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.

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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).