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How SC And Gaston County Are Ahead Of The Curve With Contraception

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Michael Tomsic
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A doctor holds an IUD.

Federal health leaders are promoting a form of contraception that's effective for years and essentially forget-proof.

They're encouraging state Medicaid programs to increase access to intrauterine devices and arm implants, both of which are more effective than the birth control pill. South Carolina as a whole and one North Carolina county are ahead of the curve on this.

Nurse practitioner Kim Hamm walked into an exam room at the Gaston County Teen Wellness Center recently. It provides counseling, education and medical care. On this day, a 14-year-old who’s talked through her options has chosen a contraceptive arm implant.

“This is the numbing medicine, so you're going to feel me touch you here,” she told the girl. “Little stick. One, two, three, ouch and then a little bit of burn, OK. You're doing awesome. We're almost done with this part.”

Next is the actual implant, which works by releasing hormones. It's about the size of a matchstick. Hamm uses a small device to insert it between the girl's biceps and triceps.

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Credit Michael Tomsic
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The device that staff use to demo an insertion of the contraceptive arm implant.

  “You're going to feel tons of pressure here,” she said as she inserted it with a click. “That’s it.”

It takes longer to fill out the paperwork than to get the implant.   

“You did awesome," Hamm says. “Yay, no babies for three years!”

Research shows long-acting contraception, like the arm implant or an IUD, is more effective than anything other than sterilization or abstinence. The American College of Obstetricians and Gynecologists recommend it as their first choice.    

But because it's not that well known, it can be expensive, and there were problems with much older versions, less than 10 percent of American women use it.

There's a big push nationally to change that. Gaston County got a head start.

“We wanted women to complete their education,” county Medical Director Dr. Velma Taormina says. “We wanted to give them an alternative to the other forms of what I call the forgettable types of birth control and then just to be able to work with them on their reproductive planning.”

Since 2009, all providers in county clinics have been trained to insert the devices. The county uses federal funding to help cover the cost for the uninsured, which can be roughly $1,000.

There are versions that last three, five or 10 years. But women can get them out whenever they want. 19-year old Kie'Ja Phillips chose the three-year arm implant before heading to college.

“I do not want to have children until I'm done getting my education,” she says. “I want to be able to provide for my children and give them a stable household financially and emotionally and physically.”

Phillips also helped teach other teens about their options. She says a lot of them knew about the pill but very few about IUDs or implants.    

“They have a lot of misconceptions and myths about it,” she says. “Like, how am I supposed to get it out? You go to a doctor to get it out. You don't take it out yourself. It's just things like that, common misconceptions that people have.”

Last year, nearly 30 percent of teens who got contraception at the clinics chose the long-acting kind.

Dr. Taormina says that's a key reason the county's teen pregnancy rate has been dropping faster than the state as a whole. Gaston County has also largely erased the disparity in that rate between African-Americans and whites.

“We feel very strongly that this is making a huge impact here,” Dr. Taormina says.

The effort was funded in part by the CDC. Now, federal health leaders are calling on all states to make long-acting contraception more accessible through Medicaid. In their guidance a few months ago, they highlighted the way South Carolina has been doing that.       

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Credit Michael Tomsic
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A simulated birth in the SimCOACH in Columbia, SC.

It happens right after birth.

Staff with the Palmetto Health-USC School of Medicine in Columbia showed how recently in SimCOACH, which is basically an RV with two hospital rooms and high-tech mannequins that can simulate a variety of birth outcomes . Palmetto Health drives it around the state to teach hospital staff, including about contraception. 

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Credit Michael Tomsic
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The Palmetto Health-USC School of Medicine SimCOACH.

“The IUD is inserted 10 minutes after delivery of the placenta when a patient has had a vaginal delivery,” Dr. Judy Burgis says.

This is what South Carolina Medicaid figured out before any other state: inserting long-acting contraception right after birth and making sure hospitals get paid for it.

B.Z. Giese is director of the South Carolina Birth Outcomes Initiative. She says the reason for the change was simple: about half of women who gave birth on Medicaid weren't showing up to their postpartum visit. 

“That's normally when a contraception would be initiated,” she says, “so we were missing a lot of moms that did not come back, and actually the next time the doctor saw them, they came back pregnant with another child.”

In 2012, South Carolina Medicaid implemented a new way of reimbursing hospitals so they'd take care of contraception before the mom left the first time. It's still completely up to her, and they talk through it in advance.  

18-year-old Ana Walker chose the arm implant.

“I mean right when I heard about it, I went for it because I was just like that's probably going to work best for me,” she says.

Walker got the implant right after giving birth to her daughter. She says she didn't feel a thing, although it did swell up the next day.

“At first, like a couple weeks after I got it, it was a little tender,” she says. “But now it's not tender anymore. I kind of forget it's in there unless I touch my arm and I can feel it.”

The other side effects women can have early on are cramping and irregular bleeding. Back in Gaston County, Kie'Ja Phillips says she spotted for a few months.

“Spotted meaning a light blood flow, but it's like very light,” she says. It was continuous.

“Oh yes, it was every day,” she says with a good-natured laugh. “Once I got into the routine, I just figured always keep panty liners and pads with me just in case.”

She says that resolved itself after four months. Now, it's been almost a year since she had a period. That's normal for a lot of women on this kind of contraception.

Its use can actually save Medicaid money. South Carolina researchers estimate the state comes out ahead when you factor in the lower pregnancy rate that results and the delivery costs you avoid.

B.Z. Giese calls it a win-win.

“It is a cost savings,” she says. “It is a convenience for the mom. The satisfaction rate of the moms that we know leave the hospital is extremely high.”

Now at some hospitals, around 30 percent of moms leave with an IUD or implant. Giese says that number was basically zero just a few years back.