They were young women, 14 to 19 years old, from the St. Louis area. They were at high risk of becoming pregnant themselves and, in fact, some already had. But then they heard about a study, in which they could get birth control and counseling for free. And it wasn’t just any birth control. There was an opportunity to get long-acting forms of birth control, like intrauterine devices, that are effective for several years. Nearly three-fourths of the participants chose the long-acting option and the results were dramatic. Nationally, the pregnancy rate for sexually active young women of that age group is 158.5 (per 1,000 people). The rate among participants in the study was just 34.0.

Results from NEJM study

These findings, from a study published Wednesday night in the New England Journal of Medicine, are getting a lot of attention already. But they shouldn't surprise anybody. Birth control reduces pregnancy and long-acting birth control reduces pregnancy by quite a lot, since it doesn’t depend on human beings putting on a condom or taking a pill. That’s why, earlier this week, the American Academy of Pediatrics revised its clinical guidelines, urging members to advise sexually active teens to use IUDs as the preferred form of contraception. My colleague Rebecca Leber wrote about that study, in case you missed it. 

The new paper is also one more reminder of why the Affordable Care Act's contraception mandate, which requires that all insurance policies pay for birth control without co-payments, is so important. Critics have dismissed its significance, because, they point out, condoms and even hormonal birth control bills are frequently available for very little money. But pills don’t work for everybody and neither method is as reliable as an IUD, which is a lot more expensive. Make it available at no cost, and more people will use it.

The right’s objection to the mandate, of course, is a moral one. Some religious conservatives believe that IUDs are forms of “abortifacients,” even though that's at odds with the available science. (Read Jen Gunter’s primer on this, from a few months ago, if you want a fuller treatment of that question.) They'd prefer the devices not be used and they certainly don't want to pay for them indirectly, whether it's through taxes or through insurance premiums.

But here’s something to consider. Birth control doesn’t simply reduce unwanted pregnancies. It also reduces abortions. In the New England Journal study, the mean abortion rate among participants was less than one-fourth the rate for sexually active 14- to 19-year-old women nationally. That’s a pretty massive difference. Some social conservatives don’t consider that argument relevant, because they think women can and should avoid pregnancy through other methods. To the rest of us, however, those numbers sure look like a powerful case for making birth control free.

Jonathan Cohn

News from Wednesday:

EBOLA The Centers for Disease Control released more information about the patient in Texas. The good news is that he's in serious but stable condition, while officials are following the relative people who came into contact with him once he started to show symptoms. The bad news is that doctors had sent him home after his first visit to the hospital, rather than recognizing a possible case of Ebola based on his travel history. Julia Belluz breaks it all down and Jonathan Cohn asks why hospital staff failed to catch Ebola when they first saw the patient. (Vox, QED) 

VOTING RIGHTS: A federal appeals court blocked parts of North Carolina’s 2010 law that imposed broad voting restrictions, such as the elimination of same-day voter registration. This isn’t the end of the story, since government officials are sure to appeal the decision. (Steve Benen, MSNBC) 

SECRET SERVICE: Secret Service director Julia Pierson resigned a day after a blistering round of congressional hearings in response to the breach in White House security. (Zeke Miller, Time)

DEFENSE: Defense Secretary Chuck Hagel called on the military to get its hospitals and clinics into shape, giving underperforming facilities between four and six weeks to outline plans for improvement. His directive comes after a report that found that in one-fifth of military hospitals, patients who need acute care can’t receive help within twenty-four hours. (Sharon LaFraniere and Andrew Lehren, New York Times

Articles worth reading 

Hate read of the day: Camille Paglia’s new column will give you many opportunities to be angry, whether it’s when she dismisses campus rape as “oafish hookup melodramas,” tells women that not being raped is their “personal responsibility,” or seems to attribute the disappearance of Hannah Graham to “bared flesh and sexy clothes.” (

Take note, Federal Reserve: A new paper by Dartmouth professor David Blanchflower reports that unemployment takes a far larger toll on happiness than inflation. (Pedro Nicolaci Da Costa, Wall Street Journal)

Paul Ryan’s Poverty Plan Isn’t So Novel: Beginning in 1997, a program called Building Nebraska Families strived to dig families out of poverty by assigning each a caseworker -- a strategy that is central to Paul Ryan’s plan. Daniel Luzer writes what we can learn from that experiment. (Governing)

Getting Inside the Minds of Conservatives: If you want to change a conservative’s mind about climate change, you might want to ask a psychologist, writes Jesse Singal. Framing the issue in a way that conservatives can stomach might be key to getting their support. (New York)

Happy Birthday, Jimmy: Ed Kilgore celebrates Jimmy Carter’s 90th birthday by reminding us that he’s a much more complicated (and sympathetic) figure than his reputation suggests. (Washington Monthly)

Stories we'll be watching today

We have our eyes on Ebola. 


Rebecca Leber calls out those who pin some of the blame for the Secret Service’s failures on the women at the top and in the ranks. Bryce Covert wonders whether Pierson was a victim of the so-called "Glass Cliff." Meanwhile, Danny Vinik takes to task a misleading tweet from Republicans on the anniversary of Obamacare’s rollout. 

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