After more than a decade of decreasing birth rates among teenagers, the birth rate among teenagers 15 to 19 in the United States rose for the first time since 1991, according to a recent report by the Centers for Disease Control. Births among teenagers tend to lead to poorer health outcomes for both the young mothers and their babies. Not surprisingly, the report further inflamed the already heated debate surrounding “abstinence only” versus “comprehensive” sex education and ignored crucial access issues. Sexually active women, especially young women, are at increasing risk for unintended pregnancy and unmarried pregnancy due to constricted access to effective contraception on a number of fronts. First, the increase in the number of states limiting teens’ access to confidential reproductive health services, legislating parental notification laws not only for abortion but also for contraception despite demonstrated reductions in teen pregnancy rates. Second, women’s and girls’ reproductive health is endangered by pharmacists’ refusals to fill legal prescriptions for emergency contraception and oral contraception, their refusals increasingly protected by so-called “conscience” legislation that sacrifices women’s and girls’ health to ideology. No lobby no presence. Third, the cost of contraception has increased beyond the means of college students. In July the Centers for Medicare and Medicaid issued regulations that remove the incentives for drug companies to provide deeply discounted prices to college health clinics; a one-month supply of oral contraceptives, formerly $3-$5 at college health clinics, now costs between $40 and $50 for name brands and $15 to $20 for generics. The price increase was widely expected to cause students to switch to less reliable forms of birth control (oral contraceptives are used by 39% of women in college according to the American College Health Association) or to cease using birth control due to lack knowledge about alternatives. Some college health clinics have tried to subsidize a portion of the price increases; others have ceased to offer oral contraceptives altogether.
We’ve lost sight of why we are having the sex education debate in the first place: because of its serious implications for women’s and girls’ health and well being. The ideal of access is not exhausted by having the best available information; we also need to assure the material conditions of making that information effective.