The "hard truth of our economic turmoil is almost at term," as hospitals are beginning to report a decrease in the number of births, about nine months after "American banks first admitted their collective crisis," author Lauren Sandler writes in Slate's "The Big Money" column. Sandler writes that the trend is "hardly unprecedented," noting that the contraception business "was just about the only one booming" during the Great Depression. She asks, "Are market forces the great contraceptive?" Sandler continues that in the first few months of 2009, Nielsen reported a 10% increase in U.S. sales of condoms and emergency contraceptive pills. Additionally, sales of the permanent female contraceptive Essure have increased 28% over the past year, and clicks on physician profiles on Vasectomy have risen 40%. According to Sandler, Vasectomy's chief operating officer, Maya Wank, reports that many urologists say that vasectomies are increasing because patients' salaries are down, with many men seeking vasectomies out of fear of job or health insurance loss.

Sandler writes that the "tanking economy has delivered an awakening" that the "choice to have a child is probably the most serious, not to mention one of the most costly, that you'll ever make." According to Sandler, a Gallup poll found that 12% of women say they know someone who has delayed a planned pregnancy because of the recession. The poll also found that one in five women reports that she is more concerned about unintended pregnancy than she was one year ago, and the same number reports being more "conscientious" about using birth control. Additionally, the poll found that, compared with one year ago, 13% more women who use hormonal contraception are concerned that they will be unable to afford their birth control. Since 2008, there has been an increase of 15% in the number of U.S. residents who say they had to cut back on medications due to cost.

Sandler writes that it is "not surprising" that the National Network of Abortion Funds reports a fourfold increase in the number of calls from women who need assistance paying for abortion procedures. The Centers for Disease Control and Prevention also recently announced that teen birth rates are up after a 14-year decline. "In other words, the recession could result in a drop in birth rates for women with easy access to contraception and abortion," Sandler writes, adding that experts believe that women with "more limited access ... may see the rate climb." Sandler concludes that "it's not unreasonable to consider what things will look like if the middle class reduces its reproduction, while men and women who are struggling to even afford condoms expand their numbers despite their personal choice" (Sandler, "The Big Money," Slate, 5/17).

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