David Turok remembers a patient he saw at a clinic in downtown Salt Lake City a few years ago.

The woman had come “way too close to dying” while previously giving birth, Turok said. She wanted an IUD, but didn’t have insurance and couldn’t afford it.

“Why are we making it so hard for people to plan their families?” he said.

Turok, an associate professor with the University of Utah Department of Obstetrics and Gynecology, was a panelists at an event Monday held at the Brookings Institution in Washington D.C. focused on “improving opportunity through access to family planning.”

“Unintended pregnancies are at an all-time low in the U.S. but still represent about 45% of all pregnancies,” according to a Brookings Institution report released this month.

Isabel Sawhill, a Brookings senior fellow and one of the report’s authors, said Monday that “there’s no smoking gun” she can point to to explain the decrease, but there are some potential reasons.

One is that “social norms around women’s roles” are changing, Sawhill said, with more women expected to work or get some sort of postsecondary education to support their families. Women delay marriage and motherhood to achieve these goals, and they “increasingly realize that completing one’s education, securing a decent job, and finding a stable partner before having children all contribute to a better life for oneself and one’s children,” the report states. One way to achieve that is through birth control, according to the report.

Another possibility for the decrease is better access to and use of the most effective forms of contraception, such as intrauterine devices, according to Sawhill.

Reducing unintended pregnancies has positive benefits, including “better pregnancy outcomes, improved child well-being, more opportunities for women and their partners, reductions in costs to governments and lower abortion rates,” the report states.

“So much comes down to this is a solvable problem. This is not an unsolvable thing,” said Turok, the Utah professor.

In 2015 and 2016, 20.8% of women in Utah reported that their birth resulted from an unintended pregnancy, according to the Utah Department of Health, and that rate has remained steady in recent years. The data is based on unintended births, not unintended pregnancies, and does not include miscarriages, stillbirths or abortions, according to the department.

Turok highlighted HER Salt Lake, a partnership between the University of Utah Family Planning Research Group and the Planned Parenthood Association of Utah. The initiative provided free, same-day reversible contraception to more than 7,400 people who visited four PPAU health centers in Salt Lake County between September 2015 and March 2017, according to Turok and the report.

HER Salt Lake then expanded the initiative through Family Planning Elevated to help health clinics across the state by providing education and training to increase contraceptive services to patients, despite cost or distance, Turok said.

Researchers and clinicians in Utah are not waiting for a policy shift to address the issue, Turok said. Instead, they “get out ahead of it” to show what can be done and encourage legislators to follow, he said.

“Obviously, the main tension in a conservative state like Utah is about abortion, and there is just no denying it,” Turok said.

Last week, Sen. Dan McCay announced he was crafting legislation to end elective abortions in Utah. Abortions in the state have steadily decreased in recent decades, according to the state Health Department.

The Brookings report acknowledged that abortion remains a “contentious issue,” but said “reducing unplanned pregnancy also reduces abortion.”

“Let’s acknowledge the tension and move past that” to get to a place where we “can do some good,” Turok said.

Jack Markell, who previously served as governor of Delaware, said he had some anxiety about the response he would receive when his state began to address unintended pregnancies. In 2014, Delaware had the highest share of unintended pregnancies of any state except Florida, according to the report.

Delaware partnered with Upstream USA to increase access to effective contraceptive methods, he said.

Between 2014 and 2017, the percentage of Delaware clients, ages 20 to 39, at clinics that receive federal funding who used long-acting reversible contraception increased from 13.7% to 31.5%, according to Markell and the report.

“It’s replicable and it’s sustainable,” Markell said.

Becky Jacobs is a Report for America corps member and writes about the status of women in Utah for The Salt Lake Tribune.