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Demand for Contraceptives Increases as Barriers to Access Persist 


Reproductive Health

Nurse Practitioner Nicole Martinez, of the Santa Barbara Neighborhood Clinics, in Goleta, California, holds an IUD. The Santa Barbara Neighborhood Clinics are among the hundreds of community health centers across the U.S. that received Bayer-donated IUDs to bolster reproductive health services for uninsured women. (Photo by Erin Feinblatt for Direct Relief)

For people who don’t want to become pregnant, there are many ways to prevent pregnancy, but accessing these options can be challenging.

One of the most effective reversible contraceptives is an intrauterine device, or IUD. This small, t-shaped device is either plastic or copper and can prevent pregnancy for up to 10 years, depending on the type of IUD. However, high costs and misinformation prevent many from using the method.

Lack of health centers and transportation, clinicians trained in providing the full range of contraceptive methods, and person-centered care also contribute. About 28 million U.S. residents are without health insurance, limiting their options for access to sexual and reproductive health care. Recent judicial and legislative changes have also shifted options for family planning, like dollars that support healthcare access through the Title X Family Care Plan and the reversal of Roe v. Wade.

As laws and budgets change, the importance of health clinics and health centers that provide access at low-to-no cost remains constant. The Pew Research Center reported a decrease in births during the coronavirus pandemic and that more than half of women aged 50 and under with no children said that they don’t plan to have children in the future. For those who are sexually active, medical professionals say contraceptives are a safe option to prevent pregnancy.

“If people don’t want to be pregnant then we don’t want them to be pregnant,” said Whitney James, a nurse practitioner at Knox County Health Department in Knoxville, Tennessee. James said requests for contraceptives are ongoing and that patients have questions about the different types of contraceptives and where they can access the medications or devices. The Knox County Health Department provides services for people with or without insurance. James said that there are several contraceptive options, like a vaginal ring, birth control pills, intrauterine devices or IUDs, implants, and Depo-Provera shots. Each work differently with the same goal — preventing pregnancy.

However, without insurance coverage, IUDs have a high upfront cost that could be over a thousand dollars when you include the cost of the procedure to insert it. There are five FDA-approved IUD brands in the U.S., all of which must be inserted by a medical professional. “It’s a very simple procedure, but it can be painful for some,” James said. “It feels like a bad menstrual cramp.”

The IUD lasts for several years while other contraceptives are used daily, weekly, monthly, or every few months. James said many patients forget to take the pill daily and are averse to returning for doctor visits every few months for a shot.

The nurse practitioner said staff speak with patients about the process of getting and removing an IUD because the use of the device is not commonly known. According to James, many people don’t know the benefits of the device or that they can receive family planning care from the health department. Avenues for family planning in the Knoxville area are limited. Tennessee is one of 12 states nationwide that did not expand access to Medicaid when the Affordable Care Act was introduced, and 20 of the Knox County census tracts are considered medically underserved areas. The county reported that just 8% of Knox County residents were without health insurance pre-pandemic and that 38% of residents identified medical debt as a major problem. Black and Hispanic residents had a higher uninsured rate than white residents.

The Knoxville Planned Parenthood burned to the ground in December of 2021, followed by the forced closure of the Knoxville Center for Reproductive Health on August 31 of this year. The state’s Heartbeat Law went into effect this summer which bans abortions after six weeks. The temporary and permanent closures of these businesses and the newest abortion restrictions have limited residents’ access to learn about and address family planning.
Lack of prenatal or maternal care can contribute to low-birthweight babies, infant mortality, and maternal mortality, and medical professionals across state lines say greater access to family planning care is necessary.

In Georgia, Dr. Gabriela Pena says their clinic sees patients when they are well into their pregnancy. “I’d rather they come late to care than not get care at all,” Pena said. Pena works for Your Town Health, a network of seven nonprofit community health centers serving six counties. Their bilingual network allows them to communicate with their diverse patient base, but Pena said they mostly serve underinsured or uninsured residents.

Like Tennessee, Georgia did not expand access to Medicaid and has a law in place that bans abortions after six weeks. For people who do not want to be pregnant, they need to receive care earlier in the process.
Pena said that barriers to access to maternal health care include lack of insurance, being underinsured, lack of transportation, lack of available practitioners, inability to find doctors that speak the same language, and the costs of care. They offer services on a sliding scale, so patients pay what they can afford. Given the changing laws, YourTown Health expects an influx of requests for family planning care.

In the past, older and often married people who already had children were likely to request an IUD. But Pena said she now sees younger people who are beginning to make the same request and prevent pregnancy for several years.

Through donations from Bayer U.S. and Medicines360, Direct Relief has distributed 31,160 IUDs to 494 U.S. health centers and clinics, free of charge, since 2018.

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