Claudia Haltom was a juvenile court judge in Memphis who, as she puts it, got tired of taking babies away from teenagers. The final straw came when a 17-year-old mother of three stood in front of her, pregnant. “Who is taking care of your other children while you’re here?” Haltom asked. The girl didn’t know.
During her 17 years as a judge, Haltom witnessed firsthand the hardship and pain and poverty sometimes faced by young women who get pregnant before they are ready—or better said, by both the young mothers and their little ones. She can rattle off statistics. “In 2011, 606 girls between the ages of 10 and 17 gave birth in Shelby County [the area surrounding Memphis]. Over eighty percent of those pregnancies were unintended. Almost all were paid for by TennCare, Tennessee’s Medicaid program. Half of those babies will still be on public assistance at age 13. Less than 50% of their moms will graduate from high school or get a GED by the time they turn 22.” But what drives her are the individual stories behind those statistics—years of listening to heartbreaking testimony and looking into the eyes of young moms who wanted something better for themselves and their kids.
When girls came into her courtroom, Haltom would ask them about what they wanted out of the future. Many had big dreams. College, trade school, and travel were on their lists. But consistently she bumped up against one specific factor that made such dreams unlikely:
I always asked ‘What are your plans for more children?’ They would say, ‘I’m on the pill.’ And I would ask, ‘Have you taken it today?’ In 17 years not one had actually taken it that day. They had lots of good reasons – on drugs, just put out of apartment, no government benefits, the unaffordable price tag of $30/month. But what it added up to was an epidemic of unintended pregnancies.
Haltom saw a spiral of dreams abandoned and multi-generational poverty. She decided to do something about it—to ensure that every woman or youth in Shelby County has access to a kind of birth control that actually will work for her, if that is what she chooses.
The Pill has a 9% failure rate overall and an 18% failure rate for teenagers. This means that on the Pill, 1 in 11 women gets pregnant every year, and it’s worse when life is chaotic, like when a teen is trying to juggle school and parenting and making ends meet. Young moms can get caught in a vicious loop. But it doesn’t have to be that way. With a top tier long acting method like an IUD or implant, the annual pregnancy rate drops below one in five hundred.
Haltom started looking for options and ran across research at Washington University Medical School in St. Louis—known as the CHOICE Project. In the CHOICE Project, over 9000 females age 14 and up were given the contraceptive of their choice for free. The researchers presented the top tier methods first. These methods are known to be cheaper in the long run and to have a higher satisfaction rate (85% vs. 50-60% for the pill, patch and ring), but they can have an up-front cost of $800 to $1600 dollars. With the information available and barriers gone, three fourths of the study participants chose a state-of-the-art IUD or implant, and the teen pregnancy and abortion rates plummeted. Haltom had what she was looking for.
In 2011, she launched A-Step-Ahead Foundation, which seeks to reduce barriers so that every teen or woman who wants a top-tier contraceptive in Shelby County can get one. No barriers, just choices.
A Step Ahead has four goals:
- Knowledge: Increase awareness of the benefits of long acting reversible contraception (LARC) through major grassroots community efforts.
- Proficiency: Encourage medical training and provider awareness.
- Availability: Increase access to long acting, reversible methods by enabling community clinics to keep these methods stocked and by major policy changes.
- Cost: Pay for what insurance or other programs may not cover, or pay if a woman does not have insurance for these long acting reversible methods and their removal.
The program, which is paid for with private funding, tackles these four goals in a variety of ways. After engaging community clinics as partners, the head of The CHOICE Project, Dr. Jeffrey Peipert came to Memphis to answer questions and provide training. Trainings like these ensure that outdated information is dispelled and providers have the opportunity to build relevant skills. A Step Ahead has advertised the program on radio and television, and at local health fairs and festivals. Staff visit public assistance offices and let women know that they now have free options. A 24/7 telephone switchboard schedules each client with the clinic nearest her zip code, which agrees to see her within a week. Taxi vouchers cover any travel expense. Increasingly, clients are learning about the service from family members and friends.
The University of Memphis, Center for Research on Women, conducted a program evaluation at the end of A Step Ahead’s first year. At that time, 2210 women had called the hotline and over 1,000 had signed consent forms seeking services. Three quarters had already experienced one pregnancy. The evaluation confirmed that without the program, most of these women would not have been able to afford top tier birth control. Many women had some benefits or partial insurance for payment, however 431 women received services paid for in full by the program. Those services included “well women” clinic visits, contraceptive devices, and insertion procedures—at an average cost per patient of $343.55.
Haltom says that the cost of the program is cheap compared to the cost of an unintended pregnancy, and when she lays out the numbers donors sit up and take notice. Most of the savings accrues to the taxpayers of Tennessee. Almost all teen pregnancies are paid for at taxpayer expense. Government benefits pay $4,668 for the birthing expenses and almost $10,000 per year in government benefits after that.
But the big economic story is what happens to young women themselves. Recall that when girls give birth in high school less than 50% graduate, as compared to 90% of their peers. Without a high school diploma the starting salary in Shelby County is $6,657. (See Economic Impact Study of Dr. David Ciscel, University of Memphis, 2009.) Over the course of a lifetime the high school dropout will receive $1,400,820 less than her college graduate peer. And those differences ripple through the whole community, contributing to a broader vicious cycle of poverty, because what a woman doesn’t earn she can’t spend.
The numbers may compel the donors, but Haltom herself continues to be compelled by those stories that first set her on this mission—along with the stories of women who are using her program to plan their lives. “A young woman who plans her life will have goals that will motivate and encourage her. If she plans her family then she will be more selective about who is the father, and hopefully with age and maturity, she will marry the young man and they will plan their babies together, at a time in their lives when they are ready.”
Haltom has her own big dream—that when young women have excellent tools to fulfill their plans, generations of poverty will turn into generations of education and goals fulfilled.
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Valerie Tarico is a psychologist and writer in Seattle, Washington. She is the author of Trusting Doubt: A Former Evangelical Looks at Old Beliefs in a New Light and Deas and Other Imaginings, and the founder of www.WisdomCommons.org. Her articles can be found at Awaypoint.Wordpress.com.