An ounce of prevention: policy prescriptions to reduce the prevalence of fragile families.

Isabel Sawhill, Adam Thomas, and Emily Monea believe that given the well-documented costs of nonmarital births to the children and parents in fragile families, as well as to society as a whole, policy makers' primary goal should be to reduce births to unmarried parents. The authors say that the nation's swiftly rising nonmarital birth rate has many explanations--a cultural shift toward acceptance of unwed childbearing; a lack of positive alternatives to motherhood among the less advantaged; a sense of fatalism or ambivalence about pregnancy; a lack of marriageable men; limited access to effective contraception; a lack of knowledge about contraception; and the difficulty of using contraception consistently and correctly. Noting that these explanations fall generally into three categories--motivation, knowledge, and access--the authors discuss policies designed to motivate individuals to avoid unintended pregnancies, to improve their knowledge about contraception, and to remove barriers to contraceptive access. Some motivational programs, such as media campaigns, have been effective in changing behavior. Some, but not all, sex education programs designed to reduce teen pregnancy have also been effective at reducing sexual activity or increasing contraceptive use, or both. Programs providing access to subsidized contraception have also been effective and would be even more so if they could increase the use not just of contraceptives, but of long-acting, reversible contraceptive methods such as intrauterine devices (IUDs) and implants. Finally, the authors present simulations of the costs and effects of three policy initiatives--a mass media campaign that encourages men to use condoms, a teen pregnancy prevention program that discourages sexual activity and educates participants about proper contraceptive use, and an expansion in access to Medicaid-subsidized contraception. All three have benefit-cost ratios that are comfortably greater than one, making them excellent social investments that can actually save taxpayer dollars.