Legislators consider contraceptive implants to combat unwanted pregnancies

Should the state offer contraceptive implants at local Department of Health offices? That question was considered Monday by a legislative joint subcommittee.

The discussion was started by a 2015 bill by Rep. Kim Hammer, R-Benton, that would have created an incentive for unmarried women with one child who are receiving Medicaid benefits to voluntarily agree to a surgically implanted contraceptive device. Filed late in the session, it did not pass, so Hammer carried it forward.

The discussion was broader at Monday’s meeting of the Health Services Subcommittee of the Senate and House Public Health, Welfare and Labor Committees. Legislators and witnesses discussed what could be done about preventing unwanted pregnancies among teens and other women using long-acting reversible contraceptives, or LARCs.

Hammer said the discussion is still fluid and could apply to mothers inside and outside the Medicaid program. Robert Brech, chief financial officer of the Department of Health, said his agency must serve everyone who walks in the door, regardless of their personal income or whether or not they have insurance.

“As the conversation’s evolved over the last year and (we) get into the subject a little deeper, it’s a matter of do we want to talk about incentives, or do we want to talk about, are we not adequately supplying the devices that are necessary, and are people who are wanting them not able to access them?” Hammer said afterwards.

Hammer said the subject is “an uncomfortable conversation” that should start long before the 2017 regular session.

Brad Planey, chief of the Family Health Branch with the Arkansas Department of Health, and Brech touted the use of Nexplanon, a device that can be inserted under the skin by a trained nurse and would help prevent pregnancies over three years by slowly releasing progestin, a hormone found in birth control pills. Brech said the department has provided some of those devices, which cost $360 for the product alone, not counting the cost of implantation.

The department could provide them to anyone who requests them at a local office. For those who do not have health insurance, the fee would be no more than $5.

“We’ve very interested in doing this,” Brech said. “We desperately want to. The problem right now is cost.”

The department also would offer more traditional interuterine devices, or IUDs. These also would be implanted in a local Health Department office. Like Nexplanon, IUDs are reversible.

The cost of the devices would be higher than the cost of oral contraceptives, but they would be more effective because oral contraceptives must be taken every day, and people have a tendency to forget.

Still, it would save the state money over the cost of single teen motherhood. Hammer cited a study by the Arkansas Center for Health Improvement that showed that teen births had an economic impact of $143 million on the state in 2008.

Planey said teen birth rates have been falling steadily in Arkansas, from 73.4 live births per 1,000 females ages 15-19 in 1996 to 39.3 in 2014. However, those rates are still the highest in the nation. Across the country, rates have dropped from 53.5 to 24.2. Ninety-three percent of Arkansas teens ages 15-17 giving birth are unwed, and for females ages 18-19, it’s 78%.

The Arkansas Department of Health has made it a goal to decrease the teen birth rate to 34.7 live births per 1,000 females ages 15-19 by 2019.

Planey said teen births are problematic for both children and mothers. Only 3% of teen mothers finish college by age 30, and they are more likely to have low-paying jobs, and they are more dependent on family and the government, he said. Babies of teen mothers are more likely to be born prematurely, die in infancy, have health problems, grow up to be incarcerated, and eventually become teen mothers themselves.

Sen. Joyce Elliott, D-Little Rock, said the problem goes deeper than people wanting to have sex and involves a lack of economic opportunity. She expressed concern that fathers are not included in the effort.

“Are there shots or something, or is this forever a female burden to bear?” she said.

Brech said that fathers are not listed on birth certificates, which makes it hard to track the numbers.

Sen. John Cooper, R-Jonesboro, asked what other states have done to reduce teen birth rates. Planey said California had reduced teen birth rates by offering more education and services and had encouraged abstinence. Colorado made LARCs available for free and ran a media campaign over five years. However, funding wasn’t renewed, and teen birth numbers have begun increasing, he said.