After an Oklahoma teenager gives birth, at least 22 percent will have another child within two years.
This statistic was released in 2008, just as the teen birth rate started increasing. It has remained steady, according to Community Service Council associate director Jan Figart.
The Oklahoma State Department of Health Vital Statistics also found that 33 percent of all women will have another child within two years of giving birth.
Community concerns grew that the time between births was an indicator of risk to the mother and child. And it was contributing to several indicators for poor health and poverty.
In response, the Taking Control Initiative was launched in February 2010 to give women the option and access to long-acting reversible contraceptives in their family planning.
"The social risks are poverty and poor child rearing - having children too close together to provide nurturing and stimulation to the child," Figart said.
"The health risks are increased complications for mother and baby - a greater incidence of prematurity and low birth weight. The economic risks for mothers are that they are less likely to sustain employment or complete their high school education. Collectively, all of these things increase the likelihood of economic struggles and potential poverty."
With the Tulsa City County Health Department as a lead agency, the initiative is a collaboration among 100 nonprofit, medical, philanthropic and government agencies, along with funding from the George Kaiser Family Foundation.
The service is available at 16 clinics for Tulsa County women who are at 200 percent of the federal poverty level, which is $21,780 annual income for a single person.
Since its founding, the initiative has funded 1,653 contraceptive devices and helped about 4,600 women access the contraception through other available funding sources.
The program is considered a payer of last resort, filling in the funding gap so all women can consider the devices as birth control options. In the past, most users have been mostly middle- and upper-class women with insurance or financial means.
About 60 percent of women who have used the program are in their 20s, with the other 40 percent split equally among women older than 30 and teenagers.
Figart said the partners have come into the initiative for different reasons, but all have a concern about early childbearing.
"The health and social services in Tulsa and most of Oklahoma recognize the significance of early childbearing in all risk categories - health, social and economics. The challenge is the solution," Figart said. "The 100 partners are not one voice on the solutions, even though they may be harmonious on the need to address teen births."
Dr. Michael Gardner, chairman of the University of Oklahoma-Tulsa School of Community Medicine Department of Obstetrics and Gynecology, said the devices are not cheap.
"But if you look at them compared to birth control pills over five to seven years, they are very cost-effective," he said. "But if you have to pay in cash, it will include the cost of the device and cost for the physician. For a lot of people, that out-of-pocket expense is no small feat."
Some states, including Oklahoma, will cover long-acting birth control in their Medicaid programs. Some insurance companies have had limited coverage of these types of contraception.
That would change under the federal Patient Protection and Affordable Care Act and a mandate issued in January by the U.S. Health and Human Services Department to require parity in birth control coverage among insurance plans.
Those aspects are being challenged by some faith-based employers on religious grounds.
Even with the coverage provided among current insurers, some women are not able to get access because they are under-insured or uninsured.
Gardner said women who prefer long-acting contraception are those not wanting a medical procedure known as a tubal ligation but wanting to prevent pregnancy. Women opting for these types of contraception like not having to take a daily pill.
"We used to emphasize these devices for women who had children before, but we've gotten away from that," Gardner said. "We are using long-acting contraception for a wider group than what we had been seeing. We have a lot of people who know they want to forestall pregnancy for a while, and these devices give them an option to do that."
The three devices available in the program - Mirena, ParaGard and Implanon - are put into place by a physician, have at least a 99 percent effectiveness of preventing pregnancy and last from three to 10 years. Fertility is regained fairly quickly after they are removed.
"The pill is only effective if you take it regularly," Gardner said. "What people are seeing with effectiveness is that it's better with long-acting devices because once it's in place, it works on its own."
Gardner said a problem with an intrauterine device in the 1970s led to a reluctance to use the devices through the '80s and early '90s.
"We now know those concerns are not founded and there is a growing comfort level to include the devices as choices," Gardner said. "The reticence to use them has gone away, and it gives women more options. Cost was a barrier for women. By removing that barrier, it opens up that option to a lot more women."
Gardner said women wanting contraception will be given the array of choices, with pros and cons of each. He said doctors are not pushing contraception or any certain type of birth control onto patients.
"We truly believe women need education and options for making an informed decision, and we respect the decision they make," Gardner said. "While we point out options, we are big believers in advocating for women and letting women make these choices, whether they choose contraception or not.
"Before this initiative, we would tell women that other contraception options were out there, but they couldn't access it because of cost. We are very appreciative of this program and hope it continues.
"There is a benefit to society at large by allowing choices to be made so families are able to have a child when they feel comfortable socially and economically to take care of their children."
Taking Control Initiative
- Started in 2010 to give Tulsa county women access to affordable long-acting reversible contraception
- Choice between Mirena, ParaGard and Implanon
- Services include insertion and removal of the devices
- Has more than 100 community partners and offers services at 16 clinics
- Eligibility includes being at 200 percent of the federal poverty level. That is an annual income of $21,780 or less for a single person or $44,700 or less for a family of four.
Types of Contraception
Mirena: An intrauterine system providing birth control for up to five years. It is estrogen-free and provides a consistent low dose of hormones directly to the uterus. It is considered 99 percent effective for pregnancy prevention. Cost $700.
ParaGard: A hormone-free intrauterine device with effectiveness for up to 10 years. It has a 99.4 percent pregnancy prevention rate. Cost $600.
Implanon: A flexible plastic single-rod implant placed under the skin in the upper arm. Releases a low daily dose of estrogen-free hormones. It is 99 percent effective and lasts for up to three years. Cost $650.
In addition: Office visit ranges from $100 to $150.
Ginnie Graham 918-581-8376
ginnie.graham@tulsaworld.com
Original Print Headline: Initiative aids women with birth control
RELATED ITEMS
See past stories and related resources.
Local
Her biological father from Oklahoma and her adoptive parents from South Carolina spent several hours Monday and Tuesday on the sixth floor of the state's Kerr office building, where the Court of Civil Appeals meets in Tulsa.
A cause of the fire is under investigation.
