Giving Compass' Take:

• Kate Welti and Jennifer Manlove explain how Delaware Contraceptive Access Now increased the use of contraception by Title X clients. 

• How can funders work to increase access to contraception and family planning?

• Learn more about reproductive health and rights.

Nearly half of all pregnancies in the United States are unintended, and unplanned pregnancies are linked to poor health outcomes for women and their children. One strategy to reduce unintended pregnancy and promote better outcomes for women and children is to increase the use of effective contraceptive methods among women seeking to avoid pregnancy. Child Trends’ examination of Title X clinics in Delaware suggests that increased use of highly effective contraception can reduce unintended pregnancy.

In December 2014, Upstream USA—a nonprofit whose mission is to ensure that all women have convenient access to the full range of contraceptive methods—launched Delaware Contraceptive Access Now (Delaware CAN), a statewide initiative to reduce unintended pregnancy by increasing the use of effective contraceptive methods. Upstream commissioned Child Trends to examine how contraceptive use among family planning clients at Title X clinics in Delaware changed during the implementation of Delaware CAN. Child Trends then input contraceptive data into the microsimulation model FamilyScape 3.0 to project how the unintended pregnancy rate among this population may have changed based on the observed shifts in method use.

As reported in a Child Trends research brief, from 2014 to 2016, there was a substantial increase in the use of long-acting reversible contraception (LARC), defined as IUDs and implants, among Delaware Title X family planning clients ages 20–39. Our simulations projected that this increase in effective contraceptive use, along with a decrease in no-method use, was associated with an estimated 15 percent decline in unintended pregnancy among this population. By comparison, we found only a small increase in LARC use and a minor decrease in estimated unintended pregnancy for women at Title X clinics nationwide.

Following the release of the Title X family planning data for 2017, we have now updated our findings with an additional year of data. These recently released Title X contraceptive use data suggest that rates of LARC use continued to increase among clients at Title X family planning clinics in Delaware from 2016 to 2017, and thus the simulated unintended pregnancy rate for this population continued to fall. Increases in LARC use and projected decreases in unintended pregnancy among Delaware Title X family planning clients remain greater than those observed among clients nationwide.

  • Using available contraceptive data from 2014 to 2017, LARC use increased from 13.7 to 31.5 percent among Delaware Title X family planning clients ages 20 to 39.
  • This increase was offset by a decrease in the use hormonal methods such as birth control pills, patch, and ring, and a decrease in condom use.
  • In Delaware, this observed movement from moderately effective methods to highly effective LARCs, paired with a small decrease in non-use (a reduction of 2.5 percentage points from 2014 to 2017), was linked to a substantial simulated decrease (24.2 percent) in the unintended pregnancy rate among this population from 2014 to 2017 (as predicted by the FamilyScape model).
  • Similar analyses of changes in method use among Title X family planning clients nationwide found a smaller increase in LARC use—from 13.6 percent to 19.9 percent—and no decrease in non-use from 2014 to 2017. FamilyScape simulated a decrease in unintended pregnancy of 3.0 percent during the same period.

Read the full article about Delaware Contraceptive Access Now by Kate Welti and Jennifer Manlove at Child Trends.