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Esther J. Cepeda: America needs to expand women’s access to affordable birth control

First Published      Last Updated Dec 05 2016 06:08 pm

Chicago • It looks as though president-elect Donald Trump is getting serious about repealing the Affordable Care Act, which means that the gains women made in access to birth control are as up-in-the-air as the vitriol-inducing requirement to pay a fine for opting to not get health insurance.

But before fretting about what might be taken away, it's worth noting that even in its present form, the ACA did not magically make birth control universally accessible to all the low-income women the law hoped to cover.

According to data from the National Campaign to Prevent Teen and Unplanned Pregnancy, a nonpartisan, nonprofit organization, there are currently 19.7 million women in need who live in what they call "contraceptive deserts." This means they lack "reasonable access" to public clinics that offer a full range of birth control methods, from access to condoms and spermicide to pills, IUDs, implants and others.



They define "reasonable access" as a county where the number of public clinics, and estimated number of providers in those clinics, are enough to meet the needs of the county's population, defined as at least one clinic/provider for every 1,000 women.

But even having this baseline number of health care providers in a geographic area doesn't mean that women are necessarily able to access the birth control services they need.

"We tend to think of this lack of access as a rural or suburban issue but when you look at access maps, even in large urban centers, where it looks as though they have better access than people who live in remote locales, it's still a major issue for low-income women to get to where the doctors are," Ginny Ehrlich, the CEO of the National Campaign, told me. "These are women who are navigating the challenges of public transportation, who may not have paid time off or the ability to pay for child care costs so they can go to the clinic — it can take four hours to go five miles in some urban areas." And such difficulties are but aspirational inconveniences to the 3.1 million women that the National Campaign estimates are in need of low-cost reproductive health care and birth control but live in counties without a single public clinic that offers the full range of contraceptive methods.

So, yes, the ACA benefits are much needed to keep the numbers of unplanned pregnancies at their present historic low. But even still, the Guttmacher Institute, a sexual and reproductive health and rights research and policy organization, estimates that in 2011 nearly half of all U.S. pregnancies were unintended and they are increasingly concentrated among low-income women.

Rep. Tom Price, R-Ga., president-elect Trump's pick for heading the Department of Health and Human Services, is said to be, paradoxically, both a fierce opponent of abortion and of the ACA's birth control mandate. If so, he's out of step with a majority of Americans.

"In a time where we're constantly being barraged by divisive partisan issues, this is an issue that by and large and across the board we agree upon," said Ehrlich. "Everybody loves birth control," she said, citing a recent survey the organization did which found that eight in 10 adults (86 percent) support policies that would make it easier for those 18 and older to get the full range of birth control methods.

Further, the National Campaign's survey found that 76 percent of all respondents support policies that make it easier for teens to access birth control with 70 percent of Republicans and 90 percent of Democrats agreeing that birth control is a basic part of women's health care. Of those respondents, 74 percent of Republicans and 86 percent of Democrats agreed that those who oppose abortion should strongly support birth control.

Not everyone thinks that ample access to birth control is a bipartisan point of agreement.

In 2012 Rep. Price said that there was "not one woman" who was "left behind" from access to birth control. Many others, who themselves are not impacted because they are affluent enough to have the means necessary to easily access a full range of health care services, also don't understand the need for ensuring that every woman that wants to keep from getting pregnant can so do safely.

They will have to learn. And if the Trump administration doesn't gain this understanding, millions of women and their advocates will be sure to enlighten them on how the cost of birth control stacks up to surging levels of unplanned pregnancies.

estherjcepeda@washpost.com.

 

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