I cry with happiness and relief. Thank you, DELAWARE AND ALL THE PEOPLE WHO ARE TAKING ACTION. I am 64 yrs of age...had an abortion at age 18-1977. So glad they were legal and so glad of my decision.
1
According to Planned Parenthood, half of pregnancies are unwanted and the number one reason for this is that women frequently neglect to take the pill. Even PP acknowledges that the main reason for unwanted pregnancies is carelessness and that birth control would be far more effective if women were more responsible.
45
Not sure that forgetting to take a daily pill while one is getting ready for work, getting dinner ready, doing laundry, and paying bills is best described as “carelessness”. I’m not sure if you realize it, but the pill must not only be taken every day, it should be taken at the same time every day. Ever forgotten to take your lunch to work or forgotten where your keys are? Life happens. It’s pretty easy to miss a dose of daily birth control.
I would better describe this initiative as “eliminating an easily forgettable daily task, thereby improving women’s lives”. Bravo to this program. I hope Texas will someday follow suit.
452
@michjas "If women were more responsible"? Women do not get pregnant alone. Both MEN and women face that responsibility. But this new method offers a safe, worry-free choice for both.
244
@Mary K O'Brien "Women do not get pregnant alone." How true! But it is also true that the responsibilities and burdens of becoming pregnant--planned or not--and childcare still remain heavily on women. Men can and must become more responsible in all aspects.
64
Is it any coincidence that NH, VT, MN, UT, WI, NEB, ND and Iowa all have the very lowest amounts of teen pregnancy?
Look at the demographics, what do they all have in common?
6
According to hhs.gov the states mentioned in your post do not all have the lowest teen pregnancy rates. So I am wondering what your point was.
12
@SB They have nothing in common. Some are blue states, some are red states.
@SB
I just looked at the lifescience.com article. The one I found cited 2010 data. hhs.gov cites 2016 data.
Sick and tired of targeting women for birth control, using methods which can be dangerous, such as IUDs (hemorrhage, sepsis) and oral contraceptives (blood clots). Offer child-averse males free vasectomies. And women, just say no to vaginal intercourse when you are in your fertile time of the month.
9
@Anne Russell
AMEN!
3
@Anne Russell
I developed blood clots while taking oral contraceptives. I knew when I went on them there was a chance I could get clots. I wanted an effective contraceptive method because I wasn't able to provide for a child at that time in my life. When taken as directed, the pill is as much as 99.9% effective.
According to the National Women's Health Network, 5 in every 10,000 women who are not pregnant or on birth control pills have a blood clot within a year. Although women on oral contraceptives do have a slightly higher risk of a clot (between three and nine out of every 10,000 pill users). I was willing to take that risk because of the pill's efficacy.
Do I regret taking the pill? No. I read the literature and knew the risk. No drug is without risk, and some risks are far larger than oral contraceptives. I took it knowing I could be susceptible to clots.
For example, non steroidal
antinflammatory drugs (NSAIDs) such as ibuprofen have a known increased risk of gastrointestinal bleeding, particularly when taken with blood thinners or by the elderly. Yet these drugs are taken regularly, often over-the-counter.
The risk-benefit ratio is an important factor to consider when taking a medication.
1
@Anne Russell are you even aware that many women cannot accurately track their fertility, nor do they want to. And the incidence rate of complications from contraceptives is very small and becoming better.
7
Excellent article. Any reliable studies of long-term consequences of implanted IUDs? I thought the early results were linked with cancer? Hope not. This program seems really promising and unlike Colorado's plan it does not stigmatize poorer women.
Of course reducing or eliminating children being born to those that don't have capability of properly raising them would have massive impact on our country. Not only in poverty and spending but those especially females without such children could be trained to be productive members of society. Replacing many of those illegals that do such jobs. Getting it done will be very difficult to impossible.
3
@vulcanalex - I'm guessing you don't have many women in your life if you think the only alternative to child bearing is working in the fields or washing dishes.
Newsflash, women are starting to outnumber men in college attendance and some of us are earning more than the men in our lives.
7
@vulcanalex - "...especially females without such children could be trained to be productive members of society."
Hate to break it to you, but females, even those without children, are already productive members of society.
11
Sounds good, but would this be considered a form of eugenics? Also, the author's last name is Sanger - any relation to Margaret? I ask both sincerely out of curiosity and not as a provocation. I love the (mostly) thoughtful comments on this story and am learning a lot.
1
@M Wrench
No, this is not a form of eugenics as long as everyone is asked the same question and given the same options.
16
I don’t think so if what it’s doing is equalizing the playing field. Few of the well off white families I know don’t ensure their kids are educated and well supplied to avoid teen pregnancy, a huge boon to those girls.
6
The most common reason that a patient leaves without contraception is because pregnancy cannot be ruled out. Contraception is started when a woman is on her menses or when she has been abstinent.
@Renee
Could you clarify this comment? It dosen't make any sense — "Contraception is started when a woman is on her menses or when she has been abstinent". If a woman is abstinent, she doesn't need contraception; and what does menses have to do with contraception?
It would serve us all well to keep in mind that we are only one generation into safe, generally reliable, widely available and inexpensive chemical treatments of many kinds, including birth control.
Fear of ingested or injected chemicals stretches back for millennia and that fear was well deserved.
It will take more than a few generations for evidence to wipe away fear and institutional policies born out of that mistrust.
"Better contraception COULD be a key to reducing poverty"?
Unless they're born rich, or so beautiful that they marry rich, or so clever and industrious that they become rich, having fewer babies is the ONLY way for women to keep their economic heads above water.
Sorry. Most Americans don't live on the farm anymore.
7
I took birth control pills the moment I became sexually active (very lucky to not get pregnant--lost virginity while having period. Don't know the science behind that.)
BC pills made me fat; didn't like side effects. Then I tried the Copper 7 IUD. Insertion was agonizing, and afterward I bled so much had to go to Student Health Service to have it removed.
Think I went back on the Pill after that. I know today's BC pills have much lower doses of Estrogen than what I took, but the removable IUD in this article sounds great.
2
As a women's health NP, and in the public health arena, I am having this conversation 20+ times a day. Statistic do not lie. Birth control works. I find religion to be an issue as well as ignorance. I have had to place birth control clandestinely so the pt spouse didn't know. We hear stories all the time about men coercing women to be pregnant so they will stay in the home. There is a lot of work to do on this issue, but every little step is helpful.
13
Overpopulation is at the root of global warming.
Imagine how much more healthy and pleasant our planet would be with the population levels we had in the 1950s,and before....fewer plastic bottles floating everywhere, just for starters.
10
@Lily
Well, Lily, the wonders of modern medicine have made it possible for people to survive the maladies that once killed us; and despite poverty and drought and famine, modern medicine has enabled the population of places like Africa to double.
Migrations to already overpopulated Western nations will continue and grow worse.
@Lily
And I do not mean to imply that doctors should not go to Africa to try to save the sick. But it therefore behooves all of us, and that includes less sophisticated peoples on the planet, to use birth control.
1
It takes two to procreate and the state seems to encourage the man to be left out of the conversation. The state should have no interest or say in pregnancy. The U.S. is not China.
1
@Eugene Patrick Devany The state is not saying a woman should or should not get pregnant. It's giving HER the choice and freedom to accept or reject the offer with no strings attached.
13
Finally, good news published ... for a change
2
I applaud this effort.
At its core it, addresses fundamental issues such as:
- children have the right to be born to parents who are prepared emotionally and financially to parent them appropriately. Teenage mothers and fathers are not emotionally or financially prepared to do so; and they burden their own parents with extra costs which lead to less money in retirement for their own care;
- women are given more autonomy over their reproductive choices without worrying about paying for the cost of contraception;
- this reduces the demand for abortion, which can only lead for across-the-board support for these kinds of policies across the political divide (side note: Roman Catholics who oppose contraception are free to decline and we the people should bill the Church for the Medicaid spent on those kids, seriously...)
13
Would be great for this to happen in Africa and the parts of South American where poverty is overwhelming. And the Middle Eastern Muslim countries. And then there's India. Time to move more people out of poverty and not have their children malnourished or starving
6
@leftrightmiddle: Your hope is an extraordinary one.
Parts of sub-Saharan Africa have trouble enough with underage brides, slavery, child soldiers, and other social ills.
India already has had reproductive health initiatives like free sterilization and it will be furthered with Modicare (https://money.cnn.com/2018/02/01/news/economy/india-modicare-healthcare-program-largest/index.html; https://www.guttmacher.org/fact-sheet/2015/sexual-and-reproductive-health-young-women-india)
And the only proven way to decline fertility in those countries HAS BEEN to educate females and enfranchise them so that they have bodily autonomy to make these choices for themselves. Otherwise, it's coercive and self-serving to the patriarchy.
1
@leftrightmiddle
What would be really great is for the rich to be limited to one child per couple. The fundamental cause of poverty is now and always has been the rich keeping more than a fair share of society's wealth. Period.
5
@zootsuit
Good God, Zootsuit. The fundamental cause of poverty is now and always has been that women who begin to have babies too young can never get educated, and almost never rear children to want an education.
It's the rare child who somehow aspires to learning when his family and generations past have been subsisting only.
2
Are young (or older) men also being asked if they want to impregnate a women in the next year? If they say no are they offered birth control that they can take so that the physiological burdens of birth control can be shared by both genders? If there are no viable steps men can take, other than vasectomy, why not? IUDs, three-month arm implants and BC pills all can have serious consequences. Why does this responsibility fall only on females?
14
@Barbara
If you read the prior comments, several us have made the point that due to the fact that men make sperm 24/7, it is a much more difficult process to suppress than monthly ovulation.
I wish this were not the case. I will also say that I'm not sure I'd leave my reproductive fate up to a man.
17
@Barbara: because it's females who get pregnant. Anyone for male pregnancy?
2
@Barbara
AMEN TO THAT, TO THE TENTH POWER.
If only this were being done in the interests of women, rather than in the interest of the state saving money on Medicaid. ..
2
@Barbara
I used to work for the State of Delaware's Public Health department. I can assure you that this program was implemented for the welfare of mothers, children, and families. I agree though that in dealing with state and federal legislators, it always helps if it saves money.
10
I want the State and Medicaid to save money! I resent the fact that some of my tax payer’s money goes to feeding the children of irresponsible breeders. Not that I want these unfortunate children to starve of course.
5
@Barbara - how about stepping back for a moment and the anthropocentric view that all living things deserve to live only so far as they serve human kind.
Consider the hellish conditions that are maintained at factory farms to raise pigs and chickens to feed the human population. From hatchlings that are almost immediately brought over conveyor belts to be drowned and fried after being born, to pigs (highly intelligent animals) that are kept in darkness all their lives only to see light on the day they are led to the slaughter.
Consider the grief stricken other apes that have their habitat torn up to babies routinely torn from their mothers arms so as to serve as bush meat.
The fishing trawlers that carry with them nets 15 miles wide to vacuum up the ocean floor and leave it bereft of life.
It's not just about medicaid ----- if you have a heart and can stop for a second to empathize with other living things then you may accept the fact that someone needs to speak up for mercy for all the living things on the planet threatened by our satanic power and heartlessness.
3
As a woman with insurance, it took me 3! visits to my obgyn to get my IUD replaced. Insurance would not Ok it until after my annual visit even though i already had one and it was at the end of its useful life. Incredibly frustrating
5
Birth rates are highest where pension plans are poor or non-existent.
Having many children to take care of you is the oldest pension plan of humanity.
4
Many young women are still wary of birth control. They hear all kinds of things with no basis in fact. So, this rather ominous picture which looks as if the doc is poking with sharp scissors seems to me a poor choice.
4
@Martha Alston - Come on, Martha. This is a photo of a healthcare professional practicing a medical procedure, a procedure that can assist women in planning their families. While birth control needs to be explained to women, particularly young women, in a complete and succinct way, the last thing we need to do is not provide them with all the facts - and this picture is a factual representation of how doctors insert an IUD - because it might be too ominous and frightening for them. (And for God’s sake, the doctor isn’t just going in there with those scary sharp scissors without using some kind of anesthesia/pain reliever first.) How do these young women for whom you’re so concerned think an IUD gets in place anyway, through a wish and a dream? If they get upset by seeing a photo of a medical professional just practicing this specific procedure, then maybe an IUD isn’t for them. Or maybe they’re not mature enough to be sexually active and should grow up a bit first rather than go to pieces over a medical photo. Honestly, my concern for young women in this particular instance isn’t for their feelings, it’s for their health. We do them a total disservice if we refuse to show them a factual photo that could assist in their sexual health education because it might prove too “ominous”. Not every young woman has a fragile psyche that we need to coddle at the expense of everything else, and we need to stop treating them like they do.
8
@Martha Alston. What are the things with no basis in fact you mention? There are also side effects which fall on some women more profoundly than others. Birth control caused one of my friends to become infertile. Years of the BC pill caused another to get cancerous cysts on her liver that had to be dissected and continues to recur. These long term side effects were not known in the beginnings of these drugs and techniques. I know another woman whose IUD became a big problem, causing a strange growth. Some women have family histories that preclude some forms of birth control. Many people insist BC is always no big deal and women should be spared a lot of scary information and "just do it." I had a wonderful doctor who told me early on that due to my family history I should never take any hormones. She was right and that was long before many things were known generally. Women are not "one size fits all" consumers and never should be.
3
@Martha Alston I know no young women who are wary of birth control. Maybe that is why my state has a low teen birth rate.
3
I am very happy to see Delaware is again stepping forward into being the “First State!” Every state should follow Delaware’s example. We lived in Delaware for close to 10 years. I loved the state and I salute their forward thinking.
9
@Alexa: The U.S. population is in decline. The state has no right to get involved with population control. The state should NEVER encourage or discourage pregnancy.
1
@Eugene Patrick Devany
Providing free and deeply discounted medical services to the pregnant poor (of all faiths, races, and ethnicities) encourages pregnancy and population growth. And while it’s true that the economies of Developed Nations struggle to grow because of low fertility rates, that is a cycle that has played out for millennia. Birth control just accelerates it.
1
Poverty and unprepared parents lead to unintended pregnancy, which creates a new generation of poverty and unprepared parents. One solution would be to make reversible contraception mandatory between the ages of 12 and 24, and then require the woman to put up a child rearing completion bond before it can be removed. This would cure 80% of social ills in one generation. Naturally we will never put such a system in place.
8
Or we could lock up all males between the ages of the and 24 and they would have to pay a bond to get out and breed. geez
13
@Richard Schumacher A better idea would be to make it apply to all men of all ages, incomes, and races. And testing for STDs before being certified for intercourse. In all states.
14
@Richard Schumacher
Your “plan” has no provisions for making males responsible for their actions. Do you think pregnancy happens via immaculate conception? The only places such a system would be put in place are the Republic of Gilead or the Middle East.
8
"Brookings Institution has measured the wide gulfs in outcomes between young women with unintended children and those with planned pregnancies later on...But...One study of teenagers with unintended pregnancies found only small differences in outcomes". Then why even cite them, and not a large-scale, long-term study, if it exists?
The real and indisputable result is that 100% of children born to poor, young mothers are by definition born into poverty - and will live in poverty for at least substantial parts of their lives, so give the would-be moms reliable birth control.
13
@Erich Lichtblau
Some young mothers and fathers find that becoming parents gives them an impetus to focus on bettering themselves for their children. I am not sure what you mean in saying children born to poor teenage mothers will be "liv[ing] in poverty for at least substantial parts of their lives". How long is that? Do you have any statistics to back up that assertion? Living in poverty and never having children would seem like dual punishment. People are not things that other people can impose their will upon because they might have more money or education (not just abstinence education, obviously). Having baby is often also a matter of choice, even for poor people.
1
Well, duh: Children are an enormous responsibility and an enormous drain on resources. Having them before one is prepared to do it properly is a great mistake. Preventing such mistakes is both a personal and a social good. This should surprise no one and be opposed by no one.
13
Some Roman Catholics are opposed to contraception and that is their right. They are not forcing their views on anyone so neither should they be ridiculed for theirs. This is so difficult for liberals to understand. And they never will. I will get some flak but this was mentioned in the article. I had to speak up about this and know I am in the minority on this comment board. So be it.
3
@WPLMMT - As a Roman Catholic who is not opposed to contraception, I understand that some of my fellow Catholics are opposed to it. It is their right to not use birth control if they feel morally opposed to it. Just as it is their right to exercise choice in their personal lives, it is my right to do the same: I choose to use birth control and I should be able to obtain it. Anyone who wants to use birth control should be able to obtain it. No one is forcing anyone to use it; rather, the option to obtain it is being made available to those who want it. That's what you, frankly, don't seem to understand.
35
But the Vatican is forcing its view about birth control, especially in underdeveloped countries where superstition is still rampant and Catholics tend to believe anything the priest tells them.
19
@WPLMMT
The US Conference of Catholic Bishops is constantly filing lawsuits seeking to ban access to birth control not only for Catholics but for everyone. New York’s Timothy Dolan is one of the agitators. I am very familiar with your posts on the RCC’s position on birth control, abortion, pedophilia, and other church stances. It is disingenuous of you to claim the church isn’t interfering in birth control access. The RCC attempt to ban birth control is a global initiative.
35
Many have asked why we are not talking about men’s role.
As a human, I accept my personal responsibility for the direction of my own life. I chose LARCs early, and used them for 20 years with gratitude.
As a woman, yes, I’m irritated that men don’t *always accept responsibility for their reproductive choices in the same way; how many single fathers do YOU know, versus how many single mothers? And yet think about it — they’re out there.
I’m the child of a single dad and the wife of a committed coparent: the men in my life are terrific partners. Men are amazing and we need to give them better choices.
As a mother of young sons, I feel powerless to help my boys take on full responsibility for their reproductive choices. Yes, only have sex with someone you love enough to discuss unplanned pregnancy and contraception with. Yes, wear a condom. But those are not “effective” methods of contraception. Who is working on the (reversible) LARC for men?
14
There is one long lasting form of contraception not in the conversation here yet .That is vasectomy . That was our method after our 2nd . and my son also after his 3rd . we are very happy with that freedom and shared responsibility .
7
@Ace J. For every single mother there is a single or absent father. Perhaps he's married to someone else so absent from the life of that mother and child. Let's stop calling them single mothers and start calling them mothers abandoned by fathers to raise the children on their own. Just because one may know more single mothers than fathers does not mean there are not a similar number of both. The men just don't stand out because they move away, deny responsibility, and go through life without those pesky children hanging around them. How many men have you asked if they have children they are not raising or do not know? The logic that there are more single mothers than fathers is flawed.
4
The huge new initiative in India (Modicare) will grant health care to 500 Million people. Clearly this understanding that providing alternatives to women may be the best route toward control of their lives, and concomitantly population pressures, indicates that as a species we are beginning to embrace lasting solutions to poverty and futility.
9
After an IUD almost killed me, I began using 'the pill', which made me crazy emotional. So I went back to the diaphragm, which is the form of birth control I'd used first. It doesn't affect your hormones, like the pill or block the fallopian tubes, causing infection like the diaphragm. It's totally sex connected. That is, you're only using birth control when you decide to have sex.
3
But it’s such a drag to use. :p
2
@C Also, only around 80% effective at best
4
Most women are fertile just a few days a month. Men (assuming no issues with sperm) are fertile every day of the month. Remind me why contraception is exclusively a women’s issue? Why aren’t men asked if they’re planning to make a baby that year in their annual check ups?
19
@MGS As I understand it, it's mostly because the female reproductive system is easier to temporarily disrupt. The male reproductive system is so simple that there's not much gray area between "working" and "sterile", and as such there are no LARCs for men. And while there are studies being done on forms of male birth control, the bar for "safe and effective" is higher because while the side effects of female birth control only have to outweigh the risk of pregnancy, men have no such physical risk associated with not using birth control.
There's also the issue of autonomy. There's an argument to be made for a woman, rather than her male partner, being in charge of whether she gets pregnant.
4
Because they don’t care.
6
@MGS-Taking responsibility would be for men who already have one or two (or God forbid, more!) children to have a vasectomy. Whether married or single.
7
From the article:
"...Better Contraception Could Be a Key to Reducing Poverty..."
That is exactly why the GOP/Republicans and the Catholic church want to prevent access to contraception; they profit from poverty and misery.
16
I wonder how anybody benefits from people who need to be housed, fed and kept out of trouble...
1
As a cradle catholic, I still cannot imagine why the church opposes birth control. And surely even our priests know that most folks use artificial birth control.
18
@Terry McKenna I was raised Catholic too. My understanding of the Church's opposition to contraception is that sex is only for procreation.
4
@Terry McKenna
Perhaps for the same reason it is opposed to suicide. The long history of the Church, State and Military being the sole purview of the aristocracy means there is a lot of keeping the peasant/slave population high so those on top can ride on the labor and blood of the poor.
3
I have tried to find the rationale for the Catholic Church’s opposition to birth control. I am not seeking an argument. It just seems to me that the family should be making such an important and personal decision. Can someone provide a link? Birth control may be the most frequently ignored Vatican ruling by Catholics themselves.
5
@JSK
I was born and raised Roman Catholic. There are many rules that defy common sense until you realize it’s all about control — especially about controlling the lives of women and making us submit to the church’s male hierarchy. According to the RCC sex is for procreation only. To the Catholic Church birth control is a double edged sword, it allows people — especially women — to enjoy sex without fear of pregnancy.
9
@JSK Um -- The Church doctrine is 2,000 years old! When Paul was addressing the "heathens" he WANTED them to "go forth and multiply". It's a little different, now, when the planet is groaning with over-population, people work so many hours they can't supervise their children or, worse, the majority of people in developed countries work outside the home. They know they can't support large families, and depend on contraception. Those who don't have access, live in insurmountable poverty. In underdeveloped countries, the same is true. As healthcare becomes more accessable, more children survive, and parents want to limit their families, so that they can afford to feed and educate their children. SOME BIBLICAL RULES CANNOT BE FAST-FORWARDED TO THE 21st CENTURY.
4
@JSK I’m not Roman Catholic, but I know for a fact that they are not opposed to birth control. They are opposed to un-natural chemical birth control. As are most other world religions.
Remember it takes two for conception. If women have to take the responsibility because men will not, give them whatever they need to be the responsible ones.
11
I am pleased to see that my state is bringing Upstream in to start a similar project here.
6
If men got pregnant they'd have more sense.
Let women control their bodies and give them a chance to make rational choices about when to have children, and the world will be a better place. The children will benefit as well.
Meanwhile, an administration that takes small children away from their mothers and throws away the key has no right to claim they care about children and families.
Meanwhile, the increase in population from 1 to 7 billion in the 20th century, now increasing not quite as fast in the 21st, is putting our hospitable planet's carrying capacity and all the creatures - including humans - who share it at risk.
Sensible support of women's family planning would make abortion safe, legal, and rare.
35
This is a fabulous idea. Men should be asked a similar question, “Do you plan to father any children in the next year?” They should be counseled accordingly along with their partner.
A word of warning, if you’re a man who had a vasectomy, make sure you have the recommended sperm tests afterward. I knew a woman who got pregnant after her husband had a vasectomy because he never followed up with the testing. He accused her of having an affair, she hadn’t. Turned out one vas deferens was missed.
Ideally, there shouldn’t be any restrictions on birth control availability. If religious people are serious about reducing unwanted pregnancies and abortion then birth control should be free and readily available. Unfortunately, erecting barriers to contraception and abortion access is about controlling women.
I hope the Delaware experiment is successful and easily replicated in all states.
42
I would be concerned about having an iud device inside my body for three years. Is it really safe to leave a foreign body there for such a long period of time? I would be afraid of complications and infections. There is always the possibility of something going wrong and possibly not being able to conceive later on. It may be rare but if it happens to you it would be very upsetting.
2
@WPLMMT I’ve had two, no wait: three. No issues, and while I had trouble conceiving the first go-round, after my third IUD was removed I got pregnant within two months. They are very safe. Now I have two gorgeous kiddos who are wanted, planned, and deeply loved.
23
@WPLMMT
Well that is why they do research before FDA clearance. IUDs have been extremely successful as of the past 30 years and are one of the safest and least side effect riden options on the market. There are many things we implant in the body, many to save human lives, that are done very successfully.
23
Really that clueless (Id assume NYT readers would be more educated on basic public health topics)?
Or are you an anti-contraception extremist trying to sow fear into the truly ignorant NYT readers?
There’s always the possibility of “something going wrong.”
Pregnancy almost certainly causes more health hazards, infertility & death than contraception (including IUDs) & abortion combined especially in 3rd world nations.
Pregnancy, by the way, can cause infertility. Uncontrolled post-partum bleeding (not terribly uncommon) often requires emergency hysterectomies.
19
The direct connection between slowing population growth to stasis, and preventing climate change caused by consumption, is undeniable.
Incentivizing family planning should be job #1 for the climate change focused activists, even before green technology, because it can be literally put in place overnight, as fast as contraceptive implants can be gotten to people in overburdened, under resourced, overpopulated nations.
India does not need one more citizen, nor does China, or Pakistan, Philippines, Indonesia, Bangledesh etc. and the world needs population to decline not grow. There is a huge build-in benefit in economic freedom too, as corporations see wildly increasing populations as increasingly cheap labor pool.
31
Re: "[Unintended pregnancies are] a symptom of poverty, of inequality, of hopelessness about the future."
Sure. But if you can prevent an unintended pregnancy it is much easier to treat poverty, inequality and hopelessness. The addition of a child to the equation complicates this immensely.
17
The Republicans scream about states rights. With McConnell trying to pack the courts with older white men who will probably cancel Roe in the near future. Any federal ruling on contraception is also a non-starter I fear.
All blue states need to adopt a program like Delaware's so it is as widely available as possible . PP, other groups that deliver this service need to be publicly and privately funded so they can make contraception even more widely available then it is now.
Although several red states will try to stop it....contraceptives can be brought in from out state whether it be legal or a sign of civil disobedience.
We talk about fighting poverty...contraception has been logically shown to be very effective in doing that.
Let us stop with the flat-earth policies like abstinence and start dealing with the reality of economics and human nature.
This is not the 1950s, it is the 21st century.
20
I have always believed that contraception is a mans responsibility—and I insist my male partner has had a vasectomy and/or uses a condom. The real question is where are the technologies resolving MALE fertility and why is our society not insisting men get screened annually as be asked if THEY want to get pregnant in the next year? Why should any woman, already burdened with menstruation, pregnancy, yeast infections, UTIs, etc etc as a result of sex, have to put up with horrible technologies like IUDs, vaginal rings, hormonal implants and surgery? Most of these have really terrible side effects that can lead to serious health issues. We need to turn the table over and put this on MEN who are far more motivated sexually than their female partners. I imagine they will solve the issue in no time!
17
@RachelK I do hear you, but the woman is the one who has to deal with pregnancy and the risks involved to her - which can include death, loss of income due to pregnancy-related disability or the possible risk of raising the child on her own. I'm for ensuring that women take control of their futures and not depend on the male - condoms are not as effective (often due to user error), and the permanence of a vasectomy may not be acceptable.
14
Nice in theory, but I would never rely on ANY male, no matter how well-intentioned, to make sure that I don’t become pregnant. That’s an area where there is simply no room for guesswork or magical thinking, therefore I will be the one to make sure I don’t get pregnant. That’s my covenant with myself, to ensure good self-care at all times. The stakes are simply too high to depend on anyone else to watch out for my best interests. I am always amazed at these young women who become pregnant because they missed a pill, or forgot other forms of contraception prior to the occasion. A child is a lifetime of commitment, and conceiving one should not, in my view, be left to the other party - or to chance. It’s MY body, therefore I will take full responsibility for it. But to each their own.
18
@RachelK Many years ago, when around me womenfolk "forgot" the pill, or just got broody, and young folks started families for no reason, I said to myself I wanted some control of this process. And hightailed it to Marie Stopes in London, where I was living, and had me snip. Not a big deal, but after that, I began to realize that the majority of men just won't, for reasons I do not understand, unless they're knee deep in critters. What hasn't been researched is why men, who tend to want to be in control of everything, don't want to be in control of their fertility - unless, of course, getting the girlfriend pregnant is a form of control. I can't help but wonder if this is something we could educate our male children to, in school. But that would require churches and mosques to buy into teaching children procreation is not a good thing, and that would never fly, would it? That would solve global warming too, so it should be PC. Or maybe we can offer all young serious offenders who get a ten year sentence five years off when they get the snip. Etc.
4
Contraception should be free to all citizens, not just here, but globally. There are simply too many humans on the planet, and reducing the birthrate WILL improve EVERYONE'S life.
It was identified as the root cause of our environmental climate changes by Gore, who, oddly but predictably, FAILED to address solutions at the conclusion of his famous book/lecture/film. After all, he has four children, so he couldn't very well be an example for population management.
21
This sounds like a very good program. I hope that Delaware demonstrates that access to good contraception devices work.
However, while this may solve Delaware's problem, the real need for population reduction via contraceptives is overseas in Africa, Central America and the Middle East. If we could reduce the overpopulation in those countries that might reduce the need to try to come illegally to Europe, and caravans trying to break into the US.
12
@judyweller
Contribute to Planned Parenthood International.
4
This has always been pretty obvious. Nice to have a study to valid common sense. The Evangelicals who are against abortion and against contraception simply haven't connected the dots.
10
This is a no-brainer. Provide free care for those living in poverty that provides contraceptives, mammograms, vasectomies and abortion. Society will only gain from this and in a big way.
12
Other states that need to be watching this are not. Consider how many red states we have where they are basically against birth control. Yes red staters will claim they are just against the government paying for it clearly missing the point that birth control is always cheaper than children.
17
If only Margaret Sanger were alive today, she would wholly applaud Delaware's programs to increase birth control access to women. A contraception activist from the late 1880s until her death in 1966, Sanger advocated for women, who gave birth to large numbers of children because birth control was basically nonexistent.
As a visiting nurse in New York City, she watched as women sought abortion illegally; many were at risk of death from undergoing botched procedures. Her own mother died at age 50, and Sanger believed her death was caused by having many children (11).
In 1916, Sanger opened the first birth control clinic in America. She mailed out diaphragms to women, for which she was arrested and jailed under the Comstock Act, a federal law which made the use of birth control a criminal act.
In 1921 she organized the American Birth Control League, which later became Planned Parenthood. She worked with reproductive specialists to bring the first birth control pill, Enovid, to the U.S. market in 1960. She also witnessed the Supreme Court reversal of the Comstock Act in 1965.
Sanger would be astounded to see all the contraceptive methods that are now available, how well and safely they work, and how easy they are to use. I applaud Delaware for progressing forward with this program, and I hope other states will follow.
59
I totally agree about the importance of available and cheap or free contraception. However please remember that in spite of many positive actions Margaret Sanger was a eugenics believer.
8
@Wandering This is a disingenuous comment that misrepresents Margaret Sanger's actual views. See the following for a more nuanced explanation of what she believed and supported: https://www.npr.org/sections/itsallpolitics/2015/08/14/432080520/fact-check-was-planned-parenthood-started-to-control-the-black-population
2
Not only is free, safe, and easy access to contraceptives, abortion, and vasectomies a key to reducing poverty, it's also a key to reducing the inherent pain, injury and potential mortality of gestation and childbirth, and to reducing the rate at which our species extinguishes the biosphere.
9
The core idea - one stop shopping for everything to do with pregnancy and contraception -- is so wonderfully simple, that it smashes barriers which have often stopped young, and poor women [and a lot of other women as well] from facing the idea of pregnancy as a decision to m be made, not just something that happens. Access. Confusion. Cost. It is a wonderful idea.
Will it reduce poverty? That is a tall order, since poverty is much more complicated. It requires good education, provided from early years on, jobs, etc.
But being able to easily secure contraception - will keep some young people from being trapped with massive responsibilities before they have graduated from high school, or ever held a job.
I don.t know how they got the legislative support for it - but I'm impressed.
10
We need to be seeing more articles such as this one. Contraception is not discussed often enough. So many of these excellent comments reiterate again and again just how life changing it is to be listened to for once and to be presented with choices. Programs like this one and the excellent Denver program need to be established throughout the entire country - and those services made available to all women - especially teenagers. Women began to make themselves a force in politics this past election, now they need to present programs that will empower even more women - especially those from disadvantaged backgrounds to move forward to happier and fulfilling lives.
11
What I miss in this article is the role of males in this whole thing. Women don't get pregnant by themselves, but they seem to have to do all the preventive work by themselves.
23
@Tonina Satta, that has ALWAYS been the case. Since men don't get pregnant, they don't care nearly as much as women about unplanned pregnancy. And, they often escape from supporting kids they father. Not all men, of course, but far too many. And women still do most of the work in child-rearing.
24
@Tonina Satta Thank you for saying that. The men being left out of this discussion is a step backward. I believe in a woman's right to choose and want birth control available and affordable to all who want it. But men be held responsible for the unwanted pregnancy.
3
@Tonina Satta
Pointing out the lack of responsibility men typically have doesn't change the fact that women end up with unwanted pregnancies when they don't have access to birth control.
Ultimately, you have to be responsible for your own body.
5
I live in Portland, which has rampant homelessness, due to factors such as drug addiction, mental illness, and economic hardship. It absolutely breaks my heart to see how many children are born to parents that can't take care of themselves, much less the multiple children they often have. And I also know of women who are ostensibly trying to get on their feet financially, only to accidentally get pregnant, and then their employment options become limited once again.
I'd never dream of forcing contraception on anyone, but I think it would be great to offer up free long-term contraception to those who want it. The people I see who suffer from drug addiction and mental illness are sometimes just not capable of making daily decisions that will prevent pregnancy over the years. Allowing them to make a decision that will prevent pregnancy for multiple years will help prevent the really tragic outcomes I see on a daily basis.
37
Abolishing the role of religion would make everything easier, especially and starting with social policy that encourages and supports birth control worldwide. Imagine a world without oppression, misery, physical and mental suffering by women and the children they don't want. That is a world without religion. Bring. It. On.
33
I am sure that a charge of racism is on its way.
How sad that a reasonably thought out possible solution will be pushed to the side for a specious argument.
4
I had an abortion at 17. I am thankful for my IUD so that I can get my masters degree and then have a kid. I won't breed them, if I can't feed them. My body, my choice.
45
@Realist
Thank you so much. You're saving yourself a lot of pain and injury that comes with gestation and childbirth, and you're also not contributing to the human population load that comprises anthropogenic mass extinction.
3
I hope that people and organizations who are anti-abortion will really support this program. The best way to end abortion is to provide contraception.
124
So the whole idea is that being a “vessel” for life is a gift from “god” and you should do it as often as possible. Thus, women are mere baby-factories for the anti-abortionists cult of choice. Contraception is, by this logic, a sin.
2
While it may seem harsh to blame women for neglecting to take the pill as prescribed, it’s just being fair.
Women want “old white men” to stay out of their reproductive choices. I agree. But with freedom comes the burden to manage one’s life choices prudently.
When my adult daughters were children I gave them as many choices as I could and, aside from safety and health issues, I didn't protect them from the unpleasant consequences of their poor choices. As a result, they've learned to make good choices and have grown up to be responsible, contributing citizens.
One can’t have the freedom to make one's own choices then blame someone else for one’s poor decisions or lack of diligence.
5
@Son of liberty
While I agree with your statement the same responsibility should fall to our sons as well. It takes two to tango as the saying goes.
29
@Son of liberty - No one chooses to have their birth control fail, something that occurs quite often through no fault of the woman.
btw using contraception is responsible behavior.
5
@Son of liberty
"While it may seem harsh to blame women for neglecting to take the pill as prescribed, it’s just being fair."
This doesn't make any sense whatsoever. The fact that women are entitled to reproductive freedom does not mean that there are no barriers to access to care. The fact is that old white men are responsible for many of those barriers. The fact is that good government policy can eliminate many of those barriers. The barriers should be eliminated/reduced for everyone's benefit.
"Women want “old white men” to stay out of their reproductive choices. I agree. But with freedom comes the burden to manage one’s life choices prudently. "
You fully do not have the right to interfere with my decisions irrespective of whether they are responsible or not.
Should women be responsible? Yes of course. But you are wrong in asserting that freedom to manage one's body is contingent on *how* one exercises that freedom. These concepts are unrelated.
6
It us high time for this. We do not force women to wear a burka or refuse their right to drive or own property. Why? Because these belong to other religions and cultures. That these ideas are from conservative Christian religions makes no difference. When we talk about religious freedom, this sadly very much DOES include sexuality, and in most religions always has. Many of our forefathers came to this country to escape religious persecution and I am appalled that it continues to this day. My religious beliefs, and those of many others, include honoring women in healthy ways, and the first is freedom of choice about partners and reproduction. Just because you want to give up your rights does not mean I should ever have mine taken away.
If you don't want to use birth control, then by all means don't use it. But you do not get to decide what's right for other women.
Three cheers for Delaware!
31
Well said!
3
People should have as many children as they wish.... if they can afford it and not have them at the tax payer’s expense.
Any contraceptive would be great to reduce unwanted pregnancies, reduce abortions (go figure!), starvation, maternal deaths, overpopulation, pollution, wars, and even bend the curve of unsustainable growth in wealth that the wealthiest take from any additional population. Alas the latter is why the kleptocrats insist on population growth to feed their avarice for wealth on the backs of more and more desperate poor. Besides, contraceptives empower women - and that is a no no for the ownership-tax-avoiding class.
Those inflicting their perverse beliefs on contraceptives, barring women from even being offered it as an option anywhere in the world will have to explain how they obviously condone pregnancies through rape. Yes, I do question the morality of those who oppose AND bar access to contraceptives of others. The believers should be restricted to inflicting their beliefs only on those who believe as they do and leave everyone else alone.
13
Why is this being presented as a new idea? Poor people make their lives worse by having children? Stop the presses. The original Planned Parenthood had a similar insight and got accused of practicing eugenics.
12
Delaware may be ambitious, or rather assertive, as it is the right thing to do. Justice may finally have it's say. Birth control pertains to both parties, man and woman, but more specifically to the one that gets pregnant ought to have the final say.
4
@manfred marcus--Not necessarily. Babies are not conceived by women alone. More men, especially those who are already fathers, should consider vasectomy. Men need to step up and participate fully in the effort to reduce unwanted pregnancy. The one who gets pregnant and the one who impregnates are equally responsible.
9
The objectives of the “One key question”, “Are you planning on becoming pregnant over the next year”:
Reducing the rate of unplanned pregnancies for all women
Reducing the number of abortions
Healthier planned pregnancies
Empower women to continue their education, earn more money, and reduce the chances of being in poverty
Having fewer children trying to fight their way out of poverty
These all sound like they should be able to be achieved with this initiative
But what about the unintended consequences:
Fewer people to contribute to global warming, species extinction, pollution, deforestation, world hunger, etc.
Reducing the need for government aid (since unplanned pregnancies happen more to those in poverty)
That does not sound too bad either. Why is this not a program in every state???
21
The premise of this program has been the vision of public health professionals for a long time. I look forward to learning more about its outcomes and long term effects. Sadly, many elected officials do not support sound public health interventions that benefit women and families. Good luck Delaware. Hopefully, other states implement similar programs.
20
I agree with the article. This is not some revelation. Social scientists, economists, politicians and others have been discussing this for a long time, but here is the dilemma: Republicans do NOT want to reduce poverty - only to increase it. Their entire agenda has been based on going against social welfare and helping ordinary people. While this may have been obvious to many, for a long time, their intentions are now out in the open. They have no desire to make improvements in the quality of living for the poor and middle class. They only care about their donors and the 1%.
16
I fully support this contraceptive movement. It is essential for a woman to be able to control her own fate. I do hope, however, that they also emphasize the need for condom use to prevent STDs. Pregnancy is not the only result of a sexual liaison.
23
This is certainly a good start. Most wealthier couples have two or three children because they plan ahead, while most on assistance have four or more, frequently with different fathers because they don't plan ahead. Many will call this racist, but white women do it too. When you read many of the neediest cases, they have more children than they can afford. (I am not talking about the ones who have inherited their sister's children.)One of the biggest problems will be getting these women to a clinic in the first place. With Trump and his gang waging war against Planned Parenthood, this will be a losing battle. Contrary to what the anti-abortionists insist, Planned Parenthood's primary purpose is preventing unwanted pregnancies. Good luck to this program, I hope it works.
17
@S.L. - I work with women "on assistance" and most do not have four or more children. Where do you get that idea from?
5
First off, why should anyone care what the 'catholic church's' viewpoint is on contraception. Why are They to tell Anyone how to live??
Secondly, we need to remove all the excuses that certain irresponsible, reckless women use for having accidental pregnancies, and one after the other. In many instances the problem is a combination of despair, self-destructive behaviors, depression and cultural norms (i.e., everyone else around here has babies from multiple dads, so what's the big deal?)
When certain women take the very real potential of pregnancy so lightly, it is their own children who suffer the consequences, and then society as a whole will also pay the price. Having a child is not a 'right' but a massive privilege and responsibility, 24/7/365 and for 18 years. I only wish more people understood this.
14
@Lisa
- we should all care because the Catholic Church oversees a huge percentage of all the healthcare delivered in the United States. In Iowa, where I live, there are TWO hospital systems and the University of Iowa's Hospitals and Clinics. 42% of the hospital beds are Catholic. So, when you have a monopoly or near-monopoly on a market, and if people's insurance compels them to go to the Catholic hospital (like mine does), and if you refuse to provide an entire class of medications to an entire group of people based on the presence of a body part and YOUR firmly held religious beliefs, the Catholic Church is a Big Somebody to Tell Women How to Live. It is really unfair, unjust, and morally corrupt. They should simply NOT OFFER WOMEN'S HEALTH SERVICES. That would be honest. They cannot provide patient-centered, evidence-based care, and they need to stop. Just. Stop. pretending that they can take care of women. Because they don't really care about women, and they (a bunch of ostensibly celibate men) certainly do not grant us respect as autonomous human beings with a right to control our own bodies and enjoy our sexuality free from the hazards of pregnancy, just like men have always enjoyed.
7
Go Delaware! Finally a step in the right direction. It should be easier, not harder, to obtain effective birth control. Give women control over their bodies, and watch them thrive.
15
Several years ago, I told a work associate how one women's university in the east was offering ru-486 pills for $20 each with the vending machine in their dorm. He had a degree from a small Colorado divinity school and he got totally bent out of shape about these vending machines.
When living in Manhattan many years ago, NY was the only state offering abortions and frequently I would see young women flying with their mothers to NY to get an abortion. There only other abortion choice was Mexico or a back alley and a clothes hanger.
I had just went straight to the Navy after graduating from Purdue where there were 15 guys for every woman. Living in NYC at the height of the Vietnam was and the pill just being made available - WOW. Women were free of getting pregnant and they were openly making their needs known. Japan for many years has had more abortions than live births and in China, male children far out number female children. The typical ratio is 105 male to 100 female.
1
@Butch Burton - Are you sure it was RU-486 (mifepristone) in those vending machines? That is an abortifacient and is not available without a prescription.
More likely it was Plan B (levonorgestrel) which is indeed a available without a prescription. Plan B can prevent, but does not terminate, a pregnancy.
It is really important to differentiate between the two.
6
I'm struck by the debate of whether or not unintended pregnancy is a symptom or a cause - it's both. I've been working in reducing unintended pregnancies in NYC teens for nearly 20 years and we are finally starting to see impact not just because of the number of sex education programs out there, but because of the increase in LARC use. People forget that poor girls grow up in poor neighborhoods - attending failing schools that don't prepare them for any opportunities. Instead of seeing an unintended pregnancy as a catastrophic event, they see it as an opportunity to propel themselves into adulthood with all the respect and resources adulthood can often provide. Wouldn't it be better for these young (often poor) girls/women to receive the same services that their wealthier peers receive? By providing LARCs to informed, consenting girls/women, you provide them the power to direct the trajectory of their lives. That's a win/win for everyone. Teen pregnancy rates have been dropping dramatically in NYC - even in our poorest neighborhoods - by 60% since 2000. That's not by accident - that's by design. As a result, we are starting to see high school graduation rates increase. Let's see what the poverty rate looks like in 5-10 years time.
124
Thanks for this really insightful comment. NYT, I would love to read a follow up article about this program and how things are changing.
13
What a terrific idea!! Imagine if every birth was a planned and wanted child. The immediacy is a winner and this question should have been included long ago in the H&P--Do you want to get pregnant in the next year. Amazon is so effective with its 2 day shipping. Immediate results will win easily every time.
6
just thinking of this now? Well, of course, single mother pregnancy(ies) continue to burden society and the invidivuals themselves. I am always struck how States (New York in particular) is so quick to just write tax payer checks for life without ramifications and almost encourage this cycle to be the norm into the next generation(s). Why, even the NYT with its "feel good" the neediest cases last week had a 55 year old Manhattan woman with 6 kids and 19 grandkids and somehow we are supposed to cheer her recklessness because she took an online course (and couldn't pay for it). At what point do the social workers say, hey no more kids, you want the ones you have to succeed right ? 3 kids? 4 Kids ? The article says she got custody of her son's kid 5 years ago. but now there are 2 more, under 5. It appears that this woman has never worked, lives downtown (NYCHA) and New Yorkers have paid for all of it. Why even the woman with the baby taken from her by the police at the welfare office was living in South Carolina, but better benefits here. Is it any reason over 100 New Yorkers leave every day ?
6
@212NYer Your comment is filled with non-sequitors. Your claim of New Yorkers' departures leads one to ask where are they landing? In many cases, states where they go have EVEN HIGHER rates of unintended pregnancies and Medicaid-provided births, such as Texas with its Third World-standard of teen parenthood. In many of those Southern states, Medicaid-provided births now approach 70-80% which is nearly 20 points higher than New York's.
2
Were we really the pragmatists Americans are known for being, we'd understand that birth control is like infrastructure - it serves us all. Oh, wait, we don't even value infrastructure anymore in this Igotminetoheckwithyou society.
15
Mixing apples and oranges again? If you want to end poverty; end income inequality (apples). If you want population control (new age eugenics); push contraception (oranges). Not all unplanned babies are unwanted. For unwanted babies (unfortunately), there should be abortion. But let’s not get it twisted; or you could pay women not to get pregnant. Or, pay men to get sterilized. But don’t give us “ending poverty” by ‘ending people.’ If you are conceived and born, allow parents to provide for their children. Maybe even encourage men to be more involved. This “one stop shopping” sounds dystopian. Just sayin!’
@Richard Mays We DO need to reduce births (world population is now over 7.6 billion) - why not reduce those that would be unplanned? If we don't reduce our numbers Nature will find a way to do it and her way will not be pleasant.
19
@Cal There is an apparent racial agenda here. What populations do you think are intended to be reduced, Europeans and Anglo Americans? Not so much. The Third World is considered expendable by many at the top of the pyramid. Every time sterilization programs are suggested who do you think they are suggested for? There is plenty of room for everyone and plenty of wealth to share. However, endless wars are on the way to normalizing "population reduction" and climate change might come in handy to boost the forces of "Mother Nature." So, consider those things before you start curtailing bloodlines. Unless you know of any volunteers. I think this is part of the "New World Order" H W Bush was so eager to unleash. Just sayin'!
Income inequality? Well, why those who don’t work or hardly work have an income comparable to those work hard? Why highly qualified individuals wouldn’t be able to be compensated more?
Wonderful article and such good news for us all!
4
What would happen to poverty in American if every 14 yo girl were offered a cash stipend of a few hundred dollars a month in exchange for agreeing to have having an implantable birth control device. The stipend would continue until they decide they don't want it any longer or when they turn, say 21.
@Laurence Berk It would be more beneficial to them and society if the benefits of delayed pregnancy were illustrated in higher pay for women, more women leadership role models and fewer men willing to impregnate teen girls.
2
@Laurence Berk Or simpler still we just took a sperm sample from every boy and then give them a vasectomy. That way there would only be children when desired, as it would require a trip to the freezer to start the next generation.
5
The benefits of this program are so obvious it truly makes one wonder why we so slow in adopting it across the country. The first step to addressing abortion concerns is to reduce the number of unwanted pregnancies, so that the issue is minimized. Shame on us for not taking a more mature and considered approach.
12
An unplanned pregnancy can on occasion be a blessing. This happened with one of my cousins. She had a child late in life and that child was a comfort to her when her husband unexpectedly died. The older children were all out of the house and this little girl was a blessing. She and the daughter were so happy together and it was not at all a burden. This event was one of the best things that could have occurred for both mother and child. It had a happy ending.
2
@WPLMMT
That’s wonderful FOR HER. It’s not always such a happy ending for many many other women stuck in bad marriages, crippling financial circumstances, already caring for born children, or simply not in the life plans of the woman, as was my case. That’s why personal choice by the woman doing the childbearing is and should always be the absolute and only standard for contraception and access to abortion.
19
@WPLMMT - For God's sake! It's not a blessing or a happy ending for everyone. Your cousin and her child were fortunate: even though the pregnancy was unplanned, they were loved and happy together. That is not the reality for every unplanned child in every family.
17
@WPLMMT On the other hand, I know many women with children late in life whose children had life-threatening medical conditions and now the burden of lifetime caring for them has taken away any dreams of a joyous retirement.
16
That 45 percent of pregnancies are unplanned in a country with nearly foolproof, long acting birth control is a scandal and a public health crisis. I am glad to see programs like this and would happily pay higher taxes to make LARCs free for low income women.
I've used a copper IUD to space my three children. Every one of them was very planned. The joy of having a planned and well prepared for child is something all mothers should have access to.
37
@A
In fact women on BC (one form) do become pregnant possibly more often than statistics indicate. Also breast-feeding moms... Consider yourself lucky!!
Breast feeding is not a form of birth control!
It's not the birth control at fault for pregnancies, but rather incorrect usage - forgetting to take a pill, medications which reduce the effectiveness of the pill and the worst - pulling a condom off before ejaculating. p
Editor’s note: This comment has been anonymized in accordance with applicable law(s).
3
@A F REmember that unplanned is not the same as unwanted. I have a few friends who have had unplanned pregnancies, but were happy to have the babies and are able to provide a loving and stable home for them. My own brother was unplanned, but was born to my married parents who had planned to one day have kids, just not quite then.
45% may be unplanned, but is not necessarily indicative of bad situations.
1
Glad to have read some good news this morning. What a great way to start the day.
9
You mean the part where men continue to be completely irresponsible for getting young women pregnant and leave women holding the bag with potentially dangerous treatment “solutions” to their fertility?
"A string of studies showed that, when birth control arrived, women’s careers and educational attainment improved" And this is why so many far-right religious groups oppose birth control.
59
I agree. The Republicans need people to blame for the severe equities in this country; if women did not have so many unintended pregnancies, then you would not need to pay so much in taxes, instead of telling the truth, which is that the average tax payer subsidies the huge tax cuts that millionaires get. In terms of religious groups, while they are entitled to their opinions, the laws are not supposed to be based upon those groups; that crazy ideology that we used to follow, the separation between church and state is still part of our constitution.
I was surprised by the statistic that 45% of pregnancies in the US are unplanned. And that made me think of the fact that I know three young mothers, in their 20s, who were using birth control but got pregnant while taking antibiotics, not knowing that would reduce the effectiveness of their oral contraceptives. None of these women were aware of the pregnancy risk because they were never informed about it by their physician or pharmacist. It was probably in the printed material that came with the RX, but it's something that should be stressed by healthcare professionals. A baby is a bigger side effect than drowsiness.This is a good example of the unilateral thinking so prevalent in modern healthcare. The sinus infection was treated, so all is fine. The three women had their babies, but their lives and the lives of their parents and partners lost important future options, like money/time for education and resources for already existing children.
22
This obvious solution to many problems took a long time to be implemented, due no doubt to bizarre attitudes about sex, conception and contraception, who owns women's bodies, and who gets to decide how other people should live. We are a strange, strange country, still mired in warped and badly defined puritanism. Some of the "mired" are now on the Supreme Court.
12
@GreaterMetropolitanArea
really, it could just be reduced to: who owns women's bodies
2
I wish this article discussed the fact that needing to get a prescription for birth control pills forms an unnecessary barrier to women accessing them. The American College of Obstetricians and Gynecologists and the American Academy of Family Physicians both support making birth control pills available over the counter without a prescription. Birth control pills are available over the counter in several other countries, and some U.S. states have moved in the right direction by allowing pharmacists to prescribe them. They are far less dangerous than many other pills available over the counter and the fact that a prescription is needed is pure sexism!
22
@Tara - This sounds good until you realize how many versions of the pill are out there and look at the fact that some of them can be dangerous for people with certain medical conditions.
A prescription should be used for at least the first time someone takes them.
2
How about this: A man does to the doctor and is asked: "Do you want to impregnate a woman in the next year?" If the answer is no, then he is given a case of condoms and instructed on their use. Better yet, he is given some hormonal injection that stops sperm production. Oh wait, that is not been invented yet. There were some clinical trials on "birth control for men" but they complained too much about the side effects!
52
The "male pill" just doesn't work.
1
@PeteH There is a male injection that does work. It hasn't been brought to market because of side effects, which are comparable to the side effects women experience with hormonal contraceptives.
16
@kate
"It hasn't been brought to market because of side effects, which are comparable to the side effects women experience with hormonal contraceptives."
There you have the answer. As usual, women should deal with the side effects, not men.
12
It may -only- be a training exercise but the LNP in the first photo should be practicing with GLOVES ON!
6
Global warming and all pollution problems are being driven by the population explosion. Women have proven that they will control the number of children they have if given the chance. This program should be replicated throughout the world.
26
@john holcomb I believe a similar program in Colorado lost its funding after a Republican legislature was elected. The Republicans felt that free birth control only increased teen sexual activity and promiscuity.
3
There is no such thing as an "unplanned" pregnancy. If a woman does not use birth control, she knows that she runs the risk of getting pregnant. So it is planned; the only question she has is when.
4
@SJW Of course there are unplanned pregnancies, and they can happen to women even if they \use birth control. Even the article states that 70 women out of 1,000 who are taking the pill become pregnant every year, and 4 out of every 1,000 IUD users will also become pregnant. If you are using birth control and you get pregnant anyway, that's unplanned.
17
@SJW Many unplanned pregnancies are the result of failed birth control. Birth control is not 100% effective.
13
@SJW Birth control fails. And I know several women who have been told they will never get pregnant due to some serious health issue so they don't bother with precaution and then they do get pregnant (and there have even been movies on this subject - see for example Baby Mama with Tina Fey).
4
Planned Parenthood saved me from motherhood in college and I am forever grateful. It was free and that also was a game changer when you are on a very tight budget.
Lets get out front with this and it should also please the so called 'pro-lifers' if in the end there are fewer abortions.
Can we at least agree on that?
And thank you Pelosi and Obama for making contraceptives free... the only smart and intelligent way to tackle the issue of unwanted pregnancies.
36
This is cool. Birth control should be free for everyone (not just those with insurance...) One thing this article didn’t talk about is how birth control still somehow falls on women’s shoulders. While IUDs are super helpful for a lot a women, they’re still a process to get put in, adjust to, and then eventually take out. Most of the birth control methods rely on fake hormones, which can really mess with women.
Where are birth control methods for men? They’re a part of this equation, too. Time to get men as physically invested in birth control as women and make them better allies.
20
Great sentiment but I’m afraid men won’t be interested in contraceptives until the day that they can get pregnant.
Exercising a little self-control every now then rather than simply relying on technological wonders also might go a long way toward reducing "unplanned" pregnancies and poverty.
2
Why should couples have to exercise "self control"? Sex is a part of being a couple. Why should people endure a dour, celibate life just to avoid pregnancy?
31
@Diego
True. Puh-leeze, though, in the real world! And tell it to the men.
20
@Diego
It takes two to tango and to make babies. Many men would not be thrilled to be told, in the heat of a romance, "not this week, honey,I think I am fertile." Not all women have regular cycles and can predict when they are fertile. So now you have celibacy as the only alternative. Not many boyfriends or husbands would accept that. If YOU are not willing to practice celibacy, then you have no vote on this issue.
13
My goodness, a program that works to solve problems based in science & research...can we have more? Thanks NYT for covering this...we need more stories like this on an array is issues.
18
It is amazing to me, a baby boomer, that this is still up for debate. Birth control was arguably the most important 20th century innovation giving women control of their lives! Reduced abortion, greater educational & financial opportunities, healthier families. Frankly, we should be giving away birth control to anyone who wants it for free. Kudos to Delaware, but seriously, isn’t this what Planned Parenthood has been doing all along? ...that is until the slow dismantling by ideologues. Guess every generation must reinvent the wheel for itself...
29
@Deb
It is amazing that so many people still don't get that "giving women control of their lives!" is still an issue. It is THE issue.
This is the reason behind every other reason out there. "Men don't have" b.c. options because they don't pick up the tab most of the time, and therefore don't need bc. options. When was the last time a man died in childbirth?
It isn't free and wasn't covered for YEARS after ED meds were for the same reason. What happens to women doesn't matter. We have Brett Kavanaugh on the SC to demonstrate that.
Until we stop voting for old men, old white men, we will have this problem.
Women's lives don't matter, poor lives don't matter, black and brown lives don't matter to our elected leaders. Old white men matter.
10
Unfortunately our current administration will not support intelligent and compassion efforts like this one. They'd rather force women to give birth while taking away any safety nets.
9
While I agree in general, I think birth control should be easy for everyone, I despise the double standard.
We can make this simple: Reproductive Equality. That means men and women have access to the same general types birth control, i.e. condoms, abstinence, and (possibly) sterilization. Those are barrier method, not having sex, and permanent end of fertility. Are these ideal methods? No. Are they the options that would be available to both biological genders? Yes. Ms. Miller has the choice, along with many others, to raise the battle cry for easily reversible male contraception as well. Why? You want to see how quickly birth control becomes 100% legal, make a method of easily reversible birth control for men, and all insurance companies will end up legislated into covering all birth control in short order, including the religious employers.
I have zero doubt that Ms. Miller (and her ilk) would, rightly, stare in shock at the suggestion that a woman who didn't want a baby should keep her legs closed. I also have zero doubt that Ms. Miller (and her ilk) would be right in line to blather that a guy should've kept it in his pants if he didn't want a baby. That is part of the infuriating double standard.
1
@Joseph S.
"Ms. Miller has the choice, along with many others, to raise the battle cry for easily reversible male contraception as well."
Um, pretty much everyone who works in repro health does want this. We can't force big pharma to make it. It's not a double standard-- it's just that an effective male contraceptive analogous to the pill with a sufficiently low level of side effects has yet to be developed. You want it so bad? You lobby for it. We're busy pretty busy working against the onslaught of restrictions on abortion and family planning resources as it is.
While you're at it, why don't you start a campaign to get young men to quit whining about using condoms.
15
@ Joseph S.
Seriously? Perhaps when men are equally at risk of the physical and emotional effects of pregnancy and childbirth can we talk about “Reproductive Equality”.
1
My reaction to this headline was, “Why is this news?” But I know the answer.
If we really want to reduce poverty and improve the lot of women, this question should be asked in health clinics in every high school in America.
8
People have children while living in war zones, live in poverty and have no way to support themselves or their progeny? What motivates them to multiply in these circumstances?
The world is over crowded and endless "wants" by every one is destroying the earth faster than anticipated?
Birth control must be a way out of this destruction? "Go forth and multiply" Indeed !- any method should help counter this destruction of the earth.
8
@Hrao - Biologically speaking, the only reason we are born is to reproduce. Hence, there is a very strong urge to have sex, even in war zones, even in poverty.
4
This program is great for numerous reasons. I completely believe that free access to birth control is essential to dismantling patriarchal structures and achieving income inequality. I do worry, however, about the potentially dangerous side effects of some of these methods. Hormonal birth control's effect on mood is widely documented, yet understudied. Most studies focus on the pill. There have been no controlled studies about the effect of the implant on mental health. This is a much newer method and should be treated with more caution. I have heard many women who have had experiences with the implant where they ended up deeply depressed, attempted suicide. Many did not realize the implant was causing anything until they had it removed for other reasons. Of course, many people love this method. I just worry about the same day appointments-- women should have the chance to do their own research and hear others' experiences. I trust doctors and health care professionals, for the most part. But the medical device industry is very corrupt (please watch The Bleeding Edge documentary on Netflix), and we should all want more independently funded testing on newer devices before recommending them to millions of women.
2
@Julia Thank you, this was my thought as well. IUDs and implants can migrate elsewhere in the body, cause autoimmune reactions and blood clots, perforate organs, and more less serious but still debilitating side effects. Policymakers view low rates of women using IUDs and say how can we use policy muscle to guide more women to use them, rather than say maybe women have perfectly good reason to be skeptical about foreign objects being stuck in her body for years.
@Julia. What could be more depressing than an unwanted pregnancy?
2
I have to ask: How often do people below the poverty line visit a doctor? If women don't have fiscal stability to support regular medical visits, how much impact are we really going to have on poverty? I would think most of the benefit would go to lower-to-middle income families to keep them from backsliding into poverty. Aside from Medicaid recipients, the already impoverished probably won't improve much.
5
Poverty is impacted because women will have the option of working and supporting themselves instead of taking care of unwanted children.
4
@Andy
Excellent point. This is why we should follow the examples of European countries that have b.c. available in public schools. Women need access at the point of sexual initiation, along with honest and complete sexuality education.
Once you are working two jobs and already have children, getting to the doctor must be heallacious.
1
Program makes a lot of sense, always did. Unfortunately, I can imagine that at least one surpreme court judge would like to make it unconstitutional.
6
The story of Sonia Ramirez makes an important point about the difference between a Rx for pills versus an implant or IUD. The Chair of my Ob/Gyn department published a study on their family planning clinic about 20 years ago. Teen-aged girls who came in for the first time and requested birth control had 75% pregnancy rates the first year. Why? They were there because they had become sexually active, but did not understand and did not have the maturity to take a pill every single day.
I got my first grandson because my daughter was on the pill and then was prescribed tetracycline for walking pneumonia. Tetracycline kills the gut bacteria that recycle steroids metabolized by the liver and plasma drug levels will drop. I asked whether her physician had told her to use an alternative form of brith control. "I don't think so???" If instead she was on a LARC, no grandson.
8
This is a fascinating article, on a subject that I, a person who has lived in DE for 4 years (including college), was unaware of. It is also an interesting contrast to the work the governor and the mayor of wilmington are doing (see shipping prisoners out of state and criminalizing poverty while promoting gentrification). It's nice to know that some people are working to fix the root causes of problems.
4
Sounds like a great experiment and I hope the idea spreads.
As to "the Roman Catholic Church remains broadly opposed", well, that's RC officialdom, and some very very conservative Catholics.
One question I might have missed in reading the article - does funding apply for covering women even if they're in jobs where their employer is forcing the employer's religious views about contraception onto their employees with that contrived "free speech" exemption?
8
"Ms. Myers said an effort like Delaware’s would improve women’s autonomy and reduce abortions. But she was skeptical that it would necessarily reduce poverty."
This woman, Ms. Myers, is an associate professor and yet she doesn't somehow understand how having a child can perpetuate poverty. As wonderful as babies and children are, they are expensive. They cost money to feed, to house, to clothe, and to educate and meanwhile, without a good day care solution it is often also impoverishes the mother as she can no longer go out to work.
This program sounds wonderful.
17
@lzolatrov — From the paragraph before:
”One study of teenagers with unintended pregnancies found only small differences in outcomes between those who had miscarriages and those who delivered babies.”
This is a global solution, especially the three year implant.
Now that the Gobal Fund has shown such great success against AIDS, TB and malaria, birth control, then micro-finance, are the next steps to alleviating poverty world-wide.
Once there is funding for education, nothing is more important to keeping girls in school than fertility control. And there is nothing more important to combatting poverty than keeping girls in school.
15
I have been an attorney for many years, and I have met many people from every strata of society. It is clear to me that the greatest social costs are a result of births to teenage mothers. The fathers almost always disappear within a short time, the mothers have problems, and, as a result, abuse, neglect and child support cases end up in family court, at tremendous expense. Mothers drop out of school and work, and they and their children become dependent on state aid. Education is provided for free, but the mother (again, the father is gone by this time) is not a taxpayer.
There are higher rates of criminal behavior by the children of teenage moms, and there are other poor outcomes (see the Freakanomics book).
SO, I SAY TO YOU COLD-HEARTED PEOPLE WHO CARE NOT TO PROVIDE WOMEN WITH THE MEANS TO TAKE CARE OF THEIR OWN BODIES, SUPPORT CONTRACEPTION TO HELP YOURSELVES.
38
@NYC299 This is my problem, even without this program they have the same options that are the only options for men: Condoms (barrier), abstinence (foregoing), and possibly sterilization which is unlikely as it is permanent. However, as a society, we regularly tell men to deal with the problem and that if they didn't want a baby they "shoulda kept it in their pants", now pay up.
You want to get birth control, all birth control, available by insurance for everyone? Introduce a little reproductive equality by coming up with easily reversible (e.g. a pill or other method like vasalgel) male birth control. I can guarantee in a couple years you will see insurance companies covering birth control, and even religious employers won't get a choice. This will mean that state programs will pay for it as well, since the bible thumpers will have lost the support of every mom & dad who will be taking their boys to get (as an example) something like vasalgel ASAP. I know my parents would've taken me to get get something like that in a heartbeat.
1
Better contraception could be a key to reducing poverty? Could be? Is that a "maybe" I'm hearing? Really??
Better-- and more available, as in "free" -- contraception, of all the possible checks on poverty that can actually be put in place, is the simplest, thus the most likely to succeed. Sure, there are pipe dream solutions that sound better, but this can actually work.
18
I am amazed that this article is necessary in 2018 although I am so glad that it has been written. I am British and I think that I am correct in saying that free contraceptives were available in the 1960s. There was a shift around that time, removing family planning clinics from the back streets to better premises in the high streets
The result of social changes such as seatbelts and free contraceptives meant a huge drop in pressure on valuable medical resources.
But I am glad to see that the states are moving in this direction. Apart from having the ability to control our family size, I felt that I now had dignity and care from the better and more welcoming facilities.
And I was able to back to work and train as a science teacher while not having to worry about an unintended pregnancy.
13
The article would have been much better if it included any discussion about the fact that hormonal contraception is not the best option for many women. Oftentimes, there are side effects, and women find that it’s not worth it. It may seem that applying long-term hormonal contraception to every woman who does not wish to have kids is an all-too-simple solution, but it is not. Measures such as the one discussed in the article being rolled out in Delaware should include alternatives, and women should be aware of possible side-effects, of all the ups and downs of distinct methods. I’m not sure if everyone would benefit from making this decision in one day without being told in advance.
10
@A, good try, but that's not what's happening. If you think they're going to force the woman to choose a contraception method RIGHT NOW or she can't leave, you are being foolish.
It's all a part of trusting women. If the patient wants more information, she'll get it. If she wants to think about it first, she can do that.
The program is addressing an actual issue. Can you guess what that is? Controlling one's own reproduction schedule. According to you, information and action are coercion, not freedom.
Also, isn't an IUD hormone free? And how is the woman forced into 'long term' situations? In fact, did you read the article at all? You make it sound like a re-education camp or something.
5
@A - Not all long acting contraceptives contain hormones. The Paragard IUD has no hormones.
7
@A agreed. Nor does it mention how it is nearly impossible to access non hormonal BC methods such as a cervical cap anymore. They simply are not manufactured or available in the US - you have to order them yourself, from Europe. The medical community poo-poo's women's reaction to hormonal BC saying there's no proof - yet nearly every woman I know can't take hormonal BC because of complications.
1
Besides global warming the greatest threat to life on earth is the explosion of the human population.
23
@Tracy Rupp Hence the need for human extinction, as stated in this NY Times opinion: https://www.nytimes.com/2018/12/17/opinion/human-extinction-climate-change.html
1
@Tracy Rupp — Global population growth peaked in the 1960s.
Contraception unquestionably is the most effective antidote to poverty. Three cheers for Delaware!
29
@Penseur No, abstinence is more effective than any contraception.
@SJW Tell that to a 14 year old girl with no money, nowhere to go and a boyfriend who says he loves her.
4
@SJW
Tell that to the women who didn't choose to have sex. Then again, I gather that abstinence is, like b.c., something women are always responsible for.
4
Hooray for Delaware and other places around the globe. IUDs are great.
15
If I were king of the world I would make contraception and tampons and women's services free and women's health education mandatory for all. Then I would overhaul the education system and bridge the education gap between women and men. Those steps are the only ones towards equality. Then we would need education on how to be conscientious and courteous -- cornerstones of equality.
19
The problem is not technological.
The solution is not technological.
Contraceptives only work if they’re used.
The problem is cultural.
Until out of wedlock parenthood is portrayed in popular culture as a supreme disgrace, poverty will only get worse.
7
@Melvin
Precisely. Many well meaning people think money and some type of non-specific "education" is the answer to all of societies' ills. These won't help. Cultural changes are ultimately all that work. Unfortunately this can be difficult to accomplish. We've been heaping money and education on problems to no avail since Lyndon Johnson's Great Society. It has not helped.
4
The type of contraception they're discussing in this article will be used, because the woman can't remove it without a medical specialist. No cultural shift needed.
3
This is a shameful post. People make mistakes and have accidents in life especially younger people. Why should a young mother and her baby suffer because the mother is not married. Go back to the Middle Ages!!
12
But, but, ... , pregnancy is how conservatives control women. How will we control women who have contraception?
27
@Mexaly My, my! Whatever will the Catholics and evangelicals say!
3
SHOCKED, SHOCKED that making birth control available and affordable cuts down the rates of abortion. (sarcasm tag)... This is so sensible, its scary. I am past child bearing age but it makes perfect sense to help women and their families plan when to have a child.
28
This is a good first step... but what about the boys/men? When they go to the doctor are they asked if they want to be fathers? Seems like a good opportunity to have a conversation with them also... sigh, let them be responsible too!
53
@SH: Good point. How about it doctors!?!
3
Most of the comments here talk about women getting pregnant. To be fair, men can also get pregnant, namely transmen. Please stop referring to pregnancy as a female problem.
3
I've never understood the low numbers of IUDs. I got my first one a little more than a year after my daughter was born in 1974 when I found out I was prone to blood clots. These days they can stay in place for years without problems. The ability for women to choose when and with whom to have a baby threatens some people, especially those who want a patriarchal society to remain in place with cheap labor readily available. Women who can control their own reproduction threatens that. I salute Delaware for taking the lead in allowing women the freedom of true equality.
22
@Vanessa Hall
Wonderful that they worked well for you but they can also cause pain and bleeding.
2
IUDs are fantastic, unless you're one of the estimated 5% of women with congenital uterine anomalies. Screening for these anomalies before insertion would jack up the price tag considerably.
2
@Nora. The implant would then be a good choice.
@Cal They would be a good choice for women who do not have uterine anomalies; the IUD may fail if the uterus isn't shaped correctly. Many women report severe discomfort after IUD insertion and I wouldn't be surprised if they have undiagnosed anomalies. A physical examination does not screen for these anomalies; expensive imaging techniques such as ultrasounds are necessary.
'she wondered if Upstream was tipping the scale by first telling patients about long-acting methods because they are “most effective.”'
Why do you put 'Most Effective' in quotes as though this is someone stating an opinion and thus must be directly qutoe rather than a fact? You even cite the facts later on. It drives me crazy when you guys do this as everyone immediately imagines someone making air quotes while rolling their eyes which then discredits the information in the quotes.
12
@Erin B Because effectiveness depends on responsibility, like the responsibility of women to use birth control pill daily at the same time. It's nearly 100% effective if you use it, but not effective if you skip doses. Likewise, abstinence is the only method that is 100% effective if used.
@SJW
But that's the point, SJW. You don't have to remember anything when you have an implant or an IUD. That is one of the main points of the article.
I might add that abstinence is similarly not effective when it is not used, which is exactly why we have so many unintended pregnancies.
9
@Madeline Conant
Abstinence is NOT something women have consistent control of. Stop pretending it is. Even within "committed" relationships, even within marriage women are sometimes forced to have sex that for them is unplanned.
Astinence works for MEN consistently.
5
Maybe this will soon/eventually lead to free contraceptives for the world and help reduce the population before we kill ourselves by over-population!
Make every child a wanted child. Life is tough enough without being born accidentally and into poverty, hunger and/or war...
22
This program should be implemented in the third world countries in sub Saharan Africa which is predicted to increase the population of those in poverty by the billions.
By 2050 sub-Saharan Africa as a whole will be home to 86% of the world’s extreme poor.
23
Yay Delaware for playing a very small part in reducing the number of humans on our dying planet! When will the NYT start presenting reports like this in conjunction with all of their wonderful (and thoroughly depressing) climate coverage? The two topics are inextricably linked.
18
So happy to read this. So, when will New York get on board? @governorcuomo
12
The Catholic Church is outdated in their doctrine. They absolutely have no say in a woman’s body and their choice in birth control. None.
25
This is great.
But once again the young men are left out. Men still have no safe, effective, reversible birth control.
Sixty -- 60! -- years after the birth control pill gave women control over their fertility, men are still left with one -- ONE ! -- not particularly effective option: condoms.
Condoms FAIL nearly 1 time in 5, when used as directed.
Federal and State governments have invested nothing in male birth control. Big pharma too has ignored the market, mainly because the most promising technologies don't involve repeat-sale drugs. Planned Parenthood? M.I.A.
Unplanned fatherhood is one of the leading causes of young men dropping out of high school and college.
Why does no one care about young men?
9
@Frank, Not a priority. Birth control has mostly been all upon the shoulders of women. Why should they worry?
They've got their Viagra.
8
It's not so simple Frank. Men produce sperm 23/7, women ovulate once a month. To effect sperm production without decreasing testosterone and giving men side effects they won't tolerate has been challenging. Targeting a once a month event has been more successful. I agree that there needs to be continued research on a male method both for men's benefit (I have sons so I worry about them) but also for women not to bear the burden of unplanned pregnancy. If you want to get into the "no one cares about young men" argument, far more women have their options limited by unplanned pregnancy than men.
20
@Frank
Please tell us about the advocacy work you are doing to ensure that young men have reliable contraceptives. Are you lobbying Big Pharma for the development of such drugs? Passing out condoms in schools? Lobbying for greater sex-ed?
Folks who work in the reproductive justice/health world are *not* leaving out young men. We are desperately trying to get all men to take responsibility for their sexual activity. In my experience, it's not that *we* don't care about them, it's that *they* don't care, because they see pregnancy as the woman's problem to deal with and burden to prevent.
Somehow I doubt that you have the displeasure of listening to men whine and whine and whine about how little they like condoms.
5
but we knew that...
2
How do we get this for New York State?
6
It's always amazing to watch the wheel be reinvented. Margaret Sanger started this at the turn of the last century. I can't believe we have to have this conversation again. I'm heartbroken we have to keep having the conversation about how uncontrolled fertility derails women's lives. I'm so glad that this program addresses the need immediately, but I'm sure some jerk will decide that female fertility is the purview of a board, or an assembly or a congress (anyone but they woman in question) and then in their usual regressive fashion, will mess it up.
12
The implant lasts for five years, not three!
3
@Family Doc Actually, the current implant (Nexplanon) only lasts for three years. The very first version, years ago (Norplant), lasted for five.
4
@jm - The Nexplanon is approved for 3 years, but there is evidence that it protects for longer than that.
1
Don’t have babies you can’t afford, pretty straightforward.....
8
@There’s - Birth control helps people do that. It’s pretty straightforward.
30
Check out the "Colorado experiment" for another look at this topic that supports the conclusions of the work being done in Delaware.
https://www.nytimes.com/2015/07/06/science/colorados-push-against-teenage-pregnancies-is-a-startling-success.html
9
What about men and their responsibility?.
Vasectomies, free if you have to, an develop reliable reversible vasectomies.
Vas deferns control shoul be our focus for the next 50 years. After all we have been monitoring worms forever.
8
@garlic11 Vasectomies are not reversible and require invasive surgery.
Vasectomies are done on an out-patient basis and are MUCH less invasive than tubal ligation.
Editor’s note: This comment has been anonymized in accordance with applicable law(s).
2
Missing entirely from this conversation is why nothing being done to advance these types of long term birth control options for men. All pregnancies, unplanned or planned, are the result of male ejaculation. Wouldn't men want to ensure they aren't burdened with child support payments and unwanted children by having better birth control options than condoms? What's driving the lack of medical research into male birth control? Could it be that it's assumed men won't be responsible enough to take it? That the side effects might be prohibitive and inconvenient (like mood swings and weight gain.) Until we require men to take an equal responsibly in all aspects of family planning, women will continue to bear the burden while being unilaterally blamed for unplanned pregnancies.
21
As someone else mentioned in this thread, biology makes hormonal make bc difficult. Women ovulate usually once a month. Men produce sperm 24/7--interfering with that without side effects would be difficult.
1
I certainly don't think this is a bad program, and it may even be good. However, it doesn't get to the heart of the matter, that many women of childbearing age simply allow themselves to become pregnant because they're not sure what to do with their lives, want someone to love them, or may even hope for increased benefits. These issues are sociological and cultural and will likely not be resolved by simply offering free birth control. Many of these women have access to contraception but simply refuse to use it consistently. Often that's because they lack a clear sense of themselves or a path for their lives. They may also come from families in which there have been generational unplanned pregnancies. That's where culture comes into play, and as anyone who has really dealt with women like these knows, that's very hard to change. But one surefire way to shock them into changing their sexual behavior may be to implement a one-child rule with respect to benefits. That is, housing allowances, cash assistance, food stamps, etc. would not be increased if a woman has another child while already receiving assistance. Knowing additional help will not be forthcoming might force a reckoning that's long overdue.
15
@Rhonda- your cure does not follow your diagnosis. You just finished describing your target group of women as often lacking "a clear sense of themselves or a path for their lives". So why would they have a logical response to the threat of an aid cut if they get pregnant again?
I'm not arguing with your description of some of the issues society and poor women face here. I just think that a program of positive reinforcement begun at child bearing age for women and girls in poverty would work better. A stipend for each month not pregnant and an extra amount in a personal college fund adjusted to grade point averages rewards staying "un-pregnant' and helps them see a way forward for themselves if they apply themselves. Contraception of their choice would be provided at local federally-funded family centers.
6
@Rhonda Right, so let's punish the innocent children. Food stamps for your older brother, but no food for you!
8
@Rhonda "One child rule" "Shock" "women like these" "force a reckoning." All right wing buzz words about punishment and control.
16
This is just common sense. After the doctor asks the woman whether she plans to become pregnant, if she answers yes, she should be asked whether she can afford to become pregnant. It may be an invasion of privacy, but the doctors should invade one's privacy on issues like this. They already do on questions of drinking and drug habits. Our society needs to lower the birth rate for everyone's good, just as we should for drug addiction.
15
I gave birth to twins last month, 3 years after my first baby.
I'm in my late 30s and am definitely done at this point.
The first time around, I don't think anyone asked me about birth control. This time, it came up frequently. Before the C-section, the doctor broached the subject of tubal ligation since it's a fairly easy to add-on. Several times in the hospital, including on the day of discharge, the doctors asked about birth control methods going forward including LARCs.
At my 1 week OB appointment, the doctor offered to insert an IUD and then gave me a name of a doctor he recommends for vasectomies.
Frankly, sex and birth control was the last thing on my mind right after giving birth. But I was glad for the reminders and how easy everyone sought to make the process. Now home with 3 kids under 3.5, I can really see the benefit to dealing with it while at the hospital.
So I think this is great progress. And yes, we got that vasectomy appointment scheduled.. (though I think I made a mistake not choosing a tubal)
25
You had a good experience at your hospital but clearly it wasn’t a Catholic one.
Kudos to Delaware, and now to Washington and Massachusetts. Finally, a true public health program!
All women in this country and around the globe should have access to reproductive health care and contraception, provided in a humane, supportive and efficient manner. The burdens and obstacles that prevent many women from obtaining this life-transforming service must be removed.
28
@CA Reader
With the Democrats coming to Washington we can have the conversation with the GOP who cut funding to health programs in Africa and parts of the United States. The attack on Planned Parenthood is all about cutting funding so that women are empowered to take care of their own bodies and decide how many children they want. It's always women who need to live with the choices that old white men decide for them. The whole discussion on birth control has been about men telling women what they can and can not have. Look at Trump and the funding that has been held because they didn't like what was going on with countries who needed to address unwanted births that led to deaths.
Finally a new day.
6
This could do a lot to end the cycle of poverty in low income communities, where the birth rate far outpaces that in any other sector of the economy. More than 70 percent of infants are born to single mothers in some impoverished communities. It needs to be implemented on a major scale, like school eye and hearing exams and vaccination.
28
@M Davis Women who earn less, and have partners that earn less, will likely never marry. Marriage is artifact indulged in by the rich, the rest of working America avoids it. So if a couple, of modest means, have a child, it is a child born to a single mom.
This is a great program, and I hope it can be expanded to other states. The other need, though, is to have more comprehensive family planning education for teenagers. Most programs still -- if schools have them at all -- focus on the mechanics of sex and pregnancy and STDS, and not on the consequences or on female agency. What we need is comprehensive programs that cover relationships, consent, life planning, financial literacy and contraception holistically. Some commenters have noted that teenaged girls in impoverished communities want to get pregnant, but that is because they have no sense of control over their lives. So giving these girls some tools to exert control over their lives (including their financial lives) might encourage them to take control over their fertility as well.
17
If only Catholics could understand that better access to birth control means fewer unwanted pregnancies and less demand for abortion.
But of course the Church ignores that fact and continues to discriminate against women and common sense.
54
@Jack Noon If they don't want births, they can just practice abstinence. It's called self-control.
@SJW
"Just" practice abstinence?
That's just ridiculous. Don't you understand that for most adults, sex is a natural, healthy part of romantic relationships? Do you expect people to just quit having sex with their spouses? Do you really think it is reasonable for people to forego romantic partnerships for their whole lives?
Do you think that husbands and wives who want to have sex are people who lack self-control? Do you really think that not having sex with a spouse is a simple matter of whether or not you are capable of exercising self-control?
It's interesting to me that you pretend that abstinence has no serious consequences. It's interesting that you choose to frame it as an issue of "self-control," as if people who choose to have sex are some how moral failures who are incapable of regulating their behavior.
13
@Jack Noon: not only do over 90% of Catholic WOMEN use contraception....the Church is not the official religion of the USA and isn't even the largest or most dominant Christian sect.
They have little or no influence over our laws or what kind of birth control women can get in hospitals, clinics or doctor's offices.
2
Next - start a similar program for young men..
23
I have hope that giving women this biological agency and control (power some women may have never expected) will induce them claim more even more agency and control, in every area of life.
That would bring a whole host of benefits!! Imagine empowered women! What a beautiful sight!
14
Asking whether a woman wants to get pregnant sounds like an invasion of privacy to me. I would tell them it was none of their business and that they were getting too personal.
.
Aborting an unwanted child is outrageous. No child is unwanted and there are many people who would gladly adopt the baby. Just ask couples who are unable to conceive and they will tell you they would love to adopt this infant. Abortion is not the solution.
3
@WPLMMT The problem with your argument is that we see daily examples of innocent children who indeed are treated as if and may in fact be unwanted by their mother. Those longing for a child are not connecting with those mothers willing to give up their baby. One might say this hints at a baby factory industry, and how do we deal with that?
Further sexual interaction between humans is a strong as it is between animals, and is one of the most urgent biologic functions on this planet. From those situations pregnancy will result, even when the want of the mother is to not be pregnant, but enjoy intimacy.
Further, to say that a woman is just a carrier for the baby until it is born to then be given to a hopeful set of parents completely marginalizes the risk and experience of being pregnant, which are not insignificant. Women die during pregnancy due to complications. Some women, finding they are pregnant, do not want that supposed joy and excitement that is so deeply rooted and held by those wishing to be a mother and a family.
Those wishing to not become pregnant must be allowed to have every opportunity to make that choice, and do so before the fact so as to avoid the concerns of abortion.
37
@WPLMMT
Black babies, brown babies, opioid-addicted babies?? The babies born without prenatal care? Besides, once the baby is born, very, very few mothers voluntarily relinquish their child.
15
Contraceptives = no unwanted pregnancies (or very few) = fewer abortions. Doctor - patient conversations are private. It doesn't see like an invasion of privat to me.
21
Global warming is mostly caused by overpopulation.
Why the constant coverage of global warming and yet almost no talk about overpopulation?
The New York Times should do an in-depth report on the issue, and not be chicken about it and try to make it politically correct. Or word it for the sensibilities of some.
Over population has greatly contributed to global warming. And, it’s only the beginning. Obviously limiting population is a key tool to save our planet.
29
@Lily Because global warming is not "mostly caused by overpopulation." It is largely driven by the lifestyles of the rich, "developed" world. Lots of reasons to support family planning and lower population, but the tidy cause and effect you posit is simply not there.
2
I suggest watching Florida over the next year for comparison purposes. The incoming Republican Speaker of the House and the new Republican governor look ready to cut already minimal state spending on health care.
Politically, we're South Alabama but without legislation that would hurt the vast (but low wage) tourist/convention trade.
8
The most effective method of contraception begins with the letter “A” and is free: abstinence. This is incontrovertible. End of story.
2
@SJW Do you practice what you preach?
Humans have tried to stop other humans from having sex for about 6,000 years using your approach. It hasn't worked very well, has it? Time to try something new, don't you think?
30
@SJW
But that doesn't happen, does it? The drive to reproduce is built into our genes. I guess you were never a teenager! Unfortunately for human beings, they become sexually mature long before they become emotionally mature enough to raise children responsibly. Why do you think the world population is close to 8 billion today? We breed like rabbits and our impact on the earth is much higher than rabbits ever will be. As humans, we can manipulate our environment, purposefully or not, and our population is becoming more and more unhealthy because people are surviving and reproducing today who would have been weeded out by "survival of the fittest" before modern medical science. My mother's mother had 13 children who all survived to have their own offspring. As a result, in my generation, 2 people have produced over 250 descendants!!
17
@SJW- Abstinence doesn't work for all and never did -- even in the Bible.
So thank God for contraception for those who don't choose abstinence and don't want a baby yet.
It's their choice, isn't it?
17
We need to encourage all young people to follow the example of the Obama's! Get an education, get married, get goods jobs AND then have children - preferably just two! Why this path to success is not widely taught baffles me! Of course, contraception is part of this equation!
15
@Donna Gray, Yes, only the Obamas ever had this idea.
7
I hope it works. But my aunt works as a teacher in a very poor middle & high school and tells me that the young women there (really girls - some are just 14) WANT to get pregnant. They think of a baby as a status symbol of sorts and think that having one will be like taking care of a kitten. She’s been doing this work for 40 years and the contraception message in that very disadvantaged community is not getting through.
30
The only “conceivable” explanation for effective birth-control not to be on the front line of the war against poverty is interference run by the unconstitutional marriage of church and state.
29
Long term contraception is great - except for the teen age girl who gets talked into having sex without fully realizing the consequences of bringing a new human being into the world - usually alone because the boy - or his parents - doesn't take responsibility.
The morning after pill should be widely available - without a prescription just like condoms - and no questions asked. New human beings should be planned and welcomed - not "accidents" that change the lives of all around them and usually not for the better.
34
@njglea Long-term contraception (IUDs and implants) prevent the new human from coming into the world. The issue of consent, real and otherwise is a completely different issue.
5
@njglea: get with the program.
Plan B is available at almost all drugstores and pharmacies, and for FREE thanks to Obamacare.
1
Thank you, Concerned Citizen. I didn't know that. However, why not have vending machines with the pills in women's restrooms - just like they have/had condoms in men's restrooms?
Some girls and boys are too embarrassed to buy these things in stores. The ideas is to STOP unwanted pregnancy.
Common sense to most people who believe that contraception is a key factor in preventing poverty. Yes it is mostly a blue state practice and again will not really take hold in red states especially the South.
I wonder if there is any way to avail these services despite state law....perhaps funding trips to blues states to get contraceptives and counseling?
The South and flyover states wonder why the elites perceive them as uneducated yockels...well, science based logic as described in this article make a very powerful argument for contraception....we are living in the 21st century not the 1950s...racially, socially and sexually.
10
Not all unplanned pregnancies are unwanted. If someone is asked if they are sexually active and are planning for pregnancy this year, they almost all state they are not planning on pregnancy. "Are you planning," is the wrong question. "If it happens, it happens, " a common American response means "Hey, surprise me, relationship." My point is 45% of pregnancies are unplanned, but many are machinated, and most definitely not unwanted.
As health care providers we are not making a good case for prenatal preparation and the importance of quitting tobacco/ alcohol/ other drugs and starting prenatal vitamins. As a result we have a much higher rate of children with deformities, premature deliveries, developmental delays, and NICU visits at birth.
A similar Colorado experiment for several years had a 13% reduction in total pregnancies. This is the general estimate for true unintended pregnancy.
4
The clinicians are asking if the patient wants to get pregnant, not if she is planning on it.
13
@Karen
Any effort helps and 13% isn't chicken feed.
10
Wait.
99% of sexually active women between the ages of 15 and 44 have used birth control? And the Catholic hierarchy and much of the Fundamentalist Christian hierarchy deem this "immoral"? And we know that preventing unintended pregnancies yields many benefits to society as a whole as well as to the individuals who use birth control and to their families? And one of the two major political parties in the US does not want unwanted pregnancy prevention covered by health insurance policies?
Get ahold of yourself, America. You seem to be losing it.
15
This so-called “benefit” is nothing more than a government conspiracy to give women control over their own bodies.
This slippery slope can only lead to other unintended outcomes like equal pay and increased participation in civil society.
Shame.
43
Bravo Delaware! A voluntary program available to women, at no cost,
with the potential to reduce both poverty and abortions...hard to find a downside.
20
A society that cannot afford children is truly impoverished, even if it is the United States of America. It is also a society that does not believe in its future, and does not deserve one.
1
@JOHN nobody is having children for “society”. Women are having - or not having - children for themselves. What are we, brood mares at the collective farm USA? I have two kids and I don’t want any more because I want to do other things in my life besides changing diapers. I want to have a career, I want to travel, I want to have money to spend on myself. Why is it so hard for some men to wrap their heads around the idea that motherhood is not the be-all and end-all of a woman’s life? Some women don’t want kids at all because they don’t like kids. Some - like me - want two. Some want more. I believe in the future and I work for the future as a scientist, a scholar and a writer. Why is my contribution in those fields less important than an additional baby, or two, or five? Humanity is hardly in danger of extinction because women are finally able to regulate our reproduction.
5
Wow it’s about time! Bravo Delaware!!!!! One of the “groups” I have personally run into that impede access to birth control is...obstetrician/gynecologists. Look at it this way there is way more medical billing for a pregnancy than a one-time annual visit and birth control. Also I live in the Deep South every ob/gyn I have seen (men and women) are deeply biased toward women having babies it’s usually why they are in this specialty and many have religious beliefs that don’t support birth control. I have been obstructed from receiving birth control IMMEDIATELY when I request it for any number of reasons. The immediacy of Delaware’s program is going to make it more effective especially if the women choose iuds.
14
Gapminder, a public service site that shows how we tackle world population issues, and world poverty, factors in birth control into maintaining a lower world population. In Yemen, the 4 malnourished babies a doctor was treating on a documentary, who will be dead 2019, will have a new sibling, as mother has no control, and no access to birth control. Yay! When I looked at it 10 yrs ago, a neighborhood high school had a planned parenthood nearby. back then, $170 for initial visit, and one month of birth control. What 10th grader has $100 bucks when their boyfriend's hormones take over?
8
I asked my OBGYN to insert an IUD after I delivered in 2006. I paid $750 for it because the insurance refused to cover it. The IUD had to be replaced after 10 years, and I tried to get a new one, but my OBGYN as well the insurance company were least interested in following up on my request. They kept asking me to call a bunch of numbers to get clearance from my insurance provider. Finally, when I was visiting my family in India, my sister who is an OBGYN inserted it and the device itself was free of cost, because the government in India actively promotes the use of this method of contraception. Boy, did I save a few hundred dollars and a lot of headache!!! Never understood why the insurance companies in the US run a scam to prevent people from getting this cost effective and convenient way of contraception.
31
I would not want my doctor or a family nurse practitioner asking me if I was going to become pregnant. I think that is a bit prying. Why don't they just come out and ask me if I want contraception. Then I will tell them my answer.
1
@WPLMMT Just say "No". Not so difficult.
9
Delaware Child Protection Agency: Keep an eye on your declining referrals for child abuse and neglect over the next 20 years. I'd bet a fairly major body part they'll go way down.
26
I’m really happy to see other blue states conducting real-life laboratories into proving my long-term view that easily accessed, widespread availability of contraception is key to resolving many of the current issues facing American society and its economy. A widespread culture of informed, well-practiced family planning, especially if begun in early teen years, will revolutionize our society in ways that the fear-mongering religious mythology used to shame, confuse, punish, and disempower women could never hope to do.
Red states and Republicans are hopelesssly and forever beholden to the evangelical patriarchy that is currently attempting to furiously shove the childbearing genie back into the 1950s bottle of women’s enslavement to biology and ancient religious moral codes. So, it’s up to blue states to forget about them and move forward into the future. Eventually, the giant and accumulating pile of evidence blue states are creating will prove that if you’re anti-abortion and wish to continue living in our science-based 21st Century society, you have to be pro-contraception.
16
This is a wonderful and important program. I wish it were supplemented by free abortion on demand but given the extent of religious irrationality on this subject, I am not optimistic. Unregulated reproduction not only increases poverty, creates generations of abused children, and contributes to higher crime rates. It also diminishes women’s human dignity. We are not brood mares. We are not defined by the content of our uteri. I am a mother of two children but this is not my only, or even my most important, identity. However, it is not enough to prevent young girls from falling victims to their biology. It is equally important to develop their minds and imagination, to instil in them the ambition to be more than breeders. Yes, give them contraception but give them books too.
17
Retired secondary teacher here. What a different life some of my former students would be living if only they had been given this choice. What a difference it would have made in breaking the cycle of poverty and abuse in the lives of girls forced to abandon their education and take on responsibilities beyond their maturity.
223
Actually, irresponsible ejaculation causes 100% of unplanned pregnancy. Women cannot become pregnant without an irresponsible ejaculator. Perhaps you should bemoan all the irresponsible men who are at the real root of unplanned, and in many cases, unwanted pregnancy.
We could have another satisfying and enlightening conversation about how many of those irresponsible ejaculators walk away from the babies they creat.
3
@Kelly Clark
You're not helping.
Do something useful, and donate money for medical research on a 'pill for men'.
1
@Kelly Clark What on earth are you talking about? She isn’t blaming the girls, she is wishing that they could have had options to avoid getting pregnant in the first place. -NW
The idea that early motherhood leads to poverty is an attractive one, but it may not be true. Some studies found that for working class women, having children early is an economic advantage. This is because women who delayed pregnancy often ended up single mothers raising a child without a stable partner to share the burden. But they also lacked the family support that younger women often had and had a more responsible job that caring for a child interfered with.
As one researcher suggested, if you are working as a store clerk, you can call in with a sick child. You may lose some income, but you likely won't lose your job. But if you are the store manager, chances are it will eventually prove unacceptable.
There is no doubt that the ability to decide when and whether to have children lead to the liberation of women. Before the courts legalized birth control, married women were routinely excluded from professional training on the premise that they would get pregnant and drop out of professional life, regardless of their intentions. But we ought to be careful that we don't start believing that delaying pregnancy is necessarily the best option.
The way to reduce abortions is to reduce unwanted pregnancies. Providing easy access to contraceptives is the best way to do that. But many opponents of abortion are not really focused on preventing abortion. They see the threat of pregnancy as a way to stop sexual behavior they don't approve of and punish those that do it.
71
@Ross Williams As you point out having children is an advantage. One gets ones own house or apartment, one gets a variety of other government benefits.....one is grown up. In societies such as the Near East or Africa or Central America women with children are less likely to be raped or abused. And men want a say in having children. In many societies men are judged by how many children they create and they are not entirely happy with the idea that women should be able to control their fertility. With NGOs and worldwide migration becoming commonplace the economic consequences of overpopulation are gradually being minimized.
5
@Ross Williams
Please cite these studies you refer to, because I am having trouble making it add up. Where I live, store clerks are not given extra slack to stay home with sick children, they get two strikes and they are fired. And young women who get pregnant are more likely to have a stable partner? Links, please.
74
“Some studies found...having children early is an economic advantage...”
I wish you included links to this claim because it’s “widely assumed” that young people saddled with children just don’t have the resources older women who prioritize career and life experience have. I realize I too don’t include links (busy but had to reply) but I have widespread assumption on my side and am interested in any new evidence that counters that.
I also have personal experience. Had I continued my pregnancy in my sheltered senior year at a fundamentalist evangelical Baptist high school that I began attending in kindergarten, my world would have remained catastrophically narrow and my future imploded. As for family support, there were four more sisters coming up behind me and my parents were beyond exhausted in time and resources.
Teens and young adults lack life experience as well as financial resources that older women use to navigate your purported obstacles of job and family support. My parents weren’t a support option until 14 years later when my youngest sister graduated. The man I was involved with my senior year turned out to be a dead end dropout. I instead attended college, traveled, and lived a full life. My marriage in my late 30s to a man with a PhD and high income greatly expanded my resources.
And most importantly, had I decided to have children (didn’t), waiting made me not only richer but also a far wiser and more competent candidate for motherhood than my teen self.
44
Bravo to Delaware. I just moved here. So maybe now the state legislators can do something about the fact that there are no Family doctors in the state taking new patients. Maybe they should fund the K-12 schools so that maybe doctors would want to live in Delaware and everyone here could actually see a general practitioner when they need one. Even Christiana Care, the main hospital system here, has a wait list for a new patient to see a GP of eight months. One step forward, two steps back.
115
The IUD was my contraceptive method-of-choice in my 30’s. I had to travel from Madison to a Milwaukee “Women’s Center” to have it implanted Fortunately, it was available that close. That method served me well until the early 1990’s, when I had it removed to have a family. At the time, it seemed to be the most logical (and finally, non-“invasive”) choice, as its use was somewhat controversial at the time. I cannot fathom why it has taken so long to be recognized as a logical form of birth control. I am happy to see it promoted in this article.
6
Many women suffer from heavy and painful periods, which greatly affects productivity, cause anemia, and just feel miserable.
For those women, getting a hormonal IUD that significantly decreases or eliminates menstruation altogether can be literally life-changing. I know because I'm one of them. The impact it's had on my life cannot be be understated. I no longer have anemia, I am no longer in severe pain for several days every month, I don't have to use sick days for particularly awful days, I don't have to skip workouts, and on and on. I cannot imagine going back, and my only regret is not having gotten it earlier. Now I'm privileged in that I knew to request specifically an IUD (which they don't often suggest to nulliparous women), had insurance, and had the ability to come back to have it inserted (since they don't keep them in stock at the office.)
But I hope Delaware and other states track the tremendous positive impact IUDs can have on women's productivity, health, and quality of life when used to treat menorrhagia, so that more women can benefit.
224
@NYT Reader
Good for you! As a young woman, I had this problem. If only such a help had been available to me. . . This article about Delaware is very inspiring. I hope the ideas/action spread far and wide!
14
@NYT Reader
I’m glad this helped you.
My IUD caused heavy, painful, irregular periods which thankfully returned to normal when I had it removed.
Our endocrine system is delicate and not well-understood. I am frustrated by the lack of nuance when discussing these options. There is much more disruption to the body than just the possibility of pregnancy. For some people, like you, it is a helpful disruption. For others not.
I wish birth control were treated more as a medical issue than a public health/social policy issue. I am aware that it is both, but the focus is tilted heavily toward social engineering, as with this program. It is demeaning to women.
13
@NYT Reader
VERY IMPORTANT INFORMATION. I wish I had had one when I was fourteen: severe pain, huge bleeding, vomiting, etc. It would have made my life more comfortable and more productive.
14
This is awesome! Well done, Delaware! I just got my very first IUD earlier this month and it's such a relief not to have to remember to take a pill every day. The insertion process was the most painful thing I've ever experienced, but it was over relatively quickly and was well worth it for the protection it provides. When I saw my health insurance breakdown, I was so thankful for the ACA for making it possible (around $2000 ended up being $0).
I would really love to see Rhode Island adopt a program like Upstream. I think I might reach out to my governor to see what she thinks about the idea.
181
$2000 seems a lot. I assumed prices will go down with increased demand. Back in 2010 I paid $700 to the doctors office because they said not everyone’s insurance covered it. I was later reimbursed by my the insurance company later. Looking back IUD was much better choice, nothing to worry about for a decade.
For this program to be successful we must ensure that IUD companies are not profiting off increased demand.
2
@Shipra
Prices are not going to go down because the ACA guarantees coverage for birth control. Health care companies can now charge pretty much whatever they want.
Excellent article. It highlights a program that deserves support from both pro-choice and pro-life constituencies, because it reduces the number of unwanted pregnancies without requiring abortions. It's also suggestive of what our health care system might achieve as a whole if it drastically reduced the "come back in two weeks" approach to medical diagnosis and treatment.
188
@BWF Unfortunately, anti abortion groups are equally opposed to contraception.
12
"Unplanned pregnancies remain astoundingly common. According to the Guttmacher Institute, they represented 45 percent of all pregnancies in the United States in 2011. The majority of abortions, which numbered more than 900,000 in 2014, are in response to unplanned pregnancy..."
All contraception should be totally free and readily available to all women, insured or not.
70% of our nation's poor are women and children.
35 percent of single women with children live in poverty in this country.
Free birth control is absolutely critical to reduce the unwanted pregnancies amongst impoverished women.
Christians, want to reduce unwanted pregnancies and abortions dramatically?
Provide free contraceptives to all women.
This is not rocket science.
11
This is a great program! However, it still does not capture or attempt to understand the ambivalence that so many women express about becoming or not becoming pregnant. As a health care provider, this has been the number one barrier for me when offering birth control to women. The economist mentions hopelessness that leads women to become pregnant unintentionally. In my experience this is an explanation that fits from a white, affluent perspective but doesn't explain what is happening. In my experience and conversations, women are ambivalent or even hopeful because becoming pregnant brings hope, happiness, family, keeps a partner around and/or structure. Things we crave and seek as humans. Part of offering birth control needs to be a way to offer ways to create those things for women whom are poor or young or pregnancy is not ideal.
Ending poverty isn't just about controlling or changing reproductive choices but creating opportunity to reach beyond the chaos that living in poverty so often brings.
269
@Kelly Pezzella A friend who worked in reproductive health with underprivileged young women told me years ago one of her patients cited as a reason to have a baby "so I'd have someone who loves me." It broke my heart. Still does.
50
@Kelly Pezzella
If having children “keeps a partner around” we would not have the numbers of single moms that we now have. I believe emotional maturity and economic security are far better ways to “keep a partner around”.
18
@Kelly Pezzella "...women are ambivalent or even hopeful because becoming pregnant brings hope, happiness, family, keeps a partner around and/or structure."
Really? Can't you explain that this is not always the case? Women can feel overwhelmed by maternity especially when they do not have the means to support the baby; they can feel unhappy because a baby means postponing whatever plans they had for themselves; partners not always stay to create and provide for a family; and life with a baby can become more, and not less, chaotic. It all depends on how prepared people are before getting pregnant. So birth control and planning can pave the way for the desired outcomes, while an unplanned pregnancy most probably will not result in those.
10
"For women using a hormonal IUD...fewer than 4 out of 1,000 will become pregnant....And an implant...lasts three years and is the most effective form of contraception available."
there are also copper IUDs, as the article later notes. also, the 1970s were a long time ago and not very relevant to 12-44 year olds today.
implants, hormonal IUDs and hormonal pills can also alter menstrual cycles, sometimes greatly reducing or stopping them, or the opposite. a variety of hormonal pills with different types and dosages of progestins and estrogen are available. levonorgestrel is a common progestin.
...
"The [US abortion] rate is now the lowest since government measurement began in 1969."
this is where politics and religion should be introduced. also note that the fertility rate (measuring live births) has fallen over the decades, and fertility rate in the US is now below the replacement rate.
...
"[in delaware,] among the low-income women in the Title X family planning program who weren’t trying to become pregnant, the proportion choosing an IUD or an implant has jumped to 32 percent..."
usage rates in other states and countries and for specific types of long-acting reversible contraceptives would be informative.
1
I’ve been saying this for decades. Free birth control and wide access will reduce, if not elimate, generational poverty in just a few cycles.
Problem is that around many parts of the world, women don’t have agency.
343
@JA Access to birth control is a step in the right direction and can certainly help reduce poverty in many cases, but a decent wage is the real key to poverty reduction. Working long hours for minimum wage or $10/hour (common in the South) will never get you out of poverty even if you are childless.
111
@Elaine,
Agreed, but at least there is not the burden of having to care for another human being without any resources.
Everyone from the janitor to a barista should be able to earn a living wage, have access to basic healthcare (not cadillac) and an education (not private schools).
46
The article twice mentions objections to birth control by certain groups. The bottom line: their religious preferences and/or misogyny should not dictate other people’s choices. If they don’t want to use birth control, that is fine. But, as equal citizens, women must have the unimpeded right to determine their own destinies and make their own medical decisions. It is wrong, and in my view, unconstitutional for one group’s religious beliefs or beliefs based in sex discrimination to limit the health care and life choices for women.
687
@J.
Hard to believe that we still have to contend with people for whom it's not sufficient to be free to follow their own personal beliefs; they want to impose them on everyone else as well. Is this the 21st century or the 15th?
84
@J. Agreed. Worse, I don't really understand the push to prevent access to contraception by the same folks who claim they want to get rid of abortion. Let women be in control of their bodies and the need for abortion decreases substantially. Not 100%, but this goes a heck of a long way toward that goal.
47
@J.....Indeed. But why does America, more than other civilized countries, let the religious right have so much sway in our politics? Other countries seem to fulfill our credo of 'separation of church and state' better than the US.
We need op eds discussing this difference.
Other democracies don't have large anti abortion groups affecting their politics. The US lets religion intrude into politics, same as it does racial/ethnic prejudice, thus to stir up our political polarization and hostility.
It's time for the US to reach 20th century standards of separation of religion and politics.
22
It's so encouraging to read of this effort. I was happy to hear the training discusses the very real barriers to not just the decision but the logistics of getting on birth control. Women living in poverty have many, many moving parts in their day to manage: picking up and dropping off kids, catching public transport (for many, which takes longer than driving yourself), lack of flexibility at your one or more jobs, and the list goes on. These women are one sick babysitter or lost bus pass away from a downward economic spiral. Making birth control easy for those who want it respects their time and money and lets them have control over this one thing in a world where they often have little.
9
probably good idea for all states and for any woman under 26 or earning less then twice poverty rate but not on medicaid it should be free. Just think Repubs. all those Dems. you won't have to dream up methods to discourage their voting.
6
As great as it is to give women more options to control their bodies and their futures, am I the only one who wonders about the state's motives?
The paranoid right fears loss of its white majority and power, and other than immigration, the source of minority people is having children. Although minority women have no exclusive claim to poverty, the ranks of the poor are disproportionately minority.
Why is it always poor women who should have fewer children? Children of the rich consume far more resources. And how will this eliminate poverty? Poverty is created, and reproduced, by the economic system that we have created.
1
@M I think a critical aspect here is that this program makes any option available to any patient. It's not that the state believes poor women should have fewer children, it's that if a poor woman wants to be on long-term contraception, she should be able to make that choice without having to dodge substantial barriers to entry. Certainly Delaware needs to make sure that there is no unintended inequity when they get this program rolling, as it will be difficult to distinguish later on whether a spike in low-income women using contraception is because they want to or because the state has nefarious intentions.
1
@M
Communism doesn't work. Poverty can never be fully eliminated, but low paying jobs cannot support very large families. One parent households are often headed by women who don't complete their basic education, with few chances to earn even a minimum wage. Western countries have come a long way to enable people to escape poverty, but people have to be willing to take the leap, and make choices. One teen aged pregnancy is one thing, multiple ones is plain stupidity. Which is no excuse.
4
@M - Lower income women and me should avoid children until they are able to provide for them. Follow the path of President and Michelle Obama. Wait to have kids and limit the number!
3
As a CASA volunteer of some ten years, I have seen so many young women who appear in Court with four or five children none of whom were planned and the fathers of whom are no where to be found. The mother dropped out of school at age 15 or 16, has no education and no job skills and of course cannot support her children thus loses them due to ‘neglect’. The solution to the epidemic of abused and neglected children is explicit sex education and free on demand birth control devices.
13
Sanity at last !!
This should be implemented on a national and global level.
Bravo to Delaware
8
Fantastic program which should be replicated across the United States and introduced to girls at the age of 16.
5
It's a great social program, but just like most such as Head Start which also returns $7 for every $1 invested, it is opposed by the Republican Party that never wants to spend a public dollar on the poor that can be given to the rich. In this, of course, they're joined by the religious pro-life backers from evangelical Christians to the Catholic Church. It's a shameful violation of our Constitutional right to access to birth control going back over 50 years to Griswold v. Connecticut. It's also part of the larger social, cultural battle between the rights of women reflected in the #MeToo movement and the predatory male patriarchy on display recently in the Catholic Church itself, the confirmation hearings of Brett Kavanuagh, and Donald Trump's criminality in silencing two women he had affairs with.
6
The right of a wanted child to be born and loved to a degree that may help with one factor in our degenerating society is finally being addressed, and with government support, rather than continuous erosion with stupid limitations, or enforcing by non-science based laws that instruct those giving services to remain mute, or give wrong information.
I can hope that this is the first step in helping, rather than hindering, people (women, especially) in their basic right of living as they wish.
Yet, it won't be long until a comment is submitted that we need to worry that the future generation will not be numerous enough to pay the taxes needed to support the outgoing citizens. When people are only seen as a source of income for the country, things are very bad for humanity.
3
I've been saying this for years, people should not be single parents.
4
Ah, been saying this for YEARS here, and being ignored by NOT being published comment most of the time, but latex is cheap, widely available, AND effective. We don't need to grow more food. We need to produce fewer people. Once we do, many of the problems in our world won't be solved but they will be greatly alleviated and the only ones who won't benefit are those who rely on surplus population for the consumption of their worthless goods and services.
3
Didn't Colorado already conclusively prove this a few years back? How many experiments do we need before we learn the completely obvious?? If the GOP really cared about fighting poverty and cutting health care costs, they'd be behind this a thousand percent nationwide.
5
And yet...at the same time, one of the first victims of the war against the ACA is coverage for birth control. Let's hope middle class and indeed all women continue to have contraception as part of their health care, and not be at the mercy of greedy pharmaceutical companies.
6
Wait a minute, this is happening in the United States and it makes sense...what am I reading? Now if we could apply this model to every state and every nation, we would go a long way to solving all sorts of problems. Women's empowerment will go a long way to solving the problems of poverty and even global warming. The Catholic Church should mind it's own business and see to it that their clergy doesn't commit sexual abuse. I hope this model continues and spreads. What a nice story for a change.
4
The biggest hurdle: getting to teenagers BEFORE that first pregnancy so that girls can finish high school and have a chance to get out of poverty. So many parents need to understand that teenagers WILL have sex. Abstinence only education is a failure. The cycle of poverty will only end when we create that incentive out. I see many young women who see the benefits they receive by having a child - just like their mothers - and the cycle continues.
9
This is such an important development in controlling unwanted pregnancies and really helping to deal with over-population, simply the single biggest problem the world faces. I do hope more states sign on soon. How some can be against abortions AND against contraception is beyond dizzying hypocrisy, but because of that I do fear that southern states won’t sign up for this.
3
Medical fake news is also a big problem in this area. Many women are afraid of IUDs and believe all kinds of baseless claims about their dangers. All my previous girlfriends flatly refused to use an IUD. (They also refused to take the pill, which makes a lot more sense given its often serious side effects.)
After this resulted in having an unplanned child, I decided to take care of the matter myself and got a vasectomy. Unfortunately it's the only safe way for men to prevent pregnancies, and obviously not an option for those who still plan to have children in the future. But for those who don't, it's the best solution by far.
5
@GS I believe vasectomies can now be reversed, though the surgery is more complicated than the vasectomy itself.
1
Family planning discussions and availability should be as common as vaccines. We can’t move forward or plan for our future without it.
Women who want it should get it for free and without judgement.
2
Yes, women should be responsible in keeping themselves from becoming pregnant when a pregnancy and raising a child isn't affordable, or wanted, or the woman is too young. How about we give some of that responsibility to men. After all, they are involved. Why not a crack down on men, forcing responsibility for the children they father? Every child out their deserves the support of that child, from both mother and father.
2
There is no “could” about it - contraception does reduce (and eliminate) poverty - it also tends to reduce violence and crime. The countries that encourage contraception are both wealthier, healthier and better educated than the countries that do not. The tragedy of Africa - an unsustainable population growth along with non stop wars. The same tragedy is happening in the Middle East.
3
Contraception absolutely is a key to reducing poverty. All forms of contraception should be free, with condoms also available at the check out line at every pharmacy, free.
3
Well this just makes too much sense. I don't know if we can allow this kind of radical thought. What is the next step? Targetted job training? Help with school? Or, God forbid, affordable health care?
8
This Program soundscape wonderful. I hope it will become available to many more women.
1
The implant is effective for up to 4 years. ACOG and Planned Parenthood encourage the use of the implant for up to four years, though the original patent/FDA approval was for 3.
2
This sounds like a great program that should be expanded beyond Delaware, our 2nd smallest state.
There are two other areas that I would hope are included in the program’s counseling session:
1. Is the individual’s motivation, as in Kelly’s comments that: “women are ambivalent or even hopeful because becoming pregnant brings hope, happiness, family, keeps a partner around and/or structure.”
2. Would be that there are counseling and resources devoted to STD’s to include free human papilloma virus (HPV) as well as (if not to late) HPV vaccines.
Might such programs be implemented in places like Central America? In the longer term they might be more cost effective in reducing "illegal" immigration to America than billion dollar border walls.
2
This should be a national program. It makes sense and it achieves positive results in both unwanted pregnancy and abortion rates. In Colorado when the private funding was to expire for our program the Democrats in the legislature wanted the state to pick it up. Low and behold the Republican Senate killed the funding. Maybe that is why we now have a Democratic legislature and administration.
6
It will be different when people need to make plans to get pregnant instead of depending on accidents to make their family. I was a little ditsy when I was younger, and was surprised and pleased when I had a baby two years after I was married. I wonder when we would have made up our minds, nowadays.
I still remember Ogden Nash's poem from that time:
You fell in love and went together, in stormy and unstormy weather.
To prove your affection wasn't phoney, you even indulged in matrimony.
And now, you've gone and had a baby... What were you expecting? Guppies, maybe?
2
"Use effectiveness" is hardly a new concept in contraceptives. Condoms are very effective when appropriately employed, but how often does that happen in the heat of the moment (or in an ethanolic haze)? Implants do a wonderful job of addressing the "Opps!" issue, but what about STDs? Pregnancy will decrease, but STDs will rise. Which has the greater impact from a social and health care perspective? It's a difficult choice when there's no good outcome.
I don't think complex problems have simple solutions but this is a giant step forward!
3
This sounds like a great program. I would suggest asking men if they want to become fathers in the next year whenever they go to the doctor. Those who don't could be given condoms and education. Men need to be part of the birth control conversation and take realize that they have responsibility in preventing unwanted pregnancies as well.
16
I work with many young people with very tenuous connections to employment and economic self-sufficiency. I can't count the number of unplanned pregnancies they and their partners have had. Each one disrupts their lives and makes it that much harder for them to ever sustain themselves through the only sort of jobs they are every likely to have. To be able to avoid having to raise a child or children until they were more financially and emotionally ready would be a gift whose value can't be overstated.
8
Birth control and many other issues which are very closely linked to socioeconomic development of a community and society can not be done or sustained if its population, mainly the younger generation, is not properly educated in science subjects and have some basic understanding of logic and truth, "truth" as validated by science.
A large part of birth control debate in USA is due to very low science illiteracy, which is connected with overall literacy and quality of education in our schools. That ignorance is influenced mostly by high religious belief and that is exploited by political parties, mainly GOP.
Now about 20% of American adults are illiterate in all practical sense. Despite of being the most expensive education system in the world, the quality of our education is very poor too. USA is now the worst among all developed countries in terms of science literacy. About 40% of American college graduates "strongly believe that God created human beings in its present form". These college graduates totally deny hard (school level) science of evolution. That percentage is the highest among all 35 developed countries surveyed. It's also the worst in our own recent history since 1920 era of Scopes trial. Its consequences include not just birth control debate but many other equally, or even more, important issues like climate change, rise of "fake news", and many more- ultimately leading to the core values needed for a democracy- sense of justice and truth.
4
According to the 2010 census, 4.9 million American children were then being raised by grandparents. I'm here to tell you that a generation of people coming out of retirement to raise kids is a disaster. You come out of retirement less employable, less healthy, and financially unprepared. Unlike the first round of kids, you don't have dreams for the future - you probably won't live to see how this generation comes out. The best way to make the situation worse? Take medical care away from the grandparents and keep adding unexpected kids. Hurray for Delaware, and for the families who are dodging disaster.
10
I am all in support of this program, but I surely question asking all women of childbearing age if they wants to get pregnant in the next year. What do we do with a 13 or 14 year old girl who says, "Yes, I want to get pregnant. I want a baby". Is our society obligated to honor the wishes of a girl who cannot buy cigarettes, or go to an an R Rated movie? Should the parents, if available, or the courts, have some say in requiring the child to be on birth control? After all, is the only thing the parents can do is pay the bills and help raise the grandchild.
1
@Gary - How often do you think such a thing happens? Are you suggesting that we force someone like this to use birth control?
4
@DR The USA still has a very high rate of pregnancies and births to girls under age 18. Often times, girls will signal their desire to have a baby by simply saying, "I want a baby", with the end result being a baby. Sometimes the world in which an adolescent girl has been raised and lives is unloving, uncaring, hostile and exploitative. Too often the hearts of those girls long for a baby. All I am saying is that somehow, the use of effective birth control should not be the kid's choice alone. The responsibility for raising both the girl and her baby too often falls upon the strained backs of the girl's mother .
It's more than unplanned children that contribute to the "underclass." It's the "investor" (gambler?) economy. Is a computer game expert more of a contributor to society than a competent subway cleaner? (To me , NO.)-- yet one is paid much more than the other.
One has to applaud this new planned part of a medical check-up. (We still need carefully programmed computers to ask lots of health/life style questions -- humans can be very impatient!)
But given that society WANTS/NEEDS babies -- maybe the first five years of motherhood should be paid for. Alternatively, why exactly do mothers pay for childcare if society expects them to work?? get educated so they can be a lawyer better paid than a home healthcare provider??
1
@Make America Sane We don't need to encourage anyone to have children. If anything, we should pay people NOT to have them, and to revise the narrative that having children is some kind of milestone expected of every adult.
Automation will relentless continue to take jobs; there will be continuing upheavals due to climate change, species extinctions and environmental pollution. We are already overpopulated.
2
I love the approach of "Do you want to get pregnant in the next year?" This frames the question as a simple, positive question about her goals, rather than asking about one of many factors in the process of trying to achieve or avoid pregnancy. Asking this question at a regular medical appointment makes it easier for many women to get the contraceptive services she wants.
As for men being involved, a woman can always say "I want to discuss this with my husband/partner." But it's important that the decision belongs to the woman.
We often gloss over the unpleasant truth that many women are coerced, pressured and/or forced to have sex, in relationships where they lack the resources or opportunities to leave. The idea that women and girls can protect themselves from pregnancy by "saying no" assumes that all men will take "no" for an answer. So for many women, contraceptives that the women can control themselves are essential for preventing pregnancy.
45
I would recommend changing the title to this article. Why isn’t it enough to give women access to contraception instead of the usual model of forcing women to jump through dozens of hoops and pay fees for a basic medication? Framing it through an “opportunity” landscape, particularly for children, is so directly implying that the women in the doctors office isn’t the most important part of the equation. Yes, duh, reducing unplanned pregnancy is great for society, it is almost like women have been trying to demand that right for the last 60 years!
15
This program is great and should be rolled out nationwide. When people bring up concerns about "reproductive coercion", I am reminded of what happened at my first "real" job in a professional office. Management allowed "casual Fridays", where people were allowed to wear jeans or otherwise dress a little more casually than the rest of the week. Predictably, some people abused the privilege by wearing sweatpants, ripped jeans, shorts, or t-shirts with inappropriate logos. Management then took away casual Fridays.
With freedom comes responsibility. If we prove ourselves to be irresponsible, then we lose freedoms, including reproductive freedom. It's far better for us as a society to voluntarily restrain ourselves before we find ourselves in a situation where others are doing the restraining for us.
7
Contraception is about choice. Sad some women need financial assistance to make that choice, and the Delaware program helps women realize what they choose. In dealing with unwanted pregnancies, contraception is superior in every way to abortion for women.
1
The root causes of poverty are not located in a woman's reproductive system and cannot be fixed by giving individual women more control over when they bear children. But, if billing this program as a means of reducing poverty is what gets policy makers on board, I suppose I can live with that.
3
@H.L. - Oh well, I'm so glad that you can live with it. I'm not sure how the rest of us would have managed to go on if you hadn't been able to do that.
Of course the root causes of poverty are not "located in a woman's reproductive system". There are quite a number of social, economic, and even political factors that cause poverty and perpetuate it. However, it cannot be denied that giving women easier access to birth control, thereby allowing them to plan their families, can keep or even lift many women out of poverty. When women have children they cannot afford to raise, or have children at a moment in time when they cannot afford to raise them, poverty is often the result and it can be an extremely difficult cycle to escape. When women are given access to birth control - because, let's face it, not all guys are mature and thoughtful and step up to the responsibility plate with this - they are able to plan their families and their lives and, for women who are already struggling financially or in other aspects of their lives, it provides a measure of stability in an existence that might already be challenging. This isn't about just getting policy makers on board or whether you can, with a self-righteous sniff, decide you can live with what this article outlines. This is about giving women choices and options and, when women and their families have choices and options, they can move forward and moving forward often means moving out of poverty.
38
@H.L. So over population is not a root cause of poverty in the US? Who knew? And if it is not what might you think it is? Racism? How foolish today if that is your answer.
4
Amen to that!
Thank you, Delaware. I look forward to the day when obvious common sense will lead every state to the same conclusion. Unintended pregnancies should be avoided because it is massively cost-effective for society, and more humane for children and mothers. Let's have a 50-state rollout of this sensible program soon.
57
From Delaware, you are welcome!!
I loved that women were asked this simple question: “Do you want to get pregnant in the next year?” It's so simple and proactive.
At age 55 I joined an HMO. When I had my Gyn appointment they gave me a laminated page and a dry erase marker that asked a few questions. Two affected me deeply. They asked if I had ever been verbally abused and another if I had ever been physically abused. I wished someone had asked 10 years before. I would have burst out crying, admitted to myself that yes I had been, and gotten help. I was in denial. I told myself he didn't mean to hurt me, he was just tired or hungry or stressed from work. Those 10 years and a few more nearly destroyed me.
Asking questions is very powerful. My highest compliments to Upstream.
103
@Anne
Amen, the tendency is to answer no (out of embarrassment) but it plants the seed that these behaviors are not right and should not be tolerated.
My HMO has such a poster in the women's bathrooms with the same questions.
5
@JM I have a strong tendency, to tell the truth when asked a direct question. Posters help a little but most people tune out in a world of constant images. I would have.
There is no real substitute for a person that cares to ask the good very direct questions. Same with birth control, posters are not enough.
8
@Anne
That they asked you questions about possible domestic abuse is heartening. Unfortunately, during my nursing career I witnessed too many health professionals ask these questions in front of a spouse or significant other thereby invalidating the purpose. I was once covered in bruises and my doctor did ask when we were alone if my husband hit me. He didn’t, however, that one question led to additional questions, a discussion, and eventually a lupus diagnosis. Not only does asking the right questions help identify domestic violence but they may also reveal an illness that could have gone undiagnosed for too long, early intervention is always preferable.
3
"A review of the returns on investment from contraception found relatively small effects."
Presumably, the review focuses on the return to the single mothers themselves, not the returns to the taxpayers who have subsidized the growth of the American underclass. It is not surprising that poor single women, whether they have children or not, generally remain poor and single throughout their lives. They lack good career or marriage prospects, owing to their lack of skills and the scarcity of gainfully employed bachelors in their social environment. The welfare benefits that accrue to poor single women who have unplanned (or planned) pregnancies are are perhaps at best a net wash to these women, compared with the alternative of not becoming pregnant and not having children to feed. The same can't be said of the benefits to society of these women not becoming pregnant. The costs of taxpayer-funded contraception are miniscule compared with the enormous cost of maintaining a large permanent welfare-dependent underclass.
29
@David
Single moms should have free contraceptives routinely mailed to their homes just like other medications.
1
@David What is you suggestion and ideas to solve this problem.
1
@JM Agreed. I hope it was clear from my comment that I support publicly funded contraception as a way of containing the growth of the population of poor, whose fertility rate exceeds that of middle- and upper-income women.
1
Yes finally... this is a big big factor and is something that could assist these women in so many ways. Educate Educate Educate these women on the types of birth control and their risk factors as well so an educated decision could be made on their part. So many possibilities to bring awareness .
17
@Kathy
Time to focus on programs to empower young teenage girls BEFORE they have an unintended pregnancy.
1
Good for Delaware and it should be available in every state. The saddest statistic remains, 45% of pregnancies are unplanned. The statistic that will prove most interesting in the future is the abortion rate. Other studies have shown declines in abortion rates with increased use of contraception but alas, in our flyover state, the majority of the anti abortion supporters are also opposed to increasing availability of contraception. Their cognitive dissonance is breathtaking.
84
Yea for Delaware, and I hope those who need it will take advantage of this service. But I’m not so sure it will improve poverty statistics. I work in a food pantry and a young pregnant woman came in with a two year old on her hip. When I said what’s the due date. She sighed and said it was due in about a month or two and that she really was not that excited because this would be child number six. So I had two thoughts - the old saying “poor people have poor ways” or she has timed her pregnancy to take advantage of/use the welfare system’s WIC program. ANd there are plenty of services in this community where she and others can get free birth control if they want.
11
It saddens me deeply that someone who works in a facility meant to assist those in need is so quick to make assumptions about them. Short of directly asking her about the nature and origin of her pregnancy (please don’t), her condition, and how she got there, is not for you to judge.
20
@Danielle But stating reality that a poor person has 6 children when they have options is the real point, nobody knows why they have done this, but I hope most would agree that it is bad for her, bad for her children, and bad for society. How to address it is complex and difficult, but needed.
8
I write this comment as I am caring for my three week old, having not gotten more than two hours of sleep a night in the past three weeks, after a harrowing and physically debilitating pregnancy experience. Nobody goes through the travails of pregnancy and infant care just to get a few more dollars on WIC. Give me a break.
7
If you look at the statistics, the bulk of the children born to poor unmarried women are born to women in their late 20s and early 30s. Teenage pregnancy has gone done dramatically in the past few decades.
This phenomenon is probably not due to the lack of available contraceptives. These women may have wanted to get married and have a family, but there are too few suitable men available.
Once again, our social problems turn out to be due to low wages, and lack of suitable jobs for blue-collar men.
18
@Jonathan How is it possible the contraceptives are not available, they have them in every pharmacy sometimes at like 10 per month. And no it is not due to low wages etc. If you can't afford a child just don't have one, we are overpopulated in the US. Perhaps we need a subsidy for those not having children instead of one for those that are.
1
Don't confuse pregnancies by unmarried women, which is not the topic of this article, with unwanted pregnancies. They're not the same thing.
8
@Jonathan
Age has nothing to do with it.
70% of our nation's poor are women and children.
This is abominable!
Let's start a plan to avoid ADDING more children to this shameful statistic.
Contraception, in all forms, should be OFFERED for free to all women without any questions or restrictions by old men in power.
And if you didn't notice, the operative word here is "offered"... which means having a choice to say either "yes" OR "no thank you".
4
Birth Control needs to be universally available and affordable.
Delaware is leading the way and all states need to follow.
A planned pregnancy is the result of careful decisions and investment in preparation for a child.
An unplanned child can cause chaos in the family: Taking care of a child is costly in time, labor, and money. An unplanned child is at greater risk of neglect and abuse: leading to developmental, educational and psychiatric problems. All these cost our nation a lot of money: child support services, medical care, child protective services, special education, psychiatric care, juvenile justice costs, drug abuse costs. Dysfunctional families lead to dysfunctional children who grow up to be dysfunctional.
Delaware is going to save lots of money. And so will the U.S.A.
38
.."But the experience in Delaware revealed the importance of front-office staffers. They do the scheduling, and they spend more time talking to patients than doctors do."...
And we wonder what's wrong with the medical profession.
58
@B Dawson I work as a medical scribe in an emergency department (ED) so I can offer some insight to why doctors don’t spend as much time with their patients. Doctors spend over 50% of their time documenting on the computer. This is a necessity because one lawsuit can ruin a career which takes as many years to build. Granted the demands of an ED physician are different than family medicine doctor but both can sometimes spend up to three hours after the end of their scheduled shift completing their medical charts. If you asked a doctor if they wanted to spend more time with their patient the overriding answer would be yes. But documentation must be completed. I could elaborate but let me know if you want to know more.
10
I don't have great things to say about the doctors I had, but they spent more minutes than front-office staffers with me. Both spent most of the time with eyes on the computer, though. Front-office staffers do scheduling and can schedule things together, which is the key reason for involving them. Besides, they are a lot cheaper than doctors, helping to control cost of the contraception program.
1
This past election cycle we hosted a mayoral candidate to our home for a meet-n-greet. A woman from the Urban League attended. She, in clear and certain terms, said that if a woman in Minneapolis can't get child care, education, career, earning ability and a better apartment move out of reach. It is fair to assume that unintended pregnancy is sometimes the root of this unfortunate sequence.
That day I began to believe that unintended pregnancy is often at the center of both poverty and the perpetuation of poverty in our city, and I assume in other cities as well.
My thoughts went to education on sexual health and wellness, but informed access to contraceptives, especially contraceptives that are unknown to male partners, are one obvious keys to helping women preserve their ability to plan their lives and choose their paths.
Offering women the choice of contraception is compassionate policy that can have a significant impact helping woman to avoid poverty, helping them to climb out of poverty and helping them to avoid introducing a child to the world in poverty. Helping a woman to preserve her choices can help her to bring a child into the world when she is ready to care for it.
Whether unintended pregnancy is a cause or a result of poverty, this simple intervention is a compassionate response.
83
Let's not forget that Elizabeth Warren's past research indicated in her book, "The Two Income Trap", that a key predictor of going bankrupt is having a child.
And that book was written over ten years ago, so it's encouraging to see government finally recognizing the value of her book's findings and doing something pragmatic to prevent unwanted pregnancies.
Maybe the electorate should also be paying more attention to some of her other economic proposals, that we might find equally constructive, and not get bogged down in Native American identity politics.
59
Since, 2009, the Colorado Family Planning Initiative (CFPI) has provided low-income women and teenagers access to low or no-cost contraceptive devices, including IUDs and implants, and trained providers in insertion and counselling techniques.
The Colorado Family Planning Initiative drove a 50% reduction in teen births and abortions, avoided nearly $70 million in public assistance costs and empowered thousands of young women to make their own choices on when or whether to start a family.
Teen birth rate was nearly cut in half.
Teen abortion rate was nearly cut in half.
Births to women without a high school education fell 38
percent.
Second and higher order births to teens were cut by 57 percent.
Birth rate among young women ages 20-24 was cut by 20 percent.
Average age of first birth increased by 1.2 years among all women.
Rapid repeat births declined by 12 percent among all women.
Costs avoided: $66.1-$69.6 million.
Guess who couldn't stand it ?
The Party of Stupid.
https://www.theguardian.com/us-news/2015/may/06/colorado-contraception-family-planning-republicans
https://www.colorado.gov/pacific/cdphe/cfpi-report
D to go forward; R for reverse.
357
While I absolutely love the Colorado program and it did great things, to provide a little more context -- the program came into being during a nation-wide decline in teen pregnancy. For example, in a 10 year time period around the program, Colorado had a 60% decline in teen birth rates, and Texas and most of the rest of the nation had a 50% decline. There were a lot of other factors going on driving that decline.
19
The real conundrum is that long lasting contraception needs to be offered to teens.
Finishing high school also addresses poverty among teen mothers and their infants.
101
@MGU
Agreed, long lasting contraception that does not require intervention in the heat of battle is the answer. Everyone has access to conundrums they just don't use them.
2
This is so fundamentally obvious that it astounds me no one has attempted it before. But on second thought I expect there were forces opposed to the idea for all the wrong reasons. Bravo Delaware!
138
I love this idea and bravo to Delaware legislators.
It’s striking the contrast to neighboring Pennsylvania where the health curriculum in schools MANDATES an “abstinence only approach” to preventing pregnancy.
Abstinence only is a flawed theory has been pushed for a generation by conservative (white, male) legislators and religious zealots and has been proven through multiple studies to increase unplanned teen pregnancy, poverty, abortion rates and let’s not forget domestic violence against both mother and child.
When my now college aged daughters attended middle and high school in a great school district near Pittsburgh they both reported that teachers nervously responded to health class questions about birth control with “ask your parents”.
179
@JAS, Nothing like going backwards. I graduated from a suburban Pittsburgh HS in 1976, and I'm pretty sure we had relevant sex ed at that time, and none of this anti sex, abstinence only nonsense.
6
@JAS
Not in my PA public school district. But I am sure this is widespread in our newly deplorable state.
1
Finally, common sense is being used! Inexpensive easy access birth control is a no brainer. I hope that the program succeeds and spreads.
422
Imagine that - a state government using its public-policy ‘laboratory’ powers to expand rather than restrict women’s reproductive rights and access to gynecological health care at all income levels. Encouraging to see Washington and Massachusetts following Delaware’s example, with one hopes many more rationally governed states following suit soon. This well-reported story should help.
335