Any time a friend has described their method of birth control as
“pulling out,” I instinctively give them a judgmental look. We won
Griswold v. Connecticut. We can buy condoms at any corner store. Sure,
Plan B is over the counter, but why risk it?
Any time a friend has described their method of birth control as “pulling out,” I instinctively give them a judgmental look. We won Griswold v. Connecticut. We can buy condoms at any corner store. Sure, Plan B is available over the counter, but why risk it?
While this seems to be the standard reaction, it could have more basis in cultural stigma than in fact. Recent studies have shown that in this age of infinite options, withdrawal might be just as good as diaphragms and condoms. According to an article on The Globe and Mail, researchers and academics have been embracing the withdrawal method as a viable option of birth control.
“‘Withdrawal has a bad rep, but if you look at the research, it substantially reduces the risk of pregnancy,’ said Rachel Jones, a senior research associate at the Guttmacher Institute in New York.”
So could pulling out finally lose its stigma? The answer, it seems, rests in the results.
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According to the article, “when it comes to reducing pregnancies, withdrawal rivals even the use of condoms. Failure rates for condoms hover at about 17 per cent, while 18 per cent of couples will get pregnant in a year using the withdrawal method, according to estimates of contraceptive failure from the 2002 national survey, which was based on reports from hundreds of women.”
If pulling out is as effective as condoms at reducing pregnancies—though not at preventing STIs—why wouldn’t a monogamous couple choose it?
“A simple tax deduction is not going to deal with the larger affordability problem in child care for low- and moderate-income individuals," Hunter Blair, a tax and budget analyst at the Economic Policy Institute told Rewire.
In a recent speech, GOP presidential nominee Donald Trump suggested he now supports policies to made child care more affordable, a policy position more regularly associated with the Democratic Party. The costs of child care, which have almost doubled in the last 25 years, are a growing burden on low- and middle-income families, and quality options are often scarce.
“No one will gain more from these proposals than low- and middle-income Americans,” claimed Trump in a speech outlining his economic platform before the Detroit Economic Club on Monday. He continued, “My plan will also help reduce the cost of childcare by allowing parents to fully deduct the average cost of childcare spending from their taxes.” But economic experts question whether Trump’s proposed solution would truly help alleviate the financial burdens faced by low- and middle–income earners.
Details of most of Trump’s plan are still unclear, but seemingly rest on addressing child care costs by allowing families to make a tax deduction based on the “average cost” of care. He failed to clarify further how this might work, simply asserting that his proposal would “reduce cost in child care” and offer “much-needed relief to American families,” vowingto tell the public more with time. “I will unveil my plan on this in the coming weeks that I have been working on with my daughter Ivanka … and an incredible team of experts,” promised Trump.
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An adviser to the Trump campaign noted during an interview with the Associated Press Monday that the candidate had yet to nail down the details of his proposal, such as what the income caps would be, but said that the deductions would only amount to the average cost of child care in the state a taxpayer resided in:
Stephen Moore, a conservative economist advising Trump, said the candidate is still working out specifics and hasn’t yet settled on the details of the plan. But he said households reporting between $30,000 and $100,000, or perhaps $150,000 a year in income, would qualify for the deduction.
“I don’t think that Britney Spears needs a child care credit,” Moore said. “What we want to do is to help financially stressed middle-class families have some relief from child-care expenses.”
The deduction would also likely apply to expensive care like live-in nannies. But exemptions would be limited to the average cost of child care in a taxpayer’s state, so parents wouldn’t be able to claim the full cost of such a high-price child care option.
Experts immediately pointed outthat while the details of Trump’s plan are sparse, his promise to make average child care costs fully tax deductible wouldn’t do much for the people who need access to affordable child care most.
Trump’s plan “would actually be pretty poorly targeted for middle-class and low-income families,” Hunter Blair, a tax and budget analyst at the Economic Policy Institute (EPI), told Rewire on Monday.
That’s because his tax breaks would presumably not benefit those who don’t make enough money to owe the federal government income taxes—about 44 percent of households, according to Blair. “They won’t get any benefit from this.”
As the Associated Press further explained, for those who don’t owe taxes to the government, “No matter how much they reduce their income for tax purposes by deducting expenses, they still owe nothing.”
Many people still may not benefit from such a deduction because they file standard instead of itemized deductions—meaning they accept a fixed amount instead of listing out each qualifying deduction. “Most [lower-income households] don’t choose to file a tax return with itemized deductions,” Helen Blank, director of child care and early learning at the National Women’s Law Center (NWLC), told Rewire Tuesday. That means the deduction proposed by Trump “favors higher income families because it’s related to your tax bracket, so the higher your tax bracket the more you benefit from [it],” added Blank.
A 2014 analysis conducted by the Congressional Research Service confirms this. According to its study, just 32 percent of tax filers itemized their deductions instead of claiming the standard deduction in 2011. While 94 to 98 percent of those with incomes above $200,000 chose to itemize their deductions, just 6 percent of tax filers with an adjusted gross income below $20,000 per year did so.
“Trump’s plan is also not really a solution that deals with the problem,” said Blair. “A simple tax deduction is not going to deal with the larger affordability problem in child care for low- and moderate-income individuals.”
Those costs are increasingly an issue for many in the United States. A report released last year by Child Care Aware® of America, which advocates for “high quality, affordable child care,” found that child care for an infant can cost up to an average $17,062 annually, while care for a 4-year-old can cost up to an average of $12,781.
“The cost of child care is especially difficult for families living at or below the federal poverty level,” the organization explained ina press release announcing those findings. “For these families, full-time, center-based care for an infant ranges from 24 percent of family income in Mississippi, to 85 percent of family income in Massachusetts. For single parents the costs can be overwhelming—in every state annual costs of center-based infant care averaged over 40 percent of the state median income for single mothers.”
“Child care now costs more than college in most states in our nation, and it is an actual true national emergency,” Kristin Rowe-Finkbeiner, CEO and executive director of MomsRising, told Rewire in a Tuesday interview. “Donald Trump’s new proposed child care tax deduction plan falls far short of a solution because it’s great for the wealthy but it doesn’t fix the child care crisis for the majority of parents in America.”
Rowe-Finkbeiner, whose organization advocates for family economic security, said that in addition to the tax deduction being inaccessible to those who do not itemize their taxes and those with low incomes who may not pay federal income taxes, Trump’s proposal could also force those least able to afford it “to pay up-front child care costs beyond their family budget.”
“We have a crisis … and Donald Trump’s proposal doesn’t improve access, doesn’t improve quality, doesn’t lift child care workers, and only improves affordability for the wealthy,” she continued.
Trump’s campaign, however, further claimed in a statement to CNN Tuesday that “the plan also allows parents to exclude child care expenses from half of their payroll taxes—increasing their paycheck income each week.”
“The working poor do face payroll taxes for Social Security and Medicare, so a payroll tax break could help them out,” reported CNN. “But experts say it would be hard to administer.”
Meanwhile,Democratic presidential nominee Hillary Clinton released her own child care agenda in May, promising to use the federal government to cap child care costs at 10 percent of a family’s income.
A cap like this, Blank said, “would provide more help to low- and middle-income families.” She continued, “For example, if you had a family with two children earning $70,000, if you capped child care at 10 percent they could probably save … $10,000 a year.”
Clinton’s plan includes a promise to implement a program to address the low wages many who work in the child care industry face, which she calls the “Respect And Increased Salaries for Early Childhood Educators” program, or the RAISE Initiative. The program would raise pay and provide training for child-care workers.
Such policies could make a major difference to child-care workers—the overwhelming majority of which are women and workers of color—who often make poverty-level wages. A 2015 study by the EPI found that the median wage for these workers is just $10.31 an hour, and few receive employer benefits. Those poor conditions make it difficult to attract and retain workers, and improve the quality of care for children around the country.
Addressing the low wages of workers in the field may be expensive, but according to Rowe-Finkbeiner, it is an investment worth making. “Real investments in child care bring for an average child an eight-to-one return on investment,” she explained. “And that’s because when we invest in quality access and affordability, but particularly a focus on quality … which means paying child-care workers fairly and giving child-care workers professional development opportunities …. When that happens, then we have lower later grade repetition, we have less future interactions with the criminal justice system, and we also have a lower need for government programs in the future for those children and families.
Affordable child care has also been a component of other aspects of Clinton’s campaign platform. The “Military Families Agenda,” for example, released by the Clinton campaign in June to support military personnel and their families, also included a child care component. The former secretary of state’s plan proposed offering these services “both on- and off-base, including options for drop-in services, part-time child care, and the provision of extended-hours care, especially at Child Development Centers, while streamlining the process for re-registering children following a permanent change of station (PCS).”
“Service members should be able to focus on critical jobs without worrying about the availability and cost of childcare,” said Clinton’s proposal.
Though it may be tempting to laud the simple fact that both major party candidates have proposed a child care plan at all, to Rowe-Finkbeiner, having both nominees take up the cause is a “no-brainer.”
“Any candidate who wants to win needs to take up family economic security policies, including child care,” she said. “Democrats and Republicans alike know that there is a child care crisis in America. Having a baby right now costs over $200,000 to raise from zero to age 18, not including college …. Parents of all political persuasions are talking about this.”
Coming up with the right way to address those issues, however, may take some work.
“We need a bold plan because child care is so important, because it helps families work, and it helps them support their children,” the NWLC’s Blank said. “We don’t have a safety net for families to fall back on anymore. It’s really critical to help families earn the income their children need and child care gives children a strong start.” She pointed to the need for programs that offer families aid “on a regular basis, not at the end of the year, because families don’t have the extra cash to pay for child care during the year,” as well as updates to the current child care tax credits offered by the government.
“There is absolutely a solution, but the comprehensive package needs to look at making sure that children have high-quality child care and early education, and that there’s also access to that high-quality care,” Rowe-Finkbeiner told Rewire.
“It’s a complicated problem, but it’s not out of our grasp to fix,” she said. “It’s going to take an investment in order to make sure that our littlest learners can thrive and that parents can go to work.”
“They said, ‘Go take her to another hospital. Take her to another place. Those places are available to you. We don’t have to do it here…’,” the OB-GYN explained.
The case is among many contained in a new paper, “Referrals for Services Prohibited in Catholic Health Care Facilities,” which will be published in the September issue of Perspectives on Sexual and Reproductive Health. The study explores whether Catholic hospitals make timely referrals, provide complete and accurate health-care information, and supply emergency treatment when needed.
And it comes as Catholic facilities exert more and more control over U.S. health care, now accounting for one in six hospital beds nationwide, according to recent figures from the advocacy group MergerWatch.
“Until now, there hasn’t been a study asking about referral patterns in Catholic hospitals,” lead author, Dr. Debra B. Stulberg, assistant professor of family medicine at the University of Chicago, said in a phone interview with Rewire. “We set out to ask OB-GYNs how the institution where they worked affected the care they provide.”
In 2011 and 2012, Stulberg and her co-authors conducted in-depth interviews with 27 OB-GYNs who were working or had worked in Catholic hospitals.
The OB-GYNs came from a diversity of faiths and hailed from all parts of the country; 17 were female, ten were male. And while the qualitative nature of the survey means the responses cannot be generalized across Catholic hospitals nationwide, the survey reveals a referral process plagued by reports of inconsistencies and treatment delays.
Survey respondents described cases where they felt that referring a patient to an outside provider put the patient’s health at risk.
One OB-GYN found it “nearly impossible” to treat heavy vaginal bleeding because of the hospital’s ban on hormonal contraceptives.
“Say you have…a 45-year-old who comes in [at three in the morning] with heavy bleeding and irregular periods. The most common approach to stopping her bleeding is to give her high-dose birth control pills for a short period of time. So, that became very difficult…’cause they didn’t have them in stock. I won’t say it’s impossible to get them, because like the head pharmacist knows where there’s three secret packs, and if you happen to manage to find the head pharmacist at [that hour], you can. But it’s nearly impossible to get birth control pills to treat heavy bleeding.”
OB-GYNs described broad inconsistencies in how hospitals handled referrals, with some hospital administrators and ethicists encouraging or tolerating referrals, and others actively discouraging referrals. Sometimes doctors kept referrals hidden. Respondents reported that patients needing abortion care were given less assistance with a referral than those requesting other prohibited services.
In one instance, a secretary tried to block an abortion care referral.
“What doctors told us is sometimes for abortion … there was a sense of, ‘You’re on your own,'” Stulberg told Rewire. She said the disparities in referrals can delay medical treatment and reinforce abortion stigma.
By referring patients for abortions rather than allowing the doctors to administer the prohibited care, some respondents felt the hospital “dumped” or “punted” the patients.
“It tells women that this care is not standard. It’s something we do on the side, under the table,” Stulberg said. “Imagining myself in those patient’s shoes, I might feel really abandoned by my doctor.”
Respondents reported that they received mixed messages from hospital authorities when the facility’s moral teachings were pitted against its financial interests.
For example, Catholic doctrine prohibits handling eggs and sperm for in-vitro fertilization procedures, but a respondent said a Catholic hospital system skirted the ban by opening an off-site fertility clinic.
As the OB-GYN explained, “Now, they’re getting a little crafty with how they get around it, and they go off-campus [to provide such services]. So we actually do now have…an infertility specialist, who is starting up an in vitro fertilization clinic off-campus…. We had somewhere to send them anyway before—it was just out of the system—but now the system wants the business.”
The authors call on policymakers to require Catholic hospitals that refuse to offer care to refer patients to providers and to inform patients beforehand about the limits on treatment at religiously run facilities.
“Having consistent procedures and help to access abortion will reduce the chance that the patient will be given the run around and have her care delayed,” study co-author Lori R. Freedman, assistant professor in the departments of Obstetrics, Gynecology, and Reproductive Sciences at University of California-San Francisco, told Rewire in a phone interview.
The recommendations are in keeping with ethical guidelines from the American Congress of Obstetricians and Gynecologists, which advises health-care providers with religious objections to abortion care to notify patients beforehand and to refer them to abortion care providers.
The study builds on research published in Contraception by a team that included Freedman and Stulberg. They found that Catholic hospitals’ ban on tubal ligations caused unnecessary second surgeries and erected barriers to care for patients with low incomes.
“You really want women to find safe and compassionate providers as soon as possible,” Freedman told Rewire. “Delays…are not good for women.”