Forget Plan B: To Fight Teen Pregnancy, Focus on Economic Opportunity

By Phillip Levine and Melissa Kearney
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(Reuters)

Last week, the Obama administration made the controversial decision to appeal a federal court ruling that would have made Plan B -- better known as the morning-after pill -- available over the counter to girls of any age. The move has riled women's health advocates, who accused the administration of letting politics get in the way of stopping teen pregnancy. But without minimizing the issue of contraceptive access, a measure of reality is needed here. The fact is that whether or not young girls get access to Plan B will have no discernible impact on the country's extraordinary rate of teen childbearing.

Over the past decade, we have devoted considerable scholarly effort to understanding the problem of teen pregnancy in the United States, conducting our own analyses and incorporating the lessons from others. A full 20 percent of American women give birth before the age of 20, more than in any other developed nation. Our traditional approaches to fighting the problem tend to focus on solutions like contraceptives, sex ed, and abstinence only programs. Our work has led us to the conclusion that a new approach is necessary.

If we really want to combat teen childbearing, we need to present girls at risk of becoming pregnant with an attractive alternative. It is not enough to offer them contraception and to explain to how to use it. We need to convince them that they want to use it; that they and their children will be better off if they wait to become mothers.

Even more challenging: We need that message to be true. This is a much more difficult proposition, but all of the evidence suggests that this is what is required -- interventions that change the life trajectory of girls on the path to teen motherhood.

Why Contraception Isn't Enough

The evidence on targeted teen pregnancy prevention approaches is almost always disappointing. In previous work, we have shown that access to free family planning services for low income teens reduces the likelihood of giving birth, but not by very much. The most rigorous studies assessing the impact of access to Plan B emergency contraception points against there being an effect on pregnancy or abortion rates. Abstinence only programs also have no discernible impact on teen births. Sex education has been shown to have an impact on some outcomes like delayed initiation of sexual activity, but the evidence regarding its effectiveness in reducing teen childbearing is weak at best.

Why don't these policies have more of an impact? We believe it is because they do not address the fundamental forces that drive most teens to have children. They focus on the immediate precursors to pregnancy, and miss a lifetime of behaviors and decisions that build towards it. 

Advocates for these types of short-term interventions will point to research on brain development demonstrating that teens are less capable of thinking beyond the moment. Therefore, they argue, we should craft policies aimed at making sure, for instance, that teens have a condom handy or hear consistent messages regarding abstinence. We have no doubt that some teen pregnancies happen because young people fail to consider the long-term implications of their actions. But we do not believe that explains the majority of them. One needs to look no further than the enormous geographic disparities in teen birth rates to suspect that something other than the adolescent brain is at fault. Why would teens in Mississippi or New Mexico have so much more trouble controlling their impulses than their peers in New York or New Hampshire?

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An alternative view -- the one we favor -- is that teen childbearing is a symptom of living a life full of obstacles. Facing limited education and job prospects, as well as a slim chance of finding a suitable man to marry, some low-income girls simply ask, "Why not have a baby now?" Ethnographic work on young, single mothers supports this theory. So does economic research showing that the financial and social problems teen mothers and their children experience are mostly driven by the mother's socio-economic background, not her decision to have a baby early in life.

Why Income Inequality Plays a Role

This view also helps explain why income inequality seems to encourage teen pregnancy. We have found that girls from disadvantaged backgrounds who live in places with a larger gap between the poor and the middle class are considerably more likely to give birth as a teen than girls who have similar backgrounds, but face less inequality. Income inequality is strongly linked to lower economic mobility -- the ability to improve one's station in life. And so our findings seem to suggest that girls who don't see a chance to better their lives are more likely to have a child.

This all isn't to say we should abandon our traditional approaches to fighting teen pregnancy. Some do deliver benefits. For instance, greater access to contraception may not prevent many teen births, but it prevents some, and it is a cost-effective strategy to pursue. It also provides teens who are seeking to prevent a pregnancy a way to achieve that goal. But, in the end, our current policies only make dents around the edges of the problem without addressing the root cause.

We want to attack the cause -- the lack of opportunity so many girls face. Policies do exist that have been demonstrated to improve the life course of disadvantaged youth, including a reduction in teen childbearing. Particularly effective educational interventions are among the types of policies we have in mind. For instance, Promise Academy schools in the Harlem Children's Zone have not only improved educational outcomes, but girls also are less likely to become pregnant as teens. Teen pregnancy prevention programs, like the Carrera Program, that include extensive educational and career counseling elements also have been found to be successful. In general, improving educational attainment for young women seems to work.

To really drive down rates of teen childbearing, we need young women at risk of becoming teen mothers to see a reason to delay motherhood. They need to believe that they have reason to invest in their futures, and they need a viable way to do so. That is where we need to focus our efforts.

This article available online at:

http://www.theatlantic.com/business/archive/2013/05/forget-plan-b-to-fight-teen-pregnancy-focus-on-economic-opportunity/275623/