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Contraception Editorial December 2010

Putting The Pill To Work

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Jessica Arons

This year marked the 50th anniversary of the FDA approval of the birth control pill, and with that milestone came numerous stories about the sexual liberation of women. While the pill deserves much credit for revolutionizing our sexual culture, it merits even more for transforming our workforce.

Providers have long known the individual and public health benefits of family planning, but the medical community may not be fully aware of the economic stability contraception brings to their patients' lives and to society overall.

Last year, women became half of all payroll employees in the United States for the first time in our history.1 They could not have reached this watershed moment without widespread access to modern contraception.

Family planning services not only give couples the ability to begin and grow their families when and if they are ready to do so, they also give women the opportunity to develop their education and careers, participate fully in our economy and build economic security for themselves and their families.

As a highly effective and convenient contraceptive method, the pill gave women the certainty they needed to invest in their careers and education and to delay marriage and childbearing, according to Harvard economists Claudia Goldin and Lawrence Katz.2 Moreover, because the pill made marriage delay acceptable for all women, it indirectly encouraged career investments even for women not using it.

These benefits have made the act of contracepting a nearly universal experience. In a National Center for Health Statistics study, 98% of women who have had sex with a man reported using at least one contraceptive method during their reproductive years, with the pill listed as the leading method.3

Women's need to be able to plan their pregnancies is perhaps more important than ever before. By the end of 2009, men had lost seven out of 10 jobs in the Great Recession.4 Indeed, in the first part of that year, 2 million working wives had an unemployed husband,5 making women's income even more critical to a family's economic well-being.

The evidence is incontrovertible that those who were thinking about starting or increasing their families have put those plans on hold because of the bad economy and are using family planning and abortion services to do so:

  • In a 2009 survey, 44% of women reported that they wanted to reduce or delay their childbearing because of the economy.6
  • Twenty-nine percent of women reported being more careful about contraceptive use because of the economy.6
  • As of May 2009, reproductive health clinics reported a rise of up to 15% in the number of abortions they had performed and the National Network of Abortion Funds, which provides financial assistance to women in need of abortion, said calls to its national hotline had almost quadrupled over the prior year, while local funds surveyed had experienced an increase in calls from 50% to 100%.7, 8, 9

Unfortunately, family planning centers are also hurting in this tough economy and ill equipped to meet today's heightened demand for contraception:

  • Two-thirds of federally funded family planning centers saw an increase in the number of clients seeking contraceptive services a 26% increase on average.10
  • More than 80% of centers reported an increase in clients who were eligible to receive free or subsidized care and an increase in uninsured clients, while almost two-thirds reported a decrease in clients who could pay their full fee.10
  • Almost half of federally funded family planning centers reported staff layoffs or a hiring freeze in 2009, and many centers reported having to reduce services or increase wait times.10
  • Because of problems with affordability, some women have skipped doses, delayed filling or purchasing prescriptions, switched to a cheaper birth control method, stopped using birth control and/or delayed doctor visits as cost-cutting measures.6

It should come as no surprise, then, that 1 million more women needed publicly funded family planning services in 2008 than in 2000, bringing the total need up to 17.4 million women,11 or that there was a 59% increase during the same period among the proportion of abortion patients who are poor.12

Increased investments in family planning services would provide sorely needed relief and assistance to families struggling to get by and make ends meet. It would also reduce the number of unintended pregnancies and abortions, improve women's health, increase their economic productivity and tax contributions, and produce overall savings for the government.

  • Publicly funded family planning services help prevent 1.4 million unintended pregnancies and 600,000 abortions each year.13
  • Without publicly funded family planning services, the abortion rate would be 50% higher.11
  • Every dollar spent on family planning results in a savings of nearly $4 in pregnancy-related and newborn care.11
  • The net public savings from family planning services in averted birth-related Medicaid expenditures in 2008 was $5.1 billion.11

Yet, because of tight finances and age-old political fights around reproductive services, politicians often fail to provide needed increases for family planning budgets and sometimes even target them for cuts. For instance, President Obama's attempt to insert funding for family planning in the 2008 stimulus bill was roundly mocked and he immediately removed the provision.

And this past summer, New Jersey's progressive legislature sparred with its conservative governor over his decision to cut $7.5 million from the state's family planning programs despite the fact that the state would lose the overall cost-saving benefits as well as $9 in federal matching funds for every $1 of state money spent on Medicaid family planning services.14

This failure to recognize the links between contraception and economic security is shortsighted and counterproductive.

Women are the breadwinner or co-breadwinner in 63% of families with children. Nearly half of all families are headed by a dual-earner couple and another one in five is headed by a single working parent. Within married-couple families, the typical working wife now brings home just under half of her family's earnings.15

In order to protect families' economic security and foster economic growth, women must be able to plan wanted pregnancies and prevent unwanted ones. And to do this, they must have access to affordable contraceptive options that best suit their medical needs and particular life circumstances.

The Patient Protection and Affordable Care Act (PPACA), the health reform law that passed in March, included important measures to increase access to family planning services, but that was just the first step. States no longer need to apply for a waiver in order to increase family planning eligibility under their Medicaid programs, but they must be made aware of that fact. And a measure known as the Women's Health Amendment will require certain preventive services to be made available to patients with no cost-sharing, but the implementation process must be monitored to ensure that contraception is included in the definition of preventive care.

Moreover, the PPACA did not address every policy need. We still need better funding of our nation's Title X family planning clinics and increased investments in research on new contraceptive technologies. Providers bring an important perspective to these debates and can now add economic arguments to the public health concerns they have traditionally raised.

What was once seen as a novel new option for women is now an economic necessity. Fifty years after the advent of the pill, it is working for us harder than ever.

Jessica Arons
Women's Health & Rights Program
Center for American Progress
Washington, DC

References

  1. Maria Shriver and the Center for American Progress . The Shriver Report: A Woman's Nation Changes Everything; Oct. 2009. Available at: http://www.americanprogress.org/issues/2009/10/womans_nation.html Last accessed July 21, 2010.
  2. Goldin C, Katz L. The power of the pill: oral contraceptives and women's career and marriage decisions. J Polit Econ. 2002;110:730770.
  3. Mosher WD, Martinez GM, Chandra A, Abma JC, Wilson SJ. National Center for Health Statistics, Centers for Disease Control and Prevention. Use of contraception and use of family planning services in the United States: 19822002. Advance data from Vital and Health Statistics, No. 350, Dec. 10, 2004. Available at: http://www.cdc.gov/nchs/data/ad/ad350.pdf Last accessed July 21, 2010.
  4. Bureau of Labor Statistics Current Establishment Survey, Tables B-1 & B-5. Available at: http://www.bls.gov/news.release/empsit.toc.htm. Last accessed July 21, 2010.
  5. Heather Boushey, Center for American Progress . Women Breadwinners, Men Unemployed; July 20, 2009. Available at: http://www.americanprogress.org/issues/2009/07/breadwin_women.html Last accessed: July 21, 2010.
  6. Guttmacher Institute . A real-time look at the impact of the recession on women's family planning and pregnancy decisions; Sept. 2009. Available at: http://www.guttmacher.org/pubs/RecessionFP.pdf Last accessed July 21, 2010.
  7. Paul AM. Is the recession causing more abortions? Slate; May 15, 2009. Available at: http://www.doublex.com/section/health-science/recession-causing-more-abortions Last accessed July 29, 2010.
  8. Marcotte A. Economics of family planning and ignorance in Texas. RH Reality Check. April 5, 2009. Available at: http://www.rhrealitycheck.org/blog/2009/04/05/economics-of-family-planning-and-ignorance-in-texas Last accessed July 29, 2010.
  9. Marcus P. Abortion rate spikes: some say 10% rise in Colorado may be due to bad economy. Denver Daily News; April 2, 2009. Available at: http://www.thedenverdailynews.com/article.php?aID=3806 Last accessed July 29, 2010.
  10. Guttmacher Institute . A real-time look at the impact of the recession on publicly funded family planning centers; Dec. 2009. Available at: http://www.guttmacher.org/pubs/RecessionFPC.pdf Last accessed July 21, 2010.
  11. Frost JJ, Henshaw SK, Sonfield A. Guttmacher Institute. Contraceptive needs and services: national and state data, 2008 update; May 2010. Available at: http://www.guttmacher.org/pubs/win/contraceptive-needs-2008.pdf Last accessed July 21, 2010.
  12. Jones RK, Finer LB, Singh S. Guttmacher Institute. Characteristics of U.S. abortion patients, 2008; May 2010. Available at: http://www.guttmacher.org/pubs/US-Abortion-Patients.pdf Last accessed July 21, 2010.
  13. National Family Planning & Reproductive Health Association . Family planning facts. Available at: http://www.nfprha.org/main/family_planning.cfm?Category=Main&Section=Main Last accessed July 21, 2010.
  14. Livio SK. N.J. Senate restores $7.5M in budget for family planning clinics serving uninsured women. June 28, 2010. Available at: http://westfield.patch.com/articles/family-planning-advocates-brace-for-impact-of-christie-veto. Last accessed July 21, 2010.
  15. Boushey H. The new breadwinners. In: The Shriver Report. Available at: http://www.awomansnation.com/economy.php Last accessed July 21, 2010.

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Used with permission from Elsevier, Inc.