Remember the culture wars? If you tuned into the chatter on contraception and religious freedom in the last couple weeks, you could be forgiven for thinking that it was 1985 all over again. The Obama administration wants to require all employers to include contraception in their health insurance at no cost. The Catholic Church balked at this requirement as it applies to Catholic universities and other religious institutions. The Administration countered with a compromise, kind of.
The issue of contraceptive policy is often framed as a matter of religious freedom or sexual liberation, but it is also a very serious social policy question. Ben pointed me to these interesting graphics from the Economist that show stunning 25-year declines in teenage pregnancies, birth rates, and abortions for whites, blacks, and Hispanics in the United States. The widest disparities, between blacks and whites in teenage pregnancy rates, are narrowing substantially over time.
This is good news, even if it is blunted by the fact that progress has stalled in the last couple of years. It is also the case that the proportion of children being raised by single mothers is actually steadily increasing over time (see Figure 1). All else equal, it is better for children to be raised by two parents, and it is better for parents to achieve some financial independence.
Has increased uptake of contraception caused the decline of teenage pregnancies and abortions? In 1992, 29% of females used no contraceptives at first sex, but this declined to 25% in 2002. Condoms were the most common method, but hormonal contraception use also increased substantially among teens during this period. Despite the emphasis on teenage abstinence – and the claim that abstinence-only education works –quasi-experimental evidence suggests that such policies are useless or worse in decreasing teenage pregnancies.
The truth is that there are many factors that have contributed to the long-run trend in teenage childbearing. In a 2003 paper, Lopoo et al. demonstrate that some policies, such as more aggressive child support enforcement, have led to increased teenage pregnancies. The explanation is probably that teenage males are more likely to use contraception in response to a more credible threat of having to pay child support. Decreasing generosity of welfare benefits also caused single motherhood to be less attractive to teenage women (validating a claim that supporters of welfare reform have frequently made).
The structure of social and demographic disadvantage might also impact teenage pregnancy rates. Poverty is generally considered a risk factor for early childbearing, especially if the opportunity cost of teenage pregnancy is low (for example, if there are few opportunities in the labor market). Moreover, teenage pregnancy could provide validation and companionship to disadvantaged women, and help them to gain esteem in their community. This idea is supported in the research of Kathy Edin and colleagues. However, Melissa Kearney concludes in a 2009 review that the relationship between rates of disadvantage (such as being the child of a single or low-educated parent) and early childbearing is modest after inclusion of state and period fixed effects. Higher income can change the quality of child care that parents can provide once a child is born – both in terms of time spent parenting, and in economic resources. Reducing teenage pregnancy among the poor should still be a priority.
What will be the next frontier for reducing teenage pregnancy? The Obama administration has placed part of their bet on free access to contraception for all women. They have also very deliberately shifted away from the abstinence-only approaches of the Bush Administration. These are positive steps. Changing incentives is also likely to be important: if teens are provided with other avenues to gain personal fulfillment, in school and in the labor market, they may be less likely to engage in risky sexual behaviors.