Just over half of all pregnancies in America are unplanned.

The most effective reversible birth control methods are hormonal implants and intrauterine devices. Less than 1 percent of women using these long-acting contraceptive methods will become pregnant over the course of a year. That’s compared to 9 percent of women using the pill who will get pregnant, and to 18 percent of women whose partners use a condom.

Yet fewer than 12 percent of women who report using birth control have an IUD or hormonal implant.

Researchers from the University of California, San Francisco had an interesting idea about how to increase that rate. Instead of directly educating women about IUDs and implants, they conducted a study to see if educating health care workers about the latest innovations and statistics regarding contraceptives would make a difference.

It did. Unintended pregnancy rates among young women in the study dropped by almost half.

“Providers were much more likely to counsel them on these highly effective methods — IUDs and implants,” says Cynthia Harper, the UCSF professor and family planning researcher who led the study. “Women had demonstrated greater knowledge of these methods. They were more likely to select them.” Details of the findings were published Tuesday in the Lancet.

Harper says a number of new contraceptive methods have come out in the last few years, including the hormonal IUD and the contraceptive implant. The training administered in the study helped clinicians understand technicalities of each method, including their benefits, side effects, and which method might be most appropriate for patients with various needs.

UCSF partnered with 40 Planned Parenthood clinics across 15 states in the study. Workers at half the clinics received the latest training about birth control methods; half did not.

The discussion of IUDs and implants was starkly different in clinics where counselors got the extra training compared to clinics without the training: 71 percent of providers who received training brought up these long-term birth control methods with their patients, versus 39 percent of providers in the control group.

Fifteen-hundred women, ages 18 to 25, were enrolled in the study. They were eligible only if they said they wanted birth control counseling and that they did not want to become pregnant. Those who received counseling from health care workers who had undergone the recent update training on contraceptive methods chose an IUD or implant 28 percent of the time. Only 17 percent of women at the control clinics chose those methods.

Harper says a major barrier for many women in choosing an IUD or implant was cost. IUDs can cost up to $1,000. But they actually are more cost-effective than other methods over time, since their effectiveness lasts for years.

The study was done from 2011-2013, before the Affordable Care Act — and its coverage of birth control — took full effect, and 38 percent of the women studied did not have health insurance.

“I’m hopeful that if the ACA is in place and if women are more likely to be insured for contraceptives, then they’ll be able to afford these methods that have higher upfront costs,” Harper says.

The pregnancy rate dropped from 15 percent to 8 percent over the course of the study. But for reasons the researchers say they can’t explain, that drop only occurred among women who came to the clinic specifically seeking contraception and family planning counseling. There was no change in the pregnancy rate among women who sought birth control after an abortion.

The researchers found that fewer women who wanted to use an IUD or implant after an abortion were actually able to get them. Nearly a quarter of these women were pregnant again within a year.

Only 44 percent of the women who chose IUDs or implants after an abortion actually obtained them, Harper says.

“Now we’re looking at why,” she says. “What were the restrictions?” Harper notes that there are restrictions in the use of public money for birth control in clinics that provide abortions.

This story was produced by State of Health, KQED’s health blog.

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Coinsurance? Premium tax credit? HMO and PPO?

Swimming through the health insurance word soup can be frustrating for anyone. Even though I cover health, I couldn’t define “cost-sharing reduction plan” until I Googled it just now.

And it seems I’m not the only clueless 20-something here. Young adults, who generally have little experience managing their own health care expenses, are finding it especially hard signing up for insurance under the Affordable Care Act, according to a study published Tuesday in the Journal of Adolescent Health.

Researchers at the University of Pennsylvania wanted to see how well young people would fare navigating through HealthCare.gov. So they rounded up about 30 young adults, aged 19 through 30, who were interested in enrolling for insurance. They were all college-educated, and based in Philadelphia.

The researchers sat them in front of computers and observed as they navigated through the online enrollment process. “We asked them to think out loud, so we could really capture their experience,” says Charlene Wong, a pediatrician at the University of Pennsylvania who lead the study.

Wong and her colleagues interviewed the participants right after they completed their enrollment and again a month later.

“Many of them said, ‘You know, I’ve never tried to do this before and it feels a little bit overwhelming because there’s so many different options,’ ” Wong says.

Half of the participants couldn’t define “deductible,” and three quarters couldn’t explain “coinsurance.”

Plus most of them were unaware of subsidies for insurance, and they didn’t have an idea of how much insurance plans generally cost. Most thought that an affordable plan cost less than $100 a month — but the cheapest plan in Philadelphia cost $187 monthly, without tax credits.

The study involved college-educated, tech-savvy young people, Wong points out. “Considering that, we were really surprised at just how much they didn’t know.”

Previous surveys have turned up similar findings. The recent study is small, Wong says. But it takes a more in-depth look at how young people feel about the enrollment process.

The results suggest that the government as well as insurance companies need to do a better job of educating people about the basics, Wong says. Making the process easier for young people is crucial to the success of Obamacare, she points out, since more healthy young Americans need to pay into the insurance system to help cover the costs for older, sicker people.

Of course, getting anyone to retain information about insurance isn’t easy. “It’s dry material,” says Erin Hemlin the health care campaign director at Young Invincibles, an advocacy group that helps educate young people about health policy.

Young Invincibles has tested out some creative ideas to get people interested, like sponsoring concerts. They conduct weekly Twitter chats. And they’ve developed an app that helps guide people through the enrollment process.

If the process is confusing for the young people in this study, Hemlin says, it’s even harder for demographic groups.

“I spent about four months in Texas during the first open enrollment period helping a mostly low-income, Latino population apply for insurance,” she says. “It was so disheartening, because these insurance terms are confusing in English. And they don’t translate well at all.”

Lots of young people she encounters are intimidated by the process so they’re not able to take advantage of the services available to them, Hemlin says. “This lack of health insurance literacy is the biggest barrier right now. I want more young people to realize ‘Oh, wait, I actually can afford this.’ “

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