Colorado’s Effort Against Teenage Pregnancies Is a Startling Success

Nobody ever mentions the problems with environmental pollution and human cancer with chemical contraception. It's very conspicuous. If it were any other product the downsides would be heavily discussed. http://i.imgur.com/S8RCxEe.jpg

jkestner2• 11 years ago

Here they're not being discussed because this program is not using oral contraceptives. IUDs and implants.

pavel_lishin3• 11 years ago

I tend to distrust quotes that use terms like "the barren left" - it's clearly not aimed at me, someone who Steven Mosher would probably lump into that category.

Isn't the dumping of antibiotics causing similar problems? The problem doesn't seem to be birth control itself, but improper disposal of household chemicals, really.

Also, do you have a citation for the cancer thing you mentioned?

balls1875• 11 years ago

So comes the <del>hypocrisy</del>inconsistency of the conservative rationale.

Cigarettes are a far more potent carcinogen than estrogen and progestogen (the Pill). However when it comes to smoking, conservatives believe the government shouldn't interfere and say it's "Personal Choice."

When it comes to birth control, they want government to limit access on the grounds of morality, and (dubious) health claims.

The Public Research Institute is an anti-abortion, anti birth-control group in leagues with the Catholic Church and thinly veiled under the guise of "Humans Rights Advocate" for Chinese.

austenallred3• 11 years ago

So you're seeing that giving kids birth control reduces teen pregnancy? Shocking.

Everyone knew this would happen, but some believe that giving teens birth control is encouraging them to have sex, so initiatives like this are almost always blocked. It's very much a political problem.

pavel_lishin3• 11 years ago

It's very much a "we're not fighting teen pregnancy, we're fighting teen sex" problem.

dylanjermiah• 11 years ago

but some believe that giving teens birth control is encouraging them to have sex

I don't understand, encouraging them to use contraception while having sex (and perhaps lead to more intercourse)? or encourage more unprotected sex?

aidos• 11 years ago

Encouraging them to have sex at all, presumably. If you help with contraception, it's an implicit endorsement of sexual intercourse (at least, that's what many would argue).

noelwelsh4• 11 years ago

A vocal chunk of the US still believes that access to contraception will lead to a mass outbreak of fucking amongst the youth.

Look in this very thread and you will see much hang-wringing about STI rates, which is a code-word for OMG-the-youth-are-getting-it-on. As if they weren't already (pregnancy rates are dropping ...), as if this was somehow wrong (if anything is natural, sex is), as if there were huge surges of STI rates in countries without these hangups about sex, and so on.

balls1875• 11 years ago

The former.

The logic certain politicians in the US use is that the only acceptable form of birth control the government can support is abstinence. This is often tied to Judeo-christian beliefs, and often used to gain favor with the conservative base.

If the consequences of sex (i.e. pregnancy) are mitigated, it will encourage teenagers to have sex.

Typically there is some form of slut shaming that happens during the debate on birth control.

seiji3• 11 years ago

and perhaps lead to more intercourse

In America, the popular public society-wide meme opinion is "sex is bad outside of procreation." You're not allowed to encourage it, you're not allowed to make it safer, and many doctors aren't even comfortable talking about it.

Running a "birth-free sex" program is an affront to the victorian sensibilities of genital shame and a general war on happiness. The one true path is dedication to god and hard work, not personal enjoyment of anything. And we're going to have our 80 year old half-senile business moguls fund all politicians to ensure sex is always dangerous, unsafe, and bad for you.

deelowe2• 11 years ago

It's seen as implicit approval of teen sex. Period.

The issue is that acknowledgement of birth control as a valid form of contraception also acknowledges that a significant number of teens have sex. The conservative religious crowd feel that this isn't the right solution. They don't want "underage sex" to be seen as something that's so commonplace that contraceptive is readily available. They feel it's taboo and offering tools that lessen the risk of underage sex is also taboo.

As another person stated, some aren't interested in fighting teen pregnancy and poverty. They are interested in fighting teen sex. Two very different things.

Ntrails2• 11 years ago

The former. By telling people 'how' to have sex it carries an implication of approval. This will lead, logically, to more people thinking it's ok to have sex (otherwise why would they be being told how).

This probably does increase the levels of total sex-having somewhat, but it also allows for much much higher levels of safe and informed sex having. Apparently this is not always considered an acceptable trade off.

eli_gottlieb3• 11 years ago

Everyone knew this would happen, but some believe that giving teens birth control is encouraging them to have sex

I don't see the problem.

a8da6b0c91d5• 11 years ago

There is an STD pandemic. Multi-drug resistant STIs are rapidly spreading. The "sexual revolution" was basically the twenty year period when a shot of penicillin cleared anything up. That's over.

rdudek• 11 years ago

Not shocking, this is common knowledge and I'm glad this actually helps the poor folks. Raising a family is tough.

genericuser12• 11 years ago

I agree, but the people who write head lines understand that including the word 'Startling' increases their clicks dramatically, despite the fact it would of been more accurate without that word added.

scarmig3• 11 years ago

I don't know the data, but it doesn't strike me as insane to think that decreasing the marginal cost of a subset of sex would increase overall amounts of sex.

It's just that optimizing over "minimizing sex" is idiotic compared to optimizing over "minimizing unsafe sex."

austenallred3• 11 years ago

That's exactly what it is. Different groups optimizing for different outcomes.

For most religious folk, teens having sex is bad regardless of whether it's safe or not, so it makes sense to push for abstinence-only education. Giving out condoms is like giving up. Or maybe even slightly worse than giving up - implicitly encouraging kids to go out and have sex.

Of course, this doesn't stop kids from having sex, but it does make it so that when they do they're generally unprotected.

ma2rten• 11 years ago

I don't think it's about marginal cost, it's psychological. In these people's minds, giving a teenager a box of condoms sends a message: "It's okay to have sex".

auganov2• 11 years ago

Say if they use depo provera injections as the long term contraceptive it could very well reduce their willingness to do it. And help with [painful] periods btw.

fineman6• 11 years ago

I'm pretty sure you have enough data to know that that argument is actually bunk in this case.

It's not like teens (and the poor, etc) are saving up to afford condoms and only having sex when they can afford them. The profusion of unplanned babies and the well-known tendency of the poor to have more children than they can support should prove this.

euroclydon• 11 years ago

but some believe that giving teens birth control is encouraging them to have sex

Do teenagers really need to be encouraged to have sex? An absence of discouragement should be sufficient, for mutually attracted pairs.

High-availability abortions and contraceptives given out in schools are just examples of governments giving people what they want. However many in the anti-abortion and abstinence movements are engaged in an ambitious social engineering effort, telling teens to resist their strong biological urges to have sex, in favor of marriage and monogamy, because they believe this leads to a more spiritually healthy outcome, long-term.

There is surprisingly little innovation in this space. It's taken for granted that teenage-pregnancy is a bad word, that 30-40 year olds make better parents because they have more money. Society could choose to support early marriage and childbirth. Parenting requires a lot of energy, something that youth have in abundance. Also, young people remember what it's like to be a child, and make more empathetic parents.

donohoe• 11 years ago

Gonna have to disagree with you on that last paragraph. You make very broad assumptions that I'd dispute as an accurate generalization.

As a dad to 2 kids (became a father at 28) I would strongly urge people to wait until they were 30-38 before having kids.

Given the great innovations in this space I'd even say 40 is a great age to have kids - though it gets harder with age beyond this imho.

a8da6b0c91d5• 11 years ago

What you propose makes a ton of sense absent the welfare state. In a world where extended families are the support network, young parenthood makes a great deal of sense. As things stand now what we see in practice is a massive transfer of wealth from the 40% of people who pay taxes to high time preference people who are net tax drains.

webjprgm5• 11 years ago

It isn't just lack of money. Teenagers are not as emotionally mature, they have not finished figuring out what to accomplish with their lives (career or otherwise), and often they end up being single parents. There is tons of family research on why it is better to have two parents in a family.

Government giving people what they want? Please. Teenagers can't even vote, so they aren't voting themselves contraceptives. This is adults imposing yet another view on their children. It just so happens that this is a differing view than the traditional religious view of teaching abstinence. (Or of teaching that teenagers who get pregnant should then immediately get married and the dad get a job.)

KirinDave9• 11 years ago

Your argument is that maybe it's okay if teens are pregnant, totally ignoring the social reality around you. Bravo, sir!

Let's trap women in an unending economic and social perdition because they'll have empathy!

pluma5• 11 years ago

An absence of discouragement should be sufficient

In fact, discouragement has been proven time and again not to work (or worse: to result in more erratic behaviour as a consequence of the cognitive dissonance of enjoying something you've been vehemently taught to think of as evil).

gwern• 11 years ago

Shocking.

Everything needs to be tested. How many treatments, therapies, and drugs seem like pure common sense and then turn out to be useless when rigorously examined or outright harmful?

explorigin8• 11 years ago

I wonder if there was also an increase in STDs. The article makes no mention.

breitling• 11 years ago

I was thinking the same thing. They have less of an incentive to use protection with this device implanted. Let's wait and see until the STD numbers surface.

Ultimately, what's cheaper? Having a baby or taking care of an STD? Perhaps the benefits outweigh the costs.

agentdrtran• 11 years ago

Taking care of an STD will be cheaper for the individual and the state, without question.

AnotherZaphod• 11 years ago

Given they are getting pregnant, suggests many of them are already having unprotected sex.

genericuser12• 11 years ago

Wouldn't it be taking care of an STD or having a baby AND taking care of an STD in many cases?

merpnderp• 11 years ago

If the STD causes problems conceiving and requires tens or hundreds of thousands of dollars in IVF treatments to conceive later in life.

The UK is having this problem, but mostly from women putting off pregnancies until their 30's or 40's.

klenwell• 11 years ago

Why would you expect an increase in STDs? Are you assuming that free IUDs and implants are encouraging more teenagers to have more sex? Is it leading to sexual behavior that displaces other safer forms of sex (that were leading to teenage pregnancies)?

The preoccupation with STDs in this thread seems a bit weird and irrational.

aidenn02• 11 years ago

It seems safe to assume that some fraction of sexually active teenagers were using condoms as their only form of birth control before the program was instituted.

It seems likely that some fraction of those will use condoms less when other forms of birth control become widely available. Among this group, this will still likely lower pregnancy rates, since condoms have a lower efficacy than other forms of birth control, but it could potentially raise STD rates.

My intuition is that the increase will be negligible, but others' intuition is different. It would be good to have some numbers on this so that we aren't guessing.

KirinDave9• 11 years ago

If you think long and hard about the kind of specific cases IUDs address over other forms of birth control, I think a grim and sad outline of reality may emerge for you.

rubiquity3• 11 years ago

Don't IUDs have a lot of negative impacts on a woman/teenage girl's health? I seem to remember there was a study about bleeding, irregular menstral periods, and an increase in urine tract infections. It seems irresponsible to give a device like that out to any teenager that wants one. Not that pills are any better.

It doesn't matter what direction the arrow on the graph is pointing if the way you got there is by potentially hurting people.

noelwelsh4• 11 years ago

All medical treatments are a trade-off.

Geeek• 11 years ago

Yups. My SO has the most unpredictable periods since she got her IUD. It's a huuuuge tradeoff that we are not sure it worth it in the long run.

KirinDave9• 11 years ago

That may be true, but many women upon receiving an IUD actually find that after a few months their menstrual cycles stabilize and decrease.

It's such a pronounced effect that doctors use certain types of IUDs to help stabilize certain conditions. It doesn't help everyone with this, but it helps enough people that it's worth trying.

JupiterMoon2• 11 years ago

Not your job to police women's bodies. If she is fully informed and wishes to use one then this is her personal decision. Not yours.

rubiquity3• 11 years ago

That's completely fair! I'm not trying to make the decision for anyone and I'm not sure where you got that from my post. But isn't it a bit irresponsible for something as large/respected as an entire State to put their backing behind something with pretty well known, negative tradeoffs?

Is it OK for a large body of authority to support something that will harm you as long as they leave it to the individual's choice to use it or not? Where do we draw the line on this?

balls1875• 11 years ago

You're making a straw man argument here.

The parent commenter is asking the risks of intrauterine birth control.

In the US, the FDA polices all medical drugs for safety and efficacy, regardless if they are for reproductive health or not.

deelowe2• 11 years ago

I think the topic is more spurred from this being a government sponsored service that is offered to minors. Overall, this seems like a shining success. However, are IUDs the safest option? Should the government offer others? No "policing" is necessary to answer these questions.

TallGuyShort5• 11 years ago

My concern here would just be parental knowledge. I would permit my daughter to get an IUD at a young age if that was her decision regardless of our families religious / moral views (though I would encourage her to be informed), but if I'm responsible for her health and safety, I damn well better know what someone else is implanting in her.

dalke• 11 years ago

Pregnancy also has "a lot" of negative impacts.

Quoting from http://www.plannedparenthood.org/learn/birth-control/iud in the section about disadvantages:

You may have:

  - mild to moderate pain when the IUD is put in
  - cramping or backache for a few days
  - spotting between periods in the first 3–6 months 
  - irregular periods in the first 3–6 months — with Mirena or Skyla
  - heavier periods and worse menstrual cramps — with ParaGard

> Pain relievers can usually reduce bleeding, cramping, and other discomforts. If they are severe and do not seem to lessen, tell your health care provider.

Serious problems with the IUD are rare. ... In rare situations, a woman could develop an infection when using the IUD. This happens if bacteria get into the uterus when the IUD is inserted.

emidln• 11 years ago

Mirena in particular is also linked with mood disorders in 5%-10% of users.

Edit: s/15/10/ as per [1]

[1] http://www.mirena-us.com/safety-considerations/

Osmium• 11 years ago

I am not a doctor. That said, my understanding is that IUDs are one of the best contraceptive methods out there. They have a bad reputation because they had issues when they were initially introduced, and they haven't quite overcome that reputation yet even though modern ones are excellent. There are non-hormonal ones too (pure copper), so it can avoid a whole host of side effects that some women experience with hormonal birth control. However they can also cause heavier periods with some people. Otherwise they seem to be the model of what you'd want a contraceptive to be (excellent effectiveness, safe, easily reversible, and forgettable–they last years and years).

DanBC4• 11 years ago

When you ask female "women's health providers" what contraception they use for themselves a modern IUD is top of the list.

Here's a Vox article about it: http://www.vox.com/2015/2/23/8092483/birth-control-iud

__z3• 11 years ago

Don't IUDs have a lot of negative impacts on a woman/teenage girl's health?

IUDs are classified as "pretty safe" for most users. They are also easily removed if undesired side effects are noted. They almost certainly are safer than pregnancy for most users. Individual users have contraindications that prevent IUD use or make IUD use riskier, that is why they are a prescription medical device and users are advised of the risks and their other options.

IUDs also have some benefits.

I seem to remember there was a study about bleeding, irregular menstral periods, and an increase in urine tract infections.

There are two types of IUDs, hormonal and copper. ANY hormonal contraception "messes" with periods in ways that aren't predictable. If side effects are not bearable you can simply get the IUD removed, it is easily reversible. Irregular bleeding is not harmful in any way but can be a huge nuance. Copper IUDs can cause increased bleeding but aren't hormonal. If UTIs or other complications are a problem then the IUD can be removed.

It seems irresponsible to give a device like that out to any teenager that wants one.

It seems irresponsible to not offer teenagers a very effective contraceptive. All medical interventions have a risk of side effects. We would like the user to be aware of such risks and make an informed choice.

UIDs (in general) got a bad rap because of the Dalkon Shield in the 1970s. It had a design flaw that harmed a large number of users. Modern IUDs are much safer.

s_q_b2• 11 years ago

IUDs have an excellent success rate and safety profile. They can cause problems, but from a societal perspective, it may be worth it.

Really we need non-invasive male birth control, as soon as possible.

XorNot4• 11 years ago

I would argue invasive is fine, what we need is reliably reversible. Vasectomies can be reversed, but it's a big if at any juncture.

s_q_b2• 11 years ago

Even injection at the site will result in high rates of patient non-compliance. There's been some work done in India with temporary implants. However, I believe if we are to reach zero unintended pregnancies, the male procedures need both medical and reversibly surgical options.

shoo• 11 years ago

In my opinion this is obviously a pretty good thing to do, and it is fantastic to see it is happening. Dear world: let's see more of this kind of thing, please.

But the experiment in Colorado is entering an uncertain new phase that will test a central promise of the Affordable Care Act: free contraception.

caseyf7• 11 years ago

Here's the link to the study referenced in the article.

http://www.nejm.org/doi/full/10.1056/NEJMoa1400506

webjprgm5• 11 years ago

I don't think 2-3 partners is really low. I find it hard to imagine most people being successful at seducing a very large number of people. Probably in most cases it is <= the number of boyfriends the girl has had.

I could also point out that my church would consider 2-3 partners something akin to "running wild". One partner, one time could be a lapse in judgement. Multiple partners or one partner multiple times indicates a pattern.

balls1875• 11 years ago

I could also point out that my church would consider 2-3 partners something akin to "running wild". One partner, one time could be a lapse in judgement. Multiple partners or one partner multiple times indicates a pattern.

Thankfully, this type of puritanical thinking is on the decline in America.

jdross• 11 years ago

As a counterpoint, 85% of the gains were found in neighboring counties without the program. Teenage birth rates are plummeting everywhere.

Questionable source, but data and linked study appear correct: http://www.nationalreview.com/agenda/385884/no-one-program-d...

archgoon• 11 years ago

Interesting, thanks for the reference. Though paragraphs like

"But these “linear trend lines” based on the three previous years of data aren’t really useful. The authors’ projection shows that births would actually increase a bit during the period CFPI was put in place, despite the fact that, like the abortion rate, the teen birth rate is declining nationally, noticeably and steadily."

are somewhat bizarre. The entire point of using the trend lines is to take into account, well, the trend. Still, good to know the counterarguments, otherwise you're just listening to the echo chamber of "Well, of COURSE the program would work!"

hiou• 11 years ago

Indeed national averages during that period trend similarly.

http://www.cdc.gov/teenpregnancy/about/birth-rates-chart-200...

irq-1• 11 years ago

The 2007-2013 numbers for 'All' show about 40% drop, but: it's a longer period (than 2009-2013), and there's a very sharp decline between 2007 and 2009, which would make the national numbers worse when compared to the same period.

KirinDave9• 11 years ago

It's almost like having fewer women present in a 50mi radius that can get pregnant reduces local pregnancy chance...

hammock• 11 years ago

Colorado’s Effort Against Teenage Pregnancies Is a Startling Success

Any time I see a headline like this, I have to look for the discussion about what unintended consequences were observed. There usually are some, there is no such thing as a free lunch. Some commenters have already mentioned negative health effects, spread of STDs, environmental impact, social consequences. I found no such discussion in this article.

KirinDave9• 11 years ago

Probably because it's entirely outside the scope and would only be useful to people trying to derail the conversation.

It's not like IUDs suddenly stop other safe sex practices. It's not Sex MMO where your "Contraceptive Equipment Slot" only can fit one item per party.

nsgi4• 11 years ago

Why would it be outside the scope? It's intuitive that decreasing the "price" of one form of contraception would decrease demand for weak substitutes, so it is one possible and very negative effect of the policy.

rickdale• 11 years ago

This is interesting because I always claim that the reverse is true where I live. Like, getting pregnant is glorified to young girls. The conspiracy theorist in me says that the gov does that to occupy peoples lives. It's like, they have nothing better to do so lets make having a baby seem like the greatest thing in the world. So in my view, this goes both ways.

csours• 11 years ago

The conspiracy theorist in you may want to look to society, hormones, and evolution as well.

webjprgm5• 11 years ago

Since all my comments so far have sounded like I oppose giving out contraceptives (since I am very much a proponent of moral living), let me clarify. I think it is great to help lift people out of poverty. Since there is a trend among poor teenagers to have more unplanned pregnancies it makes sense to address that problem, and this is one possible step.

I do not think it should replace teaching abstinence. But I also don't think that teaching abstinence using scare tactics in school is all that effective. Religious and moral teachings are much more so. So it still comes down to the responsibility of parents to teach their children correct life principles.

Let the government give free contraceptives to at-risk populations. But also encourage parents to teach good morals.

true_religion• 11 years ago

Just so I can have another data point in my anecdote web. May I ask you if you mean 'abstinence till marriage', if you abstained till marriage and at what age you got married.

facepalm2• 11 years ago

I've heard that unwanted pregnancies are more frequent in the "wait till married" crowd. That is because they are unlikely to have condoms with them when their emotions overwhelm them. They don't account for their changed decision making process when aroused. (Source: Dan Ariely's Irrationality MOOC).

MichaelGG• 11 years ago

That's what I've seen from personal experience. Thinking along the lines of: Birth control's for sluts, and I'm not like that, so I don't need that, this is special, etc.

apta• 11 years ago

Perhaps they should discourage teenagers from sleeping with each other. As far as I know, teenage pregnancy is not an issue in conservative Middle Eastern cultures for instance.

Colorado’s Effort Against Teenage Pregnancies Is a Startling Success

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