A consensus is building at an astounding rate that long-acting reversible contraceptives (LARCs) such as the IUD and hormonal implants may be something of a magic bullet in the fight against unplanned pregnancy (especially for younger women, who tend to have less success using condoms and the Pill). Yet despite the possibilities this opens up for reducing both poverty and the abortion rate, there are early warning signs that the Catholic Church may emerge as a roadblock to the widespread acceptance of LARCs.
A new study in the New England Journal of Medicine finds that young women who were offered free birth control and counseled about the availability of LARCs had a pregnancy rate that was less than a quarter of that of their peers—34 pregnancies per 1,000 girls versus 158.5 for those who weren’t in the study. The girls in the study, near three-quarters of whom chose LARC methods, also had 77 percent fewer abortions.
This data comes on the heels of recommendations made earlier this week by the American Academy of Pediatrics that LARCs should be considered the method of choice for adolescents to counter the 600,000 unplanned teen pregnancies that occur annually and the astounding success of a five-year LARC program in Colorado that decreased teen pregnancies by 40 percent.
It sounds almost too good to be true—and it is, at least for the Catholic Church, which beyond its blanket ban on contraceptives takes an especially hard line against the IUD which, it incorrectly asserts, can function as an abortifacient. When Medicaid officials in Illinois announced recently that they planned to double reimbursement to doctors for IUDs to encourage their use based on the success of the Colorado program, the Illinois Catholic Health Association objected to the program, saying it might force its providers out of the Medicaid system.
Illinois says it will not require Catholic hospitals or doctors to provide IUDs, but may require them to file a referral plan with the state, which the Illinois Catholic Health Association indicated would still be objectionable, indicating that Catholic providers may be gearing up to make an issue of IUD promotion.
Even a referral work-around could dampen the effectiveness of a LARC initiative because it interrupts the continuity of care for female patients, requiring them to get an appointment with another provider in another office at another date. This can deter younger and poorer women, who often have difficulty with transportation or getting off from work or school, from following through to get a LARC. In fact in Illinois, the program to encourage the use of LARCs specifically allows providers to be reimbursed for two services—the office visit and the IUD insertion—in one day to remove this barrier to LARC use.
It’s also hard to imagine how enthusiastically Catholic-affiliated doctors who aren’t allowed to provide them would recommend IUDs—explicitly countering the recommendations of both the AAP and the American College of Obstetricians and Gynecologists that they be first-line recommendations for patients. Because many women are unaware of the availability and benefits of LARCs, proactive counseling from doctors is essential.
In addition, the number of Catholic providers is increasing as part of the consolidation of health care happening as a result of the Affordable Care Act. Catholic hospitals are buying up secular hospitals and doctor’s practices, meaning more and more providers will be under the Catholic health care umbrella and effectively prohibited from prescribing IUDs.
But the biggest danger is that in their attempt to keep women from using birth control—especially the most effective birth control that practically guarantees young women can have sex without getting pregnant—the Catholic Church will do to the IUD what it did to emergency contraception: turn it into an abortifacient bogeyman to stall the spread of LARCs, especially in publicly funded Medicaid programs.
The tragedy is that 37 percent of girls in this latest study chose an IUD, making it the most popular LARC, responsible for more than one-third of the reduction in unplanned pregnancy and abortion. How could anyone in good conscience object to that?
