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Published Online: 14 May 2015

Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review

Publication: Journal of Women's Health
Volume 24, Issue Number 5


The Contraceptive CHOICE Project (CHOICE) sought to reduce unintended pregnancies in the St. Louis Region by removing cost, education, and access barriers to highly effective contraception. CHOICE was a prospective cohort study of over 9,000 women 14–45 years of age who received tiered contraceptive counseling to increase awareness of all reversible methods available, particularly long-acting reversible contraceptive (LARC) methods. Participants were provided with contraception of their choice at no cost for 2–3 years. We studied contraceptive method choice, continuation, and population outcomes of repeat abortion and teen pregnancy. Seventy-five percent of study participants chose one of the three LARC methods (46% levonorgestrel intrauterine system, 12% copper intrauterine device, and 17% subdermal implant). LARC users reported greater continuation than non-LARC users at 12 months (87% versus 57%) and 24 months (77% versus 41%). In our cohort, LARC methods were 20 times more effective than non-LARC methods. As a result, we observed a reduction in the percent of repeat abortions from 2006 to 2010 in St. Louis compared with Kansas City and nonmetropolitan Missouri and found substantial reductions in teen pregnancy, birth, and abortion (34.0, 19.4, and 9.7 per 1000 teens, respectively) compared with national rates among sexually experienced teens (158.5, 94.0, and 41.5 per 1000, respectively). Improved access to LARC methods can result in fewer unintended pregnancies and abortions and considerable cost savings to the health care system.

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Published In

cover image Journal of Women's Health
Journal of Women's Health
Volume 24Issue Number 5May 2015
Pages: 349 - 353
PubMed: 25825986


Published online: 14 May 2015
Published in print: May 2015
Published ahead of print: 31 March 2015


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Natalia E. Birgisson
Department of Obstetrics and Gynecology, Division of Clinical Research, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Qiuhong Zhao
Department of Obstetrics and Gynecology, Division of Clinical Research, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Gina M. Secura
Department of Obstetrics and Gynecology, Division of Clinical Research, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Tessa Madden
Department of Obstetrics and Gynecology, Division of Clinical Research, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Jeffrey F. Peipert
Department of Obstetrics and Gynecology, Division of Clinical Research, Washington University in St. Louis School of Medicine, St. Louis, Missouri.


Address correspondence to:Jeffrey F. Peipert, MDDepartment of Obstetrics and GynecologyCampus Box 82194533 Clayton AvenueWashington University School of MedicineSt. Louis, MO 63110E-mail: [email protected]

Author Disclosure Statement

Dr. Madden receives honorarium for serving on an advisory board for Bayer Healthcare Pharmaceuticals and on a data safety monitoring board for phase 4 safety studies of Bayer contraceptive products. Dr. Peipert receives research support from Bayer Healthcare Pharmaceuticals, Merck & Co, Inc., and TEVA Pharmaceuticals, and serves on advisory boards for TEVA Pharmaceuticals and MicroCHIPS. For all other authors, no competing financial interests exist.

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