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A Family Planning Miracle In Colorado: Program Has Teen Births And Abortions Drop by Half, And It’s Heading To Other States

Reprinted with permission from Alternet.
By Valerie Tarico

Most businesses would jump at the opportunity to invest a dollar that saves them $5.85 over the next three years and then keeps on returning savings, all the while improving service to their customers.

That’s what the state of Colorado accomplished by upgrading family planning services between 2009 and 2014, and other jurisdictions have reported even greater returns over the long run. For instance, when Delaware governor Jack Markell saw Colorado’s results, he got excited and kicked off a copycat process of retooling family planning services across his state, where over 60 percent of pregnancies were unintended. Will Oregon and Washington follow suit?

The Colorado Success Story, by the Numbers

Almost half of Colorado women who got pregnant in 2008 said that the pregnancy happened sooner than they wanted or that they hadn’t wanted to get pregnant at all. That was similar to the US average: the rate of unintended pregnancy has been stuck around 50 percent since the 1960s.

Global health experts call unintended pregnancy an epidemic because it’s so common, and the toll on physical health, mental health, and child development so large. A cascade of benefits follows from reducing unsought pregnancies: better health and education for women, more financial security for families, healthier babies, and less strain on social services dedicated to helping families with lower incomes or wealth.

After implementation of the Colorado Family Planning Initiative, teen births and abortions dropped by nearly half.

Public health experts have known this for decades, and evidence showing the protective benefits of intentional parenthood keeps pouring in. The challenge has been how to move the dial. That’s why Colorado’s success caught experts’ attention worldwide.

After implementation of the Colorado Family Planning Initiative, teen births and abortions dropped by nearly half. They fell by nearly 20 percent among women aged 20-24. (Note: Under normal circumstances, over 80 percent of teen pregnancies and 70 percent of pregnancies among single women aged 20-29 are unsought, so this change means women’s realities are better matching their family desires.) Second-order births to teens—teens who gave birth a second or third time—dropped by 58 percent. High-risk births, including preterm births, also diminished.

Poor families benefited the most, because unsought pregnancy is four times as common and unsought birth seven times as common among poor women as among their more prosperous peers. With fewer families facing the dire circumstances triggered by an unexpected pregnancy or unplanned birth, the state saved $66-70 million in public assistance, according to a team of economists at the University of Colorado.

How Colorado Did It: LARCs as the Lynchpin

How did Colorado get such dramatic results? Much of the improvement came from a technology revolution in contraception. Couples switched away from error-prone family planning methods that require action every day or every time they have sex—methods like pills and condoms (and crossed fingers)—to long-acting IUDs and implants that make pregnancy prevention easy. These methods are “get it and forget it.” They eliminate contraceptive challenges such as ponying up for pills year after year, or just remembering to take it daily, and they work 20-50 times better than the pill. When a woman wants to get pregnant, her health care provider can remove the implant or IUD, usually in a five-minute procedure, and normal fertility returns almost immediately.

A study of 9,000 women called the Contraceptive Choice Project and conducted by Washington University in St. Louis demonstrated that long-acting contraceptives dramatically reduce unplanned births and abortions. It also showed that most women prefer these technologies when high cost and other barriers are removed.

In recent years, protective agencies such as the US Centers for Disease Control and Prevention (CDC) and professional groups such as the American Congress of Obstetricians and Gynecologists have declared these methods far more effective and safer than any other method—even for teens and women who are HIV-positive—and far safer than the risks from pregnancy itself. One of these methods, the hormonal IUD, has bonus health benefits, including protection against some cancers.

But for implants and IUDs to become widely available and popular among Colorado women, health agencies had to upgrade their system of care. And that’s what they did.

The Colorado Department of Public Health and Environment, in partnership with an anonymous philanthropic foundation, launched a process of retooling the state’s clinic system to provide state-of-the-art care. Together, they expanded the range of clinicians and facilities that offer contraceptive care, retrained counselors and providers, updated scheduling and billing practices, and launched a public awareness campaign.

Colorado’s Four Foundational Strategies

The Colorado Family Planning Initiative (CFPI) organized around four strategies.

1. Increase access to quality services. CFPI adopted a “no wrong door” approach that brought services to women wherever they might encounter the health care system. Grants to over 100 public health centers, including school-based and rural clinics, supported training for residents, advanced practice nurses, and others, allowing them to improve counseling and to insert (and remove) implants and IUDs. More flexible hours at these health centers improved access for working women. CFPI integrated family planning into primary care, labor and delivery, and post-abortion care.

2. Increase availability of IUDs and implants. CFPI funding made all methods available with no co-pay, a standard that later would be incorporated into Obamacare (now on the chopping block, of course). Implants and IUDs are cheaper in the long run than other forms of birth control, especially if you include the costs associated with an unplanned pregnancy. But until recently, the up-front price of long acting contraceptives has made these methods unavailable to many women.

3. Promote healthy decisions and planning. Better access to better birth control doesn’t do much good if people don’t know about it, so the CFPI worked to normalize conversations about sexual health. Young Latinas, who have a higher-than-average teen pregnancy rate, talked with each other in culturally proficient after-school programs. Social service agencies offered sexuality workshops or provided onsite access to educators. A website, BeforePlay, offered practical information about contraception and sexual health, as well as specific resources available across the state.

4. Improve public policy and practices. When it came to building the policy framework for intentional parenthood, advocacy organizations, public agencies, and legislators all played their part. Data from Denver Health and the University of Colorado led the state to change reimbursement policies so that women could get an IUD or implant of their choice immediately postpartum in hospitals. The state Department of Education is developing new standards, and about a third of Colorado children now receive age-appropriate, science-based sexual health education. Despite objections from some religious conservatives, the Colorado State legislature extended funding for the updated health services.

The key to Colorado’s success lies in the interplay between these four strategies. The result has been a dramatic shift toward intentional parenthood as a new norm, one that empowers young people to live lives of their choosing and helps Colorado families to flourish.

A Model for the Pacific Northwest to Follow

At the start of CFPI, teen and unintended pregnancy in Colorado were significantly worse than in the Pacific Northwest. Now they are nose-to-nose. So, the question is whether Cascadia will deploy some of Colorado’s methods to leap ahead.

Today, despite improvements, Oregon and Washington (and Colorado, too) would still be considered part of the global unintended pregnancy epidemic. In contrast to most of Europe, rates of unsought pregnancy in Washington and Oregon remain close to 50 percent. (Note: More recent state figures put unintended pregnancy in Washington at 37 percent because of a change in the way it is measured. The new figure does not count women who were “unsure” if the pregnancy was intended.)

Groundwork in Oregon

Although Oregon has not yet launched a state-wide initiative akin to Colorado’s, Governor Kate Brown recently affirmed that she and the Oregon Health Authority “place a high priority on improving women’s health and reducing unintended pregnancies by implementing pregnancy intention screenings and providing effective contraceptives to women who do not wish to become pregnant.” Oregon nonprofits, public agencies, and care systems are moving forward on both fronts.

Pregnancy Intentions Screening: The Oregon Foundation for Reproductive Health has developed a technique—now a national model—that makes it easier for primary care, chronic care, and mental health providers to open up conversations about family planning. It is called One Key Questionand the question is: Would you like to get pregnant in the next year? If a woman says yes, this leads to a conversation about preparing for a healthy pregnancy, called “preconception care.” If she says no, she has an opportunity to explore contraceptive options, including top-tier methods that might not be familiar. If she says I’m not sure or I’m ok either way, she receives both.

Contraceptive Access: In January 2016, two new laws went into effect in Oregon expanding access to oral contraceptives. Following a California model, retail pharmacists can now prescribe oral contraceptives or patches. A second law, the first in the nation, requires insurers to cover a 12-month supply of birth control at a single prescription fill.

Aligning Incentives: In 2015, Oregon began to assess how many women served by regional Coordinated Care Organizations receive contraceptives that are considered “more effective” (like pills) or “most effective” (like implants and IUDs). This new measure allows the Oregon Health Authority to link payments to high-quality care.

Setting Standards: The summer of 2017 will see the publication of new quality guidelines for family planning care along with self-assessment tools to be used by care systems. The advisory council creating these guidelines includes representation from the state, local, and private and public health sectors. The council has the goal of providing primary care and family planning clinics with clear, state-of-the-art standards of excellence for contraceptive care.

In 2016, the Population Institute, an international nonprofit that promotes high-quality and voluntary family planning services, graded Oregon in its top tier for reproductive health and rights, second only to California. The grading system covers effectiveness, prevention, affordability, and access. Several factors contributed to Oregon’s positive rating, including a mandate for comprehensive sexual health education in public schools and expansion of family planning coverage through Medicaid.

But part of the reason Oregon rated well is because the United States as a whole rates so badly. Despite promising trends, the US teen pregnancy rate is far higher than any of the other 34 countries in the Organization for Economic Cooperation and Development. Oregon’s rate is 44 per 1,000—below the national average of 52 but still leaving plenty of room for improvement. Across all age groups, the percent of Oregon pregnancies that are unsought—46 percent—also leaves room for improvement. What would it take to establish a norm of intentional parenthood in Oregon?

Next Steps for Oregon

With national health care policy hanging in the balance, Oregon officials may have to scramble to protect residents against funding cuts that could make things worse: a reversal of Medicaid expansion, elimination of the ACA’s contraceptive mandate, cuts to Title 10, or defunding Planned Parenthood. But regardless of how these funding issues play out, there will be opportunities to increase intentional parenthood in Oregon through practice improvements and better public awareness.

Oregon’s One Key Question is a case of “local kid done good,” and by implementing the model statewide, Oregon has the chance to become a national leader in health care integration. This will mean incorporating routine pregnancy-intentions screening into primary care, labor and delivery, chronic care, mental health, and drug treatment programs—and doing so in a way that reduces rather than increases the burden on already harried physicians.

To reap the full benefits, clinical settings across the state will need to retool to be fully capable to support IUDs and implants, so that women can obtain the family planning methods they desire with minimal barriers. Upstream USA and the Bixby Center at the University of California San Francisco offer evidence-based training and consultation to help clinic team members streamline scheduling and billing procedures, improve contraceptive counseling, and get skilled at inserting implants and IUDs.

Lastly, the story must be told. Metrics that document downstream cost savings and improved wellbeing will help build durable public support for these programs and ensure that savings can be invested in other services for Oregon families.

Groundwork in Washington

Public officials in Washington have paid close attention to the models in St. Louis, Colorado, and Delaware, and they are keenly aware that better pregnancy prevention and birth timing can improve lives.

Like Oregon Governor Brown, Washington Governor Jay Inslee’s office has voiced support for upgrading contraceptive care statewide. The governor’s Results WA measures aim to reduce unintended pregnancy by 10 percent in five years, recognizing that achieving this goal will likely require broader and easier access to implants and IUDs. When Planned Parenthood showed that low reimbursement for IUD insertions had become an obstacle for clinics serving poor women, the state changed reimbursement rates.

Local and regional players also have stepped forward to upgrade contraceptive services and facilitate a technology shift to “get it and forget it” contraceptives for those who want them:

  • School-based clinics in Seattle now offer the full-range of birth control options to high school students, and Neighborcare Health, which runs several of these clinics, employs educators who help teens and their parents explore options.
  • The North Sound Accountable Community of Health, which is a front runner in Washington’s Medicaid Transformation process, has launched a series of continuing education trainings to ensure that clinicians in small and rural clinics can provide state-of-the-art care: initiating conversations about pregnancy desires, counseling women effectively about pre-conception health and family planning options, and providing implants and IUDs as desired.
  • King County, the state’s most populous county and home of Seattle, has a miracle of its own: a 55 percent drop in teen pregnancy over seven years. Although some factors are unknown, this didn’t happen by chance. In 2008, King County Public Health secured a small grant to train and provide technical assistance to school-based health centers so they could offer IUDs and implants on-site, with follow-up support from Public Health. Three of these health centers hired half-time sexual health educators, who taught in biology and health classes, and provided contraceptive counseling to teens and their parents. These services currently only reach Seattle teens, but the Best Start for Kids levy will help fund new school-based health centers in other King County cities. Not content to stop there, the County Executive’s office and Public Health Department have convened a team of experts—Title X family planning providers, community health centers, school-based health centers, and University of Washington’s Family Planning Division—with the mission to improve birth timing and reduce health disparities for local families.

Next Steps for Washington

Like Oregon, Washington gets high marks from the Population Institute, but statistics on teen and unintended pregnancy remind us that those high marks are rather like being near the top of the class in a B-grade school. The stats on teen pregnancy (47 out of 1,000) and the percent of pregnancies that are unintended (48 percent) come in slightly worse than Washington’s West Coast neighbors.

Routine screening for pregnancy intentions and a statewide upgrade of contraceptive services, if coupled with a public awareness campaign, could radically change those figures. Proven practices from local front runners like Neighborcare’s school-based clinics and the North Sound clinician training project could be inserted into the Medication Transformation process as it rolls out across the state. The Upstream model for retooling clinic practices could become a “shovel-ready” optional project adopted by Accountable Communities of Health across the state.

Changes like these would mesh well with another Washington State imperative—addressing the epidemic of opioid addiction. Neonatal care units are overflowing with newborns suffering from Neonatal Abstinence Syndrome, a form of withdrawal. But much of this suffering could be prevented if more priority were given to helping addicted women manage their fertility. Eighty-six percent of pregnancies in opioid-addicted women are unintended, suggesting that simply helping them to not get pregnant when they don’t want to could prevent a significant part of this suffering.

Looking to the Future

Within a few decades, a surprise pregnancy may actually be surprising. Men likely will have contraceptive options that rival those of women today, and intimacy won’t feel like a roll of the reproductive dice. Nobody will be forced to take action every day or every time they have sex for decades on end simply to prevent ill-conceived pregnancy. With long-acting methods offering years of protection and with each person in charge of his or her own fertility, children will come into the world by the mutual consent of two people who want to create a child together. Intentional parenthood will become the norm. This is the shape of the future.

Today, better birth control for men has yet to emerge from the laboratory, but that doesn’t mean we are stuck. States like Colorado and Delaware are moving rapidly in the direction of intentional parenthood simply by ensuring that all people have access to the information and tools currently available.

In the next few years, Washington and Oregon thought leaders will face policy and health delivery choices that could either stall improvements now underway or accelerate our own trajectory toward intentional parenthood. With Colorado’s model in front of us, the possibilities are exciting.

This article was made possible by the readers and supporters of AlterNet.

5 Ways ‘Obama Knows Exactly What He’s Doing’

Marco Rubio revealed that his greatest strength is his greatest weakness at Saturday night’s GOP presidential debate in New Hampshire.

When confronted by Chris Christie with the less-than-creative observation that the Senator’s entire campaign revolves around him regurgitating carefully poll-tested “25-second speeches,” Marco Rubio regurgitated the same talking point again and again on Sunday.

The line “Obama knows exactly what he’s doing” is a telltale example of the mini-Trump, hyper-pessimistic belligerence that has defined Rubio’s campaign, which has begun to drown in an undertow of anti-Muslim bigotry. Rubio’s sinister suggestion about the president arises from the fevered swamps of the Republican right , where Dinesh D’Souza gets rich and gets jailed while suggesting that Obama has a secret anti-colonialist plan to ruin America. Newt Gingrich picked up this strain of conspiratorial nonsense in 2012, although since then it has largely dissipated into the wingnut-o-sphere as the nation experienced the best two years of job creation since the late 1990s.

To say “Obama knows exactly what he’s doing” sounds like a scary proposition in the GOP primary, where voters believe he is about to seize their guns and replace them with health insurance. But it’s actually a great election talking point. And if a Democratic candidate is elected in November, it will largely be the result of Barack Obama’s continued popularity.

The president’s approval rating is flirting with 50 percent, giving him the highest favorable rating of any active national political figure by far. When Gallup asked Americans last month whether they’re better off now than eight years ago, 50 percent said, “Yes.” In this ultra-partisan atmosphere that is the closest thing you’re going to get to a consensus.

Marco Rubio, on the other hand, is forced to flee his immigration bill, which is the closest thing to an accomplishment in his Senate career. Whenever he has been faced with a major challenge — in his State of the Union response, when House Republicans refused to even vote on his bill, during Saturday’s debate — he has crumbled.

Still, the press loves his face and GOP donors love his pliability. What plutocrat wouldn’t love a guy who wants to cut the richest Americans’ tax rate to zero?

But Rubio is right about Barack Obama. He clearly knows exactly what he’s doing Because despite inevitable imperfections and failings, especially in Syria and the Veterans Administration, and amidst multifarious disasters that he inherited, Obama’s successes far outshine his limitations. Today, our first African-American president heads towards his home stretch as the first president since Eisenhower to conclude a second term without being personally implicated in scandal.

Here are five examples of Barack Obama knowing exactly what he’s doing.

  1. We have the best economy in the world.
    Republicans have been clear that president is only responsible for jobs created or stock market conditions when the news is bad. America’s economy isn’t great — unless you compare it to the rest of this century and the rest of the world. While our economy still needs tons of improvement to repair the hollowing out of decades of conservative policies, we’ve experienced more than six years of unfettered private sector job growth,  an undisputed record. Best of all, job creation picked up dramatically since taxes went up on the rich and Obamacare went into full effect, disproving conservative economic nostrums yet again.
  2. Our uninsured rate is at a historic low.
    About nine out of ten Americans now have health insurance. Seventeen million Americans gaining coverage doesn’t mean health care in America is perfect. It just means Obama knows what he’s doing. At the very least he has a lot better sense of what he’s doing than the last president, who numbly watched about 8 million Americans lose their insurance.
  3. He’s gotten the rest of the world, including China, to commit to fighting climate change.
    Marco Rubio lives in a state that’s literally sinking into the the horrors of global warming. But the only evidence he needs to assure us that climate change doesn’t exist are checks from his donors. Obama, however, accepts climate science and has done more than all other presidents combined to fight it. His greatest accomplishment on this front — even greater than building a clean energy industry that could save the world via the Stimulus — is taking away the right’s favorite excuse for doing nothing about this looming disaster. He “pushed publicly and privately for China to commit to serious, meaningful reductions in emissions. The result was a landmark bilateral agreement where, for the first time, China agreed to concrete targets for emissions reductions. That, in turn, helped pave the way for the COP21 agreement reached in Paris,” explained Brandon Fureigh of the Truman National Security Project.
  4. Iran has given up 99 percent of its uranium peacefully.
    As we continue to deal with the endless consequences of a war we launched to remove weapons of mass destruction that didn’t actually exist, Obama has led the global effort to prevent Iran from gaining nuclear weapons. Thus far the government in Tehran has complied fully with the agreement and willingly avoided any path that could lead to it gaining such a weapon. “And even if the Iranians were to attempt to produce enough nuclear fuel for a bomb, it will now take them more than a year to do so,” the New York Times editorial board noted. “Before the agreement, that breakout time was two to three months.”
  5. Under Obama, abortions and teen pregnancies have fallen to new lows.
    If you actually care about preventing abortions, you should be a huge fan of Barack Obama. Rubio said that he’d be willing to lose an election to defend his view that abortion should become illegal, even in cases of rape and incest. But the biggest difference between Rubio and Obama is that Obama prevents abortions. The abortion rate today is about half of what it was in 1976. Teen pregnancies are at an all-time low. Here is the greatest irony of the so-called life debate: Abortion is more common where it’s illegal. And if you want to prevent abortions, you do the opposite of what Republicans did in Texas by defunding Planned Parenthood and denying poor women access to health care. Instead, you do what Barack Obama did, with the greatest expansion of contraception coverage in American history via the Affordable Care Act, which may have been the one thing the U.S. government has done that will prevent the most abortions. Of course, Marco Rubio wants to repeal it.

As ‘Abortion Pill’ Turns 15, Debate Rages On

By Marie McCullough, The Philadelphia Inquirer (TNS)

Fifteen years after its approval in the United States, the drug mifepristone is used in nearly a quarter of all abortions, a proportion that has grown steadily even as the national abortion rate has fallen to a historic low.

Federal data also show that mifepristone has accelerated the shift toward early pregnancy terminations — before 10 weeks — when it is safest and has the most public acceptance. Maker Danco Laboratories says more than 2 million women have used its “early option pill.”

The impact, however, has not fit the predictions of either side in the nation’s bitter abortion divide. Mifepristone has not made abortion more common or endangered women’s health, as opponents said it would. It has done little to make abortion more accessible or part of private medical practices, as supporters hoped.

What mifepristone has done is open another front in the political battle over abortion rights. Supporters have worked to enable mifepristone to be prescribed by nonphysicians such as nurse practitioners, and remotely through “telemedicine” technology, while abortion opponents have worked to block such measures.

A few states, notably Texas, have put up high barriers to medication abortion — although legal challenges have removed or delayed most of the measures. For example, these states require doctors to stick to the outdated prescribing regimen proposed by Danco 15 years ago and approved by the U.S. Food and Drug Administration, which limits mifepristone use to no later than seven weeks of pregnancy. The simpler, lower-dose regimen used through nine weeks is recommended by medical groups and the World Health Organization.

“It’s clear that the anti-abortion movement has targeted this technology for restrictions,” said Daniel Grossman, an obstetrician-gynecologist at the University of California, San Francisco, who studies abortion access.

Cheryl Sullenger, senior policy adviser with Operation Rescue, countered with the anti-abortion view: Medication abortion is risky, painful, and involves insufficient medical supervision.

“I think it’s a moneymaking scheme for the abortionist, an opportunity to make a lot of money with a little effort,” she said.

The divide over abortion is as deep as ever. Planned Parenthood, a main provider of medication abortions, is facing Republican congressional challenges to its federal funding. Anti-abortion activists have accused the group of improprieties in donating fetal tissue for medical research, which Planned Parenthood vigorously denies.

Medication abortion actually involves mifepristone, developed in the 1980s by the French company Roussel-Uclaf, plus a second drug, misoprostol.

The mifepristone pill, taken by the patient at the abortion clinic, triggers bleeding by blocking a hormone needed to sustain pregnancy. Up to 48 hours later at home, she takes misoprostol to cause uterine contractions and ensure expulsion of the grape-sized fetus. An ultrasound or blood test two weeks later confirms the abortion.

The process feels like a heavy menstrual period, said Dayle Steinberg, president and chief executive of Planned Parenthood of Southeastern Pennsylvania.

“Most women experience strong cramps, and it takes longer than a surgical abortion,” she said.

The method has been well-studied by researchers, the FDA, and the Centers for Disease Control and Prevention:

Surgery is needed to complete about 5 percent of medication abortions. About 0.2 percent of patients suffer serious complications such as hemorrhage. There have been 14 deaths among women taking the drugs, one since 2011, and none that the FDA could definitely link to the abortion drugs.

Very early termination — through six weeks — has risen from 19 percent of all abortions in 1998, to more than a third now. The increase was greatest in the two years after mifepristone’s approval, suggesting it fueled the trend.

Medication abortion requires minimal medical equipment. A study found 193 of the nation’s abortion facilities (17 percent) offered only this option in 2011. The cost of an abortion through 12 weeks, whether surgical or medication, averages $500.

Exactly how many private physicians provide the abortion pill is unclear, but there are not many.

In 2011, 286 doctors’ offices did some type of abortion, and the total number of procedures was about 14,000 — 1 percent of the nation’s one million abortions, according to the Guttmacher Institute, a research center that supports abortion rights. Danco says 7 percent of its mifepristone sales last year were to private physicians.

“There are many reasons why private doctors may not offer it,” said Beverly Winikoff, a public health physician who worked to get mifepristone licensed and approved. “There are many building leases that prohibit them from performing abortions. Or their partners don’t want them to. Or they fear the political situation. Why should they take on that monster problem? In that sense, I have to say the anti-choice people have kind of won because people have to be so terrified all the time.”

Because abortion access remains a problem — 35 percent of women of childbearing age live in counties with no providers — some activists want to expand telemedicine.

Here’s how it works where it is now permitted: The patient goes to an abortion clinic, where a nurse does the usual work-up, which includes taking a medical history and doing an ultrasound to verify that she is less than 10 weeks pregnant.

Then the patient is connected via videoconference with a doctor in a distant location. After reviewing her records and answering questions, the doctor remotely opens a drawer in front of the patient containing two pills. The patient takes the mifepristone while the doctor and nurse observe, goes home with misoprostol, and returns in two weeks.

This option is now available in only two states — Iowa and Minnesota.

The FDA-approved but outdated abortion-pill regimen has also been the subject of legal fights in at least five states, even though physicians have discretion to prescribe approved drugs in “off-label” ways. Danco, a privately held, one-product company in New York, is “very aware” of this issue, said spokeswoman Abigail Long.

“But it costs money to change the label. We are a small company, so we have to think carefully about it. It would cost a little over $1 million,” she said.

“At the appropriate time, we’ll have a discussion with the FDA about it.”

(c)2015 The Philadelphia Inquirer. Distributed by Tribune Content Agency, LLC.

(Photo from Flickr Commons/World Can’t Wait)

GOP Lawmakers Vote To Increase Unplanned Pregnancy Rate

In early July, Colorado’s success with free long-acting contraceptives was trumpeted by news media. The New York Times called the results “startling” and “stunning.” “Colorado’s free birth control experiment could change the world,” raved SFGate, a news website.

But the news was not so surprising.

After health authorities provided free contraceptives such as intrauterine devices to low-income girls and women over six years, from 2009 to 2013, the out-of-wedlock birth rate among teenagers dropped by 40 percent. The abortion rate among that group declined by 42 percent, said the Times, using figures from Colorado officials. And they reported similar declines among unmarried women younger than 25 and without high-school diplomas — a group likely to be mired in poverty if they started motherhood too soon.

Aren’t those results exactly what you’d expect when young women are given easy access to a reliable and simple-to-use method of birth control? Isn’t that what advocates of women’s reproductive health have been preaching for decades?

Here’s the surprise: The Colorado state legislature has refused to provide $5 million to renew the program, despite its dramatic results. Apparently, its members were cowed by opposition from the usual coalition of right-wing religious groups, such as Colorado Family Action. (The initial funding was provided by an anonymous donor.)

“We believe that offering contraceptives to teens, especially long-acting reversible contraceptives, while it may prevent pregnancy, does not help them understand the risks that come with sexual activities. We should not remove parents from the equation,” Colorado Family Action said in a statement.

Allow me to interpret the statement from CFA: If teenage girls have sex, we want them to get pregnant and suffer for it. This sort of political falderal makes me want to bang my head on my desk. If we want to reduce unintended pregnancies — which leads, of course, to a reduction in abortion rates — we know how to do it: Provide free contraception, preferably long-acting and reversible methods such as IUDs. Yet, the very right-wingers who denounce abortion rights refuse to support widespread contraceptive use.

While the figures from Colorado are dramatic, rates of teen pregnancy have been falling for decades. The teen pregnancy rate in the United States reached its peak in 1990 and has been dropping since then.

According to the Alan Guttmacher Institute, a non-profit that works to advance reproductive health, the decline, at least since 2003, has “little or nothing to do with teens’ delaying sex. … Instead, the decline in teen pregnancy in recent years can be linked to improvements in teens’ contraceptive use.”

In the late 1990s, reproductive experts started to notice that unintended pregnancies had dropped, especially among teenagers, as they began using long-acting birth control methods such as Norplant, which was implanted under the skin, and Depo-Provera, administered through injection. The advantage lies in ease of use: Women don’t have to remember to take a daily pill.

Still, even with the successes of recent decades, the United States has a higher rate of unintended pregnancies — more than half are unplanned — than virtually any other industrialized country. And 40 percent of those end in abortion, according to Guttmacher researchers.

Cultural and religious conservatives insist that teaching teens to abstain from sexual activity is the answer. But the states most likely to insist on that approach — my home state of Alabama is one — have the highest rates of teen pregnancy. Alabama has the 15th-highest rate of teen pregnancy, according to federal statistics. Mississippi, equally conservative and even poorer, has the second.

If you still don’t believe it, take a look at Bristol Palin, daughter of Tea Party darling Sarah Palin. Once a spokesperson for the National Campaign to Prevent Teen and Unplanned Pregnancy, she pledged after her first child not to have sex again until she married. She is now pregnant with her second child as a single mother.

The facts are staring us in the face: We know how to prevent unplanned pregnancies and the poverty they so often drag in their wake. We know how to dramatically reduce the rate of abortions. It’s simply crazy that we refuse to do what works.

Copyright 2015 Cynthia Tucker

Photo: +mara via Flickr