Illustration by Emma Günther
What is contraceptive access?
Everyone who wants birth control should be able to get it.
Top things to know about contraceptive access:
Access to birth control can be limited by where you live
There are laws in the USA that limit access to birth control, especially for minors
Many people cannot afford birth control or the transportation needed to get it
Accurate sex education and more birth control options can help people access contraception
Someone who has “contraceptive access” can get birth control when they want it. Almost all women and people with cycles have used birth control at some point (1). If you have ever been able to visit a healthcare provider or pharmacy for contraception and had no trouble filling or buying your prescription, you had access to contraception. It isn’t so easy for everyone though. There are barriers that prevent some people from getting birth control, as well as barriers that prevent them from using it as prescribed (2).
Access to birth control should be convenient, affordable, and personalized. Because this isn’t the case for everyone, it’s important to understand what barriers get in the way of accessing birth control and how these barriers can limit people’s options.
Laws and policies regarding birth control vary all around the world. For the purposes of this article, we will talk about how laws and financial policies in the USA impact people’s access to birth control.
Cost and financial inequalities can limit access to birth control
The ability to get and use birth control is critical to prevent unintended pregnancy. A major factor in getting birth control is being able to pay for it. Oftentimes people who cannot afford birth control are the hardest hit by unintended pregnancies (3).
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In the USA, the Affordable Care Act (ACA) now requires that health insurance plans cover the cost of contraceptives (at least one from a list of 18 categories), although some employers claim religious exemption (2). But not everyone has insurance, or the insurance might use a loophole to avoid paying, and not everyone can afford the transportation needed to get to a clinic or pharmacy (4). More people gained access to birth control, with the expansion of telemedicine services during the pandemic. But, even with access and insurance coverage, some insurance companies require a person to choose a less expensive birth control method that might not be right for their body or lifestyle (2).
For example, access to long-acting reversible contraceptive methods (LARC) like intrauterine devices (IUDs) and implants may reduce the number of unintended pregnancies in teenagers. While these methods are some of the most effective forms of birth control available, they have a higher upfront cost than other methods, coming in around $800 (5). Although the cost of a long lasting method is higher initially, these methods are more cost-effective over time — up to 10 years for the IUD and five for the implant (6).
Research suggests that teens are happy with LARCs as a birth control method, but few can afford an IUD or implant without insurance (7). Even when teens have insurance, they may be unable to pay other out-of-pocket costs such as a co-pay (7).
The legal system sometimes limits your access to birth control
Although insurance plans are required to cover contraception in the USA, there are some exceptions. Because insurance is usually bought through a person’s job, access to birth control can be compromised by the employer’s beliefs. The Supreme Court ruling Burwell v Hobby Lobby gives an employer the power to deny employees coverage of birth control if they do not agree with it (2).
Laws can be even more restrictive for people under 18 years old. Young people deserve to make informed choices about their bodies and sexuality. Yet, only 27 states and the District of Columbia allow people under 18 to consent to birth control without parental permission (8).
Where you live can limit your access to birth control
To effectively use contraception, you need a source, or a place to get it (3). Contraceptive deserts exist in the USA where the people who need birth control are not able to get it. Over 6% of women in the USA don’t have access to contraception (9).
There is a link between using contraception and how far someone must travel to get it (3). One study showed that when people had to travel over 30 minutes to get contraception, they were two and a half times less likely to use it (3).
Sometimes birth control might be available near you, but it might not be the right contraception for you and your body. When there are more contraceptive options available in a location, it is more likely that people will use contraception (3).
People’s beliefs can limit your access to birth control
It is common for people to cite their religious beliefs as a reason to deny other people birth control. For example, if you request birth control in a Catholic hospital or clinic, you might be denied. This is a problem, considering that 40% of large hospital systems in the USA are Catholic (10).
There have also been reports of pharmacies and pharmacists denying access to contraception because of misplaced religious beliefs for example a pharmacists won’t dispense emergency contraception (it is over the counter but in limited quantities) because they think it is an abortifacient (medication that induces abortion) when it isn’t (2). If this happens to you, know you can try another pharmacy if there is one close to you.
Understanding birth control improves access
When people have a limited knowledge of birth control and how it works, they may be less likely to use it. This might happen because people don’t know their birth control options. It can also happen when people hear and believe myths about birth control and its safety (2). Claims that birth control is dangerous or causes abortions are not true (2).
Sex education in schools should inform adolescents about all of their birth control options and the risks and benefits of each (2). Healthcare providers should also be able to provide all the options and educate people on which options might be best for them (2).
Birth control should be easy to get
Other obstacles can get in the way of getting your birth control prescription. It is a commonly held belief that you’ll need to visit a healthcare provider and have a pelvic exam before you can get a prescription for birth control. This is an outdated practice (2). You can always say “no thank you” to a vaginal exam if it is requested during a visit.
In fact, you can visit with a provider online through the number of emerging online health clinics that offer birth control like:
Favor (formerly The Pill Club)
If you would like an IUD for contraception, this procedure will require a pelvic exam and perhaps a visit (or two) to your doctor’s office.
The power of choice
Birth control helps people prevent and space out pregnancies (11). When women and people with cycles can choose when they want to be pregnant, they and their children benefit both physically and emotionally (8, 11). Having this autonomy also results in better outcomes in their education, careers, achievements, family income, and safety (8, 11).
All people who want birth control deserve it. When people are educated about all birth control options, both hormonal and non-hormonal, they can choose the contraceptive that works best for them.
