Here's how Congress can show its commitment to reducing teen pregnancies
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The mother of a teenage girl. A college student. A 15-year-old who came to me on her own. These are among the many women who have asked me in recent weeks if they, or their daughters, will still have access to birth control in the near future. They are particularly concerned about access to long-acting birth control devices, which work for up to 10 years and are the most effective pregnancy prevention options. These fears are in direct response to what these women are hearing as the debate on the future of the Affordable Care Act (ACA) rages on.

Adolescent and young adult women and their families stand to lose a lot as efforts to repeal the ACA move through Congress. Changes to the health care law could increase the cost and reduce access to contraceptive services, which would significantly and negatively affect our nation’s teen pregnancy rates. Yet, concerns about teen pregnancy have not been part of the conversation and the importance of adolescent access to contraceptive services has neither been acknowledged nor protected.

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Since their high in the 1990s, teen pregnancy rates have declined by 51 percent and teen births by more than 64 percent. This is largely thanks to improvements in contraceptive access and use. Although this reduction represents a historic public health achievement for our nation, the sobering fact is that the number of teenage girls getting pregnant in America remains up to seven times higher than rates in other industrialized nations. The difference between nations is not due to the number of teens who are sexually active. The difference is that contraceptives are almost universally available to young people at low or no cost in these other countries.

 

The ACA’s recognition that contraception is vital for the health of women and girls was an important step in reducing unintended teen pregnancies. Under the ACA, core preventive health services, like contraception, are available without a co-pay. Insurers now have to cover at least one contraceptive method in each of 18 categories, including those long-acting contraceptive devices teens and moms have been asking me about. Removal of this cost barrier resulted in increased contraceptive use among women in all 50 states, and all racial groups.

While it may not be popular to talk about birth control for teens, the reality is that birth control is at the forefront of many parents’ minds and is perhaps more impactful than any other single intervention for determining the course of a young woman’s life. Many of my patients are from low-income families, or families very familiar with the far-reaching effects of unintended pregnancy. Barely a week goes by without me seeing at least one mother, sister or friend of a teen who has brought her loved one in to ask if the teen can start birth control. The mothers are often young women themselves: former teen mothers whose babies are now capable of bearing children. What these mothers tell me is that they want their daughters to have more options in life than they did and that getting pregnant would limit those options.

The preventive health benefits provided under the current health care law offer women and their daughters those options. Options that, along with these young women’s futures, are at risk as the debate about the future of the ACA continues.

The important gains we’ve made in reducing teen pregnancies are also threatened by the one-year elimination of Medicaid payments to organizations engaged in family planning and other reproductive health services, like Planned Parenthood. The impact of this will be felt by many young women in this country. For example, nearly one-quarter of Planned Parenthood clients are under the age of 20, and 80 percent of Planned Parenthood’s clients receive services to prevent an unplanned pregnancy. Nationwide, 54 percent of Planned Parenthood health centers are in rural or medically underserved areas.

Removing federal support for family planning programs will take the ability to choose when to have children away from the people who stand to reap the most benefits, particularly adolescent women. While not always thought of in these terms, family planning saves taxpayer dollars because 1) a planned pregnancy, complete with appropriate prenatal care, is more likely to result in a healthy birth and a healthy baby, both of which are less costly than the alternative; and 2) reducing teen pregnancy increases the likelihood that a teen will graduate from high school or college and become financially independent, consequently reducing later reliance on taxpayer supports. Thus, it is for both health and financial reasons that Medicaid provides family planning services.

Protecting access to affordable contraception and family planning services for young people is an important investment in their future as well as an efficient use of taxpayer funding.

We must do what we can to ensure that the adolescents who see me for contraceptive services, and their peers around the country, have what they need to be healthy and successful long term. By doing so, we are investing in the health and security of our nation.

Aletha Akers, MD, MPH, FACOG, is a faculty member at PolicyLab at Children’s Hospital of Philadelphia (CHOP), an adolescent gynecologist and Medical Director of Adolescent Gynecology Consultative Services in the Craig-Dalsimer Division of Adolescent Medicine at CHOP.


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