
Colorado’s Effort Against Teenage Pregnancies Is a Startling Success - westi
http://www.nytimes.com/2015/07/06/science/colorados-push-against-teenage-pregnancies-is-a-startling-success.html
======
austenallred
So you're seeing that giving kids birth control reduces teen pregnancy?
Shocking.

Everyone knew this would happen, but some believe that giving teens birth
control is encouraging them to have sex, so initiatives like this are almost
always blocked. It's very much a political problem.

~~~
dylanjermiah
>but some believe that giving teens birth control is encouraging them to have
sex

I don't understand, encouraging them to use contraception while having sex
(and perhaps lead to more intercourse)? or encourage more unprotected sex?

~~~
seiji
_and perhaps lead to more intercourse_

In America, the popular public society-wide meme opinion is "sex is bad
outside of procreation." You're not allowed to encourage it, you're not
allowed to make it safer, and many doctors aren't even comfortable talking
about it.

Running a "birth-free sex" program is an affront to the victorian
sensibilities of genital shame and a general war on happiness. The one true
path is dedication to god and hard work, not personal enjoyment of anything.
And we're going to have our 80 year old half-senile business moguls fund all
politicians to ensure sex is always dangerous, unsafe, and bad for you.

~~~
digi_owl
Heh, i recall reading the experience of someone from some Nordic nation or
other who went to USA to visit his in-laws to be.

"Back home" they were sharing a bed and sleeping in their undies each night.

While visiting it was pajamas and sleeping in different ends of the house.

~~~
seiji
That's reasonably common in the US if the parents are religious. If the kid
and their significant other are visiting parents and aren't married then they
aren't allowed to sleep in the same room (because they might do _shenanigans!_
).

~~~
digi_owl
I see i forgot to include that i think the couple was both well into their
20s, just not married (yet).

~~~
seiji
They are still children in the eyes of their parents. :)

Doesn't matter if it's 20/30/40, you still need to be protected from the
temptation of living in sin.

~~~
digi_owl
* They are still children in the eyes of their parents. :) *

True, and something that transcends cultures.

------
jdross
As a counterpoint, 85% of the gains were found in neighboring counties without
the program. Teenage birth rates are plummeting everywhere.

Questionable source, but data and linked study appear correct:
[http://www.nationalreview.com/agenda/385884/no-one-
program-d...](http://www.nationalreview.com/agenda/385884/no-one-program-did-
not-reduce-colorados-teen-pregnancy-rate-40-percent-callie-gable)

~~~
hiou
Indeed national averages during that period trend similarly.

[http://www.cdc.gov/teenpregnancy/about/birth-rates-
chart-200...](http://www.cdc.gov/teenpregnancy/about/birth-rates-
chart-2000-2011-text.htm)

~~~
irq-1
The 2007-2013 numbers for 'All' show about 40% drop, but: it's a longer period
(than 2009-2013), and there's a very sharp decline between 2007 and 2009,
which would make the national numbers worse when compared to the same period.

------
explorigin
I wonder if there was also an increase in STDs. The article makes no mention.

~~~
breitling
I was thinking the same thing. They have less of an incentive to use
protection with this device implanted. Let's wait and see until the STD
numbers surface.

Ultimately, what's cheaper? Having a baby or taking care of an STD? Perhaps
the benefits outweigh the costs.

~~~
agentdrtran
Taking care of an STD will be cheaper for the individual and the state,
without question.

~~~
danesparza
I'm not entirely sure about that.

The long term effects of certain STD's will require hospitalization, doctor's
visits, and medication. If these programs target teens and poor people, this
demographic would also struggle to pay for those things as well -- and they
would need to use them for a more protracted period than 10-18 years.

Also: Birth control might give a false sense of security leading to more
casual sex and a surging rate of STDs. That last theory makes STDs noticeably
absent from the article.

~~~
VLM
"The long term effects of certain STD's will require hospitalization, doctor's
visits, and medication."

Without a "think of the children" argument, is that necessarily bad, if poor
judgment has consequences? Shouldn't poor judgement have negative lifestyle
outcomes?

My hiking hobby exposes me to some medical risk of lyme disease, skin cancer,
ankle and knee damage, but its not like I'm about to stop. Now that you're
done yawning about my dangerous lifestyle choices, likewise if casual sex is
medically dangerous then ... why exactly should anyone care?

~~~
MacsHeadroom
> Shouldn't poor judgement have negative lifestyle outcomes?

That's absurd. Having unprotected sex would not constitute "poor judgement" if
there were no possible negative outcomes.

------
s_q_b
IUDs have an excellent success rate and safety profile. They can cause
problems, but from a societal perspective, it may be worth it.

Really we need non-invasive male birth control, as soon as possible.

~~~
XorNot
I would argue invasive is fine, what we need is reliably reversible.
Vasectomies can be reversed, but it's a big if at any juncture.

~~~
s_q_b
Even injection at the site will result in high rates of patient non-
compliance. There's been some work done in India with temporary implants.
However, I believe if we are to reach zero unintended pregnancies, the male
procedures need both medical and reversibly surgical options.

------
rickdale
This is interesting because I always claim that the reverse is true where I
live. Like, getting pregnant is glorified to young girls. The conspiracy
theorist in me says that the gov does that to occupy peoples lives. It's like,
they have nothing better to do so lets make having a baby seem like the
greatest thing in the world. So in my view, this goes both ways.

~~~
csours
The conspiracy theorist in you may want to look to society, hormones, and
evolution as well.

------
sneak
I wonder what these sorts of barrier-free contraception methods are doing to
STI rates.

~~~
a8da6b0c91d
Nobody ever mentions the problems with environmental pollution and human
cancer with chemical contraception. It's very conspicuous. If it were any
other product the downsides would be heavily discussed.
[http://i.imgur.com/S8RCxEe.jpg](http://i.imgur.com/S8RCxEe.jpg)

~~~
pavel_lishin
I tend to distrust quotes that use terms like "the barren left" \- it's
clearly not aimed at me, someone who Steven Mosher would probably lump into
that category.

Isn't the dumping of antibiotics causing similar problems? The problem doesn't
seem to be birth control itself, but improper disposal of household chemicals,
really.

Also, do you have a citation for the cancer thing you mentioned?

~~~
a8da6b0c91d
[http://www.nbcnews.com/id/8759578/ns/health-
womens_health/t/...](http://www.nbcnews.com/id/8759578/ns/health-
womens_health/t/hormone-pills-added-list-carcinogens/)

Also, the problem is literally in urine. I don't understand your line about
disposal. You want all women on the pill to always pee and poop into jars for
proper permanent disposal? And no, "disposal" of antibiotics is not a big
ecological problem whereas pharmaceutical hormones clearly are.

~~~
pavel_lishin
Ah, I didn't know that the hormones were excreted via urine.

Also, that link mostly talks about hormonal menopause therapy, and oddly only
mentions the BC pill in passing, noting that only high-dosage pills seem to be
linked to cancer.

In the end, tbh, it's up to a woman and her doctor to decide how to balance
the risks of pregnancy and cancer.

------
caseyf7
Here's the link to the study referenced in the article.

[http://www.nejm.org/doi/full/10.1056/NEJMoa1400506](http://www.nejm.org/doi/full/10.1056/NEJMoa1400506)

~~~
webjprgm
I don't think 2-3 partners is really low. I find it hard to imagine most
people being successful at seducing a very large number of people. Probably in
most cases it is <= the number of boyfriends the girl has had.

I could also point out that my church _would_ consider 2-3 partners something
akin to "running wild". One partner, one time could be a lapse in judgement.
Multiple partners or one partner multiple times indicates a pattern.

~~~
balls187
>I could also point out that my church would consider 2-3 partners something
akin to "running wild". One partner, one time could be a lapse in judgement.
Multiple partners or one partner multiple times indicates a pattern.

Thankfully, this type of puritanical thinking is on the decline in America.

------
hammock
>Colorado’s Effort Against Teenage Pregnancies Is a Startling Success

Any time I see a headline like this, I have to look for the discussion about
what unintended consequences were observed. There usually are some, there is
no such thing as a free lunch. Some commenters have already mentioned negative
health effects, spread of STDs, environmental impact, social consequences. I
found no such discussion in this article.

~~~
KirinDave
Probably because it's entirely outside the scope and would only be useful to
people trying to derail the conversation.

It's not like IUDs suddenly stop other safe sex practices. It's not Sex MMO
where your "Contraceptive Equipment Slot" only can fit one item per party.

~~~
nsgi
Why would it be outside the scope? It's intuitive that decreasing the "price"
of one form of contraception would decrease demand for weak substitutes, so it
is one possible and very negative effect of the policy.

~~~
KirinDave
Honestly I'm not sure where to begin in the time I have here to write with
you...

Consider that IUD usage overlaps only partially with other practices for
starters.

------
shoo
In my opinion this is obviously a pretty good thing to do, and it is fantastic
to see it is happening. Dear world: let's see more of this kind of thing,
please.

> But the experiment in Colorado is entering an uncertain new phase that will
> test a central promise of the Affordable Care Act: free contraception.

------
keedot
How is this startling?

~~~
sneak
Condoms are free.

~~~
jkestner
Condoms have lower compliance and higher failure rates.

~~~
kale
Check out this series of charts. Each method of contraception in its own
chart, and "perfect use" and "typical use" are both plotted.

Out of 100 couples using a condom as birth control, 55 will have an unplanned
pregnancy in 4 years with typical usage (8 out of 100 with perfect usage).

[http://www.nytimes.com/interactive/2014/09/14/sunday-
review/...](http://www.nytimes.com/interactive/2014/09/14/sunday-
review/unplanned-pregnancies.html?_r=0)

------
apta
Perhaps they should discourage teenagers from sleeping with each other. As far
as I know, teenage pregnancy is not an issue in conservative Middle Eastern
cultures for instance.

------
rubiquity
Don't IUDs have a lot of negative impacts on a woman/teenage girl's health? I
seem to remember there was a study about bleeding, irregular menstral periods,
and an increase in urine tract infections. It seems irresponsible to give a
device like that out to any teenager that wants one. Not that pills are any
better.

It doesn't matter what direction the arrow on the graph is pointing if the way
you got there is by potentially hurting people.

~~~
JupiterMoon
Not your job to police women's bodies. If she is fully informed and wishes to
use one then this is her personal decision. Not yours.

~~~
rubiquity
That's completely fair! I'm not trying to make the decision for anyone and I'm
not sure where you got that from my post. But isn't it a bit irresponsible for
something as large/respected as an entire State to put their backing behind
something with pretty well known, negative tradeoffs?

Is it OK for a large body of authority to support something that will harm you
as long as they leave it to the individual's choice to use it or not? Where do
we draw the line on this?

~~~
noelwelsh
Do you like jails? Do you like cars and roads? Do you like electricity? States
and countries put their backing behind many things with well known, negative
tradeoffs.

Update: for example, a paper on the psychological damage done by jailing
people:
[http://aspe.hhs.gov/hsp/prison2home02/haney.htm](http://aspe.hhs.gov/hsp/prison2home02/haney.htm)

~~~
rubiquity
Your argument is ridiculous so I'm just writing to let you know I won't even
entertain you. Hopefully nobody else does either.

~~~
noelwelsh
Nice attempt at ducking the argument. Let me spell it out for you (and other
readers should they be so misguided).

You argue "isn't it a bit irresponsible for something as large/respected as an
entire State to put their backing behind something with pretty well known,
negative tradeoffs?"

The state supports many things with that have negative aspects. I listed a few
obvious ones in my previous comments. In fact everything in life involves a
tradeoff. One can study these things and develop some quantitative measure of
the negative and positive effect.

Here are some studies on IUD complications:
[http://www.popline.org/node/490794](http://www.popline.org/node/490794)
(youths)
[http://www.sciencedirect.com/science/article/pii/S0010782406...](http://www.sciencedirect.com/science/article/pii/S0010782406002897)
(following birth)
[http://www.sciencedirect.com/science/article/pii/S0140673600...](http://www.sciencedirect.com/science/article/pii/S0140673600026994)
(UIT infection specifically)
[http://www.medscape.com/viewarticle/718183_5](http://www.medscape.com/viewarticle/718183_5)
(general)

You can see that the complications are generally regarded as being quite minor
or low probability. For many people this is a tradeoff worth making, given the
near 100% success rate in prevent pregnancy.

Now this refers to IUDs. The Colorado program also provides hormonal birth
control, via a long lasting implant. I'll let you do your own research on
these.

------
webjprgm
Since all my comments so far have sounded like I oppose giving out
contraceptives (since I am very much a proponent of moral living), let me
clarify. I think it is great to help lift people out of poverty. Since there
is a trend among poor teenagers to have more unplanned pregnancies it makes
sense to address that problem, and this is one possible step.

I do not think it should replace teaching abstinence. But I also don't think
that teaching abstinence using scare tactics in school is all that effective.
Religious and moral teachings are much more so. So it still comes down to the
responsibility of parents to teach their children correct life principles.

Let the government give free contraceptives to at-risk populations. But also
encourage parents to teach good morals.

~~~
facepalm
I've heard that unwanted pregnancies are more frequent in the "wait till
married" crowd. That is because they are unlikely to have condoms with them
when their emotions overwhelm them. They don't account for their changed
decision making process when aroused. (Source: Dan Ariely's Irrationality
MOOC).

~~~
MichaelGG
That's what I've seen from personal experience. Thinking along the lines of:
Birth control's for sluts, and I'm not like that, so I don't need that, this
is special, etc.

