A Problem to be Treated

Unintended pregnancy has been medicalized. It’s viewed as a problem “treated” with birth control, but birth control medications are used for more than preventing pregnancy. Many use birth control for other health conditions, including acne, polycystic ovary syndrome, and low estrogen levels. However, the very name this contraceptive product implies a singular function: birth control. In addition to experiencing barriers to getting birth control, there are concerns surrounding the language providers use when consulting patients on birth control.

Among women who are sexually active, 99% have used a contraceptive method at least once in their life. However, 78% of those women use birth control that can only be acquired by prescription or medical procedure. By having most birth control options available only in the health care space, birth control access becomes extremely difficult due to inequities in health care. Additionally, physicians are required to have a medical consultation with their patients about birth control options.

Many people face barriers when seeking birth control. A research team led by Jamie L. Manzer wanted to evaluate patient experiences when seeking birth control. They interviewed 86 women in Delaware seeking birth control. The team found that the healthcare system is like that neighbor that invites you to the party, but doesn’t open the front door. Though the healthcare system offers birth control, the system also stops many from coming in.

Manzer et al. found two main barriers: 1.) level of insurance coverage and 2.) the contraceptive counseling patients received from their doctor. Most patients were limited by what their insurance could cover, since coverage varies greatly between individual insurance plans, especially for those on Medicaid. Essentially, the ACA contraception coverage mandate was intended to cover a vast range of contraception types, to make most birth control options free or low cost.  However, there’s caveats to insurance. Often, when patients switched insurers in hope of expanded coverage, their new insurer did not always their current birth control method.

Within a reproductive justice framework, patients should be fully informed and have access to all kinds of birth control, without any persuasion or suggestion by the physician. This would be ideal, but it’s not reality. Regarding contraceptive counseling, most states required providers to ask patients a key question: Would you like to become pregnant in the next year? This question can signal and underlying belief that condoms are not a qualified choice of birth control and ascribes a primary “pregnancy preventer” function to birth control. Patients noted that this question limited their ability to make adequate decisions in electing for birth control, along with feeling rushed during consultations, and instances where the provider undermined their knowledge.

Barriers to birth control are especially felt by people of color and low socioeconomic status. Physicians are more likely to urge people of color to use implant birth control, IUD’s, and sterilization methods more so than white people. In addition, Black and Latinx patients report increased pressure in choosing the birth control option their provider favors. As access to birth control still faces downfalls, people of color face confounded adversity in a historically biased healthcare system.

Given these barriers, the researchers suggest expanding Medicaid coverage and including programs like the Children’s Health Insurance Program will cover even more birth control options than the ones listed in the ACA. Additionally, they suggest that providers offer a full range of birth control options and add additional appointment time for contraceptive counseling.

Birth control doesn’t just prevent pregnancy but is essential healthcare that should be treated as such.

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