Anybody who says that talking about reproductive rights is a distraction from talking about economics is not running the numbers.
On October 4, a study of 9,000 women showed that access to free contraception radically dropped the rate of unintended pregnancies, two-thirds of which according to the Guttmacher Institute are paid for on the public dime. Unintended pregnancies cost U.S. taxpayers an estimated 11 billion a year in obstetric costs and neonatal care. But that's just the beginning.
Around the world, the relationship between reproductive health and economic prosperity is a given. Lack of contraceptive access dilutes family resources to the point that parents on the edge can't feed their kids. It contributes to school drop outs, illiteracy, and an excess of workers competing for unskilled labor jobs. In some of the poorest communities, one in eight mothers dies from pregnancy -- often unwanted -- leaving motherless children scrabbling to survive rather than climbing a ladder of opportunity. Women are acutely aware of the costs and risks of unwanted pregnancies, and some go to extraordinary lengths to safeguard themselves and their families -- scraping together bus fare, traveling for hours with an infant or toddler and waiting in line for a contraceptive injection, only to repeat the process a few months later. Melinda Gates talked with a poor mother in Kenya who explained her pursuit of contraception this way: "I want to bring every good thing to one child before I have another."
American parents want the same thing. We want to stack the odds in favor of our children. We want to be healthy -- psychologically and physically -- so that we can meet their needs and our own. We want to be financially secure so that we can provide the necessities, deal with emergencies, and still have enough left over for the little extras that make life fun. We want to raise our kids in thriving communities with good streets and schools and parks and clean air and water, in a country that is fiscally solid with sustainable budgets and sustainable resources. This is the definition of economic prosperity. And all of it, to a greater or lesser degree, is predicated on American men and women being able to decide when to have children and how many to have.
Here are nine reminders of why reproductive rights and health care are critical to American prosperity.
1. Kids cost money. Duh. Fiscally responsible families know that six or seven thousand diapers are just the beginning of what it takes to raise a healthy kid. According to statistics from the U.S.D.A., a middle income family pays between $12,000 and $15,000 per year in child rearing costs. Overall, parents can expect to shell out almost $300,000 between the time a child is born and the time he or she hits college - and that's assuming a functioning public school system. On top of that college costs today range from about $60,000 at an in-state university to $240,000 at a selective private college. Working families want to time their childbearing so they can save for and manage these costs.
2. Unintended pregnancies push women out of the workforce, which means family income goes down as costs go up. Enrolling one kid in a daycare center can cost as much as 18 percent of the median income for a married couple. No matter how much a man and woman may value the work they do outside of the home, it doesn't take very many kids before it's simply not worth it for both parents to stay on the job. Obviously, many parents stay home with their kids by choice and love doing so. But with half of the pregnancies in this country unintended, we have to assume that many others simply are making the best of hard trade-offs. For families at the margins, these tradeoffs can push them out of the middle class.
3. Unpredictable childbearing keeps women from attaining their potential as business leaders and innovators. Traditional gender roles are scripted around women not having control over their fertility. In the 1960s, when modern contraception finally became legal in the U.S., there were no female CEOs of Fortune 500 companies. Last year saw a record of eighteen. You might point out that this number is shockingly far from parity, but the fact is that without access to effective, reliable contraception, we'd likely still be at zero. In general, women in positions of business leadership have risen slowly. Even so, by 2007 there were 70 million woman-owned businesses in the U.S.
4. Even apart from childbearing, untreated reproductive health problems contribute to absenteeism, lost wages, and a glass ceiling for otherwise capable female workers. American women miss over a hundred million hours of work annually because of reproductive symptoms including endometriosis, heavy bleeding, menstrual nausea and migraines, and menstrual cramps that can be as intense as early labor. In Italy, cyclical absenteeism due to such symptoms is calculated to account for fourteen percent of the wage differential between men and women. Symptoms related to problem periods are now treatable, largely through the use of continuous or long acting contraceptives (LARCs), but in the absence of widespread healthcare access and education, reproductive health problems continue to be a drain on the economy.
5. Lack of effective contraception keeps women and girls out of school. Because family wage jobs in the trades and military tend to be male dominated, schooling is particularly central to women's economic opportunity. Contraception is one key to female education. At the time contraception became legal, men outnumbered women in college 65 to 35. Today, women continue to lag in the highly paid STEM sector (science, technology, engineering, and mathematics), but are a majority overall. Among high school girls, unintended pregnancy can be an overwhelming barrier to economic advancement. At today's level of sex education and contraceptive access, 80 percent of teen pregnancies are unintended. Only 40 percent of teen moms ever finish high school, and less than two percent have a college degree by age thirty. Because teens are particularly bad at using older contraceptive technologies like the Pill or barrier methods, they are particularly impacted by policies that don't provide state-of-the-art LARC (long acting reversible contraception).
6. Early unintended pregnancy contributes to multi-generational poverty. Children born to teen parents -- recall that 80 percent of those pregnancies are unintended -- come into the world primed to end up economically challenged. Two thirds grow up in poverty. They do less well than average in school and on standardized tests and are more likely to drop out. Girls are more likely than average to become teen mothers themselves. Boys born to teen parents have almost three times the average risk of ending up in prison. Of course, the most significant cost here is the cost in human suffering. But the economic cost is also real, both for the individuals involved and for their communities.
7. Unwanted pregnancy increases domestic violence and associated costs. The relationship between domestic violence and unwanted pregnancy is a two way street. In one study of 3,000 abused women, 25 percent said that their partners sabotaged or forbid contraception. Coerced pregnancy is a shockingly common control tactic that may be aimed at keeping a woman in a violent relationship. On the other hand, unwanted pregnancy increases the risk of physical aggression. One in six victims of domestic violence says that the abuse first occurred during pregnancy. Once again, the primary cost can be measured only in human suffering. But the economic burdens also are real -- women are kept out of the economy, unable to attain financial independence, or unable to function at their best, while expensive crisis intervention and social services tax community resources.
8. Unintended pregnancy unbalances state budgets. In Washington State, almost half of live births are paid for out of public funds at a cost of over $600 million annually. Some of these are chosen pregnancies; many are simply a result of difficulties poor women face in obtaining effective contraception. According to the Guttmacher Institute, every public dollar spent on contraception saves three dollars that would otherwise be spent on Medicaid payments for pregnancy-related and newborn care. But we would be a cruel society if the public outlays stopped at the end of the newborn phase, which means that the savings in the long run are even greater. The State of California saved an estimated 2.2 billion dollars over a five year period by increasing birth control access for residents who fell below 200% of the federal poverty level.
9. Unintended pregnancy unbalances our national budget. Nationally, it is estimated that teen pregnancy alone costs the American taxpayers nine billion dollars each year. In addition, early childbearing is correlated with low earnings far beyond the teen years. One study estimated that the "earnings deficit" incurred by teen mothers cost $925 million in tax revenues in 2004 alone. Add that to the earnings deficit incurred by overburdened older mothers. Budget balance is affected by both outlays and inputs. Lower tax revenues are a cost that directly results from women or couples not having access to effective contraceptives that let them decide how many children they want and when they feel ready to bring those children into the world.
Not long ago Faith in Public Life launched a campaign to remind American voters and our elected representatives that the budget is a moral document. Whether we ask rich people and corporations to pay their fair share and how we invest our tax dollars directly affects the well being of real men, women and children. Some conservatives seem to have forgotten this. They also seem to have forgotten the converse: that human rights and public services lay the foundation for economic prosperity, both for individuals and for the country as a whole.
Patriarchal conservatives who want to restrict access to contraception, abortion and other reproductive health care are putting ideology ahead of compassion and equality. But they are also putting ideology ahead of America's economic well being -- and they should be forced to admit it. Every anti-abortion, anti-contraception politician should have to stand in front of the cameras and say: "I actually don't care what the War on Women does to the economy. I'm so determined to keep females in the kitchen that I'm willing to have our country take an economic hit." That, really, is the bottom line.