Policy Problem

Stakeholders

Key stakeholders in regards to birth control include ordinary men and women, pharmacists, elected officials, employers, community leaders, religious officials, and educators. Methods of contraception are being developed and have already been developed for both men and women to use in order to avoid unplanned pregnancies, although renewed popularity in the idea of declaring fetuses the legal status of “personhood” has incentivized elected officials to propose legislation that aims to curb access to contraception. Several states also allow pharmacists to refuse filling legally authorized prescriptions for contraceptive care. Religious leaders and anti-abortion advocacy groups, as elaborated upon later, also play a significant role in their communities in swaying public opinion in opposition to contraception.

Educators, also elaborated upon later, have the power to control what kind of sexual education their students receive, which has led to discrepancies in knowledge about contraception among adolescents. Employers also have the ability to exclude contraceptive care in their employees’ health insurance plans. However, many advocacy groups exist which support the ability of women to access safe contraceptive care, most notably Planned Parenthood, which actually began searching for an oral form of contraception as early as 1950. Other notable groups include the American College of Obstetricians and Gynecologists (ACOG) and NARAL Pro-Choice America.

Risks of Indifference

Ever since the first hormonal contraceptive pill was approved by the Food and Drug Administration in 1960, access to safe methods of birth control has been incredibly advantageous to women in the United States. The Supreme Court delivered a legal victory to advocates of contraception in 1965 with its decision in Griswold v. Connecticut, as well, meaning that no state could restrict the use of contraceptives by married couples. With access to birth control, women could finally take control of their reproductive cycles and claim power in their relationships, and many women in the 1970s entered the workforce as a result of this newfound bodily independence.

However, not all women have benefitted from expanded access to birth control: women with lower socioeconomic statuses are more likely to become pregnant and deliver children as adolescents. These women are also less likely to have health insurance, preventing them from accessing alternative, more effective methods of contraceptives (besides condoms). Minority women have also expressed more ambivalence towards pregnancy compared to White women, which correlates with a higher rate of unintended pregnancy and a lower rate of usage of contraceptives.

Moreover, with the Supreme Court poised to overturn its landmark decision in Roe v. Wade this summer, states could once again begin (and have already begun) imposing heavy restrictions on abortion and access to contraceptives, which would continue to hurt low-income minority women who aren’t financially able to cross state lines in order to receive safe contraceptive care. 

Nonpartisan Reasoning

Disparities in access to birth control in the United States can be attributed to a few key factors: socioeconomic status, cost, and healthcare coverage, moral and cultural objection, and lack of knowledge. Firstly, socioeconomic status can determine whether or not a woman is financially able to access such contraceptives as well as bear the cost of settling an unplanned pregnancy via adoption or abortion.

In fact, nearly half of all pregnancies in the United States are unplanned, and the impact of this reality is severe: births resulting from unplanned pregnancies equated to nearly $13 billion in government expenditures in 2008. About 48% of women ages 15-44 have experienced an unplanned pregnancy, and for this same age group, about twenty-two unsafe abortions occur per 1000 women. A woman’s inability to settle an unplanned pregnancy also applies to her inability to access methods of contraceptives, which are often costly, that could prevent the pregnancy from occurring in the first place. Low-income minority women are more likely to be uninsured and experience unplanned pregnancies compared to high-income women, and low-income women are also less likely to access and use methods of contraception. Secondly, the variety of sexual education programs within the United States vary in nature, which contributes to a lack of knowledge about contraceptives in some parts of the country.

Abstinence-only education has proven to be as popular in the United States as it is ineffective, and when adolescent students are not made aware of the resources available to them in order to engage in activities of a sexual nature safely, the risk of unplannned pregnancy and contracting sexually transmitted infections and/or disease increases when they ultimately decide to engage in such activities. When abstinence-only education is combined with the inability of those receiving it to afford contraceptive care, the chance of unplanned pregnancy also increases. Furthermore, in recent years, legislatures across the United States have proposed new measures to restrict access to contraceptives. Twenty states currently restrict the ability of minors to access contraceptives, and legislators have proposed removing the ability guaranteed by Title X of minors to receive contraceptive care confidentially.

Laws have also been introduced to weaken contraceptive access for employers in more than a dozen states, and in 2012, the Supreme Court ruled in Burwell v. Hobby Lobby Stores that the First Amendment protects the ability of employers to exclude contraceptives in their employers’ insurance plans. It’s also important to keep in mind that religious and moral objections to contraception have begun to manifest in the healthcare sphere. The Catholic Church sponsors ten of the twenty-five largest healthcare facilities in the United States, and when these work with other hospitals, access to contraceptives decreases. Some pharmacists also reject filling prescriptions for contraception or providing emergency contraception, which can create a plethora of challenges for women to obtain such contraception if access to an alternative pharmacy is unavailable or they live in a rural area.

Six states explicitly protect the ability of pharmacists to refuse filling prescriptions for contraceptives even though they are legally prescribed. Social attitudes towards pregnancy are also important to keep in mind: ambivalence towards pregnancy, especially among minority women, often correlates with the decreased likelihood of using effective contraception and the increased likelihood of unplanned pregnancy. Black women and Hispanic women indicate more ambivalence towards pregnancy compared to White women.

There are also stark differences between methods of birth control available for men and women in the United States, with women having access to more methods of birth control compared to men. Women have access to a variety of options, the costs of which vary, including birth control implants, IUDs (intrauterine devices), birth control shots, vaginal rings, patches, birth control pills, condoms (external and internal), diaphragms, and sponges. Men, on the other hand, primarily have access to condoms (which are 98% effective against STIs and impregnating) and vasectomies as means of contraception, although the development of a male birth control pill is underway (with high demand) as well as a contraceptive body gel, although whether or not this method is entirely effective remains to be seen. 

Policy Options

Legislators have several policy options for eliminating disparities in access to birth control and expanding methods of contraception. For starters, only eight states explicitly prohibit pharmacists from refusing to fill prescriptions for contraceptives; legislation prohibiting such refusal at the national level would relieve many low-income women, particularly those living in rural areas, from the burdens they face with having to find alternative methods of obtaining contraception.

Moreover, in order to solve a lack of knowledge regarding contraception, Congress could propose a standardized sexual education curriculum and incentivize states to implement it, although the efficacy of this proposal may not be perfect and societal ambivalence towards pregnancy may not change all that much. Furthermore, as stated before, efforts to expand male birth control are also gaining popularity; while condoms remain available and effective, and vasectomies are available to men who are intent on not being able to have children, the development of male contraceptive pills is already underway and has so far proven to be widely popular.

71.4% of men of various nationalities between the ages of 18 and 50 expressed interest in taking a contraceptive pill, and women, who feel that they bear too much of a burden in their relationships by being the only ones to take contraceptives, also support the development of a male contraceptive pill. Moreover, the 2014 partnership between the Center for Disease Control’s Division of Reproductive Health and the Washington University School of Medicine, which created the Contraceptive Action Plan (CAP), could also be revitalized, having proved to be successful in the St. Louis area.