The United States has a high rate of unintended pregnancy. In 2011, nearly half (45 percent) of pregnancies nationwide were unintended (either unwanted or occurred sooner than desired).1 Researchers have found that births resulting from unintended pregnancies are linked to a range of negative health outcomes for women and children.2-4 Increasing the use of effective methods of contraception among sexually active women, especially long acting reversible contraception (LARC) methods such as the IUD and implant, can help reduce unintended pregnancy and improve maternal and child health outcomes.5-8
Upstream USA is a nonprofit whose mission is to change health care so that all women receive the highest quality services and have convenient access to the full range of contraceptive methods. In December 2014, Upstream introduced its first statewide initiative in Delaware. The organization is working in partnership with the governor and the Division of Public Health to implement Delaware Contraceptive Access Now (Delaware CAN). Delaware CAN is a comprehensive, statewide program to ensure all women in the state have convenient access to the birth control method of their choice. Upstream is providing training, technical assistance, and quality improvement activities to all publicly funded Title X health centers, the largest private providers, and five of the six hospitals in the state.
Upstream commissioned Child Trends to examine how contraceptive use among female family planning clients at Title X clinics in Delaware has changed during the implementation of Delaware CAN and to estimate, using the microsimulation model FamilyScape 3.0, how these changes in contraceptive use may have affected unintended pregnancy among this population. FamilyScape 3.0 is a microsimulation model designed to replicate fertility-related behaviors and outcomes among U.S. women of childbearing age. In the absence of pregnancy data for Title X family planning clients, FamilyScape 3.0 allows us to simulate changes in unintended pregnancy due to changes in contraceptive use.
We also compared the changes in contraceptive use and unintended pregnancy among women at Delaware’s Title X clinics to changes in contraceptive use and unintended pregnancy among Title X family planning clients nationwide. LARC use has increased in the last decade across the country,9 and we wanted to understand whether the findings for Delaware were unique or simply part of a nationwide trend. These analyses allowed us to assess whether and how the estimated declines in unplanned pregnancy in Delaware differed from those in the country as a whole.