Colorado Leads the Way in Reducing Teen Pregnancy

May 11, 2017|2:52 p.m.| Eighmey Zeeck

ASTHO’s Increasing Access to Contraception Learning Community involves 27 states and territories working to disseminate strategies and best practices to states and help implement policies and programs that provide access to a full range of contraception methods.

During the three years that representatives from Colorado have participated in the learning community, they have proven themselves to be leaders, with much of their work centering around the Colorado Family Planning Initiative, which aims to reduce the state’s teen pregnancy rate. Much of the state’s success can be attributed to Larry Wolk, MD, executive director and chief medical officer of the Colorado Department of Public Health and Environment (CDPHE), who has made it a priority to focus on primary prevention programs to decrease teen pregnancy in the state.

Given that May is Teen Pregnancy Prevention Month, ASTHO reached out to Wolk to discuss how Colorado is improving access to long acting reversible contraceptives (LARCs), how the department worked with the state legislature and other partners to collaborate on the Colorado Family Planning Initiative, and what strategies CDPHE is using to sustain this successful coalition.

Can you provide some background on why Colorado decided to focus on reducing its adolescent pregnancy rate, and why the state chose to increase access to LARCs in this specific population?

Teen pregnancy was one of Colorado’s unmet health needs. We had one of the higher unintended teen pregnancy rates in the country. We received private funds, an eight-year grant worth $27 million, to test the theory that investing in LARCs would pay off in a number of different areas, such as increased graduation rates and a decreased use of social support programs, such as food stamps and Temporary Assistance for Needy Families benefits.

How did CDPHE create buy-in from the state legislature, faith-based organizations, and other outside partners to collaborate on the Colorado Family Planning Initiative?

We strengthened the support base, particularly in locations where women were already seeking services. It was more than just making LARCs accessible. We made them a top priority for all women considering different forms of birth control. We were careful to collect important data elements in order to demonstrate both a decrease in pregnancy rate and a minimized reliance on state- and federally-funded programs. There was also potential for the data to show an increase in societal gain, longer stays at school and work, and further delay or birth spacing accordingly.

CDPHE facilitated funding, data collection, and publicized outcomes from the policy standpoint. The department also played an integral role in educating the public by speaking with the local and national media outlets, collecting stories from the field, hosting peer groups for young women, and training clinical providers to counsel on and insert LARCs.

How has CDPHE been able to sustain the coalition’s focus on maintaining a low rate of teen pregnancy within the state?

The sustainability plan was to make sure Medicaid had appropriate levels of reimbursement and that family planning providers became experts in collecting insurance reimbursement for services. The payment reimbursement for Federally Qualified Health Centers and rural health centers did not align, and we needed to strengthen reimbursement policies make sure that happened. It was vital to have this sustainability piece in place in order to move from donor funds to Medicaid and insurance funds. In the first three years of the roll-out of the ACA, Colorado family planning clinics saw a five-fold increase in insurance reimbursements of clinical services. By no longer having to focus funding on young women who either did not have insurance or were not insurable, the state could then work on the public health education piece to reduce stigma and increase training for healthcare providers. In addition, the Colorado General Assembly provided CDPHE with a few million dollars per year that enhanced the program and helped to fund and maintain past gains.

What was key to successfully messaging to the adolescent population and generating buy-in?

We took advantage of the existing websites and sources of information that teens use. The Colorado program, an online platform that distributes information to promote sexual and reproductive health to reduce unintended pregnancy, helped channel that education through social media venues and college campuses. Word of mouth within their own peer networks was also successful.

What is the overall cost savings of providing contraceptive access for adolescents and thus avoiding unplanned pregnancies in this population?

Cost models vary, but the most conservative model came in between $66-$69 million avoided in public support costs (2010-2014 for women ages 15-24). That is a four- or five-to-one savings on cost avoidance. This does not include the downstream savings or productivity gains.

Now that CDPHE has become a national leader in reducing teen pregnancy rates, what are next steps to ensure that this program remains robust and continues to receive funding and support?

There is still a need for a national inventory program that makes it easier and more affordable for providers to keep LARCs stocked in their clinics. It is also important to continue provider training because most women are seen by a primary care manager, pediatrician, or family practitioner. These medical professionals must be adequately trained to provide counseling and insertions for women that chose LARCs. In addition, there is still a need for patient education through peer networks that teens pay attention to.

How has membership in the ASTHO Increasing Access to Contraception Learning Community bolstered CDPHE’s work on this project?

Colorado emerged as a leader within this group. It was a great opportunity for Colorado to show that primary prevention works, and ASTHO has been great about supporting the work that we are doing and promoting that work to other states.