A Real Time Look At The Impact Of The Recession On Women/'s Family ...
A Real-Time Look at the Impact of the Recession on
Women’s Family Planning and Pregnancy Decisions
September 2009 © Guttmacher Institute www.guttmacher.org
Background
Decisions that women and their partners make about
The data for this report come from a national, Internet-
family planning—when to have a child, how many
based survey of 947 women aged 18–34 conducted by
children to have and even whether to have children at
the Guttmacher Institute in July and August of 2009. To
all—take on a special significance and urgency during
focus on women whose reproductive behaviors were
periods of economic turbulence. The ongoing recession
most likely to be influenced by the recession, the survey
in the United States has altered the economic realities of
sample was limited to women who were at risk of getting
many families’ lives, and it has dramatically reshaped the
pregnant and had household incomes less than $75,000.
environment in which people make, and try to act upon,
Key measures were examined for the full sample of
decisions about their reproductive lives.
women, as well as separately for a subgroup of “financial-
Numerous anecdotal reports and press accounts over
ly worse-off” women—those who reported earning less
the past year have speculated about the impact of the
money than they did a year ago or who said they were
recession on Americans’ fertility and family planning pref-
generally worse off financially than they were a year ago.
erences and behaviors.1–3 While provisional figures from
(All differences presented are statistically significant at
the National Center for Health Statistics indicate that the
the p<.05 level.) Findings from this analysis are presented
number of births in the United States declined by nearly
below, and the methodology is detailed in the Appendix.
2% in 2008, they do not explain the underlying reasons
for this decline.4 This report provides the first real-time
evidence on the impact of the recent economic downturn
on women’s fertility-related attitudes, needs and behavior
and on their ability to obtain family planning services. It
examines a number of interrelated issues, including
• how women feel the current economy has affected
them and their families;
• changes in preferences regarding whether and when
to have a child;
• women’s attitudes toward contraception and their
contraceptive behavior;
• patterns in contraceptive method choice and sources
of payment for contraceptive prescriptions;
• challenges women face in obtaining family planning
services; and
• connections that women see between the economy,
their fertility and their families’ current and future
economic well-being.
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Guttmacher Institute
Findings
Women and the Economy
Changes in Fertility Preferences
Many women face shrinking household budgets or find
Women’s fertility preferences have been affected by the
themselves generally worse off than they were a year
current economic conditions. Concerns about unemploy-
ago. More than one in four women or their partners have
ment, lack of health insurance and whether families can
lost jobs or health insurance in the past year, and many
afford to raise a child become even more central during an
have lost confidence in their ability to provide for their
economic crisis.
families.
• Nearly half of surveyed women (44%) report that
• Fifty-two percent of surveyed women are financially
because of the economy, they want to reduce or delay
worse off—they are earning less or financially doing
their childbearing (Figure 1, page 4).
worse than they were a year ago.
• Most of these women want to get pregnant later
Women who are financially worse off are more
(31%), want fewer children (28%) or now do not want
likely than other women to report having lost a
any more children (7%).
job, lost health insurance or received unemploy-
• These changes in fertility preferences are more
ment benefits in the last year.
common among the financially worse off than among
These financial setbacks are occurring evenly
others (53% vs. 34%).
across various groups of American women.
• Lower income women (those with household income
Indeed, there are no significant differences in
below $25,000), who may have less cushion or
the reported share of women who are financially
flexibility in their household spending, are more likely
worse off by age, education, marital status, race
to report changes in their fertility preferences than are
or ethnicity, region of the country or household
higher income women.
income.
• Sixty-four percent of women agree with the
• Overall, women report having greater money and
statement, “With the economy the way it is, I can’t
family worries than they had one year ago. Financially
afford to have a baby right now.” This concern is more
worse-off women are significantly more likely than
common among the financially worse off than among
other women to report increased worry about money,
others (77% vs. 50%; Figure 2, page 4).
providing for their children and their jobs.
Nearly three out of four women report worry-
Birth Control Use
ing more about money. This concern is nearly
Many women have altered their birth control use because
universal (91%) among those who are financially
of the economic downturn. For some, the recession
worse off.
appears to have promoted a shift toward more effective
Among women with children, 57% report worry-
birth control methods and more effective use.
ing more about taking care of their kids. Among
• Overall, 29% of surveyed women agree with the
the financially worse off, 78% voice this concern.
statement, “With the economy the way it is, I
Increased worries about loss of jobs or health
am more careful than I used to be about using
insurance are common among those who are
contraception every time I have sex.” Those who are
employed (40%). Such worries are expressed by
financially worse off are more likely than others to
57% of those who are financially worse off.
agree with this statement (39% vs. 19%).
• Women who say they want to delay having children or
want to have fewer children because of the economy
Guttmacher Institute
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FIGURE 1. Because of the economy, many women want to reduce or
delay their childbearing
FIGURE 1. Because of the economy, many women want to reduce or delay their childbearing
All women
44
Economic
situation:
Worse off
53
Others
34
Household
income:<$25,000
52
$25,000–49,999
40
$50,000–74,999
40
% 0
20
40
60
80
100
FIGURE 2. “With the economy the way it is…”
FIGURE 2. “With the economy the way it is…”
%
100
All women
Worse off
Others
77
80
64
60
50
39
40
29
19
17
20
12
7
0
I can’t afford to have
I am more careful than I used to
I’m thinking more about
a baby right now
be about using contraception
getting a long-lasting birth
every time I have sex
control method*
*Among women not currently using a long-term method.
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Guttmacher Institute
FIGURE 3. In this economy, women have more difficulty paying for
FIGURE 3. In this economy, women have more difficulty paying for birth control and
birth control and accessing care
accessing care
%100
All women
Worse off
Others
80
56
60
42
40
34
30
27
23
24
19
17
20
12
11
5
0
Have a harder time
Put off a gynecology
Switched to a less
Worry more about
paying for birth control
or birth control visit
expensive provider
taking time off from
to save money
work for care*
*Among women currently employed.
are more likely than others to report being more
However, some women report using birth control less
careful about using contraceptives (45% vs. 17%),
consistently, as a way to save money.
as well as more likely to have chosen a new method
• Eight percent of women report that they sometimes
of birth control to reduce their chance of getting
did not use birth control in order to save money.* This
pregnant (18% vs. 8%).
cost-cutting behavior is more common among those
• Twelve percent of women who are not already using
who are financially worse off than among others (12%
a long-term contraceptive method (such as the IUD
vs. 4%).
or injectable) are thinking about switching to one
• Among women using the pill, 18% report inconsistent
because of the economy. Those who are financially
use as a means of saving money. Pill users said they
worse off are more than twice as likely as others to be
skipped pills (4%), delayed getting a prescription filled
considering this option (17% vs. 7%).
(12%), went off the pill for at least a month (11%)
• The recession appears to have made contraceptive
and obtained fewer pill packs at one time (8%). Such
sterilization a more appealing option for some women.
inconsistent use is more common among women
Among those who want no more children, 46% report
who are struggling financially than among others (25%
that because of the economy, they are thinking more
vs. 6%).†
about sterilization. Four percent of the overall sample
had a tubal ligation or their partner had a vasectomy in
the past year; among this group, 73% are financially
worse off.
*Among those couples who are not contraceptively sterile.
†Among women using the pill during the past year.
Guttmacher Institute
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Access to and Use of Contraceptive Services
In the current economy, women report a variety of cost
constraints on their access to contraceptive services and
their ability to pay for birth control.
• Twenty-three percent of surveyed women report
having a harder time paying for birth control than in
the past (Figure 3, page 5). This proportion rises to
one out of three among financially worse-off women.
• Nearly one out of four women report having put off
a gynecological or birth control visit to save money in
the past year. Such forgone care was more common
among those who are financially worse off than
among others (30% vs. 19%, p=.06). Women who
lost their health insurance during the past year are
more likely to report delaying a visit than are those
who did not.
• Eleven percent of women report switching to a less
expensive provider for their reproductive health care
services—17% of those who are financially worse off,
compared with 5% of other women.
• Forty-two percent of employed women agree with the
following statement: “With the economy the way it is,
I worry more about taking time off from work to visit
a doctor or clinic.” Those who are worse off are more
than twice as likely as others to identify such a worry
(56% vs. 27%).
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Guttmacher Institute
Discussion
This study found clear indications that the current reces-
them the impact of the recession was magnified.
sion has spurred a broad range of changes in women’s
These findings demonstrate the importance of
fertility preferences, contraceptive preferences and use,
economic issues in women’s childbearing decisions, and
and access to services. With this recession being more
show how women may try to avoid unintended childbear-
severe—in both depth and length—than any this country
ing to improve their ability to provide for their families.
has seen in decades, it is not surprising that the major-
Family planning and childbearing decisions are not made
ity of women report worries about money, work and
in a vacuum, but have always been influenced by broader
the expense of caring for their children. The recession’s
economic and other external forces. Women take into ac-
impact on childbearing decisions and women’s contra-
count many factors, including their ability to appropriately
ceptive use has been profound. More than four in 10 of
care for their present and future children, their employ-
the surveyed women say that because of the economy,
ment and their family’s economic stability.
they now want to get pregnant later than they otherwise
would have planned, have fewer children or not have any
——————————
more children. For many women, the current economic
This posting examines the current recession from the
situation is leading them to be more careful about using
viewpoint of women and their attitudes and behaviors.
birth control, and some even report considering steriliza-
The next posting will analyze information gathered from
tion or long-acting contraceptive methods because of the
the providers who aim to serve these women.
recession. But many women are struggling to obtain the
care they need; they report having a harder time paying
References
for contraceptive services, and worry about taking time off
1 Locke M, Couples double up on birth control, Myrtle
from work to obtain health care. As a result, some women
Beach (S.C.) Sun-News, June 20, 2009.
appear to be taking chances that could put themselves or
2 Recession affects family planning, with abortions
their families at risk. We found evidence of women put-
and vasectomies up, St. Petersburg (Fla.) Times, Mar. 30,
ting off a visit for either regular gynecological care or birth
2009.
control, and sometimes not using birth control and using
3 Dembosky A, As economy in Silicon Valley slides,
methods inconsistently—all in an effort to save money.
birth control booms, San Jose Mercury News, June 26,
2009.
Women who use these short-term money-saving strate-
gies are at risk for long-term negative consequences,
4 Tejada-Vera B and Sutton PD, Births, marriages,
divorces, and deaths: provisional data for 2008, National
including unintended pregnancy.
Vital Statistics Reports, 2009, Vol. 57, No. 19.
Importantly, the findings of this study also indicate
that the recession has affected individuals and families
across a wide range of income levels—not just the poor
or those who are out of work.‡ It appears that changes in
Americans’ sense of economic well-being have created
Acknowledgments
stressors that have had a direct impact on family forma-
The Guttmacher Institute thanks Laura Lindberg and Lawrence Finer
tion and childbearing decisions. Half of the surveyed
for their substantial research contributions; Cecily Stokes-Prindle for
women were identified as “financially worse off,” and for
aiding in the survey design; Sameen Qadir for research assistance;
Rachel Gold, Cory Richards, Gustavo Suarez and Rebecca Wind for
reviewing early drafts; and John Thomas for editing the report.
‡Of course, women of reproductive age are not the only ones
affected by the current recession. In a July 2009 National Public
This report was made possible in part by a grant from the Educational
Radio survey of 850 likely male and female voters, 53% said
Foundation of America. The Guttmacher Institute also gratefully acknowl-
they are worse off financially than they were a year ago (source:
edges the general support it receives from the William and Flora Hewlett
National Public Radio, National Survey Results, July 28, 2009,
<http://www.npr.org/assets/news/2009/07/28/pollppt.pdf>,
Foundation, the David and Lucile Packard Foundation, the Ford Founda-
accessed Aug. 25, 2009).
tion and other donors, which undergirds all of the Institute’s work.
Guttmacher Institute
7
Appendix: Methodology
The survey was fielded by Knowledge Networks (KN)
The survey had 29 questions, and 90% of eligible
using their KnowledgePanel, a national household panel
respondents completed the interview in less than 25
recruited using probability-based methodology. The
minutes. Topics included changes in financial well-being;
panel totals approximately 50,000 individual household
reproductive attitudes and behaviors, including respon-
members older than 13 and is representative of the U.S.
dents’ ability to access the reproductive health services
population. To achieve scientific validity, KnowledgePanel
they need; and self-reported perceptions of how changing
is based on a sampling frame that includes individuals
economic factors have affected attitudes and behaviors.
with listed or unlisted telephone numbers, those without
Appendix Table 2 compares the KN sample to a
a landline phone and those without current access to the
similarly defined sample of respondents from the 2002
Internet or a computer. Panel members are recruited by
National Survey of Family Growth. The two samples are
telephone and mail with probability-based recruitments
similar in terms of demographic characteristics and contra-
based on a random-digit-dial and address-based sample.
ceptive behavior.
To reach individuals who do not have Internet access, KN
Data analysis was conducted with Stata 10.0, using
provides a laptop computer and Internet access to panel-
the svy command and sampling weights to adjust for the
ists who do not already have them. Self-selected volun-
complex sampling design of the survey and to produce
teers are not accepted.
corrected standard errors. We estimated chi-square
Panel members who met the primary inclusion criteria
tests for differences between subgroups; all differences
were invited by e-mail to participate in this survey. This
presented in this report are statistically significant at the
initial contact was limited to women aged 18–34 with an
p<.05 level. The key subgroup in this analysis was women
annual household income of less than $75,000. Of the
identified as financially worse off; they reported either
panel members meeting these criteria, 1,630 responded
earning less money than a year ago or being generally
to the English-language survey, yielding a completion rate
worse off financially than they were a year ago. Key mea-
of 65%. Respondents were then screened and eligibility
sures were examined for the overall sample of women,
was limited to those women who had had sex with a man
as well as separately for financially worse-off women and
in the past three months and who were not pregnant.
others.
Women were excluded if they or their partners were
surgically or otherwise sterile, unless contraceptive ster-
ilization had occurred within the past 12 months. A total
of 947 women met these eligibility criteria (see Appendix
Table 1.
The Guttmacher Institute’s human subjects review
board approved data collection and analysis. Panel
members can choose to leave the panel at any time, and
receipt of the laptop and Internet service is not contingent
on completion of this specific survey or any particular
survey. Nonspecific survey incentives are used to reduce
attrition from the panel; panelists not receiving the free
laptop and Internet service receive participation checks
for $4–6 per month. All data from this survey were de-
identified by KN prior to transmittal to Guttmacher, and all
survey responses were confidential.
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Guttmacher Institute
APPENDIX TABLE 1. Number of women meeting
APPENDIX TABLE 2. Comparison of 2002
eligibility criteria for the Internet survey, July–
National Survey of Family Growth (NSFG) and
August 2009
Knowledge Networks (KN) samples of women
aged 18–34, by selected characteristics
Category
N
Characteristic
NSFG KN
No. of panelists responding to survey
1,630
(%) (%)
No. of ineligible panelists
683
Race/ethnicity
Did not have sex in last three months
358
Hispanic
18
15
Currently pregnant
94
Black
14
17
White
62
61
Respondent/partner medically sterile
61
Other
6
7*
Respondent/partner contraceptively
170
sterile >12 months ago
Age
No. of eligible panelists
947
18–24
42
41
25–34
58
59
No. of children ever born
0
48
45
1
25
23
≥2
27
32
Household income
<$10,000
13
12
$10,000–19,999
20
11
$20,000–34,999
29
25
$35,000–49,999
17
25
$50,000–74,999
21
27
Total
100
100
Currently married/cohabiting
61
59
Current contraceptive use
Pill
36
33
Condom
28
36
*Includes women reporting two or more races. Note:
Samples were limited to women who had household
income of <$75,000, who were sexually active in the last
three months and not currently pregnant, and who were
not sterile.
Guttmacher Institute
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