My column today looks at a relatively underappreciated form of inequality: unequal access to family planning and fertility decisions. High-income, highly educated Americans have more choices than ever when it comes to childbearing, while low-income, less-educated Americans have trouble just getting access to effective birth control. But it’s not just a financial barrier they face; it’s an information one, as well.
A few years ago the National Campaign to Prevent Teen and Unplanned Pregnancy released a study based on survey data about young unmarried adults’ use of and knowledge about contraception. The ignorance and misperceptions are often shocking. I asked the organization if they could sort responses by socioeconomic class of the respondents; they didn’t have income data, but they did have information about respondents’ educational attainment, which tends to be a good proxy for income and employment prospects.
The numbers were disappointing pretty much across the board, but they tended to be worse for those with less education. Twenty-somethings with college degrees report using birth control much more consistently than people with no more than a high school diploma. People with less educational attainment were also much more likely to say they know little or nothing about condoms and the pill. And the amount of mistrust, misinformation and old-wives’-taling about birth control was astounding among the less educated, though not wholly absent among college grads.
Among unmarried people in their 20s, for example, people with no more than a high school education are almost four times as likely to (incorrectly) believe that having sex while standing up is an effective form of birth control.
When it comes to real forms of birth control, there is a tremendous amount of skepticism that they actually do anything. With “perfect” use, for example, the pill is estimated to be 99 percent effective at preventing pregnancies. But lots of young singles, and especially less-educated young singles, perceive that the pill doesn’t work most of the time:
Many believe birth control doesn’t matter anyway, because they don’t think they can have kids no matter what they do. About a quarter of people with a high school diploma or less think they are infertile:
For the most part, these respondents don’t think they’re infertile because a medical professional diagnosed them as infertile. Isabel Sawhill, whose new book on curbing unplanned births I highly recommend, suggested that the belief might come about because people assume if they’ve had unprotected sex before and didn’t get pregnant, that must mean they are unable to get pregnant. So why not roll the dice again?
Of course, for many of these women, their unsubstantiated beliefs about their infertility turn out to be completely wrong and lead to unplanned pregnancies. A recent CDC report included a survey of women who had unintended births after unprotected sex and found that the most common reason women cited for not using birth control was that they thought they couldn’t get pregnant. Among moms with a high school education or less, 42 percent said they hadn’t used birth control because they wrongly believed they couldn’t get pregnant.
Reading through responses to some of the other questions in the Fog Zone report, you’ll find a pervasive distrust of birth control, especially among the less-educated:
Some of these findings may reflect lingering mistrust in low-income communities of birth control and public health campaigns following the shameful history of forced sterilization. Some of it has to do with abstinence-only education, or otherwise low-quality information young people receive about reproductive health. But whatever the cause, this is a public health issue worth addressing. The vast majority of young unmarried people have had sex. Nearly all of them say that it is important for them to “avoid pregnancy right now,” the Fog Zone report finds. But partly thanks to this sex ed gap, their behaviors are not matching their intentions.