Estrella Peña, an 18-year-old recent high-school graduate, wasn't using birth control when she got pregnant with her son Cristian, now 11 months old. But when she heard community health clinics were offering free, long-acting contraceptive methods to girls her age, she quickly made an appointment.
"I was more than happy to have my baby, to keep him and raise him, but I felt like I was too young," she said. "I want to further my education, and I know it would be more difficult having another child."
Thanks to funding from the federal government (wonkily named the Medicaid 1115 waiver), the San Antonio Metropolitan Health District, in partnership with Bexar County's University Health System, has provided 258 long-acting, reversible contraceptives to teenage girls ages 13 to 19 in the Alamo City since April, surpassing its goal of reaching 250 teens in just six months. UHS provides counseling and clinical services to teenagers at 10 clinics around town, and the city's health district also operates its own teen clinic one night per week.
A growing body of research shows that these methods of birth control are more effective than oral contraception. Commonly known as LARCs, they include the IUD (intrauterine device), arm implants and injections. A St. Louis-based study conducted over three years found that, given the option, the majority of adolescent girls overwhelmingly chose a LARC as their preferred method of birth control. The same study found that the teenage girls and women who were provided birth control for free had lower rates of pregnancy, birth and abortion than their peers nationwide.
Providing the implant and injection birth control to adolescent women is part of San Antonio's multipronged effort to address the city's high rates of teen pregnancy and teen births. Through the Medicaid 1115 waiver, San Antonio's health district has allocated approximately $1.5 million per year for three years for teen-pregnancy prevention. Called Project Worth, the city's strategy integrates sex education, clinical services, counseling and provider training in the hope of reducing Bexar County's rates to no higher than the national average. According to San Antonio Metro Health, Bexar County's teen birth rate was 42.8 per 1,000 adolescent women in 2012, while the U.S. rate was 29.4. The city is targeting the south and west sides of town, where teen birth rates are higher.
Terri de la Haya, UHS senior vice president of community health and clinical prevention programs, said an increasing number of San Antonio teens are choosing LARCs because they last longer and require no maintenance, while oral birth control pills must be taken at the same time every day. LARCs are more expensive than the pill, but offering them for free eliminates the cost barrier many low-income teen girls face.
"A lot of girls don't have access to education, counseling and contraception ... they're unaware that these contraceptive methods are available," de la Haya said.
Teens under the age of 18 are required by state law to have parental consent for birth control. Mario Martinez with the San Antonio Metro Health District said parents have also given positive feedback on the LARC methods.
"The parents or guardian are the ones who are going with them to the clinic, helping them make the decision," he said. "Many are saying 'Yes, this is a good option for my daughter.'"
Just last month, the American Academy of Pediatrics recommended that pediatricians prioritize IUDs and implants when discussing birth control options with adolescents, pointing to their "efficacy, safety, and ease of use." The American College of Obstetricians and Gynecologists made similar recommendations in 2012.
City health officials say it's too early to track the impact of LARCs on the local teen pregnancy and birth rates, but they do credit an overall decrease over the last few years to the collaborative strategy. Still, the fact that the city and UHS reached its distribution goal in six months speaks to the overall demand and preference for these types of birth control methods. Peña chose the implant because it lasts three years.
"I'm grateful that [the City] is helping more teens know that they can go get a contraceptive to prevent pregnancy and any other thing that can happen," she said. "I'm thankful to the teen clinic for helping me put my family on hold."