Public Health Director Sees Contraception Program Value

Collin Szewczyk, Aspen Daily News

Birth rates in ‘high-risk’ groups on the decline

A state program that offers free, long-term contraception is helping to limit unintended pregnancies for women in “high-risk” categories, public health director Liz Stark told the Pitkin County commissioners on Tuesday.

But its funding is running out soon and Stark is hoping that a proposed state bill will, as well as some county funds, will provide enough money to keep the contraception program going.

The program began in 2009, and offers women free long-acting reversible contraceptives (LARCs) in the form of intrauterine devices (IUDs), and implants (Implanon and Nexplanon) that release the hormone progestin, which prevents eggs from leaving the ovaries.

“The long-acting contraception is a great option for young women who don’t want to have a family yet,” Stark said. “It’s a very safe, reliable method.”

IUDs are small, T-shaped flexible plastic implants that are placed in the uterus to prevent pregnancy for up to 12 years. The implants are matchstick-sized rods that are implanted in the woman’s arm and are effective for three to five years.

Those birth-control methods are provided locally by Community Health Services.

And while funding for the program expires on June 30, the Long Acting Reversible Contraceptives Bill (HB 15-1194) is now before the Colorado Legislature. If passed, that measure would appropriate $5 million from the state general fund for the Colorado Department of Public Health and Environment to provide LARC services in the 2015-16 fiscal year.

The Title X (ten) program was initially funded by an anonymous donor so the state could accrue baseline statistics to gauge the effectiveness of LARCs to combat unintended and teen pregnancies, according to Commissioner Rachel Richards.

“The results that have been reported are at least a 40 percent reduction in [unintended and teen] pregnancies,” Richards said. “The donor made their generous gift, it proved the program was of value, and now it is up to the state to determine whether they’d like to go forward with it or not.”

Enacted in 1970, Title X are federal grant programs that provide comprehensive family planning and preventive health services.

Richards added that she’d like the board’s approval for penning a letter of support for the bill to legislators.

Stark said Community Health Services received $75,000 from the state in 2009 to purchase the contraceptives, but funding has decreased each year since and only $11,000 was granted for 2015.

According to Planned Parenthood, the implants can cost up to $800 apiece, and IUDs can run upwards of $1,100 each.

Stark said Friday that 110 women received contraceptives through the program in 2014.

“We’ve continued to purchase them, based on the demand, but we’re not getting those funds through the program any longer,” she said Tuesday. “So, we’re really funding them through Pitkin County grants and … unallocated funding sources.”

She also proposed that the contraceptives program be a line item in the county’s general fund in the future to ensure that it continues.

Pregnancy rates on the decline

Stark contrasted Pitkin County data from 2008 and 2013 and said that unintended and teen pregnancies, as well as statewide abortion rates, are on the decline since the program began.

“The birth rate among women ages 10-19 dropped from 4.1 percent to zero percent,” she said. “In 2013, we did not have any teen pregnancies in Pitkin County.”

Stark noted that in 2008 there were 171 live births in the county, and seven of those were to teenagers.

She also said that other high-risk groups including unmarried and low-education level women saw declines in pregnancies over that five-year span.

In 2008, there were 31 live births to single women in Pitkin County, but that number dropped to 15 in 2013, a decline from 18.2 percent to 12.2 percent.

Stark said there were 123 live births in 2013.

The low-education group entails women who didn’t complete high school or receive a GED. The birth rate for them fell from 19.2 percent to 9.9 percent.

According to the state bill, birth rates in counties that offered the program were 29 percent lower than expected among women between the ages of 15 and 19, and 14 percent lower among low-income earning women ages 20-24. The birth rate for women under 25 who have no high school education lowered by 24 percent between 2009-2011.

“So I think that we have seen some of the same benefits locally [as across the state],” Stark said.

Sliding fee scale for contraceptives

As the only Title X program in the Roaring Fork Valley, women without health insurance can access these forms of contraception on a “sliding fee scale,” Stark said.

She noted that the plan was to use revenue from insurance claims to fund the program locally, but it was soon discovered that most of the women seeking these contraceptives were uninsured.

“The majority of the women that we serve in this program have an income, according to the federal poverty level, of less than 200 percent (or $23,540 for a single mother),” she said. “So we’re serving the lowest income with this program.”

Stark said that half of the people that participate in the program live in Pitkin County, while the remaining women are from western Eagle and Garfield counties, with 25 percent from each.

“We’re serving women up and down the valley in this program. It has no geographic boundaries,” she said. “We’re making an impact with this program really for women not just in Pitkin County, but in our valley.”

The commissioners gave a unanimous thumbs up to penning a letter of support for the program.

“I’ve always been a big believer that an ounce of prevention is worth a pound of cure, and this is certainly one of those programs,” Richards said. “If you look at it from the human and social side of someone’s life not being interrupted with an unintended pregnancy, the likelihood of completing high school [or going to college] is so much higher. … This is a move that is being heralded for preventing a cycle of poverty.”