How Money Complicates Sex

Obvious Child screenshotContraceptives aren’t free. They aren’t even cheap. A Buzzfeed video from October made this point by asking, “What If Buying Condoms Was Like Buying Birth Control?” The young man in search of Trojans finds he has to endure parents (“Can I go make an appointment to see your man doctor?” he asks his horrified dad), bureaucrats, “an invasive physical exam; this is gonna hurt,” and, at the end of all of that, a bill for $150. “I hope it’s worth it,” says the pharmacist, with a grin.

That being the case, it’s hardly surprising that low-income women use fewer contraceptives and, since women at all income levels have roughly the same amount of sex, have more unplanned pregnancies and more bundles of hard-to-afford joy.

Research shows that women who earn less are also less likely to use contraceptives. Just about 16 percent of women below the poverty line ($11,770 for an individual) say they had unprotected sex in the past year. Among women earning more than 400 percent over the poverty line (about $47,000 annually), that number falls in half, to 7.9 percent. … Nine percent report becoming pregnant in the past year, three times as many as women who earn more than 400 percent of the poverty line.

As Homer puts it, when Marge is giving birth to their third child, “Oh boy, here it comes, another mouth.” 

Higher-income women have more options for dealing with unplanned pregnancy: “higher-income women have a much higher abortion rate than lower-income women.” And the upshot is, women who can least afford the financial burden of child-rearing “are five times more likely to have an unplanned baby than those who are affluent.” 

If low- and middle-income women had the same access to family planning and termination as wealthier women, here’s what the demographics would look like, according to Business Insider:

abortions at the rate of wealthy women cause the birth rate to go down by about a third. Using contraception at the rate of the wealthiest women causes the birth rate to go down by nearly half. …

the paper’s authors think that income is the real factor that matters here. “Our view is that income gaps in accessibility and knowledge are the key factors here,” they write. This is an economic issue, and a policy issue.

The most effective forms of contraception — long-acting reversible types like IUDs — have high up-front costs, even if they are cheaper than other forms of birth control over the long run. Abortions are expensive, and depending on where you live, just plain unavailable without traveling a long distance. The ACA contraceptive mandate is to some extent helping with the former issue, but the government is more likely to restrict abortions than make them more available and affordable.

Which means the people who need them most will be able to use them least. ThinkProgress confirms that the difficulty is real:

Thanks to the hundreds of state-level abortion restrictions that have been imposed over the past several years, it has become more difficult and more expensive for women to have an abortion. Harsh laws ensure that Americans must navigate logistical hurdles that ultimately drive up the price tag, which presents a particular challenge for impoverished women.

For instance, 11 states have mandatory waiting period laws that require women to make two separate trips to an abortion clinic — which means they must take additional time off work, pay more for transportation, and potentially even stay overnight in a hotel if the clinic is hundreds of miles away from their home. Plus, abortion is routinely excluded from low-income women’s insurance plans, leaving them to shoulder the full cost of an unexpected health event on their own.

In fact, a recent ThinkProgress investigation calculated that an archetypal women living below the poverty line in Wisconsin, where many of these stringent anti-abortion laws are currently in effect, could pay up to $1,380 to end a pregnancy. That type of expense is insurmountable for many individuals who are already struggling to make ends meet. Previous research has confirmed that some low-income women are unable to get an abortion because it takes them too long to save up the money for it.

But even if we can’t make abortion a real alternative for everyone, regardless of their financial circumstances, we can attack the root of the problem: the cost of reliable contraceptives. And IUDs, which are long-lasting, reversible, and 99% effective, are getting vastly more popular. “Planned Parenthood told TIME it has experienced a 75% increase in IUD use among its patients since 2008.” That’s thanks in part to greater awareness and in part to Obamacare. Then there are also significant and successful programs to make IUDs and other effective contraceptives accessible, like the one in Colorado:

Five years ago, a private grant funded the state program that’s made intrauterine devices (IUDs) and contraceptive implants much more widely available. … In the first few years of the effort, the number of young, low-income women using one of these forms of contraception went from one in 170 to one in 15. At the same time, Colorado’s teen and unintentional birth rate dropped faster than the national average. 

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