FACING FACTS ON THE PILL AND THE POOR
ANOTHER bit of socialpolicy “wisdom” turns out to be false: Providing poor women with greater access to birth control doesn’t mean they’ll have fewer unplanned births. But the researchers and advocates touting a new report from the Brookings Institution want to believe it anyway.
The new report confirms significant class gaps in unintended pregnancies and births. “A poor woman is more than five times as likely as an affluent woman to have an unintended birth,” the study found.
And, in part because those births are more likely to be outside of marriage, they’re “associated with higher rates of poverty, less family stability, and worse outcomes for children.”
But, Brookings reports, it’s not that poor women are having more sex. Women in the highestincome bracket are actually the most sexually active. ( That’s no surprise: Married people tend to have more sex, and wealthier people are more likely to be married.) And it’s not that poor women want to get pregnant more than rich ones either. The authors asked women, “How would you feel if you got pregnant?” The answers didn’t vary much with income.
Indeed, the rates of unplanned pregnancies have much more to do with the use and nonuse ( or misuse) of contraception. But why do lowerincome women use contraception differently or not at all?
As with many problems, liberals tend to think the answers are all about “access.”
Richard Reeves, a coauthor of the study, told the Atlantic: “I think that the evidence is . . . that it’s access to effective and safe forms of contraception and abortion” that will bring down unwanted pregnancy rates among the poor.
In fact, it’s not that hard to get contraception; and the barriers have fallen dramatically in recent years.
Condoms are readily available. And, as of two years ago, almost all insurance policies — including the Obama Care exchanges — cover the pill at no out of pocket cost.
And it’s not just the financial barriers that have come down. Women no longer have to get a pelvic exam to get a prescription for the pill, either.
Yet there’s no evidence of an increase in the use of the pill since these changes were enacted.
Proponents will say that there are still barriers— and indeed, there’s not much reason to require a prescription at all.
But if we’re being honest, it’s not economics standing in the way of lowincome women using the pill. It’s the fact that lowincome women are less likely to take any medication on a regular basis and they’re less likely to plan ahead to get a prescription refill.
Which brings the “contraception access” crowd to what’s called “longacting reversible contraception,” or LARCs; the IUD is probably the bestknown form. In fact, the Brookings report particularly pushes these methods, which can last for several years. They’re considered the most effective form of contraception because they don’t require any effort on the part of the user after the initial insertion.
Yes, the upfront costs for these devices can be more than $ 1,000. But here’s the odd part: Rich and poor women are just as likely to use LARCs.
Megan Kavanaugh of the Guttmacher Institute notes, “There was no significant difference in LARC use by income level”: Among all women who use contraception, 8.1 percent of those with incomes below the poverty line use LARCs, as do 8.3 percent of those with incomes at least three times the poverty level.
But if cost isn’t really the motivating factor in the use of birth control, why do rich women use it more than poor ones? “A range of factors,” says Brad-Wilcox of the National Marriage Project.
Wilcox’s research suggests that “coming from intact family” makes you more likely to use contraception regularly. So does “believing that single parenthood is wrong.” How you answer all sorts of questions about “what kind of family you’re coming from and what kind you expect to form,” says -Wilcox, shapes your choices about contraception.
There are even fuzzier factors. Researchers like Paula England at NYU have found that your belief that you can control your own future actually affects how much effort you exert to do so.
As England writes of individuals from lower socioeconomic groups: “A lifetime of adverse events that one has limited power to change is likely to lead to a lower sense of control in the world. This lowered sense of efficacy may be present even in those situations where one could, in fact, change the outcome.”
Just like poverty isn’t solved by giving people money, so the discrepancy in contraceptive use won’t be solved with greater “access.”
AsWilcox says, “There is no magic pill.”