contraception, women, society – why are we (still) having this conversation in the US???

plenty has been said about this, so i am going to highlight the points of a few others. but the whole frame of the present national media and political conversation is infuriating. forgetting all the convolutions involved in saying that, in proposing an insurance mandate, anyone is asking anyone to use their taxpayer dollars to pay for them to have sex (and therefore give them the right to watch) or the weird suggestion that use of the pill, like condoms or plan b, would increase with the number of sex acts…

1. hormonal contraception does have health benefits beyond preventing pregnancy, which should be considered more seriously than is allowed in the present debate.

2. allowing people to have sex without the potential outcome of a pregnancy if that is not desired – and, ideally, also without the potential outcomes of sexually transmissible infections – is a really good idea for a society.

(we could argue fertility rates have fallen too far in some OECD countries – in part because of delaying the beginning of childbearing through the use of contraceptives – but that is so far removed from the present media debate that i’ll mostly leave it. that said, in the whole ‘yay society’ theme of this post in terms of how we treat women and sex and choices, it is worth noting that the antidote to sub-replacement (or lowest-low) fertility seems to be “encourag[ing] women’s labor market participation and the opportunity to reconcile work and family life. [these have] emerged as a key factor of the fertility rebound in a context of high female employment. this factor partly explains the reversal in the relationship between GDP per capita and fertility.” so, you know, let women/couples have kids when they’re ready and then help them & their families out a bit)

people are having sex. including teenagers. in the US.

teenage births, along with other factors, are an important indicator of future opportunities for women to pursue education and of career prospects. young mothers are more likely to drop out of education and work in low-paid jobs with long-term consequences on family welfare. the Adolescent Fertility Rate or Teenage Birth Rate is defined as the number of children born alive to women aged 15-19 per 1000 women of this age range. in all OECD countries for which data is available the teenage birth rates have decreased over the last twenty five years. at over one-third of the female adolescent population, the rate is especially high in the United States, Turkey, Chile and Mexico.

(there is nuance and debate around whether teenage pregnancy is detrimental and to what degree – nuance to which we should be attentive. to wit: “the broader society is selective in its attention to the actual life chances of urban African Americans and how these chances shape fertility-timing norms, in part, because this selective focus helps maintain the core values, competencies, and privileges of the dominant group. delayed childbearing is an adaptive practice for European Americans and an intensely salient goal they have for their children. yet early fertility-timing patterns may constitute adaptive practice for African American residents of high-poverty urban areas, in no small measure because they contend with structural constraints that shorten healthy life expectancy. European Americans put their cultural priorities into action ahead of the needs of African Americans and employ substantial resources to disseminate the social control message meant for their youth that teenage childbearing has disastrous consequences. their ability to develop a more nuanced understanding of early childbearing is limited by their culturally mediated perceptions. thus, cultural dominance can be perpetuated by well-meaning people consciously dedicated to children’s well-being, social justice, and the public good. the entrenched cultural interdependence of and social inequality between European and African Americans leads African Americans to be highly visible targets of moral condemnation for their fertility behavior, and also sets up African Americans to pay a particularly high political, economic, psychosocial, and health price.”)

abstinence-only education – which means education in which abstinence is the only thing taught, not that education under other labels doesn’t promote abstinence as a desirable outcome – doesn’t work all that well in the US or elsewhere. i mention this because a lot of the conversation seems to be focused on the decision to have sex or not, which really isn’t the decision a lot of people are making. the decision is whether or not to have sex safely and with intention toward the outcome. deal with it.

these data show clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S.

yay for society. at least, what i think is a reasonable goal for society. this nytimes article gives a nice summary of the links between contraception, labor market participation, & economic development – and plenty of links for further reading.

there is a wealth of economic evidence about the value of the pill – to taxpayers… as well as to women in general.

as the economist Betsey Stevenson has noted, a number of studies have shown that by allowing women to delay marriage and childbearing, the pill has also helped them invest in their skills and education, join the work force in greater numbers, move into higher-status and better-paying professions and make more money over all.

the pill also helped make the marriage market “thicker,” they write. by decoupling sex from marriage, young people were able to put off getting married and spend more time shopping around for a prospective partner.

those changes have had enormous impacts on the economy: increasing the number of women in the labor force, raising the number of hours that women work and giving women access to traditionally male and highly lucrative professions in fields like law and medicine. such trends have helped narrow the earnings gap between men and women. indeed, a study by Martha J. Bailey, Brad Hershbein & Amalia R. Miller suggests that the pill accounted for 30% of the convergence of men’s and women’s earnings from 1990 to 2000.

Quick insurance thoughts (mandates and exemptions)

“The core problem is that inserting employers between health insurers and individuals created an unnecessary tension between the provision of certain goods and the consciences and preferences of employers.” More in response to 13 Feb’s The Daily Show. Bottom line: de-coupling insurance from employment would likely be a positive step.

Why the individual mandate was deemed important and a consideration of whether it is the right tool for the job. But if it isn’t, then what is?

The link between the mandate and interstate commerce is the claim…that the individual mandate will discourage people from “free riding”… But what if the individual mandate actually doesn’t accomplish that goal? That is, suppose the individual mandate, as written into the law passed by Congress, doesn’t actually apply to most of the people who obtain health care without paying for it (e.g. accessing the emergency room)?… Uninsured patients may be broadly divided into two groups – (1) those with (a) low income or (b) preexisting conditions, who can’t afford insurance; and (2) those who are generally healthy, have moderate or high incomes, and choose not to obtain insurance. The individual mandate will impact mainly the latter group – a group with very low rates of uncompensated care, and very low consumption of health care at all… Of the (1a) low-income uninsured, most will be either covered by the health reform law’s vast expansion of Medicaid eligibility… Individuals with (1b) expensive pre-existing conditions will be able to obtain coverage at premiums substantially below their health care expenditures, and thus have a powerful incentive to obtain insurance even without that mandate. This leaves those with (2) income high enough that their health insurance premium is less than 8% of their income, too high to qualify for Medicaid, and healthy enough that they are likely to find health insurance a bad deal financially.”