Whether it be on the congressional floor or around grandma’s Thanksgiving dinner table, mention topics like governmental funding of birth control or reproductive rights of women in a room full of conservatives and progressives, and one is likely to receive a reaction somewhere between deafening silence and the throwing of drumsticks.
However, like a therapist might say to a couple who has reached a seemingly insurmountable impasse, isn’t there at least some room for common ground? Aren’t there at least a few areas on which we all can agree? One might argue that, in fact, there are several. Although many may disagree on how to get there, the desired results look strikingly similar for both parties.
Even the most liberal Democrats and the most conservative Republicans could agree on the following desired outcomes: Most people want fewer teen and unwanted pregnancies, and most people want fewer abortions, and although many may disagree on the desired role of the government in reaching these results, most people can agree that it makes sense to try to achieve them using the most fiscally responsible methods.
Funding of family planning services by the government hasn’t always been so controversial and politically charged. Ironically, Richard Nixon, a Republican, is credited with the creation of Title X of the Public Health Service Act. That act provides grant funds to clinics like Planned Parenthood and many other agencies and is a federal grant program dedicated to providing people, particularly those who are low-income or are uninsured, with comprehensive family planning services, including birth control and related preventive health services, at reduced or no cost.
Nixon believed the policy enacted by his Democratic predecessor as part of the “war on poverty” didn’t provide a clear enough funding source for low-income individuals to access birth control, which he believed all who wanted, regardless of their ability to pay, should have access to. When proposed, Title X passed unanimously in the Senate—imagine that happening today—and overwhelmingly in the House.
Title X still exists today and has received much press as of late due to the controversies surrounding Planned Parenthood. Though a misconception among many, those federal funds can’t be used to provide abortions. Critics of Title X argue that while federal funds aren’t used directly for abortions, the use of the grant funding for providing access to birth control and other family planning services may potentially free up other funding sources to be used to fund abortions.
The debate surrounding continuation of Title X funding is certainly far from over. Nonetheless, it’s estimated that Title X funded clinics prevent nearly a million unintended pregnancies every year.
It appears Nixon was on to something in terms of the suspected relationship between poverty, sexual behavior, and birth control access. According to the Guttmacher Institute, women with income below the federal poverty level have more than five times the unintended pregnancy rate of women at 200 percent of the poverty rate and greater. According to a recent report by the Spokane Regional Health District, about 46 percent of all births in Spokane County were to women receiving Medicaid. And among those receiving Medicaid, about 56 percent of pregnancies were unintended.
Additionally, teen pregnancy rates are higher among the poor. According to recently reported data from SRHD, local teens living in poverty—compared to teens with household incomes about 200 percent of the federal poverty level—have earlier first sexual encounters, at 15.5 years old vs. 16.3 years old. Also, they averaged nearly twice as many sexual partners, at 8.3 compared to 4.6, and were less likely to have used condoms the last time they had sex, at 55 percent compared to 39 percent.
Another economic and social burden associated with teen pregnancy, especially among the nation’s poor, is the increased risk of giving birth to a low birth-weight baby. According to the Washington State Department of Health, single-baby, low birth-weight births increase with lower income, with rates being highest among those on welfare receiving Medicaid and Temporary Assistance for Needy Families. Low birth weight among babies born to 15- to 19-year-olds was higher than all but the 40- to 44-year-old age group. Young low-income women are more likely to be uninsured and those living in poverty are less likely to receive health checkups throughout pregnancy.
Maternal behaviors can impact the health of offspring greatly. Though babies can be classified as “unhealthy” for many reasons, the costs associated with the hospital charges for “unhealthy” newborns in Spokane County from 2007-2011 averaged $72,700 per infant, as compared to average charges of $2,100 for healthy newborns, according to a Spokane Regional Health District report. This striking economic difference illustrates the importance of prenatal health, including regular health checkups.
According to HealthyPeople.Gov, “The average annual cost of teen childbearing to U.S. taxpayers is estimated at $9.1 billion, or $1,430 for each teen mother per year.” Those costs include increased health care costs, foster care, incarcerations, and lost tax revenue.
Although there are certainly exceptions, teen parents are more likely to use public health care, more likely to rely on public assistance, and they receive nearly twice as much federal aid for nearly twice as long as those who delay childbearing until their 20s, and they earn an average of about $3,500 less per year. Also, they are less likely to graduate from high school, and are more likely to engage in risk behaviors while pregnant. Research also supports the estimation that for every dollar invested in publicly supported family planning, $3.74 is saved.
So, if people of all political ideologies can agree that the desired outcomes are fewer teen and unwanted pregnancies, fewer abortions, and fiscal responsibility, what will work to accomplish those goals? One way to determine that is to look at what has worked in the U.S. and elsewhere.
Though teen pregnancy rates in the U.S. have steadily declined, we are still a global leader in teen pregnancy, with the highest rate among 20 other high-income countries, according to data from the Guttmacher Institute. In fact, the U.S. teen birth rate is 15 times as high as that of Switzerland. And compared to other developed countries, the U.S. also has some of the highest abortion rates.
According to research, countries that are successful at maintaining low levels of teen pregnancies have several commonalities: long-established sex education programs, free family planning services and low-cost emergency contraception that are widely available, and sexually active teens are expected to use contraceptives.
But the success of this approach isn’t limited to policies and programs abroad. Colorado recently implemented a health program that provided long-lasting contraception, such as IUDs and implants, to low-income teens and other individuals for low or no cost with astounding results.
In just five years, teen birth rates dropped 40 percent. And according to data from the Colorado Department of Public Health and Environment, abortion rates fell by an unparalleled 42 percent.
Despite its success, even winning an award from the National Family Planning and Reproductive Health Association, the program lost conservative support and wasn’t renewed after the initial granting period ended.
Though the debate surrounding reproductive rights and the appropriate role of governmental spending is far from over, the conversation may move ahead more productively by focusing on a “common ground,” outcome-oriented, pragmatic approach, using what is working well—both domestically and abroad—as our guide.
Robin Pickering is an associate professor in the health science department at Whitworth University.
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