Free birth control cuts teen pregnancies and abortions
When Washington University School of Medicine researchers removed barriers to contraception for teens – such as cost and the lack of education about the various methods – most opted for long-acting birth control, like intrauterine devices (IUDs) and implants. Their study shows that the teens had significantly lower pregnancy and abortion rates compared with those for sexually active U.S. teens. The research appears in The New England Journal of Medicine and involved teens enrolled in the Contraceptive CHOICE project.
Contraceptive Use Trends and Hormone Hesitancy
While removing barriers increases uptake of effective methods, other studies show shifting trends in contraceptive behavior. Contraceptive users in the UK appear hesitant to use hormonal methods. We found a shift in contraception use from more reliable hormonal methods of contraception to less reliable fertility awareness-based methods of contraception among abortion patients in England and Wales. Largely anecdotal and some qualitative data suggest that younger women are turning towards more ‘natural’ methods of contraception including withdrawal and the use of mobile phone apps to facilitate use of the calendar method and track fertility, hereafter referred to as fertility awareness-based methods (FABM). Hormone hesitancy attributed to the influence of social media has been reported in other European countries.
Comparative Analysis of Contraceptive Methods at Conception
We compared self-reported contraceptive use at conception among patients presenting for abortion at British Pregnancy Advisory Service from January to June 2018 (N=33 495) and January to June 2023 (N=55 055). The following data reflects the reported contraceptive method use at conception among patients presenting for abortion:
| Contraceptive Method | 2018 (Usage %) | 2023 (Usage %) |
|---|---|---|
| No contraception | 55.8% | 69.6% |
| Hormonal methods | 18.8% | 11.3% |
| Long-acting reversible contraception (LARC) | 3% | 0.6% |
| Fertility awareness-based methods (FABM) | 0.4% | 2.5% |
Implications for Healthcare Services
Significantly fewer abortion patients report using effective methods of contraception around conception while also reporting an increased use of fertility awareness-based methods. Those reporting using no contraception at the time of conception significantly increased by 14% (p<0.001) when comparing data from 2018 with data from 2023. The typical use failure rate for FABM ranges from 2 to 23 in 100 in the first year of use. The decline in use of effective contraception and increase in abortion rates have wider implications for healthcare services. While further research is required to investigate the underlying driving forces of this shift, in the interim, investment will be needed for accessible abortion and contraception services to meet demand.