Currently, almost half of the 6.7 million pregnancies in the United States each year are unintended — a rate higher than that of many other industrialized countries. These unintended pregnancies are roughly evenly divided between women who did not use contraception at all and those who did, but ineffectively. Higher proportions of unintended pregnancies are found among adolescents and women in their early 20s and among women with lower levels of education and income.

To reduce unintended pregnancy, women need better access to the most effective contraceptive methods. Use of the most effective and reliable long-acting reversible contraceptive (LARC) methods —  that is, intra-uterine devices (IUDs) and implants — is lower in the U.S. than in many other developed countries. (Oral contraceptives — the most widely used method in the U.S. — are highly effective when they are used perfectly, but many women find it difficult to achieve perfect use: taking the pill at the same time each day, every day.)

Low rates of LARC use persist despite the conclusion by a wide range of organizations concerned with reproductive health, such as the American Congress of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention, that LARC methods, given their effectiveness and safety, should be considered a “first-line recommendation” for all women and adolescents.

Why is this issue important? There is strong evidence that unplanned and unwanted births are associated with negative outcomes for both women and their children. Unintended childbearing is associated with feelings of powerlessness among women, which in turn is associated with poor physical and mental well-being; in contrast, better birth spacing has been found to improve health outcomes for both mother and child. Having an unintended birth may also prematurely end education and job training for a young mother, putting her at risk of long-term poverty.

The Improving Contraceptive Options Now (ICON) project will assist primary care health clinics to better serve patients’ family planning needs by offering women a broader range of effective contraceptive options, including LARC, and by providing them with accurate information about these methods. Led by MDRC, ICON builds on pioneering work conducted by the Contraceptive CHOICE Project at Washington University in St. Louis and by the Bixby Center at the University of California, San Francisco.