conclusion that same-sex relationships are not good for kids. some of the studies that have suggested that the kids didn't do so well in, with same-sex couples were done during an era or a period of time when because of the stigma and the lack of legalization of marriage, the kids were being born in somewhat unstable circumstances. they might have been the product, for example, of an opposite sex marriage, and then later that couple broke up, and the gay or lesbian parent moved into a same-sex relationship, and the children came with that parent. and that led to some instability in the lives of the children, and that, most researchers believe, is not a good thing for kids. in the future, it will be very different. and my book, which ron was nice enough to mention, talks a lot about people drifting into

parenthood. and i use the word "drifting", very cautiously, because i think that's a lot of what's happening. this is unplanned pregnancies and births, but in the same-sex world, by definition, when people have kids, they do it by choice. now we had another very interesting chapter on the extent to which marriage matters for child well-being. is a child who grows up in a two-parent family better off than a child that grows up in a one-parent family? are children in married families better off than children in co-habiting families, and this adds to all the literature on those issues, and basically all of that literature, of which there's a ton now, has led, i think, presiden think, pretty much to a consensus that on average, on average, growing up in a

two-parent married family is better for kids than not. that said, you have to then ask, well, why should marriage matter? and one reason it matters is simply because the people who marry are a self-selected group. they have other characteristics like income and education. and this author david rieber goes through all those reasons and in the end concludes that all of them have some evidence of making a difference for children's lives, and that if we wanted to replace marriage, for example, with government programs that made up for the lost income of the second parent or other things of that sort, we could do that, but it wouldn't fully replace the benefits that children now derive from marriage itself. we had a lot of debate around the production of the volume and

amongst the authors about whether or not or why there's been this decline. everybody agreed there was a decline. the issue is why. and these are the usual factors that get debated and talked about. women's new opportunities have made them clearly less dependent on marriage. it's no longer something they need for their economic well-being. and then there's the argument that men, especially less-educated men, have not been doing well in the labor market. declining employment and earnings. and that has made them less marriageable. and this the lack of marriageable men, it is argued, has been a contributing factor to the decline in marriage. finally, there are arguments about whether government programs are inhibiting marriage, because if you marry somebody that has additional income, you may become ineligible for various programs,

and that may discourage marriage. and ron haskins in his chapter does a very nice job of reviewing that and other government programs, including marriage education programs and some others that we'll get to. and then, of course, there's been a huge change in the culture in attitudes about marriage. i like to talk about just how our language has changed around these issues. used to be that we called someone who had a baby outside of marriage, we called the child an illegitimate child. i mean, as recently as three or four decades ago, we used that term quite commonly. we wouldn't think of doing that today. we called people who were co-habiting living in sin. imagine using that term today. so that's just an illustration of how much attitudes and culture has changed here. brad wilcox who was a big advocate of how we need to change the culture, bring back

civil institutions and religious institution to support marriage wrote a very nice chapter with his co-authors on that set of issues. and i would say there were some differences of opinion between the group of authors about the relative importance of all of these factors, but everybody agreed that you can't just say it's one or the other. you can't just say it's economics or culture, for example, it's both. so this is probably the most, my last and most important slide here. and the one you're probably most interested in, which is, well, is there anything we can do about these trends if we think they haven't been ideal for children. and the bush administration pioneered a set of marriage education programs, and thanks to ron haskins and others, those programs were very carefully evaluated, and by the time we produced this volume we finally had the results. and the results are not very

encouraging. they didn't show that we were able to move the needle vetch using marriage education programs. some people would say, well, we need to try harder. we need a new generation of such programs. and that's a legitimate argument. other people argue that we need to reduce the so-called marriage penalties in both tax and benefit programs. we've done a fair amount of that already. it's very expensive to do it, because it requires moving el jibt for those programs quite far up the income scale, and when you do that, you're getting into the thicker part of the income distribution, and it's costing you a lot of money, and there isn't a huge a evidence that it moves the needle behaviorally. so that's an issue, but i don't think it's one that has got a lot of promise to it. finally, we have here or not finally, but second to last, we have improving either mens or

women's economic prospects, and hoping that that will help them to marry or form more stable unions, at least. that's been a big issue of debate of late. and one of the most interesting chapters to me, probably the most interesting chapter in this whole volume is the one by danny schnyder, professor at berkley, who looked at 15 social experiments, all designed to improve the economic status of either men or women, usually more disadvantaged men or women, all of the programs have been evaluated using randomized control trials. and most of them were focussed on looking at what happened to the economic status of the recipients, compared to a control group. but many of them, 15 of them, actually had evidence on what happened to marriage. and what he finds is that with two exceptions, out of the 15,

improving male economic prospects did not move the needle on marriage. for women, it did. for women, there was a lot more increase in marriage rates after a program improved their economic prospects. so i'll let you mull over why that might be. a final issue here is one that we're going to spend, hopefully, the rest of the morning talking about or most of the morning. and that is reducing unplanned pregnancies. when you think about what i started with, which is marriage has declined, but people are still having kids. and then you think about who's having the kids, it's mostly younger women, women in their 20s, and 60% of those births to young, single women are unplanned, according to the women themselves. and that's from the government data with a sample of 20,000 people and so fort.

-- forth. and i think that's pretty solid, although we can debate what this nuance, what this unplanned means. if that's the case, and one way to improve the prospects of the children and help the women as well is to enable them to only have children when they really want to have children and feel ready. and that would mean they would be older, more mature, more experienced, completed their education and more likely to be in a stable relationship with a stable partner. so this is a very promising direction and one we're going to talk more about, because what came out of this entire effort to produce this volume was that this was one of the few areas that we saw where you could probably make some difference. and you're going to be hearing, now, from some people who know a lot more about that. so i'll stop and turn this back to ron.

>> thank you, bell, so bell already gave my introduction for me, which is, if you're really interested in marriage and think marriage has a big impact on children's well-being, and then we look around for interventions that have an impact, according to good studies, random assignment studies, pretty much the only thing that really has consistently shown an impact are -- thank you. the only thing that's consistently shown an impact is reducing non-marital births. and there's some evidence, i would not say it's scientifically persuasive, but women who do not have out of wedlock births have a greater chance of subsequently marrying. there's also studies on women who have not had an out-of-wedlock birth have a more stable marriage and so fort. so if someone's interested in marriage, this would be something that they would focus

on. not that they do in the real world, and we'll get to that in a few minutes. this is the strategy that makes a difference. and in and of itself it make as difference for several other things which i'm going to talk about right now. so that's why we selected in a volume on marriage, we selected the topic of non-marital births and birth control. all right, so first of all, we've had this enormous increase, bell talked about this a little bit. if you're like me, you forget stuff in about five minutes. so five minutes is up, now i'm going to repeat it. the message here is extremely important, which is we've had an onslaught of non-marital births. so if there's something that results from non-marital births that's not good for the country or not good for children or not good for couples, then it's a problem, and it's getting worse and worse and worse. i would direct your attention -- i'm not going to talk about this too much, but there has been a certain amount of stability over the last -- depends on what measure you use, but over the

last decade. and in fact even more than that if you look at the rate of non-marital births per thousand women between -- i think the date is 18 and 54 or something like that, has been pretty stable for over two decades. so we still have these enormous rates, and as bell said, over 40% of kids are born outside of marriage. so it's a big problem. but for some reason it seems to have slowed down an a little bit. so that's a good thing. now here comes an aspect of this i think often is missed by people, and that is, who is having all these non-marital births? we always like to be politically correct and don't like to point out who's doing something that could put their kids at risk or who could take actions that result in more government spending and so forth, so here you can see there are big ethnic differences between cross blacks, hispanicing, and whites.

you know about the family composition and the thesis basically that blacks are not going to be able to take advantage of all the rights that they're winning in the 1960s because the black family has disintegrated. and that of course was extremely controversy a i don't recall any academic fight, maybe over bell curve was the only academic fight i can think of that was so intense and nasty. it was really ugly. and now we have come and basically the volume says moynahan was right. now what do we do? because we, it's spread throughout the whole society. and in fact, the rated for white births now is higher than it was when moynahan wrote his alarmist report about the impacts on blacks. but anyway, so if it does bad things, there are going to be differences among ethnic groups. and equally bad, the same thing is true -- the same thing is

true of education level. so moms with less education are more likely to have a non-marital birth. moms with less education are less likely to have a non-marital birth. so i wouwe have the most disadvantaged groups in our society having more non-marital births. there's one fact that's undeniable. and that is they are much more likely to live in poverty, and i have not yet met anybody who makes the claim that poverty is good for kids or for adults. so five times the rate. can you think of any intervention that produces an impact of five times an experimental group better than the control group? we don't have many like that. and here it is, kids are five times as likely to be poor if they're in the single-parent family, which, by definition, every non-marital birth is a single parent familiar limit so clearly there's a big impact on poverty. and then if you want to just summarize, which is what i'm trying to do here, there are many, many other outcomes that

there's at least one what i would call decent study, and for many of these there's a whole literature featuring random assignment studies. so you have reduced poverty rates, which there's no question about that. a lot of evidence that the lower abortion rates. because win who are pregnant outside marriage are more likely to get an abortion. there's a lot of evidence on better spacing of babies, which is good for the kids and for the mother. there's an increased likelihood of prenatal care. i didn't know this until recently, kids who are i think twice as likely to get prenatal care if they have a planned pregnancy rather than an unplanned pregnancy or a birth outside marriage. there also is less postpartum depression among moms who have planned pregnancies. there are reduced partner separation rates. more education for the mothers. bell has written about almost all of these things, and there are a loltd of study the now on cost savings for government. i think that the, maybe the

numbers are somewhat exaggerated sometimes, but the very good review of the evidence shows that large, the benefit-cost ratio is about $7 of benefits for every dollar of costs, and that does not include any of the long-term benefits. and there's a wonderful review of literature by martha bailey, university of michigan that shows big, long-term impacts, in fact in the second generation, moms who avoid early births have kids that do better than moms who do have early births. the kids do better. they grow up to get more education, less welfare and so forth. so no one has taken those measures into account as far as i know, and it's definitely not included in the 7/1 figure. so this is a spectacular list of advantages. and if we could do something about non-marital births, the mother would be better off. the child would be better off, the community they live in would be better off, and the nation would be better off, and the government would save money.

that's a pretty good list of benefits. now we have, in the last decade or maybe a little more, come increasingly to realize that lars. hong and acting reversible contraception, which includes iuds and sub dural implants, and last up to ten years, that they can have a huge impact on pregnancy rates for women who want to avoid pregnancy. so this data's from one study. the st. louis study. as far as i know every study has shown roughly this same kind of thing, and it's the probability that a woman lo get pregnant if she's on various types of birth control. so if a woman is on pill patch or ring, she's nine times as likely to get pregnant as if she's taking an larc. and, as i say, i wouldn't focus on the exact ratio here, but it's huge. and many studies have shown

this. if birth control produce good outcomes and larcs are the best form of birth control for ensuring that women don't get pregnant, then we want to folk a lot of attention on larcs. and that's what we want to do their morning. we do have some barriers. i do want to mention this now, i invited people to come talk on the panel who are experts in these issues so we're going to reflect on these in more detail. we've already talked about cost. in this case, the initial cost of an larc is more than the initial cost of the pill, but in the long run, especially if it lasts for a decade, it actually saves money, and not to mention the impacts which also saves money. so in the long run, this is the typical thing that the government faces. if up spend the money now. you don't have to spend it later. provider training is an issue. it's become addressed thanks in part to mark edwards here. there are a lot of administrative issues. you have to have it available on

site, and people available on site. s so you don't want women to come in and say they want birth control and choose an larc and then come back in a week. that's a bad approach. we need better patient education about what the various forms of birth control are. we don't want a situation where women feel like think are pressured into taking larcs or any other form of birth control. so we have a great opportunity, and that's one of the main reasons we want to have this event this morning. i think it was a main factor behind bell's book and definitely, bell was involved in establishing the national campaign on unplanned pregnancy. they are a great organization. if we could measure these things accurately, they've had an impact on the decline especially amongst teens on non-marital birthrates. we're on the right track. the question is how can we do it

more effectively, and if we could, a lot more benefits would flow. so the rest of our event, we hope to elucidate that issue a little more clearly. next we're going to have lieutenant governor -- don't get up yet. i have a 15-minute introduction here. it begins with your mother and her background, you know. so lieutenant governor northam was kind enough to agree to drive all the way up here i guess we would say, to washington, to talk at this event. we had the idea, because he's the governor, a politician's talk we all know that. but very few of them can write more than a sentence. i spent a lot of time with policymakers. i know this to be true, and yet he wrote an editorial about what he hoped virginia would do with regard to reducing non-marital births and mentioned larcs and so forth. it was a very nice column. and i thought wow, who is this guy. by coincidence, the next week i met him because we were meeting about preschoolers. this is one of his focuses.

since he's been an elected official has been preschool. it turned out well, and they were able to clear his schedule, so he came. so he is a doctor. he's pied yeah trick neurologist, he has an undergraduate degree from virginia military institute and a medical degree from eastern virginia medical school and he's not only lieutenant governor but active in practice, plus he teaches. so, you know, he doesn't get a good night's sleep very often. and, as i said, his political career began in 2008 when he was elected to the virginia state senate and he's been lieutenant govern since 2013. i want to tell you that i know for sure that he's a very open-minded individual. and the reason i know that is that his son is a, doing his residen residency, thank you for that complicated term. residency, at the university of north carolina, chapel hill, which is not overry popular in virginia. so you can tell he's a very

open-minded gentleman. so lieutenant governor, thank you very much for coming. [ applause ] >> well, good morning. and ron, thank you so much for the kind introduction. my son wes, we have two children, he's doing his intern in neurosurgery at chapel hill. that was not exactly his first choice, but being a virginian any port in the storm. but he's enjoying it down there and working hard and having a good experience. bell, thank you so much for your comments, and i really appreciate the opportunity to be here this morning. it takes me away from norfolk, which is where i practice medicine and the city of richmond, which is our capital in virginia. so it's nice to get a day up in the nation's capital, and i would like to also take this opportunity to thank the brookings institution and as well as princeton for all of the great work that y'all are doing. one might ask, why is a

pediatric neurologist before you this morning talking about contraception? and i will try to go through in the next maybe ten to 15 minutes and explain that. but, as a practitioner, as a pediatric neurologist and also as a policymaker in the commonwealth of virginia, the concept of contraception and, as a way to decrease unintended or unplanned pregnancies, also to decrease the number of abortions, not only in virginia but in this country and our society, and also to increase the health and well-being of our children and their families. so it's an important concept from both a practitioner and a policymaker, and i want to just go through those steps with you a little bit this morning. i, as ron said, i, a lot of people don't realize the lieutenant governor, at least on paper in virginia, is a part

time job. so, unless one is independently wealthy, which, ron, i am not, then -- i know you are. that's what i wanted to clarify things. so we continue to have another job. and my job is being a pediatric neurologist. so about three to four days, depending on what's going on in the schedule, i see about 15 to 18 patients a day. a lot of my patients are teenagers. and when weagersteenagers, from the 15 to 19 year old age range. we see patients after 18, but most of my population is starting prenatally up until 18 or 19. and interestingly a lot of my patients are epileptics as you may imagine or perhaps have mieg rains but are on medications that can affect the health and well-being of a fetus.

so we deal with individuals in that age group who become pregnant, and those become interesting discussions and dilemmas for a lot of these folks. so, to be able to prevent those pregnancies, especially in that time of one's life is very important. a second comment i would make is that we see a lot of individuals, as pediatric neurologists in the neo-natal intensive care unit, and we are able to maintain life and now 22 to 23 week fetuses. newborns. and for better or worse, that becomes somewhat of a challenge in a couple ways. the morbidity, as you might imagine, in a 22 or 23-week fetus is very high. there are some outcomes, but not all of them are good outcomes.

so if you look at financially ha happens to take care of these babies, probably, a conservative estimate would be $1 million up to $4 million to $5 million, up to a year plus in our neo-natal intensive care units. and what i have found, in taking care of these individuals, because when you take care of babies, you also take care of parents. in this case, most of the time mothers. but while that baby is in our hospital, in our nic u as we say, oftentimes the mother will become pregnant with her second or third baby. so how can we stop that process? and i see these individuals in my office as well when usually the mothers bring the families in, and the mother may be less than 20 and have one, two, or three children.

and so i describe it as this kind of vicious cycle of poverty. and so as a physician i have watched that during my 25 years of practice, and then it carries over into policy-making. now so when we talk about ways that we can help these families, and i have been to home visits and, by the way, i probably won't talk about that a lot, but if you want to help these mothers and their children, we have found, at least in virginia, and i think in other places, if we can get into the home and help them get back on track, that this is one of our best investments. and we're actually looking at that concept in the commonwealth of virginia. so how do we take this data and move it into the policy area. and that's my other life, and that is making laws in the commonwealth of virginia.

so we're, there's a diversity or two different concepts, if you will, that makes it somewhat challenging policy wise. and personally, i fieel that if we want to bend that curve of poverty, if you will, if we want to decrease the rate of unplanned pregnancies. if we want to decrease the number of abortions, the best way to do that is through education and through access to health care. ie, and this is why we're here this morning, to talk about larcs. i just want to talk a little bit about the reality of policy-making in virginia and we're not here to throw stones this morning, but i did want to talk about what the philosophy or the approach of some other individuals who are policymakers. and so if you've been keeping up with the news in virginia over

the last couple of years, in ste 2012, we had the infamous vaginal ultrasound. and that was to, i think most people would agree, to deter or to make it more difficult for women who had chosen that avenue to have abortions. and the way that ralph got in the middle of that discussion is that i'm the only practicing physician, only physician, period, in the senate. so when it came time for someone to get up and debate the issue, what better person than a pediatric neurologist, right, to talk about vaginal ultrasound. so it was a little bit of a learning curve for me, ron, but we made it through. and we actually were able to educate folks and say that the purpose and the response from having a vaginal ultrasound really didn't add a whole lot. it's very costly. so we had that bill and we took care of that. and then we have a bill that was

proposed too, that women that had miscarriages should report that miscarriage to the police, hey, really? how about reporting it to your provider or your physician? we've also had the infamous personhood bill, which is not only a state bill, but it's been a national piece of legislation. and the personhood bill says that conception or life starts with conception, and so the concern over the personhood bill that, and if we, i don't know if we'll get into how contraceptives work, but it possibly could make most forms of contraception unlawful in the commonwealth of virginia, and it also would make in-vitro fertilization unlawful. and then we had the trapp laws that were intended to shut down some of the women's reproductive health clinics in virginia. so it's one approach, education and access to health care, versus the other pieces of

legislation. and the, the trick is how to, you know, bring these folks together, sit down at the table and come up with a consensus. and so what happened in colorado and st. louis is just very powerful data. and over a five-year period, at least in colorado, and i will quote that study, the number of unplanned pregnancies went down 40% in the 15 and 19 year age group. and the number of abortions went down 42%. and those are good numbers. and so, you know, i think the message that i try to give my colleagues in richmond is let's at least agree that the less abortions the better. so if we can agree on that, then we can move forward, and then i will start talking about some of the data from st. louis and colorado to hopefully make the case that this is, i see, a good direction to go in.

so that's what we're involved in. two last points i'd like to make, and i certainly don't want to go over my time limit. i see these cards over here, one minute, three minutes, i feel like i'm in a debate, and i start having flashbacks. [ laughter ] but i did want to make [ inaudible ] >> i promise you, i don't want to do that. but we have, there are two more issues i just want to talk briefly. the first is the affordable care act, which, as you know, covers all forms of contraception and as part of the affordable care act we have medicare expansion, which is an option for states. unfortunately, in my opinion, virginia has chosen not to expand medicaid and what that does, we have all paid in through our taxes to the federal system, to support the affordable care act, really, all we're trying to do is bring that money back to individual tastat,

in this case, virginia, to provide coverage for up to 400,000 working virginians, and i would underline the word "working." these are individuals that have maybe one, two, three jobs, but the costs of health care have gone up much faster than their salaries, so they don't have coverage. and these folks who don't have coverage are women, who end up not being able to minimum wage choices for larcs, for example. they are mentally ill who don't have access to providers, don't have access to the medications, end up in the emergency room or in the jail and penitentiary system, and believe it or not, are veterans, and having, i now ron and i both marine and army. but it's good service, nonetheless. [ laughter ] but these are our veterans coming home from afghanistan and iraq. and i tell people, the least that we can do is to provide those folks that have risked their lives for our freedoms the access to quality health care. and from a business perspective,

just very quickly, about $4.5 million, the commonwealth of virginia is contributing to surrounding states who we compete with over politics. and since january of 2014, when we had the option to expand medicaid, we have given away more than $2.8 billion with a "b." and that's a lot of money that we could use for education and health care and transportation. so finally, what are we doing in virginia? and then i will come to a close and take questions. we are very committed to the health and well-being of our children and families. and for the first time in administrations in virginia, the governor formed a children's cabinet. and there are several individuals that sit on that, but within the children's cabinet, we have a, and i know this is a mouthful, but the commonwealth council for childhood success. and we're looking at several areas. the first of which is pre-k education.

we feel very strong. and that, by the way is a nonpartisan issue. the chambers are very enthusiastic. we know there's a tremendous learning potential in our children before they ever reach kindergarten. so we applied for a grant. we received a grant of about $70 million over four years, so we're using that to provide access to pre-k across the commonwealth of virginia. we're also looking at child care. as you all know in our economy, most parents are both working. so it's important to have accessible and affordable and quality child care for our families, and then we want to make sure that our children are healthy, that their immunizations are up to date, that three have good nutrition. so all of these issues are being looked a but one of the areas -- and i'll close on this -- that we spoke on this just a minute ago are home visits. so when one goes into the home and sees a single mother who has perhaps two or three children, and i have gone into the homes, how can we help that family?

and, again, we help that family through education. and we help them with access to medical care, i.e. contraceptions to really get them out of that rut, if you will, or that vicious cycle of poverty. and that's where the use of larcs comes in. and when you talk about different types of contraception, whether you use oral contraception, the birth control pills, were you use condoms, whether you use larcs. i mine, tean the data is clear these are very effective, up to 99%, which in mid sin, you don't get up to 99% very often. they are becoming more affordable. there is now an iud for $50 that will help with the cost of health care. and also they're reversible. so what a great opportunity to h help single mothers get on a path of helping their current

children, become being educated, being able to obtain a job and be productive members of society. so the larc is a great concept. so anyway, that's kind of my background as a clinician, as a policymaker and maybe just a few quick comments on what wheee're trying to do in the commonwealth of virginia to decrease the number of unintended or unplanned pregnancies, to decrease the number of abortions and to make it healthier for our children and their families. so thank you, ron for allowing me to say just a few words. i look forward to your comments and your questions. thank you very much. [ applause ]

>> thank you, lieutenant governor, that was very nicely done. i can tell by talking before and knowing about your background and talking to people who know you and listening to your printation that you're a person of substantial reason. and you appear to be willing to give some credit to people who don't see things the way you do. in a couple of states, including colorado, and at the federal level, there appears to be politics that are extremely

difficult. and people's minds are made up. and they are in cement, and in the case of colorado, it resulted in a not funding a program that had pretty strong evidence of success. now it's my understanding the private foundation or individual has picked up the slack, but they might not do it permanently. so here's my question to you. you're on the front line here. you just described your involvement with several issues having to do with birth. and so what, have you found it helpful? what, what, how do you approach people on the other side who are against policies that would spread birth control? >> that's a great question. and it's a challenge that we have, because in virginia we have 40 senators, and 100 delegates, and they come from very diverse parts of the commonwealth of virginia, and they bring with them, you know,

different, i guess different attitudes, different experience, and so i think that one of the ways that we're going to plan to move forward with this is to use the data from, from colorado and st. louis and look at what it's done for the well-being of families and children. and also what it has done financially. and so sometimes when we talk to our fellow legislators, they don't always believe in science, which we have talked about that a little bit earlier, but if you put it to them in a manner where you talk about the data, and also how it can be cost saving to the commonwealth of virginia, virginia's a very conservative state. we balance our budget each year, which is a good thing. so i want to give you a quick analogy of how i've done this or how we have done this before. but back in 2008 the governor asked me to patron a bill to

eliminate smoking in restaurants. and if you can imagine virginia being very conservative, tobacco being a big part of our economy in the past, that was my first year in the senate, like thank you very much governor for asking me to do that. but i talked about the science as a pediatrician, what second-hand smoke, the ill effects of that, and also the costs to our health care that are exposed to second-hand smoke. so the first year it passed in the senate, was defeated in the house. the second year i reached out as we're talking and continued to educate folks on both sides of the aisle, and we were able to get that passed the second year. one of the things, though, that helped with that. politicians like to be reelected. as you all may realize. and so every two years in

virginia, the delegates run for reelection. every four years the senators. so we actually did some polling, talking to individuals across the commonwealth. and in that case, 70% of the population said that they would like to go into a restaurant and not be exposed to second-hand smoke. so we presented that data as well and were able to move forward. so i think you use creative thinking perhaps, changing semantics. but coming at it from different angles. and things happen in policy-making in small steps. so you take one small step at a time. but this is what i plan to do this year, and i didn't mention, and i'll, i don't mean to be so long-winded. but part of our commonwealth council for childhood success, we have offered about 25 recommendations to the governor that we will be acting on this year in the general assembly. and one of those recommendations is to increase funding for

access to larcs across the commonwealth of virginia. so i will be taking this message on the road, if you will, and also to my fellow legislators. >> one of the arguments when i first started understanding and read studies that appeared to show, and let me say, many of these studies are not random assignments. so we always have to leave, be a little bit cautious about the results. but having said that, the big studies. iowa, colorado, st. louis, and now a big study by the bixby center at the university of california, san francisco that is random assignment, randomly assigning 40 clinics around the country, and ones that emphasize -- >> unplanned pregnancy. >> i'm sorry, unplanned pregnancy, in half. so that's pretty good evidence.

during those studies, i don't know what they found in the bixby study. but they showed reductions in abortion. and some of them were quite substantial. so would this, do you think that's an effective argument? i, by the way have used it often and discussed it with my republican colleagues and didn't seem all that impress bid reduction in abortions which really surprises my. you think that that would be a leading argument. >> ron, i hope that it will be. and whether you want to talk about gun control or gun violence or the number of abortions, i think that's the first step is you have to reach out to your colleague and say, do you agree with me that we have too many abortions. and the less abortions in the commonwealth of virginia would be better. and if you do, if we can agree on that, then how can we, you know, change that, that curve or that number. and so, it's, it's almost, in my

mind, hypocritical, if one says that they want to decrease the number of abortions, but they're opposed to contraception. you can't have it both ways. so my first question would be, let's decrease the number of abortions. and if so, one of the best ways of doing that is to provide women with education, as i said earlier, but access to quality and affordable health care. i.e., to be able to make the decision whether they want to, you know, take a long-acting reversible contraceptive, so that's the way weel'll move forward. >> i just wanted to follow up on that, because it's on the same wavelength, which is i would think the other argument that you might start with is what about the government cost? >> absolutely. >> and i'm wondering, do you have any data in virginia, even you know, rough data on how much you can save in medicaid and

other programs if you can reduce unplanned pregnancies. you mentioned the very high cost. >> yes. >> of these babies that are born at very low birth weight. and that's very interesting. but i'm wondering about bigger numbers on medicaid generally. >> no, we do have those numbers. and, you know, we, you mentioned, i think, a great figure that i think people can hang their hat on. for every dollar that we invest in access and education you save $5 to $7. and that's a pretty good investment, i would think. >> yeah. >> so that will be something that we, a piece of data that we use. and the point you maid, biell, and i probably didn't articulate it as well as i could have, but to have a, let's say a 23 or 25-week infant that has been in the hospital for let's say five or six months, that has cost the taxpayers several million

dollars. that's just the start. >> right. >> and we do have numbers of what it costs to take care of that individual, especially if they have problems like, you know, if think have ventricle peritoneal shouldn'unts. and the other thing, morally, is it fair to a child and what does that do to a family? so all of these, i think, are strong facts that we can use to try to make our point. >> but the last point that i would say is that, and we have this discussion oftentimes. it is the people that ultimately will make the decisions. just like we did in the smoking ban in restaurants. it's the people that will tell their representatives that this is the direction that we want society to go in. and you're either going to be part of the plan or we're going to vote for someone else. that's, and that's the good thing about democracy. >> yes. i think that one of the things that the national campaign to prevent teen and unplanned pregnancy has done is a very

interesting, andrea kane, who is our public policy director and who will be speaking later will say more about this and i'm happy to see jenny ehrlich here, hi, jen enyjenny. if you ask republican women about these issues, especially younger republican women, they're in favor birth control. the issue is they think it's already available. they don't see what the problem is. andrea, you can correct me, but that's my summary of it. and i think that fits in with what you're saying. go to the public and find out what they want and what think think. >> so, audience, we have time for a couple questions from the audience. would someone like to ask the lieutenant governor a question? yes, right there in the, near the back. please tell us your name, stand up, tell us your name and ask a question with a minimum comment,

okay? thank you. >> my name's megan troy. i'm wondering, lieutenant governor, you talked about the importance of home visits. as a social worker who's moving into policy, i agree with you, they're very important. but what do you think about increasing training and just education for the people that are going into the homes, talking about this? it's often a really hard conversation. there are a lot of religious and moral objections to birth control for teens, so just wondering what you would do for the people who are actually providing it. >> that's a wonderful question and i thank you for bringing it up. because when we talk about going into homes, do we have the manpower, if you will, the number of social workers, to and nurses and whoever we choose to take into the homes, and the answer to that is no. we are a very underfunded for that. and so just to give you an example. in hampton roads where we have a, chip is the name of the

program, and that's a state-wide program where we go into homes. for every one home that we visit, there are ten others that need our help. so we're chipping away, really, by what we're doing right now. about you're exactly right. and not just in that area, but mental health issues that we're working on in virginia. we're very much underfunded and understaffed with psychologists, social workers. so it's all about priorities and all about where we want to make our investments, but your point is well taken, and we do need to make sure that we have more individuals that are trained to do that and able to get into these homes and help, again, as i say, try to bend that curve of poverty. that's what our intentions are. >> right here on the aisle. wait until you get the mic. >> thank you, i am a virginia voter, so thank you for being here and your service. >> that sounded like a warning to me. >> no. it's not. but i would suggest that the

smoking analogy is slightly off, since most religions didn't think that smoking was a sin. and there are still a number of religions who think sex outside of marriage is wrong. >> yeah. >> so there's a difference there. >> good point. >> but the political, the question i would actually like to pose to you is that you say the people will ultimately choose. but the people are actually the people who vote. who choose to come to local elections and state elections, and not just national elections. and in the state of virginia, women between the ages of, say 21 and 35, do not necessarily come out to vote. i'm not a politician or pollster, but it's pretty obvious. >> you're on the right track. you're doing very well. >> so i would ask you to comment

on the need or the role for outreach to the voters who don't vote in local and state elections. in states like virginia. regarding issues like this. >> your point is so well taken. and i think that a lot of us, and if we remember back to when we were 25 years old, politics and policy-making was not real high on our radar screen, so one of the things that we're doing and we're very active, at least in virginia. i can't speak for other areas, but it's going to our colleges and universities, our community college systems and talking to those individuals and talking about these very issues. just like with larcs. and whether legislators, most of whom are minute, by the way, should be telling women what they should and shouldn't be doing with their bodies. whether legislators should be telling people who they should love, who think should live with. so that is all part of the

process as we move forward to make our young folks, and i, the reason i'm so interested in this is i have a 27 and a 24 year old. and i, i see their friends. i see what's important to them. and i, you know. wo am working as hard as i can to make sure we do reach out to that population. just as a follow up and conclusion to that, when we do do polling, when i ran in 2013 for lieutenant governor, we knew that the people that would be voting were elderly and women. those were the two big areas. and that's, that's who the folks that were heavily targeted. does that mean that we should ignore the rest of the folks? no. so that's our job now to get out and make sure that in the next election it's not just the elderly and women but it is the young folks who are educated and in clinls and universities, so that's part of the overall plan.

you make a good point. i don't now what your career is in, but politics and polling may be good for you. [ laughter ] >> another question, over here. in the middle up here. and then the next and last one will be on the back aisle there. >> lieutenant governor, i'm also a virginia resident and voter. and i want to congratulate you on whatever role you had in turning around the bogus regulations of clinics. >> yes. >> but there have to be some challenges for the next several steps to make sure that it sticks. >> yes. >> zoo what do you see as the challenges, where they're coming from, and what is your approach going to be? >> iyes, ma'am, that's a great equipment and you're referring to the trapp laws, and those change the structural ielements

for women's clinics. that was done as a basis of making it safer for women. we have people like my who are doing procedures in our office. for example, i do lumbar punctures, you have dermatologists, plastic surgeons doing procedures that are much more dangerous than an abortion if you look at the data. so my question to them, when they introduced and unfortunately passed this legislation, am i next? if you're worried about the safety of our patients, you know, what's going to happen if you think this out. so right now we have been able to kind of stop the progress of closing down our women's clinics. and that's all through what we call an executive order. that's done through the governor and the board of health. but what needs to happen if we're going to make those changes permanent, is we need to change some of the seats in the

legislature. right now the republicans have the majority in both the house and the senate. so it's difficult to go back on laws that have been passed. but that's down the road what we would need to do and what we would hope to do i think, to keep virginia moving in a positive direction and, you know, i would just tell you that a big part of my job as lieutenant governor is in economic development. we want to bring businesses, manufacturers, josbs to virgini, because that's what pays for all of the things that we talk about. and if we are going to do that, we need to have the lights on as they say. we want to welcome people. we don't want to deter women from coming to the commonwealth and folks like lgbt community. we would like to accept anyone who would like to come and live in virginia. so that's the direction we need to go in i believe, to move virginia forward. >> so, governor, before we end this panel, i have a suggestion

for you. >> i'm always open to suggestion. >> well, good. this is a suggestion about how to advance the debate on larcs. and that is that we mention the colorado situation where they had a big fight and republicans were opposed to paying for larcs or extended birth control, and they won. despite the fact that one of their most conservative the members, a guy named don corn led the fight against his own party. so i suggest you invite him to virginia to come down and talk to republicans in your legislature. >> that's a great suggestion and we'll take you up on that. >> great, invite me to come when you do that, because i want to hear. thank you so much. good to see you. [ applause ] >> fantastic. >> okay. if you just bear with us for a minute. we're going to bring up more opinions.

okay. thank you very much. now we have the distinguished panel of people with lots of views on these issues. and i hope -- you probably all

memorized my last slide about all the advantages we could get if we were more successful in ending or at least reducing the number of unplanned pregnancies. and for almost every issue, i know some on this panel have studied it, written about it, thought about it, so i'm hoping that we'll really get into some of these issues. so let me just introduce the whole panel. and then, and then we'll proceed. i need to be on the right side of the piece of paper here before i can do that. so this is andrea kane. bell's already introduced her. i've worked with andrea for many, many years. and my typical response to her is yes, ma'am. that's what i'm going to do. and it's amazing how much she knows about what's going on, on the hill. i really like people like that who keep up with the hill.

i call and she tells me who to call. so that's very good. to the extent possible. it would be great if you would reflect things that you have heard about the hill and your remarks. and then rachel gold. she just wrote a wonderful paper -- i shouldn't say "just". on coercion. that's an issue that we are concerned about. that some women may feel -- the lieutenant governor brought up about males telling women what to do.