HEALTH CARE/Joan Retsinas

Driving Women Up the Ladder

Mission Impossible for impoverished teenagers: scaling the Herculean ladder out of poverty. Statistically, they are mired in what we, a supposedly classless society, now recognize as a bottom class, rungs below the middle class: the poor.

The poor among us need: education, job-training, subsidies for housing, health, income, and a higher minimum wage – all Democratic solutions, promised in this campaign-without-end.

Republicans take a jobs-based tack. They maintain that the poor need tax cuts – not for themselves, for they pay no income taxes. (They do pay regressive sales taxes.) Businesses need the cuts. Optimistically, with lower taxes, businesses will expand and, ultimately, hire all those Americans long unemployed – a Republican solution, offered ad nauseum. Some Republicans would throw into the “solutions” pot the deportation of undocumented, but employed, immigrants, expecting the nation’s poor to flock to fill those jobs.

Admittedly, the poor need all of the above. And all of the above are not sufficient. We’ve had a medley of programs, including a “War” on poverty, yet the poor remain resolutely poor. And all but diehard conservatives question the oft-cited rising-tide-lifts-all-boats economic theory. No convincing data support that optimism. Ditto for the calls for widespread deportation of undocumented workers.

Maybe we should throw free effective contraception into the “solutions” pot. Maybe poor young women need better contraception. Maybe LARC holds a key to bolstering women out of poverty.

LARC is not another government program. Instead, it stands for Long-Acting Reversible Contraception, specifically, an intraueterine device (IUD) or implant that a clinician inserts. Our politicians promise “magic bullet” solutions. LARC is not one. LARC will not give women education, jobs, and income. LARC will not spur businesses to hire more uneducated, unskilled workers. But it will keep teenagers from having babies that the women themselves admit they didn’t intend. And delaying child-bearing is crucial to climbing that economic ladder.

A Brookings Report, “Improving Children’s Life Chances through Better Family Planning,” by Isabel V. Sawhill and Joanna Venator, puts a spotlight on LARC as an economic tool. Half of all women, once pregnant, admit they didn’t intend to be pregnant. For unmarried women younger than 30, the percentage climbs to 70%. Crucially, poorer women are far more likely to admit the pregnancy was “unintended” than higher-income women. Consider the numbers: 183 per 1000 poor women considered their pregnancy “unintended,” versus 40 per 1000 high-income women. Sixty percent of “unintended” births will result in a birth. (The other 40% of pregnancies end in miscarriage or abortion.)

One long-standing myth is that these women didn’t use contraception. The truth is more complex. Many women with “unintended” pregnancies used contraception, but relied on the pill, on condoms, on hormonal patches. Those methods work, provided women use them all the time, on schedule. But the onus is on the woman to waylay pregnancy. Other women did not want a child, but were deterred by myths about contraception, myths about pregnancy, or the costs. LARC costs about $1,000.

But LARC is truly effective, for it shifts the onus: the woman is protected against pregnancy. To become pregnant, she must have the IUD removed.

What happens if women know about all the methods? And what happens if women have the choice of an intrauterine device, at no cost? In St. Louis, the CHOICE program provided free contraception and counseling. Campaigns in Colorado, Iowa, and at the University of California San Francisco spread the news of LARC. The not-surprising results: IUDs were far less likely to fail.

Teenage single mothers rarely scale the Herculean ladder out of poverty; their children generally face just as grim a future. Delaying childbirth, moreover, is not a sure-fire panacea. But the research is strong: children from “unintended,” “unwanted” pregnancies tend to fare worse than children who are intended, wanted. If a teenager delays child-bearing until she is older, with more schooling, with a higher income, she may well make that climb. Children are a blessing, but not an economic one for single uneducated teenage moms.

Unfortunately, the call for more clinics offering women free long-acting reversible contraception does not spark fervor. The fervor focuses on the abortion wars, as proponents and opponents battle it out, rhetorically, and in state legislatures, parrying over bills that erode this legal right.

Yet long-acting reversible contraception belongs in both the public health and the economic arsenal of strategies to boost the poor. LARC can help teenagers defer childbearing, giving them more time for school, more time to mature. At the same time, LARC can reduce the incidence of abortions. Republicans and Democrats should step outside the abortion arena to support LARC.

But that is hard in the realpolitik of this campaign season, when Republican candidates are railing against Planned Parenthood, vowing to shutter the clinics that might deliver this handhold. If they succeed, the victory will be sadly Pyrrhic.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, April 15, 2016

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