abortion clinics to meet the standards of outpatient surgery centers. It prevents unwanted pregnancies and abortions. A win-win unless, of course, punishing women with unwanted pregnancies is your thing.

Some will raise the issue of cost. The insertion of the devices by a doctor costs about $900—pricey to be sure. But I suspect it is ever so much cheaper than bringing an unwanted pregnancy to term and then having to provide social services programs to support a mom who is unable to care for herself and her child without them.

The pro-choice and “pro-life” debate has been deadlocked for years. The battle between the two sides has been painful, particularly for young and poor women who often find themselves without good options to take control of their bodies and their lives. Widespread access to LARCs would provide an excellent way to reduce unwanted pregnancies and abortions without infringing on their constitutional rights.

The bottom line: LARCs should be offered free or at very low cost to all women who want them.



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