In Delaware USA, at every doctor’s visit, women are now asked if they plan to get pregnant soon, even if the visit has nothing to do with their reproductive health. If a woman answers no, she gets whatever form of birth control she wants on that same day, free of charge. This new approach aims to reduce unwanted pregnancies to help women escape poverty. 

Whereas Delaware used to have the nation’s highest rate of unplanned pregnancies, this number is estimated to have declined with a whopping 24 per cent since the start of the program three years ago. Its key to success seems to be its same day ‘delivery’ of birth control. This is important, as many hurdles prevent women from coming back for a new appointment. For instance, it can be hard to take time off at work or to find someone to baby sit while they are at the doctor’s office. 

A similar program is conducted in Colorado USA. Here women can choose to have a contraceptive intrauterine device (IUD) or implant placed without charge. So far, 30 000 devices have been placed and the results are promising. The age at which women become pregnant significantly increased. Whereas first, half of all births to the most unfortunate women in Colorado occurred before the age of 21, this age increased to 24 after only five years of the program. This result caused Colorado to climb ten spots up in the US ranking for lowest teen birth rates. But that is not all. Not only did teen births drop with 40 per cent between 2009 and 2015, but the number of abortions also decreased by 35 per cent. Moreover, more than 80 million dollars were saved on Medicaid costs. Unsurprisingly, the success of these programs inspired others. Washington and Massachusetts are now starting similar programs.

Access to contraceptives: not a given

Nowadays, the benefits of birth control are clear, and its use is fairly accepted. A rare exception is the Roman Catholic Church, which formally forbids the use of all contraceptives. In the USA, 99 per cent of sexually active women aged 15 to 44 used contraception at some point in the past. 

Unfortunately, reliable contraceptives are not a given for many women. In the EU, there are large disparities in access to birth control. While in Belgium and France 91 per cent of women have access to contraceptives, other countries score much lower. In Andorra, for example, only 18.8 per cent and in Greece, only 38.2 per cent of women have access. Religion, costs of birth control, health insurance coverage and infrastructure are just some examples of factors that can prevent women from accessing contraceptives.

Worldwide, over 200 million women do not use any or use risky contraceptive methods, even though they do not want to get pregnant. This is often due to lack of access, money, or information. It is estimated that, if these women had reliable contraceptives, the number of unintended pregnancy would drop from 89 million to 22 million yearly. Moreover, 45 per cent of pregnancies in the USA are unplanned, and 65 out of every 1000 women aged 15-44 in developing regions unintentionally got pregnant in 2014 (23). In the EU, on average 6 out of 1000 women aged 15 to 17 become pregnant. This is usually unintentionally, considering their young age.

The complex relationship between contraceptives and poverty

While many women do not have reliable access to birth control, its role in preventing poverty is increasingly acknowledged. In the USA, the concept of birth control as a tool to increase economic mobility first emerged in the 1970s, after contraceptives and abortion became legal. Quickly after, women’s careers and educational attainment started to improve. Ever since, it has played a role in poverty reduction. In fact, it was found that women who have legal access to birth control are significantly less likely to experience poverty later in life. 

But, as poverty is a complex topic, its relationship with unplanned pregnancies is not yet fully understood. Thanks to research and political interest, we are now starting to explore the dynamics. 

Protecting the health of women and children

One of these dynamics is the effect that prevention of unplanned pregnancies has on health. Unfortunately, pregnancy does not come without health risks for both mother and child. And, as it turns out, these risks are even higher in case of unintended pregnancies. A mother’s likelihood of facing maternal depression and anxiety, for example, is higher in case of unplanned pregnancy. 

Especially young women face risks when they get pregnant. In fact, complications during pregnancy and childbirth are the leading cause of death in teenage girls. Moreover, when teenage girls get pregnant, this poses risks to the baby as well, especially in developing countries. Here, babies are at higher risk of dying and low birth weight, preterm delivery, and severe neonatal conditions. Moreover, the use of condoms, an easy-to-use method of contraception, prevents HIV and other sexually transmitted diseases. Clearly, by preventing unintended pregnancies, birth control helps protect the health of women.

Additionally, a share of unwanted pregnancies inevitably leads to abortions, whether safe and legal, or unsafe and illegal. Yearly, approximately 3.9 million unsafe abortions take place worldwide, contributing to maternal mortality and health problems. The use of birth control prevents unwanted pregnancies and abortions. Whatever your stance on abortions, preventing them is a worthwhile cause.

Improving educational and economic chances

Unintended pregnancies most often happen in young women. As raising children demands time and money, this can force them to drop out of school, decreasing their future earnings. But not only parents are affected by unintended pregnancy. Children born after unplanned pregnancies are more likely to stop their education early and to earn less later in life.

By preventing unintended pregnancies, birth control gives women a chance to stay in school, thereby improving their career perspectives. In fact, it was found that American women who have unrestricted access to contraception during their late adolescence were 17 per cent more likely to be enrolled in university at age 21. 

Curiously, women and girls do not necessarily need to use contraceptives themselves to experience positive effects. Just the proximity of contraceptives and family planning services can be beneficial. It is shown that access to contraceptives encourages girls to plan better futures by investing in education, especially in developing countries. As it allows women to exert control over their reproductivity, all of the sudden it is worthwhile to stay in school. In Malaysia, for example, it was found that just the availability of family planning services made girls remain in school six months longer. And in Indonesia, it was found that girls have higher attendance and accomplishments in school when these services were available in their neighbourhoods. 

Additionally, when contraceptives become more accessible, employers are more likely to hire women, as they are less likely to miss time at work. Because of the chances that occur when women have access to birth control, it has the ability to reform economies.

Other positive effects

While reducing poverty is extremely expensive, reducing unplanned births is fairly easy and cheap, and has the potential the render huge returns. Studies have shown that for every dollar invested in contraception, the costs of pregnancy-related healthcare is reduced by $ 2.20. Looking further at the socioeconomic effects, universal access to quality sexual and reproductive health services might return $ 120 for every dollar invested in it.

Moreover, birth control gives women (and their partners) more control over their lives, and may lead to better outcomes for children. Of course, the decision whether to have kids or not should never depend on whether you can afford birth control or not. Children deserve to be born into a family where they are wanted, and where parents have the resources needed to take care of them. 

Additionally, birth control might affect the relationship between unintended pregnancies and staying in abusive relationships. Women in abusive relationships are two to three times more likely to be forced into pregnancy and to have an abortion. After giving birth, they are more likely to stay in the abusive relationship, risking their own lives and wellbeing, and their children’s. 

The potential of contraceptives in developing countries

Access to birth control is especially a problem in developing countries. Here, it is estimated that 214 million women and girls do not have access. If these girls and women had access to proper contraceptives, approximately 67 million unintended pregnancies and 76,000 deaths could be prevented each year. 

You could argue that access to birth control is especially needed in developing countries. Populations are growing quickly here and resources are very limited. Since many people already live without sufficient resources to meet their needs, restraining population growth is necessary.

However, increasing the use of contraception in these areas is not as easy as it seems. Even if birth control is freely accessible, factors such as religion, education and social norms affect whether or not girls can use them. In some cultures, for instance, having many children is considered a symbol of status. Of course, the unequal position of women in some places also plays a role. 

The dark history of state contraceptive programs

All the positive effects of birth control aside, state contraceptives programmes have a dark history that should not be ignored. In the 20th century, 33 American states had programs of compulsory sterilisation in the name of eugenics and wellbeing. In 1976, it was found that 25 to 50 per cent of Native Americans were sterilised between 1970 and 1976. It is suspected that some of these sterilisations took place during other surgical procedures without the consent of the patient. In Nazi Germany, the Law for the Prevention of Hereditary Diseased Offspring resulted in thousands of forced sterilisations. While these laws and events seem to be things of the past, more recently, judges offered reduced sentences to defendants if they agreed to be sterilised or use birth control.

Acting on the belief that limited reproduction of the poor would be beneficial for society, these programs violated reproductive rights, especially those of people of colour and with disabilities. Even today, black women are more likely to feel pressured to use birth control and healthcare professionals are more likely to suggest IUDs to black and Latina women.

Another risk of contraceptives programs is that the high pressure to succeed can cause clinics to ignore the wishes of patients and pressure them to use contraceptives whether they want it or not.

Our understanding of poverty

Obviously, poverty and its relation to birth control is a complicated topic. The question remains whether unintended pregnancies cause poverty, or poverty causes unplanned pregnancies. For example, while there is no difference in sexual activity, a poor woman is over five times more likely to unintentionally get pregnant than an rich woman. And the age at which women have children is related to their socioeconomic status as well. For instance, places where women have children earlier in life have bigger gender pay gaps. It seems that unintended pregnancies is as much of a sign as a consequence of poverty.

The risk of framing contraceptives as a tool to fight disparities is that it can simplify our understanding of poverty. Structural factors, such as racial discrimination and the availability of social services, lie at the heart of poverty and need to be addressed. These issues will not go away simply by increasing access to birth control and reducing unintended pregnancies.

The power of education

Another important, and often underestimated, factor in reducing unplanned pregnancies is education. Merely teaching girls how to read enables them to use contraception and to understand sex education resources. Girls who have received a high amount of education are less likely to become pregnant early in life and to enter into child marriage, and more often have future healthy pregnancies. Moreover, it should be taught that pregnancies and the use of contraceptives is the responsibility of both men and women, instead of solely a woman’s responsibility. 

Full of potential.. and risks

It is clear that contraception has a huge potential to change people’s lives and decrease conditions of poverty. But there is a thin line between enabling women to take charge of their reproductive health and violating reproductive rights. Any program offering forms of birth control should be based on the consent and wishes of each individual patient. Moreover, the aim of such programs should be to give women the means to take control of their lives, not to fix society’s poverty.

Furthermore, access to birth controls should not be seen as a single remedy for poverty.  It should always go hand in hand with regular education, scientifically-based sexual education for both genders, and action to tackle structural causes of inequality. Only then, contraceptives will be fully effective in preventing poverty and creating chances for women and children. 

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