Chronicles of Contraception Access: The Providers’ Perspectives
By Jane Haines, Communications Intern, The National Campaign
Although significant obstacles remain for millions of women seeking contraceptive care, 55 million women have benefited from no cost preventive services under the Affordable Care Act (ACA), including birth control. That’s great news because the only thing a woman should worry about when choosing from the full range of contraceptive methods is which one she and her provider decide works best for her. Thanks to the ACA’s no co-pay birth control provision, frequently prohibitive out-of-pocket costs are no longer part of that equation.
So there’s a lot at stake should this provision of the ACA be repealed: access to affordable contraception will be even harder to come by and recent successes in efforts to reduce unplanned pregnancy could be reversed. This isn’t just a matter of policy—it’s a situation that will impact millions of real people. We asked health care providers to share their stories about how the ACA’s birth control provision has affected their practice and patients. This is what they told us:
Elle E., an OB-GYN in Albany, N.Y., has seen a difference among what methods her patients choose and their ability to use those methods consistently. “When I started training, options for women living without insurance or [who were] under-insured were very limited. If they could afford a birth control pill it was often one that gave them symptoms (headaches, moodiness, loss of libido etc.) that would lead to them stopping the pill and getting pregnant.” Once the ACA was implemented, “immediately there was an increase in the use of not only LARCs [long-acting, reversible contraceptives like IUDs and the Implant], but also pills that were once too expensive. Suddenly adherence to many methods wasn’t an issue because the barrier to care had been removed.”
The elimination of cost barriers also has made a difference to the patients seen by Charlene G., a physician specializing in adolescent medicine in New Berlin, WI. “Prior to the ACA and its expanded contraception coverage, if a patient came in for general contraception coverage and decided they wanted a Nexplanon [the implant] placed, I had to obtain prior authorization to ensure it was covered. It made it impossible to insert the same day. Now I know they are covered and they can get their preferred method immediately.”
Since the presidential election, however, the ACA’s uncertain future has left women scrambling to get IUDs and the implant for fear their insurance benefits may disappear. Many providers have witnessed this phenomenon up close as they enter a new reality in which birth control could become more difficult—or outright impossible—to access.
Catherine S., a pediatrician in Lebanon, N.H., reports that her clinic has seen a 170% increase in demand for LARC methods since November. “Many of these teens and their mothers are asking for placement now because they are worried that the access to no cost LARC through insurance companies will be repealed in the coming months.”
Then there’s the challenge that young women who came of age under the ACA face—they don’t know what it’s like to pay out-of-pocket for their contraception:
Ann M., an OB-GYN in Boulder, Co., who has been in practice for three decades, says she’s realized recently “that we have a whole group of women who have become sexually active since ACA was enacted.” She notes that these young women “do not realize the potential cost and risk to their health if this aspect of ACA is repealed.” She wonders “how do we get people to recognize benefits they are experiencing from ACA if they have never known anything different?”
Julie G., a health educator who works with high school students in Alameda, Calif., says she’s getting different kinds of questions from her patients since the election. Rather than the usual queries like “would I remember to take the pill each day?” or “would the patch show when I wear a tank top?” she’s noticed a stark change. “Instead, they asked with panic, ‘will you still be here next year? Should I get an IUD because I won’t be able to soon?’” Adding, “for the first time in a long time as a provider I am hoping for the best yet preparing for the worst.”
Hopefully the contraceptive coverage provision will remain when the ACA is repealed, replaced, or repaired. If not, there are millions of women who will find it much harder and more expensive to take control of their futures by choosing the right method for them and determining if, when, and under what circumstances to become pregnant. For more of their personal stories, keep reading the Chronicles of Contraceptive Access and visit our storytelling portal.