An interview with Rep. KC Becker, D-Boulder

Birth control, in the opinion of state Rep. KC Becker, D-Boulder, is an economic issue that impacts the health and social wellbeing of women, children and families statewide. That’s why she is sponsoring House Bill 1194, which would appropriate $5 million in state general fund dollars to distribute long-acting reversible contraceptives (LARCs) to low-income women across the state. The funds would allow for the continuation of a four-year, grant-funded pilot project, implemented by the Colorado Department of Public Health and Environment in 2009, to family planning clinics in 37 counties throughout the state. In an interview with Catherine Strode, policy outreach specialist with Advocacy Denver, Becker explains that the long-term impact of funding reversible contraception can result in cost savings for the state and better educational and financial futures for Colorado’s young women.

Following this interview is a second one conducted by Strode with state Rep. Lori Saine, R-Dacono, who opposes such a bill.

What is reversible contraception?

“The mechanism for preventing pregnancies can be different, but basically, it’s contraception that is inserted as an implant either vaginally or under the skin. It can go in for three to nine years. When it’s removed, you’re immediately fertile again. It’s been shown to be really effective in reducing birthrates and abortion rates because there’s no human element in terms of remembering to take a pill or doing something on a daily basis. There are hormonal and nonhormonal IUDs. Hormonal IUDs are much like birth control pills in that they can prevent ovulation. The nonhormonal or the copper IUD changes the chemistry in the uterus, which impairs sperm function and doesn’t allow fertilization to occur. They do not interrupt an implanted pregnancy. That’s important because there’s a misconception that they do. Contraceptive implants work much like birth control pills in that they prevent ovulation.

“LARCs are considered very highly effective in preventing unintended births because they require little or no effort after the initial implant or insertion. Fertility returns to normal immediately upon removal.”

What was the purpose of the pilot project?

“There’s a high initial price (for LARCs) and that’s one of the reasons that we typically see lower use, especially among low-income women. That’s why this pilot project was done from 2009 to 2013 to expand distribution of LARCs such as IUDs and hormonal implants. We saw incredible results. Between 2009 and 2011, when the Colorado Family Planning Initiative was successful in making LARCs more widely available, the birth rate among low-income women ages 15 to 19 dropped 40 percent; and for women ages 20 to 24, it dropped 18 percent. Colorado saw a 38-percent reduction in births to unmarried women under age 25 who had not finished high school. Between 2009 and 2013, when LARCs were more readily available to all women, the abortion rate among women ages 15 to 19 fell by 42 percent and dropped 18 percent among women 20 to 24.”

What does the bill do?

“The bill authorizes a general fund appropriation to fund the Colorado Department of Public Health and Environment to continue to provide these services at Title X and other clinics. It is $5 million for fiscal year 2015 to 2016. We do hope in future years there will be an appropriation but that will have to be revisited at that time. We think we can decrease the amount because as more women end up on this, it decreases the number of people who actually need it. This bill will provide training for providers and staff regarding LARC methods and counseling strategies and managing side effects. It will provide funding for technical assistance to the clinics and general support to expand capacity for the family planning clinics to provide LARCs to low-income women.”

Why do you think this bill is important?

“Unintended pregnancies are really associated with many poor health and social outcomes.

“By reducing unintended pregnancies, you’re strengthening and stabilizing women’s health. We know that IUDs and implants are highly effective but they are quite expensive. Once the cost barrier is removed, women have greater access to it. It leads to more opportunity for them to plan their futures, plan their pregnancies, and plan the number and spacing of their children. That means there is less need for Medicaid, WIC (Women, Infant and Children), TANF (Temporary Assistance to Needy Families), and other programs. It means better health and social outcomes for women – more stable families, girls staying in schools longer, people accessing state programs less. It saves money for the state and it leads to better social outcomes for the families who use this.”

An interview with Rep. Lori Saine, R-Dacono

State Rep. Lori Saine, R-Dacono, says birth control is not the state’s business, nor is subsidizing contraceptives, either for women or men. That’s why she is against House Bill 1194. Citing the economic theories of incentives and moral hazards, Saine explains her opposition to appropriating state funds to provide birth control to Coloradans.

In addition to her lack of support for providing funds for LARCs, she questions the accuracy of claims that HB 1194 will save the state money and prevent health risks for women.

Why are you opposing House Bill 1194, which would appropriate state general funds for long-acting reversible contraceptives?

“While the sponsors are well-meaning, I would be against a bill that provided reduced cost or free condoms to men for the same reason: this is not the role of government.”

Proponents of the bill claim that providing contraception to women across the state has substantially reduced the state’s teen pregnancy rate. Would that not be a good result of this bill’s passage?

“Let’s refer to some very old laws in economics regarding incentives and moral hazards. With incentives, we know that if you subsidize something, you get more of it; and moral hazards refers to the propensity of people engaging in riskier behavior when shielded or insured against risk. Blending these two together, when subsidizing a commodity, you also reward the behavior surrounding the commodity. So in this scenario, the government is subsidizing sex… because a woman typically doesn’t get birth control to hold hands and watch re-runs of “Gilligan’s Island.” Also, I have seen no longitudinal-type study with a control group for this program.

“But based on the aforementioned economic tenets, the groups receiving these benefits will probably engage in more risky behaviors. And, I’ve seen no long-term data from experimenters regarding the increased costs to society with the psychological and medical risks and costs that come with more risk-taking behaviors like frequent sexual encounters.

“In addition, devices like IUDs are wedded to well-documented medical risks like uterine perforation, which can lead to pelvic abscesses and increased instances of PID (Pelvic Inflammatory Disease). According to past research, women with IUDs for three or more years have twice the rate of tubal pregnancy even after the IUD is removed – a contributing factor to pregnancy-related deaths which have been rising since 1987. Are any of these long-term costs considered? According to the Center of Disease Control, the rate of teen pregnancies has been declining since 1940 and every year is a new record low nationally. And somehow this happened without the government contraceptive fairy.”

Proponents maintain that funding contraception at these clinics has saved the state money in Medicaid dollars. Does that change your position on the bill?

“Proponents also seem to be saying ‘I’m the government and I am here to help in your bedroom,’ so I’m also skeptical when I see reports that the government is saving money in one area by spending money in another area because bureaucracy solves bureaucracy.”

Supporters of the bill also say it is good legislation because supplying contraceptives reduces abortions. Your thoughts?

“I believe that any society that regards a child as a curse or a burden instead of a blessing will not long endure. It is possible that in the near future, we will look upon abortion clinics with the same horror we regard Auschwitz. Some of the groups behind this bill think it is the role of government to shield men and women from their actions by seeking to separate sexual intercourse from its fruit: children. So I am dubious of the sudden concern for abortions because it seems these are the same groups that won’t recognize a child in the womb at any stage of his or her development anyway. And, the proponents seem to be claiming credit for a national trend: according to the CDC, abortion rates have also been declining to historic lows nationally.”