Editor’s Note: Jack Markell is the former governor of Delaware. He is on the board of directors for Upstream USA, a national nonprofit that works to expand economic opportunity and mobility by reducing unplanned pregnancy. The opinions expressed in this commentary are his own.
Governors often say their most important job is expanding economic opportunity for all. This year, 36 states will hold gubernatorial elections, and you can be sure every single candidate will run on their plans to make the American dream attainable.
When I served as governor, I woke up every day focused on how to help all Delawareans achieve their full potential. In my early days in office, I focused on traditional policy areas to create economic opportunity across the state: increasing early childhood education, reforming a broken justice system, and developing better workforce training. I also talked to young men and women to better understand what’s holding them back from career and financial success. Time and time again, I heard a similar refrain: “I was in college, but then I got pregnant,” or “my girlfriend got pregnant and we weren’t planning it.”
To face this unexpected reality, they might have to drop out of education or the workforce, or juggle multiple jobs to support themselves and their child. In 2014, Delaware had the highest percentage of unplanned pregnancies in the country. I came to the conclusion that one of the most important things that we can do to expand opportunity is empower women to choose if and when they want to become pregnant.
You may be wondering why a 57-year-old, male, former governor is talking about birth control, but contraceptive access should be at the center of our policy plans, not sidelined as a “political” issue.
The problem of unplanned pregnancy in the United States is not a small one: Out of 6 million pregnancies each year, nearly 3 million are unplanned. The rate of unplanned pregnancy among low-income women is five times that of higher income women – often because the places where they receive medical care do not provide comprehensive reproductive health care. In Delaware, our unplanned pregnancy rate is 57%, and the annual public cost is upwards of $90 million.
When I started looking closely at my state, I found significant barriers to access to contraception, such as a lack of trained providers, health centers requiring multiple appointments, and misinformation and poor patient counseling. In fact, in 2015, only 30% of publicly funded community health centers nationwide provided same-day access to the full range of contraception. One of the largest federally qualified health care centers in Delaware told me it had a six-month waitlist for the most effective methods: long-acting reversible contraceptives (LARCs) such as IUDs and the implant.
That’s unacceptable. This is a problem we can solve, and the solution is a win for everyone. It’s good for families, society, and most importantly, it’s what women themselves want: to be empowered to make their own decisions about their health and economic lives.
Delaware partnered with Upstream USA in 2014 to create Delaware CAN (Contraceptive Access Now), a public-private partnership to change our state’s reproductive health care infrastructure for the long term. By working within our existing health care system, they provided training and technical assistance to over 150 health care delivery sites, and integrated reproductive care with primary care. Today, more than 126,000 women across Delaware have access to the full range of contraceptive methods, all available same-day and free of charge.
Some people may find this surprising, because providing access to affordable health care can be a polarizing topic, but this work was not met with any controversy. In fact, I even announced Delaware CAN in my last State of the State address in 2016, including a specific mention of “IUDs.” The initial results of this work speak for themselves. Child Trends, a nonprofit and nonpartisan research group that studies the development of children, estimates there was a 15% decrease in unplanned pregnancies among some of our most at-risk patients from 2014-2016.
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This substantial reduction is even more impressive when compared to the 1.3% decrease nationally over the same period. Recent patient surveys conducted in Delaware demonstrate women are making their own choices about their birth control. And that federally qualified health center with a six-month waitlist for LARCs has now eliminated the waitlist altogether. This all translates into women getting access to the care they deserve and making their own decisions for themselves and their families.
The national conversation today focuses on partisanship, bickering and talking heads. But there are so many examples of common-sense, effective solutions at the state and local level. Yes, even initiatives to expand birth control access. Our work in Delaware with Upstream demonstrates the success of a public-private partnership in a remarkably short period that’s replicable and sustainable. By empowering women to choose when and if to become pregnant, the ripple effects will benefit generations of Delawareans. Future governors across the country have a responsibility to take a step back from the partisan rhetoric and look at what really works if they want to run on opportunity.