If states truly want to reduce the number of abortions: Colorado’s Effort Against Teenage Pregnancies Is a Startling Success

An ounce of prevention is worth a pound of cure. From the article below: “The state health department estimated that every dollar spent on the long-acting birth control initiative saved $5.85 for the state’s Medicaid program, which covers more than three-quarters of teenage pregnancies and births. Enrollment in the federal nutrition program for women with young children declined by nearly a quarter between 2010 and 2013.”

Sabrina Tavernise reports in the NY Times:

Over the past six years, Colorado has conducted one of the largest experiments with long-acting birth control. If teenagers and poor women were offered free intrauterine devices and implants that prevent pregnancy for years, state officials asked, would those women choose them?

They did in a big way, and the results were startling. The birthrate among teenagers across the state plunged by 40 percent from 2009 to 2013, while their rate of abortions fell by 42 percent, according to the Colorado Department of Public Health and Environment. There was a similar decline in births for another group particularly vulnerable to unplanned pregnancies: unmarried women under 25 who have not finished high school.

“Our demographer came into my office with a chart and said, ‘Greta, look at this, we’ve never seen this before,’ ” said Greta Klingler, the family planning supervisor for the public health department. “The numbers were plummeting.”

The changes were particularly pronounced in the poorest areas of the state, places like Walsenburg, a small city in southern Colorado where jobs are scarce and many young women have unplanned pregnancies. Taking advantage of the free program, Hope Martinez, a 20-year-old nursing home receptionist here, recently had a small rod implanted under the skin of her upper arm to prevent pregnancy for three years. She has big plans — to marry, to move farther west and to become a dental hygienist.

“I don’t want any babies for a while,” she said.

More young women are making that choice. In 2009, half of all first births to women in the poorest areas of the state happened before they turned 21. By 2014, half of first births did not occur until the women had turned 24, a difference that advocates say gives young women time to finish their educations and to gain a foothold in an increasingly competitive job market.

“If we want to reduce poverty, one of the simplest, fastest and cheapest things we could do would be to make sure that as few people as possible become parents before they actually want to,” said Isabel Sawhill, an economist at the Brookings Institution. She argues in her 2014 book, “Generation Unbound: Drifting Into Sex and Parenthood Without Marriage,” that single parenthood is a principal driver of inequality and long-acting birth control is a powerful tool to prevent it.

Teenage births have been declining nationally, but experts say the timing and magnitude of the reductions in Colorado are a strong indication that the state’s program was a major driver. About one-fifth of women ages 18 to 44 in Colorado now use a long-acting method, a substantial increase driven largely by teenagers and poor women.

The surge in Colorado has far outpaced the growing use of such methods nationwide. About 7 percent of American women ages 15 to 44 used long-acting birth control from 2011 to 2013, the most recent period studied, up from 1.5 percent in 2002. The figures include all women, even those who were pregnant or sterilized. The share of long-acting contraception users among just women using birth control is likely to be higher.

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

The private grant that funds the state program has started to run out, and while many young women are expected to be covered under the health care law, some plans have required payment or offered only certain methods, problems the Obama administration is trying to correct. What is more, only new plans must provide free contraception, so women on plans that predate the law may not qualify. (In 2014, about a quarter of people covered through their employers were on grandfathered plans, according to the Kaiser Family Foundation.)

Advocates also worry that teenagers — who can get the devices at clinics confidentially — may be less likely to get the devices through their parents’ insurance. Long-acting devices can cost between $800 and $900.

“There’s no lifeboat with the Affordable Care Act,” said Liz Romer, a nurse practitioner who runs the Adolescent Family Planning Clinic at Children’s Hospital Colorado, which went from giving out 30 long-acting devices a year in 2009 to more than 2,000 in 2013.

The state failed to get additional funding through the General Assembly this spring, a shortfall Ms. Klingler said would slow, but not stop, its progress.

Women’s health advocates contend that long-acting birth control is giving American women more say over when — and with whom — they have children. About half of the 6.6 million pregnancies a year in the United States are unintended. Teenage births may be down, but unplanned births have simply moved up the age scale, Ms. Sawhill said, and having a baby before finishing college can be just as risky to a woman’s future as having one while in high school.

Colorado’s program, funded by a private grant from the Susan Thompson Buffett Foundation, named for the billionaire investor Warren Buffett’s late wife, was the real-world version of a research study in St. Louis (also paid for by the foundation, which does not publicly acknowledge its role). The study came to the same conclusion: Women overwhelmingly chose the long-acting methods, and pregnancy and abortion rates plunged.

“The difference in effectiveness is profound,” said Dr. Jeffrey Peipert, a professor of obstetrics and gynecology at Washington University in St. Louis, who ran the study. The failure rate for the pill was about 5 percent, compared with less than 1 percent for implants and IUDs.

The methods are effective because, unlike the pill, a diaphragm or condoms, they do not require a woman to take action to work. And while an early incarnation, the Dalkon Shield introduced in the 1970s, had disastrous results, the modern devices are safe and have been increasingly promoted by doctors. Last fall, the American Academy of Pediatrics published guidelines that for the first time singled them out as a “first-line” birth control option for adolescents, citing their “efficacy, safety and ease of use.”

“There’s been a big shift in the mind-set,” said Dr. Laura MacIsaac, director of family planning for Mount Sinai Beth Israel in New York. “The demand is coming from everywhere now.” . . .

Continue reading.

Why doesn’t Alabama, Georgia, Missouri, et al. try that approach?

Answer: If they were serious about reducing abortions, they would.

Finding my way in a plant-based diet

Today I worked out a meal plan, and I thought I’d present it with comments. I am doing this in the context of WW Freestyle, so I’ll note points, my daily allowance being 23 points. For each food that has points, points are noted. (Many foods on WW Freestyle are zero points.)

Breakfast – 7 points

I arise quite early, and I make a small pot (a pint) of tea, this morning Murchie’s No. 10, and pour it into my Temperfect mug to sip as I read the news. I also squeeze lemon into a glass, add 1/4 cup of pomegranate juice (2 points), ice, and white tea to fill. I generally drink that first, since the tea in the mug stays at drinking temperature for some hours. I drink pomegranate juice because it’s good for arterial health. Update: I  have discontinued the pomegranate juice after more research showed me how thin the evidence is for its efficacy (except, perhaps, for those with severe coronary heart disease). Live and learn. /update

I made my standard breakfast, today with 1/2 cup cooked oat groats. I skipped the flaxseed, since I plan to have it for dinner. The extra-virgin olive oil was 3 points and the 1/2 cup of cooked oat groats 2 points.

Lunch – 5 points

I bought some salad greens and added 3 chopped scallions, 1/2 chopped yellow bell pepper, 5 or 6 sliced cherry tomatoes, some broccoli that I previously steamed, some broccoli sprouts, and 1/2 cup previously cooked Lima beans from the fridge.

For the dressing, I put into a little jar: 1 tablespoon extra-virgin olive oil (4 points), juice of a lemon, a pinch of salt, some freshly ground black pepper, and about 1/2 teaspoon smoked paprika. I shook it well, poured it over the salad, and sprinkled the salad with a tablespoon of nutritional yeast flakes (1 point) because of its B12 content. (That much nutritional yeast has enough B12 to more than satisfy the daily requirement.)

Snack – 1 point

Mid-afternoon, I stir 1 tablespoon of mugi miso (1 point) into a mug of hot water. Mugi miso is made from barley and soybeans. It’s tasty and a nice lift. Miso is a probiotic and has good health benefits. Update: I have stricken miso from the list because of its high sodium content, but there is evidence that the sodium in miso is balanced by the soy so it has less in the way of ill effects. But I don’t actually need it, and I’m keeping my sodium at below 1200mg/day. /update

Dinner – 10 points

I halved a kabocha squash, removed seed, cut it into chunks, tossed it with 1 tablespoon extra-virgin olive oil, and put it on a lined baking sheet. I sprinkled it with Maldon salt, pepper, cinnamon, and grated orange peel and roasted it until it was tender. I figure about 1 teaspoon of olive oil was lost to the bowl and baking sheet, so each portion will have 1 teaspoon of olive oil consumed (2 points total). (I also think there will be some kabocha squash left over.)

I’ll heat a cup of previously cooked quinoa (6 points total) and 1/2 cup of previously cooked Lima beans (0 points), perhaps adding a dollop of water if needed, and add 2 tablespoons chopped walnuts (4 points total), 1/4 cup ground flaxseeed (4 points total), 2 tablespoons nutritional yeast (2 points total), and 4 teaspoons white sesame seed (2 points total). That makes 20 points total, so each of the two portions is 10 points.

Total: 23 points

I went shopping today and bought various things to cook and chill for use later: winter wheat (whole grain wheat berries), navy beans, broccoli (which I’ll steam). Also carrots (to roast), leeks, zucchini, and Melt, a vegetarian butter substitute that’s highly rated. Having things on hand makes it easy to throw together meals.

So far, so good.

A standard good shave elevated by the aftershave

The brush (a Maggard 22mm synthetic), soap (Colonia), and razor (Edwin Jagger with black-rubber handle) are all quite good: excellent performance, well made, and deliver a fine shave. But Anthony Gold’s Red Cedar aftershave takes the shave to the next level: a familiar and warm fragrance in an unexpected context. When I was in high school, I helped my step-father line some closets with red cedar, and the fragrance thus has strong connections for me—a kind of madeleine doorway to the past, as it were.