November 8, 2016 — Delaware's teenage pregnancy rate this year was the lowest it has been in three decades, driven in part by a decline in the number of teenagers having sex and improved sex education, as well as the increased use of long-acting reversible contraception (LARC), the Delaware Public Media reports.
The state this year launched a public-private initiative, called Delaware CAN (Contraceptive Access Now), that aims to ensure same-day access to LARC or another form of contraception at low or no cost (Smith Dallabrida, Delaware Public Media, 11/4).
The program is a collaboration between the state and Upstream USA, a health care not-for-profit. Health professionals from Upstream are helping to train medical providers on how to administer LARC, provide contraceptives to physicians' offices and inform women about LARC safety and efficacy.
The program is being funded by private donors, as well as a $1.75 million allocation from the Delaware Division of Public Health. The program uses the money to fund LARC training for physicians, reimburse providers for the cost of LARCs and educate women on the safety and efficacy of various LARC methods. To ensure women have same-day access to LARC, the funding will also be used to stock LARC at physician offices (Women's Health Policy Report, 2/26).
According to the Delaware Public Media, Colorado seven years ago launched a similar initiative that has since helped cut the state's teenage pregnancy rate by nearly 50 percent and the repeat teenage birth rate by 58 percent. Colorado said that every dollar invested in the initiative has saved Medicaid about $5.58.
Delaware's unintended pregnancy rates still high
According to the Delaware Public Media, LARC access and other factors have helped lower the state's rate of unintended pregnancy, particularly among teenagers, but Delaware's overall rate remains high. The overall percentage of unintended pregnancy in the state is nearly 60 percent, the highest in the nation, while the unintended pregnancy rate among teenagers in the state is 20.4 per 1,000 teenagers.
The Centers for Disease Control and Prevention (CDC) also reports that 46 percent of high school students in Delaware have had sex, compared with the national percentage of 41.2 percent. In addition, according to CDC, adolescents in the state also report having sex at an earlier age, with 6.8 percent saying they have had sex before age 13. In contrast, 3.9 percent of adolescents in the nation overall report having had sex before age 13.
Providers praise LARC benefits
Krishna White, head of Adolescent Medicine at Nemours/A.I. du Pont Hospital for Children, praised increased access to LARC for lowering the state's unintended pregnancy rate. "We have really good choices now and LARC is something that patients want," she said.
According to the Delaware Public Media, a gynecologist at Nemours has taught two providers and a nurse practitioner how to administer LARC to meet patient demand for the birth control method. White added that providers have adopted a more comprehensive approach to birth control, such as by screening adolescents seeking contraception for sexually transmitted infections (STIs) and telling them about LARC.
Separately, Ruth Lytle-Barnaby, president and CEO of Planned Parenthood of Delaware (PPD), noted that 17 percent of teenagers and young women who access abortion care at PPD are opting to have an intrauterine device, a form of LARC, inserted immediately after their procedure.
Lytle-Barnaby also acknowledged CDC findings that nearly 90 percent of adolescents are using at least one form of contraception, but she highlighted problems with consistency when it comes to shorter-acting methods. "With the pill you have to take it every day and should take it at the same time," she said, noting that a "teenager might think you can miss three days and then take three on one day. Or she might forget that the pill is not as effective if she is taking certain other medications."
Noel Anupol, a physician at the Delaware Center of Excellence in Obstetrics and Gynecology, said LARC can help women address some of those concerns. "LARC is extremely effective because it doesn't require any action on the part of the user," Anupol said. He added, "Plus, it's long lasting, at least three years. Women can go to school, go on with their life, and when they are ready for pregnancy it's reversible."
Noting that some of his patients had not heard of LARC until he discussed it with them, Anupol said, "It's our responsibility to make woman aware of their choices so they can make the best decision for them and their families ... If we aren't talking about all the options for birth control, we aren't doing our job" (Delaware Public Media, 11/4).