“Foundations” is an occasional series of informal question-and-answer sessions with employees and others affiliated with The William and Flora Hewlett Foundation to give them an opportunity to explain their work.
Peter Belden is an officer with the Foundation’s Population Program, which makes grants to enhance the reproductive health and rights of individuals worldwide. It also works with grantees across the country and in the San Francisco Bay Area to promote family planning and reproductive health. Belden leads the Foundation’s domestic grantmaking with a focus on reducing unplanned pregnancy and protecting reproductive rights. Before joining the Hewlett Foundation, he managed the San Mateo, California, clinic for Planned Parenthood Golden Gate. He also has worked on population issues internationally and as a fellow at the U.S. Agency for International Development’s Office of Population. Belden has an M.B.A. from the Graduate School of Business at Stanford University and a B.A. from the Woodrow Wilson School of Public and International Affairs at Princeton University.
Here, Belden discusses the Population Program’s work with one grantee to reduce the need for abortion in the United States.
Can you explain how Hewlett first decided to explore ways to reduce unplanned pregnancy and the need for abortion in this country?
In 2005, a number of foundations were discussing common values – places where the broad center of American opinion unifies on social problems that are otherwise polarizing – to see if they could help make progress on those issues. This led to an internal discussion here in the Population Program. The staff realized reducing abortion was one such unifying issue. While there is polarization about abortion, the American public widely agrees about the desirability of reducing the need for abortion in the first place.
At that point, the Foundation commissioned a year of extensive research to better understand the likelihood of success. Would there be support throughout a broad range of the public to work on this? What about support from a wide range of leaders? Would there be ways to measure progress on this issue? We conducted focus groups. We commissioned opinion research. We met with religious leaders, elected officials, and other civic leaders across the political spectrum. And the answers to all the questions were yes.
What else emerged from the research?
We explored what grantmaking strategies would give the Population Program measurable progress. The first is improving the delivery of family planning to those who want it. Research showed that this would result in large reductions in the need for abortion, in the hundreds of thousands. We also found that efforts to provide information about avoiding pregnancy had largely overlooked those ages 18-30. Practically no one provides sex education for sexually active young adults.
Several other opportunities emerged. Repeat abortions were one. At least half of all abortions in the United States are to women who have already had one abortion. In theory, helping them avoid another pregnancy that would lead to an abortion could cut the abortion rate in half. Raising low usage rates of intrauterine devices, or IUDs, and other long-term reversible contraceptives in the United States also has potential to reduce unplanned pregnancies.
How did the research lead you to focus on people in their twenties?
Sometimes research is helpful in pointing out new directions. It appeared that young adults in their twenties had been largely overlooked in terms of getting education about sex and family planning. That’s true even though 80% of all abortions are to women over twenty. So the core target audience of the effort became single adults throughout their twenties. Practically no one was providing sex education for sexually active people in that age range.
Why are people in their twenties so likely to have unplanned pregnancies?
It really shouldn’t be a surprise. People are thrust out into the world in their twenties. They may have had four hours of sex education when they were thirteen, and here they are, twenty-two years old, in a co-ed environment, probably sexually active, with alcohol readily available, and they don’t have anyone offering information tailored to them about these issues. There also has been a change in how people in their twenties live. Some researchers call this decade the “odyssey years.” Rather than immediately marrying and starting a career after they finish schooling, as once was typical, many more people today remain unmarried and unsettled in careers for much of that decade. It’s a time of exploration, but that often also means that those in their twenties are not ready to start families.
What came next for Hewlett?
The next step was to find a nonprofit organization that could work on this area of common values, and The National Campaign to Prevent Teen Pregnancy (with a slight broadening of its mission and a change of name) was the perfect candidate. It is a big-tent organization. It’s very deliberate about looking for support from both political parties, from different religious perspectives – a big tent ideologically, politically, in every way. That was crucial to us because we wanted to reach that broad swath of the American public that agrees on this issue.
This organization has always had a big focus on evidence. It’s interested in what works, and that also tends to reduce polarization. It’s hard to argue with being effective. The Foundation awarded the National Campaign a grant of $6 million a year for three years. That initial period is now close to ending, and the Hewlett Board just agreed to extend it with another $12 million.
How does The National Campaign to Prevent Teen and Unplanned Pregnancy go about its work?
Compared to the size of the problem, it’s a small organization. So it looks for places where a relatively small investment can have a big effect. The staff works on changing policy, which can have a large impact; with the entertainment media, which reach large audiences, particularly people in their twenties; and with religious leaders, who also reach a large audience. Community colleges are another focus. A lot of students don’t complete community college because of unplanned pregnancies, so community college leaders naturally have expressed an interest in joining this effort.
How does The National Campaign work with the entertainment media?
For one thing, it provides sitcoms and other television shows with facts about unplanned pregnancy, debunking myths that young adults believe about sex and providing other information that then finds its way into storylines. A lot of these shows have related Web sites where the National Campaign can share information. And it does outreach through its own Web site. The key is to be fun. It created a site called “Stay Teen” that lets teens upload their own video commercials about how to avoid teen pregnancy, offers advice about relationships, and has features like “Tell Us Your Sex Ed Horror Stories.” It’s all subject matter – the good and the bad – that young people find compelling.
But getting information to people is only part of it. Research indicates that often the problem isn’t that people won’t use birth control. It’s that they use it inconsistently or badly. When making any behavior change, it’s helpful to have continuing support or to be part of an informal club. So one exciting new thing the National Campaign is piloting is an online support system for women using birth control. It’s like an online trainer. It gives weekly tips and advice.
What does the National Campaign do with regard to public policy?
It creates an astounding array of documents, including analyses of proposed policies. It also responds to requests from policymakers and conducts educational briefings. Last year, the National Campaign had a briefing for policymakers in Washington called Contraception 101, which brought in doctors to answer questions about birth control. It works very hard to involve people from both parties and across the political spectrum.
What about working with religious leaders?
One approach is developing materials designed for particular communities, such as its recent publication “How Latino Faith Communities Can Help Prevent Teen Pregnancies.” Tailoring brochures and other information this way makes it more useful. More broadly, the National Campaign has a board representing a wide religious spectrum that offers advice on promoting personal responsibility, religion, and values.
How do you measure the National Campaign’s progress, and what are the signs thus far?
It’s too soon to expect that changes we see in the unplanned pregnancy and abortion rates would be a result of this small, emerging effort. And there is always a lag in the data.
While our grantees have been focusing on people in their twenties, we also know that after fifteen years of decline, the teen birth rate in the country went up for two years in a row, in 2006 and 2007. The birth rate for some other age groups also rose. And we don’t know what effect the current recession might have.
So there is cause for concern. But there also are grounds for optimism because there has been a lot of progress on the intermediate steps to turn things around. The entertainment media, which are crucial partners, have been enthusiastic about engaging young people in their twenties. The prospects for improved public policy look good. It’s not just a change in the administration. There’s a growing movement, of which the Foundation’s grantees are a part, toward reducing the need for abortion and reducing unplanned pregnancy. And it’s gaining steam.