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tv   Discussion on Family Planning and Birth Control  CSPAN  October 18, 2015 1:55am-3:56am EDT

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you have to let your heart be broken. you cannot be too professionalized about this. you have to let your partly hearts be broken. everyone treating you grandly. you don't get out and away. heart beour broken. that will come in a number of ways. au touch on a point which is point of immense personal pain of how i hold truth and compassion together in discourse. myself,my time talking telling myself i got it wrong.
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i had a conversation a few years africa aboutaharan human sexuality. were deeply into it. theiristened, sense of betrayal -- you have to let yourself be touched by that. you cannot reject it as a direct s an ignorant view. part of the dialogue is a dialogue that has great pain. we must let ourselves be hurt. because i with it like all of us -- i don't like to be hurt. i don't like to feel pain. i go a long way to avoid it, emotional pain particularly. does that make any sense? >> very much. tom: i'm afraid we have to close
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it down now. the archbishop has to be leaving. one final thought. we have been talking a lot about issues -- climate change, migration, violence -- better handled by secular institutions. do you see any challenge, danger in the church becoming too secularized by its focus on these institutions? what you mentioned is very important. the importance of not soft peddling. archbishop welby: i think there is. us,ink making people like we can end up saying the wrong thing about everything. -- not only myself -- as a christian, i'm called to be someone, the scripture, the
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words of jesus teach me to to believe that being a disciple of christianity is the best decision in your life. happens to be. i need to say that. and not to become what pope aancis what is called practical atheist. it is all about jesus. tom: very good. thank you so much, archbishop. [applause] tom: this has been an on the record event. the council of for a foreign relations -- the archbishop has to take off
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pretty quickly. if you could give them the courtesy as he takes off. archbishop welby: thank you very much. [applause] [captions copyright national cable satellite corp. 2015] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] newsmakers,eekend's american enterprise institute president arthur brooks is our guest. he talks about the state of conservatism, the upcoming election of the new house speaker and the 2016 presidential race. watch the interview sunday at 10 a.m. and 6 p.m. eastern on c-span. >> this monday on c-span's new series landmark cases, 1830, the
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mississippi river around new orleans was a breeding ground for call a rough and yellow -- cholera and yellow fever. louisiana only allowed one government run slaughterhouse to operate in the city district. all of the slaughterhouse cases the873 were joined by former solicitor general and michael ross. to help tell the history of this time in the south with personal stories of the butchers and the state of things in new orleans and as well as the supreme court justices involved in the decision. be sure to join the conversation as we take your calls, tweets and facebook comments. c-span3day on c-span, and c-span radio. for a background in each case, order your copy of the companion
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book. it is available for $8.99 plus shipping on c-span.org/landmarkcases. a coming up next on c-span, discussion on family planning and public policy. that is followed by secretary of state john kerry unveiling the state department annual international religious freedom report. later, a look at the transatlantic trade agreement and public opinion on the u.s. and europe. virginia lieutenant governor spoke earlier this week about improving access to birth control for women in his state and finding common ground in refusing the number of abortions regardless of one's party affiliation. this happened at the brookings institution and including other speakers with experience in family planning programs. it runs almost two hours.
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>> welcomes to brookings. center and my former codirector is here to watch me carefully and correct my errors. i'm glad the you were able to come this morning. if we start at 9:30, everyone comes at 9:40. it's amazing how that works out, but that is how it is. here is the plan for the event today. i will make some introductions. if you want to go to one place to know about the status of research and thinking about
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marriage, this volume is it. it includes several chapters on birth control, and given our interest on birth control here, we decided we would focus this event on birth control. that is what we are here to talk about. when bell finishes reviewing the volume, i will review the policy reef. we are very fortunate to have lieutenant governor northam here. we will give you a chance to ask them questions. then, we will have a panel, a panel of people who are experts on this issue. i will ask them some questions, and hopefully we will have some disagreements. we will give the audience the channel to stump the panel. in introducing bell, this
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wonderful book, chapter six in this volume is something on this topic that is about as good as he will get. bell is one of the great experts on this issue and the country. bell sawhill talks about marriage and the volume. thank you. ms. sawhill: i want a little help here on the slides. there they are. oh, that is the wrong one. anyway, let me say a few words while we are sorting that out. thank you very much for being here, by the way, i really appreciate it. this is a wonderful volume. we do this in conjunction with our partners at princeton university. the editor in chief of this
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volume is sarah mcclanahan, and a number of our princeton colleagues are here today. i cannot mention all of them, but there are three or four of them here. i particularly want to mention john wallace, who is the managing editor of the volume. where are you? thank you. it has been a wonderful partnership over about a decade's time. as ron suggested, this volume, i think, is one of the best values we have ever done. we did a volume about 10 years ago on marriage. we were asked to revise and update at this year. we got a new set of authors, and they were terrific people. they all wrote great chapters. i cannot possibly do justice to the entire volume. i think there are copies outside.
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you can feel free to take one and read it at your leisure. i will show you the table of contents here see get a sense of what is in the volume, and who contribute to it. i can't, as i say, do more than just give you the highlights and a few comments from me. let's start with what has been happening. as you know, marriage is in retreat. it is declining from about 85% back in 1950 to about 60% now. this is for the age groups, 30-44. you can look at this in different ways. however you look at it, you see this decline. just because marriage has been declining does not mean that
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people are still not have a children, they just having a outside of marriage, in that of inside marriage. here is the data from the volume on that issue. as you can see here, we have very high rates of unwed childbearing in the united states now. overall, about 40% of all kids are born outside of marriage. this varies by class and race. if you look at education, as a proxy for socioeconomic status or class, you can see that the rate declined sharply with more education. keep in mind, this last category here, where the rates are quite low, those with college degrees is a small group still. it is only about 30% of the population. the other lines here referred to the other 70%. with each education category, there are racial gaps. we had an entire chapter in the volume on these gaps by race and class. we also had an entire chapter on same-sex marriage.
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as we were preparing the blame, the supreme court was considering what to do. you all know, in june, they finally legalized same-sex marriage. that made this whole discussion very interesting and timely. part of the debate, leading up to the court decisions, was about whether same-sex couples are good for kids are not, whether this is a good environment for which to raise kids. there are research studies on that, not all of them of equal merit, but our author did a nice review of the evidence, and lot of other evidence and background, including the legal background on this movement to
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legalize same-sex marriage. he finally concludes, after looking at all of the evidence, you really can't come to the conclusion that same-sex relationships are not good for kids. what some of the research has suggested kids did not do well in same-sex marriages is because of the stigma and lack of legalization of marriage, the kids were being born and somewhat unstable circumstances. they may have been the product of an opposite sex marriage, and then later, the couple broke up, and again or lesbian parent moved into a same-sex relationship, and the children came with that parent. that led to some instability in the lives of the children. that, most researchers believe, is actually not a good thing for kids. in the future, it will be very
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different. my book, which ron was nice enough to mention, talks about people drifting into parenthood. i use the word "drifting," very cautiously because i think that is a lot of what is happening. these are unplanned pregnancies and birth. in the same-sex world, by definition, when people have kids, they do it by choice. we had another very interesting chapter on the extent to which marriage matters for child well-being. is a child who grows up in a two parent family better off than a child who grows up and one parent family? our children in married families better than children and cohabiting families? this chapter as to all the literature on those issues. basically, all of that literature, which there is a ton now, has led pretty much to consensus that, on average, growing up in a two parent married family is better for
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kids then not. that said, you have to ask, why should marriage matter? one reason it matters is because simply, the people who marry are a self-selected group. there are other reasons as well. this author goes through all of those reasons. in the end, he concludes that all of them have some evidence of making a difference for children's life, and if we wanted to replace marriage, for example, with government programs that made up for the lost income of the second parent, or other things of that sort, we could do that, but it would not fully replace the benefits that children now derive from marriage itself.
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we had a lot of debate around the production of the volume, and amongst the authors about whether or not -- or wider has been this decline. everybody agreed there was a decline. the issue is why. these are the usual factors that get debated and talked about. women's new opportunities have clearly made them less dependent on marriage. it is no longer something they need for their economic well-being. then, there is the argument that men, especially less educated men, have not been doing well in the labor market. that has made them less manageable -- marriageable. this has been a good to be infected to the decline of marriage. finally, there are arguments about whether government
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programs are inhibiting marriage because if you marry someone who has additional income, you may become ineligible for various programs. that may discourage marriage. ron haskins, in his chapter, does a nice job of reviewing that and other government programs including marriage education programs, and others that we will get to. then, of course, there has been a huge change in the culture and attitudes towards marriage. i would like to talk about how our late which has changed around these issues. it used to be that we called someone who had a baby outside of marriage, we call the child an illegitimate child. we would not think of doing that today. we call people who were cohabiting as "living in sin." imagine using that term today. that is just an illustration of how much attitude and cultures
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have changed here. brad wilcox, who is a big advocate of how we need to change the culture, bring back so when institutions and religious institutions to support message wrote a chapter on those issues. i would say there was some difference of opinion amongst authors of the relative importance of these factors, but we agree that it is not one or the other. this is probably my last and most important side here. and, the one you're probably most interested in witches, is that anything we can do about these trends everything they have not been ideal for children? the bush administration pioneered a set of marriage education programs, and thanks to ron haskins, and others, were
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very closely evaluated, and by the time we produce this volume, we had the results. the results are not very encouraging. they do not show that we were able to move the needle very much using marriage education programs. some people would say, we need to try harder, we need a new generation of such programs. that is a legitimate argument. other people argue that we need to reduce the so-called marriage penalties and both tax and benefit programs. we have done a fair amount of that already. it requires moving eligibility for these programs quite far of the income -- up the income scale. there is not a huge amount of evidence that it moves the needle behaviorally. that is an issue, but i do not think it is one that has got a lot of promise to it.
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second to last, we have improving either men's or women's economic prospects, hoping that will help them to marry or for more stable unions, at least. that has been a big issue of debate. one of those interesting chapters, to become, the most interesting chapter in this whole volume is the one by danny schneider, who looked at 15 social experience all designed to improve the economic status of men or women, usually more disadvantage men or women, and all of the programs have been evaluated by using random controlled trials. many of them, 15 of them, had evidence on what happened to marriage.
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what he finds is with two exceptions, out of the 15, improving male economic prospects did not move the needle on marriage. for women, it did. for women, there was a lot more increase in marriage rates after a program improved the economic prospects. i will let you think about why that may be. and, reducing planned pregnancies -- what i started with, marriage has declined, but people are still having kids, the you think about, who is having the kids. it is mostly younger women, women and their 20's. 60% of those births to young, single women, are unplanned, according to the women
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themselves. that is from the government data of a sample of 20,000 people. i think that is pretty solid, but we can debate whether there are some nuances there, what does unplanned really mean. if that is the case, one way to improve the prospects of the children, and help women as well, if enabled them to only have children when they really want to have children, and feel ready. that would be they would be older, more mature, more experience, completed their education, and more likely to be in a stable relationship with a stable partner. this is a very promising direction, and one we will talk more about because what came out of this entire effort to produce this volume was that this was one of the few areas that we saw where he could probably make some difference. you will be hearing now from some people who know a lot more about that.
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i will stop, and turned it back to ron. mr. haskins: thank you, bell. bell already gave my interdiction for me which is if you really care about marriage, and children's well-being, and we look around for interventions for impact, pretty much the only thing that has consistently shown in impact -- ok. thank you. the only thing that has consistently shown an impact is reduced nonmarital births. there is some evidence, i would not say this scientifically persuasive, but women who do not have out of wedlock births have a greater chance of subsequently marrying, have more stable marriages, and so forth. if someone is interested in marriage, this is something that
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they would focus on -- not that they do in the real world, i will get to that in a few minutes, and so will the lieutenant governor. that is why we selected, in a volume on marriage, the topic of nonmarital births and birth control. first of all, we have had this in order to increase, bell talked about this a little bit, but if you're like me, you forget about it in five minutes, so i will repeat it. the message here is extremely important. we have an onslaught of nonmarital births. if there is something that results from non-marital births, it is not good for the country, not good for the couples, it is a problem getting worse and worse. there has been a certain amount
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of stability over the last -- it depends on what measure you use -- decade. it has been pretty stable over two decades. we still hav these enormous rates, and as bell said, 40% of kids are now born outside of marriage. it is this big problem, but for some reason, has slowed down a bit. here comes the aspect of this that i think is often missed by people. th is, who is having these nonmarital births? we want to be politically correct, and not point out -- those who could take action thanks to more government spending. there are big differences across lots, hispanics, and whites -- blacks, hispanics, and whites.
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a thesis said that blacks would not be able to take event of all the rights that they won in the 1960's because the black family has disintegrated. the, of course, was extremely controversial. it is the only other academic fight that was so intense and nasty. harvard just did of volume and said that monahan was right, what do we do? it has spread throughout the whole society. in fact, the rate for white births is higher now than when monahan wrote his report on blacks. there will be differences among ethnic groups.
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equally bad, the same thing is true of education level. moms with less education are more likely to have a nonmarital birth. we have the most his advantage groups in our society who are having more nonmarital births. there is one impact on both the mother and children, and perhaps the father as well, that is undeniable. that is they are much more likely to live in poverty. i have not yet met anyone who claims that poverty is good for children or adults. five times the rate. can you think of any intervention that makes an impact five times in the experimental group than the control group? clearly, there is a big impact on poverty. if you want to just summarize, which is what i will do, there are many, many outcomes.
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for many of these, there is a whole literature featuring random assigned studies. you have reduced poverty rates, no question about that. lower abortion rates because women who are pregnant outside of marriage are more likely to get an abortion. there is a lot of evidence of better spacing of babies, which is good for the kids and the mother. there is an increased likelihood of prenatal care. i did not know this, until recently, kids are twice as likely to get prenatal care if they have a planned pregnancy rather than unplanned pregnancy or birth outside of marriage. there is also less postpartum depression for moms who have planned pregnancies. there is more education for the
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mothers. bell has written about almost all of these things. and, they are now studies on cost savings for government. maybe the numbers are somewhat exaggerated sometimes, but a very good review of the evidence shows that the benefit cost rate -- it does not include any of the long-term benefits. there is a wonderful review of literature by martha bailey of michigan that shows big, long-term impacts. in fact, moms who avoid early births have kids that do better. they grow to have more education, more income, less welfare, and so on, and so forth. no one has taken those measures into account, as far as i know. this is really a spectacular list of advantages. if we could do something about nonmarital births, the mother would be better off, the child would be better off, the
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community we live in would be better off, and the nation would be better off, and the government would save money. that is a pretty good list of benefits. we have in the last decade, or little more,, increasingly to -- come increasingly to realize that contraception, which includes iuds, and some thermal implants, and last of to 10 years, they can have a huge impact on pregnancy rates for women who want to avoid pregnancy. this data is from one study, the st. louis study. as far as i know, every study has shown pretty much the same thing. it is the probability that a woman would get pregnant if she is on various types of birth control. if a woman is on a pill, patch, or ring, she is nine times as likely to get pregnant.
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if you control produces good outcomes -- is birth control produces good outcomes, we want to focus a lot on mars. we have some barriers, and i will only just mention this, because we've invited people to take part in the panel, who are experts on the issues. the initial cost is initially more than the cost of the pill, but in the long run, especially if it lasts a decade, it saves money, not to mention the impact. if you spend the money now, you don't have to spend it later. there are a lot of administrative issues. there are a lot of
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administrative issues. you have to, for most effective, you have to have available onsite, and you've got to have people available onsite. you don't want women to come in and say they would like to have birth control, and they might choose a larc, and say, "ok. come back in a week." that's a bad approach. we need better patient education about what the various forms of birth control are. we do not have to have a situation where women feel like they're pressured into taking larcs, or any other form or birth control. and there are big socioeconomic and race issues that i mentioned in the first place. so we have a great opportunity and that's one of the main reasons we want to have this event this morning. i think it was the main factor behind bel's book. and definitely she was involved in establishing national campaign to prevent teen unplanned pregnancy. and they are a great organization, i think if we could measure these things accurately. they've had a major impact on the decline, especially among teens in non-martial birth rates. so we're on the right track.
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the question is how can we do it more effectively. and if we could, a lot of benefits would flow. so the rest of our event we hope to elucidate that issue a little more clearly. next we're going to have lieutenant governor -- wait, don't get up yet. i have a 15-minute introduction here. [laughter] it begins with your mother and her background. lieutenant governor northam was kind enough to agree to drive all the way up here, i guess we would say to washington to talk at this event. we had the idea because he's a governor. politicians talk, we all know that, but very few of them can write more than a sentence. i don't know if you've ever noticed that. but i spend a lot of time with policymakers, i know this to be true. and yet, he wrote an editorial about what he hoped virginia would do with regard to reducing non-martial births, and mentioned larcs and so forth. it was really a very nice column. i thought, "wow, who is this guy?" by coincidence, the next week i meant him.
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so it turned out well and they were able to clear his schedule and so he came. so he is a doctor. he's a pediatric neurologist. he has an undergraduate degree from virginia military institute and then a medical degree from eastern virginia medical school. and he's not only lieutenant governor, but he's active in practice, plus he teaches. so he doesn't get a good night's sleep very often. as i said, his political career began in 2008 when he was elected to the virginia state senate, and then he's been lieutenant governor since 2013. i want to tell you that i know for sure that he's a very open-minded individual. and the reason i know that, is that his son is doing his residency. residency, at the university of north carolina at chapel hill, which is not overly popular in
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virginia. so you can tell he's a very open-minded gentleman. so, lieutenant governor, thank you very much for coming. [applause] mr. northam: good morning. ron, thank you so much for the kind introduction. my son, wes, we have two children, he's doing his neurosurgery training in chapel hill. that was not exactly his first choice, but being a virginia you any port in a storm. he's enjoying it down there and working hard, and having a good experience. thank you so much for your comments. i really appreciate the opportunity to be here this morning.
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it takes me away from norfolk, which is where i practice medicine, and the city of richmond, which is our capital in virginia. it's nice to get a day up in the nation's capital. i would like to also to take this opportunity to thank the brookings institution as well as princeton for all of the great work that to you all are doing. now, one might ask why is a pediatric neurologist before you this morning talking about contraception. i will try to go through in the next maybe 10 to 15 minutes and explain that. but as a practitioner, as a pediatric neurologist and also as a policymaker in the commonwealth of virginia, the concept of contraception, and as way to decrease unintended or unplanned pregnancies, also to decrease the number of abortions, not in in virginia but in this country and our society, and also to increase the health and well-being of our children and their family. so it's an important concept from both a practitioner and a policymaker. i want to just go through those
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steps with you a little bit this morning. i, as ron said, a lot of people don't realize the lieutenant governor, at least on paper in virginia, is a part-time job. so unless one is independently wealthy, which ron, i'm not, -- i know you are. that's why i just wanted to clarify things. i have another job being a , pediatric neurologist. so about three to four days, depending on what's going on in the schedule, i see about 15 to 18 patients a day. a lot of my patients are teenagers. and when we say teenagers from the 15 to 19 age range. we actually see patients after age 18, but most of my population is starting prenatally up until 18 to 19. interestingly a lot of my patients are epileptics, as you may imagine, or perhaps have migraines, but are on medications that can affect the
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health and well-being of a fetus. we deal with individuals in that age group who become pregnant and those become interesting discussions and dilemmas for a lot of these folks. to be able to prevent those pregnancies, especially in that time of one's life, is very important. a second comment i would make is that we see a lot of individuals as pediatric neurologists in the neonatal intensive care unit. we are able to maintain life in now 22 to 23 week fetuses, newborns. for better or worse that becomes somewhat of a challenge in a couple of ways. the morbidity, as you may imagine, in a 22 or 23 week fetus is fairly high. there are obviously some great
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outcomes, but not all of them are good outcomes. if you look at financially what happens to take care of these babies, probably a conservative estimate would be a million dollars up to four to five million dollars, up to a year-plus in our neonatal intensive care units. what i have found, in taking care of these individuals, because when you take care of babies, you also take care of parents. in this case most of the time mothers. while that baby is in our hospital, or in our nicu, as we say, oftentimes the mother will become pregnant with her second or third baby. so how can we stop that process? i see these individuals in my office as well, usually the mothers bring the families in,
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and the mother may be less than 20 and have one, two, or three children. i describe it as this kind of vicious cycle of poverty. as a physician i have watched that during my 25 years of practice, and then that carries over into policymaking. now, when we talk about ways that we can help these families, and i have been to home visits, and by the way i probably won't talk about that a lot, but if you want to help these mothers and their children, we have found at least in virginia, and i think in other places, that if we can get into the home and help them get back on track, that this is one of our best investments. we're actually looking at that concept in the commonwealth of virginia. so how do we take this data, and move it into the policy area? that's my other life, and that is making laws in the
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commonwealth of virginia. there's a diversity, or two different concepts, if you will, that makes it somewhat challenging policy-wise. personally i feel that if we want to bend that curve of poverty, if we want to decrease the rate of unplanned pregnancies, if we want to decrease the number of abortions, the best way to do that is through education and through access to health care. this is why we're here this morning to talk about larcs. i just wanted to talk a little bit about the reality of policymaking in virginia. we're not here to throw stones this morning, but i did want to talk about what the philosophy is, or the approach of some other individuals, who are policymakers. if you've been keeping up with
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the news in virginia over the last couple of years, in 2012 we had the infamous vaginal ultrasound bill. that was to deter or to make it more difficult for women who had chosen that avenue to have abortions. the way that ralph got in the middle of that discussion is that i'm the only practicing physician, only physician period in the senate. when it came time for someone to get up and debate the issue, what better person than a pediatric neurologist to talk about vaginal ultrasound. we actually were able to educate
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folks and say that the purpose and the response from having a vaginal ultrasound really didn't add a whole lot. it was very costly. so we had that bill, and we took care of that. we have a bill that was proposed too, that women that had miscarriages should report that miscarriage to the police. it was like, really? how about reporting it to your provider, or your physician? we've also had the infamous personhood bill, which is not only a state bill, but it's also been a national piece of legislation. the personhood bill says that life starts with conception. so the concern over the personhood bill, and i don't know if we'll get into how contraceptives work, but it possibly could make most forms of contraception unlawful in the commonwealth of virginia. it also would make in vitro fertilization unlawful. then we had the t.r.a.p. laws that were intended to shut down some of the women's reproductive health clinics in virginia.
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so it's one approach, education and access to healthcare versus the other pieces of legislation. the trick is how to bring these folks together, sit down at the table and come up with a consensus. so what happened in colorado and st. louis is very powerful data. over a five-year period, at least in colorado, and i will quote that study, the number of unplanned pregnancies went down 40% in the 15 to 19 year age group. the number or abortions when -- went down 42%. the message that i try to give my colleagues in richmond is that let's at least agree that the less abortions the better. if we can agree on that, then we can move forward. then i will start talking about some of the data from colorado
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to make the case this is actually a good direction to go in. so that's what we're involved in. two last points i'd like to make, and i certainly don't want to go over the time limit. i see these cards over here. one minute, three minute. i feel like i'm in a debate. i start having flashbacks. [laughter] i promise you, i don't want to do that. there's two more issues i just want to talk briefly. the first is the affordable care act, which as you know, covers all forms of contraception. and as part of the affordable care act, we have medicaid expansion, which is an option for states. unfortunately, in my opinion, virginia has chosen not to expand medicaid. what that does, we have all paid
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in through our taxes to the federal system to support the affordable care act, really all we're trying to do is bring that money back to individual states, in this case virginia, to provide coverage for up to 400,000 working virginians. i would underline the word working. these are individuals had maybe one, two, three jobs, but the cost of healthcare have gone up much faster than their salaries, so they don't have coverage. these folks that don't have coverage are women who end up not being able to make choices for larcs, for example. they are our mentally ill, who don't have access to providers. don't have access to their medications. end up in the emergency room or in the jail and penitentiary system. believe it or not our veterans. it's good service nonetheless. these are our veterans coming home from afghanistan and iraq. i tell people the least that we can do is to provide those folks that have risked their lives for our freedoms that access to
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quality healthcare. from a business perspective, about $4.5 million the commonwealth of virginia is contributing to surrounding states who we compete with over politics. since january of 2014, when we had the option to expand medicaid, we have given away more than $2.8 billion with a b, and that's a lot of money that we could use for education and healthcare and transportation. what are we doing in virginia, and then i will come to a close and take questions. we are very committed to the health and well-being of our children and families. for the first time in administrations in virginia the governor formed a children's cabinet. there are several individuals that sit on that. within the children's cabinet we have, and i know this is a mouthful, but the commonwealth
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council for childhood success. and we're looking at several areas, the first of which is pre-k education. we feel very strongly, and that, by the way, is a non-partisan issue. the chambers are very enthusiastic. but we know there's a tremendous learning potential in our children before they ever reach kindergarten, so we applied for a grant. we received a grant of about $70 million over four years. so we're using that to provide access to pre-k across the commonwealth of virginia. we're also looking at childcare. as you all know in our economy, most parents are both working, so it's important to have accessible, and affordable, and quality childcare for our families. we want to make sure that our children are healthy. that their immunizations are up to date. so all of these issues are being looked at. but one of the areas, and i'll close on this, i spoke 20 about it just a minute ago, are home visits. so when one goes into the home and sees a single mother who has perhaps two or three children
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and i have gone into the homes, how can we help that family? we help that family through education and we help them with access to medicare care. contraception, to really try to get them out of that rut, if you will, or that vicious cycle of poverty. and that's where the use of larcs comes in. when you talk about different types of contraception, whether you use oral contraception, the birth control pills, whether you use condoms, whether you use larcs, the data is clear that these are very effective up to 99%. in medicine you don't get to 99% very often. they are becoming more affordable. there's now an iud for $50 that will help with the cost of healthcare. they're reversible. what a great opportunity to help
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single mothers get on a path of taking care of their current children, becoming educated, being able to obtain a job and be productive members of society. so the larc is a great concept. anyway, so that's kind of my background, as a clinician, as a policymaker, and maybe just a few quick comments on what we're trying to do in the commonwealth of virginia to again, and i think ron mentioned this, to decrease the number of unintended, or unplanned pregnancies. to decrease the number of abortions, and to make it healthier for our children and their family. so thank you, ron, for allowing me to say just a few words. i look forward to your comments and your questions. thank you very much. [applause]
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mr. haskins: thank you, lieutenant governor, that was very nicely done. i can tell from talking to you before and knowing about your background and talking to people who know you, and listening to your presentation, that you're a person of substantial reason. you appear to be willing to give some credit to people who don't see things the way you do. in a couple of states, including colorado, and at the federal level, there appears to be politics that are extremely
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difficult. people's minds are made up and they are in cement. in the case of colorado, it resulted in not funding a program that had pretty strong evidence of success. it's my understanding that a private foundation or individual has picked up the slack, but they might not do it permanently. so here's my question to you, you're on the frontline here. you just described your involvement with several issues having to do with birth. have you found it helpful -- how do you approach people on the other side who are against policies that would spread birth control? mr. northam: that's a great question and it's a challenge that we have. in virginia we have 40 senators and a hundred delegates and they come from very diverse parts of
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the commonwealth of virginia. they bring with them different attitudes and different experience. one of the ways that we're going to plan to move forward with this, is to use the data from colorado and st. louis and look at what it has done for the well-being of families and children. and also what it has done financially. sometimes when we talk to our fellow legislators they don't always believe in science, which we talked about that a little bit earlier, but if you put it to them in a manner where you talk about the data and also how it can be cost saving to the commonwealth of virginia. virginia is a very conservative state. we balance our budget each year, which is a good thing.
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i want to give you a quick analogy of how i've done this, or how we have done this before. back in 2008 the governor asked me to patron a bill to eliminate smoking in restaurants. if you can imagine virginia being very conservative, tobacco being a big part of our economy in the past, that was my first year in the senate. it's like, thank you very much, governor. [laughter] i talked about the science, as a pediatrician of what secondhand smoke, the ill effects of that. and also to our healthcare of people that are exposed to secondhand smoke. the first year it passed in the senator. it was defeated in the house. i continued to education folks on both sides of the aisle and we were able to get that passed the second year. one of the things though that helped with that, politicians like to be reelected, as you all may realize. every two years in virginia the
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delegates run for reelection, every four years the senators. we actually did some polling talking to individuals across the commonwealth and in that case 70% of the population said that they would like to be able to go into a restaurant and not be exposed to secondhand smoke. we presented data as well, and so we were able to move forward. i think you use creative thinking perhaps. maybe changing semantics when you have that opportunity. but coming at it from different angles. things happen in policymaking in small steps.
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so you take one small step at a time. this is what i plan to do this year. i don't mean to be so long-winded, but part of our commonwealth council for childhood success, we have offered about recommendations to the governor, that we will be acting on this year in the general assembly. one of those recommendations is to increase funding for access to larcs across the commonwealth of virginia. so i will be taking this message on the road to my fellow legislators. mr. haskins: one of the arguments that when i first stated understanding and read studies, that appeared to show, and let me say many of these studies are not random. we always have to be a little bit cautious about the results. having said that, the big studies, iowa, colorado, st. louis, and how a big study by the bixby center, at the university of california at san francisco, that is random assignment, randomly assigned 40 clinics around the country, 20 experiment, 20 control. unplanned pregnancy in half compared to the centers that didn't. so that's pretty good evidence.
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three of those four studies, i don't know what they found in the bixby study, but they show reduction in abortions. some of them were quite substantial. so do you think that's an effective argument? i have used it often and discussed it with my republican colleagues, and didn't seem to be all that impressed by reductions in abortions, which really surprises me. you'd think that that would be a leading argument. mr. northam: i would hope that it will be. i think that whether you want to talk about gun control, or gun violence or the number of abortions, i think that's your first step, is you have to reach out to your colleague and say, "do you agree with me that we have too many abortions? and the less abortions in the commonwealth of virginia would be better? if we can agree on that, then
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how can we change that curve or that number?" it's almost, in my mind, hypocritical if one says that they want to decrease the number of abortions, but they're opposed to contraception. you can't have it both ways. my first question would be let's decrease the number of abortions. one of the best ways of doing that is to provide women with education, as i said earlier, but access to quality and affordable healthcare. to be able to make the decision whether they want to take a long acting reversible contraceptive. that's the way we'll move forward. ms. sawhill: i just want to follow up on that, because it's on the same wavelength, which is i would think the other argument that you might start with is
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what about the government costs. i'm wondering do you have any data in virginia even rough data on how much you can save in medicaid and other programs, if you can reduce unplanned pregnancies? you mentioned the very high cost of these babies that are born at very low birth weight. i'm wondering about bigger numbers on medicaid generally. mr. northam: no, we do have those numbers. you mentioned i think a great figure that i think people can hang their hat on for every dollar that we invest in access and education, you save five to seven dollars. that's a pretty good investment . that will be a piece of data that we use. i probably didn't articulate it as well as i could have, but to have let's say a 23 or 25 week infant that has been in the hospital five or six months that has cost the taxpayers several million dollars, that's just the
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start. we do have numbers of what it costs to take care of that individual. especially if they have problems like, if they have ventriculoperitoneal shunts. and they have epilepsy and cerebral palsy, all of those things are very costly. the other thing, morally, is it fair to a child? and what does that do to a family? all of these are i think strong facts that we can use to try to make our point. the last point that i would say is that, and we have this discussion often, it is the people that ultimately will make the decisions. just like we did in the smoking ban in restaurants, it's the people that will tell their representatives that this is the direction that we want society to go in. you are either going to be part of the plan or we're going to vote for someone else. that's the good thing about democracy. ms. sawhill: yes. i think that one the things that the national campaign to prevent
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teen and unplanned pregnancy has done, is a very interesting, andrea kane, who is our public policy director, and will be speaking later may say more about this, and i'm glad to see our new ceo here. if you ask republican women how they feel about these issues, especially younger republican women, they're in favor of birth control. the issue there is that they think it's already available. they don't see what the problem is. andrea, you can correct me, but i think that fits in with what you're saying about go to the public and find out what they want and what they think. mr. haskins: so audience, we have time for a couple questions from the audience. would someone like to ask the lieutenant governor a question?
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yes, right there near the back. please tell us your name, stand up tell us your name, and ask a question with a minimum comment. >> i'm wondering, lieutenant governor, you talked about the importance of home visits, as a social worker who's moving into policy, i agree with you they're very important. but what do you think about but what do you think about increasing training and just education for the people that are going into the homes talking about this? it's often a really hard conversation. there a lot of religious and moral objections to birth control for teens, so just wondering what you would do for the people that are actually providing that? mr. northam: it's a wonderful question and i thank you for bringing it up, because when we talk about going into homes, do we have the manpower, if you will, the number of social workers, and nurses, and whoever we choose to take into the homes. the answer to that is no. we're very undeunded for that. just to give you an example in hampton roads, where we have a
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program, a statewide program where we go into homes. for every one home that we visit, there are ten others that need our help. so we're chipping away really by what we're doing right now. but you're exactly right. and not just in that area, but mental health issues that we're working on in virginia. we're very much underfunded and understaffed with psychologists, social workers. so it's all about priorities and all about where we want to make our investments. but your point is well taken and we do need to make sure that we have more individuals that are trained to do that, and able to get into these homes and help. try to bend that curve of poverty, that's what our intentions are.
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mr. haskins: right here on the aisle. wait until you get the mic. >> thank you, i am a virginia voter, so thank you for being here and your service. mr. haskins: that sounds like a warning to me. >> i would suggest that the smoking analogy is slightly off, since most religions didn't think that smoking was a sin. and there are still a number or religions who think sex outside of marriage is wrong. so there's that difference there. but the political, the question i would actually like to pose to you is that you say the people will ultimately choose. but the people that are actually the people who vote who choose to come to local elections and state elections, and not just national elections. in the state of virginia women between the ages i would say of 21 and 35, do not necessarily come out to vote. i'm not a politician, or a pollster, but it's pretty obvious. mr. northam: you're on the right track, you're doing very well.
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>> i would ask you to comment on the need or the role for outreach to the voters who don't vote in local and state elections in states like virginia regarding issues like this. mr. northam: your point is so well taken. and i think a lot of us if we remember back to when we were 25 years old, politics and policymaking was not real high on our radar screen. one of the things that we're doing and we're very active, at least in virginia, i can't speak for other areas, but is going to our colleges and universities, community college systems and talking to those individuals and talking about these very issues just like with larcs. and whether legislators, most of whom are men by the way, should be telling women what they should and shouldn't be doing with their bodies, whether
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legislators should be telling people who they should love, who they should live with. that is all part of the process as we move forward to make our young folks -- and the reason i'm so interested in this is i have a 27 and a 24-year-old. i see their friends. i see what's important to them. i am working as hard as i can and a lot of other folks are, as well, to make sure that we do reach out to that population. just as a follow up and a conclusion of that, when we do do polling, when i ran in 2013 for lieutenant governor we knew that the people that would be voting were elderly and women. those were the two big areas. that's who the folks that were
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heavily targeted. does that mean that we should ignore the rest of the folks? no. that's our job now is to get out and make sure that in the next election, that it's not just the elderly and the women, but it is young folks who are educated and in colleges and universities, so that's all part of the overall plan. but you make a great point. i don't know what your career's in, but politics and polling may be good for you. mr. haskins: another question. over here in the middle up here. and then the next, and last one, will be on the back aisle there. >> lieutenant governor, i'm also a virginia resident and voter, and i want to congratulate you on whatever role you had in turning around the bogus regulations of clinics. there have to be some challenges for the next several steps to make sure that it sticks. so what do you see as the challenges? where are they coming from? what is your approach going to be? mr. northam: that's a great question. those changed the structural regulations for women's reproductive clinics. i certainly don't want to get off on a tangent, but that was
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done in the guise of making it safer for women. and the data is not there to support that. my concern, as a pediatric neurologist, and as physician, i have people like me that are doing procedures. in our office, for example, i do lumbar punctures. you have gastroenterologists, plastic surgeons, dermatologists, that are doing procedures that are much more dangerous than an abortion, if you look at the data. my question to them when they introduced and then unfortunately passed this legislation, am i next? if you're worried about the safety of our patients, what's going to happen if you think this out?
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so right now we have been able to kind of stop the progress of closing down our women's clinics. that's all through what we call an executive order. that's done through the governor and the board of health. what needs to happen, if we're going to make those changes permanent, is we need to change some of the seats in the legislature. right now the republicans have the majority in both the house and the senate. so it's difficult to go back on laws that have been passed. but that's down the road, what we would need to do and what we would hope to do, to i think to keep virginia moving in a positive direction. i would just tell you that a big part of my job, as lieutenant governor, is in economic development. we want to bring businesses, manufacturers, jobs to virginia, because that's what pays for all of the things that we like to talk about.
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if we're going to do that, we need to have the lights on, as they say. we need to welcome people. we don't want to deter women from coming to the commonwealth and folks like lgbt community, we want to accept anybody that would like to come and live in virginia. so that's the direction we need to go in, i believe, to move virginia forward. mr. haskins: so governor, before we end this panel, i have a suggestion for you about how you you can, this is a suggestion
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about how to advance the debate on larcs. and that is that we mentioned the colorado situation where they had a big fight and republicans were opposed to paying for larcs, or extended birth control. and they won. despite the fact that one of their most conservative members, led the fight against his own party. so i suggest you invite him to virginia to come down to talk to republicans in your legislature. mr. northam: i think that's a great suggestion and we'll take you up on that. mr. haskins: good. invite me to come, because i want to hear what happens when you do that. join me in thanking the lieutenant governor. [applause] bear with us for a minute, we're going to bring up more opinions. thank you very much.
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now we have a disguised panel of people with lots of views on these issues. i hope, you probably all memorized my last slide about all the advantages we could get if we were more successful in ending or at least reducing the number of unplanned pregnancies, and for almost every issue on there, someone on this panel has studied it, written about it, thought about it, so i'm hoping that we'll really dig into some of these issues. so let me just introduce the whole panel and then we'll proceed. so this is andrea kane. she's the head of policy at the national campaign to prevent teen and unplanned pregnancy. i worked with andrea for many, many years, and my typical response to her is, yes, ma'am. that's what i'm going to do. it's amazing how much she knows about what's going on in the hill.
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i really like people like that that keep up on the hill. i've been able to have contacts through lots of staffers on issues. i call andrea and she tells me who to call, so that's very good. to the extent possible it would be great if you could reflect things that you have heard about on the hill in your remarks. then rachel gold is from guttmacher institute. she just wrote a wonderful paper. on coercion, and that's an issue that we're very concerned about that some women may feel -- the lieutenant governor brought up the issue of males telling women what they should do, and they we throw racial issues and ethnic issues into the match. this is an area that we ought to anticipate and be sophisticated about or we could really cause some problems or even worse we could do things that are wrong.
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then mark edwards. mark is a wonderful story. mark was on the board of directors at the national campaign to prevent teen and unplanned pregnancy, and talk about turning someone into a true believer. he quit his job and moved to another city so he could start an organization called upstream, and he now flies all over the country and he tells people how they can bill the federal government to pay for birth control measures. is that right? rachel's reaction was, oh god. anyway, mark really knows a lot about this because he teaches states how to set up these clinics and train their personnel and all the issues having to do with what it takes to do a good job, especially with regard to having a good program that makes larcs available. they each have a chance for an opening statement, and then i'm going to try to stump them, and
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then you get a chance to try to stump them. so we're going to begin with mark. mr. edwards: i've been introduce lots of ways. never that way. i want to thank you for today and for your incredible work. part of that story's actually true which is that the two of you really have inspired me to change what i'm doing to work on this important issue. i remember when i read the creating opportunities society, which was an extraordinarily powerful book. i think this volume here is fabulous. i will admit my bias. i think that helping women achieve their own goals and become pregnant when they want to is one of the most powerful things we can do increase opportunity and economic
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mobility. upstream usa delivers training and technical assistance to health centers so they can offer their patients the full range of contraceptive methods, particularly the most effective ones. we've done work in about half a dozen states around the country. one thing we didn't talk about as much in the beginning here is that the government, all the governing bodies in the medical field now are really behind these methods, so the cdc sort of talks about how important it is to have access to these
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methods. the american college of ob-gyns, and most recently the american academy of pediatrics has come out with a definitive committee opinion saying that iuds and implants should be the methods of choice for all women, including all adolescents. so this is really sort of middle of the road sort of modern contraceptive methods. part of what we do is acknowledge that there's a big gap between what the policy may
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say and then what actually happens in health centers. what happens more often than not is that women are given a false choice when they go to a health center. they're told you can get the pill today or it'll take you two or three visits to get one of these other methods of contraception. as an aside, only in women's health would this kind of a false choice be available. if there was a really good stent that was 20 times more effective than a regular one there would be law suits if you couldn't get those methods the same day, but we can't. and so when women are faced with that choice they will either use the pill, and we know that the failure rate in the pill is really quite high, or they'll say they'll come back for one of these other methods. they don't come back and they often will come back pregnant. so we've had a couple examples that illustrate, i think, what can happen. the very first health center we did some work in was in amarillo, texas. a place that has incredibly high rates of unplanned pregnant, teen pregnancy, premature birth, and this is a health center that just wanted to do best in class medicine for their patients. they are now, after the training, making sure that the entire health center is aligned to make these methods available same day. that means not only training clinicians and providers on how to place iuds and implants, but also ensuring that they can bill for them, code for them. they can schedule properly and they can be counseled properly. too often patients aren't counseled. they don't know the difference in the efficacy rates between these various methods. what the data shows that when you tell patients about this, and you make them aware of the various efficacy rates they will often, on their own, chose iuds and implants for themselves. my colleague rachel's going to talk about coercion, which is a
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really important piece of this here. we should not be forcing women to do anything. they should be given a true choice, and unfortunately, the choice they have right now is not a true choice. but at this health center now they're doing six times as many iuds and implants as they were before the training. what's most interesting though is that also their revenue is up about 400%, and it's largely because of word of mouth. when women know that they can get these methods they are then tell their friends. patient volume is way up. satisfaction is way higher. we asked patients who chose the method? did you choose it? did you choose it with your provider or did your provider choose it for you? i think it's a really important question because we want to make sure women are not being forced into this. what we're finding is that upwards of 95% of the women are saying they chose the method. when you give women full information they make great choices. another area where we're seeing a real issue, most of this unplanned pregnancy, of course, occurs to women who are using a contraceptive method, but it's using a method that's not working well for them. these really are accidental pregnancies. these are pregnancies that are often occurring to women who know this is not a good time to get pregnant. they know this is not when they want to get pregnant, but the pill, as a method, is simply not that effective unless you're really good about taking it. so this is really an opportunity to help women achieve their own goals. what we're also seeing is that in many health centers women are not even being screened for pregnancy intention as a regular part of their well care. women are actually in these health centers for a whole range of other health issues, but no one is asking them about pregnancy intention. and so one of the things that we do with our training is to ensure that that becomes a standard part of their intake, and so women are asked the question, do you want to become pregnant in the next year? it's sort of a standard part of their intake. we should have a conversation about contraceptive counseling. if the answer is yes, then let's get you into preconception care right away. unfortunately, that is a
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question which is not a standard part of care. we're doing a project at a large health center in massachusetts. only 18% of the women of reproductive age are considered contraceptive clients. the other 82% are there in the health center for a whole variety of other reasons, but no one is asking about pregnancy intention, and as a result some of the same women are coming back just a few months later accidentally pregnant with this whole set of negative outcomes that the lieutenant governor was just speaking about because no one thought about this. this is not a central piece of women's care, as i really believe it should be. finally, just speaking to the notion of costs. we're doing a state-wide project in delaware. delaware's really interested. it actually has one of the highest rates of unintended pregnancy in the country. we crossed medicaid data with
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prams data, the pregnancy risk assessment monitoring system data, and discovered that 74.6% of the medicaid births were unplanned, three out of four medicaid births were unplanned. this isn't what women want themselves. it is extraordinarily expensive for the state, just in health outcomes alone. so it really is, i think, unusual opportunity to both help women achieve their own goals, and also to save money at the same time. i just want to close with three quick points. one is that this really has to be all about patient choice. i know rachel's going to be talking about this, but that is such a central part of this. we cannot force women to use any methods at all, but true choice means that they really ought to
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be offered the full range of methods same day. that's what the data shows, how critical that is. not that they can get some methods some days and takes you two or three visits for another, but rather all methods same day. that's really important. second, is that iuds and implants, they're not a panacea. we know that that's not the solution to the cycle of poverty, as the lieutenant governor spoke about. but we also know that last year there were 1.4 million unplanned births in this country. my own view is that if we want to increase opportunity, if we want to make sure that children can achieve their full potential we really need to include this as part of what we think about as an opportunity continuum. we can't just simply start the conversation once children are born. we have to ensure that the children are born to parents that want them, who plan for them, and who think this is a good time to have them. finally, i just want to say that this basic idea that women should be able to plan their pregnancies and have children
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when they want them -- in my view, this is not about those women. this is what i would want for my own children. i have three college-aged girls, myself. my new occupation has certainly changed the conversation around the dining room table in my household, as you can imagine. but i want them to become pregnant only when they want to, and not a minute before. so this is really why wouldn't i want them to have access to the most effective methods of contraception? if those methods don't work then we can move on to something else, but my oldest is now 23 was never offered these methods. she just didn't even know about them, and yet we know the failure rates are so different. i think it's important as we have this conversation to recognize that this is not -- we focus a lot on poor women and low income women where the rates of unplanned pregnancy are actually going up. this is important and best class medicine for all women. [applause] mr. haskins: thank you, mark. ms. gold: i could not agree with mark more about the importance of enabling women to make free judgments and free decisions about their child bearing. i think that is an absolutely critical goal. i could not agree with mark more about the potential of larc methods.
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they have amazing potential. i think that means several things. i think that means that we have an obligation to remove any and all barriers to use of these methods. we have to make sure that women can afford them. we have to make sure that they are available and accessible in the places that women go for care. i think we need to make sure that women who have just had a baby, who have just delivered have access to larc methods that day. i think we need to pay a whole heck of a lot more attention to the availability of larc methods for women who have just had an abortion. i think that's something we don't talk about a whole lot. we don't think about a whole lot. i think that's a really important missing piece of this whole debate. having said all of that, i think we have to, as we go down this road, be mindful every single minute of going too far. in the guise of making sure that
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we are removing barriers and leveling the playing field we absolutely cannot go too far and end up titling that playing field in the other direction, and end up being directive. i think that is something we have to constantlyeep in our minds as we go forward. in that regard, i think it's important to look at history and learn the lessons of history. i guess one lesson for me is once a history major, always a history major, so let's think about the history and some of the history having to do with contraception in this country unfortunately is not great. some of the history specifically having to do with larc methods in this country is not great. i think that means we have an obligation to learn those lessons. within days of when the initial larc method, or one of the initial larc methods, the contraceptive implant was approved by the fda in 1990, within days there started to be proposals to offer financial incentives to women if they agree to get a contraceptive implant. that instantly embroiled this
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method in an incredible controversy. a controversy from which i don't think it ever recovered. just within a couple of years, in 13 states legislators had introduced provisions that were not adopted. they were not enacted, but they were introduced, offering women financial incentives if they agree to get a contraceptive implant. in seven states legislators introduced measures mandating use of contraceptive implants for women on welfare, women who had recently given birth to a drug exposed infant, and at least in one case mandating use of contraceptive implants to women who had had a publicly funded abortion. again, none of these were passed, none of these were adopted, but they were proposed. we also in five states had judges handing down decisions or offering deals to people who had been convicted of child abuse, offering reduced sentences if they agreed to get a
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contraceptive implant. what this did was it took this method, that had such potential, and completely engulfed it in controversy, and especially engulfed it in controversy in those very communities that we, as family planning programs, were seeking to serve, and moved this method from having enormous potential to being a source of controversy. it was an incredibly unfortunate event. even more unfortunate is that we're starting to see some ripples of this come back. just this year there was a bill proposed in the legislature in arkansas, again proposed, not adopted but proposed, that would have offered women $2,500 to a woman on medicaid who already had a child, a $2,500 payment if she agreed to a larc method. again, didn't go anywhere, but it was considered by a committee. the district attorney in nashville, tennessee, you know, which is like not a foreign place. that's where my son lives, nashville, tennessee. the district attorney went so far as to formally ban the prosecutors that worked for him from offering reduced sentences to people who had been convicted of child abuse if they agreed to sterilization.
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apparently, according to media reports, the da took this action after four reports in the last five years of these deals being offered to people. not widespread, but i think something we just have to keep in our minds constantly. so i think while these methods have enormous, enormous potential while we have an obligation to remove any and all barriers that could possibly stand in the way of women getting access to these methods. i think these are some minefields we have to be mindful of. that was not a great sentence. we need to be careful to remember these minefields. we need to remember that the principle of giving women the voluntary and informed choice of the full range of contraceptive methods has been at the heart of family planning programs in this country for decades. that principle has served us incredibly well and we need to remember that principle. we need to remember that for some women the choice of a contraceptive method is not solely about efficacy. it's about what choice this woman wants to make and what she feels is going to be best for her life. because at the end of the day the method that the woman chooses voluntarily, the one that she thinks is going to best fit into her life is going to be the method that she can use most effectively to avoid a pregnancy that she doesn't want to have. thank you. [applause] we need to remember that for
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some women the choice of a contraceptive method is not solely about efficacy. it's about what choice this woman wants to make and what she feels is going to be best for her life. because at the end of the day the method that the woman chooses voluntarily, the one that she thinks is going to best fit into her life is going to be the method that she can use most effectively to avoid a pregnancy that she doesn't want to have. thank you. [applause] ms. kane: i feel like when we talk about this issue we're sort of talking almost on two levels. there's so much progress. there's so much momentum. the conversations that we're having around the country.
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the research that's coming out of places like colorado and iowa and st. louis are so exciting. then there's also a lot of landmines, as rachel said. what i want to do is just try to put some of this in policy and political context based on the experience that national campaign has had in talking to a lot of people from diverse viewpoints around the country, on the hill, and state governments, local communities. i think one of the most encouraging things is there is potential for broad bipartisan support on this. i think as the lieutenant governor said, if you look at the list of arguments that ron put up or the list of potential outcomes that ron put up if we reduce unintended pregnancy. there's something there for everyone, and it happens to be true which helps too. reducing unintended pregnancy,
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in particular, through the use of effective contraception does reduce abortion. it does save money. it improves child outcomes. it empowers women to achieve their goals, and there's something there really for everybody. what we can learn from are some of the places where people have come together to find ways to talk about this. it doesn't mean that it's all perfect. colorado's worth just spending a little bit of time on because it is an exciting, but also cautionary tale. the legislature there who ron mentioned is a very conservative, pro-life, self-proclaimed redneck republican who saw the value of making iuds and implants available to women in the state. they weren't the only methods available, as rachel said, but
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it reduced the barriers to those methods being available by extra education and counseling so that women could choose those as well as other things. when good counseling was available, when the barriers were removed lots of young women did choose those methods. that initiative was privately that initiative was privately funded, as ron said, and when it came time for the state of colorado to step up and continued the initiative and a very modest sum of $5 million, this republican was one of the champions. you should look him up, you should google him, because his quotes are really priceless, but i want to mention a couple of them because for a state like virginia they could be very helpful. he said, "if you are like i am and you do not support abortion and you wanted to break the
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cycle of poverty and save taxpayers dollars, why would you not support this legislation?" he thought cost savings to medicaid would be a way to get his colleagues along. i think the fact that he was only able to get three republicans to join him is extremely telling and cautionary. the reason he gave for that is extremely important. he said it was fear. behind the scenes, and this is similar to what we here on the hill -- ron asked me to talk about that -- behind the scenes his colleagues said, "i get it, i would love to support this bill. the research is there, it is fantastic policy.
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but there is a political liability for doing that." there is every expectation that other people in colorado will come back at this next year. maybe they will have more success. they have learned some things about how to tweak the approach from how to talk about it, that could be instructive. one of the other landmines is when we talk about iud's and implants in teens. i find it a little bit unfortunate that so many of the headlines coming out of colorado or colorado is giving iud's to
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teenagers. no, it was making it available to women, including teenagers, the headline -- but the headline "iud's for teenagers" grabs attention and i don't think it has been helpful. we definitely find that on the hill when we talk to republicans that when we talk about making contraception available to women of all ages, you get a very different response than when you focus on teenagers. that doesn't mean teenagers have
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to be excluded. i just think it is really important. i think the cost argument is very, very powerful. but it also can be -- there are some landmines there. i think the arkansas example is a good one. that legislator was very motivated by the idea of saving government money, and we can give people incentives to save money, but perhaps that had unintended consequences that we have to be really, really careful about. we definitely have to get the policies aligned. the affordable care act, the contraceptive coverage requirement, making all methods of contraception available with no cost sharing to women who have private plans is a huge step. but we can't forget that there are still a number of states where people don't have access to medicaid. the medicaid expansion. including virginia. there are still a lot of low-income women who don't have that choice, as rachel said.
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that is a big policy barrier. we can't just look at the national picture on this. we have to look at the specific states and the work that mark is doing to help improve access is really important. even if we can get the financing in the policies all aligned and the supply side is all perfect, i think we have a lot of work to do politically and on the ground in terms of the demand side and patient education. if we want voters to be the ones that help make the decision, we have a lot of work to do to educate voters about this. and to educate consumers, the patients we are talking about. the national campaign recently finished qualitative research with the target audience, young women 18 to 30 who would benefit from iud's and implants, and we learned a lot about how to talk about it and how not to talk about it. the first insight is don't use the word larkin that is something we have to learn from.
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we have to listen to the patients, also has voters, and look at what they want. a couple of important research findings from public opinion data -- knowledge about the iud and implant is very limited. what people do know is often incorrect, inaccurate, out of date, confused. for example, we found 77% of adults say they know little or nothing about the implant. 68% say they know little or nothing about iud's. how can they communicate their desires to elected officials if they don't have good knowledge themselves about the issues? we have work to do there. we often talk about sex education for teenagers. that is often where the debate goes and it often becomes a debate.
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but we can't stop at teenagers. it was a fantastic policy initiative announced in new york mr. haskins: [indiscernible] give us an idea of the overall state of the financing for birth control in general in the states where you have been. is financing a big problem, or can they figure it out and mostly get the federal government to pay their share? mr. edwards: i would toss this also to andrea, who has a better sense of the national sense. many health centers think they are losing money when they offer these methods, what when they actually do the data and look at it, they actually are not.
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they are actually making money, in part that this is part of the procedure to make money there. cost is less of a barrier -- mr. haskins: you are not talking about benefit costs. you're talking about it brings in more money to operate their center. mr. edwards: the notion that somehow these methods are so expensive -- mr. haskins: do you tell that to the next clinic you work with? do they believe it? mr. edwards: again, we have not been in every clinic in the country and there are many where that is not the case, but in many cases, cost has not been -- just some important areas we need to do work on. for example, postpartum access to iud's, post-abortion. in the middle of that bell curve, cost is actually not the barrier here. mr. haskins: add to this, and jump in anytime. ms. gold: one thing we hear from family planning centers anytime is that it is having the upfront money, so that you have it in
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the closet that waiting for the woman to come in and want it. it is available on the same day. it is being able to have that upfront money and make that investment. i think, as andrea said, we made a lot of progress on the insurance side. medicaid, expanding medicaid in many states -- unfortunately, not virginia. although virginia is one of the several states that has medicaid expansion specifically for family planning. and then we have made a lot of progress, again, as andrea said, on the affordable care act, making sure that women have a
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choice of contraceptive methods in their private coverage. what we still have is the gap between medicaid and private coverage. we have low income women who don't qualify for medicaid. we have low income women -- we have immigrants, recent immigrants who don't qualify for medicaid. we have people going on and off coverage. we can't just look at the insurance side. we have to make sure that there is a pot of funding available to provide coverage for people who are between or without insurance coverage. that is what federal programs
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like the federal title x and national family planning program can do and to provide a flexible funding to meet the needs of women who don't have insurance coverage on the day they come in. ms. kane: just to jump in on that, i think that is where we have a perfect storm between the politics and the policy, because the title 10 program is often what provides a flexible funding, and there is good research that shows that when a clinic gets the title 10 funding, it provides better quality care and access to a range of methods. that is proposed for elimination by the house appropriations bill, cut by 10% in the senate, really for political reasons, which just makes no sense when it is very clear it helps reduce abortion and save money. again, that is the political reality that we face. mr. edwards: rachel talked about an important issue, the question of if health centers can't offer them the same day, any health centers don't realize you can get 90-120-day terms with these methods. one of the improvements we do is to renegotiate those contracts so they can get 120-day terms and they can get the cash flow to have the methods.
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there are ways we can work within the system to make sure the cost is not the barrier. mr. haskins: ok, bringing up politics, always fascinating and fun to talk about politics at brookings and the politics of this issue especially. but they are kind of serious. you use the word "fear," that republicans say in interviews that they would ordinarily support this, i think you said, fantastic policy, yada yada, but they are fearful. what are they fearful of? >> losing. [laughter] becoming unemployed. ms. kane: i think they are fearful of challenges, primary challenges, from the far right, and i think that was in the "national journal" article. i've heard that from republicans on the hill i have talked to. i don't know if that is true. i wish one of them would stand
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up for what is right and test proposition and we would find out. those are extreme views that are not where most voters are. but obviously, we have a very gerrymandered districts. it depends on where you are from. we often call this the whack-a-mole problem. on different days they are afraid of different things. if you're talking about teenagers, it is about encouraging every 14-year-old, making an iud available for them, although there was absolutely no evidence that is true, or they are afraid we are condoning sex outside of marriage, or afraid that we are doing something that is inconsistent with people's religious values, or afraid of certain methods of contraception may act as abortifacients, or or or. the argument just changes on different days, but there was a lot of fear. ms. sawhill: i think the fact that mark udall lost his bid for the senate in colorado after talking about family planning and being attacked by "the denver post," a liberal newspaper, for being a one-issue candidate, was probably a big element in colorado. don't you think, andrea? ms. kane: i do, and i also think it is fascinating he was beat by a republican who went out of his way to show that he supported
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contraception, said it was a very valuable thing for women. his particular policy solution was different. it was to propose over-the-counter contraception, which, by the way, doesn't help at all with iud's and implants, but he went out of his way to say no, no, i am for contraception, too. that was a very interesting election and one that has gotten more republicans to think about ways to be for something when it comes to contraception. i don't think we have seen that yet in terms of iud's and implants of the federal level, but certainly a number of republicans have supported over-the-counter access.
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ms. sawhill: the other issue that comes in year and is related to what you said about the number of adults who have very limited knowledge of this information, the forms of contraception, is that there has been very little use up until now. when i first started working on my book, they were saying only 2% of women using contraception were using a long-acting form. you probably know the data better than i do now, up to something like 12% now. it is higher than that if you look at young women. the word is spreading very rapidly. i think that will play into the politics because once more, and it goes back to your very good question about young women maybe
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not voting as much, but as this becomes better known and more women are using it, and they support it by the medical community, that will make a difference politically. but we have to be patient about that. mr. haskins: andrea, we have not talked enough about teen pregnancy, which is a great story. the teen pregnancy rate has declined every year since 1991 except for two years, down 60%. and yet we have 10 times the teen pregnancy rate of japan, greater than most european countries. so there is room for a lot of progress here. this in administration at the beginning started a program called teen pregnancy prevention, giving the most thorough evaluation that i know of, in 102 places around the country. we have already talked about all the potential advantages of more effective forms of birth control, especially with young, with teenagers. and yet the house killed it and
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they senate cut it by 80%. were they fearful? i don't understand why this is happening. ms. kane: first, i want to mention that the program is not a program that provides contraception. it is an educational program. it is helpful to educate people on why to wait to have children and how to do that from the actual delivery from contraceptive services. that said, it is an evidence-based program, one of the gold standard evidence-based programs, and it is mind-boggling that it would have been proposed for elimination. i think of everything we have heard, it has gotten caught up in politics. shocking. i think the larger politics around planned parenthood has sort of shifted into putting that tpp program at risk. we are hopeful it can get restored, and that science and evidence will prevail.
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mr. haskins: science and evidence prevail. that has a ring to it, right? it is one time that i have been very pleased that the bill is not going to pass. the continuing resolution and maybe we will get the money for another year, because this is a brilliant program. here is the last question and i want to open it up to the audience. briefly, what is the number one thing we could do to make these long-acting reversible forms of contraception more available especially to low income women? what is the single most important thing we should do? go ahead, rachel. ms. gold: i think it is working at the service delivery level, and i think it is a lot of training. i think it is a lot of the staff are older and are schlepping around baggage from 20 years ago, and the transition to get into the place we are thinking these methods are appropriate and find for teenagers and young adults is a long transition. i think it is the hands-on training of how to do it. i think it is also talking to
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people and helping people understand that this needs to be part and parcel of the service delivery package at every one of these sites. mr. haskins: rachel just said, mark, you are doing the most important thing that needs to be done. one is the next thing we should do? mr. edwards: i will take that and raise it one step forward. if we could establish quality family planning guidelines for the kind of work that should be going in health centers, and
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time medicaid payments to meeting this guidelines, that would be a great thing. mr. haskins: this is a version of training because he would have good guidelines and then -- mr. edwards: tie the payments? mr. haskins: here, let me ask the question. mr. edwards: sorry. mr. haskins: this is really a version of training that has the guidelines, but then there would be some way to train clinics on how to follow -- mr. edwards: create some incentives. mr. haskins: what do you think? ms. sawhill: i very much agree with this. this is the supply-side. dince it has only been covered, we have to work on the demand side. educating the public more broadly and getting young women knowledgeable about the fact
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that it is safe and effective and so forth is really, really important. ms. gold: i am all for the quality family planning guidelines. i get very uncomfortable with performance standards. what the level is of uptake of these methods, and then they tie that to payment, which then can have the impact of giving providers a financial stake in the methods that women choose. that makes me really uncomfortable. in one performance standards where we spot low numbers and use performance standards to spot low uptake as may be sign of a barrier to access. i get nervous when we have a performance that could end up in this world of pay-for-performance that is the rage in health care at the moment. i get nervous when we end up in a system where providers have a financial stake in what methods women shoes.
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ms. sawhill: let me ask a follow-up on that that might be slightly push back, which is mark talked about having a screening question that is on every health care form. when you go to your doctor for just an annual checkup, and you are a woman of reproductive age, there should be a screening questionnaire on do you intend to get pregnant, want to get pregnant in the next year. i think that that could be a game changer. but to get doctors and other providers to do that, you might have to regulate or provide a financial incentive. would that be going too far, in your view? ms. gold: no, where i get uncomfortable is when it affects the choices -- ms. sawhill: just wanted to clarify. ms. gold: absolutely foundational to me that women should have the unfettered ability to choose the method that is best for them. mr. haskins: audience, let's
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start off here. nick, you can't tell us about your magnificent adoption study, ok? >> apart from your mention of the shield, you had no discussion of medical complications of these methods. also, the media coverage of those medical complications. it seems to me that the stories i've seen tend to be very one-sided. they talk about the risks and do not -- at the end of the article say that these are the most effective contraceptive methods. maybe part of what we need to do is balance what journalists do about the complications and the benefits. mr. haskins: that is an excellent point.
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ms. kane: that's a really good point, and you are right, the intensity a lot of attention to the side effects and the problems. you have to remember, the doctor/lieutenant governor would remind us of this, that any medical device has risks. but the key point in counseling with women is to talk about that, to talk very honestly about the benefits and the downsides of these methods so they can make an informed choice, and in our public messaging to put those risks in context. from the qualitative research we have done with young women, also from the national survey work we have done, those negative stories, even the fine print that you hear in ads on tv about all the side effects, those loom very large in women's minds, and that is often all they know about the method. mr. haskins: that makes the
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point even more important. mr. edwards: and there are a lot of risks associated with pregnancy. [laughter] mr. haskins: all the way in the back. >> my name is lauren haggler. on risks and the coercion that is to become what about when they came out and, for instance, my personal experience, my mom was like, why would you want to do that, it is really unsafe? based on bad experiences she had. what you guys think about that? ms. sawhill: i think we should just reiterate something that mark already said, that if the american college of ob/gyn and the american academy of pediatricians has said that this is not only safe, but should be the first line of defense for any woman who wants to avoid a pregnancy, what more medical certitude can you get about safety? now, it is true, and mark, i'm sure you know more about this than i do, that a lot of providers out there, including existing gynecologists who are in practice and are well respected, will tell of women -- will tell a woman when she comes in, i don't do that, it is not safe. i have friends, younger friends,
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obviously, who spoke to their gynecologist after they read my book and asked for an iud and were told by their doctor, oh, no, we don't do that, it is not safe. there is an education job to be done here. mr. edwards: it is so important that these are called the same thing but i think the evidence is really clear. what the research shows, particularly out of stimulus, is when women choose these methods, they tend to like them much more than the pill, they tend to stay with them longer, which is one of the reasons it lowers the rates of unintended urgency, and they also returned to their original fertility faster than they do with other methods of contraception. there are lots of things about these methods that women like better. mr. haskins: next question. up here in the front. >> hello, thank you. i was wondering why is it there seems to be hesitation about focusing on teenagers, with education, the method, the lack, and all that.
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one of you said you want to just call it women, not teens. i have experience in the minority communities. i am a ghanaian and they call themselves girls more than women. they don't see a path belonging to them. why does there seem to be hesitation to talk about it in terms of teens? mr. haskins: andrea, will you -- repeat the question quickly. ms. kane: i think the question was why the hesitation to talk about teens, and sometimes we talk about women, which includes teens, and teens may not hear themselves in that. they think of themselves as

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