A reproductive win to reduce poverty?

Shortly after the Supreme Court struck down an anti-abortion law in Texas, the Boone Family and Harold Simmons Foundations donated $2 million to Planned Parenthood of Greater Texas. The three-year endowment is expected to provide long-acting, reversible birth control and STI screening to 1,000 low-income women in Dallas-Fort Worth each year. Cecilia Boone, board member of the Boone Family Foundation, said, “Each time a Texas woman has expanded access to healthcare and education, regardless of her ZIP code, income or insurance status, it is a win for public health and for our communities.”

More than 60% of women in the US use some method of contraception, and the number of unintended pregnancies is starting to decline. But unplanned births are still five times higher for women living below the poverty line. Better access to long-acting, reversible birth control — such as intrauterine devices (IUDs) and implants — could help close the inequality gap. IUDs and implants are currently the most effective methods of birth control for sexually active women, with failure rates less than 1%. In comparison, birth control pills and condoms have respective failure rates of about 9% and 18%, largely due to incorrect or inconsistent use.

“There has been heavy reliance in the United States on the pill and condoms for young people. It’s easy for people to forget to use these methods, which can lead to accidental pregnancies,” said Dr. Cynthia Harper, a professor at the University of California, San Francisco, Bixby Center for Global Reproductive Health. In contrast, IUDs and implants require very little action from the users to ensure their effectiveness for years. When a woman is ready to become pregnant, she can simply have the device removed. Despite the effectiveness of IUDs and implants, less than 10% of women using contraceptives have them. This is largely due to a lack of user knowledge, insurance barriers, and costs, which can exceed $800.

When Colorado decided to remove some of these barriers, the results were staggering. Between 2009 and 2013, Colorado offered free, IUDs and implants to 30,000 teens and women living below the poverty line. Four years later, teen pregnancies dropped by 40% as teen abortions declined by 42%. Results were similar for unmarried women under the age of 25 without high school diplomas.

Other states are now beginning to follow suit. Delaware, a state with one of the highest rates of unplanned pregnancies in the country, recently announced Delaware Contraceptive Access Now (CAN) to provide low or no-cost, long-acting birth control. The nonprofit Upstream USA will help train health professionals, cover costs and educate women regarding the safety and effectiveness of IUDs and implants. Virginia will initiate a similar plan in January 2017.

The success of these programs, of course, is limited by funding. Colorado’s family planning program was made possible with a $23 million grant from the Susan Thompson Buffett Foundation. But by the summer of 2015, the seed money was running out, and Republican lawmakers rejected Governor John Hickenlooper’s request for state funding to continue the program. Some of the lawmakers were concerned that free or low-cost birth control would increase the rates of sexually transmitted diseases. Others opposed the program’s lack of parental involvement for teen participants. To maintain the program, the state is now trying to piece together smaller, private grants.

As Isabel Sawhill, an economist at the Brookings Institution, has stated, “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.”