While the Affordable Care Act expanded the coverage of contraception through both public and private providers, lack of proximity to such providers still plagues low-income and rural women. The National Campaign to Prevent Teen and Unplanned Pregnancy estimates nearly 20 million women live without reasonable access to a full range of contraceptive options, and over three million women live in a county without a single clinic. This results in a teen birth rate of 30.9 in rural areas versus 18.9 in urban communities. Why is this happening and what impact does it have on a community? Condoms are available almost everywhere, so why is it that communities lacking women’s reproductive options still have such extreme unplanned pregnancy rates?
Availability vs. Access
The notion of a contraceptive desert comes down to the difference between availability and access. This is another form of the equality and equity debate, which shows how an expansion of coverage does not directly translate into the ability to utilize that coverage. While this idea holds strong across a variety of issues, it has a devastating impact on women’s reproductive rights, especially if they are low-income.
Women living in rural communities often face long drives with little, if any, public transportation to get to the nearest clinic offering a full range of birth control. Beyond distance and transportation, additional barriers include child care costs, missed work, and truancy. For data purposes, the term “contraceptive desert” specifically refers to publicly funded clinics per 1,000 women (who are sexually active and of reproductive age). This ratio is based on Dr. Richard Cooper’s 2012 model which indicates the number of physicians (across a variety of specialties) required to serve a community.
Let’s use Colorado as an example. The Colorado Family Planning Initiative is a state-sponsored program that gives teens and low-income women low or no-cost, long-acting, reversible contraception (LARCs). The ground-breaking program began in 2009 and has been a phenomenal success. Between 2009 and 2014, the birth rate and abortion rate for ages 15 to 19 fell by 48 percent, declining more rapidly than in any other state. LARCs national usage rate has increased nearly five-fold within the past 10 years (increasing from 1.5 percent in 2002 to 7.2 percent in 2011 to 2013)
However, the LARC usage rate in Colorado is at a staggering 29.6 percent as of 2014. This program is special because it gave women the opportunity to choose which birth control option was right for them. Particularly for younger teens, situational birth control is less likely to be used effectively, if at all, and contributes to the higher birth rate.
Lasting anywhere from three to 10 years, LARCs are ideal for younger women who may struggle with daily doses and always using condoms but wish to have children later in life. A copper intrauterine device (IUD) lasts for up to 10 years, enough time to make it through both high school and college with a 99.9 percent success rate. These forms of birth control are also reversible, meaning it can be removed anytime the woman wants to pursue pregnancy. This gives women complete control over their reproductive future, an important step for breaking the poverty cycle and allowing women to prosper.
The other end of the spectrum: abstinence only sex education
While we can view Colorado as the gold standard, let’s also look at the other end of the spectrum: Texas. Texas is ranked 46th nationally for highest rates of teen pregnancy by The National Campaign; in 2010, $2.2 billion was spent on unplanned pregnancies and 54 percent of pregnancies were unplanned.
While the unplanned pregnancy rate has been steadily declining, it is declining at a much slower rate in Texas. Texas also has the highest rate of repeat teen pregnancies. The reason? It is one of the only states that requires parental consent for contraception for minors, even if you are already a parent; meaning you are legally in charge of another human but cannot make legal medical decisions for yourself. The majority of schools in Texas teach abstinence only sex-ed or lack sex ed entirely, so many teens don’t realize how soon they are able to conceive again.
The long-term implications
What does all of this mean for communities at large? While the cost of providing birth control is relatively low, states repeatedly vote against providing free or low cost options to residents. The Colorado Department of Public Health and Environment estimates that for every dollar spent on LARCs, $5.85 is saved in Medicaid costs. They believe this equates to saving between $49 and $111 million. Imagine the long term implications. With this amount of money, how could the government help improve communities and allow for all residents to prosper?
Colorado has seen a decline in the poverty rate and an increase in median household income, ranking sixth nationally in 2014 for poverty decline. Unfortunately, programs like these are fought at every turn. The Colorado program was privately funded and, despite its phenomenal results, did not succeed in gaining state funding; even with Texas’ incredibly high teen pregnancy rate, they are voting to further limit women’s health clinics as opposed to opening new ones.
Nevertheless, we persist. Planned Parenthood and numerous other women’s health clinics are fighting to stay open and provide this necessary service. Victories, such as Whole Women’s Health vs Hellerstedt, show that justice can prevail and create both equality and equity for everyone. Now more than ever people need to stand up and remind government officials that they work for the people, not to serve their own agenda.