After Jazmin Perez gave birth to a son when she was just 16, she got serious about avoiding another pregnancy until she was ready.
Through Gaston County’s Teen Parenting Program, she learned about the ease and effectiveness of long-acting birth control devices that can be implanted under the skin or inserted into the uterus.
She chose a Nexplanon implant – impossible to see inside her upper left arm – that lasts for three years.
“For me, it just works,” said Perez, now 18, whose son Rodrigo is almost 2. “I would forget to take (birth control) pills. With this, I don’t have to worry about nothing.”
Perez reached her goal with help from professionals involved in a project aimed at providing teens with evidence-based education about reproductive health through multiple medical clinics and community organizations.
The project’s goal was to reduce teen pregnancy by 10 percent, but the results were much better – a 45 percent drop – from 2010 to 2015.
That success story is one that Mecklenburg County health officials and other community leaders would like to replicate.
Dr. Marcus Plescia, Mecklenburg’s health director, called the Gaston results “phenomenal” and said he’s “determined” to improve Mecklenburg’s rate of unintended pregnancy not only for teens but for all women of child-bearing age.
Plescia presented his idea to county commissioners in February. But instead of having to push the idea on his own, he said he’s been impressed by the interest of others, including foundation leaders who could provide funding and the Charlotte-Mecklenburg Opportunity Task Force, which has been meeting for more than a year to come up with solutions to help more people rise out of poverty.
“That’s what makes me think something is really going to happen,” Plescia said.
As part of its community-wide “listening tour,” the task force will address the topic of “Family Planning and the American Dream” at a free forum from 5:30 to 8 p.m. April 18 at the Booth Playhouse, 130 N. Tryon St. A part of the conversation will be about women having access to long-acting birth control devices that can be removed when they want to become pregnant.
The task force was created after a 2014 academic study showed that poor children in Charlotte have the worst odds of those in America’s 50 largest cities of extracting themselves from poverty.
Dr. Ophelia Garmon-Brown, a task force co-chair, said the program will address “family structure” as one of the indicators of upward mobility. The “intendedness of pregnancy” has been cited as one of the most important contributors to a child’s future economic opportunity.
Later in the week, the task force will meet with a representative from the U.S. Centers for Disease Control and Prevention, which provided $5.8 million for the teen pregnancy project in Gaston County.
The Duke Endowment, which has funded a small program to reduce unintended pregnancy in Darlington County, S.C., is also interested in participating in a Mecklenburg program, said Tamika Williams, program officer for the endowment’s child care division.
And Liz Winer, who with her husband Brad created the Winer Family Foundation to promote early childhood health, said they’re supporting a Mecklenburg initiative.
“When we come to the table, Republicans, Democrats, it’s not a partisan issue,” Winer said. “Everybody can agree. If you want to have a baby, that’s great, let’s make sure you have the resources you need.…But if you don’t want to have a baby, we want to make sure you have the resources to make the right decision. We’re not forcing it on anybody. It’s just making people aware.”
Gaston supported project
Among the speakers at the forum will be Michelle Reese, a senior staffer with SHIFT NC, formerly the Adolescent Pregnancy Prevention Campaign of North Carolina.
Her agency oversaw the Gaston project, which was successful in part because the county’s medical director Dr. Velma Taormina and the agency had been advocating for better sex education for teens for many years.
“It’s extremely important to have a medical champion,” Reese said. “A lot of communities don’t really have a medical provider who’s willing to step out front.”
Taormina, an obstetrician/gynecologist since 1994, said she had been reluctant in the past to recommend that teens use the long-acting Depo-Provera injection because of potential negative effects on bone density.
But she became a supporter of the original contraceptive implant, called Implanon, because it offered protection for three years without affecting bone health. Today’s implant is called Nexplanon, and it’s greater than 99 percent effective, Taormina said.
When her staffers counsel patients at the Gaston health department, she said they always ask women of child-bearing age about their intentions for pregnancy. If they say they don’t want to get pregnant in the next year, they are counseled about which birth control options are the most effective.
At the top of the list are the three types of long-acting reversible contraceptives – also called LARCs – that include the Nexplanon implant and four intrauterine devices.
Nationally, only 7 percent of patients using publicly funded health centers are using long-acting reversible contraceptives. Gaston’s rate was 25 percent among adolescents after the five-year project.
According to N.C. law, minors don’t need parental consent to get birth control or treatment for pregnancy, sexually transmitted diseases, mental illness or substance abuse. Parental permission is required for an abortion.
Doctors and nurses weren’t the only ones engaged in the Gaston project. Parents as well as leaders from schools, churches and other community organizations – including those who promoted abstinence only – were invited to be part of the conversation.
A survey at the beginning of the project showed that 96 percent of respondents thought the community should do more to address teen pregnancy by giving teens accurate, up-to-date information.
“It gave everyone in the community permission to talk about it,” Taormina said.
Doctor groups recommend LARCs
Nationally, about half of all pregnancies are unintended. But in Mecklenburg, Plescia’s concern goes beyond that, to the frequency of unintended pregnancies.
From 2010 to 2014, more than 5,400 Mecklenburg women had a second pregnancy within six months of giving birth. That was about the same as in Wake County and the state as a whole. That’s 12 percent of total births.
“A pretty significant number of women are having a child and then getting pregnant again in a pretty short interval – 18 months or even six months,” Plescia said. “They’re not getting access to family planning. Very few people would want to get pregnant again that quickly, and it’s a huge medical risk factor for poor pregnancy outcomes.”
Also, only about 29 percent of Mecklenburg mothers on Medicaid, the government health program for low-income women and children, began using contraceptives in the six weeks after giving birth, compared with the statewide average of 35 percent.
“We’re usually the same as or better than the rest of the state,” Plescia said, “(but in this measure) we’re actually doing worse.”
A key moment
A pivotal point in the history of LARCs occurred in 2011 when the American College of Obstetricians and Gynecologists issued a bulletin recommending implants and IUDs as the most effective reversible contraceptives, with the added benefit that they didn’t require “ongoing effort” by users and that fertility returns quickly after the devices are removed.
That bulletin was followed by another in 2012 recommending LARCs specifically for adolescents who had not previously given birth. The American Academy of Pediatrics followed suit, and that gave “everybody working with adolescents the same guidelines,” Taormina said.
In addition to the Gaston program, Plescia has also cited a much-heralded teen pregnancy program in Colorado.
Started in 2009 with an anonymous private grant, the state-run Colorado Family Planning Initiative gave free or reduced-price IUDs or implantable birth control to more than 30,000 women. The teen birth rate fell 40 percent between 2009 and 2013.
“I never see numbers like that,” Plescia said.
According to published reports, the Colorado governor’s office said the state saved $42.5 million in health-care costs associated with teen births – almost double the $23 million anonymous donation. But last year when state health officials asked for $5 million to keep the program going, the GOP-led legislature declined.
Colorado Family Action, which opposed state funding for the program, said using taxpayer dollars would inappropriately insert the government between children and their parents. “We believe that offering contraceptives to teens, especially long-acting reversible contraceptives, while it may prevent pregnancy, does not help them understand the risks that come with sexual activities,” CFA said in a statement.
So far, the incipient Mecklenburg initiative hasn’t experienced opposition. Indeed, Plescia said Republican Gov. Pat McCrory’s administration has supported family planning efforts to reduce infant mortality.
Just this month, Mecklenburg received a three-year, $1.5 million grant from the state Department of Health and Human Services for a collaborative effort with Union County to reduce infant mortality rates and disparities. The focus is partly on promoting the use of long-acting contraceptives.
Plescia emphasized that any recommendations about using LARCs will be voluntary, and as the name suggests, the devices are all reversible. That’s in stark contrast to North Carolina’s decades-long program of forced sterilization for some women, which ended in the 1970s.
“We’ve got some painful history here, and we want to be clear that this is very different,” Plescia said. “We don’t want to do anything to pressure people.”
Not ready for another baby
Jazmin Perez, the Gaston youth who chose a LARC implant, said she appreciated being able to get education about the various types of contraceptives. With counseling and guidance from Diana Willman, coordinator of the Teen Parenting Program, Perez was able to continue high school and is on track to finish with her senior class this spring.
“We love LARCs for teens after they give birth,” Willman said. “There’s less human error. ...They don’t have to think about it.”
Jazmin admits that if she hadn’t gotten the implant, she probably would have gotten pregnant again. When her current implant expires in a year, she plans to get another.
“I’m not ready for another baby,” she said.
Birth control methods
Most effective – less than 1 pregnancy per 100 women in a year
▪ Implant (Nexplanon): Must be implanted in arm by health care provider, lasts up to three years
▪ Intrauterine device (Paragard, Mirena, Skyla, Liletta): Must be placed by a health care provider, lasts from three to 10 years
Effectiveness: 6 to 12 pregnancies per 100 women in a year
▪ Depo-Provera injections: Administered by health care provider, one shot every three months
▪ Patch: Must be applied each week for three weeks (21 days); don’t wear during fourth week
▪ Ring (NuvaRing): Placed in vagina by the user; stays for thee weeks, out for one week.
▪ Pill: Swallow one pill every day
▪ Diaphragm: Placed in vagina by user; must be used correctly during every sexual encounter
Least effective: 18 or more pregnancies per 100 women in a year
▪ Condoms: Must use correctly during every sexual encounter
▪ Sponge: Must use correctly during every sexual encounter
▪ Spermicide: Must use correctly during every sexual encounter
▪ Rhythm method: Must be practiced strictly by following monthly menstrual cycle
▪ Withdrawal: Must be practiced correctly during every sexual encounter
Sources: U.S. Centers for Disease Control and Prevention, www.cdc.gov/vitalsigns/teenpregnancy; American College of Obstetricians and Gynecologists, http://www.acog.org/Patients/FAQs/Long-Acting-Reversible-Contraception-LARC-IUD-and-Implant
Want to go
“Family Planning and the American Dream” – a free community program sponsored by the Charlotte-Mecklenburg Opportunity Task Force and the Robinson Center for Civic Leadership, 5:30 to 8 p.m. April 18 at at the Booth Playhouse, 130 N. Tryon St. Register: http://civic-leadership.org/events/42/leading