As a 22-year-old professional a year and a half into my first job in Washington DC, my future is looking bright. In the next year I’ll get married, buy a house and hopefully adopt an adorable pooch (or two!). But 1 in 4 girls my age—and even younger—are facing a much harder reality: unplanned parenthood. I’d never thought about the possibility of getting pregnant at a young age until I started working at The National Campaign to Prevent Teen and Unplanned Pregnancy. It was then that I learned that 1 in 4 girls gets pregnant (at least once) by the age of 20.
The Campaign works in a variety of different ways to change policies, educate women and re-shape the narrative of teen and unplanned pregnancy. One of our biggest initiatives is “Thanks, Birth Control,” a day dedicated to praising birth control all over the world wide web. Although I’m waiting to have sex until I’m married, I started taking birth control in high school to help with some terrible acne and even worse cramps. The fact that I only have occasional breakouts (and cramps don’t keep me in bed all day) is enough for me to say “Thanks, Birth Control!”
In preparation for “Thanks, Birth Control,” which is coming up on November 16th, I sat down with Ginny Ehrlich, the CEO of the Campaign, to talk about creating opportunities for young women, persisting disparities and the unprecedented declines in pregnancy rates.
PW: Teen birthrates have gone down 64% in the past twenty years. Why?
GE: We’ve seen such incredible declines in overall teen birthrates for a number of reasons. One, we’ve shifted the norms. Now, young women can decide when, if, and under what circumstances to get pregnant, and more and more young women are deciding to wait so that they can complete their education, achieve their career goals and really be well-positioned to raise the next generation. We also know that contraception has improved, both from a technological perspective as well as a use perspective. The studies are showing that that has been a real game-changer as we look at these issues, in addition to the fact that teens are delaying sex until later in life.
Contraception has improved. Why is that? Why are more people using it? Why have we seen such dramatic increases in use of contraception in the past decade?
We know that technology around contraception has improved, so the effectiveness of the methods multiplied by more people using it has made contraception a real pivotal piece of this story. We also know that we have a lot of work to do. Among teens and young women in their 20s who indicate that they do not want to get pregnant in the next year, only about 50% are using contraception at all or reliably, so we have a lot of work to do to align intentions with intentional behavior. We have the good fortune of methods that are more effective than they were ten, twenty years ago, as well as a better price point for them as a result of the Affordable Care Act.
We still have some barriers, though, in terms of proximity barriers. Just because methods are free— just because they’re available—doesn’t mean that young women can get to them. If they don’t have a car and the nearest place they can get them is three hours away, that makes it pretty tough. If they’re working two jobs and they have to travel two or three times for appointments more than an hour, that makes it tough. There’s still some barriers to address, but we’ve made a lot of progress, and we have all the tools to make it work.
Can you explain how the IUD now is different than the IUD back when a fifty-year-old woman would have heard about it last?
The IUDs of today are not your mama’s IUD, as I like to say. Back in the day, twenty years ago, when I was doing direct sexuality education, I was saying, “IUDs are recommended for women who have completed their childbearing goals.” Now, the reality now is that the American Medical Association, the AAP, the American College of Obstetricians and Gynecologists all recognize modern day IUDs as being safe and are actually recommended for use among teens and among all women, because they do not have an adverse impact on future fertility. That gives us real opportunity around some of these newly refined methods, and it gives young women options to choose from that might be lower maintenance. Now that being said, at the end of the day, we want to make sure that every method is available to every woman so that she can make the decision that’s best for her.
Birthrates and pregnancy rates have both gone down, and as you mentioned, contraception use has improved and the actual effectiveness has improved. Why is it still important to talk about birth control?
Despite all of the amazing declines we’ve seen, we still have work to do. [The United States] has the highest rates of teen births as well as unplanned pregnancy in the developed world. We know that one in four young women get pregnant before the age of twenty and that those rates are significantly higher among African American and Latina young women, as well as young women living in poverty. We still have a lot of work to do to level the playing field so that all young women have the power to decide their futures. Birth control is essential to this conversation because we know that contraception makes a difference, and numerous studies have shown that contraception has had some of the most pivotal impact on rates of teen births as well as rates of unplanned pregnancy. The more that we can ensure that young women have accurate information, that they know where to access contraception, that they can access it in a way that’s realistic for their lives, meaning close by, and at a free or a very low cost price point, the more we’ll see additional declines in teen pregnancy as well as unplanned pregnancy for young women in their twenties.
You mentioned accurate information. How are we getting accurate information now to young women?
Young women have lots of sources for accurate information. We have the largest birth control information network in the country—it’s available at Bedsider.org. It’s fun and it’s cheeky. Bedsider has the most comprehensive national listing of birth control providers and clinics ever compiled. We have a reminder app so that women can stay on top of their birth control.
Fact or fiction: If birthrates are declining, it’s because abortion rates are increasing.
The reality is that both birthrates and abortion rates are declining, and that if we look at that from a regional level, the declines in birthrates and abortion rates go hand in hand. What that means is that contraceptive use is a pivotal part of this, and preventing an unplanned pregnancy in the first place does have a positive impact on reducing abortion as well.
While 99% of sexually active women have used birth control, it can still be taboo to talk about. Why is that?
I have no idea why birth control is taboo to talk about! 99% of women use it. The vast majority of the public loves it: Upwards of 90% believe that birth control should be available to everyone. That crosses political party lines, different demographic groups, different religions and faith. Bottom line, everybody loves birth control, yet everybody’s afraid to talk about it. That’s what we have to shift and really make this a part of the conversation that when we talk with young people, both female and male, about what it takes for them to have the power to decide their future, and part of that is ensuring that they have the power to decide when, if, and under what circumstances to get pregnant. Birth control makes that possible.
Why is it still sometimes controversial or awkward for moms and daughters to talk about or to have the talk? What is the best way to have the talk?
We know that parents matter. In fact, teens in particular talk about parents being the most influential in their decisions around sex and sexuality. We also know that the talk is always a challenge and fodder for lots of TV shows and lots of jokes, but the reality is that the best approach is for family members, parents, and other trusted adults to talk with young people about sex, relationships and their future often and early. Then it doesn’t just become “The Talk,” but it’s a part of how communication happens and how families talk about life in general. I can’t tell you how many parents of teens have said that they had their best conversations with teens happen over text. Hey, if that’s how communication happens on other key issues like other life decisions, why not this, too?
Very true. But a little crazy.
That creates the opportunity to really have that conversation without having the face time that might make it a little more awkward. A lot of people say that when they talk about sexuality for younger kids, they do it as they’re driving somewhere. That’s a way where you’ve got literally a captive audience to have a conversation in an environment that’s safe and fun. I think again the bottom line is it’s not really about “The Talk,” it’s about open channels of communication early and often.
I feel like that’s instead of saying, “We’re going to have the sex talk. Sit down on the sofa,” just bringing it up in natural conversation is such a great way to do it. We’ve established that it’s important to talk about, both in society and in families, so how do we raise the conversation to a national level and make it normalized?
How to normalize these conversations, how to create an environment where we’re all “hugging birth control” is really the magic question. We know the more people hear about these issues, whether it be birth control or conversations about sex, relationships and their futures, the more that they’re likely to take actions that make it so that they can live their best life stories. [78% of people agree that if more people talked about birth control more people would use it.] The one day we have to really draw attention to this— and really recognize the effects that contraception has had – is “Thanks, Birth Control” Day on November 16th. That’s a day where we ask everyone to “hug birth control,” to really celebrate the game-changing effects for their families, for their lives, for themselves, for society.
Can you just explain the concept of “Thanks, Birth Control”?
“Thanks, Birth Control” is a campaign that we are doing year-round to really celebrate the game-changing effects of birth control. That relates to societal effects. Women were not CEOs of Fortune 500 companies before birth control was legalized. Everyone has a story about how birth control has given them the opportunity to live their best life, to achieve something that they might not have been able to achieve as easily as if they had had unplanned pregnancy. November 16th is the day where we ask people to kick off the annual campaign and to go online to celebrate birth control. Amplify that through wearing a t-shirt, sharing gifs, and taking a selfie to get the message out and encourage friends to continue it as well. It’s a day where we have a lot of key influencers from politics, from entertainment, from other thought leadership roles, really talk about what birth control means to their lives. It’s a day where we kick off hopefully more positive regard for birth control for the year ahead.
If teen birthrates are down, what’s next for the campaign? What’s still to be done? What’s the end goal?
We are at a crossroads. What we know is that the teen birthrates are down, and they’re down by levels that really paint a great public health success story overall. We also know that there’s a lot of work to be done. We know that disparities in rates persist. We know that the playing field is not even and that African American and Latina young women have an unplanned pregnancy at twice the rate of Caucasian women, that women in poverty are significantly more likely to have an unplanned pregnancy. We need to really re-double our efforts to make sure that every woman, no matter who she is or where she lives, has access to reliable and resonant information in channels that she interacts with on a regular basis. [We need to make sure] that every woman has access to the full range of contraceptive methods within an hour of where they live. It’s crucial that every woman knows, believes, and has other people telling her that it matters, and that she has the opportunity to decide her future and to get pregnant when, if, and under what circumstances, on her own terms.