When access to free and low-cost birth control goes up, the percentage of young women who leave high school before graduating goes down by double-digits, according to a new CU Boulder-led study published May 5 in the journal Science Advances.
The study, which followed more than 170,000 women for up to seven years, provides some of the strongest evidence yet that access to contraception yields long-term socioeconomic benefits for women. It comes at a time when public funding for birth control is undergoing heated debate, and some states are considering banning certain forms.
"One of the foundational claims among people who support greater access to contraception is that it improves women's ability to complete their education and, in turn, improves their lives," said lead author and Assistant Professor of Sociology Amanda Stevenson, noting that those claims have been based largely on anecdotal evidence. "This study is the first to provide rigorous, quantitative, contemporary evidence that it's true."
The study centers around the Colorado Family Planning Initiative (CFPI), a 2009 program that widely expanded access to more forms of contraception in the state.
Funded by a $27 million grant from a private donor, the program augmented funding for clinics supported by Title X, a federal grant program formed n the 1970s to help provide low-income women with reproductive services.
The grant enabled Title X clinics to provide not only inexpensive forms of birth control, like condoms and oral contraceptives, but also more costly long-acting reversible contraception (LARC), including intrauterine devices (IUDs) and implants.
Over the span of the program from 2009 to 2015, birth and abortion rates in Colorado both declined by half among teens aged 15 to 19 and by 20% among women aged 20 to 24, according to the Colorado Department of Public Health and Environment.
But how else did this greater access to contraception benefit women?
With help from a five-year, $2.5 million grant from the Eunice Kennedy National Institute of Child Health and Human Development, Stevenson and collaborators at CU Denver sought to find out.
"This was the biggest policy experiment ever conducted in contraception in the U.S. and its impacts had not been fully assessed," said Stevenson.
Using anonymized data and detailed surveys from the U.S. Census, the team examined the educational attainment of 5,050 Colorado women and compared those whose high school career occurred before and after the policy change.
To parse out what differences in their lives were due to the family planning initiative vs. other factors, the researchers also looked at the same changes in the outcomes of women of similar age in 17 other states.
They found that overall high school graduation rates in Colorado increased from 88% before CFPI was implemented to 92% after, and about half of that gain was due to the program.
Improvements in graduation rates among Hispanic women, specifically, were even greater, with graduation rates rising from 77% to 87%, about 5% of the increase attributed to CFPI.
In all, the program decreased the percentage of young women in Colorado who left school before graduating by 14%.
Put another way, an additional 3,800 Colorado women born between 1994 and 1996 received a high school diploma by age 20 to 22 as a result of CFPI.
"Supporting access to contraception does not eliminate disparities in high school graduation, but we find that it can contribute significantly to narrowing them," said Stevenson, who believes the Colorado results translate to other states.
Co-author Sara Yeatman, an associate professor of health and behavioral sciences at CU Denver, said that while the program did help some young women avoid unwanted pregnancy and abortion, the data suggest that is not the only mechanism by which increased access to contraception promotes higher graduation rates.
"We think there is also an indirect effect," she said, noting that previous studies dating back to the introduction of the birth control pill in the 1960s suggest contraception access is empowering. "The confidence that you can control your own fertility can contribute to a young woman investing in her education and in her future."
The research team is now looking to see whether increased access to birth control may influence women's futures in other ways, such as boosting their chance of going to or graduating from college, improving their income long-term and reducing their chances of living in poverty.
To Stevenson, these are stronger, more ethically sound reasons for supporting public funding of contraception.
The researchers hope their findings inform the conversation as lawmakers around the country consider proposals to boost Title X funding, lift restrictions requiring that teens get parental consent for birth control and increase access in other ways.
"When these arguments are based solely on the effect of contraception on fertility, it implies that poor women shouldn't have children," Stevenson said. "Our findings suggest that better access to contraception improves women's lives."
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