States Promoting Contraception to Reduce Pregnancies and Abortion Rates

Monday, October 15th, 2007

http://www.progressivestates.org/dispatch

Valuing Families

BY Nathan Newman

States Promoting Contraception to Reduce Pregnancies and Abortion Rates

Laws restricting abortions do not reduce their occurrence, contraception does.

In fact, abortion rates have dropped most in countries where contraception use has increased in recent years, according to a new report by the Guttmacher Institute and the World Health Organization studying abortion patterns throughout the world. Abortion rates were actually lower in countries with legal abortion because contraception was also readily available.

With 88% of Americans supporting women's access to contraception, states are increasingly guaranteeing contraception equity in health insurance, funding family planning services, ensuring access to emergency contraception, and rejecting abstinence-only sex education. These steps are reducing unintended pregnancies and abortions and have the potential to save billions in federal and state tax dollars.

Extending Contraception Funding

Access to contraception is still a problem for many women. According to the Guttmacher Institute, almost half of large-group insurance plans fail to provide birth control coverage for women. Twenty-six states ensure contraceptive equity in health insurance by requiring employers to cover contraceptive services as part of employee health plans. 

Courts Uphold Contraception Equity Laws: These laws have come under fire by religious groups, but courts have consistently upheld them. Most recently, the U.S. Supreme Court refused to question the constitutionality of New York State's 2002 Women's Health and Wellness Act which says if employers choose to provide prescription drug coverage as part of employee health plans, they must include contraceptives for women. The New York law does include exemptions for religious organizations whose aim is to spread certain values and who serve and employee only people of the same faith. However, the courts ruled that religiously-affiliated organizations such as hospitals and social service agencies which serve and employ the general public do not qualify for the exemption. As put by the ACLU, "Religiously affiliated organizations that provide nonreligious services to the public must play by public rules." 

Expanding Medicaid-Covered Family Planning Services:  Millions of American women lack access to comprehensive contraceptive services, resulting in three million unintended pregnancies each year - half of all pregnancies in the U.S. The problem is most pronounced for low-income women who do not have access to contraceptive services. In response, several states have expanded access to Medicaid-covered family planning services and, according to the report by the Guttmacher Institute, are seeing significant results.

Arkansas, California, Iowa, Minnesota, New York, and Washington have received federal waivers to expand eligibility for family planning services up to 200% of the poverty line. California's expansion prevented 213,000 unintended pregnancies in 2002, 45,000 of which would have occurred to teenagers. By preventing unintended pregnancies, these programs have saved millions of dollars for both the federal and state governments. 

In fact, the Guttmacher Institute found that expanding Medicaid-covered family planning services to women with incomes up to 250% of the poverty line in all states would provide up to 5 million women with family planning services resulting in the prevention of over 720,000 unintended births. State and federal governments would yield net-savings of up to $1.6 billion by expanding access to Medicaid-covered family planning services, as the prevention programs cost significantly less than the cost of pregnancy-related care.  

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Guaranteeing Women's Access to Emergency Contraception

In August, 2006, the U.S. Food and Drug Administration approved the emergency contraception (EC) medication called Plan B as an over-the-counter option for women 18 and older. Plan B prevents pregnancies when used within 72 hours of unprotected intercourse; it does not terminate pregnancies. Plan B and other emergency contraceptives are important medications for women, particularly women who have been sexually assaulted. 

This ruling came after several states had already made Plan B available to women of any age without a doctor's prescription, including Washington, Maine, Vermont, New Mexico, and Hawaii. Three other forward-thinking states, New York, Illinois and Wisconsin, cover Plan B through Medicaid.

Ensuring Ready Access to Emergency Contraception:  Making Plan B available without a prescription is an important first step.  Many pharmacies still refuse to stock emergency contraception. In response, a number of states have also passed laws to make sure that pharmacies agree to dispense EC contraception. After Massachusetts passed such a law, Wal-Mart changed its policy and agreed to carry EC nationwide. Most recently in Illinois, a group of pharmacists who protested the rules there on religious grounds agreed to a settlement with the state where the pharmacies agreed to make sure that someone would be available in all stores to dispense EC even when a particular pharmacist might object to doing so.

Ensuring that women are informed of the availability of emergency contraception when they most need it is the absolute necessary next step. Several states are taking the lead by requiring the staff of hospital emergency rooms, clinics and other medical professionals to inform women who have been sexually assaulted of the availability of Plan B and to dispense the medication upon request. Pennsylvania is currently debating a bill to do just this, although a vote has been pushed back on HB 288 while lawmakers wait to see if the state Department of Health changes its rules concerning emergency contraception in hospitals. Supporters of House Bill 288, including its sponsor Representative Daylin Leach, say more than half of Pennsylvania's hospitals do not provide emergency contraception in a state where 25,000 women are raped each year. Similar legislation in Wisconsin hit a roadblock when the Assembly's Judiciary and Ethics Committee gutted SB 129 by allowing hospitals and health care professionals the right to refuse to dispense EC if doing so offends their religious beliefs. The dispute has not yet been resolved, despite a 2006 survey which found that only 33% of hospital emergency departments provided on-site EC without exception to rape victims. 

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Abstinency-Only Sex Education - A Failing Grade

Despite the importance of contraception in stopping unwanted pregnancies and abortions, the Religious Right has persuaded lawmakers to waste hundreds of millions of dollars on abstinence-only sex education, which studies show don't work for many kids most in need of sex education information. Comprehensive education programs are critical in reducing teenage pregnancies, the spread of sexually-transmitted-diseases and other goals of sex education programs. In fact, a GAO review of abstinence-only sex-ed programs found that some programs are receiving false, misleading, and potentially dangerous information. One program incorrectly suggested that HIV can pass through condoms because the latex used is porous.

An extensive study of abstinence education programs, commissioned by Congress and conducted by Mathematica Policy Research, confirms the effectiveness of comprehensive sex education and the uselessness of abstinence-only instruction. The study followed 2000 students through elementary or middle and high school and found that the abstinence-only education had no effect on sexual activity, including when students started having sex and use of condoms. The students were just as likely as students not receiving the limited criteria to have sex and to have it at the same age. A striking finding was that students in the abstinence programs were more likely to report that condoms are never effective at preventing STD's.

The strictly nonpartisan National Campaign to Prevent Teen Pregnancy, whose Congressional Advisory Panels look like a "who's who" of Democratic and Republican members of Congress, praised the Mathematica study and called for comprehensive and evidence-based sex education programs.   

Comprehensive sex education that promotes abstinence is fine, but programs must be rounded out to effectively educate youngsters about safe sex, condom use, preventing pregnancy and sexually transmitted diseases.

States Reject Federal Abstinence Funding: Congress has renewed federal funding for abstinence-only programs, but it may have a hard time giving out the funds. New York State has decided to forego $3.5 million annually in federal abstinence-only sex education funding, joining at least ten other states. Citing the failure of such programs, the state health commissioner, Dr. Richard Daines, declared:

"The Bush Administration's Abstinence-Only Program is an example of a failed national health-care policy directive, based on ideology rather than on sound scientific-based evidence that must be the cornerstone of good public health-care policy." 

New York had been spending $2.6 million annually on the abstinence-only programs and is now redirecting those funds to expand comprehensive sexuality education in schools and other community settings.

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Public Supports Women's Access to Family Planning Services

With all the commotion the Far-Religious-Right causes with its fierce opposition to comprehensive sex education, contraception, and family planning services, you might think their rhetoric is reflective of public opinion. However, a recent poll commissioned by the National Family Planning and Reproductive Health Association found that 88% of voters support women's access to contraception and almost as much, 86%, support government family planning programs that provide contraception to low-income women. In fact, 62% of Catholic voters believe improving access to contraception is a more effective way of reducing abortions than more restrictive abortion laws. A 2004 Rand study found similar levels of support among Americans for family planning services, including access to contraceptions.

Teen child-bearing costs U.S. taxpayers at least $9.1 billion in 2004 in public sector costs according to a report published by the National Campaign to Prevent Teen Pregnancy titled, By the Numbers: The Public Costs of Teen Childbearing. Despite a 33% drop in the teen birth rate between 1991 and 2004, the U.S. still has the highest teen pregnancy rate in the industrialized world. 

It is increasingly clear that ensuring access to comprehensive contraceptive services, family planning and comprehensive sex education is the correct approach if you are serious about reducing unintended pregnancies and abortions and saving billions in taxpayer dollars.

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