Declines in the U.S. Abortion Rate: A Look into the Role of Long Acting Reversible Contraceptives

Nearly half of all pregnancies in the United States are unintended, the highest rate in the developed world.1 Within the U.S., teens and young adults have the highest unintended pregnancy rates, largely due to incorrect or inconsistent use of a contraceptive method.

Currently, about half of unintended pregnancies end in an abortion.2 According to a new report from the Guttmacher Institute, however, the abortion rate in the U.S. has dropped to a historical low; nearly the same rate as when abortion was legalized in 1973. Notably, the abortion rate dropped 13 percent between 2008 and 2011, the last year for which data are available. Many people may think this decline is attributable to new legislation in many states, which limits the availability and accessibility of abortion providers. In fact, however, much of this legislation was enacted after 2011, so we do not yet have data on the post-legislation years. Additionally, the greatest declines in the abortion rate were seen in states without restrictive laws. Instead, the authors of the report argue that the increasing use of highly effective, long acting reversible contraceptives (LARCs) played a central role.

LARCs include intrauterine devices (IUDs), which can last 3 to 12 years, and subdermal implants which can last 3 years. LARCs are recommended for all women of reproductive age, including teens and young adults, even if they have not yet had children. Both types of LARC can be removed at any time if a woman wishes to become pregnant or switch birth control methods — with immediate return of fertility.

There are many advantages to LARC use. First, because LARCs are not subject to user failure, they are an excellent method for women who have difficulty taking a pill on a daily basis or keeping regular health care appointments.  This may be particularly true for teens and young adults, who are more likely than older women to use methods incorrectly.

Second, LARCs are more effective than most other forms of reversible birth control, with the exception of abstinence.  IUDs and implants both have a failure rate of less than 1 percent with typical use.  This means that less than one woman in a hundred would become pregnant in a year. By comparison, the Pill has a failure rate of 9 percent with typical use.

Third, many women report higher satisfaction with LARCs than with other birth control methods, such as the Pill. Finally, although they can have high upfront costs, LARCs are among the most cost-effective birth control methods when measured over time. For example, LARC use is associated with a greater cost savings compared to oral contraceptives.

LARCs have increased in popularity in the U.S. In 2002, only 2.4 percent of all U.S. women using contraception were using LARCs; by 2009, 8.5 percent did. Most of these women rely on the IUD, although the use of implants has increased as well. Despite this increase, LARC use (particularly the IUD) in the U.S. remains lower than in many other western industrialized countries. Reasons why more women do not use LARCs include: misperceptions about how the methods work; concerns about side effects; and higher initial costs. Additionally, there are barriers to providers; family planning providers need specialized training to provide and insert these methods.

The recent decline in the abortion rate is reflective, at least in part, of increased family planning efforts across the country, including the promotion of LARCs. LARC use should only increase further, as the Affordable Care Act will allow more women to afford LARCs as their birth control method. Ultimately, an increase in planned pregnancies is good, indicative of healthy mothers, healthy children, and a healthy start for families.

[1] Singh S, Sedgh G and Hussain R, Unintended pregnancy: worldwide levels, trends and outcomes, Studies in Family Planning, 2010, 41(4):241–250.

[2] Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health 38(2):90–6. 2006.