What If Women Are Offered Contraception for Free?

3462517489_652dcec39eLast fall, researchers in Missouri caught the attention of public health experts and advocates across North America. Some 9,000 St. Louis women had been offered their choice of contraceptives for free in a study that has since been called an “Obamacare simulation.” Two years later, the teen pregnancy rate was at 6 per 1,000 instead of the U.S. average of 34. The abortion rate was less than half the rate of other St. Louis women.

Why did they get such dramatic results? The free birth control triggered a technology shift in a microcosm. When presented with simple, accurate information and a buffet of no-cost options, a majority of the study’s participants, almost 75 percent, switched from old contraceptive technologies like the Pill, condoms and other barrier methods like cervical caps to state-of-the-art “long acting reversible contraceptives” (LARCs).

Unintended pregnancy rates in the U.S. have not gone down for decades, hovering around half of all conceptions. Now, health advocates and community health agencies are eyeing a potential technology tipping point that could radically change the equation. What would it take to make the St. Louis results the new norm? And what might that mean for Cascadia, the nickname given to the Pacific Northwest where I live?

If a set of things go right, Cascadia could become the St. Louis experiment writ large. But there are a number of ifs. If the Northwest states and Washington, D.C., implement the Affordable Care Act’s provisions for mandatory free contraception—not exempting a patchwork of procedures or employer health plans. If better information about state-of-the-art contraception flows from experts through primary care “gatekeepers” to youth and women. If conversations about LARC methods become standard practice in adolescent medicine and maternity care. If access points in community and school-based clinics are expanded. And if state and provincial governments protect family planning services when making near-term budget cuts.

If we in Cascadia meet these conditions, and long acting contraceptives become the norm, the region’s unintended pregnancy rates among teens and adult women will plummet, budgetary pressure will ease, and more parents and children will flourish. Oh, and the abortion rate will fall, too.

Currently Washington has an unintended pregnancy rate of 48 percent, close to the national average. Oregon’s rate is almost identical. These pregnancies add to public medical costs. In 2006, Oregon spent $72 million on births from unintended pregnancies. But the public costs don’t begin or end at birth. In Washington, during fiscal 2012, Medicaid paid $700 million for prenatal, delivery and infant care. When surveyed by the state’s Department of Health, approximately half of the women who received this care said that they would have preferred to get pregnant later or not at all.

Mostly, by the time “go-with-the-flow” babies like these arrive, their families welcome and love them. But some unintended pregnancies stack the odds against both children and parents. Maternal drinking or poor nutrition in the weeks right before and after conception may increase birth defects. Even families of healthy babies may struggle to stretch resources like time and money and space and emotional energy. When parents get too depleted, marriages can strain or break. Poor families may not be able to afford the same level of education for four kids as three or two. In many cases, families find the resources. They adjust and adapt and get help, and kids flourish. But in other cases, they don’t get help, and kids and parents alike flounder. Adding one more Jenga block to a precarious stack crashes the whole thing—and kids get neglected or rejected or abused.

During the teen years in particular, unplanned childbearing can have far-reaching consequences for a mother and her children, and for their community. Each year in King County, Wash., alone, 15- to 17-year-old girls give birth to more than 300 babies. That’s enough kids, once a few years have passed, to keep several primary schools full. Those children come into the world with the odds stacked against them. Most will grow up in poverty. Fewer than half of their mothers will finish high school, and only 2 percent will get a college degree by age 30. A disproportionate number will experience learning or mental health problems, or end up as teen mothers themselves. Their struggles will contribute to the complicated web of challenges they and their communities face: strained social services, stretched public resources, crime and an education system overwhelmed with special needs.

And King County has one of the lower teen birth rates in Washington State, around 10 per 1,000 girls aged 15-17. The highest county rate in Washington is 55 per 1,000 girls, and the averages for Washington and Oregon are 27 and 28 respectively. (The national average is 34.)

The sheer impact of these numbers on the state budget is daunting, in large part because of the challenges faced by the children of teen mothers. Between 1991 and 2008, approximately 143,000 teens gave birth in Washington, at a taxpayer cost of $3.3 billion. The public tab includes maternal and child health, childhood welfare support and a higher than average rate of incarceration during adolescence and young adulthood.

All of this makes those numbers from St. Louis look particularly interesting at a time when Northwest families and governments are trying to do more with less. Giving women better tools to fulfill their pregnancy intentions—empowering parents so they can decide when they are ready to bring a child into the world—may offer a partial upstream solution to some of the region’s most pressing concerns: affordable health care, better educational outcomes, strong and stable families and balanced budgets.

Valerie Tarico, Ph.D., is a psychologist and writer in Seattle, Wash. She is the author of Trusting Doubt and Deas and Other Imaginings and the founder of WisdomCommons.org. Her articles can be found at Awaypoint.Wordpress.com.

This blog was reposted with permission from Sightline. Find the original post here.

Photo courtesy of ilikegranola.com via Creative Commons 2.0.


  1. i am concerned that these larc’s may ave a negative effect on women’s future fertility and could increase the amount of stds that a woman gets. because young women won’t feel able to insist on men using condoms to protect them from stds etc.
    in addition to giving young people access to free contraception i would like young women to be empowered to feel that they can have control over their sexuality and be able to say no to young mens sexual demands, be encouraged to act sexually responsible by not having multiple partners,and be made aware of the dangers of treating sex like just another recreational activity.
    indiscriminate sex creates all sorts of physical, emotional and spiritual problems, and can make young women be used by unscrupulous men who treat them like objects.
    it can also lead to young men feeling that they have no obligations to women, that women are there for their pleasure, and are mere objects.
    therefore there is no need to become a responsible adult, build relationships, and have a family etc, but they can leave it all to the woman.
    in the 60’s there was too much sexual repression, nowadays there is too much sexual promiscuity which has contributed to the complete breakdown of family life and society, leaving women in many ways worse off than we were before. in the ‘old days’ men had to take responsibility for their actions, nowadays with the proliferation of internet porn etc they see women just as objects available for their use.

    • Paul Scott says:

      tzfatisha, you raise some valid points, but the answer to them is education, not denying access to contraception. The problems that free contraception solve, or mitigate, are orders of magnitude greater than those you outlined. Let’s go the route of reducing those big problems so we can have the resources to devote to educating against the problems you describe.

  2. “What would it take to make the St. Louis results the new norm?”

    What indeed. Personally, I think women should have been offered free contraception long ago, on a nationwide basis, and I would love to see such a program put into place. However, for that to happen, our pro-choice activists and politicians in the Congress and Senate have to speak out about it in the broadcast and print media as often as they can, and they need to start doing it immediately instead of waiting until next year. I’m a frequent watcher of MSNBC programs like Politics Nation with Rev. Al Sharpton, The Rachel Maddow Show, Melissa Harris-Perry’s show on the weekends. These programs would be good for talking about the need for free contraception programs and the benefits they offer. Obviously, we keep talking about it here and in the next print edition of Ms., and in as many progressive magazines and blogs as possible too. The more public discussion we have, the better chance we have of making it work.

  3. Kirsten says:
  4. Socialist Worker says:

    Obviously the way forward is to enhance women’s rights. Control of your body is necessary to allow you to have the freedom to do what you want in life. Those who are worrying about women being responsible are the same who refuse to accept that women should have abortion rights because they can’t be responsible without the Church and State standing guard over them. Dr. Carhart wore a button that said trust women. If we can’t trust women with reproduction who can we trust? Politicians and Sky pilots. I can’t understand why someone who calls themselves a feminist is afraid that sex education and freely available contraception is somehow wrong? Its like the old argument against the ERA, “It will integrated toilets.” You can’t change male attitudes by hiding behind those we can’t trust to begin with. If we spent money on fighting STD’s instead of a mythical war on terror we would have a better success rate in terms of fight diseases and not just STD’s. As to family breakups well once again should women be forced to stay in relationships they dislike? For Politicians and the Church that is something like abortion open to continuous debate, discussion and change. For a feminist the answer should be an easy no. A socialist society would make health care available to all not just those with money and good insurance plans. One need only look at Revolutionary Cuba to see how a Socialist Society would care for the sick and disabled. You live in a Capitalist society where everything for the working class is doled out in an eyedropper.

  5. Patricia says:

    Thank you and the other commentators for their very in depth information. Great talking points and facts for discussions or talks. The whole economic issue as well as the other issues are all important, no matter what identity, political, gender, group, etc. it is. I will be sharing this with some activists who may be struggling with formulating the information as to what they want to say, but have difficulty either writing or speaking it. Thanks again.

  6. Patricia says: “Control of your body is necessary to allow you to have the freedom to do what you want in life.”

    Exactly. It’s just that many state and religious conservatives have long been opposed to women having that control. Personally, I think their biggest fear is that if free contraception is made available to women on a nationwide basis, those women would decide to have fewer children, or worse (for them), no children at all, although I seriously doubt they’ll ever state that publicly.

    Even though we live in the 21st century, there are still people who seem to believe in the archaic, 19th-century, “cult of true womanhood” ideology, which basically says a woman should plan to be a wife and mother and nothing more. That’s the backward attitude toward women and women’s reproductive rights that we’re still fighting against, two centuries later. But fight on we must, because we can’t afford to stop.

  7. “The abortion rate was less than half the rate of other St. Louis women.”

    Yet many right-wingers want to keep women from obtaining contraception even as they decry abortion. More evidence that they are more concerned about controlling women’s bodies than they are about saving “lives.”

  8. tzfatisha says: “in the 60′s there was too much sexual repression, nowadays there is too much sexual promiscuity which has contributed to the complete breakdown of family life and society, leaving women in many ways worse off than we were before.”

    Tzfatisha, I agree with the first part of your statement, but I have to wonder about the second part. Contrary to conservative and relgious beliefs (which aren’t necessarily facts, by the way), not all women want to get married or have children. Some women prefer to be single, financially independent, career women instead. Many working women may not be able to afford reliable contraception for a variety of reasons, a problem that free birth control would easily solve.

    Making contraception free empowers more women to have control over their own reproductive processes, which is a very good thing, to me anyway. When women are able to prevent more unwanted pregnancies due to having reliable birth control available to them at no cost, the number of abortions is also reduced. How anyone, especially a woman, can see free contraception for women as a potential problem is beyond me.

  9. Georgia Platts says: “Yet many right-wingers want to keep women from obtaining contraception even as they decry abortion. More evidence that they are more concerned about controlling women’s bodies than they are about saving “lives.” ”

    Exactly. My guess; they’ll never admit that in public, because it makes them look like the controlling authoritarians they really are. Romney/Ryan made their feelings too public in the last election, which is why they lost. I have a feeling they’ll go with a “stealth” approach this time.

  10. One thing that confuses me about the contraception debate is that contraception seems like a bandaid on a much larger societal issue–namely that the devaluation and the commodification of sex has gone mainstream. The biological consequences of sex–release of bonding hormones, pregnancy, possible spread of STDs–have all been ignored so that we (the upper classes) can all have as much meaningless/experimental/transitional sex as we want from the age of sixteen onward. How does that encourage anyone, teenagers or adults, to treat other people like complete human beings instead of objects? How is it holistic? How is it organic? How is it healthy? We are denying, as a culture, the biological reality that children are the result of copulation. Pregnancy isn’t a disease. How is this any different than the repressive sexual eras of the past–only in this instance instead of ignoring all the “dirty, immoral” sex people are having we’re ignoring all the “dirty, immoral” babies society doesn’t want because it wants to ignore the fundamental moral bankruptcy of the so-called sexual revolution?

  11. While pregnancy isn’t a disease, it is certainly an unwanted medical condition for many women, myself included. Having had my one child by choice, I did the best I could to make sure I did not get pregnant again. Going through the difficult stages of pregnancy and infancy once was enough. Being in my upper fifties, nature has finally stopped my reproductive process, and that is just fine by me.

    However, for the women who are still in their reproductive years, there are still quite a few who either don’t want children for a few years or don’t want kids ever. Many of these women may be in tough economic situations, which make it difficult or impossible to purchase reliable contraception on a regular basis. Going without contraception even once can result in an unwanted pregnancy, so women who can’t afford it risk pregnancy at a time when they can least afford the costs of continuing it. Making contraception free for all women would make it possible for them to prevent pregnancy to the best of their ability. I am astonished that pregnancy prevention could be viewed as a problem.

  12. Again, they failed to figure in SCHOOL TAX, which is the main public cost associated with fertility. Please read these petitions advocating municipal environmental
    contraception funding, which is increasingly politically realistic due
    to The Big Sort in more and more towns, and helps women’s rights, quality of life, and school taxes as well as being at
    least 5 times more cost-effective than any other environmental effort.

    The prochoice and contraception movements are placing too high a priority on defensive actions in the red states when we should be going on the offensive, the side of “change”, in the blue states, and cities. The worst places
    will get even worse no matter what we do, but the unrealized political potential, the low hanging fruit, is in making the best places even better. This opportunity is being caused by The Big Sort. Mayors are not answerable to rural voters, unlike governors and presidents.
    We americans love cars more than babies, Very soon we will have to choose, and we will choose cars.

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