Thanks in large part to a team of researchers on the University of Colorado Anschutz Medical Campus, a state program heralded for dramatically reducing Colorado’s teen birth and abortion rates gained a funding boost, allowing the public health initiative to continue.
Chosen from a pool of highly qualified applicants, Marcelo Perraillon, PhD, an assistant professor in the Colorado School of Public Health, and his team were tasked with crunching the numbers of the Colorado Family Planning Initiative (CFPI). Their goal: to show lawmakers the program’s fiscal worth in addition to its public-health value.
Their mission was accomplished. The independent analysis indicated the program was responsible for more than half of the drop in births from 2009 through 2015 and up to nearly $70 million in potential and actual cost-savings for state and federal programs.
Colorado Family Planning Initiative
“The CFPI was originally funded by an anonymous donor,” Perraillon said of the Colorado Department of Public Health and Environment initiative. “This special program was created to help curb unintended pregnancies. We wanted to use the report to inform decision-makers about the impact of the initiative on cost savings and health outcomes.”
The CFPI’s chief goals are to provide physician training, operational support and low- or no-cost long-acting, reversible contraceptives (LARCs). Launched in 2009, the program provided about 32,000 LARCs, which include IUDs and hormonal implants, in its first six years.
Once implanted in a female candidate, these devices are 99 percent effective and can prevent pregnancies for up to 10 years. This method doesn’t require a monthly prescription, constant monitoring by a physician or a reminder to take it, decreasing chances for unintended pregnancies. So, where’s the pitfall? Its price tag.
“LARCs are substantially more expensive than other methods,” said Perraillon. “A lot of low-income women cannot afford this option, and must use cheaper, less-reliable options, such as condoms or birth control pills. It puts them at a higher risk of unintended pregnancies.”
Although there are public health programs in which women can receive low-cost or no-cost IUDs, their waiting lists can be long, leaving economically disadvantaged women at higher risk of becoming pregnant.
Crunching the numbers
To create convincing evidence, Perraillon and his team prepared an extensive report.
Melanie Whittington, PhD, a student when she was involved in the project, assisted in estimating the percent reduction in unintended pregnancies. The other team members included Richard Lindrooth, PhD; Mark Gritz, PhD; and graduate students Rose Hardy, MPH, and Shannon Sainer, MSW.
“I’ve always been interested in health economics,” said Whittington. “It’s fascinating to uncover how policy can impact public health. This project was a great example of how we can help provide evidence to lawmakers to make Colorado a better place.”
In 2007, the abortion rate for 15- to 19-year-olds in Colorado was 11.4 abortions per 1,000 women. During the program, the rate dropped nearly by half, from 10.3 in 2009 to 5.4 in 2014. The unintended pregnancy rate dropped 40 percent, from 35 per 1,000 teens in 2009 to 21 in 2014.
Uncovering the cost savings
Perraillon and his team needed to consider the potential savings from the many different state-funded programs that assist mothers. These programs range from providing prenatal care all the way to putting a child through preschool.
“When you run an experiment, interpreting the data is fairly straightforward,” said Perraillon. “You have a control, and you have an experimental group. But when you are using observational data, things can get very complicated very quickly.”
Through sophisticated techniques for analyzing observational data, Perraillon and his team found that the CFPI helped save Colorado between $66.1 million and $69.6 million.
“It is important to note that the creation of the CFPI alone did not cause all the reduction in birth rates,” said Perraillon. “There are other factors that influence birth rates, including unemployment rates. Our analysis had to take these and other factors into account.”
However, the evidence clearly suggested the program influenced a decline in birth rates and an increased cost savings for the state. The Legislature allocated funding for the program, allowing Colorado to continue a nationwide model for family planning.
“I think just by the numbers, you can tell this effort was very successful,” said Perraillon. “I’m very pleased with the outcome of our findings.”