To Have A Child or Not? Sometimes It's All About the Economy Finds Guttmacher Institute

Here’s the simple truth, offered up in Guttmacher’s newest report on a recently completed survey:

Finances have a very real impact on women’s reproductive health decisions. As the report concludes,

Family planning and childbearing decisions are not made in a vacuum, but have always been influenced by broader economic and other external forces. Women take into ac­count many factors, including their ability to appropriately care for their present and future children, their employ­ment and their family’s economic stability.

The newest Guttmacher report, A Real-Time Look at the Impact of the Recession on Women’s Family Planning and Pregnancy Decisions, offers a look into just how influential economic realities are upon women’s health and lives. 64% of women surveyed for this report agreed with the statement, “With the economy the way it is, I can’t afford to have a baby right now.” It doesn’t get much clearer than that.

In a survey of almost 1000 women, researchers also uncover how the recession is impacting women’s decisions on everything from what kinds of contraception they use to the type of provider they see.

Some key findings include:

• Nearly half of surveyed women (44%) report that because of the economy, they want to reduce or delay their childbearing. And while most of those women (31%) say they want to have children at a later date, 7% say they no longer want more – or any – children. 
• Lower income women (those with household income below $25,000), who may have less cushion or flexibility in their household spending, are more likely to report changes in their fertility preferences than are higher income women.
• Among those [women] who want no more children, 46% report that because of the economy, they are thinking more about sterilization.
• Nearly one out of four women report having put off a gynecological or birth control visit to save money in the past year. Women who lost their health insurance during the past year are more likely to report delaying a visit than are those who did not.
• Overall, 29% of surveyed women agree with the statement, “With the economy the way it is, I am more careful than I used to be about using contraception every time I have sex.” Those who are financially worse off are more likely than others to agree with this statement (39% vs. 19%).

Of course it’s no secret that even in good times women’s reproductive and sexual health care is utterly dependent upon economics; affecting decisions like child-bearing. It’s been a long fight to ensure insurance coverage for contraception and family planning services for women. Pregnancy and cesarean sections can both be considered “pre-existing conditions” for which women are denied coverage.  According to Think Progress, most individual health insurance markets don’t cover maternity care services either.  All of these kinds of policies leave women struggling to pay for the reproductive health decisions they make – in more ways than one.

And despite clear evidence to the contrary, many legislators refuse to acknowledge that by helping women to pay for their contraception and family planning care, we save tax payers’ money and, of course, help women and their families. In an op-ed on the inclusion of family planning funds in the stimulus package, Cory Richards writes,

When the Congressional Budget Office assessed a virtually identical provision in 2007, it found that it would save the federal government $200 million over five years by helping women voluntarily avoid pregnancies that otherwise would result in Medicaid-funded births.

We are at a crossroads as we continue the fight for health care reform, specifically as it relates to a public option, making coverage more equitable and affordable for those who most need it. Since coverage of and access to contraception and family planning services and overall reproductive health care for women is such a contentious topic in this country we need to look at reports such as this and note the ways in which we can change the system so that women’s child-bearing and family planning decisions are not so utterly dependent upon economics.

Of course women’s childbearing and family planning decisions will always be made, somewhat, with their economic situation in mind - and that's not necessarily a bad thing. As the Guttmacher report notes, some women are making positive adjustments in their birth control use because of the economy; some women are simply re-thinking their decision to have more children. But, as Dr. Sharon Camp, Guttmacher President and CEO says,

“The recession has put many women—including middle-class women who are having trouble making ends meet—in an untenable situation. They want to avoid unintended pregnancy more than ever, but at the same time are having difficulty affording the out-of-pocket costs of prescription contraception. Unfortunately, while delaying a prescription refill or skipping pills may save women money in the short term, it increases their risk of an unintended pregnancy and results in greater costs related to abortion and unplanned birth later on.”

It’s that untenable situation that women are forced into – wanting to prevent pregnancy because of economic difficulties but not necessarily being able to afford pregnancy prevention tools – that is most concerning. It’s not new but it’s made all the more real during these difficult economic times.