Teens face birth control barriers at school-based health center

By Samantha Swindler | The Oregonian/OregonLive   March 30, 2016

school health care

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A tour of the school-based health center on Beaverton High’s campus. Like the clinic at Century High School, Beaverton’s school-based health center is operated by Virginia Garcia Memorial Health Center. (OS-)

 

 

In Oregon, you can make your own primary care medical decisions at age 15, without parental consent or notification.

Yet in school districts across the state, teens are likely to need a note from Mom just to get an aspirin from the school nurse.

These two very different views of healthcare are now clashing in Hillsboro, where the nonprofit Virginia Garcia Memorial Health Center wants to offer birth control services on the Century High School campus.

The Hillsboro School Board is in the uncomfortable position of figuring out what role it has – if any – in teens’ options around safe sex.

Century’s school-based health center opened in 2013 to provide primary care and mental health services for interested students or nearby residents 20 years old or younger. The school district received a federal grant to construct the building; Virginia Garcia staffs and manages the clinic. No one is denied services if they can’t pay.

Most visits are for mental health counseling; vaccines; well-child checks; ear, nose or throat issues; and sports physicals.

The district benefits because on-campus clinics cut down on absenteeism, and healthy students are better learners.

Students – particularly those who don’t have or have limited insurance coverage – benefit from convenient access to healthcare.

Parents benefit because they don’t have to miss work to take a child to a doctor’s appointment.

Win, win, win, right?

Oregon has 76 school-based health centers in 24 counties across the state. Virginia Garcia operates six, including five in Washington County.

When the Century clinic opened three years ago, the school district had an informal understanding with Virginia Garcia – no offering birth control. But Virginia Garcia spokesperson Olivia MacKenzie said the policy isn’t written anywhere in the clinic agreement between the district and the nonprofit, which puts physicians in a bind when students ask about contraceptives.

Olivia said Virginia Garcia would like to offer those services, but only if “it’s a priority to the district and families, as well.”

The clinic does offer reproductive health services, which includes things like pap smears, screening for sexually transmitted diseases and pregnancy tests, but not “family planning services” – aka, birth control.

So, a patient at the school-based health center can find out after sex if she’s gotten pregnant, but she can’t get contraceptives to prevent it in the first place.

Within Hillsboro’s two zip codes, the Oregon Health Authority reports there were 238 teen pregnancies between 2012 and 2014. Century High even has an on-campus daycare program for students who have had a child; it’s not that far from the clinic where they can’t get preventative reproductive services.

Century’s health center does provide referrals to other clinics that can provide contraceptive prescriptions, but it’s not always easy for teens to travel for help off-campus. Last year, Washington County closed its health department clinics and contracted out for care services. The clinic in Hillsboro is now only open two days a week, and without the teen program that specifically addressed contraceptive questions.

That’s part of why Virginia Garcia is now asking to be able to prescribe birth control.

Earlier this month, the Hillsboro School Board spent an hour listening to public comment about whether birth control prescriptions should be offered at the Century clinic. Eleven residents testified in favor of offering services; six testified against. At least one woman questioned why the district was involved in student healthcare at all.

That’s something school board member Erik Seligman questions, too.

“I feel bad that there’s a problem with community access to health care in Hillsboro, but the schools aren’t chartered to address that,” he said. “The intermingling with school and health care, that’s what really concerns me … but it’s a community concern, not a school concern.”

Whether a school district should help students get access to primary healthcare is an entirely different question than whether a school district should determine what kinds of primary healthcare students have access to.

Let’s start with the first question: Is is appropriate for schools to have clinics at all?

Yes. It definitely is.

No one is in a better position to help students access healthcare than the school district where they spend most of their time. That’s why this model works so well, especially for the most vulnerable populations. About a quarter of the Century clinic’s patients come from families at or below the federal poverty line; 66-percent are covered by either Medicaid or the Oregon Health Plan.

In a state survey last year, nearly half of school-based health center patients said they either wouldn’t have another place to go, or weren’t sure where they could go, for medical services outside the school clinic.

In many ways, the district is already in the healthcare business. It addresses nutrition by choosing school lunches. It address mental health with bullying and suicide outreach programs. If it’s going to provide a daycare for students with children, it shouldn’t stand in the way of services to prevent teen pregnancy in the first place.

Which brings us to the second question, about contraceptives. School boards shouldn’t be a roadblock to teens’ access to preventative care.

The district can best serve the clinic and its patients by simply being a landlord. Birth control – not abortion, mind you – is considered a function of a primary care facility. How, what, and why it is prescribed should not be influenced by a school board.

In an ideal world, you know who would be making decisions about teens’ bodies? Teens. With the guidance of a physician, and the support of a parent.

Sadly, that doesn’t always happen. Not all students have easy access to medical care. Not all students have good relationships with their parents, or have parents who know how to help them.

Those are the students who need full primary care services from the school-based health center most of all. And the last thing they need is a lecture from the school board about what kind of health care services they should be receiving.

— Samantha Swindler

@editorswindler / 503-294-4031

 

California Crisis Pregnancy Centers Must Now Inform Women of Their Options

pregnancy center

Early last year, NARAL’s Pro-Choice California released the results of a year-long undercover investigation of California’s Crisis Pregnancy Centers. These centers advertise offers of help to women with unplanned pregnancies. Their inconspicuous billboards in Los Angeles showed a young woman with a one-word question and a simple answer, “Pregnant? We can help,” followed by a phone number. There is no information about what these women will face once they go through their doors: Misinformation and pressure that they must continue with the pregnancy.

Due in large part to NARAL’s investigation, a new California law went into effect on January 1 that forces these centers to provide reproductive facts and information women can use.

The Reproductive Freedom, Accountability, Comprehensive Care, and Transparency Act (FACT) requires “a licensed covered facility, as defined, to disseminate a notice to all clients, as specified, stating, among other things, that California has public programs that provide immediate free or low-cost access to comprehensive family planning services, prenatal care, and abortion, for eligible women. The bill would also require an unlicensed covered facility, “to disseminate a notice to all clients, as specified, stating, among other things, that the facility is not licensed as a medical facility by the State of California.”

In short, any licensed facility that offers family planning or pregnancy services must inform clients of all their options, in multiple languages, at the time of arrival either through a conspicuous public notice or distributed directly to the client. Furthermore, the law states that if they do not offer any medical services (looking at you, CPCs), they must prominently display a notice that they are not a medical facility nor are there any licensed medical professionals on staff. The brilliance of the California FACT Act is that it applies to all such facilities, avoiding legal pitfalls that have prevented previous attempts to curtail CPCs’ misleading practices.

With approximately 4,000 CPCs across the country, they outnumber abortion clinics 3 to 1. In many states, they are supported by the governor and legislature and have been able to force legitimate medical providers to provide medically inaccurate information and perform unnecessary procedures. The state of California, which was the first to legalize abortion in the country, has been unsuccessful in stopping these centers from denying women their rights. The anti-choice clinics have claimed any attempts to force them to not give misinformation violates their First Amendment right to free speech.

The California FACT Act, which was authored by California Attorney General Kamala Harris, is narrowly focused and, most importantly, applies to all healthcare facilities. The law notes that all California women should have access to reproductive health care, including abortion. Furthermore, because pregnancy decisions are time-sensitive, women need accurate information quickly. A common tactic of CPCs is to lie to clients and force a delay, or even say they are too far along to terminate their pregnancy. By the time women discover the truth, they often are too far along to pursue affordable options.

Still, CPCs don’t even want women to know their options. Much like religious organizations claim that informing employees they can get birth control coverage through alternate insurance plans for free as required by the Affordable Care Act, CPCs are now claiming the new law violates their religious rights. They feel that disclosing to women when they walk in the door that the centers don’t provide the services clients are seeking and that they have other low or no cost options to get them, violates religious freedom. This is why as soon as Governor Jerry Brown signed the legislation into law in October, lawyers for several CPCs filed suit.

While the merits of the case have still not been discussed in court, the CPCs have already lost two preliminary rulings. A judge refused to grant an injunction on the law until the case winds its way through the courts, allowing for the law to go into effect as scheduled this month. The judge also noted that the bar for a free speech argument is much lower for a commercial enterprise such as theirs. Even though they are non-profit, they provide “valuable pregnancy-related goods” and, therefore, are not irreparably harmed by the law.

According to RH Reality Check, similar public information laws about reproductive health have had mixed results when challenged. Yet, a San Francisco ordinance that required CPCs “to tell the truth in advertisements” survived a challenge in federal court last year. Attorney General Kamala Harris has said that the state will vigorously defend the law as the case continues in court and feels confident it will withstand the legal challenge.

Photo Credit: Thinkstock

Read more: http://www.care2.com/causes/california-crisis-pregnancy-centers-must-now-inform-women-of-their-options.html#ixzz3xEgh6p3z

 

Supreme Court set to make pivotal rulings on abortion, affirmative action and immigration

December 29, 2015
The Los Angeles Times

As the nation heads into a presidential election year, the Supreme Court is set to decide half a dozen politically charged cases in 2016 on such topics as abortion, affirmative action, contraceptives and immigration.

In several cases, conservatives are hoping the high court will shift current law to the right or block President Obama’s policies, while liberals are defending the status quo.

But with justices closely split along ideological lines, the cases are likely to yield a series of 5-4 decisions and make clear the next president’s appointees could tip the law sharply to the right or left.

Here are the major cases scheduled for decision by June.

Abortion: The court will decide whether Texas can enforce two regulations that would force about three-fourths of the state’s abortion clinics to close.

One measure requires clinics to use only doctors with admitting privileges at a nearby hospital. A second requires abortion facilities to match the standards of an outpatient surgical center.

The first question before the court is whether these regulations will protect the health of women — as state lawmakers assert — or hinder reproductive care “by drastically reducing access to safe and legal abortion” in large parts of Texas, as abortion rights advocates contend.

In the background is a larger question about the nature of abortion rights set out in the Roe vs. Wade decision: Is it a constitutional right that trumps state regulations that may interfere with a woman’s choice, or is it a limited right subject to restriction? The case of Whole Woman’s Health vs. Cole will be argued March 2.

Affirmative action: The court’s conservatives think the Constitution and the civil rights laws forbid schools and colleges from admitting students based on their race, and they would like to strike down affirmative action policies that favor some applicants over others based on their race or ethnicity.

Justice Anthony M. Kennedy, seen as the swing vote, has agreed with conservatives in the past and condemned admissions policies that set “numerical goals indistinguishable from quotas.” But he has also refused to end all affirmative action.

In December, the court heard Fisher vs. University of Texas for a second time to decide whether the school’s admissions policy is constitutional.

Union fees: The court could deal a severe blow to the union movement in a case from California. The justices will hear a free-speech challenge to pro-union laws in more than 20 states that require all public employees to pay a “fair share fee” to their union, even if they are opposed to the union and refuse to join.

Rebecca Friedrichs, an Orange County teacher, sued the California Teachers Assn., saying the forced fees violate her rights under the 1st Amendment. Friedrichs vs. CTA will be argued Jan. 11.

Voting districts: Voters elect representatives to Congress, state legislatures and city councils in districts that are drawn to represent equal numbers of people. But that could change.

The court is considering an appeal from Texas that argues these districts should represent roughly equal numbers of eligible voters, rather than using the current system, which counts all people, including children, immigrants and prisoners.

The appeal relies on the “one person, one vote” rule established in the 1960s. If the justices agree in the case of Evenwel vs. Abbott, the ruling could have a major effect in states such as California, Florida, New York and Illinois because they have large populations of immigrants.

Contraceptives: The court will decide its fourth case on Obama’s healthcare law, and the second involving a religious freedom challenge to a regulation that requires employers to include no-cost coverage for contraceptives in their health insurance policies.

Churches are exempt from this requirement. Under a separate accommodation, religious nonprofits, such as Catholic Charities or the University of Notre Dame, need not provide nor pay for the coverage, but they must notify the government of their religious objection.

In a series of lawsuits, Catholic bishops and Protestant colleges contend the accommodation did not go far enough. The Catholic leaders said they would be “complicit in sin” if they made the required notification because doing so would “trigger” a process for providing the disputed contraceptives.

Obama’s lawyers say the mere signing of a notification does not “substantially burden a person’s exercise of religion,” quoting the 1993 federal law on religious liberty. Nearly all of the U.S. appeals courts rejected the challenges, but the high court agreed to hear seven appeals from religious entities. They were consolidated into a single case, Zubik vs. Burwell, scheduled to be heard in late March.

Immigration: The fate of Obama’s broadest effort to shield immigrants from deportation rests with the justices. His lawyers are appealing rulings by a judge in Texas and the U.S. 5th Circuit Court of Appeals in New Orleans that blocked Obama’s latest immigration action from taking effect.

It would have shielded as many as 5 million immigrants who have lived in the country illegally for at least five years and have a child who is a citizen or legal resident. Those who come forward and qualify would be offered work permits.

If the justices agree in the next few weeks to hear the case of United States vs. Texas, it will be a major test of the president’s power to change immigration policy without seeking approval from Congress. But if the justices turn down the appeal, Obama’s action will probably remain on hold until he leaves office.

Twitter: @DavidGSavage

ACLU sues Dignity Health over Redding Hospital’s Refusal to Perform Contraception Surgery

The Sacramento Bee, DECEMBER 29, 2015 5:27 PM

No More Than a Religious Mask for Bigotry

Statement of NOW President Terry O’Neill

11.06.2015
The Supreme Court has agreed to review seven consolidated cases testing whether religious extremists will be able to practice a particularly ugly form of gender bigotry — blocking women’s access to contraception.

In all seven cases, religious schools, hospitals, and other nonprofits are challenging the Obama administration’s accommodation which requires insurance companies to cover contraception in all health plans, including employer-based plans, while allowing extremist religious employers not to pay for it or even administer it. (The insurance companies would pick up the costs and the administrative tasks.) That’s not good enough for these organizations, who insist that they must be given the right to force their religious beliefs about birth control on all of their employees, believers and nonbelievers alike, and keep contraception out of their plans entirely.

There are some beliefs, no matter how sincerely held, that should simply not be respected by any government. A “belief” that targets and endangers a specific demographic group that has historically experienced discrimination is no more than a religious mask for bigotry. Just as we reject the use of religion to justify racial and homophobic bigotry, the same is true for gender bigotry as well.

Blocking women’s access to contraception is gender bigotry, plain and simple. Unintended pregnancy is deadly. It is closely correlated with infant mortality, maternal mortality and increased risk of domestic violence homicide. The U.S. has the highest infant and maternal mortality rates in the developed world — a higher rate than in many developing countries. Each year in the U.S., more than half of all pregnancies are unintended. The Affordable Care Act’s contraception coverage mandate holds the promise of saving women’s and infants’ lives by reducing the incidence of unintended pregnancy. Yet the Supreme Court is being told it must gut that life-saving mandate.

Notwithstanding extremist religious preaching, 98 percent of sexually active Catholic women, like 99 percent of sexually active women overall and 97 percent of evangelical Protestant women, have used contraception at some point. Now the religious extremists are turning to the U.S. courts to accomplish what they could not do legitimately from their pulpits. But the last I checked, we were still a secular country, and the Supreme Court does not exist to do their dirty work for them.

NOW is already mobilizing our grassroots activists across the country to raise awareness about this latest threat to women’s health care. Every woman has the right to make her own reproductive health decisions. Not her boss, not some bishop, not some politician. And not some Supreme Court Justice.

Contact

Tamara Stein , planner@now.org , (951) 547-1241

Colorado’s Effort Against Teenage Pregnancies Is a Startling Success

By SABRINA TAVERNISEJULY 5, 2015

Hope Martinez, a 20-year-old nursing home receptionist in Walsenburg, Colo., recently had a small rod implanted under the skin of her upper arm to prevent pregnancy for three years. Credit Benjamin Rasmussen for The New York Times

Hope Martinez, a 20-year-old nursing home receptionist in Walsenburg, Colo., recently had a small rod implanted under the skin of her upper arm to prevent pregnancy for three years. Credit Benjamin Rasmussen for The New York Times

WALSENBURG, Colo. — Over the past six years, Colorado has conducted one of the largest experiments with long-acting birth control. If teenagers and poor women were offered free intrauterine devices and implants that prevent pregnancy for years, state officials asked, would those women choose them?

They did in a big way, and the results were startling. The birthrate among teenagers across the state plunged by 40 percent from 2009 to 2013, while their rate of abortions fell by 42 percent, according to the Colorado Department of Public Health and Environment. There was a similar decline in births for another group particularly vulnerable to unplanned pregnancies: unmarried women under 25 who have not finished high school.

“Our demographer came into my office with a chart and said, ‘Greta, look at this, we’ve never seen this before,’ ” said Greta Klingler, the family planning supervisor for the public health department. “The numbers were plummeting.”

The changes were particularly pronounced in the poorest areas of the state, places like Walsenburg, a small city in southern Colorado where jobs are scarce and many young women have unplanned pregnancies. Taking advantage of the free program, Hope Martinez, a 20-year-old nursing home receptionist here, recently had a small rod implanted under the skin of her upper arm to prevent pregnancy for three years. She has big plans — to marry, to move farther west and to become a dental hygienist.

An intrauterine device, which prevents pregnancy for several years, at a clinic in Walsenburg, Colo. A state program that provides long-acting birth control has contributed to a sharp decline in birth and abortion rates among teenagers. Credit Benjamin Rasmussen for The New York Times
“I don’t want any babies for a while,” she said.

More young women are making that choice. In 2009, half of all first births to women in the poorest areas of the state happened before they turned 21. By 2014, half of first births did not occur until the women had turned 24, a difference that advocates say gives young women time to finish their educations and to gain a foothold in an increasingly competitive job market.

“If we want to reduce poverty, one of the simplest, fastest and cheapest things we could do would be to make sure that as few people as possible become parents before they actually want to,” said Isabel Sawhill, an economist at the Brookings Institution. She argues in her 2014 book, “Generation Unbound: Drifting Into Sex and Parenthood Without Marriage,” that single parenthood is a principal driver of inequality and long-acting birth control is a powerful tool to prevent it.

Teenage births have been declining nationally, but experts say the timing and magnitude of the reductions in Colorado are a strong indication that the state’s program was a major driver. About one-fifth of women ages 18 to 44 in Colorado now use a long-acting method, a substantial increase driven largely by teenagers and poor women.

The surge in Colorado has far outpaced the growing use of such methods nationwide. About 7 percent of American women ages 15 to 44 used long-acting birth control from 2011 to 2013, the most recent period studied, up from 1.5 percent in 2002. The figures include all women, even those who were pregnant or sterilized. The share of long-acting contraception users among just women using birth control is likely to be higher.

But the experiment in Colorado is entering an uncertain new phase that will test a central promise of the Affordable Care Act: free contraception.

The private grant that funds the state program has started to run out, and while many young women are expected to be covered under the health care law, some plans have required payment or offered only certain methods, problems the Obama administration is trying to correct. What is more, only new plans must provide free contraception, so women on plans that predate the law may not qualify. (In 2014, about a quarter of people covered through their employers were on grandfathered plans, according to the Kaiser Family Foundation.)

Advocates also worry that teenagers — who can get the devices at clinics confidentially — may be less likely to get the devices through their parents’ insurance. Long-acting devices can cost between $800 and $900.

“There’s no lifeboat with the Affordable Care Act,” said Liz Romer, a nurse practitioner who runs the Adolescent Family Planning Clinic at Children’s Hospital Colorado, which went from giving out 30 long-acting devices a year in 2009 to more than 2,000 in 2013.

The state failed to get additional funding through the General Assembly this spring, a shortfall Ms. Klingler said would slow, but not stop, its progress.

Debbie Channel, the manager of a women’s clinic in Walsenburg, said of the small Colorado city, “If you get pregnant here, you are stuck.” Credit Benjamin Rasmussen for The New York Times
Women’s health advocates contend that long-acting birth control is giving American women more say over when — and with whom — they have children. About half of the 6.6 million pregnancies a year in the United States are unintended. Teenage births may be down, but unplanned births have simply moved up the age scale, Ms. Sawhill said, and having a baby before finishing college can be just as risky to a woman’s future as having one while in high school.

Colorado’s program, funded by a private grant from the Susan Thompson Buffett Foundation, named for the billionaire investor Warren Buffett’s late wife, was the real-world version of a research study in St. Louis (also paid for by the foundation, which does not publicly acknowledge its role). The study came to the same conclusion: Women overwhelmingly chose the long-acting methods, and pregnancy and abortion rates plunged.

“The difference in effectiveness is profound,” said Dr. Jeffrey Peipert, a professor of obstetrics and gynecology at Washington University in St. Louis, who ran the study. The failure rate for the pill was about 5 percent, compared with less than 1 percent for implants and IUDs.

The methods are effective because, unlike the pill, a diaphragm or condoms, they do not require a woman to take action to work. And while an early incarnation, the Dalkon Shield introduced in the 1970s, had disastrous results, the modern devices are safe and have been increasingly promoted by doctors. Last fall, the American Academy of Pediatrics published guidelines that for the first time singled them out as a “first-line” birth control option for adolescents, citing their “efficacy, safety and ease of use.”

“There’s been a big shift in the mind-set,” said Dr. Laura MacIsaac, director of family planning for Mount Sinai Beth Israel in New York. “The demand is coming from everywhere now.”

In Walsenburg, studded with boarded-up buildings and weedy parking lots, advocates have used the Buffett grant to help women get more control. Poverty erodes health here: Last year, rural Huerfano County, which includes Walsenburg, was ranked second to last for life expectancy in the state.

“If you get pregnant here, you are stuck,” said Debbie Channel, the manager of the Spanish Peaks Regional Health Center’s Outreach and Women’s Clinic, where Ms. Martinez, the nursing home receptionist, got her implant. “We’re trying to keep them safe and baby free.”

Proponents say the program is working. The state health department estimated that every dollar spent on the long-acting birth control initiative saved $5.85 for the state’s Medicaid program, which covers more than three-quarters of teenage pregnancies and births. Enrollment in the federal nutrition program for women with young children declined by nearly a quarter between 2010 and 2013.

Ms. Martinez had a preview of life as a mother while babysitting for two young stepbrothers. She found it exhausting. She watched girls in her high school get trapped when they became mothers too soon, and she knew she did not want that for herself.

“They say they want to leave Walsenburg, but they never do,” she said. “It’s a circle. It keeps happening and happening.”

Ms. Martinez plans to leave town this summer after she marries her fiancé, now in California in military training. She is excited about the next chapter.

“I’m not scared at all,” she said. “I’m just really ready.”

Correction: July 5, 2015
An earlier version of this article described incorrectly the small rod implanted in Hope Martinez’s arm to prevent pregnancy for three years. It was plastic, not metal. An earlier version also referred incorrectly to the Colorado legislature. It is not Republican-controlled; the Republicans have a majority in the Senate, and the Democrats have a majority in the House.
A version of this article appears in print on July 7, 2015, on page A1 of the New York edition with the headline: Colorado Finds Startling Success in Effort to Curb Teenage Births. Order Reprints| Today’s Paper|Subscribe

Oregon House approves 12-month birth control refills

Saerom Yoo, Statesman Journal8:44 p.m. PDT April 30, 2015

The Oregon House on Thursday passed a bill that would require private and public health plans to cover prescriptive contraceptive refills one year at a time.

Health insurance plans often only cover contraceptive refills for 30 or 90 days’ worth at a time, even if the prescription is written for a year.

“Prescriptive contraceptives are an incredible resource, but they only work if they’re taken consistently,” Rep. Jessica Vega Pederson, D-Portland, said. “We know that one important way to make that happen is by ensuring that women have access to 12 continuous months of birth control.”

Making birth control available one year at a time, rather than a month or three months, is expected to reduce unintended pregnancy by 30 percent and abortions by 46 percent, according to a recent study. Removing the barrier of making more frequent visits to the pharmacy is thought to lead to more consistent use of the pill.

“Improved access to a full range of birth control services has resulted in a 40-year low in teen pregnancy and abortion rates. Advances in women’s health have paved the way for women to be a driving force in our economy, and access to reproductive health care is directly related to women’s ability to finish school and succeed professionally. We want to thank the Oregon House for passing this commonsense legislation regardless of party affiliation,” Alicia Temple, policy director of Planned Parenthood Advocates of Oregon, said in a statement.

Another effort in the Legislature is also aimed at improving access to oral contraceptives. Rep. Knute Buehler, R-Bend, is hoping to make it possible for women to receive contraceptives at the pharmacy without a doctor’s prescription. Instead, he wants pharmacists to be given the authority to prescribe the pill, much like they dispense emergency contraceptives.

syoo@StatesmanJournal.com, (503) 399-6673 or follow at Twitter.com/syoo.

What a single woman’s income suggests about sex, contraception, and abortion rates

Alexandria Icenhower |

baby003_16x9

New research suggests that a single woman’s income can be a factor in whether or not she has an unintended birth. In fact, poor, single women ages 15 to 44 in the U.S. have over five times more unintended births than affluent women.

A comprehensive review of single women’s sexual activity, contraception use, and abortion rates show major trends by income level that directly affect unintended childbearing rates. Since an unintended birth can shape a family for generations, it is important to examine the implications of this income gap and then work to narrow it.

Consequences for single women and their children

Preventing an unintended birth could allow single mothers “to get more education [and] earn more,” Isabel Sawhill and Joanna Venator concluded in a recent paper. But too often, low-income women are not provided education about and access to the most effective birth control, which would help prevent these pregnancies.

Furthermore, there are serious financial barriers involved. Abortions for low-income women must be paid for out of pocket, since Medicaid and many private insurers are prohibited from covering them. In the Midwest, “over 400,000 women live more than 150 miles away from the nearest abortion provider,” Richard Reeves and Joanna Venator note in a later report. As more abortion clinics are being forced to close, women have to travel farther to their (multiple) appointments, making the procedures even more costly both in time and money.

An unintended birth not only has an impact on the single mother, but also on her children. “[T]here are significant and important improvements in the lives of children who would have otherwise been ‘born too soon,’” Sawhill and Venator’s research found. Improvements include “cognitive scores in childhood, high school graduation rates, rates of teen pregnancy, college graduation rates, and lifetime income.”

Sex, Contraception, or Abortion?

View the interactive »

Why do affluent women have fewer unintended births than poor women?

In order to address this inequality, we need to first understand the causes. Do wealthier women have less sex or use better contraception—or are they more likely to get an abortion? Here is what Reeves and Venator discovered in their research:

    1. Sexual activity rates are consistent among all income levels.

Sexual activity rates do not vary along class lines. Around two-thirds of women were having sex at each income level. “Policies for abstinence are fighting against the tide,” they argue. Chastity is not the reason more affluent women have fewer unintended pregnancies.

    1. Poor women are less likely to use contraception.

Women with incomes below the federal poverty line were “twice as likely to have had sex without protection” compared to women with incomes four times the poverty line, Reeves and Venator found. The fact that poor women are not using birth control as frequently (or effectively) results in more unplanned pregnancies and contributes to the class gap. They suspect that lack of education about and access to contraception contributes to less effective use.

    1. Poor women are less likely to have an abortion.

Reeves and Venator discovered that “thirty-two percent of the pregnant women in the highest income bracket had an abortion, compared to nine percent of poor pregnant women.” This gap likely exists because of the high cost associated with abortions and the fact that it is more difficult for some poor women to travel to an abortion clinic.

    1. Contraception could reduce unintended births more than abortion.

To determine what would happen if poor women used birth control and had abortions at the same rate as wealthier women, Reeves and Venator tested scenarios that equated those variables by class. Equalizing contraception use reduced the ratio of unintended births by half, while equalizing abortion rates cut down the ratio by a third. Although both methods should be addressed, focusing on birth control use and education could do more to prevent unplanned pregnancies.

Closing the gap is difficult, but necessary.

Unfortunately, there are no easy answers to solve this problem. Education and access are key in every scenario to reducing unintended births. The Affordable Care Act (ACA) has made strides in increasing access to contraception, as it covers birth control across all insurance plans. However, women and the medical community need to be better educated about IUDs and implants (or LARCs), which have a higher cost upfront, but are more effective and less expensive in the long term. Sawhill and Venator suggest “that increasing access to and awareness of high-quality, easy-to-use contraception and improving the educational and labor market prospects of low-income women are important steps.”

Abortion is more problematic. Besides the moral, political, and personal issues surrounding abortion, there is a wider gap in access to abortion than there is contraception. This problem will not be solved unless women have access to abortion clinics and education about their options.

If you are interested in learning more, read “Sex, contraception, or abortion? Explaining class gaps in unintended childbearing” by Richard Reeves and Joanna Venator and “Improving Children’s Life Chances through Better Family Planning” by Isabel Sawhill and Joanna Venator.

http://www.brookings.edu/blogs/brookings-now/posts/2015/03/11-what-a-single-womans-income-suggests-about-sex-contraception?utm_source=FB&utm_medium=BPIAds&utm_campaign=Birthrate&utm_term=NoNoCtyUS-18^65-F-Emily’s%20ListNoCAnoBHV&utm_content=50907683

Oregon Bill Would Ensure Coverage for Reproductive Health Care, Abortions

Four Oregon lawmakers Thursday introduced the Comprehensive Women’s Health Bill, intended to ensure access to affordable, full-spectrum reproductive health care for every woman and transgender man in the state. (Shutterstock)

Four Oregon lawmakers Thursday introduced the Comprehensive Women’s Health Bill, intended to ensure access to affordable, full-spectrum reproductive health care for every woman and transgender man in the state. (Shutterstock)

by Nina Liss-Schultz, Reporting Fellow, RH Reality Check

February 26, 2015 – 1:04 pm

Four Oregon lawmakers Thursday introduced the Comprehensive Women’s Health Bill, intended to ensure access to affordable, full-spectrum reproductive health care for every woman and transgender man in the state. The bill, if passed, would make Oregon the first state in the nation to ensure every state resident is covered for every type of reproductive health care, including abortion, under all forms of insurance.

Backed by a handful of local groups, the bill is part of a larger progressive legislative effort announced Thursday that will also tackle sexual assault and domestic violence issues.

“I’m proud to be working with such a wide range of legislators and advocates on this issue,” state Sen. Elizabeth Steiner Hayward, one of the bill’s sponsors, told RH Reality Check. “We’ve got Republicans and Democrats, men and women, and advocates from across the spectrum who care deeply about this bill.”

Oregon is often considered a bastion of progressivism in a country battling over abortion and reproductive rights on both the federal and state level.

The Oregon Health Plan (OHP) provides extensive Medicaid coverage of health care for low-income residents, including abortion, though that coverage is currently added as a line item in the governor’s budget each year. And there is only one anti-choice law on the books to date. Both of the Oregon’s legislative chambers are controlled by Democrats, and the state’s new Democratic Gov. Kate Brown, who was sworn in last week following the resignation of John Kitzhaber, is widely seen as more progressive than her predecessor.

Still, even under a progressive government, efforts are needed to ensure that the funding and systems are in place for everyone to get the care they need. Even in Oregon, the high cost of family planning, abortion, prenatal, and childbirth care, among other reproductive-related services, can force people, particularly those with low incomes, to carry unwanted pregnancies to term or forgo important services during and after pregnancy.

“Currently, because of gaps in coverage, our clients have issues regarding lack of access to prenatal care and high teen pregnancy rates,” said Levi Herrera, executive director of the Mano a Mano Family Center in Salem, Oregon, which annually serves 2,000 families, most of whom identify as Latino immigrants. “Two-thirds of our clients are female. These women are part of the community, and having access to the full spectrum of health care will improve quality of life for everybody.”

Safety net health centers in 2012 alone provided contraceptive care to more than 123,300 women. In 2010, 46 percent of pregnancies in Oregon were unintended, and 32 percent of those pregnancies resulted in abortion, according to the Guttmacher Institute.

That same year, publicly funded family planning services helped women avoid 30,200 unintended pregnancies.

The Comprehensive Women’s Health Bill seeks to close those gaps in access. The bill would require that all health insurancewhether private, employer sponsored, or public plans—cover contraception, abortion, prenatal care, childbirth, and postpartum care, including breast-feeding support and folic acid without prescription. Insurers would be barred from imposing cost-sharing for abortions at more than 10 percent of the cost of the procedure, and deductibles for abortions would be barred altogether. And, critically, the bill strengthens and protects existing abortion coverage under OHP by removing it from the annual budget and codifying such coverage.

The bill also ensures coverage for a 12-month supply of birth control, without cost, to be dispensed at one time, removing time and cost constraints faced by those who seek to prevent an unwanted pregnancy.

Insurance plans would also be required to cover the cost of out-of-network provider care for these services under certain circumstances.

Access to preventive reproductive health services has increased significantly under the Affordable Care Act. As part of the law, insurers are required to cover a range of reproductive health services, including sexually transmitted infection counseling, contraceptive methods and counseling, and breastfeeding support, without cost-sharing.

But advocates in Oregon say the bill introduced today is significant, as both a proactive measure and a solution to holes in coverage.

“There are parts of the state statute that don’t align with the ACA, so it’s important to make sure state law aligns with federal,” Hayward said. “This bill standardizes across the board what we mean by access to full-spectrum reproductive health from pre-conception to postpartum.”

Reproductive rights advocates said the Oregon bill could prove critical, as the U.S. Supreme Court could soon gut the ACA’s federal exchanges and many Republican governors and GOP-dominated state legislatures refuse to expand health-care coverage.

“As the ACA is being eroded in states across the country, we’re trying to make sure that in this state there’s an assurance of care across all populations and for all Oregonians,” Aimee Santos-Lyons, director of programs for Western States Center, told RH Reality Check. “Plus, there are still communities of women that don’t have access to coverage right now, so we want to start that process. And as we’ve recently seen, governors can change on a dime, so we want to make sure this kind of health care is is codified law in our state.”

http://rhrealitycheck.org/article/2015/02/26/oregon-bill-mandate-coverage-reproductive-health-care-abortions/

Oregon Bill Would Ensure Coverage for Reproductive Health Care, Abortions

Four Oregon lawmakers Thursday introduced the Comprehensive Women’s Health Bill, intended to ensure access to affordable, full-spectrum reproductive health care for every woman and transgender man in the state. (Shutterstock)

Four Oregon lawmakers Thursday introduced the Comprehensive Women’s Health Bill, intended to ensure access to affordable, full-spectrum reproductive health care for every woman and transgender man in the state. (Shutterstock)

by Nina Liss-Schultz, Reporting Fellow, RH Reality Check

February 26, 2015 – 1:04 pm

Four Oregon lawmakers Thursday introduced the Comprehensive Women’s Health Bill, intended to ensure access to affordable, full-spectrum reproductive health care for every woman and transgender man in the state. The bill, if passed, would make Oregon the first state in the nation to ensure every state resident is covered for every type of reproductive health care, including abortion, under all forms of insurance.

Backed by a handful of local groups, the bill is part of a larger progressive legislative effort announced Thursday that will also tackle sexual assault and domestic violence issues.

“I’m proud to be working with such a wide range of legislators and advocates on this issue,” state Sen. Elizabeth Steiner Hayward, one of the bill’s sponsors, told RH Reality Check. “We’ve got Republicans and Democrats, men and women, and advocates from across the spectrum who care deeply about this bill.”

Oregon is often considered a bastion of progressivism in a country battling over abortion and reproductive rights on both the federal and state level.

The Oregon Health Plan (OHP) provides extensive Medicaid coverage of health care for low-income residents, including abortion, though that coverage is currently added as a line item in the governor’s budget each year. And there is only one anti-choice law on the books to date. Both of the Oregon’s legislative chambers are controlled by Democrats, and the state’s new Democratic Gov. Kate Brown, who was sworn in last week following the resignation of John Kitzhaber, is widely seen as more progressive than her predecessor.

Still, even under a progressive government, efforts are needed to ensure that the funding and systems are in place for everyone to get the care they need. Even in Oregon, the high cost of family planning, abortion, prenatal, and childbirth care, among other reproductive-related services, can force people, particularly those with low incomes, to carry unwanted pregnancies to term or forgo important services during and after pregnancy.

“Currently, because of gaps in coverage, our clients have issues regarding lack of access to prenatal care and high teen pregnancy rates,” said Levi Herrera, executive director of the Mano a Mano Family Center in Salem, Oregon, which annually serves 2,000 families, most of whom identify as Latino immigrants. “Two-thirds of our clients are female. These women are part of the community, and having access to the full spectrum of health care will improve quality of life for everybody.”

Safety net health centers in 2012 alone provided contraceptive care to more than 123,300 women. In 2010, 46 percent of pregnancies in Oregon were unintended, and 32 percent of those pregnancies resulted in abortion, according to the Guttmacher Institute.

That same year, publicly funded family planning services helped women avoid 30,200 unintended pregnancies.

The Comprehensive Women’s Health Bill seeks to close those gaps in access. The bill would require that all health insurancewhether private, employer sponsored, or public plans—cover contraception, abortion, prenatal care, childbirth, and postpartum care, including breast-feeding support and folic acid without prescription. Insurers would be barred from imposing cost-sharing for abortions at more than 10 percent of the cost of the procedure, and deductibles for abortions would be barred altogether. And, critically, the bill strengthens and protects existing abortion coverage under OHP by removing it from the annual budget and codifying such coverage.

The bill also ensures coverage for a 12-month supply of birth control, without cost, to be dispensed at one time, removing time and cost constraints faced by those who seek to prevent an unwanted pregnancy.

Insurance plans would also be required to cover the cost of out-of-network provider care for these services under certain circumstances.

Access to preventive reproductive health services has increased significantly under the Affordable Care Act. As part of the law, insurers are required to cover a range of reproductive health services, including sexually transmitted infection counseling, contraceptive methods and counseling, and breastfeeding support, without cost-sharing.

But advocates in Oregon say the bill introduced today is significant, as both a proactive measure and a solution to holes in coverage.

“There are parts of the state statute that don’t align with the ACA, so it’s important to make sure state law aligns with federal,” Hayward said. “This bill standardizes across the board what we mean by access to full-spectrum reproductive health from pre-conception to postpartum.”

Reproductive rights advocates said the Oregon bill could prove critical, as the U.S. Supreme Court could soon gut the ACA’s federal exchanges and many Republican governors and GOP-dominated state legislatures refuse to expand health-care coverage.

“As the ACA is being eroded in states across the country, we’re trying to make sure that in this state there’s an assurance of care across all populations and for all Oregonians,” Aimee Santos-Lyons, director of programs for Western States Center, told RH Reality Check. “Plus, there are still communities of women that don’t have access to coverage right now, so we want to start that process. And as we’ve recently seen, governors can change on a dime, so we want to make sure this kind of health care is is codified law in our state.”

To schedule an interview with contact director of communications Rachel Perrone at rachel@rhrealitycheck.org.

http://rhrealitycheck.org/article/2015/02/26/oregon-bill-mandate-coverage-reproductive-health-care-abortions/?utm_source=nar.al&utm_medium=urlshortener&utm_campaign=FB

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