How Embedding Women With Contraception May Keep Them In Poverty

How Embedding Women With Contraception May Keep Them In Poverty

Embedding poor women with long-acting contraception may produce a generation of poor people who may be worse off, lacking the comforts of family life.
Elizabeth Bauer

What’s the “success sequence” for life? Research by the Brookings Insitution back in 2013, defined it as as waiting to have children until one meets the following criteria: finish high school; get a full-time job (or have a spouse with one); get married.

As Brooking says, “Our research shows that of American adults who followed these three simple rules, only about 2 percent are in poverty and nearly 75 percent have joined the middle class (defined as earning around $55,000 or more per year).”

More recently, the American Enterprise Institute re-crunched the numbers in a report by W. Bradford Wilcox and Wendy Wang, which concludes, “Finally, 97% of Millennials who follow what has been called the ‘success sequence’…are not poor by the time they reach their prime young adult years (ages 28-34).”

Some studies critique the methodology and other pundits or policy advocates reject that there are jobs to be had, or there is anything good about promoting marriage, or that marriage is an insulator against poverty. And there seem to be squabbles over how “poor” is defined. Obviously, if your threshold is the federal poverty line, which is only marginally greater for two adults than one ($16,240 vs. $12,060), you’ll count fewer poor people than if you use multiples of the poverty line to define “low income.” Critics also seem to discard the caveat that the “success sequence” pays off in the late 20s rather than immediately.

So Let’s Just Temporarily Sterilize People

All that being said, progressives have a solution to put everyone on a short-cut to the success sequence path: LARCs, or long-acting reversible contraceptives (IUDs and contraceptive implants). To varying degrees, they advocate actions ranging from making these available through taxpayer subsidies (which is generally the case now, and was a key objective of the Affordable Care Act contraceptive mandate), to promoting them as the “first-line” choice for women and teen girls, to dreams that every woman is automatically LARC’d until she is ready to plan her first pregnancy.

My first instinct is a full-throated “No!” because proponents generally take the approach that being sexually active is a perfectly normal part of adolescence and young adulthood, something to explore and enjoy with no limits except ensuring all parties have obtained consent from the other(s). But a “No!” is admittedly not going to pass muster as a credible argument without some deeper reflection.

After all, in a perfect world, widespread use of LARCs would offer the potential of virtually ending unplanned pregnancy, whether to teens or adult women who aren’t prepared, financially or emotionally, for a child, and that’s a good thing, right? And there’s nothing preventing a girl or woman who wants to follow her religion’s teachings on sexuality from doing so, even if a LARC all but eliminates one of the consequences of not.

The Unintended Consequences of Increasing Moral Hazard

But universal LARCs will come with some unintended consequences. Among teens, at least one study has shown that teens are less likely to use condoms when the girl is using a LARC, and that those girls also have had more sex partners than users of other forms of contraception. To be sure, what’s cause and what’s effect—whether using a LARC causes teen girls to have sex with multiple partners, or whether girls who already are having multiple partners are seeking out LARCs—is not identified in the study, but at a time when diagnoses of STDs (chlamydia, gonorrhea, and syphilis) are at an all-time high, there is an immediate and serious risk to telling teens and young adults that their worries about sex are over.

While the study suggests the answer to this problem is more education, it seems contrary to human nature to imagine that people receiving what they’re told is a device that will take away any need for ongoing responsibility, and are often told that it’s simply not possible for them to be reliable enough to use other methods, can at the same time be urged to take the ongoing action of using condoms.

Here’s another worry: what happens to the girls who won’t or can’t use these contraceptives? In a 2017 study, 25 percent of women receiving LARCs discontinued them at some point in the first two years. While I want to avoid seeming to exaggerate the incidence, a meaningful portion of women who try these methods find the side effects too unpleasant to continue.

Add in the women who simply object to having a device or a drug inserted in them, or object to indefinitely putting artificial hormones and chemicals into their bodies, and those who reject these because of the uncertainty around whether these methods prevent implantation rather than conception (not to mention, yes, those women who choose not to use any form of artificial contraceptive), and you’ll basically be dividing the female population into two: those who might get pregnant, and those for whom pregnancy is highly unlikely.

How strongly would the former group be pressured to use LARCs? To what extent would their personal discomfort be downplayed for the “greater good” of avoiding unplanned pregnancies? And how would the relationships with men change, for both of these groups, if they perceive the latter group as “sexually available”?

Finally, after all is said and done, would we indeed see a generation of young people lifted out of poverty? So far as I know, none of the programs that have sought to increase LARC use (e.g., in St. Louis and in Colorado) have assessed whether the reduction in pregnancies has in fact achieved the goal of enabling these women to become educated and middle-class, or whether they are only “less poor” in the narrow sense that needing to care for a child requires more money than just supporting one’s self. In the best case, we will start to see these favorable results after enough time has passed.

LARCs May Short-Circuit the Success Sequence

But there is another possibility, and that’s that LARC usage “short-circuits” the success sequence. For pill or condom users, or for the non-sexually active in environments where the norm of one’s peers is sex, “not getting pregnant” requires self-discipline in one form or another, and this, repeated consistently, is self-reinforcing. Alternately, poor girls who make it through their teen and young adult years without pregnancy may succeed not due to their childlessness but because of the same personal characteristics that enabled them to avoid pregnancy. Consenting to having an implant or IUD is not the same. It may be that “lack of pregnancy” may mean little in isolation.

In fact, a certain natural experiment is taking place in America’s cities right now: if that which is holding back poor young women is unplanned pregnancy, and poor young men aren’t subject to the same constraints (the inconsistent obligation to pay child support is not the same as the need to be the direct caregiver), then they ought to be miles ahead of their sisters and girlfriends. But they’re not: in Chicago, nearly half of young black men (47 percent of 20- to 24-year-olds) are what’s called NEET—not in employment, education, or training. The black women? Despite the greater roadblock of pregnancy and parenting, only 35 percent of them are NEET.

Even if these women, now “freed” from the risk of pregnancy, finish high school and even college, that’s only half the equation. (Yes, progressives do have a point.) Are there enough jobs at “middle class” pay rates? Who performs the low-paying jobs that for now still exist, and cannot all universally be taken by teens working part-time, or retirees, or by these young people, working at low wages only temporarily until they move on, or others who don’t “need” a support-a-family wage?

Because if we will still invariably need to support individuals working low-wage jobs with wage supplements of some sort or another when they have children, it’s a bit disingenuous to promise the poor a no-poverty life if only they marry and delay having children, as desirable as these actions would be. While being married still has all manner of benefits—two incomes, shared living expenses, a stable upbringing, and an involved father for the children—it’s only part of the solution.

Or if the de facto reversible sterilization of poor women simply means that they are poor and childless, never able to seek removal of their device, all instead of becoming poor mothers, then we have perhaps solved one problem. We have maybe “broken the cycle of poverty,” but we still have a generation of poor people who may be worse off if the “solution” to poverty, for them, is to foreclose the opportunity for the comforts of family life.

I can’t forecast the future. No outcome is proven one way or the other. I can only be very wary of the LARC as an easy, sure-fire cure for poverty.

Elizabeth Bauer is an actuary who works at a pension consulting firm.

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