In a hotly contested decision this week, the Supreme Court ruled that for-profit employers can opt out of providing certain types of contraception coverage on religious grounds. Ostensibly, the holding is narrow: Only companies that the Court calls "closely held" can claim a sincerely held religious belief, and the case is meant only to apply to birth control, not other medical care that might conflict with an employer’s religion.
The legacy of the Court’s reasoning remains to be seen, but White House spokesperson Josh Earnest told reporters that President Obama believes women “should make personal health care decisions for themselves, rather than their bosses deciding for them.”
But contraception extends well beyond a woman’s decision whether and when to conceive, and access to reliable family planning goes deeper than a woman’s personal wellbeing. It plays a pivotal role in the financial, physical and emotional health of children, and data suggest that effective contraception and positive social outcomes are mutually reinforcing. In the end, empowering women—regardless of socioeconomic status—with more options to control pregnancies has benefits for everyone.
According to a 2013 Guttmacher Institute review of more than 66 studies, spanning three decades, reliable contraception allows women to be better parents. Among the findings: couples who experience unintended pregnancy and unplanned childbirth are more likely to have depression and anxiety—while adults who plan their children tend to be happier. Relationships are more likely to dissolve after an unplanned birth than a planned one. And those who are unprepared to be parents are more likely to develop a poor relationship with their child.
“When you support individuals and families making the right decisions for themselves, we are all better off,” said Adam Sonfield, Guttmacher Institute senior public policy associate and lead author of last year’s report on the social and economic benefits of contraception. “It all starts with educational attainment that leads to greater economic stability for women and their families.” Last year, the Guttmacher Institute concluded that access to birth control significantly increases a woman’s earning power and narrows the gender pay gap.
Given all the data, it’s still nearly impossible to separate these benchmarks of a woman’s welfare from family health and societal gains at large. Though, there are distinct benefits that accrue to children in homes with reliable birth control.
Using census data, a recent article in CESifo Economic Studies provides new evidence linking family planning programs of the 1960’s and 70’s with a decrease in the share of U.S. children and adults living in poverty today. As such, the study concludes, family planning programs may be an effective way to improve children’s economic resources.
Embedded in the conversation about birth control access is a cycle of poverty. As income inequality grows families without access to reliable contraception are potentially at a greater disadvantage. Poorer children experience more health problems, live in more dangerous neighborhoods and have higher rates of delayed academic development. Those from poorer households in the long run, have lower test scores, are less likely to complete high school or college, limiting their earning potential as adults.
University of Michigan economics professor and co-author of the CESifo article, Martha Bailey puts the findings in context. “Family planning programs also allow people to delay marriage and childbirth until they find the right partner. We know that the presence of two adults in a household helps both the parents’ economic situation and also the children’s,” said Bailey.
“Cheaper and more reliable contraception allows parents to delay childbearing, to invest in their own human capital and have children when their incomes are higher.”
Though contraception is not simply about avoiding pregnancy. Access to reliable birth control also allows women to space births which has measurable outcomes for their own health and that of their babies, according to Jennifer Reich, professor of sociology at the University of Denver and co-editor of the forthcoming book, Reproduction and Society.
Multiple studies have shown the adverse maternal and perinatal outcomes related to closely spaced pregnancies, ranging from placenta abruption to lower birth weight.
Maternal deaths associated with childbirth, Reich points out, are on the rise in the US. While the reasons are not entirely clear, the increase in the number of pregnant women who have diseases that contribute to higher-risk pregnancies— like hypertension and diabetes— may be partially to blame. “Pregnancy can exacerbate existing [health] conditions,” said Reich, “all reasons why women should be able to choose if and when to become pregnant and deserve to receive high quality affordable care in making that decision.”
Consider also the following savings for government health programs: for every public dollar spent on contraception, Sonfield explains, $5.68 is saved in Medicaid spending.
“For a variety of reasons, half of the pregnancies in this country are unintended, partly because women are not using optimal contraception for their lifestyle. Many in the field believe that IUD’s are underutilized by the medical community,” says Dr. Carol S. Weisman, a distinguished professor of public health sciences and obstetrics and gynecology at Penn State College of Medicine. “We do know that costs associated with unexpected pregnancies are high.” In addition, Weisman explains, when a pregnancy is planned, a mother is more likely to get appropriate prenatal care and abstain from unhealthy activities like smoking, so the overall health outcomes tend to be better.
And raising a child in America today is costly. According to Department of Agriculture, the annual cost of a child in a middle-income, two parent family ranges from $12,600 to $14,700. Birth control and motherhood may appear to be competing goals, wrote Bird. But studies show that the typical American family wants two children, which means a women must use reliable birth control for three decades to achieve her goal.
While women bear the physical costs of the risks and side effects, they clearly aren’t the only ones who benefit from having access to reliable contraception, she explains.
“Given that women’s employers, their health insurers, and the economy as a whole share in considerable savings from the use of contraceptives, you would think we would want to go out of our way to support everyone in having the number of children they want and to avoid unintended pregnancies,” says Dr. Chloe Bird, senior sociologist at Rand, editor-in-chief of Women’s Health Issues and author of “Gender and Health: The Effects of Constrained Choice and Social Policies.”
All the more reason, a national dialogue about contraception can no longer ignore the intricate connection between a woman’s wellbeing, her educational attainment, her family’s health, and the opportunities available to her children.