What the media and policy makers aren’t telling us—or don’t know
Recent data show that a budding public health disaster is unfolding right under our eyes, but completely out of sight. An increasing number of American women, mostly poor women, are not able to obtain reproductive health care. Many policy makers consider this a good thing. Yet, the simple fact is that limiting access to reproductive health services has a devastating impact on children’s health. Infants and children are more likely to die when their mothers cannot get the services they need to prevent pregnancy, both in the U.S. and abroad. Moreover, when women have children too closely spaced, when they have more children they can take care of, those children are more likely to suffer or die.
For example:
- In research I conducted, I found that in states where Medicaid does not pay for comprehensive contraceptive services, the infant mortality rate is significantly higher than it is in states where poor women can use their publicly funded Medicaid insurance to purchase any effective method of contraception.
- In Bolivia, one of the poorest countries in South America, researchers found that an infant’s risk of dying during his first two years of life increased by almost 50% if his mother had not used a contraceptive method.
- The Washington Post reported in December 2007 that even a modest expansion of contraceptive programs by the U.S. could prevent nearly three times more child AIDS deaths as antiretroviral programs for pregnant women.
Why are we making health policies that harm children?
A series of unrelated participants and historical events have shaped our policies. Briefly:
- In the mid-1800s American physicians decided that abortion should be made illegal—except when they deemed it necessary. One reason they wanted to outlaw abortion was that middle- and upper-class white women were having abortions, while foreign immigrants were having large families. The doctors were terrified that “the ignorant, the low lived and the alien” would take over “our own population.” Abortion became illegal.
- In the mid-1900s, it was evident that a lot of women were dying from illegal abortions. In the early 1970s, The Southern Baptist Convention advocated for legalizing abortion in order to save women’s lives, many of whom were already mothers. They advocated for abortions not only to save lives but also to avoid damage to women’s emotional, mental, and physical health.
- By the late 1970s the abortion issue became a tool used by politically active Fundamentalists to achieve prominence. They rallied their troops using an anti-abortion agenda, an agenda that originally did not appeal to their constituents. There had been no intervening doctrinal change; it was a matter of political pragmatism.
We must put reproductive health policy back into a public health framework that will allow us to base policy on scientific evidence, rather than political pragmatism. We owe it to our children.
For the first time since 1991, the teen pregnancy rate in the U.S. has increased.
Nobody has a definitive answer to the question of why, but the widely respected Guttmacher Institute has found that the major reason for the decrease in teen pregnancy was that more teens were using effective, prescription methods of contraception. Now that policies have made it more difficult for teens and women to access contraception, it makes sense that failure to obtain contraception may lead to rising teen pregnancy rates. Data analysis I did shows that teen pregnancy rates are highest in states with the most restrictive policies on contraception. The rates of unwanted pregnancy and abortion among poor adult women have also risen.
Julia’s Story: Julia is one of my teenage patients. About a year ago she took her prescription for birth control pills and her Medicaid insurance card to the pharmacy. The pharmacist told her he could not give her the pills. Why? Because, unbeknownst to Julia, she had been randomly assigned to a Catholic Medicaid HMO which does not pay for contraception. Nobody told Julia what she needed to do to get another company to pay for her pills. The result? She was without contraception. A teenage pregnancy waiting to happen.
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