Tag Archives: contraception

Marriage Revisited and Long Acting Birth Control

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Millennials are marrying later and less often. Comedian Aziz Ansari recently released Modern Romance, a smart and hilarious book of sociological research that discusses how technology provides us endless access to potential partners. So many options leave many millennials like myself wondering, “Why choose?” However, the luxury of choice does not extend to everyone. While marriage is declining overall across many high income countries, minorities and those with less education are even less likely to marry, for very different reasons. Researchers suggest that this pattern could be due to men’s increased difficulty in finding stable jobs, or changes in social norms surrounding marriage and family formation.

The latest issue of the Future of Children provides a timely reflection on the state of marriage and its effect on child wellbeing a decade following our original 2005 volume on Marriage. Some key results show that despite their best efforts, policies to improve the family by encouraging marriage, such marriage education and programs to improve education and workforce opportunities that would make men more “marriageable,” have fallen short. However, many couples that do not marry are not avoiding childbearing: 41% of births occur to unmarried parents. While cohabiting was once considered a precursor to marriage, it is increasingly replacing marriage, while the birth rate has remained similar, around 45 per 1,000 people, since 1990.

The Fragile Families study, which follows the health and social welfare of almost 5,000 unmarried and married parents and their children, shows that unmarried parents are less likely to stay together until their child is 5, and disruptions to family relationships can be harmful to the child’s wellbeing.

So, how do we help children? The Future of Children policy brief offers several concrete suggestions, such as offering long-acting reversible contraceptives (which include the implant and IUD, or intrauterine device) to help women delay unintended pregnancies until they are in stable relationships and ready for children. This recommendation comes at a time when IUDs are used more than ever in the US: 12% of contraceptive users chose an IUD, up from 2.6% of users in 2002. Both implants and IUDs have by far the lowest failure rates of any modern method (except permanent sterilization) and are extremely safe. Programs to provide these services can be funded through a number of mechanisms, which are discussed in detail in the brief.

For more information on the current state of marriage and childbearing and evidence for reducing unplanned pregnancy and childbirth, check out the latest issue of the Future of Children.

Policy Prescriptions to Prevent Teen Pregnancy

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Most teens would probably say they don’t want to become pregnant–in fact 87% of teen pregnancies in 2001 were reportedly unintended (see Figure 1). Even though there have been tens of thousands of teen pregnancies in recent years, teen births in the US have actually declined over the last 20 years, from 61.8 live births per 1,000 females aged 15-19 years in 1991 to 29.4 in 2012. This trend, which is due to factors that include teens making more informed decisions regarding their sexual health, is encouraging and suggests we can continue to make progress in preventing teen pregnancies.

First, we need to understand what makes teens more likely to get pregnant. Isabel Sawhill, Adam Thomas, and Emily Monea, in the Future of Children, outline several plausible explanations including cultural norms of increased acceptance of premarital sex and having children outside of marriage, a lack of positive alternatives to single motherhood, an attitude of fatalism, the high cost and limited availability of contraception, lack of knowledge about contraception and reproductive health, and inconsistent or incorrect use of contraception. The authors point out that these explanations generally fall into the categories of motivation, knowledge, and access.

Next, we can examine possible solutions. The Centers for Disease Control and Prevention recently released a Vital Signs brief outlining what the federal government, health care professionals, parents/caregivers, and teens can do to prevent teen pregnancy. What I like about the CDC’s suggestions is that they start where the teen is and show how adults can support teens’ healthy development. For example, professionals can encourage teens to delay sexual activity but should also encourage sexually active teens to consider the most effective methods of birth control. Parents can know where their teens are and what they are doing (isn’t there an app for that?), especially after school, and talk with their teens about sex.

Finally, are programs that promote these types of solutions worth the cost? Sawhill and colleagues, in their Future of Children article, conducted simulations of the costs and effects of policy initiatives that encouraged men to use condoms (motivation), discouraged teen sexual activity and educated participants about proper contraceptive use (knowledge), and expanding access to Medicaid-subsidized contraception (access). All three had good benefit-cost ratios, suggesting they are excellent social investments that can actually save taxpayer dollars. For more information on how to prevent teen pregnancy and unintended pregnancies in general, see the Fragile Families volume of Future of Children.

Teen Birth Rates on the Rise — Policies to Reverse Course

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As recently reported in USA Today, a report issued by the National Center for Health Statistics shows that between 2005 and 2006, the teen birth rate increased in 26 states, reversing a 14-year decline in teen birth rates. While states that historically had the lowest birth rates showed non-significant changes (New Hampshire, Vermont, Massachusetts, and Connecticut), states with already high teen birth rates (Arkansas, Mississippi, New Mexico, Texas) showed increases, leaving Mississippi with the highest rate of 68.4 births for every 1,000 female teen ages 15-19. Alaska showed the greatest increase in teen birth rates (up 19%), while the District of Columbia reported the most dramatic decline in rates (down 24%).

The numbers do not bode well for child wellbeing. In study after study, research has shown that children born and raised in single mother households are poorer than other children, and that other negative child outcomes follow. Children born to teen unmarried mothers, who often interrupt schooling to have their babies, are most vulnerable. A Hoffman and Foster study cited in a recent volume of the Future of Children volume on Poverty estimated that delaying childbearing among teens would increase median family income by a factor of 1.5 to 2.2, and reduce poverty rates by even more.

The policy goal, therefore, is to reverse course and return to the downward trend in teen pregnancy. But how do we do that? In their Future of Children article on this topic, Greg Duncan and Katherine Magnuson demonstrate that programs to prevent teen childbearing by reducing sexual activity and promoting contraceptive use have NOT been proven to be successful. More often than not, programs designed to postpone sexual behavior fail to delay its onset or reduce its frequency. Some more intensive interventions that provide mentoring and constructive after-school activities have had more positive results, but it is unclear whether these can be replicated on a larger scale.
Two other Future of Children authors, Paul Amato and Rebecca Maynard agree that the evidence on the effectiveness of programs is slim, and what we do know is not encouraging. However, they note that the programs have never truly been tested in an experimental setting. Therefore, they argue that schools should continue to offer health and sex education, starting no later than middle school, and that promising programs should be tested using the “gold standard” of research, where the comparison group is truly “treatment free.” Armed with good social science data, the federal government could provide school districts with tested curriculum models.
Since some teens, particularly low-income youth, still get pregnant despite access to contraception, we need to consider and challenge the social norms that have led to acceptance of teen child bearing. Education programs and public service campaigns (some of which are profiled in “Using the Media to Promote Adolescent Wellbeing") can support the message that nonmarital childbearing, particularly in the teenage years, is NOT an expected stage in life.
The investment in good, research based programs would be worth it. If a universal program initiative succeeded in cutting the teenage birth rate in half, the estimated return on the investment would be approximately 20 percent.
For more information, see