When I spoke to Rachel Fey, the senior director of public policy at Power to Decide, about the new administration the other month, she was giddy. “We’ve spent the last four years playing defense… playing whack-a-mole,” she said. “Trying to protect what we have. But what we know is that’s really not good enough.”
She was excited that, under the Biden administration, she could finally go on the offense in support of increasing birth control access, repairing those things that had been harmed (domestic “gag rule,” anyone?), and reimagining what reproductive health care might look like going forward.
So, what might that look like?
Breaking Down Barriers To Contraceptive Access
First, it’s important to acknowledge some of the most common barriers to contraceptive access. One of the biggest is all of the hoops one must jump through in order to procure a prescription in the first place. Someone in search of a prescription usually has to make an appointment with their doctor, or at a clinic. This can be difficult for those who have to schedule their visit around their work hours, secure child care, and seek out reliable transportation.
After finally visiting a clinician and securing a birth control prescription, they must then visit a pharmacy to fill their prescription. And this doesn’t even touch upon the agita involved with figuring out which forms of birth control their insurance covers and how much — if it’s covered at all (or if they even have insurance).
And in recent years, these barriers have seemed even more insurmountable. For years, Title X funded a network of healthcare providers throughout the country, clinics that provide essential services to patients who are low-income, uninsured, young, or otherwise underserved. But with the Trump administration came the domestic “gag rule,” which held back funding from those who provided abortion referrals or other abortion-related activities.
According to the Guttmacher Institute, this slashed patient capacity at many clinics in half, jeopardizing care for 1.6 million female patients nationwide. Luckily, the Biden administration is in the process of reviewing and reversing these Title X restrictions.
A Multi-Pronged Approach to Increasing Access
But what else can be done? Groups like Power to Decide, the American College of Obstetricians and Gynecologists (ACOG), and even the CDC, have put together reports and toolkits for those who seek to increase contraceptive access. What’s clear is that — in order to ensure access for as many people as possible — we must take a multi-pronged approach. Here are just a few possible solutions:
Increase family planning funding to healthcare centers. Laid low by Title X restrictions, clinics have been testing a range of options in order to ensure that reproductive healthcare remains accessible. Some have allowed payment on a sliding scale. Others have offered free or low-cost services to young people. Others have helped patients connect to private or public insurance. Still, lost funding has only increased the existence of contraceptive deserts. But with increased public funding, the upfront costs of some methods of birth control could be reduced, giving low-income and uninsured folks more choice to use the form of birth control that’s best for them.
Increase health insurance coverage of birth control. Speaking of contraceptive costs, wouldn’t it be neat if our health insurance covered more of it? This report from Power to Decide shows how employers and universities have been allowed to exempt themselves from covering some or all methods of birth control in their health plans. This… is not cool. On top of this, insurance often covers only three months of birth control at a time. Research, meanwhile, shows that when people are able to get at least six months of birth control from a single prescription, there are fewer breaks in contraceptive coverage and fewer instances of unplanned pregnancy. Twenty-one states (including Washington D.C.) now require insurers to increase the number of months for which they cover prescription contraceptives at one time. Let’s work on growing that number.
Make it possible for more pharmacies to prescribe birth control. Why not cut out the middle man? As mentioned previously, getting a birth control prescription can be an onerous process. But what if you could skip the doctor visit and go straight to your local pharmacy to get a birth control prescription, avoiding copays and other out-of-pocket expenses? Currently, 18 states (including the District of Columbia) allow pharmacists to prescribe and dispense self-administered hormonal methods like the pill, the patch, the ring, and the shot. We need to convince more states that this is a good thing, and we need to convince more pharmacists that it’s worth it for them to opt into offering this service.
Make it easier to find telehealth providers. In the past year, thanks to the pandemic, a greater number of medical professionals have embraced telehealth. If we can do this on such a large scale in the midst of a pandemic, why not do it for those who struggle to make it to in-person appointments in non-pandemic times? While this is not a catch-all solution — as many people still lack reliable internet service or don’t feel knowledgeable enough to use telehealth services — it can still be an effective means of increasing access to others.
Increase funding for comprehensive sexuality education. Do I need to explain again why I’m such an evangelist for comprehensive sexuality education? I have… many reasons. But most relevant within the context of this post is the fact that truly comprehensive sex ed includes lessons on the various forms of contraception that exist — and the pros and cons of each. We need to make sure that the coming generations have the knowledge and the ability to choose the form of birth control that’s best for them.
I could go on, but ACOG put together this great list of recommendations for increasing contraceptive access, and even though it’s from 2015, its contents are still relevant today.
What Else Can You Do?
I love the work being done by Power to Decide (could you tell?), so I’m going to share this toolkit for increasing contraceptive access that they put together, which contains materials for elected officials, public health officials, and advocates.
The CDC also has a toolkit for improving contraceptive access for health providers specifically.
In the meantime, if you’re having trouble accessing birth control, you might want to check out the Birth Control Pharmacies directory, Power to Decide’s Health Center Finder, or one of these online birth control services.
We’ve seen that when a person has control over whether and when they have children, and how many children they have, they are more likely to stay in school, earn an advanced degree, and establish a career, which in turn positively contributes to their future income and stability.
Why aren’t we making this easier?