On what would have been the fifty-first anniversary of the Supreme Court’s decision in Roe v. Wade, the Biden administration announced new actions the administration will take this year to expand access to reproductive and sexual health care, including contraceptive care. During this year’s State of the Union address, while he did not comment on contraception specifically, President Biden doubled down on the importance of defending reproductive freedom. These commitments are crucial and heartening, but they are only the first step.
As the administration prepares to make good on its promises, here are six crucial factors that it should consider about the state of birth control in 2024, including ongoing barriers that make it difficult for people to access and obtain the contraceptive care that they need.
Who Uses Birth Control, and for What?
Birth control use is overwhelmingly common. In the United States, over 99 percent of sexually active cisgender women ages 15 to 44 have used at least one contraceptive method in their lifetime. Contraceptive use spans racial, socioeconomic, and religious demographics. For example, 89 percent of non-Hispanic white women, 84 percent of non-Hispanic Black women, and 87 percent of Hispanic women who are sexually active and not seeking pregnancy use contraception. Eighty-six percent of sexually active women not seeking pregnancy with incomes below the federal poverty line use some form of contraception, and 91 percent of sexually active women not seeking pregnancy and who have incomes at least 300 percent above the poverty line use contraception. Moreover, almost all women who identify as religious, who are sexually active, and who are not seeking a pregnancy use birth control, including 99 percent of mainline Protestants, evangelical Protestants, and Catholics, and 96 percent of people with other religious affiliations.
People use birth control for more than preventing unintended pregnancies. Some barrier methods, including internal and external condoms, help prevent the spread of sexually transmitted infections (STIs). Both combination (which contain two hormones, estrogen and progestin) and progestin-only birth control can help manage menstrual period symptoms and regulate menstrual cycles, and combination birth control methods can also help prevent or decrease the severity of breast and ovarian cysts; endometrial and ovarian cancers; infections in the ovaries, fallopian tubes, and uterus; and premenstrual syndrome.
Access to birth control can also help minimize gender dysphoria for some transgender and nonbinary individuals. Both menstruation and unplanned pregnancy have the potential to trigger gender dysphoria. Contraception use can help prevent unplanned pregnancy, and many forms of hormonal birth control regulate or completely stop menstruation.
What Are the Main Barriers to Contraceptive Care Young People Face?
A recent survey found that young people ages 15 to 22 face significant barriers to accessing contraception. In fact, 88 percent of those surveyed struggled to access birth control, and 75 percent endured multiple barriers to accessing the contraception of their choice.
Young people face unique barriers to contraceptive access. For example, the lack of knowledge and misinformation about sexual and reproductive health is a significant barrier preventing young people from seeking out and accessing birth control. This pervasive misinformation is largely fueled by abstinence-only sex education that fails to provide adolescents with an understanding of contraception.
Young people who want to seek out birth control are often hesitant to ask their providers because of fear of a lack of confidentiality, as there is a risk that the provider may inform their parent or guardian. About one in five adolescents reported that they would not seek out birth control services if there was a risk their parents or guardians would find out. Furthermore, there is a lack of providers who can and will discuss family planning with their adolescent patients, due to provider bias and stigma against talking to young people about sexuality and contraception, and gaps in providers’ training on contraceptive methods. The lack of available providers pushes young people away from being able to access care. Even if providers do talk to young people about birth control, adolescents report that many clinicians provide judgmental or biased contraceptive counseling that harms their patients and discourages them from seeking out further contraceptive care.
Even if providers do talk to young people about birth control, adolescents report that many clinicians provide judgmental or biased contraceptive counseling that harms their patients and discourages them from seeking out further contraceptive care.
Young people also face barriers getting to a provider, as 43 percent of young people surveyed reported facing transportation challenges to get to and from their appointment and 67 percent of young people reported challenges in finding the time to attend an appointment for contraceptive care. Barriers are worsened when the provider a young person can access then refuses to provide contraceptive care, or provides their young patients with biased or judgmental care.
Cost also imposes major limitations on young people’s access to comprehensive contraceptive care. Research performed by Advocates for Youth found that nearly one-third of the young people surveyed identified the cost of care as one of the most challenging barriers to accessing birth control. The cost of obtaining a prescription, especially if one does not have insurance or does not want to use their parent’s insurance for the sake of privacy, prevents young people from accessing any type of contraceptive care. In addition to the cost of a medical appointment for obtaining a birth control prescription, other financial barriers exist that make it significantly harder for young people to afford to access care, including transportation costs and wages lost while attending an appointment.
What Are Contraceptive Deserts?
Currently, more than 19 million cisgender women of reproductive age live in a contraceptive desert. Contraceptive deserts are defined as counties where the number of health centers and providers that offer the full range of contraceptive care methods are not enough to meet the needs of people residing in the county who are eligible for publicly funded contraception (e.g., coverage via Medicaid or Medicare). Analysis of contraceptive deserts has found that millions of people with low incomes rely on publicly funded family planning services to obtain contraceptive care. Contraceptive deserts hinder contraceptive choice and equity, because the lack of access to providers and the cost of care prevents people from accessing the full range of contraceptive care.
There is a significant and growing shortage of family planning providers, including obstetrician-gynecologists (OB/GYNs), family medicine providers, and other clinicians who can provide contraception. The main causes of the provider shortage are physician burnout, barriers to medical training, and the growing demand for health care. This shortage impacts people’s ability to access contraceptive care. For example, OB/GYNs are one of the main providers of contraceptive care in the United States, but only about half of all counties in the country have practicing OB/GYN providers. These gaps leave about 10.1 million cisgender women residing in a community without easily accessible OB/GYN care. And with the growing threats of litigation and criminal penalties from abortion restrictions both pre- and post-Dobbs, there has been a significant drop in medical students pursuing a career in OB/GYN care in communities already suffering from a lack of providers. Further, although advanced practice clinicians play a critical role in the health care safety net, state-level limitations on the scope of practice bars them from being able to provide the full range of contraceptive care, which would help address contraceptive deserts.
OB/GYNs are one of the main providers of contraceptive care in the United States, but only about half of all counties in the country have practicing OB/GYN providers.
Fortunately, improved use of telehealth services has helped mitigate the harms of decreased access to care, particularly those shaped by the lack of contraceptive care providers. Much of this expanded access occurred in response to the COVID-19 pandemic, which spurred a loosening of restrictions and an increase in funding for care. Telehealth-based contraceptive care can include contraceptive counseling, provision of prescriptions for contraceptive methods, and support in management of side effects. The expansion of telehealth for reproductive health care has helped alleviate the impact of contraceptive deserts. However, people still face barriers to telehealth services, including inability to access the necessary technology like high-speed internet. While telehealth helps expand access to contraceptive care providers in remote or rural communities, many individuals living in these communities still face significant barriers in obtaining their preferred contraceptive method.
Contraceptive deserts are not solely caused by a lack of health care providers or availability of telehealth services: a lack of pharmacies is also a factor. Pharmacy deserts prevent people from accessing their contraceptive prescriptions and over-the-counter (OTC) contraceptive methods by making it impossible to get a prescription filled. While many individuals are impacted by pharmacy deserts, the impacts are not uniformly experienced. For example, pharmacy closures are more likely to occur in communities that are predominantly Black and Latinx. Research also shows that communities with fewer socio-economic resources and communities of color are more likely to have pharmacies that are open fewer hours per week; are less likely to provide easy access to condoms; are less likely to have pamphlets on birth control available to customers; and have fewer female pharmacists on staff, which can help ensure young women receive culturally sensitive pharmaceutical care intervention.
The lack of contraceptive care providers within a reasonable distance makes it extremely difficult for people to access their preferred method of contraception, and severely infringes on contraceptive equity for all.
How Would Over-the-Counter Contraception with No Out of Pocket Cost Increase Access?
People should be able to access birth control regardless of how much money they earn or their insurance status. Contraception can be expensive without insurance coverage, and cost is one of the biggest barriers people face when trying to access care. In fact, about one in five cisgender women of reproductive age who are uninsured reported having to stop using a contraceptive method due to cost. The possibility of no cost-sharing for OTC contraceptives has the potential to help address cost barriers to care.
One in five cisgender women of reproductive age who are uninsured reported having to stop using a contraceptive method due to cost.
Evidence has shown that people are more likely to access their preferred method of contraception, including more effective and long-term methods that carry higher costs, when their insurance covers the entire cost of contraceptive care. No additional out-of-pocket costs means that people can select the contraceptive method that will be best for them, instead of choosing the least expensive option out of necessity.
Last year, the Biden administration enacted new rules to strengthen access to contraceptive coverage under the Affordable Care Act (ACA). These rules clarified that the ACA and its implementation does require coverage for contraception and contraceptive counseling with no cost-sharing for people enrolled in group health plans and individual health insurance coverage. Recently, HHS has released an informational resource to help with the implementation of these new rules. The administration proposed these rules to ensure broader access amid ongoing attacks to reproductive health care.
Even with no-cost insurance coverage of birth control, there are additional costs associated with obtaining a prescription for contraceptives that still make care inaccessible. Obtaining a prescription for contraception is not a feasible option for many, as the high cost of a medical visit, taking time off from work, finding child care, and/or accessing transportation make it nearly impossible for some people to obtain prescription-based contraceptive care.
In July of 2023, the FDA approved Opill, a progestin-only form of oral contraception, for over-the-counter access, thereby eliminating the need for a prescription in order to access this contraceptive method. Opill has officially launched, and hit some pharmacy shelves on March 18, 2024. It will be available nationwide in all major pharmacy retailers and online. This is a huge win for expanding contraceptive access, but the cost still poses a challenge. The retail cost of Opill is $19.99 for a one-month supply, $49.99 for a three-month supply, and $89.99 for a six-month supply, although costs may vary depending on the retailer, and whether OTC contraceptives will be covered by insurance remains undecided. The Departments of Health and Human Services, Labor, and the Treasury have sought public input and information on how to best ensure access to OTC contraception, including the possibility of no-cost sharing requirements. Access to OTC contraceptives without cost-sharing will significantly increase people’s access to contraceptive care.
However, the fight for contraceptive equity does not end with just one form of contraception being available over the counter at no cost. Contraception is not a one-size-fits-all proposition, and so all forms of contraception should be available without cost-sharing regardless of access to insurance coverage.
What Would Contraceptive Equity Look Like?
The fundamental human right to make informed decisions about one’s health and well-being must include decisions about reproductive and sexual health. Importantly, people’s decisions to seek out contraceptives are shaped by various factors, including age, medical history, gender identity, personal preference, and more. In order for individuals to actualize the human right to informed decision-making, they need access to the full range of contraceptive care without barriers, pressure, or coercion.
Ensuring this requires contraceptive choice and equity. Contraceptive choice means that everyone has access to the full range of contraceptive care, including barrier methods, hormonal methods, and permanent contraceptive methods, as well as contraceptive counseling to determine which method is best for them and their reproductive goals. Contraceptive equity demands that we are proactive in addressing the inadequate coverage of and access to comprehensive birth control services. Equity also requires acknowledging and addressing the impact of historical and present-day reproductive harms, inflicted by contraceptive coercion and/or by the lack of access to the full range of contraception. These harms are disproportionately endured by people of color, LGBTQ people, young people, people with low incomes, people who are incarcerated, people with disabilities, and immigrants.
While people may not be explicitly or overtly pressured by their care provider to choose one method over another, if their preferred method of birth control is more expensive than other methods or is not covered by their insurance, the cost of care can limit their contraceptive choices and force them to choose a method that may not work as well for their needs. Contraceptive equity requires that people are able to make decisions about contraceptive care without worrying about the constraints of cost, regardless of insurance coverage.
Although the ACA should guarantee contraceptive coverage without out-of-pocket costs, cost-free birth control remains inaccessible. In fact, even with insurance, the estimated average annual out-of-pocket cost for birth control pills is $226, the average cost for a contraceptive implant is about $91, and the average cost for an intrauterine device (IUD) is about $56 for those who are insured. Without insurance coverage, contraception is even more expensive: an implant can cost up to $1,300 dollars and an IUD can cost over $1,000. Additionally, an annual supply of birth control pills can cost an uninsured person anywhere from $250 to $600.
In practice, contraceptive equity requires that all forms of birth control, contraceptive counseling on the full range of family planning options, and the ability to switch contraceptive methods, including the removal of reversible long-acting contraceptives (LARC), are accessible to all.
How Does the Title X Family Planning Program Support Equitable Access to Contraception?
Title X is the nation’s only federally funded family planning program, first signed into law in 1970 as an amendment to the Public Health Service Act. The Title X program is essential for ensuring that those who are under- or uninsured and those with low incomes can still access family planning services, including contraceptive care. The uninsured rate of people seeking care through the Title X program is twice the national average, and a majority of Title X clients live in poverty. It is also an essential program for ensuring health equity: a majority of Title X family planning clients identify as Hispanic, Latinx, or Black/African-American.
Unfortunately, Title X family planning funding has not increased for nearly a decade—it has been consistently funded at $286 million during that time. This lack of increase in federal funding means that the program has been unable to keep pace with the rising costs of medical price inflation or growing demands for family planning services. In order to adequately meet the reproductive health needs of the country, Congress must increase funding to the Title X program.
In his budget for Fiscal Year (FY) 2025, President Biden included $390 million for the Title X Family Planning Program. This falls disappointingly short of what the president proposed in his FY 2024 budget: $512 million, which represented a 79-percent increase above the 2023 enacted level, and which would have allowed the program to increase the number of patients served to 4.5 million.
The Title X program is a major provider of accessible and confidential contraceptive care for young people, as young people are able to consent for and access free to low-cost confidential services at all Title X-funded clinics. However, young people’s ability to access contraceptive care through the Title X program is under attack, as Title X protections for young people’s access have been challenged by Texas in Deanda v. Becerra. Recently the Fifth Circuit Court of Appeals released a ruling that held that the the federal Title X statute does not preempt the Texas state parental consent law, but also held that due to the issue being improperly raised, the current Title X regulation that protects young people’s access to confidential care without parental consent still remains in place. The extent of the implications of this decision are still unclear, but it likely will limit the ability of young people to receive the care they need from providers they trust, violate young people’s self-determination and bodily autonomy, and add to the list of barriers that already exist for young people trying to access birth control.
What Must Policymakers Do Next?
To continue building on past wins in expanding access to contraception, the Biden administration and its allies must also recognize that many individuals and communities, like young people, people of color, and those with low incomes, still face ongoing and worsening barriers that prevent the achievement of true contraceptive equity for all.
As the current administration, Congress, and states look to policy solutions in 2024 and beyond, we must keep these barriers in mind.
Here are some key steps that must be taken to remove barriers and protect equitable access to contraception:
To learn more about contraception and the various methods of birth control, check out this birth control primer by Physicians for Reproductive Health.
Tags: Reproductive Rights, Reproductive Health Care, biden-harris administration, birth control
A Primer on Birth Control Access in 2024
On what would have been the fifty-first anniversary of the Supreme Court’s decision in Roe v. Wade, the Biden administration announced new actions the administration will take this year to expand access to reproductive and sexual health care, including contraceptive care. During this year’s State of the Union address, while he did not comment on contraception specifically, President Biden doubled down on the importance of defending reproductive freedom. These commitments are crucial and heartening, but they are only the first step.
As the administration prepares to make good on its promises, here are six crucial factors that it should consider about the state of birth control in 2024, including ongoing barriers that make it difficult for people to access and obtain the contraceptive care that they need.
Who Uses Birth Control, and for What?
Birth control use is overwhelmingly common. In the United States, over 99 percent of sexually active cisgender women1 ages 15 to 44 have used at least one contraceptive method in their lifetime. Contraceptive use spans racial, socioeconomic, and religious demographics. For example, 89 percent of non-Hispanic white women, 84 percent of non-Hispanic Black women, and 87 percent of Hispanic women who are sexually active and not seeking pregnancy use contraception. Eighty-six percent of sexually active women not seeking pregnancy with incomes below the federal poverty line use some form of contraception, and 91 percent of sexually active women not seeking pregnancy and who have incomes at least 300 percent above the poverty line use contraception. Moreover, almost all women who identify as religious, who are sexually active, and who are not seeking a pregnancy use birth control, including 99 percent of mainline Protestants, evangelical Protestants, and Catholics, and 96 percent of people with other religious affiliations.
People use birth control for more than preventing unintended pregnancies. Some barrier methods, including internal and external condoms, help prevent the spread of sexually transmitted infections (STIs). Both combination (which contain two hormones, estrogen and progestin) and progestin-only birth control can help manage menstrual period symptoms and regulate menstrual cycles, and combination birth control methods can also help prevent or decrease the severity of breast and ovarian cysts; endometrial and ovarian cancers; infections in the ovaries, fallopian tubes, and uterus; and premenstrual syndrome.
Access to birth control can also help minimize gender dysphoria for some transgender and nonbinary individuals. Both menstruation and unplanned pregnancy have the potential to trigger gender dysphoria. Contraception use can help prevent unplanned pregnancy, and many forms of hormonal birth control regulate or completely stop menstruation.
What Are the Main Barriers to Contraceptive Care Young People Face?
A recent survey found that young people ages 15 to 22 face significant barriers to accessing contraception. In fact, 88 percent of those surveyed struggled to access birth control, and 75 percent endured multiple barriers to accessing the contraception of their choice.
Young people face unique barriers to contraceptive access. For example, the lack of knowledge and misinformation about sexual and reproductive health is a significant barrier preventing young people from seeking out and accessing birth control. This pervasive misinformation is largely fueled by abstinence-only sex education that fails to provide adolescents with an understanding of contraception.
Young people who want to seek out birth control are often hesitant to ask their providers because of fear of a lack of confidentiality, as there is a risk that the provider may inform their parent or guardian. About one in five adolescents reported that they would not seek out birth control services if there was a risk their parents or guardians would find out. Furthermore, there is a lack of providers who can and will discuss family planning with their adolescent patients, due to provider bias and stigma against talking to young people about sexuality and contraception, and gaps in providers’ training on contraceptive methods. The lack of available providers pushes young people away from being able to access care. Even if providers do talk to young people about birth control, adolescents report that many clinicians provide judgmental or biased contraceptive counseling that harms their patients and discourages them from seeking out further contraceptive care.
Young people also face barriers getting to a provider, as 43 percent of young people surveyed reported facing transportation challenges to get to and from their appointment and 67 percent of young people reported challenges in finding the time to attend an appointment for contraceptive care. Barriers are worsened when the provider a young person can access then refuses to provide contraceptive care, or provides their young patients with biased or judgmental care.
Cost also imposes major limitations on young people’s access to comprehensive contraceptive care. Research performed by Advocates for Youth found that nearly one-third of the young people surveyed identified the cost of care as one of the most challenging barriers to accessing birth control. The cost of obtaining a prescription, especially if one does not have insurance or does not want to use their parent’s insurance for the sake of privacy, prevents young people from accessing any type of contraceptive care. In addition to the cost of a medical appointment for obtaining a birth control prescription, other financial barriers exist that make it significantly harder for young people to afford to access care, including transportation costs and wages lost while attending an appointment.
What Are Contraceptive Deserts?
Currently, more than 19 million cisgender women of reproductive age live in a contraceptive desert. Contraceptive deserts are defined as counties where the number of health centers and providers that offer the full range of contraceptive care methods are not enough to meet the needs of people residing in the county who are eligible for publicly funded contraception (e.g., coverage via Medicaid or Medicare). Analysis of contraceptive deserts has found that millions of people with low incomes rely on publicly funded family planning services to obtain contraceptive care. Contraceptive deserts hinder contraceptive choice and equity, because the lack of access to providers and the cost of care prevents people from accessing the full range of contraceptive care.
There is a significant and growing shortage of family planning providers, including obstetrician-gynecologists (OB/GYNs), family medicine providers, and other clinicians who can provide contraception. The main causes of the provider shortage are physician burnout, barriers to medical training, and the growing demand for health care. This shortage impacts people’s ability to access contraceptive care. For example, OB/GYNs are one of the main providers of contraceptive care in the United States, but only about half of all counties in the country have practicing OB/GYN providers. These gaps leave about 10.1 million cisgender women residing in a community without easily accessible OB/GYN care. And with the growing threats of litigation and criminal penalties from abortion restrictions both pre- and post-Dobbs, there has been a significant drop in medical students pursuing a career in OB/GYN care in communities already suffering from a lack of providers. Further, although advanced practice clinicians play a critical role in the health care safety net, state-level limitations on the scope of practice bars them from being able to provide the full range of contraceptive care, which would help address contraceptive deserts.
Fortunately, improved use of telehealth services has helped mitigate the harms of decreased access to care, particularly those shaped by the lack of contraceptive care providers. Much of this expanded access occurred in response to the COVID-19 pandemic, which spurred a loosening of restrictions and an increase in funding for care. Telehealth-based contraceptive care can include contraceptive counseling, provision of prescriptions for contraceptive methods, and support in management of side effects. The expansion of telehealth for reproductive health care has helped alleviate the impact of contraceptive deserts. However, people still face barriers to telehealth services, including inability to access the necessary technology like high-speed internet. While telehealth helps expand access to contraceptive care providers in remote or rural communities, many individuals living in these communities still face significant barriers in obtaining their preferred contraceptive method.
Contraceptive deserts are not solely caused by a lack of health care providers or availability of telehealth services: a lack of pharmacies is also a factor. Pharmacy deserts prevent people from accessing their contraceptive prescriptions and over-the-counter (OTC) contraceptive methods by making it impossible to get a prescription filled. While many individuals are impacted by pharmacy deserts, the impacts are not uniformly experienced. For example, pharmacy closures are more likely to occur in communities that are predominantly Black and Latinx. Research also shows that communities with fewer socio-economic resources and communities of color are more likely to have pharmacies that are open fewer hours per week; are less likely to provide easy access to condoms; are less likely to have pamphlets on birth control available to customers; and have fewer female pharmacists on staff, which can help ensure young women receive culturally sensitive pharmaceutical care intervention.
The lack of contraceptive care providers within a reasonable distance makes it extremely difficult for people to access their preferred method of contraception, and severely infringes on contraceptive equity for all.
How Would Over-the-Counter Contraception with No Out of Pocket Cost Increase Access?
People should be able to access birth control regardless of how much money they earn or their insurance status. Contraception can be expensive without insurance coverage, and cost is one of the biggest barriers people face when trying to access care. In fact, about one in five cisgender women of reproductive age who are uninsured reported having to stop using a contraceptive method due to cost. The possibility of no cost-sharing for OTC contraceptives has the potential to help address cost barriers to care.
Evidence has shown that people are more likely to access their preferred method of contraception, including more effective and long-term methods that carry higher costs, when their insurance covers the entire cost of contraceptive care. No additional out-of-pocket costs means that people can select the contraceptive method that will be best for them, instead of choosing the least expensive option out of necessity.
Last year, the Biden administration enacted new rules to strengthen access to contraceptive coverage under the Affordable Care Act (ACA). These rules clarified that the ACA and its implementation does require coverage for contraception and contraceptive counseling with no cost-sharing for people enrolled in group health plans and individual health insurance coverage. Recently, HHS has released an informational resource to help with the implementation of these new rules. The administration proposed these rules to ensure broader access amid ongoing attacks to reproductive health care.
Even with no-cost insurance coverage of birth control, there are additional costs associated with obtaining a prescription for contraceptives that still make care inaccessible. Obtaining a prescription for contraception is not a feasible option for many, as the high cost of a medical visit, taking time off from work, finding child care, and/or accessing transportation make it nearly impossible for some people to obtain prescription-based contraceptive care.
In July of 2023, the FDA approved Opill, a progestin-only form of oral contraception, for over-the-counter access, thereby eliminating the need for a prescription in order to access this contraceptive method. Opill has officially launched, and hit some pharmacy shelves on March 18, 2024. It will be available nationwide in all major pharmacy retailers and online. This is a huge win for expanding contraceptive access, but the cost still poses a challenge. The retail cost of Opill is $19.99 for a one-month supply, $49.99 for a three-month supply, and $89.99 for a six-month supply, although costs may vary depending on the retailer, and whether OTC contraceptives will be covered by insurance remains undecided. The Departments of Health and Human Services, Labor, and the Treasury have sought public input and information on how to best ensure access to OTC contraception, including the possibility of no-cost sharing requirements. Access to OTC contraceptives without cost-sharing will significantly increase people’s access to contraceptive care.
However, the fight for contraceptive equity does not end with just one form of contraception being available over the counter at no cost. Contraception is not a one-size-fits-all proposition, and so all forms of contraception should be available without cost-sharing regardless of access to insurance coverage.
What Would Contraceptive Equity Look Like?
The fundamental human right to make informed decisions about one’s health and well-being must include decisions about reproductive and sexual health. Importantly, people’s decisions to seek out contraceptives are shaped by various factors, including age, medical history, gender identity, personal preference, and more. In order for individuals to actualize the human right to informed decision-making, they need access to the full range of contraceptive care without barriers, pressure, or coercion.
Ensuring this requires contraceptive choice and equity. Contraceptive choice means that everyone has access to the full range of contraceptive care, including barrier methods, hormonal methods, and permanent contraceptive methods, as well as contraceptive counseling to determine which method is best for them and their reproductive goals. Contraceptive equity demands that we are proactive in addressing the inadequate coverage of and access to comprehensive birth control services. Equity also requires acknowledging and addressing the impact of historical and present-day reproductive harms, inflicted by contraceptive coercion and/or by the lack of access to the full range of contraception. These harms are disproportionately endured by people of color, LGBTQ people, young people, people with low incomes, people who are incarcerated, people with disabilities, and immigrants.
While people may not be explicitly or overtly pressured by their care provider to choose one method over another, if their preferred method of birth control is more expensive than other methods or is not covered by their insurance, the cost of care can limit their contraceptive choices and force them to choose a method that may not work as well for their needs. Contraceptive equity requires that people are able to make decisions about contraceptive care without worrying about the constraints of cost, regardless of insurance coverage.
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Although the ACA should guarantee contraceptive coverage without out-of-pocket costs, cost-free birth control remains inaccessible. In fact, even with insurance, the estimated average annual out-of-pocket cost for birth control pills is $226, the average cost for a contraceptive implant is about $91, and the average cost for an intrauterine device (IUD) is about $56 for those who are insured. Without insurance coverage, contraception is even more expensive: an implant can cost up to $1,300 dollars and an IUD can cost over $1,000. Additionally, an annual supply of birth control pills can cost an uninsured person anywhere from $250 to $600.
In practice, contraceptive equity requires that all forms of birth control, contraceptive counseling on the full range of family planning options, and the ability to switch contraceptive methods, including the removal of reversible long-acting contraceptives (LARC), are accessible to all.
How Does the Title X Family Planning Program Support Equitable Access to Contraception?
Title X is the nation’s only federally funded family planning program, first signed into law in 1970 as an amendment to the Public Health Service Act. The Title X program is essential for ensuring that those who are under- or uninsured and those with low incomes can still access family planning services, including contraceptive care. The uninsured rate of people seeking care through the Title X program is twice the national average, and a majority of Title X clients live in poverty. It is also an essential program for ensuring health equity: a majority of Title X family planning clients identify as Hispanic, Latinx, or Black/African-American.
Unfortunately, Title X family planning funding has not increased for nearly a decade—it has been consistently funded at $286 million during that time. This lack of increase in federal funding means that the program has been unable to keep pace with the rising costs of medical price inflation or growing demands for family planning services. In order to adequately meet the reproductive health needs of the country, Congress must increase funding to the Title X program.
In his budget for Fiscal Year (FY) 2025, President Biden included $390 million for the Title X Family Planning Program. This falls disappointingly short of what the president proposed in his FY 2024 budget: $512 million, which represented a 79-percent increase above the 2023 enacted level, and which would have allowed the program to increase the number of patients served to 4.5 million.
The Title X program is a major provider of accessible and confidential contraceptive care for young people, as young people are able to consent for and access free to low-cost confidential services at all Title X-funded clinics. However, young people’s ability to access contraceptive care through the Title X program is under attack, as Title X protections for young people’s access have been challenged by Texas in Deanda v. Becerra. Recently the Fifth Circuit Court of Appeals released a ruling that held that the the federal Title X statute does not preempt the Texas state parental consent law, but also held that due to the issue being improperly raised, the current Title X regulation that protects young people’s access to confidential care without parental consent still remains in place. The extent of the implications of this decision are still unclear, but it likely will limit the ability of young people to receive the care they need from providers they trust, violate young people’s self-determination and bodily autonomy, and add to the list of barriers that already exist for young people trying to access birth control.
What Must Policymakers Do Next?
To continue building on past wins in expanding access to contraception, the Biden administration and its allies must also recognize that many individuals and communities, like young people, people of color, and those with low incomes, still face ongoing and worsening barriers that prevent the achievement of true contraceptive equity for all.
As the current administration, Congress, and states look to policy solutions in 2024 and beyond, we must keep these barriers in mind.
Here are some key steps that must be taken to remove barriers and protect equitable access to contraception:
To learn more about contraception and the various methods of birth control, check out this birth control primer by Physicians for Reproductive Health.
Notes
Tags: Reproductive Rights, Reproductive Health Care, biden-harris administration, birth control