Traveling by car with my 13-year-old daughter to visit the Southwest's magnificent national parks gave us ample time for listening to the new remix of Let's Talk about Sex (Baby). I would have preferred to listen to public radio, but we made that grand compromise years ago. The fact is, we do need to talk about sex. It's a difficult conversation, but an unintended pregnancy has lifelong consequences.
Those consequences are the subject of MTV's hit television shows, 16 and Pregnant and Teen Mom. Each episode follows a teenager from pregnancy through the first weeks of parenthood. When MTV launched 16 and Pregnant in 2009, its president for entertainment, Brian Graden, said the network wanted to focus on "young people proving themselves." But these shows have proven something else entirely: that unintended pregnancy is a thing to avoid. In fact, a recent study published in the American Economic Review showed a correlation between MTV's two popular shows and contraception. When the shows were on, Internet searches for contraception spiked, as did social media postings.
This accelerating interest in contraception, coupled with increased use, has had powerful results: From 2008 to 2011, unintended pregnancy--a pregnancy that is either unwanted or mistimed-dropped a precipitous 18 percent, reaching its lowest level in decades. Today, there are far more effective options than were once available. Better yet, with the passage of the Affordable Care Act (ACA) and the expansion of Medicaid, most women live in states where contraception is free.
Despite these gains, unplanned pregnancy still happens far too often. In 2010--the most recent year for which this data is available--1.5 million babies were born to mothers who never intended to have them. The question is, how do we capitalize on this moment to further help young people get the contraception they need and want?
In its May 2016 report, "'Billion Dollar Bets' to Create Economic Opportunity for Every American," The Bridgespan Group identifies 15 areas in which philanthropy can help restore economic opportunity for low-income Americans. Unintended pregnancy is one of those areas--both because of the extent to which it can derail the lives of young parents and for the momentum we already have to dramatically reduce or even eliminate the problem
The Cost of an Oops Moment
The fact is, the woman most likely to experience an unplanned pregnancy is probably already clinging to the lowest rungs of the economic ladder--and an unintentional baby is a surefire way to keep her there. She is likely to be unmarried, black or possibly Hispanic, and less educated than the average American woman. She is also likely to be poor.
An unplanned baby will cement her struggle. Pregnancy and parenthood are among the leading reasons why young people drop out of high school and community college. Unplanned babies are two-thirds more likely than other babies to have low birth rates--and their mothers are twice as likely to suffer from postpartum depression.
For young mothers and fathers, children and families, unintended pregnancy is both a symptom and a cause of poverty, passed down through generations. The financial burden imposed by those unplanned babies is one we all carry: unintended pregnancies cost federal and state taxpayers between $9.6 and $12.6 billion in medical expenditures each year.
The Solution that Can Make a Difference
Historically, even for those young women who protect themselves, contraception has been unreliable. One in five condoms break. One in 10 women on the pill get pregnant. The dearth of information on how to get or use contraception was partly to blame.
But intrauterine devices (IUDs) and the birth control implant--called long-acting reversible contraception (LARC)--have changed that. These forms of birth control require almost no daily effort, last for three to 10 years, and have less than a one percent failure rate. They offer almost ironclad protection for those lucky enough to get them.
Here's the rub: if contraception can be hard to get, since health-care clinics don't always offer family-planning services, an IUD or LARC is even harder. The Bridgespan Group's "'Billion Dollar Bets' to Reduce Unintended Pregnancy" finds that only 47 percent of low-income women are able to access any sort of family planning services from publicly funded clinics, including the federally qualified public health centers (FQHCs) that poor people count on for care. Meanwhile, less than 20 percent of FQHCs make all methods of contraception available on site. A mere 30 percent present the IUD and LARC as possible options. And even when a woman chooses one of these options, she may have to visit the doctor's office two or three times--a high hurdle, when she can take home birth control pills in just one visit.
The result? Just 10.5 percent of women ages 15 to 24 who take contraception use LARC.
With access, information, and fewer doctor visits, everything changes. In St. Louis, the Contraceptive CHOICE project offered free contraceptives, counseling, and same-day procedures to nearly 10,000 women. A significant percentage of women decided to use contraception--and three out of four of those women chose LARC, resulting in 75 percent decreases in teen pregnancy and abortion.
In 2009, the state of Colorado offered 30,000 free LARC devices to women, which started a similar decline among pregnancies. Within four years, the birth rates among teens and 20- to 24-year-old women dropped by 48 and 20 percent respectively. Medicaid also avoided nearly $79 million in birth-related costs from 2010 to 2012, making the initiative's return on investment $5.85 for every dollar spent.
What Funders and Nonprofits Can Do
For decades, thorny politics, coupled with enduring misconceptions about contraception, have impeded our ability to address unintended pregnancy--until now. Colorado and St. Louis illustrate that when we increase access to LARC, unintended pregnancy becomes an almost entirely solvable problem.
Indeed, funders and nonprofits seeking to improve upward mobility for those stuck at the bottom of the income ladder have an important and timely opportunity. If we can break down the barriers for poor people to access IUDs and LARC more broadly, we can further reduce unintended pregnancy--and give young people far greater control over their economic lives. Specifically, we can:
•Increase accessibility by providing high quality contraceptive counseling and access--on the same day that a woman wants it and through any door of the healthcare system;
•Increase demand through education and motivational campaigns that inform young people about the forms of contraceptive that will best support them; and
•Support further research to understand patterns for contraception, such as whether increased access to LARC leads to increased use, as well as to understand more about public misconceptions of birth control.
What does success look like? Effective forms of contraception will become much more commonplace, including in poor communities. Accurate, compelling information will be pushed out to young people, so they won't have to count on Google searches for the information they need to manage their lives. And the rate of unintended pregnancy will plummet still further, with more young people empowered to plan for pregnancy if and when they are ready.
Willa Seldon is a partner in The Bridgespan Group's San Francisco office. The author thanks Bridgespan partner Debby Bielak, manager Devin Murphy, and senior associate consultant Michelle Boyd for their research and insights that provide the basis for this article.