From the Desk of Carl J. Foster, MD 1 20 2017

I was struck by the incongruity in GOP policy with regard to the “repeal and replace” of the Affordable Care Act (ACA), the defunding of Planned Parenthood and the opportunity for economic advancement for those who have felt left behind. A major obstacle for young people to overcome is early pregnancy. The major portion of services (80%) provided by Planned Parenthood are for prevention of unwanted pregnancies1. Of the 2.5 million visits to their clinics 84% of the men and women served are 20 years old or older and 1 in 5 women have been served in those same clinics at least once in their lifetimes1. So the defunding of Planned Parenthood is a move that jeopardizes those services and insofar as part of the legislation against the ACA involves a rollback of the expansion of Medicaid GOP policy is about to deliver a “double whammy” to the systems that provides birth control services to the most vulnerable women in the country.

To thrive in this economy one needs marketable skills. The skills that are most marketable require highly technical training. Having the responsibility of child rearing presents an almost insurmountable burden for many poor women and men, especially the mothers. At the website babycenter.com the “cost of raising a child calculator” computes that raising a child to 18 years costs $164,1602. So the likelihood of achieving self- sufficiency is greatly increased by avoiding early unwanted pregnancy.  It seems that GOP policy against the ACA is inconsistent with their purported policy to address economic inequality.

Single mothers are usually young and are members of communities where having a baby is viewed as normal. The relationships from which their pregnancies result are not stable and the parents soon drift apart. In doing so they find new partners and new offspring result. Research has shown that a majority of children (60%)3 have a half-sibling at birth and an even larger majority by age 5 (70%)3. Thus is the manner by which single-parent families are made and the mothers are by far the predominant heads-of-households in these families. And single-parent families and income inequality are intimately linked.

Mothers as heads-of-households are at a disadvantage in the job market. As a consequence their families are disadvantaged with respect to economic status, health care, and housing conditions1. Furthermore the reduced resources that plague single-parent families lead to lower educational attainment in many of their children. In fact, teens from single-parent families tend to leave school earlier than their counterparts from two-parent families. This is a situation that tends to perpetuate a cycle of poverty which has led to the development of a permanent underclass.

So it seems to me that part of the strategies that should be put in place to address income inequality should include policies intended to reduce unplanned and unwanted pregnancies. Policies that support and promote reproductive education, life skills counseling, better contraception, as well as delayed sexual activity are some of the approaches that can be utilized to reduce the problems encountered by single-parent families. As the GOP proceeds with the “repeal and replace” of the ACA and the defunding of Planned Parenthood they would do well to consider the effects that these actions will have on at-risk populations.