This New York Times article http://www.nytimes.com/2015/07/06/science/colorados-push-against-teenage-pregnancies-is-a-startling-success.html?partner=rss&emc=rss&_r=2 asks the following question: “If teenagers and poor women were offered free intrauterine devices and implants that prevent pregnancy for years… would those women choose them?” The answer? A “resounding yes”, which they deem a “startling success”.
Pregnancies to teenagers and “unmarried women who had not finished high school” plunged, especially in the poorest areas of the state, allowing them time, according to the article, to “gain a foothold in an increasingly competitive job market”. It was seen as a poverty reduction strategy.
I wish I had been a fly on the wall during the counselling sessions that led these young and poor Colorado women to choose long-acting contraceptives. Were they fully briefed on the side effects and potential risks? Did they discuss Sexually Transmitted Infection (STI) prevention? What was the overall vision of poverty reduction in Colorado?
During my sexual health clinic days, there were women who chose – and continued to use – Depo Provera, a contraceptive injection that lasts for three months. They did so after I had fully informed them of potential side effects and risks of the progesterone-only method. Some adolescents who came to the clinic were good candidates for the copper IUD and it worked very well for them. After a clinic counselling session, when young teens or disadvantaged women opted for a method of birth control that worked for them; or they chose to end a pregnancy realizing that their circumstances would not allow them to raise a child at that time, they were making informed choices. I recognized then as I do now, that reproductive control and poverty, while linked, are not the only elements in the equation. After reading the article, I wondered about other measures proposed to reduce poverty in Colorado; and what will happen when the private grant to fund this experiment runs out.
Teenage pregnancy and pregnancy for low income women are complex issues. Factors that result in unplanned pregnancies to teenagers include lower economic status, sexism, racism, prior sexual abuse and ongoing abusive relationships. The absence of the social determinants of health can result in risk-taking behaviours, like smoking and unprotected sexual activity. With regard to sexual abuse, for example, without the benefit of comprehensive counselling, young women run the risk of future sexual assault and abusive, controlling partners. Some exploitative male partners will refuse to “allow” them to use contraception; or they may refuse to use condoms. When one has little control in one’s life, reproductive control is not even on the table.
For younger and poor women, while it may not be prudent financially, emotionally or even physically to continue a pregnancy, if poverty itself were eradicated, part of the burden to the state would be eliminated, while still allowing funding to provide parenting support.
I imagine some ideological detractors of the Colorado experiment might accuse them of eugenics, deliberately limiting births to racialized and poor women. I do not subscribe to this point of view. However, one must acknowledge the history of eugenics practices in North America and abroad that will inevitably make some people skeptical of the motivation behind this poverty reduction experiment.
And yet, research is conflicting on the relationship between teen pregnancy and poverty. According to Statistics Canada, “women from disadvantaged backgrounds are more likely to end up disadvantaged even if they delay childbearing. And while teenage childbearing continues to be a significant indicator of lower socioeconomic outcomes, the effect is smaller than originally believed” (http://www.statcan.gc.ca/pub/75-001-x/2008105/article/10577-eng.htm).
While I agree that delaying pregnancy is a tool towards poverty reduction, let’s be frank: only the redistribution of wealth will eradicate poverty.
The second issue in terms of the counselling process is STI prevention and treatment. Like women who use oral contraceptives, women who use IUDs, injections (and implants in the US) may not see the need for condom use. I would like to know if they discussed and offered testing and treatment for STIs like chlamydia, the rate of which is especially high in older adolescents and young women. Because there are no symptoms of chlamydia in the majority of cases, without testing, women may contract Pelvic Inflammatory Disease which, if undetected over time, may lead to infertility – not a recommended form of birth control.
A Public Health map of Toronto that plots adolescent pregnancies follows the same geographical trajectory as STIs in the city, which, in turn, follows the curve representing its poorest neighbourhoods.
And who is at higher risk for poverty in Toronto? Recent immigrants, Aboriginal people, those who are disabled, elderly and alone, racialized or children (http://www1.toronto.ca/City%20Of%20Toronto/Social%20Development,%20Finance%20&%20Administration/Strategies/Poverty%20Reduction%20Strategy/PDF/povertyinTO.pdf).
Poverty reduction, like unplanned pregnancy to young and poor women, is also complex. There are no magic wands, but there are proven tools. If we take the lead from developed countries where there is more economic equity, we see that a higher minimum wage and/or guaranteed income, a fair tax system where the wealthy and corporations paid their fair share and increased services, results in a profound reduction in poverty.
In the meantime, contraception and birth control, including post-coital options and abortion, should be freely available to all as a public health service.
The hidden epidemic: A Report on child and Family poverty in Toronto, November 2014
Poverty causes Teen Parenting, Not the other way around
Good Practices in Anti-poverty Family-focused Policies and Programmes in Developed Countries