Justine Izah is a high school senior in Muncie, Indiana, and is one of Rewire’s youth voices.
It is 2015, and the United States is still struggling with allowing universal access to reproductive health care and quality sex education. Not only are the resources difficult to come by for white individuals with a median income today, but racial and income disparities make the situation even worse for communities of color and other people living on the margins.
If we truly want to improve pregnancy rates and health outcomes of low-income women and women of color, we need to provide both family planning resources and comprehensive sexual health education in communities and to stop the criminalization of women of color’s pregnancies. And we must do that while we continue working to combat the systemic factors that keep families in poverty in the first place.
Comprehensive sex education in our country is taboo, even as we lead globally in teen births. Abstinence-only programs do not stop people from engaging in intercourse; oftentimes, they lead to shame and embarrassment for those that contract sexually transmitted infections and/or get pregnant. Reproductive health care fares no better, as Title X, the federal program that supports family planning related services, has received major cuts and sequesters over the last four years even under the opposition of the public.
Some states, like Colorado, have taken steps to address this disparity by bolstering family planning resources among vulnerable populations.
Between the years of 2009 and 2015, Colorado’s Family Planning Initiative offered 30,000 intrauterine devices to teenage girls and low-income women at little to no cost. During that period, Colorado saw a 40 percent drop in teen pregnancy rates and 35 percent slash in teen abortion rates.
As much as the subjects are swept underneath the rug by conservative politicians and educators alike, there is a strong correlation between contraception access and unplanned pregnancies. But in Colorado, some low-income women were given complete access to a long-acting reversible contraceptive without having the burden of worrying about the cost. So why, given the initiative’s positive effects, have programs like it not been more fully implemented in other states?
To be sure, contraception access alone doesn’t automatically improve pregnancy rates and health outcomes, and the program itself isn’t a silver bullet, especially given its state-level funding challenges. But if we can learn anything from the program and others like it, it should be that initiatives like these are needed to help cover the gaps created by patchwork health-care reforms that leave millions of Americans without affordable care.
Indeed, changes in federal policy, like the recent 10 percent budget cut to Title X, disproportionately affect women of color. As a result, some 667,000 women stopped receiving needed care between 2010 and 2013 and centers have shuttered in areas where, in 2013, up to 60 percent of patients are people of color and 70 percent have incomes that are at or below 100 percent of the federal poverty line. “North Dakota lost 33% of its family planning centers; Louisiana lost 21%; New Hampshire lost 24%; and Maryland lost 26%,” reported USA Today.
The State of Texas, once home to 36 reproductive health-care clinics, now has only ten. (In 2011, GOP lawmakers cut two-thirds of its funding for family planning services, the damage from which the state has yet to fully recover.) All ten of these clinics are located in areas where the median-household income is above the state average. Two of the lowest-income counties in Texas, Zavala and Willacy, are both located two and four hours away from the nearest reproductive health-care clinics, respectively. Fifteen percent of women interviewed in a study conducted by the Texas Policy Evaluation Project said that “there are simply no reproductive health services in their communities,” and 38 percent said that they cannot afford the care.
Marginalized communities are not only without access to needed care, but as research shows, they also lack proper sexuality education, which is necessary for them to make the best decisions for their situations.
Despite what conservatives think, a 2011 study showed that abstinence-only education in schools did not cause abstinence behavior. In fact, states that stressed abstinence-only education saw the highest levels of teen pregnancy, by effectively ignoring the idea that teens just don’t engage in sexual activity. It is ironic that this, “I can’t hear you, nana nana boo boo” type of juvenile behavior from educators and legislators when referring to sex education is supposed to teach adolescents to be mature, while simultaneously avoiding actual questions that could prevent teen pregnancy, reduce abortion rates, and halt sexually transmitted infection transmissions. What is even more interesting is the “significant negative correlation between median household income (adjusted for cost of living) and level of abstinence education,” and how “states with higher proportions of white teens tended to emphasize abstinence less and states with higher proportions of Black teens tended to emphasize abstinence more.” In short, the research shows that low-income household areas stressed abstinence, as did the areas with a majority of Black teens. However, as national teenage pregnancy rates reveal, abstinence-only education only hinders students from preventing STIs and unintended pregnancies.
A lack of access to resources and education certainly does not increase one’s chances of remaining in poverty, because as we know there are systemic inequities working against certain populations in the country. However, it also does not help that low-income women of color are not treated with the same care, and given the same guidance, as their white counterparts.
“In 2006, black women had the highest unintended pregnancy rate of any racial or ethnic group, and it was double that of non-Hispanic white women,” according to the National Women’s Law Center.
“These higher unintended pregnancy rates reflect the particular difficulties that many women in minority communities face in accessing high-quality contraceptive services and in using their chosen method of birth control consistently and effectively over long periods of time,” wrote Susan Cohen of the Guttmacher Institute.
It’s an unprecedented phenomenon that if low-income Black women have babies then they are “welfare queens” and addicted to the system, according to conservatives, but if they choose to use contraceptives or abortions, they are “baby killers” and fueling the white man’s Black genocide, according to some Black men. A simple juxtaposition of the searches, “black women are baby killers,” and “white women are baby killers,” on any search engine will surely provide the evidence of which I speak. The idea is permanently ingrained in the minds of the communities that Black women interact with daily, thus perpetuating the idea throughout generations. It is not only the professors and the teachers, but also brothers and fathers who adapt the same thoughts. The medical community and education system, whether consciously or unconsciously, have pre-selected paths for women of color based on racist tropes even before unplanned pregnancies. The people in charge may change over the years but the idea remains the same: Women of color, specifically Black women, are always in the wrong.
In low-income communities, there also is hyper-visibility of women of color when they become pregnant because of the stereotypes placed around them and an overall lack of support. The demonization of pregnant women of color by everyone around them—friends, family, and even health-care providers—comes as a split option with neither choice of the mother (to have a child or not) favorably looked upon.
Further, some women of color find there is no peaceful place to rest after they seek out an abortion because of the way they are seen by our society and how they are not treated with the same fragility as white women after taking the same actions. In severe cases, we see that oftentimes it is women of color who are firmly reprimanded for seeking out their own contraceptives or abortions when there were no other options available—either due to financial reasons, religious beliefs, or conservative legislation.
So not only are marginalized communities lacking access to quality care and comprehensive sex education, they are vilified for making what they believe to be the best decision for their current situations. We saw this play out earlier this year, when an Indian-American woman, Purvi Patel, was convicted of fetal homicide after experiencing a miscarriage. Prior to that, in 2011, a Chinese-American woman, Bei Bei Shuai, was charged with “feticide” even though the death of the fetus was through a suicide attempt after her partner left her. Laws created to “protect” mothers and fetuses from violence are now being used to jail women of color, who disproportionately lack access to mental and reproductive health care.
If done correctly, equal opportunity for contraceptive resources would place women of color in charge of their own decisions and reverse the stigma surrounding their choices. And comprehensive sex education wouldn’t be determined by one’s demographic, thus reducing the amount of incorrect information left out by omission and, again, letting women of color make their own informed decisions. Clearly, meeting these two critical needs will only address part of the larger, systemic abuses facing marginalized communities in this country. But given what we’ve seen in Colorado, I am hopeful about how they might help improve pregnancy rates and health outcomes for the people who need it most.
On the whole, the United States has difficulty accepting non-conservative values. However, the failure to accept modern needs such as comprehensive sex education and reproductive health care only leads to what policymakers are trying to avoid: teen pregnancies and STIs at best and criminal charges at worst. Further, this continues a cycle of marginalization and even fewer resources. It’s time to reform reproductive health care and education to be an all-inclusive landing mat and not a specific target zone that women, specifically low-income and of color, must land on instead.