Cascadia Scorecard Weblog

Say It Ain't So, Joe

I picked up a copy of the March issue of Seattle Magazine the other day, and happened across an article (print only, I'm afraid) by the estimable Joe Follansbee.  The article claims that Seattle suffers from an inferiority complex:  whenever Seattle residents compare their home town with Portland, Oregon and Vancouver, BC, they always decide that Seattle comes up short. Follansbee argues that Seattle should just learn to love itself just as it is, rather than falling victim to sibling rivalry.

Interesting enough idea.  But there's one thing that sticks in my craw:  in trying to puncture the reputation of neighboring cities, Follansbee claims that Portland has an unusally low number of children, compared with its neighboring metropolises:

Portland's downtown Pearl District, hailed as the embodiment of "smart growth"...had only three more children living there in 2000 than in 1990, according to demographers.  What's "smart" about a city without children?

Do we [i.e., Seattle] want to be like Portland, childless and..."proper"?

Enough already! This factoid--that Portland is devoid of tykes--is simply false. It doesn't even pass the 5 minute Google test; that is, it takes less than five minutes of web searching to see that it doesn't hold water.  And yet, it's a theme I hear again and again in discussions of Portland and smart growth generally.

It's high time to roast this chestnut.

As it turns out, what's true for Portland's Pearl District -- that there aren't many children -- doesn't hold true for the rest of Portland.  Take a look at the Census Bureau's Portland "quick facts." As of the last Census count, 21.1 percent of the city's residents were children under the age of 18, compared with 24.7 for Oregon as a whole. 

So the city does have fewer children than the state as a whole, by 3.6 percentage points.  But take a look at the Seattle "quick facts."  Minors account for just 15.6 percent of the city's population.  In comparison, Portland is teeming with kids -- 40 percent more, measured per capita, than in Seattle.  And the gap between Seattle and the whole of Washington is 10 percentage points -- nearly 3 times wider than the gap between Portland and Oregon.

So it makes absolutely no sense -- none -- to ask whether Seattle wants to be "childless" like Portland.

Admittedly, Portland has fewer kids than many US cities.  But it's pretty much on par with Denver and Minneapolis, has a few more kids per capita than Pittsburgh, and far more than San Francisco (where under-18-year-olds are just 14.5 percent of the population).  In Vancouver, BC -- often held up as an exemplar of family-friendly urbanity -- children under 18 made up only 15.5 16.6 percent of the population in 2001. 

Diving into the Vancouver numbers a bit deeper, it seems that there's no major part of Vancouver -- not downtown, not the west side, not even the semi-suburban south end -- that has a kids-to-population ratio that's as high as in Portland.  And the kid-to-population gap between Vancouver and the whole of BC is wider than for Portland and the whole of Oregon.  Vancouver's denser neighborhoods have a reputation for having lots of kids, and in large part they do -- but only because they have lots of people, period.  As a share of the population, though, Portland has far more kids than "kid-friendly" Vancouver.

I'm sure this post won't put an end to the urban legend of Portland's childlessness (although it may perpetuate the impression that there aren't many kids in the Northwest's other major cities).  But I hope it helps.

On a deeper level, I'm puzzled by all the hand-wringing about childless cities.  As of the last census, families with children comprised less than one in three Northwest households.  And the number of childless households is growing for good reasons.  We're having kids later in life, and fewer of them -- largely because of better educational and job opportunities for women.  Plus we're living longer, so seniors are making up a far larger share of the population than they used to.  For the large and growing number of childless households, urban living has a strong appeal -- they're the ones who appear to be flocking to housing in dense urban centers.  So to the extent that the trends towards "childless cities" is real, it's largely driven by demographic changes that we'd be foolish to want to reverse.

What do the angst-ridden commentators lamenting the lack of children downtown want people to do? Have kids even if they'd prefer not to? Die before they get a chance to down-nest?  Move their families to urban condos in order to save some single-family detached houses for hipsters?  Help me out here, folks.

Montana to Insurers: Cover The Pill

Late last week, Montana required that any insurance plan that covers prescription drugs generally may not exclude coverage for prescription contraceptives such as birth control pills. The Helena Independent Record reports.

 That’s big news because couples whose insurance covers contraceptives are more likely to choose the most effective forms (which tend to be expensive): pills, for example, rather than condoms alone. And better contraception means fewer unintended pregnancies and abortions. It also means that more children will be born wanted.

Among Cascadian states, California and Washington already require equal treatment for prescription contraceptives: California, by law; Washington, by ruling of the state Insurance Commissioner. In Montana, the action came in a binding legal opinion issued by the state’s Attorney General. Excluding contraceptives from prescription drug plans is sex discrimination, AG Mike McGrath concluded. The rule has the force of law unless it’s overturned by the legislature or a state court. The legislature is unlikely to do so: the state senate approved a bill to ensure equal coverage for contraceptives last fall, although the state house did not join them. It’s unlikely, therefore, that both houses would pass a law that reversed the AG’s ruling.

Plan B at Walmart

Walmart today reversed course on Plan B. Starting Monday, it will begin offering Plan B in all its pharmacies nationwide, as the Associated Press reports.

That's great news, because Walmart controls a huge share of Cascadia's pharmacy market share.

Over the long term, this development may have a bigger impact on our place's future than anything else in the news today.

Standing Up for Plan B

In Washington, the PI editorial board stands up for Plan B.

"The Washington State Board of Pharmacy is considering a policy to outline if and when pharmacists could refuse to fill prescriptions due to their personal moral, religious or ethical objections. Here's our suggestion: never."

In Washington, DC, Washington's US Senator Patty Murray does too.

Red States, Blue States, and Family Planning

Yesterday brought a number of articles on a report from New York's Guttmacher Institute on how the US states rank on efforts to reduce unintended pregnancies. (Go to full report; and a state-by-state ranking.)

Interestingly, both red and blue states (including New York, California, South Carolina, Alabama, and Alaska) were winners at helping women avoid unplanned pregnancies. But the reason is not too surprising: These states have taken family planning seriously, with steps such as funding programs to improve access to family planning, contraception and emergency contraception. They also know it's an economic issue as well as a social one: The report finds that every dollar spent on family planning can save up to $3 in health care costs related to a pregnancy.

Unfortunately, other states have stagnated in their efforts. From the WA Post article:

From 1994 to 2001, many states cut funds for family planning, enacted laws restricting access to birth control and placed tight controls on sex education, said the institute.

Despite some gains, the United States still lags far behind most industrialized nations in reducing abortion and teenage pregnancy. In 2002, 21 in 1,000 American women age 15 to 44 had an abortion. Although that is the lowest abortion rate since 1974, the decline has stalled, prompting fears that individuals and policymakers have lost focus on the underlying problem of unintended pregnancies, said Guttmacher President Sharon L. Camp.

The rankings were based on factors such as ease of access to contraception, state funding for sex counseling and support from state legislatures.

In the Northwest, Washington ranked 11th, Oregon ranked 9th, Idaho ranked 26th, and Montana 32nd. Idaho and Montana are two of the states where pharmacy access to emergency contraception--aka Plan B--isn't offered yet because the passage of Plan B was stalled at the Federal Drug Administration headquarters in DC. (See this article for an update.)

In good news, as we reported last month, the teen birth rate in Cascadia is at an all-time low.

Signs of the Echo Boom

Washington state just came out with new estimates of population increase in the state, breaking down the share of growth in recent years that resulted from migration (in-migrants minus out-migrants) vs. natural increase (births minus deaths).

Overall, the state saw a significant uptick in net migration in 2005.  From 2000 through 2004, the net inflow of new residents from outside the state had slowed quite a bit, compared with the late 1980s thorugh mid 1990s -- when in-migration was red-hot.  Now, after a cooling-off period, it seems that the state is attracting legions of new residents again.

Also interesting to note: after roughly a decade in which the total number of births remained fairly  stable, births are on the upswing again, reaching their highest level ever in 2005. (See the blue line on the right).  The period of relative stability in the number of births was, in a way, a fluke -- boomers were moving past their reproductive peak as the relatively small "baby bust" generation entered their prime childbearing years.  So even as pouplation grew, the number of births didn't.

Now, the "echo boom" generation -- the children of the boomers -- are entering their reproductive peak.  And we're seeing the fruits, so to speak, right now:  more babies born than ever.

At the same time, natural increase (births minus deaths -- the pink line in the chart) went up by a much smaller amount.  The number of deaths is rising along with the number of births, as boomers inch closer to retirement.

It'll be interesting to see if these two trends keep cancelling one another out.  Natural increase has been a surprisingly constant force in the state's population trends -- the slow-steady tortoise, compared with the on-again, off-again hare of migration.

Nativity Scene

Perhaps everyone else knew this, but I certainly didn't: most residents of the northwest US were born outside the state where they now live.  Roughly 53 percent of folks who live in Idaho and Washington, and 55 percent in Oregon, are transplants, born either in another state or country.  (For the record, I'm a wanderer too, born and raised on the east coast.)

For the most part, in-migrants came from other parts of the US, rather than overseas.  As of 2000, only 1 in 20 residents of Idaho, 1 in 12 residents of Oregon, and 1 in 10 Washingtonians were foreign-born. The rest of us came from other parts of the US.  (Of course, there's some overlap here; some folks who were born in, say, Washington now live in Oregon. So there may be quite a few people who didn't move far -- but the Census site where we got these numbers couldn't tell us specifics.) 

British Columbia, on the other hand, has a substantial population of international in-migrants: 1 in 4 residents of the province were born in another country, mostly in Europe or Asia.

I have no larger point here -- other than a bit of surprise that, for a place that seems to have inspired genuine loyalty among its inhabitants, our roots may be a bit shallower than I'd thought.

Shrink Rap

Demographers are projecting that population in some parts of the globe -- Russia, the Ukraine, Japan, much of Western Europe -- are set to decline over the next 50 years or so.  Of course, the talk of a shrinking population seems to send some people into a panic, which is why you occasionally see stories decrying the new "population crisis" -- not too many people, but too few.

The Economist has this to say about the doomsayers:

People love to worry—maybe it's a symptom of ageing populations—but the gloom surrounding population declines misses the main point. The new demographics that are causing populations to age and to shrink are something to celebrate. Humanity was once caught in the trap of high fertility and high mortality. Now it has escaped into the freedom of low fertility and low mortality. Women's control over the number of children they have is an unqualified good—as is the average person's enjoyment, in rich countries, of ten more years of life than they had in 1960. (Emphasis added.)

That seems just right to me.  And the article makes some other worthwhile points too -- including that economic output per capita is a far better measure of the health of an economy than total output.  Measured by total output, a place with a shrinking population could seem to be in economic decline, even if the average person is getting wealthier.  (Of course, even better than total output per capita would be a measure that looks at how the poor and middle class are faring.  Still, policymakers should keep in mind that per capita measures of economic health are more significant than total output.)

Babies Not Having Babies

Some more good, or at least interesting, news for 2004:  teen birth rates in Cascadia hit an all-time low. There were just under 27 live births per 1,000 women between the ages of 15 and 19, according to final data for the year.  That's probably not just the lowest rate in recent history, but the lowest since humans first inhabited this place.

(Just to be clear: we spend a lot of our time comparing trends in BC, Washington, Oregon, and Idaho -- the main political jurisdictions whose rivers flow through the temperate rainforests on the Pacific Northwest coast.  For short, we call the region "Cascadia."  End of public service announcement.)

Teen births throughout the region have fallen by about 57 percent since 1970.  But they've fallen unevenly, as the chart shows.  In the Northwest states, teen pregnancy rates are about half of what they were in 1970.  In British Columbia, however, teen pregnancies fell by an astonishing four-fifths over the same period.  Or, said differently -- teen birthrates in BC and the Northwest states used to be quite comparable.  Now, the teen birthrate is more than three times as high in the Northwest US as in BC.

As with many social and environmental trends, BC more and more looks like, well, it's in a different country than Washington, Oregon, and Idaho.  Gasoline consumption, sprawl, health, teen births -- on these measures and many others, BC substantially outperforms the Northwest states; and on many of them BC's lead just keeps getting bigger.  I'm not sure what this means; perhaps nothing. But it may also be a sign that the politics and cultures of these neighbors are gradually diverging.

Regardless, given the similarities in climate, language, and history between the two halves of Cascadia, the differences between BC and the US Northwest demonstrate--fairly convincingly it seems to me--that minor differences in policy and outlook can gradually add up to huge differences in outcomes.

Make Room!

The good ship Cascadia has another 227,000 passengers.

The US Census Bureau has issued population estimates for the states, which allow us to give an updated Cascadian population tally. As of July 1, 2005, the region – counting British Columbia, Idaho, Oregon, and Washington – had 15.6 million people. (Adding western Montana, southeast Alaska, and northwestern California pushes that figure up by another million or so, but running the county-by-county figures takes more time than I’ve got at the moment.)

The (four main jurisdictions of the) region added 227,000 inhabitants over the preceding 12 months. That's about the number that live in greater Olympia, Washinton. And it's a 1.5 percent increase, the largest since 1997.

The resurgence stemmed from rising domestic migration into the region. Natural increase (births minus deaths) remained stable at around 70,000 per year, as did international migration at around 50,000 per year. (International migration is hard to tally reliably at present. As the Census Bureau’s American Community Survey comes online, we’ll be able to track it better.)

The extra 227,000 Cascadians, especially the adult migrants, bring new resource consumption, pollution, and traffic as they arrive. But just to be unpredictable today, let me point out that they also bring new talents, productivity, and resources with them.

One dimension of in-migration that’s little noted is the way that growing populations allow more-rapid transformation of metropolitan areas. Cities that don’t have growing populations do not have many opportunities to build complete, compact communities, filling in their urban form. And compact communities can actually reduce resource consumption among their residents. It’s conceivable, in fact, that adding population--if it goes into the right kinds of smart-growth neighborhoods--might lead to such large per-person reductions in resource consumption that the aggregate total remains unchanged or even diminishes.

So migration brings big challenges (about which there’s more here) but it also brings opportunities.

Population Puzzler: Unwanted Pregnancies and Abortion Trends

Last week, the National Center for Health Statistics issued the results of a survey revealing that the share of American births that resulted from unwanted pregnancies increased from 9 percent in 1995 to 14 percent in 2002. (Seattle Times reports here.)

That’s bad news. It’s also puzzling.

It’s bad news because babies conceived by accident, when mothers do not want to have a child (or another child), tend to have what social scientists call “adverse outcomes,” as discussed here. They’re more likely to have bad prenatal care, die in infancy, fare poorly in school, and suffer violence at the hands of their caregivers.

It’s puzzling because so many reproductive trends have improved since 1995. Pregnancy rates overall have fallen, as shown in this chart for Oregon . . .

. . . especially among teens, as shown in these charts for Oregon . . . 

. . . and Washington.

Birth rates overall have fallen. Access to emergency contraceptives has expanded dramatically, as has insurance coverage for prescription contraceptives.

All of these positive trends would make you expect that the share of births that result from unwanted pregnancies has also declined. But the opposite has happened, at least in the United States overall.

The trend is less contradictory within Cascadia. Washington has the best data on unwanted births over time, and they show hardly any change—or hardly any change that’s greater than the margin of error. At best, there's been a tiny decrease in unwanted births.

Still, you’d expect that drops in pregnancies and births would lead to equally dramatic declines in unwanted pregnancies. You’d think, in fact, that improving pregnancy prevention would show itself first and foremost in a declining share of pregnancies that are unwanted. Instead, everything is shrinking dramatically except the “unwanted” percentage!

What’s going on here?

I don’t know.

The Alan Guttmacher Institute (AGI) in New York is reportedly in the midst of an analysis of this puzzler, and I hope they’ll figure it out. In the meantime, let me underline my ignorance by explaining why the obvious answers are probably wrong or, at least, inadequate.

Pro-choice advocates argue that the survey results are a sure sign of deteriorating access to abortion services, which is plausible. In Idaho, Oregon, and Washington, the number of abortion providers is lower now than it was two decades ago. In 1981, there were more than 160 abortion providers in these states; by 2001, there were fewer than 100, according to AGI.

And the next chart, comparing the share of pregnancies ending in abortion (excluding miscarriages) in British Columbia and Washington, lends further plausibility to the theory. In British Columbia, where abortion providers have not decreased in number to the same degree, abortion has grown as a share of all pregnancies. In Washington, it's shrunk.

Harassment and intimidation from extremists explains some of the drop in abortion providers, but economic consolidation has also contributed. Abortion services have become a specialized medical subdiscipline, concentrated in the hands of fewer providers who are, in general, very good at what they do. First-trimester surgical abortion, therefore, may now be safer and less expensive, in inflation-adjusted terms, than ever before. Convenient, nearby access to safe abortion services does not extend to small-town residents in the inland parts of Cascadia, but most women who want an abortion can get one, by traveling to a city--the same place they have to go for many other surgical procedures.

Anti-abortion advocates have a different exlanation for the rise in unwanted births. They suggest that Americans are demonstrating, in the words of an official at the U.S. Conference of Catholic Bishops, a “pro-life shift.” American women may be exercising their freedom to choose by electing to have fewer abortions. This explanation also has some plausibility. Abortion rates are lower in more-conservative states such as Idaho than in more-liberal states such as Oregon and Washington. Maybe a cultural change is making the whole country more like Idaho. (And maybe the Washington-BC divergence in the chart above is explained not by changing access to abortion but by changing social values.)

Maybe, but I'm dubious. For one thing, British Columbia has the same anti-abortion movements, the same media influences, and the same medical technology (such as ultrasounds that make fetuses seem like babies sooner) as Washington. But abortion trends have diverged.

For another, if the United States were experiencing such a shift, the recent survey should have found not only that “unwanted” pregnancies but also that “mistimed” pregnancies were being carried to term more often. In fact, if a “pro-life shift” were the cause, one would expect a more dramatic increase in the share of births that resulted from merely mistimed (or “too soon”) pregnancies, rather than from pregnancies that were truly never wanted at all. Women who found themselves pregnant a few years before they intended to be (and were swayed by anti-abortion arguments) would almost certainly be the first to forgo abortions, not the smaller number of women who found themselves pregnant despite their wish never to have a child (again). Wouldn’t the easy cases by “shifted” before the hard ones?

The Center found no such shift.

Between the Center’s 1995 survey (careful, enormous pdf) and its 2002 survey (careful, even larger pdf), in subset after subset of American women (young, old, married, cohabiting, Hispanic, white, first-time mothers, third-time mothers, etc.), there’s a marked increased in the share of births that women report as having resulted from unwanted pregnancies. There’s no comparable change for births that result from the far-more-numerous mistimed pregnancies.

(Oh--and just to muddy the waters futher--the same reasoning also counters the suggestion that a paucity of abortion providers explains the rise in unwanted births. If barriers to getting abortions were the problem, it would presumably afflict the more-ambivalent mothers of "mistimed" births even more than it afflicted women with unwanted pregnancies.)

This unwanted-mistimed patter is so unusual that I wonder, did some wording change in the survey skew the response? (The survey report claims the wording was identical.) Did 9/11/2001 shift women’s attitude retroactively, making them less sanguine about childbearing, and less positive about their births? (Seems unlikely, given that the survey was taken many months later and that it covered a five year period.) Did the Center’s statisticians just make a mistake?

And even if there is some statistical fluke explaining this national survey, why isn’t the Washington state “unwanted” number (and it’s similarly static “mistimed” number) dropping with the pregnancy rate?

My own partly formed suspicion centers on the fewer than 10 percent of sexually active women (and their partners) who do not regularly use contraception and therefore account for about half of all mistimed and unwanted pregnancies. If everyone but them is getting better at prevention, their pregnancies may loom larger in national and state statistics. (There are flaws with this theory, too, but it’s the best I’ve got at the moment.)

Anyone else care to theorize?

Young at Heart

I'm not sure what to make of this, but it's interesting anyway:   Young and Restless in a Knowledge Economy (pdf document), a report on how different urban areas around the US have fared in attracting new residents who are young and well educated. 

Now, the report's author clearly believes that attracting talented and entrepeneurial 25-to-34 year olds is a key determinant of a city's economic vitality--a perspective that I'm not entirely sure that I share.  (I think, for example, about this Brookings report that shows that cities can have little population growth but plenty of economic growth, as measured by income per capita.) 

Be that as it may, the report has a couple of very interesting nuggets about Seattle and Portland.  First, central Seattle (or, really, Seattle within a 3 mile radius of the central business district) saw the fastest population growth rate for young adults of any major city the authors looked at.  Between 1990 and 2000 the number of residents between the ages of 25 and 34 in and around downtown Seattle grew by more than a quarter.  This is especially striking since this group includes the "baby bust" generation born during the low-fertility years of the early 1970s; nationally, the absolute number of people in that age range fell over the decade, as the baby boomers aged and were replaced by the baby busters.  (For example, outside of a 3 mile radius from downtown Seattle, the late-20's to early-30's population in the greater Seattle area fell by 5 percent.)  So the bigger demographic trends make the concentration of young people in Seattle all the more remarkable.

This trend -- Seattle attracting lots of young adults -- shows itself in other ways as well.  In 1990, 25-to-34 year olds were slightly more likely than the average Seattle resident to choose a home close to downtown.  But by 2000, they were much, much more likely to choose a home near the city center.  Among the cities the report considers, only in Chicago do young people show a greater predilection for living in or near downtown.

Now for Portland.  The city ranked third, behind Seattle and Denver, in attracting young adults to the urban core; the population of 25-to-34 year olds in the neighbhorhoods surrounding the city center grew by a little over 20 percent. But Portland's suburbs also did surprisingly well in attracting young people.  In fact, metropolitan Portland ranked 3rd among all cities in its "relative attractiveness" to young adults -- the 25-to-34 demographic grew 9 percent faster than the population overall, despite the fact that nationwide the absolute numbers of people in that age group fell.

Much has been made about how few kids there are in Northwest cities.  (A year ago, the "fact" that there are more dogs than kids in Seattle made the rounds -- with some interesting discussion in David Sucher's City Comforts blog.)  And there's more than a grain of truth here -- there really aren't a lot of kids in the city limits of Portland and Seattle, relative to the to total size of the population.  This report may give some clues about why that's so.  Well educated women tend to have children later in life; and many of the new young adults in Portland and Seattle have completed 4 year college degrees.  So even though Seattle and Portland have attracted lots of people in their peak childbearing years, they seem to have been particularly attractive to precisely the kinds of people who delay childbearing, or who choose to have smaller families. 

Which leads to an apparent irony -- the very same trend that some folks are treating as a harbinger of economic growth is causing others to wring their hands over the "childlessness" of the cities.  But for my part, I'm not sure that these trends are worth celebrating or condemning. They just are.

Plan D for Plan B

NARAL Pro Choice America is supporting a bill in Congress to force FDA off the fence on Plan B. (Via TomPaine.com)

The bill is dubbed "Plan B for Plan B."

(Oh, and about the title, we've already used  "Plan B for Plan B" and "Plan C for Plan B," which left us with "Plan D . . . ")

Plan B: Ignore Science, Destroy Evidence

The saga of malfeasance at the Food and Drug Administration over the emergency contraceptive Plan B just keeps getting worse, as detailed in today's New York Times. (Find earlier episodes here.)

The Government Accountability Office, a nonpartisan investigatory arm of Congress, has released its report on how FDA has handled Barr Pharmaceuticals' application to sell Plan B over the counter.

The findings are damning. Among them:

• Well before FDA scientists had evaluated Plan B, according to GAO, four senior FDA officials were told by their superiors that Plan B would be rejected.
• Top FDA officials intervened in agency decisionmaking, overriding the recommendations of expert review panels and agency scientists, in ways that were "very, very rare."
• The rationale given for overruling those scientists was "unprecedented."
• All of former agency administrator Dr. Mark B. McClellan's emails and other correspondence about Plan B were destroyed, in apparent violation of federal rules.

GAO is notoriously careful in its wording. So it wouldn't be unreasonable at this point to read into these carefully modulated terms official confirmation of our worst suspicions: the Bush Administration's appointees at the FDA ignored the science and ran roughshod over one the most respected and impartial federal agencies to placate its political base. Then it launched a cover up.

Are we getting close to the territory reserved for special prosecutors?

I make these strong charges without partisan rancor. The intensity of my indignation is fired by the knowledge that ready access to emergency contraception reduces both the abortion rate and the teen birth rate. Every month that passes without over-the-counter emergency contraception means more unwanted pregnancies. Unwanted pregnancies lead overwhelmingly to abortions, which--no matter how strongly you support the right to choose--are no one's idea of a public good. To a lesser degree, they lead to births--births of babies who tend to be poorly cared for and at great risk for all manner of ills. And these unwanted pregnancies all could have been prevented with emergency contraception.

As if that tragic waste weren't enough, there is the horrifying prospect of a thoroughly politicized FDA. Let your imagination extend this precedent from emergency contraception to all manner of other pharmaceuticals and, I suspect, you'll share my deep concern.

Docs Take the Gloves Off

(Back from my three month sabbatical, I lament writing a first post that rehashes bad news. But this item simply must be marked again.)

The Kaiser Daily Reproductive Health Report has assembled published opinion from around the United States on the FDA's scandalous further delay on Plan B's application for over-the-counter status.

Highpoint: A medical doctor and his coauthors write in the staid New England Journal of Medicine:

"The recent actions of the FDA leadership have made a mockery of the process of evaluating scientific evidence, disillusioned many of the participating scientists both inside and outside the agency, squandered public trust and tarnished the agency's image."

They have also kept the abortion and birth rates higher than they need be.

Abstinence Makes the Heart Just As Fond

An interesting piece of research from Case Western Reserve School of Medicine suggests that students who completed an abstinence-only sex education showed an increase in "their HIV/STD knowledge, their personal beliefs about the importance of abstinence and their intentions to remain abstinent in the near future."

That's a good thing, right? Not so fast. Abstinence-only education changed what students said about abstinence. But it didn't make them any more abstinent -- and worse, it may have encouraged a slight increase in risky sexual activity.

...the program did not affect students' avoidance of risky sexual situations. In fact, female students and students already sexually inexperienced reported a decrease in their intent to use condoms.

The study also found the program did not significantly reduce the likelihood the teenagers would engage in sexual intercourse or to use a condom consistently.

Just another example in which actual results trump good intentions.

Plan B: I Quit

The Director of Women's Health at the Food and Drug Administration, Susan Wood, resigned today in protest over the agency's delay on a decision to approve the emergency contraceptive "morning after" pill, sometimes called Plan B, for over-the-counter use. Late Friday afternoon, the FDA stated that they would neither approve or reject an application to allow women over 17 to get Plan B without a prescription, citing "unresolved regulatory issues." In response, Wood cited unwarranted interference in agency decision-making in her choice to leave.

The FDA science staff has overwhelmingly favored approval of improving access to Plan B, but the agency has twice delayed the approval, and stated this time around that a formal and "possibly time-consuming" rule making process would be needed for approval. It seems that in what should be a science-based process, the FDA may be bowing to political pressure from the Bush administration and anti-abortion activists to keep the drug off the market with endless delays.

Seven states have already approved over-the-counter access to Plan B, including Washington, and all Canadian pharmacies now offer emergency contraception without a prescription. As we've written about here, and here, universalizing one-stop access to emergency contraception at pharmacies is one of the best public policy options toward reducing the number of unintended pregnancies—perhaps by as much as half. Children conceived intentionally receive better prenatal care and have lower infant mortality rates. Approving better access to Plan B sounds like a good plan for women's health, it's no wonder that Wood said that her employer's actions were "contrary to my core commitment to improving and advancing women's health."

Population Gains & Losses

New official population data released today by Washington's Office of Financial Management. The estimates--and they're just estimates--are for every town, city, and county in Washington and 2005.

Here's a quick look at the top 10 fastest growing cities over the past year...

	City	New residents in 2005
1	Federal Way	2,210
2	Sammamish	2,080
3	Vancouver	1,900
4	Yakima	1,800
5	Maple Valley	1,590
6	Mill Creek	1,560
7	Issaquah	1,550
8	Renton	1,480
9	Kennewick	1,440
10	Covington	1,420

And the top 10 cities for population loss from 2004 to 2005...

	City	Loss of residents in 2005
1	Bremerton	-2940
2	Bellevue	-1000
3	Shoreline	-240
4	Lakewood	-160
5	Tukwila	-130
6	Mercer Island	-120
7	Burien	-90
8	Pe Ell	-61
9	Des Moines	-60
10	Kirkland	-60

Future Passed? Notes From Buckley, Washington

Editor's Note: Dan Staley, a frequent commenter on the Scorecard blog, will contribute an occasional column on land use and quality of life from Buckley, Washington, a small town near Mt. Rainier where Dan serves as planning director. This is his first post.

I bicycle a short 5-8 miles to work in Buckley every day, taking different routes through a beautiful pastoral landscape that is full of little surprises. For the past two weeks, I’ve been taking the same route to work and home, in order to see a small herd of elk hanging out on the north side of the White River. These elk are important indicators of Buckley’s future, and I want to be sure I get to know them--at least a little--as I help set the pattern for Buckley’s growth.

I’m the new planning director for Buckley, located in eastern Pierce County, Washington. Buckley’s current population is about 4500 people, all nestled in between the White River and the northern foothills of Mt. Rainier. Buckley also has the last flat land before you head up into the Cascades--and that is the crux of the future challenges we face, being within commutable distance of Seattle and Tacoma and their high-paying jobs.

The citizens of Buckley--like many in the Northwest--are unequivocal in their wish to maintain their quality of life. Folks moved out here to be under Mt. Rainier and to have open space all around--including space in their yards. However, land speculation is rampant and many here wonder what this means for the future of Buckley, as we expect to grow by about 3500 people-–45 percent--in the next 10-15 years. Eric recently wrote about salmon being a canary in a coal mine, and Buckley may serve that same function for many cities on the rural fringe.

So. How do we maintain such a quality of life in the face of land speculation and impending development, while planning for the goals of the Growth Management Act? Do we approach this challenge like so many other towns in Washington are facing, even though we are unlike many of these towns? Do we adopt New Urbanism, even though it doesn’t have a formal theory (it is more like art and science) and we're an exurb? How much do we affect the real estate market to meet Buckley’s goals?

All planners manipulate markets when they plan--zoning arose because cities have externalities ("nuisances"). I have to justify my intervention in the real estate market to meet GMA guidelines, and in my mind, I’m justifying it by making Buckley resilient--as in how an ecosystem is resilient. I avoid concepts like "resilient" or "sprawl" with my neighbors, however, so I explain how it benefits them as individuals: their kids can buy a house here, there are preferred designs, we are making walkable neighborhoods. I also cannot use "sprawl" or "resilient" with decision-makers, so I explain how it benefits the elected’s constituents: efficient services, maintained or improved quality of life, strong businesses.

Oh, and the elk will still be around, too.

Buckley is like a little ecosystem out here, and I want to keep it that way. Please pass along your thoughts on these issues, especially regarding resilience or how you are making your place work.

Three Years After The Morning After

The headline is pretty self-explanatory: 'Morning-after' Pill Doesn't Increase Unsafe Sex. (Well, at least it didn't in Britain, where the study was done.) A pdf of the actual article from the British Medical Journal is here.

Note that Washington State was the first state in the US to allow pharmacists to dispense emergency contraceptives without a doctor's prescription, serving as a model for California, Alaska, New Mexico and Hawaii, as well as for British Columbia. See more here.

They're Kidding, Right?

From The Oregonian comes an article decrying the "baby bust" in downtown Portland, OR, and contrasting it with the baby boom in Vancouver, BC.

Now, as much as I like a good pun in a headline (and 'No Kids on The Block' counts, in my book) I found the article both annoyingly alarmist and factually misleading.

First, the article seems to suggest that the low number of kids in Portland's trendy Pearl District is some sort of crisis:

The numbers are startling. During the past 10 years Portland has built about 6,400 units of new housing in the Pearl District. But school district demographers say only 25 school-age children live there, and fewer than 20 babies are expected a year.

Now, to be sure, that's not a lot of kids. But what does it matter, really, if there are a few neighborhoods in a huge metropolis that appeal more to the childless -- empty nesters, young singles and couples, and people who choose to remain childless -- than to families with kids? Does that somehow prove that the Pearl District is a bad neighborhood? Clearly, the people who flocked to live in the Pearl District didn't think so.

And then, there's the comparison with downtown Vancouver, BC, which does have a lot more kids than downtown Portland. But from what I can see, the Vancouver central city has more kids largely because it has more people, period: lots of new residents--including some with kids, or inclined to have them--have moved into a revitalized and booming downtown. But residents of downtown Vancouver are still a very low-fertility bunch. As the graph to the right shows, lifetime fertility rates in downtown Vancouver have been stuck at about 0.6 children per woman (look down the linked page for "City Centre") since 1990. By comparison, the so-called "replacement rate" -- the level which, if maintained over the long term, leads to a stable population -- is 2.1 children per woman, more than 3 times as high as the rate in downtown Vancouver. Notably, fertility rates in downtown Vancouver haven't declined as they have in the rest of the province, but the lack of a baby bust isn't the same thing as a baby boom.

The real point of the article, I guess, is that downtown Vancouver offers some good lessons in how to create dense downtown neighborhoods that work for both kids and their parents -- lessons that Portland could take to heart. That's fair enough. But still, given that Portland's downtown renaissance is literally decades behind Vancouver BC's, it seems awfully premature to declare childlessness in the Pearl District to be a sign of some sort of urban malaise.

State Says Population is Da Bomb

Washington's population growth appears to be picking up a bit of steam:  the state added 88,600 new residents over the past year, according to the state Office of Financial Management (OFM). That was 20,000 more residents than the state added during the previous year.  And compared with 2 years before, the pace of population growth increased even more, rising from .9 percent per year in 2002-2003, to 1.4 percent in 2004-2005.  All in all, it's a fairly signficant uptick.

Now, demographers look at two distinct trends when analyzing population growth:  natural increase (births minus deaths), and net migration (in-migrants minus out-migrants). Most of uptick in growth last year stemmed from increased in-migration; on net, Washington attracted more newcomers over the past year than it had since 1997. And since new residents typically are attracted by jobs and rosy economic prospects, the OFM press release seems almost giddy about its news:

Reflecting a stronger economy, Washington State's population has grown by an estimated 88,600 people, or a healthy 1.4 percent, in the past year, Theresa Lowe, the state's chief demographer, said Tuesday.

Population growth hasn't been this robust since the early 1990s, Lowe said. It compares to an increase in 2004 of 68,500, or 1.1 percent.

But hold on a second there, bubs.  The OFM describes an increase in population growth as "healthy" and "robust."  In other words, state officials are shilling for more new residents, and trying to get the press to cover rapid population growth as an unmitigated boon, rather than a mixed blessing.

That, to me, is simply a conceptual error. An uptick in population growth may be a sign of a good thing (an improved economy), but isn't necessarily a good thing in itself.

At its current pace, the state is growing fast enough to fill a city the size of Tacoma or Spokane in a little over two years.  No matter how you slice it, that's rapid change. And at last year's growth rate -- 1.4 percent per year -- the state will double in population before today's newborns turn 50.  That's the problem with exponential growth; year-to-year change seems minimal, but over time it really adds up. Just take a look at the graph -- in just over a century, the state's population has multiplied twelve-fold.  And that growth -- and the attendant sprawl -- has taken a toll on the lowland ecosystems of Puget Sound, on air quality, and so on.

Now, setting aside for a moment the environmental concerns, it's not completely clear that population growth does any good for the economy. It certainly does benefit some sectors -- the home building industry loves it.  But growth has costs, too, including higher taxes to pay for new roads and schools (new development rarely pays its own way). More generally, as this Brookings Institution report details, fast population growth doesn't necessarily bring an increase in overall economic wellbeing; some places with slower-than-average growth have faster-than-average increases in per capita income, and vice versa. 

In short, I simply don't think it's appropriate for the state OFM to take on a role as advocates for population growth--and I have to wonder what political forces are in play that can lead them to  act more like cheerleaders than sober-minded analysts.

Update: I fixed some typos and dangling sentences. Also, see here for our analysis of the OFM's population growth figures.

Further update:  Ok, I just took a closer look at the OFM's actual figures for the components of population growth (see this pdf), and the only thing I can make of it is that the OFM press release is pure politics. 

According to the chief demographer, "Population growth hasn't been this robust since the early 1990s."  But look: the percent growth rate was the same in 2001 and 1999, and higher in 1998.  Similarly, the absolute (not percent) population growth numbers were higher in 1997 and 1996, as were the net migration figures.  All were substantially higher in the early 1990s.  So what they meant by "robust" or "early 1990s" is a mystery to me.

Which suggests to me that the OFM press release was mostly an opportunity for some needless, unhelpful, and frankly disingenuous puffery.  Grrr.

Sustainability's Purview

Michael, a thoughtful reader of our Fundamentals blog, posted a comment about our proposed principle, Ensure every child is wanted, in which he asks: "[This] goes beyond sustainability's purview, doesn't it?"

NEW has long argued that family planning plays a significant role in a range of sustainability issues, starting with our book Misplaced Blame back in 1997, and as recently as our latest book, Cascadia Scorecard 2005 (pdf)--not to mention as a regular feature of this blog.

But what do you think?

Does "Ensure every child is wanted" belong on our short list of sustainability principles?

Don't leave your comment here, though. Navigate to our full discussion of principles and values and give us a piece of your mind!

US Population Growth Slows

US population grew by slightly less than 1 percent from 2003 to 2004, according to new Census Bureau figures. In both 2003 and 2004, annual US population growth was slower than it was from 1990 to 2002, when the annual rate averaged more than 1.2 percent. (In the big scheme of things, 1 percent may not sound like much, but it's enough to double the population every 70 years. If the US continues to grow at 1 percent per year, the country will number almost 600 million people by 2076.)

But none of that stuff made headlines as did the news that Hispanics comprised half of the nation's growth. People who identify themselves as being of Hispanic origin now make up about 14 percent of US residents--about one in seven.

The Northwest states have a substantially smaller share of Hispanic residents than the rest of the country. According to the 2000 Census, Hispanics make up 7.5% of Washington, 8% of Oregon, and 7.9% of Idaho. New state-level figures will be released soon.

Cloudy Forecasts

Washington State just issued revised population estimates--and they upped their forecast for population growth from 2000 through 2010 by 110,000.  Just a year ago, the state was predicting that the state would add about 745,000 new residents over the decade, with just over half from net migration (more people moving into the state than out of it). But the new forcast predicts 855,000 new residents, with higher rates of in-migration as more people are attracted to the state by a strengthening economy.

What seems particularly interesting to me, though, is the way the population growth estimate has moved around over the past 7 years:

It's not as if the estimate got better and better, homing in on the right number as the decade went on.  It's far more random than that -- perhaps a sign that forecasters recognized a little too late what the consequences of a recovering economy might be.

Now, this isn't meant as a critique of Washington's state demographers -- just as a reminder that the future is really, really difficult to predict, even if it's your job.  Which is one more reason to take all sorts of predictions--from population to market prices to resource availability--with an appropriately-sized dose of salt.

Plan B for the Beaver State

Oregonians may not need to wait for the FDA to get over-the-counter access to the emergency contraceptive Plan B.

While the FDA stalls, the Oregon Senate approved a bill on Tuesday by a lopsided 22-6 margin making the medicine available without a prescription, as the Kaiser Daily Reproductive Health Report notes.

This is great news. If the Oregon House follows suit, Oregon's abortion rate and unintended birth rate will both decline, and it's population growth will abate slightly.

The Corvallis Gazette-Times has more.

Plan B in Canada

I missed this when it happened on April 22. Emergency contraceptives are now available without a prescription nationwide in Canada, as Medical News Today reports. They were already available in BC.

Plan B, Rape, and the FDA

The Nation has a disturbing investigative report about Dr. David Hager, who is probably the man responsible for putting the kaibosh on Plan B’s application for approval as over-the-counter medication last year. (We’ve chronicled the Plan B story here, here, here, here, and here.)

A leading voice among fundamentalist conservatives on women’s health care, Dr. Hager is accused by his ex-wife (also a fundamentalist conservative) of sexually abusing her repeatedly over many years. And the juxtaposition of these accusations of marital rape and Dr. Hager's actions at the FDA point, in the end, to why over-the-counter access to Plan B is so essential.

To understand Dr. Hager’s role in the emergency contraception travesty, you must know that an FDA expert advisory committee reviewed all the evidence on Plan B more than a year ago and voted 23 to 4 to make it available over the counter. Dr. Hager was a member of the panel, appointed by the Bush administration; not surprisingly, he voted with the minority. One panel member in the majority, professor Julie Johnson of the University of Florida’s Colleges of Pharmacy and Medicine, said, "I've been on this committee...for almost four years, and I would take this to be the safest product that we have seen brought before us."

FDA, to the shock and dismay of expert observers, ignored the panel’s advice and asked for more information, specifically on whether over-the-counter access to Plan B would encourage young teens to have unprotected sex. That question was, according to panel members, thoroughly answered in the negative by studies they reviewed. A new study answers it again, even more emphatically: over-the-counter access does not encourage young teens to have risky sex.

By January 2005, FDA was supposed to announce its final decision. Now, five months after the deadline, FDA hasn’t made a peep. Washington’s US Senator Patty Murray is pressing FDA for action: she’s placed a “hold” on confirmation of the Bush Administration’s nominee for FDA administrator (though he’s fulfilling the duties anyway, as acting administrator).

Why FDA ignored the expert panel’s advice has always been a mystery, though the obvious presumption is political interference from the White House or its appointees on the panel, prominent among them, Dr. Hager. Reinforcing that hypothesis, here’s what Dr. Hager said in a speech recently, as reported by Ayelish McGarvey in The Nation:

"I was asked to write a minority opinion that was sent to the commissioner of the FDA.... Now the opinion I wrote was not from an evangelical Christian perspective.... But I argued it from a scientific perspective, and God took that information, and He used it through this minority report to influence the decision." [Emphasis added.]

None of the four panel members I spoke with for this article were aware of Hager's "minority opinion." An FDA spokeswoman told me that "the FDA did not ask for a minority opinion from this advisory committee," though she was unable to say whether any individual within the agency had requested such a document from Hager.

The document, apparently, articulated the arguments and questions presented by FDA in its request for further information a year ago. This fills in one part of the mystery about FDA actions around Plan B—actions that the American College of Obstetricians and Gynecologists termed a "dark stain on the reputation of an evidence-based agency like the FDA."

What’s so profoundly and disturbingly hypocritical about Dr. Hager’s actions is that he has prevented over-the-counter access to Plan B for at least one year. And ready access to Plan B lowers both the abortion rate and the unwanted pregnancy rate. It’s one thing that pro-choice and anti-abortion forces ought to agree on. During that year, tens of thousands of American women who would have used Plan B were it readily available at their pharmacy instead took their chances after unprotected sex. A few thousand of them became pregnant and had abortions or gave birth to babies that they hadn't intended to conceive.

Even more poignant, the actions that Dr. Hager’s ex-wife accuses him of—raping and sodomizing her while she was, initially, in a deep sleep from narcolepsy medication—is a perfect example of the kind of case in which women most need over-the-counter, no-questions-asked access to Plan B. Dr. Hager’s ex-wife, like many women who are raped by their husbands, was mortified by the abuse. She spoke of it to almost no one.

The article doesn’t say, but I’d surmise she would have been far too intimidated to speak with a doctor and ask for a prescription for Plan B, if pregnancy was a risk in these rapes. (That is, if she was not using the pill or an IUD and if neither she nor her husband had been sterilized.) After all, her husband was a leading Ob-Gyn in their community and the famous author of a Christian medical text called As Jesus Cared for Women.

Rape inside of marriage is an ugly but shockingly common crime. Professor Vera Mouradian of the National Violence Against Women Prevention Research Center at Wellesley College in Wellesley, Massuchesetts, has summarized published research on its incidence. She concludes that, during their lifetimes, 10-14 percent of women are raped by their husbands or boyfriends on at least one occasion. And, overall, between 20 and 40 percent of all rapes are perpetrated by husbands and boyfriends.

Roughly 9 percent of births in Washington State--and a much larger share of abortions--result from unwanted pregnancies, as we discussed here. The figures are similar in Idaho and Oregon, and a bit higher in the United States overall. What share of these unwanted pregnancies stem from rape, I do not know.

But I do know that the last thing rape survivors need in those first terrifying hours after an attack is obstacles in their path when they realize they could become pregnant. The FDA’s stonewalling is unconscionable. Let's hope that the The Nation's investigation puts a national spotlight on the issue and forces action.

UPDATE: WaPo has more (registration required) on this.

The Pill Turns 45

Today is the 45th anniversary of the legalization of birth control pills in the United States. There's a nice synopsis on Writer's Almanac.

Article of the Day

William Saletan, always a perceptive analyst of US politics around abortion and reproductive health, has a perceptive Slate column on the alleged surge in pharmacists refusing, on conscience, to prescribe Plan B.

Like Saletan, I've been reading the news stories on this alleged controversy and finding them overblown. There's not much of a trend, and that's good news, whether you're concerned about lowering the abortion rate or protecting women's rights or, like me, doing both.

Boise Goes Big-Time

According to new data, Boise is probably now the third largest city in the U.S. Northwest. With an estimated 208,000 residents, it is larger than either Spokane or Tacoma, its two principal rivals. On average, Boise has added more than 5,900 people each year over the last decade.

Seattle and Portland, of course, are still much bigger--each is easily more than twice the size of Boise. For comparison, Seattle has been adding about 4,100 new people a year, while Portland has been adding nearly 7,800. 

Nit Picky

I was a bit confounded by this, from KUOW radio...

Teen pregnancy is down in Washington State. That’s the good news. The bad news is pregnancy rates among young teens have gone up.

Hm.  Here's what the state says is actually happening (see the spreadsheets for Table 1/Table 2 for actual data):

There was the teensiest of upticks between 2002 and 2003, but the longer-term trend is looking very good -- young teen pregnancies declined by about 40% between 1997 and 2003. Now, I have no quibble with the state program--aimed at reducing young teen pregnancy--that KUOW is reporting on.  And I hope I'm not nit-picking. But there's no real reason to declare that pregnancy rates among young teens are rising when the evidence doesn't really warrant it.  (Thanks to NEW intern Jessica Branom-Zwick for the heads up.)

Plan C for Plan B

American Progress Action Fund has a fiesty, partisan synopsis of the latest turn in the saga of Plan B, the emergency contraceptive. (The chronicles of Plan B are here, here, here, and here.)

To wit: Washington's US Senator Patty Murray is trying to use the leverage of confirmation proceedings for the new