Texas health officials recently made a change to doctor reimbursements that hasn’t gotten much notice. They’ve made it a little easier for low-income women and girls to get IUDs. Many health professionals see these contraceptives as the best way to stop unintended pregnancies. But many teens are skeptical.
Teresa is at the Oak West Women’s Health Center in Dallas for a follow-up after having her second baby. KERA has agreed to identify the teenager only by her first name. She is ready to talk birth control with Norma Dawson, a women’s health educator.
“The IUD is this one right here," Dawson says, as she points to a chart of birth control methods. "That one has no hormones, no mood swings, and you can have it for five years."
“My mom doesn’t want me to get it,” Teresa replied.
Teresa’s concerns about the IUD are the stuff of urban legend: “Sometimes people get pregnant and the babies come with it in their forehead or something,” she had heard.
Teresa left the clinic without an IUD. She got two months of birth control pills, a handful of condoms and spermicide, and instructions to come back in for a shot of birth control after she’s done breastfeeding her new baby.
The human error factor in family planning
Intrauterine devices, or IUDs, have gone from being dangerous in the 1970s to being hailed as the safest and best way to stop teen pregnancies by the Centers for Disease Control and Prevention.
The problem with many other birth control methods, according to physicians, is human error. IUDs and implants take that away. Here's an IUD fact sheet.
“The patient doesn’t have to remember to take a pill or do something for contraception,” said Dr. Moss Hampton, Texas chair of the American Congress of Obstetricians and Gynecologists. “They last for years."
Hampton practices in Odessa, and said IUDs are selling like hotcakes. They’re popular among women who have no plans to get pregnant for a few years, and among women who are well-insured.
But there are huge barriers for patients without good insurance. IUDs cost about $800, and up until last year the Texas government would reimburse physicians much less. They’d lose a hundred dollars for every IUD they implanted.
“The state of Texas is trying very diligently to make these available to underserved and underprivileged patients,” Hampton said.
A workaround to make IUDs affordable
Dr. Janet Realini, chair of the Texas Women’s Healthcare Coalition in Austin, worked with state health officials and a drug company to try to get more women access to IUDs in Texas.
“Texas Health and Human Services Commission did what I call a workaround, and it was announced last year,” she said.
As of August 2014, a physician can prescribe an IUD for a patient without losing any money. “The pharmacy ships that product for that patient to the doctor’s office. So in three days, the patient can come back and have that device inserted,” Realini explained.
It’s a small workaround, but the payoff for Texas could be huge. Colorado started a program to make IUDs and implants more available to low-income women in 2009 and state officials say the teenage birthrate fell by 40 percent.
One way to lower the teen birthrate
Between 1991 and 2013, the teen birth rate declined 57 percent nationwide -- and it's declined in all 50 states, according to the National Campaign to Prevent Teen and Unplanned Pregnancy.
Still, Texas has one of the highest teen birth rates in the country. The state has the fifth-highest rate, according to the teen pregnancy prevention group. Only Mississippi, Oklahoma, New Mexico and Arkansas have higher rates.
At the Oak West Health Center in Dallas, the manager Joyce Miller sees a constant stream of women trying to avoid an unwanted pregnancy.
“We are very busy!” she said.
They discuss many family planning methods in the clinic, from abstinence to hysterectomy. Right now 9 percent of teenagers in Texas on birth control are using IUDs, according to the CDC. In Miller’s clinic, teens are still highly influenced by the choices of their friends.
“The women who are coming in making the decision for the first time, which is our teenage, early 20s population, are still more likely to choose the patch or the pills,” she said. “That’s still very popular with that age group.”
Baby steps to make IUDs more affordable and accessible to teens can have economic benefits as well: for every dollar Colorado spends long-acting contraceptives, it saves almost six dollars in prenatal, delivery, and infant care costs.
KERA’s Lauren Silverman contributed to this report.