by Lilian Bui
“We mothers stand still so our daughters can look back to see how far they’ve come.”
That quote from Barbie creator Ruth Handler — or at least the one written for the actress playing her — in the new “Barbie” movie had me reflecting on just how far we’ve come from my grandmothers’ generations. Sadly, when it comes to reproductive freedom, we’re moving in the wrong direction.
One of my grandmothers was pregnant for a quarter of her life. The other, raised as a devout Catholic, knew only not to have sex until after marriage. In total, they had 20 births. My grandmothers lacked comprehensive sex education, effective contraception and access to abortion. Their families could not provide enough food, clothing, space or medical care for their children. They felt like they were subjected to childbearing and rearing with no other options.
Every person has the right to reproductive freedom. Unless you live in Texas. Or Missouri. Or Alabama. Unfortunately, this list continues to grow weekly.
In Texas, where state law encourages vigilantes to spy on and report neighbors seeking an abortion, authoritarian new “trafficking” laws in 51 jurisdictions make it illegal to transport anyone on roads within city or county limits to get an abortion. Meanwhile, a new court filing by Alabama’s attorney general outlines his ability to prosecute anyone making travel arrangements for out-of-state abortions. The intention of these Republican legislators is to make women with unwanted pregnancies live in fear.
How can we reduce unintended pregnancies to avoid repeating my grandmothers’ stories?
I became involved with obstetricians and health services researchers studying pregnancy intention across the United States. The National Survey of Family Growth and Pregnancy Risk Assessment Monitoring System (PRAMS) provide nationally representative surveys that ask women who recently gave birth about whether they had intended to get pregnant. Women categorized their recent pregnancies as: wanted at the time, unwanted at the time or at any time in the future, wanted later or sooner, and unsure. Data from between 2017 and 2019 shows 62% of women had intended pregnancies, 22.4% had mistimed pregnancies they wanted later and 15.7% had unwanted pregnancies.
The rate of unwanted pregnancy differed twofold between red and blue states. States with the highest proportion of respondents with unwanted pregnancies were Arkansas (12%), Florida (11%), Mississippi (11%), Louisiana (10%) and Tennessee (10%). States with the lowest proportions were New Hampshire (4%), New York (4%), Vermont (5%), Oregon (5%), Washington (5%) and Massachusetts (5%).
The U.S. Supreme Court’s Dobbs decision last year that repealed the federal protection of abortion will only amplify state-level differences.
What’s more, it’s the poorest women in Republican-controlled states who will suffer. Unintended births are most common among people who are younger, come from families with a lower income, have deliveries covered by Medicaid and, interestingly, have mothers who did not graduate from high school. The generational effects are evident.
Unintended pregnancies lead to health problems for mothers and infants. A study published in the Journal of the American Medical Association associated unintended pregnancy with preterm birth and low birth weight. People with unintended pregnancies were more than 50% more likely to experience depression during pregnancy or postpartum, increasing the likelihood of development problems for their infants.
Unintended pregnancy is not a happy accident.
Since my grandmothers’ reproductive years, tremendous strides have been made in contraception that could prevent unintended pregnancy and downstream health effects. That is, if young people are made aware. Medically accurate sex education has proven benefits for adolescent health.
A bill that’s already been introduced and could actually help is the Real Education and Access for Healthy Youth Act, which calls for funding comprehensive sex education and repealing ineffective abstinence-until-marriage programs, which have been proved to increase unwanted pregnancy.
Access to contraception is yet another battlefront. By covering the entire cost of prescription contraception, the Affordable Care Act decreased income-related disparities in unintended birthrates across the country. States that expanded Medicaid eligibility also saw fewer unintended pregnancies. There is hope that the Food and Drug Administration’s approval of Opill, an over-the-counter birth control pill, will increase access to hormonal contraception.
This battle for reproductive freedom is personal. Like Ruth in “Barbie,” my grandmothers wanted me to lead my life with agency and not be subjected to motherhood before I was ready. They became mothers at 15 and 17 years old and think my high school graduation was a huge feat, let alone college and my pursuit of medicine.
My grandmothers would want today’s girls to know how to avoid unintended pregnancies. And if a girl is faced with one, they would want her to have the freedom to choose and achieve the future she hoped for.
