Case Studies

The Contraceptive CHOICE Project

The Contraceptive CHOICE Project is a large clinical trial research study whose goal is to increase uptake of long-acting reversible contraception and decrease unintended pregnancy in the St. Louis area. Jeffrey Peipert, MD, PhD, the Principal Investigator for the Contraceptive Choice Project, used support from the ICTS from 2007 to 2012 for KL2 scholars, TL1 trainees, and consultations with ICTS related to this Project.

The Project involved nearly 10,000 women from the area, along with community partners and private providers.1 Providing no-cost contraception to teens in the CHOICE Project dramatically reduced the teen pregnancy and abortion rate in the St. Louis area. Of the 1,404 teens in the Project, 72% chose a Long-Acting Reversible Contraceptive (LARC) method. The teen pregnancy rate was 34.0 per 1,000 teens compared to the national average of 158.5 per 1,000 teens. Additionally, the abortion rate for teens in the CHOICE Project was 9.7 per 1,000 teens compared to the national average of 41.5 per 1,000 teens.2 Reduction of teen pregnancy rates is among the six identified CDC Winnable Battles for 2010–2015.3

The CHOICE Project is important from a clinical and translational aspect, as it represents a fundamental shift in the use of contraceptive methods and garnered significant attention from the community and media. The Project demonstrated that removing barriers to highly effective contraceptive methods such as IUDs and implants reduces unintended pregnancies by expanding patients’ access to their desired contraceptive methods.

Research Team

Jeffrey F. Peipert, MD, PhD, Department of Obstetrics & Gynecology, Indiana University, Gina M. Secura, PhD, MPH, Tessa Madden, MD, MPH, & David L. Eisenberg, MD, MPH, Divisions of Family Planning & Clinical Research, Department of Obstetrics & Gynecology, Washington University School of Medicine

Benefit Domain Indicator
CHOICE Project cited in two evidence-based guidelines. Clinical Icon Guidelines
New women’s community health center (C3) established, based on the Contraceptive Choice Project model of care. Community Icon Community Health Services
Project members have provided training to ACOG, CDC, Association of Reproductive Health
Professionals, CHOICE-Australia.
Community Icon Health Care Delivery
Local teen pregnancy rates and abortion rates
were significantly below national average.
Community Icon Life Expectancy and Quality of Life
Cited in U.S. Supreme Court Hobby Lobby case. Policy Icon Expert Testimony
The state of Missouri, as of 2018, saved an estimated $5 million in Medicaid costs. Policy Icon Cost Savings

Benefits of the CHOICE Project represent all four TSBM domains. As a Clinical and Medical benefit, CHOICE was cited in two professional pediatric clinical guidelines: the American Academy of Pediatrics Policy Statement, Contraception for Adolescents, 2014, and the American College of Obstetricians and Gynecologists Practice Bulletin, Long-Acting Reversible Contraception: Implants and Intrauterine Devices, 2013.4,5

Community and Public Health benefits of the CHOICE Project are seen in three different ways: a new women’s health community center (C3) based on the Contraceptive Choice Project model of care has been established,6 project investigators currently provide clinical training for members of the community, and the recommendations from the study are currently being tested in Australia (The Australian Contraceptive Choice Project, ACCoRd).7 The clinical trial itself dramatically reduced unintended pregnancy and abortion rates for the entire St. Louis region.

The Economic benefit from cost savings for the state of Missouri from the Project was estimated to be $5 million as of 2018 in averted Medicaid spending.8

Finally, the CHOICE project has also shown potential Policy and Legislative benefits since it was cited in amicus brief submitted to the U.S. Supreme Court in 2014 by the Guttmacher Institute.9 The CHOICE project was cited as evidence of how effective contraception reduces rates of abortion, potentially preventing more than half of abortions performed annually.


References

  1. McNicholas C, Madden T, Secura G. & Peipert JF. The contraceptive CHOICE project round up: what we did and what we learned. Clin. Obstet. Gynecol.57, 635–643 (2014).
  2. Secura, G.M.et al. Provision of no-cost, long-acting contraception and teenager pregnancy. N Engl J Med.371, 1316–1323 (2014).
  3. Centers for Disease Control and Prevention. Winnable Battles: Teen Pregnancy. [updated 2014 Nov 3; cited 2016 Oct 5]. Available from: http://cdc.gov/winnablebattles/teenpregnancy.
  4. American Academy of Pediatrics. Contraception for adolescents. Pediatrics 134, e1244–e1256 (2014).
  5. American College of Obstetricians and Gynecologists. Practice Bulletin No. 121: Long-acting reversible contraception: implants and intrauterine devices. Obstet. Gynecol.118,184–196 (2011).
  6. Washington University in St. Louis. New women’s health clinic at Washington University [Internet].Wellness Connect. 2015 Oct. 6. [cited 2016 Nov 1]. Available from: http://wellnessconnection.wustl.edu/new-womens-health-clinic-at-washington-university.
  7. University of Technology Sydney. Increasing the use of long-acting reversible contraception: The Australian Contraceptive ChOice pRoject (ACCORd) [Internet]. 2015 [cited2016 Nov 1]. Available from: http://cfsites1.uts.edu.au/find/projects/detail.cfm?ProjectId=2015000144.
  8. Madden T, Barker AR, Huntzberry K, Secura GM, Peipert JF & McBride TD. Medicaid savings from the Contraceptive CHOICE Project: a cost-savings analysis. Am J Obstet Gynecol. 219(6): e1-e11. (2018).
  9. Brief of the Guttmacher Institute and Professor Sara Rosenbaum as Amici Curiae in support of the Government, Burwell v. Hobby Lobby, 134 S. Ct. 2751, 573 US 189 (2014), (Nos. 13–354 & 13–356).


 

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