Planning for the Unplanned: Filling the Gaps in Birth Control Access

For many women across the United States, an unintended pregnancy can make a monumental difference in quality of life outcomes. Following the overturning of Roe v. Wade in the summer of 2022, access to reliable birth control has become all the more important. Unintended pregnancies have large scale implications for public health and the US economy on top of the at times disastrous effects an unintended pregnancy can have on the woman’s individual education and labor outcomes. Despite the repercussions of unintended pregnancy, access to birth control continues to be hindered for many disadvantaged populations.

The five main categories of birth control are long-acting reversible contraception (LARC), short-acting hormonal methods, barrier methods, emergency contraceptives, and sterilization. LARC refers primarily to implants and IUDs, which, in comparison to other reversible contraceptives, are consistently the most effective and lowest maintenance (Planned Parenthood). However, LARCs, the simplest method, are not attainable for many low-income households due to a high up-front cost, leaving women at the mercy of private health insurance and public services.

As of 2020, 54.4% of Americans receive health insurance through their employers (Keisler-Starkley 2021). These hard-working citizens rely on their employer to provide them with coverage that ensures their basic healthcare needs are met—including access to LARCs. In 2014, the momentous Supreme Court ruling on Burwell v. Hobby Lobby Stores made over 90% of American businesses exempt from offering the most common type of LARC, IUDs, in their insurance coverage (Dockterman 2014). Instead, the burden was shifted to the intermediary insurance company, which are required to provide access to LARCs for employees covered by withholding companies. Following the 2014 decision, 90% of American businesses reserve the right to remove contraceptive coverage, gravely impacting millions of women.

For women in particularly vulnerable economic situations, 175 Title X clinics across Texas are tasked with providing access to affordable birth control. Low-income individuals seeking free birth control are required to fill out the Application for Health Coverage and Help Paying Costs form. If you think the name is long, just wait till you pass the first page. The form is a daunting 13 pages filled with redundant questions, unnecessarily complicated jargon, and three appendices. For those who are eligible and able to correctly fill out the form, coverage lasts exactly one year. After the year is up, 13 more pages need to be filled before coverage can be renewed. For women with limited time and resources or women with limited literacy, filling out the Application for Health Coverage and Help Paying Costs form can be nearly impossible and prove to be a significant barrier to accessing birth control.

Every year, unintended pregnancies cost taxpayers around 12 billion dollars just in medical costs covered by the Children’s Health Insurance Program (Yazdkhasti 2015). This figure does not account for welfare benefits and other public assistance programs that offer aid to families and pregnant mothers. Economic losses due to unintended pregnancies extend beyond easily calculated totals. Unintended pregnancies have been found to reduce labor productivity and lower levels of educational attainment. These statistics, paired with the correlation between unplanned pregnancies and higher rates of mental health problems for the mother, paint a clear picture—maintaining a woman’s ability to decide when and how to become pregnant is crucial for individual health and the economy (Thomas 2012).

For the sake of public health, our economy, and basic principles of bodily autonomy—it is time to actively break down barriers to affordable, convenient birth control. This process starts by reducing unnecessary administrative burden, such as that present in the Application for Health Coverage and Help Paying Costs form. This form requires individuals to report information the government already has access to. A simplified version, such as those offered in previous years, are just as effective and while not nearly as burdensome as the current process. This short-term fix needs to be followed by including contraceptives in discussions surrounding the inflation of prescription drug prices. As President Joe Biden launches new initiatives combating inflation in the medical community, it is crucial that contraceptives aren’t left behind.

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References

Dockterman, Eliana. “Supreme Court Hobby Lobby Contraception Ruling: What Women Should Know.” Time. Time, July 1, 2014. https://time.com/2941323/supreme-court-contraception-ruling-hobby-lobby/.

Keisler-Starkey, Katherine, and Lisa N Bunch. “Health Insurance Coverage in the United States: 2020.” Census.gov, August 22, 2022. https://www.census.gov/library/publications/2021/demo/p60-274.html.

Parenthood, Planned. “Birth Control Methods & Options: Types of Birth Control.” Planned Parenthood. Accessed October 23, 2022. https://www.plannedparenthood.org/learn/birth-control.

Thomas , Adam. “Unintended Pregnancy and Public Policy .” Notre Dame Journal of Law, Ethics & Public Policy 26, no. 2 (2012): 501–31.

Yazdkhasti, Mansureh, Abolghasem Pourreza, Arezoo Pirak, and Fatemeh Abdi. “Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article.” Iranian Journal of Public Health. Tehran University of Medical Sciences, January 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449999/.

Photo by Reproductive Health Supplies Coalition on Unsplash