#983 2009 · Colorado Department of Public Health and Environment · Public health / family planning
Colorado stopped campaigning against teen sex and just paid for the IUD instead
the problem
Officials were asked to lower teen pregnancy through better sex-ed and abstinence messaging teens already tuned out
background
Colorado's teen birth rate ran above the national average for years, and the standard public-health response was persuasion: sex-education curricula, abstinence campaigns, pamphlets on responsibility, aimed at changing what teenagers believed about risk. The contraception actually on offer for most of that time was the daily pill, which required a choice repeated every single day — a method statistically unlikely to be sustained by teenagers whose lives were unstable, broke, or simply chaotic in the ordinary way teenage life is.
In 2009 the state used a private grant to fund something narrower than another campaign: free intrauterine devices and implants, handed out on request at family-planning clinics with no accompanying persuasion effort at all. These long-acting devices cost several hundred dollars upfront out of pocket and require no daily decision once inserted — the state had identified that many teenagers weren't skipping contraception out of ignorance about pregnancy risk, they were skipping it because the most reliable method was priced and structured out of reach.
what everyone would do
The standard public-health playbook for teen pregnancy was more sex education and stronger abstinence messaging aimed at changing what teenagers believed, on the assumption they weren't using contraception because they didn't understand the risk.
what they saw
Officials saw teenagers weren't skipping contraception from ignorance — the pill required a daily choice unstable lives couldn't sustain, and the reliable option cost hundreds of dollars upfront.
the move
The Colorado Department of Public Health and Environment funneled a private grant through dozens of family-planning clinics statewide to offer IUDs and implants free on request, with no new advertising, curriculum, or messaging campaign attached.
why it works
Long-acting reversible contraceptives work for years without requiring any daily decision, so once the upfront cost barrier was removed, teenagers already inclined to avoid pregnancy no longer needed to exercise willpower every single day to act on that intention. Because the fix targeted the mechanical failure point — cost and daily compliance — rather than attitudes, it delivered results without needing to change a single mind about sex.
the payoff
Teen births fell about 40% and teen abortions dropped 35% from 2009 to 2015, after nearly 30,000 free IUDs and implants were distributed.
where it breaks
It requires a method that's genuinely more effective without ongoing compliance, and a population whose main obstacle really is access rather than belief — if teenagers were rejecting contraception on principle rather than by default, free IUDs would change little. It also needs funding insulated from politics, since a program built on a single grant is vulnerable to being cut once results draw attention from opponents.
what came after
The program produced one of the steepest teen-birth declines of any US state in the period, became a widely cited national model for long-acting contraception access, and survived a 2015 push by state legislators to defund it after its results drew political attention.
references
- [1]Teen Birth Rate In Colorado Down 40 PercentCBS News, 2015cbsnews.com
- [2]Colorado's Family Planning Initiative: Case StudyGuttmacher Institute, 2014guttmacher.org