Making the Case for the Power to Decide
Having the power to decide if, when, and under what circumstances to get pregnant and have a child increases young people’s opportunities to be mentally and physically healthy, to complete their education, and to pursue the future they want, on their own terms. But too many young people—especially those who are economically disadvantaged or marginalized—lack that power.
This includes the power to say no to sex, even if they’ve said yes before. To decide which contraception is right, and to access it without barriers. It’s the power of information. The power of respect for young people—in every community and reflected in the news, the entertainment media, and the policies that shape our country. Having this power keeps the path to opportunity open for young people.
But today, more than 19 million women eligible for publicly funded contraception don’t have access to the full range of birth control methods where they live. That is, 49 out of 50 women in need live in what we call contraceptive deserts. To get the method of birth control that works for them, they have to search for a clinic and often have to travel more than an hour to get there—which also means extra gas or bus fare, time away from school, unpaid time off work, extra child care, and the list goes on.
This is out of sync with what the majority of people in America want. Ninety-nine percent of women who have sex with men use birth control at some point in their lives. Poll after poll shows that the majority of Americans—regardless of political or religious affiliation—think that birth control is a basic part of women’s health care and an important public investment. Bloomberg Businessweek and CNN put oral contraceptives on their lists of game changers in the past century; the Centers for Disease Control and Prevention ranks family planning and modern contraception as one of its Ten Great Public Health Achievements in the 20th Century. In short, the majority of Americans want women to have the power to decide if and when to get pregnant and have a child.
Women who decide to become pregnant and have a child, rather than having it “just happen,” are better prepared emotionally and financially for the demands of having a baby. But they can’t make that decision if they lack information and access to contraception. As a result, about 80 percent of pregnancies among young women age 18 to 29 are described by the women themselves as unplanned.
Although teen pregnancy has long been a recognized challenge—and rates have plummeted in the past two decades—unplanned pregnancy among young women age 18 to 29 has received less attention. Power to Decide, informed by evidence that unplanned pregnancy among teens and young adults can put opportunity at risk, focuses here. As a result of our work and the work of countless others, there have been historic declines in teen pregnancy and an 18 percent decline in unintended pregnancies among women in their 20s between 2008 and 2011. That’s worth celebrating—but more work remains to ensure that everyone has the power to decide.
As we speak with young women across the country, we hear how they or their peers have stepped up to become great parents no matter the circumstance. Resilient and determined, they create nurturing homes for their families, even if early parenthood is not exactly what they envisioned. And, they frequently say, their family would have had a stronger start if they’d had the opportunity to save some money, move out of their parents’ place, and feel stable in their lives before deciding if and when to get pregnant.
Unlike many other health issues, unplanned pregnancy is completely preventable. Among the 1.3 million unplanned pregnancies annually, only 5 percent occurred in women using birth control carefully and consistently. The other 95 percent of the time the couple didn’t intend to get pregnant, but their behavior didn’t match their intention. The reasons for this are complex, but it often comes down to a lack of access to information and the full range of contraceptive options.
That’s a problem we are determined to solve—for every young person in every community across the country.
Nearly all teen pregnancies are unplanned—that is, teens themselves say they did not intend to get pregnant or cause a pregnancy. More and more, teens are able to match their intentions with their actions. As a result of many factors—including increased access to sexual health information and birth control—the United States has seen a 67 percent decline in the teen birth rate since 1991, including profound declines in all 50 states and among all racial/ethnic groups.
But let’s not rest on that progress. Each year, about 210,000 teens still give birth, which is about 20 births for every 1,000 girls. Put another way, nearly two out of every 100 teen girls will have a child each year. Rates are higher among young people living in poverty, living in foster care, or facing persistent racism and discrimination.
The mere fact that teens don’t want to get pregnant is reason enough to ensure that they have access to quality information and birth control. Beyond that, however, preventing teen pregnancy helps expand opportunity, create positive social change, and allow young people to be stronger contributors to their communities.
For example, the national graduation rate is a critical priority—yet nearly one-third of teen girls who have dropped out of high school cite early pregnancy or parenthood as a key reason. Only 40 percent of teen moms finish high school, and less than 2 percent finish college by age 30. Girls in foster care, already at risk of dropping out of high school, are 2.5 times more likely than their peers to get pregnant. Ensuring that all teens have quality information and access to birth control is one of the best strategies to boost the graduation rate. Consider this: between 2001 and 2009, while teen births were plummeting, the national graduation rate increased by 3.5 percentage points.
Add in the positive impact that preventing teen pregnancy can have on so many other issues—reducing poverty and improving young people’s lifelong income, improving health and child welfare, supporting responsible fatherhood, and reducing other risky behaviors—and preventing teen pregnancy becomes not only a reproductive health issue but a national priority. What’s more, daughters born to women in their 20s are three times less likely to become teen moms themselves compared with daughters of teen moms—so it is a change that ripples across generations.
Our polling consistently shows overwhelming bi-partisan, nationwide support among adults for evidence-based teen pregnancy prevention programs. We are committed to protecting and expanding those programs until all teens have the information and access to contraception they need to honor their intention not to get pregnant and realize their full opportunity.
Investing in Opportunity
Providing a system of support that enables young people to have the power to decide if, when, and under what circumstances to get pregnant and have a child not only benefits the young people themselves, but also leads to significant savings in publicly funded programs.
In terms of pure dollars and cents, our estimates show that the public savings associated with declines in teen births amount to more than $4 billion annually, and that’s only factoring in medical and economic supports during pregnancy and infancy. Without question, we as a society must support women, prenatal care, and healthy childbirth. But it’s also essential—and more effective for women, families, and society—to provide information and contraceptive options that empower women to decide if and when to get pregnant in the first place. Providing publicly funded contraception for a woman who wants it costs about $239 per year. All totaled, researchers estimate a savings of roughly $6 in medical costs for every $1 spent on contraceptive services.
For women who are working, we also know that employer-based family planning coverage can lead also yields savings due to decreased absenteeism, increased productivity, and improved employee morale, as well as medical cost savings. And the cost to employers is minimal, accounting for less than 1 percent of total employee health insurance coverage costs.
In all cases, the opportunity that the power to decide provides—to young women, their partners, the next generation of children, our workforce, our communities, and our nation—is priceless. In a 2016 public opinion poll, the overwhelming majority of the American public clearly saw this connection. If you’re one of those people, raise your voice to ensure that every young person has the power to decide.
For more information and resources related to the public savings associated with declines in teen births, including savings in your state or community, see our Progress Pays Off page. For more on the cost-effectiveness of evidence-based unintended pregnancy prevention programs, see the report The Benefits of Birth Control in America: Getting the Facts Straight.