Kathey and Rob Raskin of Las Vegas here and for many foster children getting access to the health care they need is extremely difficult; a particular problem is birth control.

For the nearly quarter-million girls in foster care in the nation, access to contraception is simply chance. Without clear rules and regulations about foster children’s health-care needs, activists for foster youth care say girls, and boys too, frequently struggle for essential care.

Statistics show that girls in foster care are two times as likely to get pregnant. While rates of teen pregnancy have been going down across the nation, the same cannot be said for the rate of teen pregnancy among foster children. A study conducted by the University of Chicago of over 700 young people from three states reported that of the foster children surveyed, nearly 35% were pregnant by age of 17 or 18. This is compared to about 15% of children living with their birth families.

By 19, 46% of those children had experienced another pregnancy, compared to 34% for children outside of foster care who’d been pregnant once. Another study reported that of those surveyed nearly 50% of girls in foster care were pregnant by 19. Research shows that unwanted pregnancies and births greatly surpassed wanted pregnancies and births among foster children. While federal policies and legal precedents do exist to protect foster children’s reproductive rights, experts say that these frequently fall short of achieving the goal they intended. Instead, many create loose guidelines which are rarely followed.

Foster children are eligible for, and deserve, reproductive health-care insurance coverage, including contraception, under Medicaid. According to the National Center for Youth Law, states have to provide a program named “Early and Periodic Screening, Diagnostic and Treatment,” that stipulates a package of benefits, like family planning services, for children enrolled in Medicaid. Plus, under section 1396d(a)(4)(C) of the Medicaid Act, states have to cover family planning services with no additional out-of-pocket cost.

But that doesn’t mean access is guaranteed, or that children can actually use those services.

Many places in the country privatize foster care, and the oversight of foster care facilities is frequently handed over by the state to specific, private organizations. Within a system which is already so exhausted of its resources, reproductive health care such as birth control becomes even more disregarded, particularly when access is managed by establishments or individuals who see it as unnecessary or purely elective, which we know isn’t true. Many girls and women use contraceptive for genuine medically issues such as endometriosis and PCOS.

Additionally, while agencies should be proactively having conversations about reproductive health with foster children, this is usually not the case. This means foster children who are living with an unfamiliar person or people are put in a tricky, even impossible situation, self-advocating for contraceptive care. This can be really scary for young adults.

Unfortunately, for many of these children, the best outcome in regard to accessing contraceptive care, and general health care stability, is to remain living within their biological family whenever this is doable. Taking children from their homes and moving them has the chance to sever any connection they had with a trustworthy family or community member that they would have felt comfortable discussing this with.

Our foster homes and departments must do better. On the Kathey and Rob Raskin Stop DHR website, we encourage you to report complaints. They can save lives.