our nation's democracy intends to be one where we respect every resident and attend to those most vulnerable. but too often our political discourse divides us from our bestselves. too often we use religion to divide and justify one group's triumph over another. save us from the tirney of hate, greed -- tyranny of hate, greed and renew our political engagement and cultivate generosity, patience, civility and collegiality. guide us to discern and honestly articulate our own deeply held values. open our hearts to listen to and equally value our partners. restore our commitment to democratic values and strengthen us to practice them skillfully. help us contend and wrestle

with the issues and not each other. amen. the speaker pro tempore: pursuant to section 2-a of house resolution 462, the journal of the last day's proceedings are is approved. the chair will lead the house in the pledge of allegiance. i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. pursuant to section 2-b of house resolution 462, the house stands adjourned until noon, october 20, 2015, for morning hour debate and 2:00 p.m. more

chemicals and genetic changes, and it's not just g.m.o.'s i'm worried about. we have hundreds, if not thousands of chemicals that we

have never tested to determine what their real impact is or in concert with other elements or other chemicals. so i'm a huge believer in safety and in the right to know and i think we are not doing enough on either of those counts. so right now that's where i stand on it. i am not in any way pro just forward, no questions asked. i think that's not smart, but i'm also not anti-no questions asked there's no possible use for these kinds of altered crops, which we've been eating, as you know, for hundreds of years in different forms. it's just much more sophisticated now, but i am very much in favor of making sure it's labeled, making sure that no state or local community is stopped from doing what it thinks is right and much more money by independent sources in looking at the impacts so we have that better

information in the first place. [applause] ok. yes, sir. i hate to not let somebody else ask a question. back here who's had my back -- i've had my back to them the whole time. how about this young lady in the keene state debate. you know, i'm big on debate. all right. here, i'll give you my -- here you go. >> thank you. so i'm a senior at keene state and i'm majoring in hol cast and genocide studies and my amazing professor and classmates are wondering what you're doing for prevention and specifically what the plans for the atrocity prevention board would look like. thank you. hillary: well, i have to say i think -- and maybe somebody could correct me if i'm wrong, i think keane state may be the first -- keene state may be the

rst university to have a holocaust, genocide study and i join in the applause. i think that's absolutely amazing and brilliant to have a ecific curriculum to look at holocaust studies and genocide because we've got to have educated young people and others like you who are equipped to help us deal with a lot of these issues because unfortunately we are, you know, living with them and we have to come up with, you know, a better response. i was privileged to announce the atrocities prevention board when it was first set up in the obama administration. [applause] ms. clinton: and i did it at the holocaust museum in washington. if anybody's been there it was

the most appropriate perfect place to make that announcement. and i will certainly not only continue it but look for ways that its visibility can become higher so more people know that the united states has this board and that we will work to find ways to try to bring people together around some common responses to the potential for genocide, lrning from the past -- learning from the past. and there are so many, both, kind of theoretical and practical aspects to this that deserve a lot of thought. for example, we know that ethnic, s in conflicts religious, tribal, other leaders of groups actually set these genocides or ethnic cleansing in motion. they use the media.

we saw that in bosnia where people who had lived together peacefully for a very long time ere set against each other through a propaganda effort on the media that turned neighbor against neighbor and even split families. so we have to understand quickly if something like that is happening, what are the best ways to try to combat it. we saw the same thing in rwanda. we have seen the same thing in the central african republic between christians and muslims and their political battles. so we have to not only condemn this and speak out against the horrible effects of the holocaust, of genocide, of atrocities but we have to really analyze it and that's why i'm so proud of the course you're doing. like, what triggers it? what turns people against one another who have been -- maybe not loving each other -- but

not killing each other and then all of a sudden something sets them off? and how do we try to have interventions that prevent that? and a lot of cultures are on a trip wire. something can set them off. so how do we help other countries with the huge variety of cultures in the world understand what they need to do to try to prevent it from escalating? so i'm delighted, and i hope that those who are in this program and graduate from it will find, you know, ways in our government, ways in international organization and not-for-profits to really be actively involved in helping us understand what to do to prevent this from happening in the future. [applause] ms. clinton: ok. this lady right there. yeah, yeah, right there. yeah. i guess somebody -- yeah, do we have a mic? here comes the microphone.

[laughter] ms. clinton: yeah, yeah. a little more difficult to get through there. here it comes. >> thank you for taking my question. glass-steagall protected the american people and the american economy for decades, and then it was dismantled. and we crashed and hit bottom. at the debate you said you would not be in support of reinstating glass-steagall. i'm wondering why. and also, if you become president, how would you protect us from rogue banks and wall street? ms. clinton: well, i intend to do just that, and my plan is more comprehensive, more effective and in fact tougher. take a look at paul krugsman's

column today. paul, who i think has pretty amazing progressive credentials, right, basically said i had the better side of this argument. now, why did he say this? because i fully respect my colleagues who have said let's reinstate glass-steagall. and if i thought that alone would prevent the potential next crisis, i'd raise my hand and join, but that's not my assessment because if you look, as he said today in his column, the -- some of the major actors who caused the 2008 crash were not big banks. they would have never been covered by glass-steagall. a.i.g., the giant insurance company, lehman brothers, they would never have been affected by it. and what i want to do is to crack down on the banks by assessing a risk fee and

forcing them to have to comply with dodd-frank and tougher regulations. and i am absolutely in favor of breaking them up if they become a risk to the economy. but the potential next threat to our economy that has to really be reined in is what's called the shadow banking world -- the hedge funds, the money market funds. glass-steagall wouldn't do anything about it if it were reinstated tomorrow. so i have the greatest respect for my colleagues and former colleagues who are really focused on that, but i go further than that. my proposal, which you can go to my website and read about, goes much further and includes everybody that i think would pose a risk to the economy, including the big banks but going much further than that. so that's why i've taken the position i have. you can read paul today and understand why. ok. [applause] ok. this -- oh, yeah, this young

man i think has had his hand up for a long time and he's got a cheering section behind him. he's brought his own cheerleaders who are -- go right ahead. >> as a bisexual member of the lgbt community, equal rights has been a very important thing to me. you said that over the years your views on this topic has evolved. how do you compare yourself to other candidates that have -- remained firm on their views and how do you think you've done to change from your past views? ms. clinton: well, i think that if you speak with the human rights campaign or any of the large advocacy groups, they will tell you that they count on me and that you can count on me. i was i think the first and only first lady to ever march in a gay pride parade back in the late 1990's. so i've been an advocate, a

vocal, visible advocate for equality and against discrimination. yes, my views did evolve and i think most people my age would say the same thing. there might be some exceptions but largely because of my strong opposition to discrimination of any sort and my personal relationships with a lot of people over the years. i certainly concluded that marriage equality should be the law of the land, and i was thrilled when the supreme court made it the law of the land and i will -- [applause] i will enforce marriage equality, but we got to go further than that. you know, in a lot of states now because of the constitutional decision, you can get married on saturday and get fired on monday. because we still permit discrimination in employment and in public accommodations. so we have to pass the equality

act, which is currently pending in congress. that will be my highest priority, so that marriage isn't the end of the debate. it's a step along the path to true equality. and you will be able to count on me to fight for you. [applause] ok. up there. yes. ok. here you go. i love your red. [laughter] >> so i am a -- i've been a nurse for 25 yearsnd in a long-term care setting and we're faced with a lot of challenges that i'm sure many people have experienced from medicare cuts to drug companies that gouge people. we've recently had an individual that was being charged 20-something thousand dollars for seven days of medication which is just not something people have. but in a bigger scheme right

now, is the nursing shortage that's plaguing the country and it's going to gain momentum as baby boomers retire. new hampshire's experiencing it. the long-term care is experiencing to as well as the hospitals. do you have any thoughts on what we can do? because when we're looking at standards of care and quality and the things that we want for our loved ones but yet then people going into the industry are challenged between their workload, how do we manage that and how do we make it possible to raise the number of nurses out there serving our community? [applause] ms. clinton: well, first of all, thanks for being a nurse, and i think people know or should know that nursing care is often the single biggest reason people either get well and recover or not. so the nurse is at the center of the health care system in

many ways. so a couple of things about this. one, the last time i looked, most nursing programs were oversubscribed by people wanting to get into them. there were far more applicants than there were places for them. so i think we should be expanding our training programs, our educational programs so that we can actually train more nurses so we can get ahead of what is a very serious problem with the retirement of a lot of baby boom nurses. and the fact that we're just not going to have enough of a supply if we don't start trying to fill the pipeline now. so there are some excellent programs, but we're going to have to open additional excellent programs and we're going to have to try to support, and i would be in favor of federal support for programs that have a proven track record of turning out excellent nurses so they can expand. more faculty, more slots, so

they can add to the numbers who can get into the profession early. i also think it's important that nurses be given more authority in the medical settings in which they work. we know that a lot of nurses are being overworked. they're being asked to serve very long shifts, and a lot of them now, because the numbers have shrunk in a lot of settings, particularly hospital settings and i think nursing home settings as well, nurses are responsible for many more patients. and the nurses with whom i have poken have all said, this is unsustainable because if you ever shadowed a nurse, which did back in 2007, it's exhausting. in and out of patients' rooms -- i was in a hospital -- stopping to do the checking with doctors, filling out the

forms. by the end of the shift you're just drained. and if you're trying to take care of too many patients, the result can be, you know, unfortunate. because we're not setting up our systems to get the best possible care. so i think on both ends -- more training, more education, more support for those programs and try to make sure that nurses on the job have the support and the authority that they need. that's how i would try to approach this. oh, one more question. mike, there's a lot of hands up here, mike, so i'll let you pick whoever it is since you're the one -- who did you pick? with your eyes shut. ok. all right. >> bring us back to student loans. i am a senior here at keene state in the elementary education department and the last three years, all of my loans have been through a credit card company because my

parents make too much money. expected said, your income is $30,000 a year. well, they don't have $30,000 they have to give me towards my education. so i have extremely high interest rates. and the only way i now have any federal support for this year is because i got married last summer. so i just find it mind-blowing that i'm still the same person who's been with the same partner for almost six years and i've had the same parents with the same jobs and the same income, same financial situation but now the government says, hey, now we can help you because you got married. and before that, i wasn't worth any federal help. i had to go through credit card companies. ms. clinton: yeah, i can't stand that. i think that's terrible. we are going to change that. think that's -- that fasa application is absurd.

it's just absolutely absurd. so i think, you know, we had a kind of perfect storm. the application turns people off, and it penalizes people like your parents so it's a lose/lose no matter where you are. the parents plus loans have become so expensive and way beyond the means of most families to be able to manage. the federal government should not be making a profit off of student loans. [applause] ms. clinton: that is my strong belief. so we got to fix the whole system. and your example is unfortunately all too common. you're the same person. you know, families can make a contribution, fine. but it has to be reasonable. if students can work -- i worked so maybe i'm a little biased. 10 hours a week to be able to get debt-free tuition, which is

my goal. debt-free tuition. you never have to borrow tuition for public college university like keene state. so that will cut your covements and it's just -- it's just generally become, you know, so wrong. i had a young woman i think in nevada say to me, the hardest part about going to college shouldn't be figuring out how to pay for it. and the amount of stress and anguish and disappointment from young people and their families is just beyond anything it should ever be. and the other problem, which i've encountered back and forth in talking to people about all of this is that a lot of young people who try to start and then something happens and they drop out, they are stuck with the loans and they don't have anything to show for it because they never got their degree. and the worst offenders are some -- not all -- i want to

make that very clear. me of the not-for-college -- not-for-profit college are pretty unscrupulous how they treat their students and their parents and the most exploited groups are our veterans who under the new g.i. bill have the opportunity to get an education and a lot of these for-profit colleges try to recruit the vets and then they basically take the money under one of the loopholes in the law and don't produce the results for our vets. so there are a number of issues here that i'm going to be confronting. and, you know, the debt-free tuition would be a big help to you. that's going to be one of my, you know, primary goals to make college more affordable and to get the debt load down and hopefully ooh limb nated in a more reasonable -- eliminated in a more reasonable way you are facing. thank you, all, very much. [applause]

ms. clinton: thank you, all. [captions copyright national cable satellite corp. 2015] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org]

>> back up. >> i am a member of the media i have a right to be here.

>> do you want to do it together? here you go. > thank you. >> real quick. >> great job. >> thank you so much.

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indiscernible] >> hi, how are you guys? thank you so much. >> any reaction to the benghazi

>> thank you for being here. >> last time. h, hi. >> come on over here, mark. love the purple.

>> you can watch all of this event, this town hall meeting at croip.org. just a quick road to the white house update, too, hillary clinton and all of the democratic candidates will be appearing next september, the th, at the annual democratic dinner in des moines. e'll have it at 9:00 eastern hillary clinton will be appearing before the benghazi committee, her longtime -- the ranking member elijah cummings of maryland had in a break earlier spoke to reporters.

mr. cummings: we have a situation where we have had mr. mccarthy, congressman mccarthy make it clear that what this is all about. then, of course, have the hand-picked member of the , mr. palitska, confirmed what mr. mccarthy had already stated. we then have congressman hanna to reaffirm all of it. but even if we wanted to put the words to the side, the question becomes, we've been asked not to listen to the words of mccarthy, not listen ka, not listen is

to the words of hanna but look at the actions of the committee, and this morning, again, we have a situation where it is clear that when we look at the actions, calling ms. aberdeen in, letting the press know about the time, the location of her interview, when she -- based on other testimony e've gotten -- has no policy responsibilities, no operational responsibilities, has -- was not with secretary inton on the night of this phenomenal tragedy, only leads did ask the question -- e gentleman, congressman

mccarthy, congressman hanna and mr. padiska, tell the truth? that's the question. the question also becomes hether this is a tax-payer-funded effort to derail the candidacy of hillary clinton and to be very frank with you, when i take the statements of those three gentlemen and i match them up with what we have been saying all along > when we look at what they do and we look at what the gentlemen said, it matches, it comes together. it's interesting to note that those people most closely associated with hillary clinton seem to be treated differently. mr. blumenthal.

, jake mill, ms. aberdeen sullivan treated differently. i said it from the very beginning that when we joined this committee and when the democrats joined the committee i said that we would be defenders of the truth. , the whole truth and nothing but the truth. and that's exactly what we intend to do. i think it is sad, i really do, that when the families came to us and we met with all four f chris stevens,

tyrone woods, glen doherty -- sometimes they get list into this. they only asked for three things, that's all, just three things, and they basically begged us, do not make this a political football. we beg you. several with tears in their eyes. the second thing they asked for, they said, find out what happened on that night and they asked us for a third thing. and that was, do everything in your power to make sure this does not happen to someone else. ladies and gentlemen, i think no matter how you look at it, when you have the number two person in the republican party to come forward, the person who makes plans with the speaker and the person who will continue to be -- who is one step away from becoming speaker to tell you this is all about a taxpayer-funded political effort to derail the campaign

of hillary clinton, ladies and gentlemen, that is a problem. i'm not answering any questions. today outain, i again, i came e of respect. hoping that there will not links that targeted story.ve a part of the this is the last point. i have said over and over again, the e-mails of mr. blumenthal were released, i said, don't just released the e-mail, released the whole transcript so the press and the american people conceivable story.

vote, we didt a not get opportunity to do that. hopefully, come thursday, secretary clinton will have her day to explain all of this. i look forward to her testimony. i want to thank you all for being here. >> [indiscernible] way, all reports indicate that the closed-door r testimony continues on capitol hill. this thursday, hillary clinton will testify before the house committee set up to investigate the 2012 terrorist attacks on in live yet. we will have live coverage on c-span3, c-span radio, and c-span.org. tonight, former defense secretary michele flournoy speaks to a conference on women

and foreign policy. she's because about the growing number of women holding positions at the pentagon. tour in thest pentagon in the 1990's, in the clinton administration, i decided -- it is kind of a lonely thing being a woman leader at that time -- i said, let's have a lunch for all of the senior women leaders in the pentagon. he said at one table, we are like eight or 10. weeks afterwards, there were conspiracy theories that when i got together and had lunch, what were they plodding, what was going on? least when i was in the pentagon in 2012, i would say, if you invite all of the executive women, you would overflow the dining room. the work, but at the very highest level, i was so often

the only womean in the room for many meetings. i think it is improving inter-agenc, but women ar still the minority. progress, better than it was, but more progress needs to be made. >> more o from that atference coming up tonight 9:30 eastern on c-span. princeton university and the brookings institution released its latest issue of the future of children and marriage and children being revisited. they concluded that children outside of marriage fare worse. this discussion now by the brookings institution.

former codirector is here to watch me and correct my orders. i'm glad the you were able to come this morning. at 9:30, everyone comes at 9:40. it's amazing how that works out, but that is how it is. here is the plan for the event today. i will make some introductions. if you want to go to one place to know about the status of research and thinking about

marriage, this volume is it. chapters onseveral birth control, and given our interest on birth control here, we decided we would focus this event on birth control. that is what we are here to talk about. bell finishes reviewing the volume, i will review the policy reef. we are very fortunate to have lieutenant governor northam here. we will give you a chance to ask them questions. then, we will have a panel, a madness of a panel of people who are experts on this issue. i will ask them some questions, and hopefully we will have some disagreements. we will give the audience the tump the panel. in introducing bell, this , chapter six in is something on this

topic that is about as good as he will get. bell is one of the great experts on this issue and the country. bell sawhill talks about marriage and the volume. thank you. whill: i want a little help here on the slides. . there they are. oh, that is the wrong one. anyway, let me say a few words while the are sorting that out. thank you very much for being here, by the way, i really appreciate it. .his is a wonderful volume we do this in conjunction with our partners at princeton university. the editor in chief of this volume is sarah mcclanahan, and

a number of our princeton colleagues are here today. i cannot mention all of them, but there are three-for them here. i particularly want to mention john wallace, who is the managing editor of the volume. where are you? thank you. a wonderful partnership over about a decade's time. , iron suggested, this volume think, is one of the best values we have ever done. we did a volume about 10 years ago on marriage. we were asked to revise and update at this year. we got a new set of authors, and they were terrific people. .hey all wrote great chapters i cannot possibly do justice to the entire volume. i think there are copies outside. you can feel free to take one and read it at your leisure. i will show you the table of oftents here see get a sense

what is in the volume, and who contribute to it. say, do more than just give you the highlights and a few comments from me. let's start with what has been happening. as you know, marriage is in retreat. 85%s declining from about back in 1950 to about 60% now. this is for the age groups, 30-44. you can look at this in different ways. however you look at it, you see this decline. just because marriage has been declining does not mean that not have astill children, they just having a outside of marriage, in that of inside marriage. here is the data from the volume on that issue. as you can see here, we have very high rates of unwed

childbearing in the united states now. overall, about 40% of all kids are born outside of marriage. this varies by class and race. if you look at education, as a proxy for socioeconomic status or class, you can see that the declined sharply with more education. keep in mind, this last category here, where the rates are quite low, those with college degrees is a small group still. it is only about 30% of the population. the other lines here referred to the other 70%. education category, there are racial gaps. we had an entire chapter in the volume on these gaps by race and class. chapter on an entire

.ame-sex marriage as we were preparing the blame, the supreme court was considering what to do. you all know, in june, they finally legalized same-sex marriage. that made this whole discussion very interesting and timely. part of the debate, leading up to the court decisions, was about whether same-sex couples are good for kids are not, whether this is a good environment for which to raise kids. there are research studies on that, not all of them of equal did a niceour author review of the evidence, and lot of other evidence and background, including the legal background on this movement to legalize same-sex marriage. , afterlly concludes looking at all of the evidence,

you really can't come to the conclusion that same-sex relationships are not goo for kids. what some of the research has suggested kids did not do well in same-sex marriages is because of the stigma and lack of legalization of marriage, the kids were being born and somewhat unstable circumstances. they may have been the product of an opposite sex marriage, and then later, the couple broke up, and again or lesbian parent moved into a same-sex relationship, and the children came with that parent. that led to some instability in the lives of the children. that, most researchers believe, is actually not a good thing for kids. in the future, it will be very different. was nicewhich ron

enough to mention, talks about people drifting into parenthood. i use the word "drifting," very cautiously because i think that is a lot of what is happening. pregnanciesplanned and birth. in the same-sex world, by definition, when people have kids, they do it by choice. 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 who grows up and one parent family? our children in married families better than children and cohabiting families? this chapter as to all the literature on those issues. basically, all of that literature, which there is a ton now, has led pretty much to consensus that, on average, growing up in a two parent

married family is better for kids then not. that said, you have to ask, why should marriage matter? becauseon it matters is simply, the people who marry are a self-selected group. there are other reasons as well. this author goes through all of those reasons. in the end, he concludes that all of them have some evidence of making a difference for children's life, and if we , ford to replace marriage 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 would not fully replace the benefits that children now .erive from marriage itself we had a lot of debate around

the production of the volume, and amongst the authors about whether or not -- or wider has been this decline. everybody agreed there was a decline. the issue is why. these are the usual factors that .et debated and talked about women's new opportunities have clearly made them less dependent on marriage. it is no longer something they need for their economic well-being. then, there is the argument that men, especially less educated men, have not been doing well in the labor market. that has made them less marriageable. this has been a good to be infected to the decline of marriage. finally, there are arguments about whether government programs are inhibiting marriage because if you marry someone who has additional income, you may

become ineligible for various programs. that may discourage marriage. ron haskins, in his chapter, does a nice job of reviewing governmenther programs including marriage education programs, and others that we will get to. then, of course, there has been a huge change in the culture and attitudes towards marriage. i would like to talk about how changed which has around these issues. it used to be that we called someone who had a baby outside of marriage, we call the child and illegitimate -- an illegitimate child. we would not think of doing that today. we call people who were cohabiting as "living in sin." imagine using that term today. that is just an illustration of how much attitude and cultures have changed here. brad wilcox, who is a big

advocate of how we need to change the culture, bring back so when institutions and religious institutions to wrote a chapter on those issues. someld say they'rre was difference of opinion amongst authors of the relative importance of these factors, but we agree that it is not one or the other. this is probably my last and most important side here. and, the one you're probably ist interested in witches, that anything we can do about these trends everything they have not been ideal for children? the bush administration pioneered a set of marriage education programs, and thanks , were haskins, and others very closely evaluated, and by the time we produce this volume, we had the results.

the results are not very encouraging. they do not show that we were able to move the needle very much using marriage education programs. some people would say, we need to try harder, we need a new generation of such programs. that is a legitimate argument. other people argue that we need to reduce the so-called marriage penalties and both tax and benefit programs. we have done a fair amount of that already. it requires moving eligibility for these programs quite far of incomeome -- up the scale. there is not a huge amount of evidence that it moves the needle behaviorally. that is an issue, but i do not think it is one that has got a lot of promise to it. second to last, we have improving either men's or

women's economic prospects, hoping that will help them to more stable unions, at least. that has been a big issue of debate. one of those interesting chapters, to become, the most interesting chapter in this whole volume is the one by danny schneider, who looked at 15 social experience all designed to improve the economic status of men or women, usually ,ore disadvantage men or women and all of the programs have been evaluated by using random controlled trials. them, hadem, 15 of evidence on what happened to marriage. what he finds is with two

15,ptions, out of the 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 the economic prospects. think let you about why that may be. planneducing pregnancies -- what i started with, marriage has declined, but people are still having kids, the you think about, who is having the kids. it is mostly younger women, women and their 20's. to young,se births single women, are unplanned, according to the women themselves eerie that is from the government data of a sample 20,000 people.

i think that is pretty solid, but we can debate whether there are some nuances there, what does unplanned really mean. if that is the case, one way to improve the prospects of the children, and help women as well , if enabled them to only have children when they really want to have children, and feel ready . that would be they would be older, more mature, more experience, completed their education, and more likely to be in a stable relationship with a stable partner. this is a very promising direction, and one we will 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 he could probably make some difference. you will be hearing now from some people who know a lot more about that. i will stop, and turned his back to ron. r. haskins: thank you,

bell. bell already gave my interdiction for me which is if you really care about marriage, and children's well-being, and we look around for interventions impact, pretty much the only thing that has consistently ok.wn in impact -- thank you. the only thing that has consistently shown an impact is reduced nonmarital births. there is some evidence, i would not say this scientifically persuasive, but women who do not have out of wedlock births have a greater chance of subsequently , have more stable marriages, and so forth. if someone is interested in

marriage, this is something that they would focus on -- not that they do in the real world, i will get to that in a few minutes, and so will the or.utenant governm that is why we selected, in a volume on marriage, the topic of nonmarital births and birth .ontrol first of all, we have had this in order to increase, bell talked about this a little bit, but if you're like me, you forget about it in five minutes, so i will repeat it. the message here is extremely important. we have an onslaught of nonmarital births. if there is something that results from non-marital births, it is not good for the country, not good for the couples, it is a problem getting worse and worse. there has been a certain amount of stability over the last -- it

depends on what measure you use -- decade. overs been pretty stable two decades. we still hav these enormous said, 40% of bell kids are now born outside of marriage. it is this big problem, but for some reason, has slowed down a bit. here comes the aspect of this that i think is often missed by people. that is, who is having these nonmarital births? we want to be politically correct, and not point out -- those who could take action thanks to more government spending. there are big differences across lots, hispanics, and whites --

blacks, hispanics, and whites. thesis said that blacks would not be able to take event of all therights that they won in 1960's because the blood family has disintegrated. the, of course, was extremely controversial. it is the only other academic fight that was so intense and nasty. harvard just did of volume and said that monahan was right, what do we do? it has spread throughout the whole society. in fact, the rate for white is higher now than when monahan wrote his report on blacks. there will be differences among ethnic groups.

equally bad, the same thing is true of education level. mom's with less education are more likely to have a nonmarital birth. we have the most his advantage groups in our society who are having more nonmarital births. there is one impact on both the mother and children, and perhaps the father as well, that is undeniable. that is they are much more likely to live in poverty. i have not yet met anyone who claims that poverty is good for children or adults. five times the rate. can you think of any intervention that makes an impact five times in the experimental group than the control group? clearly, there is a big impact on poverty. if you want to just summarize, do,' which is what i will

there are many, many outcomes. for many of these, there is a whole literature featuring random othe assigned studies. you have reduced poverty rates, no question about that. lower abortion rates because women who are pregnant outside of marriage are more likely to get an abortion. there is a lot of evidence of better spacing of babies, which is good for the kids and the mother. there is an increased likelihood of prenatal care. i did not know this, until recently, kids are twice as likely to get prenatal care if they have a planned pregnancy rather than unplanned pregnancy or birth outside of marriage. there is also less postpartum depression for moms who have planned pregnancies. there is more education for the mothers. bell has written about almost all of these things. and, they are now studies on cost savings for government.

maybe the numbers are somewhat exaggerated sometimes, but a very good review of the evidence rate that the benefit cost does not include any of the long-term benefits. there is a wonderful review of literature by martha bailey of the overseer michigan that shows big, long-term impacts. in fact, moms who avoid early s have kids that do better. they grow to have more education, more income, less welfare, and so on, and so forth. no one has taken those measures into account, as far as i know. this is really a spectacular list of advantages. if we could do something about , the motherirths would be better off, the child would be better off, the community we live in would be better off, and the nation would

be better off, and the government would save money. that is a pretty good list of benefits. we have in the last decade, or little more,, increasingly to -- come increasingly to realize that contraception, which includes iuds, and some thermal implants, and last of to 10 years, they can have a huge impact on pregnancy rates for women who want to avoid pregnancy. the data is from one study, st. louis study. as far as i know, every study has shown pretty much the same thing. it is the probability that a woman would get pregnant if she is on various types of birth control. if a woman is on a pill, patch, or ring, she is nine to get pregnant.

if you control produces good outcomes -- is birth control , we wantgood outcomes to focus a lot on mars. we have some barriers, and i will only just mention this, because we've invited people to take part in the panel, who are experts on the issues. is initiallyost more than the cost of the pill, but in the long run, especially lasts a decade, it saves money, not to mention the impact. if you spend the money now, you don't have to spend it later.

there are a lot of administrative issues. you have to, for most effective, you have to have available onsite, and you've got to have people available onsite. you don't want women to come in and say they would like to have birth control, and they might choose a larc, and say, "ok. 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 do not have to have a situation where women feel like they're pressured into taking larcs, or any other form or birth control. and there are big socioeconomic and race issues that i mentioned in the first place. 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 the main factor behind bel's book. and definitely she was involved in establishing national campaign to prevent teen unplanned pregnancy. and they are a great organization, i think if we could measure these things accurately. they've had a major impact on the decline, especially among teens in non-martial birth rates. so we're on the right track. the question is how can we do it more effectively. and if we could, a lot of 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 -- wait, don't get up yet. i have a 15-minute introduction here. [laughter] it begins with your mother and her background. 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 a governor. politicians talk, we all know that, but very few of them can write more than a sentence. i don't know if you've ever noticed that. but i spend 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-martial births, and mentioned larcs and so forth. it was really a very nice column. i thought, "wow, who is this guy?"

by coincidence, the next week i meant him. so it turned out well and they were able to clear his schedule and so he came. so he is a doctor. he's a pediatric neurologist. he has an undergraduate degree from virginia military institute and then a medical degree from eastern virginia medical school. and he's not only lieutenant governor, but he's active in practice, plus he teaches. so he doesn't get a good night's sleep very often. as i said, his political career began in 2008 when he was elected to the virginia state senate, and then he's been lieutenant governor 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 doing his residency. residency, at the university of north carolina at chapel hill, which is not overly popular in virginia. so you can tell he's a very open-minded gentleman. so, lieutenant governor, thank

you very much for coming. [applause] mr. northam: good morning. ron, thank you so much for the kind introduction. my son, wes, we have two children, he's doing his neurosurgery training in chapel hill. that was not exactly his first choice, but being a virginia you any port in a storm. he's enjoying it down there and working hard, and having a good experience. thank you so much for your comments. 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. it's nice to get a day up in the nation's capital. i would like to also to take this opportunity to thank the brookings institution as well as princeton for all of the great work that to you all are doing.

now, one might ask why is a pediatric neurologist before you this morning talking about contraception. i will try to go through in the next maybe 10 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 way to decrease unintended or unplanned pregnancies, also to decrease the number of abortions, not in in virginia but in this country and our society, and also to increase the health and well-being of our children and their family. so it's an important concept from both a practitioner and a policymaker. i want to just go through those steps with you a little bit this morning. i, as ron said, 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'm not, -- i know you are. that's why i just wanted to clarify things. i have another job 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 we say teenagers from the 15 to 19 age range. we actually see patients after age 18, but most of my population is starting prenatally up until 18 to 19. interestingly a lot of my patients are epileptics, as you may imagine, or perhaps have migraines, but are on medications that can affect the health and well-being of a

fetus. we deal with individuals in that age group who become pregnant and those become interesting discussions and dilemmas for a lot of these folks. 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 neonatal intensive care unit. we are able to maintain life in now 22 to 23 week fetuses, newborns. for better or worse that becomes somewhat of a challenge in a couple of ways. the morbidity, as you may imagine, in a 22 or 23 week fetus is fairly high. there are obviously some great outcomes, but not all of them are good outcomes. if you look at financially what

happens to take care of these babies, probably a conservative estimate would be a million dollars up to four to five million dollars, up to a year-plus in our neonatal intensive care units. 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. while that baby is in our hospital, or in our nicu, as we say, oftentimes the mother will become pregnant with her second or third baby. so how can we stop that process? i see these individuals in my office as well, usually the mothers bring the families in, and the mother may be less than 20 and have one, two, or three children.

i describe it as this kind of vicious cycle of poverty. as a physician i have watched that during my 25 years of practice, and then that carries over into policymaking. now, 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, that if we can get into the home and help them get back on track, that this is one of our best investments. 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? that's my other life, and that is making laws in the commonwealth of virginia.

there's a diversity, or two different concepts, if you will, that makes it somewhat challenging policy-wise. personally i feel that if we want to bend that curve of poverty, 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. this is why we're here this morning to talk about larcs. i just wanted to talk a little bit about the reality of policymaking in virginia. we're not here to throw stones this morning, but i did want to talk about what the philosophy is, or the approach of some other individuals, who are policymakers. if you've been keeping up with the news in virginia over the last couple of years, in 2012 we

had the infamous vaginal ultrasound bill. that was to deter or to make it more difficult for women who had chosen that avenue to have abortions. 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. when it came time for someone to get up and debate the issue, what better person than a pediatric neurologist to talk about vaginal ultrasound. 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 was very costly. so we had that bill, and we took care of that. we have a bill that was proposed

too, that women that had miscarriages should report that miscarriage to the police. it was like, 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 also been a national piece of legislation. the personhood bill says that life starts with conception. so the concern over the personhood bill, and 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. it also would make in vitro fertilization unlawful. then we had the t.r.a.p. 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 healthcare versus the other pieces of legislation.

the trick is how to bring these folks together, sit down at the table and come up with a consensus. so what happened in colorado and st. louis is very powerful data. 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 to 19 year age group. the number or abortions when -- went down 42%. the message that i try to give my colleagues in richmond is that let's at least agree that the less abortions the better. if we can agree on that, then we can move forward. then i will start talking about some of the data from colorado to make the case this is actually 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 the time limit. i see these cards over here. one minute, three minute. i feel like i'm in a debate. i start having flashbacks. [laughter] i promise you, i don't want to do that. there's 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 medicaid expansion, which is an option for states. unfortunately, in my opinion, virginia has chosen not to expand medicaid. 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 states, in this case virginia, to provide coverage for up to

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

about $4.5 million the commonwealth of virginia is contributing to surrounding states who we compete with over politics. 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 healthcare and transportation. 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. for the first time in administrations in virginia the governor formed a children's cabinet. there are several individuals that sit on that. within the children's cabinet we have, 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 strongly, and that, by the way, is a non-partisan issue. the chambers are very enthusiastic. but 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 childcare. as you all know in our economy, most parents are both working, so it's important to have accessible, and affordable, and quality childcare for our families. we want to make sure that our children are healthy. that their immunizations are up to date. so all of these issues are being looked at. but one of the areas, and i'll close on this, i spoke 20 about it 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?

we help that family through education and we help them with access to medicare care. contraception, to really try to 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. when you talk about different types of contraception, whether you use oral contraception, the birth control pills, whether you use condoms, whether you use larcs, the data is clear that these are very effective up to 99%. in medicine you don't get to 99% very often. they are becoming more affordable. there's now an iud for $50 that will help with the cost of healthcare. they're reversible. what a great opportunity to help single mothers get on a path of taking care of their current children, becoming educated, being able to obtain a job and

be productive members of society. so the larc is a great concept. anyway, so that's kind of my background, as a clinician, as a policymaker, and maybe just a few quick comments on what we're trying to do in the commonwealth of virginia to again, and i think ron mentioned this, 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 family. 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]

mr. haskins: thank you, lieutenant governor, that was very nicely done. i can tell from talking to you before and knowing about your background and talking to people who know you, and listening to your presentation, that you're a person of substantial reason. 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.

people's minds are made up and they are in cement. in the case of colorado, it resulted in not funding a program that had pretty strong evidence of success. it's my understanding that a 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 frontline here. you just described your involvement with several issues having to do with birth. have you found it helpful -- how do you approach people on the other side who are against policies that would spread birth control? mr. northam: that's a great question and it's a challenge that we have. in virginia we have 40 senators and a hundred delegates and they come from very diverse parts of

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

smoking in restaurants. 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. it's like, thank you very much, governor. [laughter] i talked about the science, as a pediatrician of what secondhand smoke, the ill effects of that. and also to our healthcare of people that are exposed to secondhand smoke. the first year it passed in the senator. it was defeated in the house. i continued to education 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. every two years in virginia the

delegates run for reelection, every four years the senators. 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 be able to go into a restaurant and not be exposed to secondhand smoke. we presented data as well, and so we were able to move forward. i think you use creative thinking perhaps. maybe changing semantics when you have that opportunity. but coming at it from different angles. things happen in policymaking in small steps. so you take one small step at a time. this is what i plan to do this year. i don't mean to be so long-winded, but part of our commonwealth council for childhood success, we have offered about recommendations to the governor, that we will be acting on this year in the general assembly. 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 to my fellow legislators. mr. haskins: one of the arguments that when i first stated understanding and read studies, that appeared to show, and let me say many of these studies are not random. we always have to be a little bit cautious about the results. having said that, the big studies, iowa, colorado, st. louis, and how a big study by the bixby center, at the university of california at san francisco, that is random assignment, randomly assigned 40 clinics around the country, 20 experiment, 20 control. unplanned pregnancy in half compared to the centers that didn't. so that's pretty good evidence. three of those four studies, i

don't know what they found in the bixby study, but they show reduction in abortions. some of them were quite substantial. so do you think that's an effective argument? i have used it often and discussed it with my republican colleagues, and didn't seem to be all that impressed by reductions in abortions, which really surprises me. you'd think that that would be a leading argument. mr. northam: i would hope that it will be. i think that whether you want to talk about gun control, or gun violence or the number of abortions, i think that's your 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? if we can agree on that, then how can we change that curve or that number?"

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. my first question would be let's decrease the number of abortions. one of the best ways of doing that is to provide women with education, as i said earlier, but access to quality and affordable healthcare. to be able to make the decision whether they want to take a long acting reversible contraceptive. that's the way we'll move forward. ms. sawhill: i just want 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 costs. i'm wondering do you have any data in virginia even 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 of these babies that are born at very low birth weight. i'm wondering about bigger numbers on medicaid generally. mr. northam: no, we do have those numbers. 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 five to seven dollars. that's a pretty good investment . that will be a piece of data that we use. i probably didn't articulate it as well as i could have, but to have let's say a 23 or 25 week infant that has been in the hospital five or six months that has cost the taxpayers several million dollars, that's just the start.

we do have numbers of what it costs to take care of that individual. especially if they have problems like, if they have ventriculoperitoneal shunts. and they have epilepsy and cerebral palsy, all of those things are very costly. the other thing, morally, is it fair to a child? and what does that do to a family? all of these are i think strong facts that we can use to try to make our point. the last point that i would say is that, and we have this discussion often, 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. you are either going to be part of the plan or we're going to , vote for someone else. that's the good thing about democracy.

ms. sawhill: yes. i think that one 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 will be speaking later may say more about this, and i'm glad to see our new ceo here. if you ask republican women how they feel about these issues, especially younger republican women, they're in favor of birth control. the issue there is that they think it's already available. they don't see what the problem is. andrea, you can correct me, but i think that fits in with what you're saying about go to the public and find out what they want and what they think. mr. haskins: 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 near the back. please tell us your name, stand up tell us your name, and ask a

question with a minimum comment. >> 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 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 a lot of religious and moral objections to birth control for teens, so just wondering what you would do for the people that are actually providing that? mr. northam: it'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, and nurses, and whoever we choose to take into the homes. the answer to that is no. we're very underfunded for that. just to give you an example in hampton roads, where we have a