Good Contraceptive Approved/Not so Good Contraceptive App Exposed--UPDATED

Yesterday the U.S. Food and Drug Administration approved a new vaginal ring that provides a year of birth control for women who use it. The method was developed by the Population Council in New York City, and I first became aware of it eight years ago. The FDA describes it this way:

Annovera is a reusable donut-shaped (ring), non-biodegradable, flexible vaginal system that is placed in the vagina for three weeks followed by one week out of the vagina, at which time women may experience a period (a withdrawal bleed). This schedule is repeated every four weeks for one year (thirteen 28-day menstrual cycles).

The efficacy and safety of Annovera were studied in three, open label clinical trials with healthy women ranging from 18 to 40 years of age. Based on the results, about two to four women out of 100 women may get pregnant during the first year they use Annovera.

That is a very good use-effectiveness rate, as you can see if you look at Table 6.2 in my book. 

On the other hand, a widely used Swedish phone app called "Natural Cycles" designed to help women avoid pregnancy through fertility awareness methods (natural family planning) is not so good, as a recent story in The Guardian points out. Indeed, it is now being investigated in the UK by the Advertising Standards Authority:

The Advertising Standards Authority has launched a formal investigation into marketing for a Swedish app that claims to be an effective method of contraception, after reports that women have become pregnant while using it. An ASA spokesman said it had received three complaints about Natural Cycles and its paid advertising on Facebook, which describes the app as highly accurate contraception that has been clinically tested. “We would require robust substantiation from any company to support such a claim,” he said.

The app was developed by two scientists from Sweden and Austria: Elina Berglund, who worked at the Cern laboratory in Geneva on the discovery of the Higgs Boson particle, and Raoul Scherwitzl. The married couple originally devised the algorithm for their own family planning, and now both work full time for the company they founded. They claim to have 600,000 users worldwide, who pay an annual subscription.

Users monitor their fertility with the app by taking their temperature each morning. It tracks the results to detect ovulation, and advises which days are safe or unsafe to have unprotected sex without the risk of conception. The app relies on users taking their temperature at around the same time every morning, and cautions: “Remember that you must always measure as soon as you wake up before you snooze, sit/get up, or check your phone.”

Like all methods of natural family planning, there is a lot of room for error--which leads to unintended pregnancies and possibly then to abortions. 

UPDATE:

CNN today published an op-ed piece by Caroline Criado Perez that gives us more background into the Natural Cycles app, and how suspicious its claims are. She argues that since getting pregnant is one of the most dangerous things a woman can do in her life, governments should make it harder to market birth control methods that aren't very effective.

Poor Health Behaviors Increase Risk of Poor Birth Outcomes

My hope is that anyone reading this blog post will know immediately that if you engage in risky health behaviors before or during pregnancy you increase the chance that your baby will be born with health problems that may indeed last a lifetime. Still, additional research findings along these lines never hurt to keep driving home the point. For this reason I was very interested to read the summary of an article forwarded to me by Professor Rumbaut at UC, Irvine, demonstrating that the behavior of mothers matters for their baby's health. More specifically, mothers who smoked as teens are more likely to deliver smaller babies.

The article was recently published in the journal Social Science & Medicine by Jennifer Kane--a colleague of Professor Rumbaut at UCI, Kathleen Mullan Harris at the Carolina Population Center (UNC, Chapel Hill), and Anna Maria Siega-Riz, also at the Carolina Population Center. There are two interesting aspects to this paper: (1) the data and analysis are importantly connected to Past PAA Presidents; and (2) the whole subject matter takes me and Professor Rumbaut back to our collaborative research many years ago.

The data in this paper come from the National Longitudinal Study of Adolescent to Adult Health or Add-Health as it is popularly known. This project was put together by Kathleen Mullen Harris (PAA President in 2009) and Dick Dry (PAA President in 1994). It was highly controversial at the time, as you can read about in my interview with Professor Udry as part of the PAA Oral History Project. The paper also references the work of Past PAA President Greg Duncan at UC, Irvine, whose interview has just been posted to the PAA website.

Professor Rumbaut and I collaborated on research aimed at understanding the differential birth outcomes among immigrants to San Diego from Indochina and also from Mexico. You can get a feel for our research in this paper, in which we found that infant death rates among Indochinese refugees was lower in San Diego in the 1980s than among Hispanics, Whites, and Blacks. One of the reasons was that they were less likely to smoke. Yes, their husbands were quite likely to smoke (and that's not good, of course), but very few women smoked. Furthermore, babies were conceived almost entirely to women older than the teens who were married. These are all predictors of better birth outcomes, a topic I recently discussed.

U.S. Census Removes Its 2017 Projections from its Website--UPDATED

Thanks to Beth Jarosz for pointing out that the U.S. Census Bureau has removed its latest (2017) set of national population projections from its website, saying only that:

An error was identified in the 2017 population projections data release. All data files have been removed. Corrected news products and data files are forthcoming.

I most recently used these data exactly one month ago, so we will have to see if my conclusions in that blog post still hold when the revised projections are posted. 

UPDATE:

Today the Census Bureau has posted its revised population projections, with the following explanation of what happened:

The 2017 National Population Projections were revised after their original release date March 13 to correct an error in the calculation of infant mortality rates. The files were removed from the website on August 1, 2018 and an erratum note was posted. The error erroneously caused an increase in the number of deaths projected in the total population. The revised calculation in the infant mortality rate results in a decrease in the number of deaths and a slight increase in the total projected population in the revised series. The error did not affect the other two components of population change used in the projections series (fertility and migration). Additionally, major demographic trends, such as an aging population and an increase in racial and ethnic diversity, remain unchanged.

​The corrected data files are now available here.

Age at First Birth Tells Us a Lot about the Status of Women and Their Children

The New York Times today led with an interesting demographic story on the average age at first birth in America, and thanks to my good friend, Professor Rubén Rumbaut for sending me the link to it last night. The story is about starting families and my wife and I have been "vacationing" at home with the family we started several decades ago when we were ourselves married college graduates.

Becoming a mother used to be seen as a unifying milestone for women in the United States. But a new analysis of four decades of births shows that the age that women become mothers varies significantly by geography and education. The result is that children are born into very different family lives, heading for diverging economic futures.

[The analysis] was of all birth certificates in the United States since 1985 and nearly all for the five years prior. It was conducted for The New York Times by Caitlin Myers, an economist who studies reproductive policy at Middlebury College, using data from the National Center for Health Statistics.

The results are not necessarily surprising, but they reinforce other research findings showing that women who have their first baby at a young age tend to be disproportionately unmarried, not a college graduate, and more likely from a rural area. By contrast, the later ages at first birth tend to occur among college educated women, who are also more likely to be married and to live in urban areas. This matters more now than in the past because the growing inequality in income and wealth makes it ever more difficult to launch children in the direction you, as a parent, want them to go.

There has long been an age gap for first-time mothers, which has narrowed a bit in recent years, driven largely by fewer teenage births, Ms. Myers said. Yet the gap may be more meaningful today. Researchers say the differences in when women start families are a symptom of the nation's inequality -- and as moving up the economic ladder has become harder, mothers' circumstances could have a bigger effect on their children’s futures.

“These education patterns do help drive inequality, because well-educated women are really pulling ahead of the pack by waiting to have kids,” said Caroline Hartnett, a sociologist and demographer studying fertility and families at the University of South Carolina. “But if going to college and achieving an upper-middle-class lifestyle seems unattainable, then having a family might seem like the most accessible source of meaning to you.”

The law professors June Carbone and Naomi Cahn described in a 2010 book how red and blue families were living different lives. The biggest differentiating factor, they said, was the age that mothers had children. Young mothers are more likely to be conservative and religious, to value traditional gender roles and to reject abortion. Older mothers tend to be liberal, and to split breadwinning and caregiving responsibilities more equally with men, they found.

You can see, then, that the age at first birth is a key indicator of how a woman's life is going, and at the same time is a key predictor of how her children's lives are apt to turn out. 

How Important is Demography in American Politics? Part Two

One of the emerging issues in the increasingly polarized politics of the United States is the demographic divide being created by where people live. In the current configuration of the Republican and Democratic parties, Republicans tend to live in the suburbs and in rural areas, whereas Democrats tend to live in or near central cities. In theory that shouldn't matter when it comes to election time, but this week's Economist provides a civic lesson reminding us that the founders of the U.S. Constitution set up a system that effectively gives greater per-person electoral power to people living in less densely settled areas.

The source of this discrepancy is that Democrats will win their seats with big majorities in fewer districts, whereas Republicans will prevail by narrower margins in a larger number of districts. In 2016 Democrats who beat Republican opponents won an average of 67.4% of the two-party vote in their districts, whereas Republicans who defeated Democrats received an average of 63.8%. This imbalance is partly due to deliberate attempts to create districts that provide such results, and partly just down to the fact that Democrats tend to live more tightly bunched together in cities. Together, these two factors put up quite an obstacle. According to our model, the Democrats need to win 53.5% of all votes cast for the two major parties just to have a 50/50 chance of winning a majority in the House.

If this imbalance were limited to a single chamber of the legislature, or a single election cycle, the Democrats’ frequent carping about a stacked electoral deck might sound like sour grapes. All electoral systems have their oddities. But changes in where Americans live and contradictions in their constitution—a document designed to work with many weak factions that has instead encouraged and entrenched an increasingly polarised two-party system—have opened gaps between what the voters choose and the representation they get in every arm of the federal government. In recent decades these disparities have consistently favoured the Republicans, and there is no reason to think that trend is going to change on its own.

There are three underlying issues here. First, the Senate is deliberately set up so that each state has the same number of senators in order to keep the heavily populated states from dominating that chamber in the way that they can the House of Representatives. That aspect of the system is unlikely ever to change, even though a senator from Wyoming (the least populous state with scarcely more than a half million people) represents fewer than 300,000 people whereas a senator from California (the most populous state with almost 40 million people) represents 20 million persons.

Secondly, with respect to the presidential election, we have this strange thing called an electoral college system:

In all the world’s other 58 fully presidential democracies—those in which the president is both head of state and head of government—the winning candidate gets the most votes in the final, or only, round of voting. But due to the “electoral college” system that America’s founders jury-rigged in part to square the needs of democracy with the demography of slavery, this does not hold true for America. States vote in the college in proportion to their combined representation in both houses of Congress. This set-up means that a candidate who wins narrowly in many small and smallish states can beat one who gets more votes overall, but racks most of them up in big majorities in a few big states.

This could be changed, at least in theory, as could the third issue--gerrymandering of districts for the House of Representatives (as well as for many state and local issues). There has been a lot of action on this front, although most recently the Supreme Court has punted.