Truthdigger of the Week: The Colorado Family Planning Initiative

Every week the Truthdig editorial staff selects a Truthdigger of the Week, a group or person worthy of recognition for speaking truth to power, breaking the story or blowing the whistle. It is not a lifetime achievement award. Rather, we’re looking for newsmakers whose actions in a given week are worth celebrating.

At a time when many states were seeing clinic closures that threatened reproductive rights, in 2009 Colorado took what could be considered the opposite approach to the health issues of teenage pregnancy and abortion: Under a privately funded program called the Colorado Family Planning Initiative (CFPI), clinics offered many women free, long-acting, reversible contraception.

This form of contraception, known as LARC, include a new generation of devices such as the once-unpopular IUD (intrauterine device) and a hormonal implant, which are inserted internally and remain effective for several years. LARCs, Dr. Patricia Salber tells HuffPost Live, are nearly perfect in that they have a failure rate of less than 1 percent and, once implanted, allow women and men to rely on the devices for birth control without having to think about taking a pill or using a condom. In terms of unwanted pregnancies, these aspects of LARCs are key.

Not too long ago, The New York Times published a piece that dropped many a jaw. The interactive piece allowed readers to see just how effective their chosen form of contraception tends to be over a specified time. The answer to the headline question, “How Likely Is It That Birth Control Could Let You Down?” was a resounding “Very.” Both male and female condoms, for example, failed 18 to 40 percent of the time over 10 years of so-called “perfect use”—when the method was “used exactly as specified and consistently followed,” the Times article states. It added that “few couples, if any” use contraceptives in such a manner. The birth control pill, patch and NuvaRing also proved incredibly unreliable: Over 10 years, as an average couple would employ the methods, the failure rates are over 60 percent.

The only methods that proved truly effective seemed to be sterilization and, you guessed it, LARCs. And yet, perhaps due to a lack of information and some misinformation, LARCs are still not in high demand. Partly to blame are previous generations of LARCs, which had undesirable health effects. Although nowadays there are still some downsides to the devices, those drawbacks appear to be minimal compared with the benefits. One difficulty facing those interested in getting a LARC is that it requires a medical professional to insert it. However, the side effects are minor and comparable to those of the birth control pill. Acne is one effect that both forms of contraception can cause.

Another obstacle is cost. An IUD can cost between $500 and $1,000, which, as Salber points out, is cost-effective when you consider how long the devices last—the IUD and hormonal implants both remain effective for three years. But not everyone has that kind of money to spend all in one go. Here’s where the CFPI comes in.

Six years ago, working off a framework of clinics already set up in Colorado, and using a $23.5 million grant from the Susan Thompson Buffett Foundation, the program offered to cover the costs of LARCs based on income and, perhaps even more important, allowed adult women and teenagers to obtain the contraceptive devices anonymously, without having to worry about parent or partner consent.

The results have been nothing short of a miracle. A New York Times article lauded the “startling success” rates last Sunday: According to the Colorado Department of Public Health and Environment, the state saw a 40 percent drop in teenage pregnancies and a 42 percent decrease in abortion rates over the first three years of the program.

Each number represents crucial breakthroughs in reproductive health. A drop in teenage pregnancy means that more women will be able to make decisions regarding their careers and their personal as well as familial futures with an important asset under their wings: time. This is especially important for those from underprivileged backgrounds, who tend to have more unwanted pregnancies (according to the Times article, “half of all first births to women in the poorest areas of the state happened before they turned 21”). Economist Isabel Sawhill argues that “having a baby before finishing college can be just as risky to a woman’s future as having one while in high school.”

Access to affordable LARCs can create conditions under which people of all social classes and ages have more choice regarding family planning. And this is groundbreaking. Sawhill adds, “If we want to reduce poverty, one of the simplest, fastest and cheapest things we could do would be to make sure that as few people as possible become parents before they actually want to.”

But it’s important to remember that the decline in teenage pregnancy wasn’t the only astounding number reported by the Colorado Department of Public Health and Environment. The 42 percent decline in abortion rates has the potential to shake up a national debate that never seems to end: the contention over Roe v. Wade and the legal right of a woman to terminate a pregnancy.

A prime fact we learned from Times’ interactive piece on birth control effectiveness was that even when a person is responsible and uses a variety of methods, unwanted pregnancy is still highly possible. With information such as this available, it seems incredible that some people still refer to unwanted pregnancy as a choice and demonize abortion as the recourse of irresponsible people. It’s a no-brainer that providing free or affordable, highly effective birth control can reduce the rate of abortions. To Salber, the potential of LARCs is clear: “I think [the success of the CFPI] sends a message to all of us surrounding the abortion debate … that if you take away barriers to birth control, as they did in this program … it may be a far less contentious and more effective way for us to deal with abortion in this country.”

Greta Klingler, supervisor of the CFPI, says that while those who work in the program expected positive outcomes, no one foresaw such remarkable results. Asked whether she thinks the program could be applied to other states, her answer is a confident “Absolutely.” In a short interview, Klingler also told Truthdig how she thought the CFPI results contribute to the nationwide debate on reproductive rights:

Having this message and the data out in the media and in these big state and national conversations I think helps to frame [unwanted pregnancies] as a health issue; it helps to normalize the conversation around it a little bit. There’s never been data on this scale, that I know of, and I think it helps kind of prove how important these services are and helps make the case.

However, rather than look to outcomes like that proved possible by the CFPI, conservatives and anti-abortion activists continue to turn away from facts and potential solutions, instead accusing women of murder when they obtain abortions. This attitude threatens women’s health in uncountable ways, and it has now come to hinder the success of the CFPI.

Unfortunately, the Buffett grant ran out in June, and despite the program’s favorable outcomes, the CFPI hasn’t been able to obtain state funding. The Guardian reported in May that while the Colorado House of Representatives passed a bill to provide $5 million in funding for the CFPI, the measure did not pass the Republican-controlled Senate. Republican state Rep. Don Coram said of the legislation, “If you’re anti-abortion and also a fiscal conservative, I think this is a win-win situation for you.” However, it seems not all conservatives saw it this way. The Guardian writes:

Republican senators expressed concern over funding the program on various grounds, including redundancy—arguing that state and federal money already goes to general family planning services, so there’s no need to fund a specific program, Klingler said. Others raised the disputed concern that IUDs themselves can cause abortions.

“It basically comes down to political positions—what people support and don’t support ideologically. And women’s health is a big point of contention,” Klingler wrote in an email to The Guardian after the bill’s defeat.

Klingler told Truthdig she expects other states to now look toward Colorado in seeking to emulate the CFPI results. And another thing the program accomplished is putting a spotlight on the new generation of LARCs as an important, safe form of birth control.

Meanwhile, Klingler doesn’t appear to have lost hope that funding can be found to continue the program. She points out that more than half of the grant has been replaced with reimbursement from Medicaid and other sources. The Affordable Care Act, which has promised to provide free contraception, may also be a source of hope, but there are still provisions being worked out with regard to who is eligible and what forms of birth control are covered under the law.

Klingler adds that there is a lot of work to be done, because some women aren’t covered by their health care plans or don’t want to use shared plans because of confidentiality concerns, and other women simply “lack access … in other ways.” These are ultimately the women Klingler and those at the CFPI hope to assist with state funding.

The politics of control over the female body stand in the way of keeping citizens safe and healthy, and momentous work such as that done by Klingler and the CFPI will continue to be frustrated by outdated, sexist ideologies. But thanks to the Susan Thompson Buffett Foundation, the CFPI has helped over 30,000 women obtain access to LARC devices, putting their health and futures into their own hands in an unprecedented way. For their commitment to women’s health issues, for potentially reframing the conversation surrounding reproductive rights and, most important, for providing a wide range of Colorado women an opportunity previously denied them, Greta Klingler and others at the Colorado Family Planning Initiative are our Truthdiggers of the Week.