These results come from a new study by the Brookings Institute (PDF). Using data from the National Survey of Family Growth (NSFG) 2011-2013, researchers sought to answer one question:
How much do gaps in contraception and abortion matter in terms of explaining variation in unintended birth rates by income?
From the more than 10,000 men and women who responded to the NSFG, researchers focused on 3,885 single women who were not trying to get pregnant. Women fell into this category if they fell into one of the following three categories:
- Using contraception
- Not using contraception for a reason other that trying to get pregnant (e.g. cost)
- Classifying a pregnancy as unintended
The sample was then placed into one of five income categories.
- At or below FPL
- 100-200% FPL
- 200-300% FPL
- 300-400% FPL
- 400%+ FPL
The researchers used these categories to make comparisons on four measures: sexual activity, contraception, abortion, and birth.
- Sexual Activity was defined as having at least one opposite sex partner in the last year. There were no differences in rates by income level. Researchers also looked at sexual activity in the last month and total number of sexual partners in the last year and found no relationship. Sexual frequency is not captured in any of these measures and could account for some of the differences in rates of unintended pregnancy. However, past research supports the idea highlighted here that there is no connection between SES and how much sex people are having.
- Contraception was defined as any contraception use in the last year. Women with the lowest income were twice as likely to have sex without contraception compared to those with the highest income. No analyses were done by type of contraception used which can also be related to the differences in unintended pregnancies.
- Abortion rate was calculated by dividing the the women who reported their last pregnancy ended in abortion by the women who reported a pregnancy in the last year. Women with the lowest income were more than three times less likely to have an abortion than those with the highest income. Access to abortion services was not explicitly examined although it is implied that those with higher incomes would have the means to travel even if they lived in an area without one.
- The birth rate was almost five times higher for women with the lowest income compared to those with the highest.
The authors went on to determine how the gap would be different if lower income women adopted the same rates as the highest income women. Their findings are twofold:
- If all single women adopted the high SES rates of contraception use, the gap in unintended births would be cut in half.
- If all single women adopted the high SES rates of abortion, the gap in unintended birth would be reduced by a third.
These are tabulations, however, and may not tell the whole story.
Other Factors Influencing the Contraception and Abortion Gaps
Several other factors may come into play when discussing the differences in pregnancy rates by SES.
- Access to better methods of contraception. Currently 24 states do not cover long acting reversible contraceptives (LARCs), the most effective form of birth control. These states tend to be in the public health hotspots of the US including the Bible Belt where there are corresponding higher rates of poverty.
- Distrust of healthcare. Due to abuses throughout history, people of color and low income individuals tend to feel distrustful of the healthcare field. This has been shown to delay seeking medical attention. From my own experience working in medicare/medicaid clinics, there also are racial and generational differences in what forms of birth control are accepted.
- Limited access to sex education. Only about half of the states (PDF) require information on contraception be taught during sex or HIV education. Many of the states that do not cover LARCs also do not have comprehensive sex education. How can we expect people to use protection if they don’t even know about it?
- Less access to a safe abortion. Women with lower SES are less likely to have the means to get to an abortion clinic and pay for an abortion. The Washington Post reports that primary deterrent to safe procedures is financial with women in the highest income brackets being three times as likely to have had an abortion in the past year that poor women.
- Desire to have children. Some sociological research hows that having children, intended or otherwise, provides great fulfillment to women of lower income resources. As said in the study: “[it may be that] women with limited economic prospects will control their fertility less carefully because they have less to lose.” Data from the study does not show clear differences by income level in preferences for children; however it does show that a third of single women not trying to get pregnant would not be bothered by an unintended pregnancy.
Since sexual frequency does not seem to contribute to differences in birth rates, policy should focus on increasing access to contraception and abortion, especially long-acting reversible contraceptives (LARC) such as the IUD or implant. Past research shows that when money is no issue, most women choose this option; however, for many the cost is prohibitive. This alone
From a practical standpoint, contraceptive access is a slightly easier product for public health to “sell.” It lacks some, if not all, of the moral controversy of abortion. Additionally, increased contraceptive use, particularly of LARCs, leads to a decrease in abortion rates as well. Lastly, expanding access to birth control makes economic sense. Unintended pregnancies cost taxpayers $21 billion each year according to a recent analysis (PDF) by the Guttmacher Institute.
This quote from the study’s co-author Richard Reeves, policy director of the Center on Children and Families. sums things up nicely:
“In a sense, inequality starts before birth,. An important part of the policy story is helping parents have children when they’re ready. The life chances of those children will be better as a result.” Source
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