Provision of no-cost, long-acting contraception and teenage pregnancy

N Engl J Med. 2014 Oct 2;371(14):1316-23. doi: 10.1056/NEJMoa1400506.


Background: The rate of teenage pregnancy in the United States is higher than in other developed nations. Teenage births result in substantial costs, including public assistance, health care costs, and income losses due to lower educational attainment and reduced earning potential.

Methods: The Contraceptive CHOICE Project was a large prospective cohort study designed to promote the use of long-acting, reversible contraceptive (LARC) methods to reduce unintended pregnancy in the St. Louis region. Participants were educated about reversible contraception, with an emphasis on the benefits of LARC methods, were provided with their choice of reversible contraception at no cost, and were followed for 2 to 3 years. We analyzed pregnancy, birth, and induced-abortion rates among teenage girls and women 15 to 19 years of age in this cohort and compared them with those observed nationally among U.S. teens in the same age group.

Results: Of the 1404 teenage girls and women enrolled in CHOICE, 72% chose an intrauterine device or implant (LARC methods); the remaining 28% chose another method. During the 2008-2013 period, the mean annual rates of pregnancy, birth, and abortion among CHOICE participants were 34.0, 19.4, and 9.7 per 1000 teens, respectively. In comparison, rates of pregnancy, birth, and abortion among sexually experienced U.S. teens in 2008 were 158.5, 94.0, and 41.5 per 1000, respectively.

Conclusions: Teenage girls and women who were provided contraception at no cost and educated about reversible contraception and the benefits of LARC methods had rates of pregnancy, birth, and abortion that were much lower than the national rates for sexually experienced teens. (Funded by the Susan Thompson Buffett Foundation and others.).

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Induced / statistics & numerical data*
  • Adolescent
  • Birth Rate* / ethnology
  • Contraceptive Agents, Female* / administration & dosage
  • Contraceptive Agents, Female* / economics
  • Desogestrel
  • Female
  • Humans
  • Intrauterine Devices* / economics
  • Levonorgestrel
  • Pregnancy
  • Pregnancy in Adolescence / prevention & control
  • Pregnancy in Adolescence / statistics & numerical data*
  • Prospective Studies
  • United States
  • Young Adult


  • Contraceptive Agents, Female
  • etonogestrel
  • Levonorgestrel
  • Desogestrel