Well-Known Scholar Says Planned Births, Not Marriage, Top Priority for Child Well-Being

Years of research show that a baby who was unplanned or unintended is at risk for any number of things including premature birth, low birth weight, and later, doing less well in school than children whose births were planned. The sad thing is that it has never been easier to plan pregnancies.
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Isabel Sawhill, an expert in poverty and fiscal policy, has long championed the idea that couples should marry before having children. As recently as May 2012, she wrote a piece in The Washington Post supporting former Vice President Dan Quayle's remark in 1992 that TV single mom Murphy Brown had dishonored the country by bearing a child.

Her opinion generated almost 2,500 comments in the newspaper.

Sawhill, a senior fellow in economics at Brookings Institution, a public policy think tank in Washington, still strongly supports marriage. But in her book Generation Unbound, released this week, she writes that she has come to believe that while marriage is an important symbol of commitment and usually a good thing for children, it is no longer what those who care about children should insist come first. She says:

Even if we believe that more marriage would be helpful to children (as I do), turning the tide here...is likely to be difficult. Reducing fertility, on the other hand, is going with the tide, and has even more potential to improve child well-being.

She was more candid during an interview with me earlier this month. "It's the stability of the relationship that matters, not that the couple is married," she said. Also of great consequence, she noted, is whether parents want, and decide when, to have a child.

"What we need," she wrote in a column in The New York Times, "is a new ethic of responsible parenthood."

Let's be clear about one thing: Sawhill is no unbridled liberal either in appearance or policy writing. She wears conservative, well-cut suits, sensible pumps and the occasional pearl necklace. Her gray hair is short, her makeup lightly applied. She served as an associate director of the federal Office of Management and Budget during President Clinton's administration, and has led organizations with names like the Association for Public Policy Analysis and Management.

In Generation Unbound she has come out swinging on the side of making it as easy as possible for women and their partners to plan when to have babies. If she has wearied, as many of us have, of hearing reasons why certain highly effective methods of contraception are not always easily acquired, she doesn't show it. She also reassures women and men that it's okay if they don't want to be parents.

She came to her recent conclusions about raising children after parsing state and national trends in childbearing, child well-being, family formation, and marriage. She found that despite remarkable advances in the cost, variety and effectiveness of contraception, most young adults don't schedule their babies. "If there is one statistic that sums it all up," she writes, "it is that among women under 30, more than half of all babies are born outside marriage."

Additionally, she writes, 60 percent of all childbearing among young, single women is unintended. (The proportion may actually be higher. The question of intention is typically asked after the child is born. How many mothers are going to look at a newborn and say "No, I -- or we -- didn't want to have him (or her)?")

Years of research show that a baby who was unplanned or unintended is at risk for any number of things including premature birth, low birth weight, and later, doing less well in school than children whose births were planned.

The sad thing is that it has never been easier to plan pregnancies. Those of us who are older remember when there were only a couple of reliable methods of contraception. They cost a lot and were not always easy to obtain.

Today, there are six highly effective methods. Still, not all are cheap. Some states have expanded Medicaid to include coverage of all federally approved methods without cost-sharing. But other states have devised less comprehensive plans. In the private sector, women may work for a religious house of worship that is not required to include contraception in its insurance coverage. Or, as in the recent Hobby Lobby case, women may be employed by a closely held, private company that objects to particular methods. Even health care providers may not be familiar with -- and thus less likely to recommend -- the most effective methods.

"How many people fall through the cracks is not an insignificant number," says one policy analyst deeply involved in the issue.

Sawhill rightly believes that it is in the best interest of women and men, as well as the larger society, for public and private health plans to include all methods. She writes:

We should monitor the implementation of the Affordable Care Act to make sure that private health plans are providing all forms of birth control, including those with higher upfront costs, without co-pay. Insurers may not like these high initial costs, but all of the evidence suggests they are a cheaper form of birth control over the long run....The savings from less prenatal and postnatal care and delivery of a baby far exceed these costs. ...Whatever the costs, delaying parenthood is better for children.

Second, we should encourage more states to expand Medicaid coverage of family planning services to a broader group of low-income individuals, as allowed by the Affordable Care Act. Limiting such eligibility...to only the very poor is shortsighted and costly. In 2010, the average cost for one Medicaid-covered birth was $12,770, whereas the annual cost of providing publicly funded contraception for a woman was $239.

Sawhill has advised American presidents on major domestic issues. She is respected by members of Congress on both sides of the aisle, including some who don't always agree with her. We can only hope that on this subject, public officials, politicians and other people with the power to change things will listen to her -- for the benefit of all of us.