Teen pregnancy in Colorado

Because it’s garnering a significant amount of nationwide attention, I figured I’d come out of my quasi-retirement of late from blogging (really, I’ve just been bouncing around the country/world and super busy trying to get life started in a new place or three) to talk about the State of Colorado’s announcement that its teen contraception program led to a 40% drop in the teen pregnancy rate. Put another way, the teen birth rate dropped from 37 live births per 1,000 people in 2009, to 22 live births per 1,000 in 2012. This is a drop from significantly above the national average to significantly below, which is a huge accomplishment.

With those numbers, the teen pregnancy rate did indeed drop by 40%, the question is whether all of that is attributable to the program. Importantly, the press release notes:

Fertility rates among low-income women aged 15–24 were compared with expected trends. Abortion rates and births among high-risk women were tracked, and the numbers of infants receiving services through the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were examined.

However, a true comparison with expected trends would require subtracting out the expected drop in teen pregnancy rates by identifying a comparison group (this is called a difference-in-difference strategy or a randomized control trial if the program was rolled out randomly, which is probably was not). 

The Denver Post article, probably in the interest of journalistic integrity, interviewed some people about the findings, but in my opinion, not anyone with the ability to really evaluate the claim. Teen pregnancy rates have been falling in the US, as have overall birth rates, and likely would have fallen in Colorado regardless of whether these individuals received the program or not. From 2011 to 2012, the US teen birth rate fell by 6% alone. The question is whether they fell by more than they otherwise would have if the program had not been put in place. Or would they have increased?

While it seems that the state did some analysis to net out this effect from their press release, the 40% figure probably overstates the true effect of the program. It could also understate the true effect. If teenage sexual activity was also increasing among those groups targeted by the program, the expected pregnancy rate would have been higher, resulting in a larger difference. In all likelihood, the program did likely reduce the teen pregnancy rate, but I don’t think we know exactly by how much.

In related news, I’ve got a great new research idea; I just need some data on a teen contraceptive program in Colorado. Governor Hickenlooper, I’m looking at you.

Awesome things at SVRI Forum

After an awesome week in Bangkok, I thought I’d share some of the conversations, research, and events that happened last week because I’m feeling privileged to have been able to spend time with such a diverse, animated group of researchers and people passionate about ending sexualized violence. It was a singular experience, to be sure, and I can’t wait for the next one. Below is a partial list of the awesome things I saw and heard at the SVRI Forum in Bangkok, in no particular order.

  • Research on LRA child soldiers and the harsh methods used to control them by Jocelyn Kelly of the Harvard Humanitarian Institute.
  • Tweet-ups. Such a fantastic group tweeting the Forum and interacting online. Storified here.
  • An Egyptian woman recounting how she and her daughter went to the Tahrir protests for two weeks in a large group of women, and how her daughter became more autonomous, independent, and opinionated as a result.
  • A Bhutanese woman talking lovingly of her King, who she thinks looks like Elvis Presley, and the modest cottage he inhabits.
  • Limited positive effects of cash transfers on instance of intimate partner violence in Ecuador by Amber Peterman of the school that shall not be named.
  • An American woman recalling the 70s in Berkeley and abortion activists offering to pay her to get arrested to perform an abortion without a license
  • The same American woman recalling her interactions with rural Japanese housewives.
  • Lots of UN and NGO politics.
  • A Kenyan woman surmising that Kenyatta has the potential to be Kenya’s greatest president yet, if (and that’s a big IF) he doesn’t end up being a war criminal.
  • Thai food. So much wonderful, delicious Thai food.
  • Kate Falb of the Yale School of Public Health on multi-faceted interventions addressing gender inequality and economic empowerment in Cote d’Ivoire.

There were so many more. Check out all the presentations online.

On Iran’s “Erotic Revolution”

Data are always a mischievous thing and even more so when they out of a religious autocracy. In the US, it’s commonly said that women underreport their sexual partners when asked by one to two, so you can only imagine how such a question might go over in Iran.

It hasn’t, but Foreign Policy says that other data that are more readily available point to a sexual revolution in Iran that includes sex before marriage, earlier sexual debut, and increased use of contraceptives.

While not necessarily positive or negative, Iran’s sexual revolution is certainly unprecedented. Social attitudes have changed so much in the last few decades that many members of the Iranian diaspora are shellshocked when they visit the country: “These days Tehran makes London look like a conservative city,” a British-Iranian acquaintance recently told me upon returning from Tehran. When it comes to sexual mores, Iran is indeed moving in the direction of Britain and the United States — and fast.

The article is long on speculation and short on facts, mostly because they’re not available, but many data points do point to some interesting demographic changes that could signal a cultural shift in the perception of sex outside of marriage, the value of marriage and childbearing, and more.

What’s not entirely clear is why. The article gives suggests that the current generation of young people is reacting to the lack of emergence of a utopian society and that having sex outside of marriage is part of the small rebellions they are engaging against the regime.

It’s a tidy theory, but it likely obscures the story. First, demographic shifts take time to happen. Iranians didn’t wake up in 2013 and decide to stop having children. Even if they did, we wouldn’t see the changes in national averages yet. This evolved over a few decades. Secondly, there is ample evidence that young Iranian women were fairly progressive in their attitudes regarding female independence, sexuality, and empowerment before the Revolution, so it is more likely that the children of those women who underwent their own sexual revolution in the 70s are coming of age and making decisions that reflect the attitudes projected in their own homes, if not in an official or public sense.

I’d also venture to say that it might be possible that some progressive or secular Iranians are choosing not to have children because they don’t want them to grow up under the regime they have experienced. That’s more in line with the explanation offered by FP, but it’s also pure speculation.

Jobs, poverty and teen child-bearing

Several weeks ago, I printed out an NBER working paper on teen childbearing by Melissa Schettini Kearney and Phillip B. Levine. I had every intention of reading it then, but it just wasn’t going to happen at the end of this totally crazy semester. Since then, a few things forced my hand. I finished the semester (yay for surviving my first year of professoring!), the paper has been accepted for publication in the Journal of Economic Perspectives, Matt Yglesias put together a nice little review of the article in Slate, and a friend emailed me rather incensed by Yglesias’ review. From a quick scan of the JEP version, it doesn’t appear too much different from the NBER version, but my comments refer to the NBER version.

Yglesias’ review presents Kearney and Levine’s research as novel and surprising, but I think that misses the point. While the authors do a good job of aggregating statistics from several data sources and findings from different papers, the primary contribution of this paper is not novel, but rather confirming what we already know: that teen pregnancy is higher in the US than other places and; that poverty likely causes teen pregnancy more than teen pregnancy causes poverty. Past studies, cited in the paper, have shown that teen pregnancy has little to no effect on outcomes when you control for poverty, or within-family characteristics, and in some cases, may even result in better outcomes than if the teen hadn’t become pregnant. This is a significant theme in Edin and Kefalas’ ethnographic study, Promises I Can Keep, which I discussed here, and other research in fields such as sociology and demography.

Ultimately, the economics community thought it was an important paper as it went to a very prominent journal, but I really just see it as a good synthesis of what we know.

In related, and I think more exciting research, the link between poverty and teen child-bearing may be even tighter than suggested Kearney and Levine’s paper, though not in the way that the Kearney and Levine paper posit. A working paper by three Duke Sanford professors, Elizabeth Oltmans Ananat, Christina Gibson-Davis, and Anna Gassman-Pines examines the link between job losses and teen pregnancy.

I’m so predictable. I love this paper because even the anticipation of poverty, or joblessness, more specifically, predicts teen pregnancy rates. The authors show that when mass layoffs are announced in a North Carolina (before the layoffs actually occur), that county sees a subsequent corresponding reduction of births to teenagers in that county, but only for Black teenagers. The mechanism appear through both reduced pregnancy rates and reduced birth rates, which suggests that teens are both practicing safer sex and having more abortions when job prospects in their counties suddenly become dimmer.

There were a few places I thought the paper could improve, and the first one is my primary concern. Even though the authors find a statistically significant effect, I’m curious about the mechanism for how this affects teenagers. What evidence is there to show that teenagers would be affected by these job losses? Why aren’t they just in school and ignoring them? Initial information about their education level, school attendance, when they enter the workforce, etc, would be useful, to sell the story. I think the age and education of teens would be a big factor here. Wouldn’t you see a bigger effect for teens closer to graduation? Or a smaller effect in counties where teens are more likely to go to college (say wealthy Orange county, where Chapel Hill is located)?

The ability of inhabitants to migrate and commute is also problematic and suggests a (you guessed it!) spatial auto-correlation issue that I imagine is present. The authors claim they are underestimating the effects of job losses by ignoring migration and spillovers, but I wonder whether there are spillover effects that could be estimated through job loss in surrounding counties, rather than just say it’s a lower bound. Also, if spatial auto-correlation is present, that’s going to affect the standard errors, not just bias the estimates.
A minor, but I think incredibly important interesting, result is that the job losses also resulted in fewer black mothers reporting a father’s name on the birth certificate. The magnitude of the effect is approximately half of the effect of that on the pregnancy rate itself, which is pretty large. I think this result actually goes a long way towards answering my first question: Why do we think teenagers would be affected by this? If the story is that teens are being more careful about sex or having more abortions when their job prospects are low, is it really their own unemployment they fear, or also their partner’s? Teenage parents are less likely to be married than their older counterparts, so who is supporting them through their pregnancy? Paying for prenatal visits? Do teens feel they’re going to be working and raising their children? My own work shows that black mothers at any age are more likely to receive a promise of financial support and Edin & Kefalas suggest that the promise is key to the marginal have a baby (or at least stop trying not to have one) for mothers of low socio-economic status. I think this relationship could be teased out a little more.
All in all, it’s a good read, and presents an interesting counterpoint to the Levine and Kearney paper. L&K say poverty causes teen pregnancy, but the Duke paper says that teens are responsive to future job prospects, and respond by delaying (or at least trying to avoid) childbearing.
At first glance, the papers might seem incongruous, but it’s really a stock versus flows kind of issue. Other things equal, teenagers in poverty are more likely to become pregnant early due to a host of factors, but they still plan and have an idea about how they will care for the child. When that plan is disrupted, it appears it can affect some teens’ decision to bear children, on the margin.

Hot professors get better evaluations

That’s pretty much the gist of the paper. Even controlling for things like age, confidence, etc., professors who are objectively deemed attractive are more positively assessed by their students.

It makes me curious, though. I wonder if there are premiums for being hot based on student and professor compositions. Perhaps departments like economics or physics–where the professors tend to be male and the students primarily male–see higher evaluations for their attractive female professors because they are more novel. Alternatively a sociology department, comprised of more women on both the professor and student side, might give a bigger boost to attractive male professors. The authors seem to acknowledge that this might be an issue given their strategy for selecting students to rate the professors’ appearance.

h/t Bill Easterly and the WSJ

Source: “The Good, the Bad, and the Ugly: Teaching Evaluations, Beauty and Abilities,” Michela Ponzo and Vincenzo Scoppa, Università della Calabria, Dipartimento di Economia e Statistica Working Paper (March) (via Ideas)

I’m annoyed again about the ‘99% use birth control’ statistics

I’m harping here, a little bit, but I think it’s important to be precise. And this time, I have better thoughts about why.

Michael Cohen, of the Guardian, published a piece yesterday on why it’s important to view the birth control debates and increasing encroaching laws on abortion as a women’s rights issue, or a civil rights issue. In general, it’s a very well-thought out, interesting, timely, and important piece. But he uses the 99% statistic about women using birth control in the US, and he uses it in a way that conflates types of birth control and eliminates an avenue for talking about issues of access:

Since the 1965 supreme court decision, Griswold v Connecticut, which fully legalised birth control, the use of contraception has been widely-settled law. Today, approximately 99% of American women use some form of birth control.

My blog post from a few weeks ago on the subject is here, but I also wrote to Michael, quoting my own blog post as quoted in the email:

“I dug a little deeper into the original Vital Health Statistics report. In fact, 82.3% of women interviewed aged 15-44 who had ever had sex had used the Pill at some point in their lives. 93% had used condoms, more than 22% had tried Depo shots, 10% had tried the patch, and only 7.4% had an IUD (down from 18.4% 30 years ago–which is pretty interesting in and of itself).”

These are still really big numbers, but if you say that 99% of women use birth control, and imply that they are using the kinds of birth control covered in Griswold v Connecticut, you downplay the fact that many women do not have access to birth control—due to cost, education, state laws, or other reasons—which is also a significant part of this debate.

Women want to have control over when they conceive. That much is clear, regardless of what Nikki Haley says. But many don’t have access to it, a point that gets lost when we say that practically all women are using it.

Furthermore, women have worked hard to protect the right to control when they conceive, and with whom. There are still structural barriers to exercising that right. And while the 99% statistic is appealing, it’s not right and it’s not helpful.

What’s in more than 99%?

Contrary to what it may seem from the title, I am not going to enter the OWS fray here. Nor am I going to offer a rant on income inequality or corporate profits. There are plenty of people in the twitterverse and blogosphere to give you that. Rather, I am going to toss my hat in the ring of the birth control debate. But again, I’m not really interested in joining the name-calling that has dominated much of this debate. This debate has been so full of vitriol and terrible words and I have no intention of adding to it. I won’t link to them; I won’t even say their names. I am curious, however, about some of the statistics they’ve been using.

When this debate was–for that short period–primarily about Catholics, many news outlets were quoting that 98% of all Catholic women had used contraception in at some point. It rang a little false for me, but the underscoring point seemed consistent with my experience growing up Catholic. American Catholics, as I knew them, were fairly progressive and dedicated to social justice, easing burdens on the poor, and bringing healthy, wanted babies into the world.

You can call me naive or blind, but this is what I knew and saw in my suburban Denver church and even in my mother’s very Irish family back in Ohio.

When the debate shifted to the Blunt amendment and moral exemptions, people started quoting a new statistic that more than 99% of all women, not just Catholics, had used contraception at some point.

This just seemed too high. And the more I thought about it, the more unlikely the Catholic stat seemed as well. So, I went looking, and asked for help on twitter, and eventually came across this Guttmacher report summarizing a Vital Health Statistics paper on contraception use in America.

It’s a fascinating read, you know, if you’re interested in that stuff, and does appear to be the source for the >99% stat. Only, it doesn’t really say what I think many have suggested it does. Methods of contraception include vasectomy, withdrawal, and natural family planning, among others. While these are all clearly ways of attempting to control one’s fertility–which is partially how the debate has been and I think should be framed–they are not that closely related to birth control pills or IUDs or even condom use, as I think the >99% statistic suggests.

It’s important to say that more than 99% of all women who have ever had sex made some sort of conscious effort to control their fertility. But I think it’s disingenuous to suggest, using the same statistic, that all those women sought medical care to do the same. The point is that women should be given the information and tools to make their own decisions regarding their fertility and their bodies. Those decisions are between a woman and her doctor, and hopefully to some extent her partner.

And while it is true that more than 99% of women in America aged 15-44 who have had sex have used a form of contraception, they’re not all using the kind we’re debating about: hormonal or non-hormonal forms that require a doctor’s prescription. How we define and present numbers is important to the credibility of a cause.

**Update: Because @randomsubu asked (and was responsible for helping me find the Guttmacher report), I dug a little deeper into the original Vital Health Statistics report. In fact, 82.3% of women interviewed aged 15-44 who had ever had sex had used the Pill at some point in their lives. 93% had used condoms, more than 22% had tried Depo shots, 10% had tried the patch, and only 7.4% had an IUD (down from 18.4% 30 years ago–which is pretty interesting in and of itself).