Since 1994, the rate of unintended pregnancies in the US has remained fairly stagnant, hovering around 5%. The demographics that underlie that rate, however, are not stagnant; among low income people, there’s actually been an increase, weighted out by the decrease among wealthy patients. Such disparities in health outcomes for people in differing social classes are not unusual, and this is indicative of larger social trends.
Wealthier people have an increased chance of accessing comprehensive sex education. They are more likely to be able to get birth control, stay on it, and use it as recommended. They are more likely to be able to access other safer sex tools, like condoms. Wealthy people who need access to reproductive health services can get them, whether they are paying out of pocket or using private insurance, and can probably access very high quality care from care providers who meet their needs. If they don’t like their doctors, if they feel disrespected by clinical staff, they can switch practices, because they are not bound by limitations like access to transit or only being able to see care providers who accept programmes like Medicaid.
In 2006, poor women had an unintended pregnancy rate five times that of higher-income women, and an unintended birth rate six times as high.
This speaks to deep systemic inequality and serious divides when it comes to the ability to access health care. Reproductive health services have been heavily cut in a number of states in the last 10 years, on top of routine cuts to general medical services. Low-income people have a shrinking number of places to turn if they want to get birth control or would like information on pregnancy prevention. They also have few options if they do get pregnant and decide on an abortion; clinics offering abortion services are dwindling in number, which drives patients further afield to access health services. The United States is at a tipping point of returning to an era when abortions in unsafe, dangerous conditions, performed by amateurs, were the norm, and women with unintended pregnancies risked death to abort.
It is not surprising that people in poverty are less likely to be able to access health care, and are more likely to experience unintended pregnancies. The extent of that disparity may surprise some people, especially in a country that likes to pride itself on having great health care. A sixfold differential is a serious, serious thing. It speaks not to some minor differences in terms of access; private versus shared rooms at the hospital, say, but to worlds of difference, to the fact that wealthy and poor people are on two different planets when it comes to health care.
As go reproductive rights, so go other forms of health care in this country. Low income people are more likely to experience serious health problems related to where they live and work, and the stress they experience as a result of poverty. They are more likely to need health services, less likely to be able to access them, and less likely to get the care they need when they need it. A poor child who has asthma because he lives next to a chemical plant will not get the same level of care as a wealthy child with the same condition.
This is a culture that makes poor people sick, and keeps them sick. It’s cynical and calculated in every move, from the precise locations of factories to the decisions made about where and when to cut health services. These decisions lead directly to consequences like these, that growing numbers of poor people in the United States are facing unintended pregnancies even as the number of people in poverty also swells because of the economy, because of policy, because of society. This is a trend that is going to get worse, unless the government takes direct action to address it, and this is not appearing likely.
There are many mythologies about poor people and sexuality, and some of those mythologies could be easily, casually, carelessly applied to studies like this; rhetoric about ‘welfare queens’ drifts to mind. These mythologies are used not just to dehumanise poor people, to blanket them in hatred and contempt, but to argue against the provision of social services. The people who believe these things believe that increasing access to health care wouldn’t address the issue of rising numbers of unintended pregnancies in low-income people.
The same mythologies were present over 100 years ago, when people argued that poor people just ‘bred’ and had endless numbers of children and were a scourge on society. We see it today in snide comments about low income people with large families, about how poor people should be sterilised, about how poor people are too stupid to avoid pregnancy. The increase in unintended pregnancies speaks to cultural and institutional, not personal, factors in the numbers, though. If those myths were true, after all, we’d expect statistics for unintended pregnancies in low income populations to remain fairly static, rather than increasing in direct correlation with cuts to social services, cuts to health services, a rising tide of hateful legislation regarding abortion and reproductive rights, skyrocketing costs for healthcare, full-scale attacks on comprehensive sex education in US Schools.
The next time someone wants to talk about ‘welfare queens’ and ‘breeders,’ wants to dredge up these ancient and time-worn myths about poverty and sexuality, ask that person why it is that the rate of unintended pregnancies in poor people appears to increase when they can’t get health care.