News

Unintended Pregnancy Rates Linked to Proportion of Women Uninsured or on Medicaid

Martha Kempner

A new analysis from researchers at the Guttmacher Institute found that states' unintended pregnancy rates are related to the proportion of women in the state who are uninsured and receiving Medicaid.

A new analysis from researchers at the Guttmacher Institute found that states’ unintended pregnancy rates are related to the proportion of women in the state who are uninsured and receiving Medicaid.

The rates of unintended pregnancy vary widely across states and research has found that some women have much higher rates of unintended pregnancy than others.  Specifically, black and Hispanic women and women living in poverty experience higher rates of unintended pregnancy.  Researchers conducted the current analysis to determine whether a state’s demographic and socioeconomic make up was related to its rates of unintended pregnancy.  

Though their initial analysis revealed a strong relationship between a state’s ethnic composition and its unintended pregnancy rates, further analyses showed that most of this relationship was accounted for by other factors.  What did remain significant, however, was the proportion of women in a given state who receive Medicaid and are uninsured.  This was strongly associated with the state’s unintended pregnancy rate.  Specifically, the researchers found, “the greater the proportion of women who lacked insurance, or the lower the proportion covered by Medicaid, the higher the unintended pregnancy rate.”

According to the authors, these findings suggest that states look at efforts to expand insurance and Medicaid coverage among groups with high levels of unintended pregnancy as a possible way to lower these rates.    

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Variation in State Unintended Pregnancy Rates in the United States” is currently available online and will appear in the March 2012 issue of Perspectives on Sexual and Reproductive Health.

Culture & Conversation Politics

Latino Votes Count or ‘Why Would They Be Trying to Suppress Them?’: Dolores Huerta on What’s at Stake in 2016

Ally Boguhn

“We know that we’ve had this problem that Latinos sometimes don’t vote—they feel intimidated, they feel like maybe their vote doesn’t matter,” Huerta told Rewire. Huerta encouraged people to consider both what is at stake and why their vote might be suppressed in the first place.

Republican nominee Donald Trump launched his campaign for president in June 2015 with a speech notoriously claiming Mexican immigrants to the United States “are bringing drugs, and bringing crime, and their rapists.”

Since then, both Trump’s campaign and the Republican Party at large have continued to rely upon anti-immigrant and anti-Latino rhetoric to drum up support. Take for example, this year’s Republican National Convention in Cleveland, where Sheriff Joe Arpaio—whose department came under fire earlier this year for racially profiling Latinos—was invited to take the stage to push Trump’s proposed 2,000-mile border wall. Arpaio told the Arizona Republic that Trump’s campaign had worked with the sheriff to finalize his speech.

This June, just a day shy of the anniversary of Trump’s entrance into the presidential race, People for the American Way and CASA in Action hosted an event highlighting what they deemed to be the presumptive Republican nominee’s “Year of Hate.”

Among the advocates speaking at the event was legendary civil rights leader Dolores Huerta, who worked alongside César Chávez in the farm workers’ movement. Speaking by phone the next day with Rewire, Huerta—who has endorsed Democratic nominee Hillary Clinton—detailed the importance of Latinos getting involved in the 2016 election, and what she sees as being at stake for the community.

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The Trump campaign is “promoting a culture of violence,” Huerta told Rewire, adding that it “is not just limited to the rallies,” which have sometimes ended in violent incidents, “but when he is attacking Mexicans, and gays, and women, and making fun of disabled people.”

Huerta didn’t just see this kind of rhetoric as harmful to Latinos. When asked about its effect on the country at large, she suggested it affected not only those who already held racist beliefs, but also people living in the communities of color those people may then target. “For those people who are already racist, it sort of reinforces their racism,” she said. “I think people have their own frustrations in their lives and they take it out on immigrants, they take it out on women. And I think that it really endangers so many people of color.”

The inflammatory rhetoric toward people of color by presidential candidates has led to “an alarming level of fear and anxiety among children of color and inflaming racial and ethnic tensions in the classroom,” according to an April report by the Southern Poverty Law Center (SPLC). The organization’s analysis of the impact of the 2016 presidential election on classrooms across the country found “an increase in bullying, harassment and intimidation of students whose races, religions or nationalities have been the verbal targets of candidates on the campaign trail.” Though the SPLC did not name Trump in its questions, its survey of about 2,000 K-12 educators elicited up more than 1,000 comments about the Republican nominee, compared to less than 200 comments mentioning other presidential candidates still in the race at that time.

But the 2016 election presents an opportunity for those affected by that violent rhetoric to make their voices heard, said Huerta. “The Latino vote is going to be the decisive vote in terms of who is going to be elected the president of the United States,” she continued, later noting that “we’ve actually seen a resurgence right now of Latinos registering to vote and Latinos becoming citizens.”

However, a desire to vote may not always be enough. Latinos, along with other marginalized groups, face many barriers when it comes to voting due to the onslaught of voter restrictions pushed by conservative lawmakers across the country—a problem only exacerbated by the Supreme Court’s 2013 ruling gutting portions of the Voting Rights Act (VRA) meant to safeguard against voter suppression efforts. The 2016 election season will be the first presidential election without those protections.

As many as 875,000 eligible Latino voters could face difficulty voting thanks to new restrictions—such as voter ID laws, proof of citizenship requirements, and shortened early voting periods—put into place since the 2012 elections, a May analysis from the National Association of Elected and Appointed Officials found.

When it comes to restrictions like this, Huerta “absolutely” saw how they could create barriers for those hoping to cast their ballot this year. “They’ve made all of these restrictions that keep especially the Latino population from voting. So it’s very scary,” said Huerta, pointing to laws in states like Texas, which previously had one of the strictest voter ID laws in the country. (The state has since agreed to weaken its law following a judge’s order).

“We know that we’ve had this problem that Latinos sometimes don’t vote—they feel intimidated, they feel like maybe their vote doesn’t matter,” Huerta went on.

Huerta encouraged people to consider both what is at stake and why their voting rights might be targeted in the first place. “What we have to think about is, if they’re doing so much to suppress the vote of the Latino and the African-American community, that means that that vote really counts. It really matters or else why would they be trying to suppress them?”

Appealing to those voters means tapping into the issues Latinos care about. “I think the issues [Latinos care about] are very, very clear,” said Huerta when asked how a presidential candidate could best appeal to the demographic. “I mean, immigration of course is one of the issues that we have, but then education is another one, and health care.”

A February survey conducted jointly by the Washington Post and Univision found that the top five issues Latino voters cared about in the 2016 election cycle were jobs and the economy (33 percent), immigration (17 percent), education (16 percent), health care (11 percent), and terrorism (9 percent).

Another election-year issue that could affect voters is the nomination of a U.S. Supreme Court justice, Huerta added. She pointed out the effect justices have on our society by using the now-decided Whole Woman’s Health v. Hellerstedt case as an example. “You know, again, when we think of the presidents, and we think of the Supreme Court and we know that [was] one of the issues that [was] pending in the Supreme Court … whether what they did in Texas … was constitutional or not with all of the restrictions they put on the health clinics,” she said.

Latinas disproportionately face large barriers to reproductive health care. According to Planned Parenthood, they “experience higher rates of reproductive cancers, unintended pregnancy, and sexually transmitted infections than most other groups of people.” Those barriers are only exacerbated by laws like Texas’ HB 2, as the National Latina Institute for Reproductive Health explained in its amicus brief in the Whole Woman’s Health case prior to the decision: “Texas Latinas already face significant geographic, transportation, infrastructure, and cost challenges in accessing health services.”

“H.B. 2’s impact is acute because of the day-to-day struggles many Latinas encounter when seeking to exercise their reproductive rights,” wrote the organization in its brief. “In Texas, there is a dire shortage of healthcare facilities and providers in predominantly Latino communities. Texas has the highest percentage of uninsured adults in the country, and Texas Latinos are more than twice as likely as whites to be uninsured …. Additionally, the lack of public and private transportation creates a major barrier to accessing health services, especially in rural areas.”

As Rewire’s Tina Vasquez has reported, for undocumented women, the struggle to access care can be even greater.

Given the threats cases like Whole Woman’s Health have posed to reproductive rights, Huerta noted that “Trump’s constant attacks and misogynist statements” should be taken with caution. Trump has repeatedly vowed to appoint anti-choice justices to the Supreme Court if elected.

“The things he says without even thinking about it … it shows what a dangerous individual he can be when it comes to women’s rights and women’s reproductive rights,” said Huerta.

Though the race for the White House was a top concern of Huerta’s, she concluded by noting that it is hardly the only election that matters this year. “I think the other thing is we have to really talk about is, the presidency is really important, but so is the Senate and the Congress,” said Huerta.

“We’ve got to make sure we get good people elected at every level, starting at school board level, city council, supervisors, commissioners, etc. state legislatures …. We’ve got to make sure reasonable people will be elected, and reasonable people are voted into office.”

Commentary Contraception

The Promotion of Long-Acting Contraceptives Must Confront History and Center Patient Autonomy

Jamila Taylor

While some long-acting reversible contraceptive methods were used to undermine women of color's reproductive freedom, those methods still hold the promise of reducing unintended pregnancy among those most at risk.

Since long-acting reversible contraceptives (LARCs), including intrauterine devices and hormonal contraceptive implants, are among the most effective means of pregnancy prevention, many family planning and reproductive health providers are increasingly promoting them, especially among low-income populations.

But the promotion of LARCs must come with an acknowledgment of historical discriminatory practices and public policy related to birth control. To improve contraceptive access for low-income women and girls of color—who bear the disproportionate effects of unplanned pregnancy—providers and advocates must work to ensure that the reproductive autonomy of this population is respected now, precisely because it hasn’t been in the past.

For Black women particularly, the reproductive coercion that began during slavery took a different form with the development of modern contraceptive methods. According to Dorothy Roberts, author of Killing the Black Body, “The movement to expand women’s reproductive options was marked with racism from its very inception in the early part of [the 20th] century.” Decades later, government-funded family planning programs encouraged Black women to use birth control; in some cases, Black women were coerced into being sterilized.

In the 1990s, the contraceptive implant Norplant was marketed specifically to low-income women, especially Black adults and teenage girls. After a series of public statements about the benefits of Norplant in reducing pregnancy among this population, policy proposals soon focused on ensuring usage of the contraceptive method. Federal and state governments began paying for Norplant and incentivizing its use among low-income women while budgets for social support programs were cut. Without assistance, Norplant was not an affordable option, with the capsules costing more than $300 and separate, expensive costs for implantation and removal.

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Soon, Norplant was available through the Medicaid program. Some states introduced (ultimately unsuccessful) bills that would give cash rewards to entice low-income women on public assistance into using it; a few, such as Tennessee and Washington state, required that women receiving various forms of public assistance get information about Norplant. After proposing a bill to promote the use of Norplant in his state in 1994, a Connecticut legislator made the comment, “It’s far cheaper to give you money not to have kids than to give you money to have kids.” By that year, as Roberts writes, states had spent $34 million on Norplant-related care, much of it for women on Medicaid. Policymakers thought it was completely legitimate and cost-effective to control the reproduction of low-income women.

However, promoting this method among low-income Black women and adolescents was problematic. Racist, classist ideology dictating that this particular population of women shouldn’t have children became the basis for public policy. Even though coercive practices in reproductive health were later condemned, these practices still went on to shape cultural norms around race and gender, as well as medical practice.

This history has made it difficult to move beyond negative perceptions, and even fear, of LARCs, health care, and the medical establishment among some women of color. And that’s why it’s so important to ensure informed consent when advocating for effective contraceptive methods, with choice always at the center.

But how can policies and health-care facilities promote reproductive autonomy?

Health-care providers must deal head on with the fact that many contemporary women have concerns about LARCs being recommended specifically to low-income women and women of color. And while this is part of the broader effort to make LARCs more affordable and increasingly available to communities that don’t have access to them, mechanisms should be put in place to address this underlying issue. Requiring cultural competency training that includes information on the history of coercive practices affecting women of color could help family planning providers understand this concern for their patients.

Then, providers and health systems must address other barriers that make it difficult for women to access LARCs in particular. LARCs can be expensive in the short term, and complicated billing and reimbursement practices in both public and private insurance confuse women and providers. Also, the full cost associated with LARC usage isn’t always covered by insurance.

But the process shouldn’t end at eliminating barriers. Low-income Black women and teens must receive comprehensive counseling for contraception to ensure informed choice—meaning they should be given information on the full array of methods. This will help them choose the method that best meets their needs, while also promoting reproductive autonomy—not a specific contraceptive method.

Clinical guidelines for contraception must include detailed information on informed consent, and choice and reproductive autonomy should be clearly outlined when family planning providers are trained.

It’s crucial we implement these changes now because recent investments and advocacy are expanding access to LARCs. States are thinking creatively about how to reduce unintended pregnancy and in turn reduce Medicaid costs through use of LARCs. The Colorado Family Planning Initiative has been heralded as one of the most effective in helping women access LARCs. Since 2008, more than 30,000 women in Colorado have chosen LARCs as the result of the program. Provider education, training, and contraceptive counseling have also been increased, and women can access LARCs at reduced costs.

The commitment to LARCs has apparently yielded major returns for Colorado. Between 2009 and 2013, the abortion rate among teenagers older than 15 in Colorado dropped by 42 percent. Additionally, the birth rate for young women eligible for Medicaid dropped—resulting in cost savings of up to an estimated $111 million in Medicaid-covered births. LARCs have been critical to these successes. Public-private partnerships have helped keep the program going since 2015, and states including Delaware and Iowa have followed suit in efforts to experience the same outcomes.

Recognizing that prevention is a key component to any strategy addressing a public health concern, those strategies must be rooted in ensuring access to education and comprehensive counseling so that women and teens can make the informed choices that are best for them. When women and girls are given the tools to empower themselves in decision making, the results are positive—not just for what the government spends or does not spend on social programs, but also for the greater good of all of us.

The history of coercion undermining reproductive freedom among women and girls of color in this country is an ugly one. But this certainly doesn’t have to dictate how we move forward.

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