Donít let ignorance triumph in the US debate on family planning

Republican pledges to stop funding the biggest family planning organisation in the US fly in the face of health data, warns Howard Wainer

In 1849, social activist and statistician Joseph Fletcher published maps of England and Wales, with counties shaded to depict a range of social measures.

Most famous was his map of ignorance. In lesser hands, this could have been used to make invidious comparisons Ė but Fletcher had more profound goals. He juxtaposed this map with one of crime and observed that ďthe darkest tints of ignorance go with those of crimeĒ.

Fletcher advocated improving education to reduce ignorance and thence crime. In the century and a half since he died, that policy has been followed, successfully.

The lesson is clear. Fletcherís maps suggested ways to address social problems and provided a means to measure success. They made clear that to estimate the true cost of education, we must reduce expenditures by the amount we save through reducing crime. This step is critical to making practical decisions about the allocation of scarce resources.

Itís a shame, then, that in the US, a debate about resources utterly defies this long-standing approach. I am talking about attempts, sometimes successful, by right-wing politicians, especially in the Deep South, to cut funding for Planned Parenthood, a non-profit organisation offering family planning and sexual health services. Most of those hoping to win the Republican nomination for this yearís presidential election have taken this stance.

It only takes a Fletcher-like map of the incidence of four sexually transmitted infections (chlamydia, gonorrhoea, syphilis and HIV) across the US to show the ignorance of such rhetoric.

Those states with the highest overall infection rates are all in the Deep South. Climate is not a factor in STIs (unlike malaria or yellow fever), so why is this part of the country affected to such an extent?

What would jump out from such a map is that there are fewer Planned Parenthood offices in the southern states than elsewhere. Mississippi, for example, has the highest infection rates in the country, and only one Planned Parenthood office.

Contrast this with Connecticut, a state of comparable population, with one of the lowest syphilis rates and 17 Planned Parenthood offices.

Confirmation of this pattern, if any were needed, comes in a recent study published in the New England Journal of Medicine, showing a decline in use of some contraceptives and a rise in pregnancies in Texas between 2011 and 2014. In 2011, the state became the first to block public funding of Planned Parenthood.

When arguments are made about the expense of providing family planning education, we would do well to remember the costs of ignorance.