Why does it matter?

There are many benefits to providing women with services and information that allow them to decide the circumstances under which they decide to have children. Not only on an individual level, but also on a national level: all people are affected by a woman’s ability to access safe and legal contraception.

Why does it matter that men and women can get affordable, safe and legal sexual/reproductive healthcare?

TIME Executive Editor Nancy Gibbs talks about The Pill— whom it helped, whom it hurt, what it meant and why it mattered.

Why does it matter that a woman has access to safe, legal, and affordable abortion?

1 in 10 women who have experienced a gap in contraceptive use in the past year report that difficulty accessing birth control methods was directly responsible for nonuse (Frost, Darroch & Remez; 2008).

It is difficult for many women have to prevent unplanned pregnancy because they cannot afford prescription contraception. Disadvantaged women are especially likely to experience either gaps in use or overall nonuse.

We find evidence that teenage childbearing likely reduces the probability of receiving a high school diploma by 5 to 10 percentage points, reduces annual income as a young adult by $1,000 to $2,400, and may increase the probability of receiving cash assistance and decrease years of schooling (Fletcher & Wolfe, 2009).

Beyond Unplanned Pregnancy: The Broader Importance of Publicly Funded Family Planning Services

When men and women have affordable access to quality sexual and reproductive health services, they can...

avoid unplanned pregnancy and reduces the need for abortion
plan for their futures
avoid contraction of sexually transmitted disease and infection
reduce the proliferation of sexually transmitted disease and infection
avoid other adverse health outcomes such as cervical cancer, infertility and preterm /low-birth-weight births (Frost, Sonfield, Zolna & Finer, 2014)
better understand their physical bodies, as well as their sexual/gender identities and expression
adopt a stronger and healthier self-concept

Additionally, public investment in family planning has the potential to produce billions of dollars in government savings.

The self-concept is a term that refers to how someone thinks about, evaluates and perceives themselves. Psychologist Roy Baumeister (1999) defines self-concept as "The individual's belief about himself or herself, including the person's attributes and who and what the self is” (Baumeister, 1999)

The development of a concept of self has two aspects: The Existential Self which is the realization of being separate and distinct from others, and The Categorical Self which is the realization that one can be put into categories such as age, gender, or skill. In childhood the categorical self tends to be concrete, such as height, or hair color. As the child develops, the categorical self begins to incorporate internal psychological traits, comparative evaluations and how they are perceived by others.

Famed Psychologist Carl Rogers (1959) suggested the idea that the self concept has three domains: self-image, self-esteem, and ideal self.

Self Image: What view do you have of yourself?

Self-descriptions often include the following dimensions:

Physical Description
Social Roles
Personal Trait
Existential Statements

Self Esteem: How much value you place on yourself?

Self-esteem is how much we like ourselves, how much we approve of ourselves, and how much we value ourselves. Self esteem involves evaluation, and results in point on a spectrum that ranges from negative view to positive view of self.

Positive views tend to lead to…

Confidence in our own abilities
Self acceptance
Not worrying about what others think
Optimism

Negative views tend to lead to…

Lack of confidence
Want to be/look like someone else
Always worrying what others might think
Pessimism

Psychologist Michael Argyle (2008) identified 4 major factors that influence self esteem.

THE REACTION OF OTHERS: If other react positively, we develop higher self-esteem. o
COMPARISON WITH OTHERS: If the people we compare ourselves with (our reference group) and fall short, then we tend to develop a low self-esteem.
SOCIAL ROLES: Embodiment of social roles that carry prestige (e.g. doctor, professional athlete, etc.) in a particular cultural context promotes self-esteem. Embodiment of social roles that carry stigma (e.g. convict, unemployed) promote self-doubt.
IDENTIFICATION: Roles inevitably become part of our personality, that is to say that we often identity with the positions we occupy, the roles we play, and the social groups that we belong to.

IDEAL-SELF: What you wish you were really like?

If there is a discrepancy between how you see yourself and what you’d like to be, then this incongruence is likely to affect how much you value yourself. The smaller the discrepancy between your ideal self and your self-image, the more likely you are to have a healthy self-concept.

So what role does sexual and reproductive healthcare have in our maintenance of self-concept?

Why does it matter that levels of unintended pregnancy are reduced?

Unintended pregnancy can force women to face difficult abortion decisions or the potentially negative consequences associated with unplanned childbearing such as child health and development issues, relationship instability, and compromises in education and employment that may exacerbate ongoing poverty (National Campaign to Prevent Teen Pregnancy, 2007).

The increased use of contraceptives, improvements in consistency of use and greater reliance on highly effective methods can reduce levels of unintended pregnancy.

When a woman can choose when she has children, she is more likely to choose to have children when she can financially support them. This means less money needed by public assistance such as food stamps or other federally funded subsistence dividends.

When a women can protect herself reliably against unplanned pregnancy, she is are more likely to finish secondary education, attain postsecondary education and employment, and actualize increased earning power.

Research has linked state laws granting unmarried women early legal access to the pill (at age 17 or 18, rather than 21), to their attainment of postsecondary education and employment, increased earning power and a narrowing of the gender gap in pay, and later, more enduring marriages.

Unplanned births have been linked to relationship dissatisfaction and conflict. These issues can lead to other long term health consequences such as depression, anxiety and other mental illness. From an economic standpoint, fewer cases of mental illness would allow the state to allocate less funding to public mental health services. From a public health standpoint, fewer unplanned pregnancies would allow a greater proportion of women to live mentally healthy lives.

LEGAL

SAFE

Individual state legislatures continue to enact more restrictive abortion measures. Increased and unnecessary regulation of abortion contributes to the stigmatization of abortion and of the women who seek to obtain one. This stigmatization creates create a context of fear even in states where such legal and practical regulations do not exist. More research is needed to declare the extent that these regulatory roadblocks affect women seeking abortion.

AFFORDABLE

"When a woman has made the personal decision to end a pregnancy but cannot afford to, she may forgo basic necessities like heat and electricity in order to save the necessary funds." (Planned Parenthood)

When a woman cannot obtain an abortion from a licensed medical practitioner, she may resort to self-inducing an abortion or obtaining an abortion from an untrained or unlicensed practitioner which is signifcantly more dangerous.

adopt a stronger and healthier self-concept

3

2 better understand their physical bodies and sexual/gender expression

1 avoid the contraction & proliferation os sexual disease/infection

62% of Planned Parenthood health centers offer same-day appointments, a proportion similar to federally qualified health centers (58%), but higher than health departments (42%).

Moreover, the average wait for an initial contraceptive appointment at a Planned Parenthood health center is 1.2 days, while the average wait time for such a visit is 2.5 days at sites operated by FQHCs and 4.1 days for health department sites (Guttmacher, 2017)

2. WOMEN OBTAIN CARE MORE QUICKLY FROM PLANNED PARENTHOOD

Planned Parenthood health centers are the most likely, compared to other health clinics, to accommodate clients who have difficulty taking time off from work or family responsibilities to obtain health care (i.e. low-SES, those who hold more than one job).

"78% of Planned Parenthood health centers offer extended evening or weekend hours versus 57% of federally qualified health centers and just 18% of health departments" (Guttmacher, 2017; Zolna & Frost, 2016).

3. PLANNED PARENTHOOD IS FOR WORKING MOMS OR PEOPLE WITH DECREASED SCHEDULE AVAILABILITY

"In 2008, hospitals accounted for 34% of abortion facilities, but they performed only 4% of abortions. By contrast, clinics accounted for 47% of facilities and 94% of procedures. Physicians’ offices represented 19% of facilities but pro- vided only 1% of abortions.4 Hence provider type, and the number of clinics in particular, may be a more important indicator of access than the total number of providers” (Jones & Kooistra, 2011).

1. IT’S NOT ABOUT THE NUMBER OF FACILITIES: IT’S ABOUT THE TYPE OF FACILITY

"The availability of services and counseling is often related to whether the provider’s focus is contraceptive or primary care. Providers are relatively unlikely to offer a wide range of contraceptive services if fewer than 25% of their patients see them for contraceptive care. Private family practice doctors, community health centers and hospital clinics are especially likely to have a primary care focus, and they offer a narrower range of contraceptive services than obstetrician-gynecologists, health department clinics and Planned Parenthood clinics, which generally provide contraceptive services to at least 25% of their clients" (Frost, Darroch & Remez, 2008)

4. PLANNED PARENTHOOD SPECIALIZES IN WOMEN'S HEALTH

A retrospective cross-sectional study performed on 284,910 16 to 22 year-old females found that the presence of a Planned Parenthood clinic was associated with a decrease (4.08% compared with 4.83%) in female high school dropout rates (Hicks-Courant & Schwartz, 2016).