Health and Kids

By Kate Francis, Government Relations Fellow

Healthy mothers and healthy children go hand-in-hand, which is why some of the indicators that contribute to the Kid-Friendly Cities’ health grade are intrinsically related to motherhood. When women receive quality reproductive health care and are given the opportunity to space or limit their pregnancies, their children benefit too.

Each city in our study was evaluated on the basis of five criteria to determine their health grade: infant mortality, percentage of births to teens, percentage of the state’s eligible women not receiving subsidized family planning funding, whether or not the state has a contraceptive equity law, and the percentage of the state’s kids without health insurance.

While statistics on infant mortality, kids without health insurance, and teen birthrates all speak directly to children’s health, the two family planning indicators merit further explanation.

Contraceptive Equity

Contraceptive equity laws mandate equality in health insurance plans. While 97 percent of all indemnity (fee-for-service) plans include prescription coverage, only 33 percent cover oral contraceptives. Some plans do not consider birth control to be a “medically necessary” prescription, but the reality that faces women today clearly contradicts that assertion. Seven out of 10 women of childbearing age are sexually active and do not want to become pregnant. A woman who wants two children will need to use some form of contraception for over two decades of her life. While the need for access to birth control is apparent, the price of contraceptives is often cost-prohibitive. Without insurance coverage, many women are forced to pay $360 for oral contraceptives per year, or simply forego prescription contraceptives all together.

Contraceptive equity laws require insurers who cover prescription drugs and outpatient medical care in general to cover all FDA-approved contraceptives and associated outpatient services. These laws are vital to give women the financial ability to prevent unintended pregnancies and ensure each child born is both wanted and healthy. Infant mortality and low birth weights are two common effects of unintended pregnancies in the United States. Women who experience unintended pregnancies are less likely to seek comprehensive prenatal care, which places their children’s health in danger, as well as their own. If every woman in the United States had access to reliable, affordable contraception, both teen pregnancy and infant mortality rates would drop, leading to healthier children and families. Currently, the United States’ teen pregnancy and infant mortality rates are among the highest in the developed world.

You can look at the Kid-Friendly Report Card poster attached to page 20 of this magazine to see whether or not your state has a contraceptive equity law. Each state was scored as follows: a “1” was given to states that have never introduced contraceptive equity legislation; a “2” was given to states that have introduced a contraceptive equity bill, but it was either voted down or is currently pending; and a “3” was given to those states that passed contraceptive equity legislation into law.

If your city has a low health grade, this is one of the most direct issues on which you can work towards change. If your city does not have a contraceptive equity law, write your representatives in Congress and your local newspaper, let your community know that the lack of contraceptive equity is hurting our children’s health—explain the connection between rising contraceptive use and declining teen birthrates and infant mortality.

Title X

In 1970, President Nixon signed Title X (ten) of the Public Health Service act into law saying, “No American woman should be denied access to family planning assistance because of her economic condition. I believe, therefore, that we should establish as a national goal the provision of family planning services… to all who want but cannot afford them.” Title X is the only federally funded program that is dedicated exclusively to family planning and reproductive health services.

We used the percentage of eligible women in each state not covered by family planning funding, in which Title X plays a significant role, as an indicator in our health category. As with contraceptive equity, this indicator is important when considering the larger context in which a child lives and grows.

Title X standards and requirements mandate that health care providers who receive funding from the program use the funds to provide broad and comprehensive family planning services. Not only are funds allocated for contraceptive methods and counseling, but money also goes to preventive health care services, including pelvic exams and Pap smears, breast exams, testing for high blood pressure, anemia, and diabetes, and screening and appropriate treatment for sexually transmitted diseases.

By providing preventive care and contraceptives over the past two decades, Title X clinics have prevented 9 million abortions and 5.5 million teen pregnancies. An estimated 54.4 million breast exams and 57.3 million Pap smears have also been provided, resulting in the early detection of deadly diseases like breast and cervical cancer.

Title X and other subsidized family planning programs reach nearly 4.2 million women per year. However, a daunting 9.9 million women per year are eligible for assistance, but do not receive services due to a shortage of funds. While Title X and family planning have clearly proven to be highly effective over time, abstinence-only education regularly demonstrates a dismal lack of efficacy. This makes the Bush administration’s stated intent to double abstinence-only funding unconscionable. If the funds allocated to abstinence-only education in the president’s budget were used instead for a much needed boost in Title X funding, an additional 4.2 million women would have access to family planning and reproductive health services. The quickest and easiest route to reducing population growth in the United States is to reduce the rate of teen pregnancy —this can be accomplished through giving more teens access to Title X services, while abstinence- only education has the opposite effect.

Contraceptive equity laws protect working women, and Title X and other subsidized family planning programs protect and serve poor women who have nowhere else to turn. The percentage figures in the Kid-Friendly Cities’ subsidized family planning indicator correspond to a large population of women whose reproductive health needs are not being met. In real terms, this translates into millions of mothers who are not receiving adequate prenatal care and preventative services and countless teens who do not have access to contraceptives and testing for STDs. Most importantly, in the end all these factors fall on the shoulders of the children of underprivileged women to bear the weight of very arduous, but preventable, circumstances. If we want to ensure bright futures for all our children, we must first ensure family planning access and equality for all women.