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Background The rate of teenage pregnancy in the United States is higher than in other developed nations. Teenage births result in substantial costs, including public assistance, health care costs, and income losses due to lower educational attainment and reduced earning potential. Methods The Contraceptive CHOICE Project was a large prospective cohort study designed to promote the use of long-acting, reversible contraceptive (LARC) methods to reduce unintended pregnancy in the St. Louis region. Participants were educated about reversible contraception, with an emphasis on the benefits of LARC methods, were provided with their choice of reversible contraception at no cost, and were followed for 2 to 3 years. We analyzed pregnancy, birth, and induced-abortion rates among teenage girls and women 15 to 19 years of age in this cohort and compared them with those observed nationally among U.S. teens in the same age group. Results Of the 1404 teenage girls and women enrolled in CHOICE, 72% chose an intrauterine device or implant (LARC methods); the remaining 28% chose another method. During the 2008–2013 period, the mean annual rates of pregnancy, birth, and abortion among CHOICE participants were 34.0, 19.4, and 9.7 per 1000 teens, respectively. In comparison, rates of pregnancy, birth, and abortion among sexually experienced U.S. teens in 2008 were 158.5, 94.0, and 41.5 per 1000, respectively. Conclusions Teenage girls and women who were provided contraception at no cost and educated about reversible contraception and the benefits of LARC methods had rates of pregnancy, birth, and abortion that were much lower than the national rates for sexually experienced teens. (Funded by the Susan Thompson Buffett Foundation and others.)

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Objective To estimate whether providing no-cost contraception is associated with the number of sexual partners and frequency of intercourse over time. Methods This was an analysis of the Contraceptive CHOICE Project, a prospective cohort study of 9,256 adolescents and women at risk for unintended pregnancy. Participants were provided reversible contraception of their choice at no cost and followed with telephone interviews at 6 and 12 months. We examined the number of male sexual partners and coital frequency reported during the previous 30 days at baseline compared to 6 and 12-month time points. Results From our total cohort, 7,751 (84%) women completed both 6 and 12-month surveys and were included in this analysis. We observed a statistically significant decrease in the fraction of women who reported more than one sexual partner during the past 30 days from baseline to 12 months (5.2% to 3.3%, p<0.01). Most women (70–71%) reported no change in their number of sexual partners at 6 and 12 months; whereas 13% reported a decrease and 16% reported an increase (p<0.01). Over 80% of participants who reported an increase in the number of partners experienced an increase from 0 to 1 partner. Frequency of intercourse increased during the past 30 days from baseline (median = 4) to 6 and 12 months (medians = 6; p<0.01). However, greater coital frequency did not result in greater sexually transmitted infection incidence at 12 months. Conclusion We found little evidence to support concerns of increased sexual risk-taking behavior subsequent to greater access to no-cost contraception.

Chlamydia-positive women had significant increases in anxiety about sex and concern about chlamydia, but did not have marked changes in more general measures of psychosocial well-being about 1 month after diagnosis. Chlamydia diagnoses were associated with some disruption of relationships with main partners. Chlamydia-specific concerns may guide counseling messages to minimize psychosocial impact.