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Tuesday, May 21, 2024

Access to Birth Control Lets More Girls Finish High School

In 2009, Colorado’s public health department launched an initiative that helped family planning clinics expand access to low- or no-cost contraceptives and reproductive health care. By 2016, the state’s birth rate fell 54 percent for women ages 15 to 19, and the abortion rate fell 63 percent among the same age group.

“We were shocked by the reduction of the abortion and unintended pregnancy rates, but happy it was having this effect,” says Angela Fellers LeMire, interim program manager of the Colorado Family Planning Program, which oversaw the initiative. “Everyone in the field and at the state health department felt good about the work we were doing.”

Now, a study published in May in Science Advances shows that the Colorado Family Planning Initiative (CFPI) had one more benefit: More young women graduated from high school. Researchers at the University of Colorado campuses in Boulder and Denver, in collaboration with those at the US Census Bureau, conducted the study.

Using state American Community Survey and other census data from 2009 to 2017, the authors compared graduation rates in Colorado before and after the state adopted the family planning program with those of 17 other states without such policies. The researchers estimated that the program reduced the percentage of Colorado women between the ages of 20 and 22 without a high school diploma by 14 percent. This resulted, they estimated, in an additional 3,800 women born between the years 1994 and 1996 who graduated from high school by their early twenties.

“As someone who studies the subject, I was surprised. I didn’t expect to see this big an effect,” says lead study author Amanda Stevenson, an assistant professor of sociology at the University of Colorado Boulder.

For decades, the link between birth control access and educational or other achievements has been mostly anecdotal. Part of the rationale behind family planning programs, including the federal Title X program–which provides reproductive health services, including birth control, for low-income and uninsured residents–is that controlling fertility offers other potential socioeconomic benefits, like the ability for people to complete their education. The new study, says Emily Johnston, a senior research associate at the Urban Institute, which conducts economic and social policy research, is “addressing a question the field has long been interested in: What are the impacts, beyond fertility, on people’s lives?”

“Up to now, evidence regarding the effects of contraception on women’s education and opportunities comes from the 1960s and 1970s, but a lot has changed since then,” Martha Bailey, a professor of economics at the University of California, Los Angeles, wrote to WIRED in an email. “This paper shows that access to contraception may still help women take advantage of opportunities and boost their prospects in the labor market.”

To home in on whether access to birth control–as opposed to other variables like access to abortion or adoption services, school quality, fertility rates, or the presence of school programs for pregnant women–was key in contributing to the increase in graduation rates, the authors compared the changes observed in Colorado to that set of 17 other states. (The comparison states were Arizona, California, Connecticut, Hawaii, Illinois, Iowa, Maryland, Massachusetts, Michigan, Minnesota, Montana, New Hampshire, New Mexico, New York, North Dakota, Pennsylvania, and Rhode Island.) These states had similar overall high school graduation rates and state policies, like expanded Medicaid insurance coverage. "Anything is possible, but we didn’t find any statewide policy changes that affected these factors," Stevenson says.

Another factor that could have influenced pregnancies and high school graduation rates would have been if teenagers had become less sexually active. But, Johnston says, it’s unlikely that Colorado would be unique. “You would have to have reason to believe that sexual activity was changing in ways that were different for different states,” she says.

Johnston adds that, while she is confident in the results, one limitation of the study is the small Black and Asian populations in Colorado. Given studies that report racial and ethnic disparities in contraception access and use, it may be challenging to extrapolate whether the results of such an initiative would apply to states with more diverse populations, or to a national program. That suggests the need for a further analysis of family planning programs in other states.

Another question is whether it would be useful to compare the high school graduation rates for young Colorado men whose partners become pregnant to those of men from other states. “For our study, we focused on women, but we think there could be effects on young men,” Stevenson says. For instance, expanded access to contraception may benefit men because it would make them less likely to drop out of school to support a pregnant partner.

Full state funding for Colorado’s initiative only lasted through June 2015, although it received some temporary funding from different organizations for 2015-2016. Since then, Colorado's family planning program has relied on a combination of state and federal funding. Recently, Colorado lawmakers proposed a bill to expand access to birth control and other reproductive health services through the state’s Medicaid program. If passed, it could help boost state funding to continue the initiative.

A 2017 analysis by the Colorado Department of Public Health and Environment found that offering contraception benefited the state budget: It had saved Colorado nearly $70 million that would have been spent on programs like Medicaid, food stamps, and family aid.

The program also improved people’s access not just to birth control, but to clinicians who can provide other aspects of reproductive health care. According to Jody Steinauer, the vice chair of education at the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, this is essential. “Access means that someone is able to receive contraceptive counseling that is comprehensive,” she says. “We don’t want to be coercive in how we provide contraceptive care and make people pay for which method is right for them.”

“I’m thrilled that they did the study,” Steinauer continues, adding that the research “builds support for more community-level engagement and commitment to provide contraception access for all people, and it strengthens the policy argument” more directly for access for teens.

Ultimately, says Stevenson, birth control and family planning programs like the CFPI can have a long-term economic effect not only for the state, but for individual women and their families. “It’s not just the case that if you spend money on contraceptives, there will be fewer births,” Stevenson says. “Empowering people to control their fertility lets them invest in their futures in a different way. It makes people’s lives better. If more people graduate from high school, that’s good for all of us.”

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