Transcending the Piecemeal Approach to Contraceptive Access


The need for access to birth control in America is staggering. More than 98% of heterosexually active women use birth control during their lives. Nearly 40 million women are currently using a method of birth control. The average American woman, who wants to have only two children, must use contraception for about three decades.

While we’ve achieved coverage for contraception under both Medicaid and the vast majority of private insurance plans, high co-pays for contraception—sometimes reaching upwards of $50 per month—can prove prohibitive, letting too many women fall into the gap where high co-pays are a luxury they can’t afford.

Thanks to the work of advocates, mostly working on a state-by-state basis, we’ve drastically improved access to contraception. For years, the National Institute for Reproductive Health has worked to increase low-income women’s access to contraception by building partnerships with local and state advocates across the country. We launched the first national coalition on low-income women’s access to contraception, and after emergency contraception (EC) was approved for over-the-counter use in 2006, we worked with partners in to gain Medicaid coverage of over-the-counter EC.

As women’s health advocates, we should be proud of our many successes. Twenty-seven states now have laws in place requiring insurers that cover prescription drugs to provide coverage for contraception. Federal employees are guaranteed insurance coverage for contraceptives. Most recently, our partner in New Mexico, the Southwest Women’s Law Center, became the ninth state to win Medicaid coverage for over-the-counter EC.

Despite these successes, years of tireless coalition-based advocacy has proven the difficulties of a state-by-state strategy: fighting the same battles, again and again, bumping up against the same hurdles, and too often coming away with negative results.

Now, the implementation of health care reform provides an opportunity to transcend this piecemeal approach by achieving comprehensive, nationwide reform. If the Department of Health and Human Services adopts the recommendations just released by the Institute of Medicine to cover the full range of FDA-approved contraceptive methods with no copay, birth control will no longer be a luxury that millions of women can’t afford.

No-cost birth control is surely not a panacea to the high unintended pregnancy rate in the U.S. Cost is not the only barrier to contraceptive use, and—although health care reform was a step forward—far too many American women remain uninsured. We must continue to work tirelessly to further expand coverage to excluded populations, break down barriers to pharmacy access, and invest in comprehensive sexuality education.

But providing birth control at no extra cost to millions of women on the new state exchanges would make the piecemeal strategy comprehensive, and would radically transform the lives of women across the country. It is a real triumph of health care reform that such transformation is within reach.

The National Institute for Reproductive Health calls on the Obama Administration to adopt these recommendations and make access to contraception a reality for the women who have, for far too long, seen consistent, quality contraception just beyond their grasp.

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