Long-Acting Reversible Contraception Free of Charge, Method Initiation, and Abortion Rates in Finland

Abstract

Objectives: To evaluate whether a public program providing long-acting reversible contraceptive (LARC) methods free of charge increases the LARC initiation rate and reduces the unintended pregnancy rate in the general population.

Methods: Since 2013, all women in Vantaa, Finland, have been entitled to 1 LARC method free of charge. With time-series analysis between 2000 and 2015, we assessed whether this public program was associated with changes in steady-state mean rates of LARC initiation and abortions.

Results: The initiation rate of LARCs (1/1000 women) increased 2.2-fold from 1.9 to 4.2 after the intervention (P < .001). Concomitantly, the abortion rate (1/1000 women) declined by 16% from 1.1 to 0.9 in the total sample (P < .001), by 36% from 1.3 to 0.8 among those aged 15 to 19 years (P < .001), and by 14% from 2.0 to 1.7 among those aged 20 to 24 years (P = .01).

Conclusions: The LARC program was associated with increased uptake of LARC methods and fewer abortions in the population. Public Health Implications. Entitling the population to LARC methods free of charge is an effective means to reduce the unmet need of contraception and the need for abortion, especially among women younger than 25 years.

FIGURE 1—

Crude Monthly Rates of LARC Initiation and Adjusted Regression Estimates Before and After Intervention Among Women Aged (a) 15–19 Years, (b) 20–24 Years, and (c) 25–44 Years: Vantaa, Finland, January 2000–December 2015 Note. LARC = long-acting reversible contraceptive. Rates are per 1000 women. The intervention was in January 2013. The solid black line indicates the regression estimate of the mean before and after the intervention, and the dashed lines indicate the 95% confidence interval. The gray box is the time after the intervention.

FIGURE 2—

Crude Monthly Abortion Rates and Adjusted Regression Estimates Before and After the Intervention Among Women Aged (a) 15–19 Years, (b) 20–24 Years, and (c) 25–44 Years: Vantaa, Finland, January 2000–December 2015 Note. Rates are per 1000 women. The intervention was in January 2013. The solid black line indicates the regression estimate of the mean before and after the intervention, and the dashed lines indicate the 95% confidence interval. The gray box is the time after the intervention. The dashed box indicates the 3-month period of January to March 2013 before the full effect of the intervention on the abortion rate was seen.