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Improving Access to Contraceptives

Big Picture 

Access to contraceptives plays a crucial role in saving lives. By enhancing access, we can significantly reduce unintended pregnancies, minimize the prevalence of unsafe abortions and mitigate the transmission of HIV and STDs. Moving forward, it is essential to ensure consistent, effective and affordable access to contraceptives. This involves addressing barriers and disparities to ensure that individuals have the means to obtain and utilize contraception consistently, leading to improved reproductive health outcomes and a reduction in preventable risks.


Graphic From: Heather Munro Prescott, Ph. D., "New website promotes over-the-counter birth control pills." The Philidelpia Inquierer, 27 Jan. 2015, https://www.inquirer.com. https://www.inquirer.com/philly/blogs/public_health/New-website-promotes-over-the-counter-birth-control-pills.html 


Operative Definitions

  1. Contraceptive: A device, drug or surgery to prevent pregnancy. 

  2. Contraceptive prevalence rate (CPR): The proportion of people currently using birth control.


Important Facts and Statistics

  1. According to Sonfield and his colleagues in 2013, 99% of sexually active American women reported that they used some form of contraception, and 87.5% reported the use of a highly effective reversible method. 

  2. Methods of contraceptives include tubal ligation, vasectomy, intrauterine device (IUD), birth control pills, morning-after pills, NuvaRing, Depo-Provera, implanted hormone implant, hormonal patch, female/male condoms, spermicides and contraceptive gel, a diaphragm, a sponge and a cervical cap. 

  3. According to the American College of Obstetricians and Gynecologists (ACOG), contraceptive methods can provide additional benefits such as reduced menstrual bleeding/cramping and decreased risk of gynecologic disorders such as endometrial and ovarian cancer. 

  4. A study done by Finer and Zolna in 2011 showed that unintended pregnancy and abortion rates are higher in the U.S. than in most other developed countries with low-income women having disproportionately high rates. 

  5. A report done by Frost, Zolna, and Frohwirth in 2013 discussed contraceptive needs and services in 2010, which revealed that a significant portion of women in the U.S. required publicly funded contraceptive services because of their financial status and age. Additionally, in another report done by Frost in 2013, she discussed how women in the U.S. utilized publicly funded planning clinics for these services, especially since some individuals did not have access to these services through their private healthcare providers. 

  6. According to a study done by Phillips and her colleagues in 2004, the data showed that even if contraception is covered, women pay about 60% of the cost out of pocket compared to the typical out-of-pocket cost of only 33% for non-contraceptive drugs. 

  7. Data collected by Foster and her colleagues in 2006 revealed insurance barriers such as limits on the number of contraceptives. Additionally, ACOG mentions that some insurances require proof that other contraceptive methods do not work before getting approval for more expensive contraceptives such as an IUD or implant.


5-Point Plan

(1) Expansion of education about contraception use. 

There is a widespread lack of knowledge and prevalent misconceptions surrounding contraception use. Furthermore, not all educational institutions offer comprehensive instruction or training on the various types of contraceptives and their proper usage. By integrating sex education and contraceptive information into the school curriculum, we can effectively prevent young individuals from engaging in risky behaviors. It is important to make resources readily available and widely known to the public and students alike, fostering awareness and understanding of contraceptive options and their importance in promoting safe sex.


(2) Encourage healthcare providers to discuss all the options with their patients. 

Many patients have limited awareness of the wide range of contraceptive options available to them. Often, their knowledge is restricted to commonly known methods such as condoms, birth control pills or emergency contraception like Plan B. To address this knowledge gap, healthcare providers can play a crucial role. By proactively asking patients about their contraceptive preferences during each visit and providing education about alternative methods such as intrauterine devices (IUDs) or implants, providers can expand patients' understanding and choices. Furthermore, it would be beneficial for providers to share information and resources about where patients can access IUDs or implants, ensuring they have access to these effective and long-acting contraceptive options. Providing patients with comprehensive knowledge and facilitating access to a wider range of contraceptives can enhance their ability to make informed decisions and choose the best methods to meet their needs.


(3) Providing more over-the-counter options. 

Currently, most contraceptives are not readily available over-the-counter. While condoms and plan B can be obtained without a prescription, they may still pose affordability and accessibility challenges. Other contraceptive methods require a prescription from a healthcare provider. However, there have been recent developments in this area. The Food and Drug Administration (FDA) recently approved Opill as the first over-the-counter birth control option. Moreover, expanding the role of pharmacists or other healthcare providers to administer contraceptives, including birth control pills and implants, similar to administering shots, would enhance access and autonomy for individuals seeking contraception.


(4) Mandated insurance coverage for contraceptives. 

Currently, many patients have to bear a significant portion of the cost for their birth control methods, as insurance coverage falls short. To improve access, insurance should offer comprehensive coverage for all FDA-approved contraceptives, eliminating the disparities in coverage. Co-pays or deductibles should not be required, as they create barriers to access. To achieve this, it is essential to enact legislation or implement regulations mandating insurance plans to provide full coverage for contraception. Such measures can be initiated at the federal or state level to ensure equitable access to contraception for all individuals.


(5) Telehealth services as an alternative option to obtain contraceptives. 

Accessing timely appointments with primary care providers can often be challenging, with wait times of a month or longer being common. Unfortunately, non-emergent complaints may not receive priority in scheduling. To address this issue, implementing telehealth services specifically for patients seeking IUDs, implants or birth control can greatly enhance access to contraception. By offering telehealth consultations and services, patients would gain better, faster and more efficient access to the contraception they need. This would be particularly beneficial for individuals residing in underserved areas where access to these services is limited.


Why This Initiative Is Important

This initiative is crucial as it strives for equitable access to contraception for all individuals, particularly those in underserved communities. By advocating for this policy proposal, we can greatly enhance women's health outcomes. To achieve this goal, collaboration from all parties is essential. Implementation of comprehensive education and awareness campaigns about the various types of contraceptives, along with providing accessible resources on where they can be obtained, will have a profound impact on improving access and empowering individuals to make informed decisions about their reproductive health.


Economic Impact

Improving access to contraceptives can generate positive economic impacts. By providing better access to contraceptives, the healthcare system can experience reduced costs. Improved access leads to fewer unplanned pregnancies, resulting in fewer OB-GYN office visits and lower childbirth-related expenses. Moreover, enhanced access empowers individuals to have greater control over their reproductive choices, alleviating financial concerns related to contraceptive costs. Better access to contraceptives also promotes healthier pregnancies by reducing the risk of unintended pregnancies. Consequently, improved maternal health outcomes and child health can be expected. Additionally, addressing barriers to access is particularly vital for underserved populations, as unintended pregnancies can impose a significant financial burden on these individuals.


Acknowledgment: The opinions expressed in this article are those of the individual author.


Sources


"Contraceptive needs and services." 2013 Update - Guttmacher Institute. https://www.guttmacher.org/sites/default/files/pdfs/pubs/win/contraceptive-needs-2013.pdf.

Finer, L. B., & Zolna, M. R. "Unintended pregnancy in the United States: incidence and disparities." Contraception, 84(5), 478–485, 2011, https://doi.org/10.1016/j.contraception.2011.07.013.

Foster, D. G., Parvataneni, R., de Bocanegra, H. T., Lewis, C., Bradsberry, M., & Darney, P. "Number of oral contraceptive pill packages dispensed, method continuation, and costs." Obstetrics and Gynecology, 108(5), 1107–1114, 2006, https://doi.org/10.1097/01.AOG.0000239122.98508.39.

Frost, J. J. "U.S. women’s use of sexual and reproductive health services: Trends, sources of care and factors associated with use." Guttmacher Institute, 24 Aug. 2022, https://www.guttmacher.org/report/us-womens-use-sexual-and-reproductive-health-services-trends-sources-care-and-factors.

Heather Munro Prescott, Ph. D. "New website promotes over-the-counter birth control pills." The Philidelpia Inquierer, 27 Jan. 2015, https://www.inquirer.com. https://www.inquirer.com/philly/blogs/public_health/New-website-promotes-over-the-counter-birth-control-pills.html.

Phillips, K. A., Stotland, N. E., Liang, S. Y., Spetz, J., Haas, J. S., & Oren, E. "Out-of-pocket expenditures for oral contraceptives and number of packs per purchase." The National Library of Medicine, 2004, https://pubmed.ncbi.nlm.nih.gov/14768985/.

Journal of the American Medical Women's Association, 59(1), 36–42, 1972.

"Birth control: Forms, options, risks & effectiveness." Cleveland Clinic, https://my.clevelandclinic.org/health/articles/11427-birth-control-options.

Sonfield, A., Hasstedt, K., Kavanaugh, M. L., & Anderson, R. "The social and economic benefits of women’s ability to determine whether and when to have children." Guttmacher Institute, 24 Aug. 2022, https://www.guttmacher.org/report/social-and-economic-benefits-womens-ability-determine-whether-and-when-have-children.

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