EXECUTIVE SUMMARY
Contraception access is on the chopping block as women seeking birth control already are being turned away by providers, pharmacies, and even some public universities.
- Idaho public universities told staff not to discuss or refer students to abortion providers and not to recommend any form of birth control.
- In other places, states are trying to withhold funding for contraception for low-income people.
- It is possible the 1965 Griswold v. Connecticut ruling that prevents states from banning contraception for married couples could be overturned by the Supreme Court in the next few years.
Faster than most reproductive health providers could have anticipated, some abortion-ban states, politicians, and institutions have attacked contraception access. Some predict a coordinated attack on contraception in 2023 in states that have already toyed with the idea of banning emergency contraception (EC) and intrauterine devices (IUDs).
For example, Idaho public universities told staff to not refer students to abortion providers, discuss EC, and even recommend any form of birth control. The only exception is condoms, but only if the woman says she is using them to prevent sexually transmitted infections and not to prevent pregnancy.1,2
“We always knew extremists wouldn’t stop at banning abortion; they’d target birth control next,” Rebecca Gibron, chief executive officer of Planned Parenthood Great Northwest, Hawai’i, Alaska, Indiana, Kentucky, said in a statement. “The University of Idaho’s announcement is the canary in the coal mine, an early sign of the larger, coordinated effort to attack birth control access. The same day that [Idaho] lawmakers voted to ban abortion they also rejected a bill that would have made it easier for people in Idaho to access birth control.”2
Other attacks on contraception have occurred in Missouri, where Republicans tried to stop the state’s Medicaid agency from paying for emergency contraceptives and IUDs.3
What happened in Idaho is radical and extreme, says Sara K. Redd, PhD, MSPH, postdoctoral fellow at the Center for Reproductive Health Research in the Southeast (RISE) at Emory University in Atlanta.
“There was a lot of surprise and shock when the Supreme Court leak happened in early May, and there was this wave of disbelief and horror and total shock for a large swath of the population,” Redd says. “But we’ve seen the trends in this progressively radical and restrictive policymaking, and it’s been in the pipeline for so long.”
The strategic removal of Roe v. Wade has been occurring for the 50 years since it was decided. “In the circle of reproductive justice leaders who were reading the signs and have been doing so for many years, that was not a surprise,” Redd says. “To see this happening in the world of contraception also is not surprising to me. But it’s horrifying.”
In his opinion in the Dobbs v. Jackson Women’s Health ruling, Justice Clarence Thomas mentioned other court cases with established rights that could possibly be overturned — including the 1965 Griswold v. Connecticut decision that prevented states from banning contraception for married couples. The ruling was based on a right to privacy from governmental intrusion.
“It’s pretty breathtaking to see the level to which they want to control and restrict people’s access to care and to make decisions about their lives and how they live their lives,” Redd says.
Far-Reaching Effects of Closures
Changes in state policies regarding contraception are one way that access is being eroded. The closure of reproductive health clinics that provide abortion care also will affect women’s access to contraception in abortion-ban states.
“As we see abortion clinics close, it’s also limiting contraceptive access,” says Katie Massey Combs, PhD, MPH, MSW, a research associate at the Center for the Study and Prevention of Violence at the University of Colorado Boulder. “It’s limiting general sexual and reproductive health services and limiting reproductive health clinics in general. This will squeeze out marginalized groups and our youth because they’ll have fewer options and a greater distance to travel.”
Adults can more easily overcome the travel barrier than teens can. “All the things that limit other people will be much harder for adolescents to overcome,” Combs explains.
Plus, many people who are trained in providing teen-friendly, comprehensive healthcare may leave abortion-ban states — partly because their clinics are closed. “The number of people who can provide these services are likely to be dwindling in these states with bans,” Combs says.
Expanded Access
The negative impact on contraceptive care by the reversal of Roe follows a period in which contraception access expanded in most places nationwide, research shows. A recent study by Redd and colleagues revealed the least expansive landscapes for contraception access are the Midwest and South. From 2006 to 2021, many state and federal initiatives expanded contraceptive access. But some states went in the opposite direction.3
“This research came out of work we had done previously on abortion policies,” Redd says. “We were interested in expanding that to look at contraception, and there was so much in the landscape. We found 20 expansive policies and three restrictive policies, and we took a really broad approach to this.”
Policies could include insurance coverage for contraceptives and allowing people to obtain extended supplies. “Our research on state-level contraceptive policy and state-level abortion policy, across large timespans, pre-Dobbs decision, shows consistency in the areas most likely to be restrictive — the Midwest and South — vs. expansive,” says Whitney S. Rice, DrPH, a Rollins assistant professor of behavioral, social, and health education sciences, and director at the Center for Reproductive Health Research in the Southeast at the Rollins School of Public Health at Emory University. “It’s certainly possible that states choose to continue this trend. However, perhaps the Dobbs decision will be a catalyst for states in more restrictive environments to reverse course and be more supportive of the health of people who can become pregnant and their families.”
Since the Affordable Care Act (ACA) was enacted, some states have expanded the amount of contraceptives dispensed at one time, such as allowing a six- to 12-month supply of birth control pills.
“We also looked at things like Medicaid expansion,” Redd says. “Any policy that increases people’s access to healthcare and health insurance will increase their access to contraceptives.”
Redd and colleagues also studied state education policies and assessed whether they required information on contraceptives. In 2021, the most common policies that helped to expand contraceptive access involved changes in prescribing authority and Medicaid expansion. Some states allowed midwives and/or advanced practice providers, including nurse practitioners, to prescribe and dispense contraceptives.4
Effects on Free Speech
The move by Idaho public universities to stop contraception access is one of the most visible anti-contraceptive moves seen in the post-Roe era, but it is not the first or only one. For instance, 12 states allow providers to deny patients treatment for contraceptive services, including EC.5 Some healthcare entities in states like Missouri and Idaho will not provide EC because of ambiguity about whether the states’ abortion bans could be interpreted to include EC.1,5
Restrictions to abortions and contraception often include restrictions to free speech, such as providers even discussing abortion. “I have heard about faculty [in Idaho] being told they cannot mention abortion, and that’s something we’re hearing in terms of researchers, too,” Redd says. “Some universities are telling researchers they cannot study abortion. I’ve had friends at other universities say they cannot do any research on the implications of the [Dobbs] ruling, and they’re restricted from even talking about abortion.”
Even if a reproductive health expert writes an opinion piece about abortion laws and access, some universities are not allowing them to sign their name to the story, Redd says. The chilling effect of anti-abortion laws could end up a factor in decisions about where students, faculty, and healthcare professionals choose to study, work, and/or practice.
“We have not had anything like that at Emory,” Redd adds. “They’ve been very supportive.”
It is possible some medical schools and universities may offer a limited scope of training opportunities because of abortion restrictions. “These laws could also affect the decisions of prospective and accepted students, and current and potential faculty, who may want to enroll and be employed in settings that affirm and allow for comprehensive spectrum of reproductive health training and care,” Rice adds.
In 2023, it is likely that some states will pass laws that greatly restrict access to contraceptive care, especially to EC and long-acting reversible contraception (LARC) — even though evidence shows these methods do not end pregnancy. “I think this upcoming state legislative season in 2023 will be one of the most radically restrictive in policies related to sexual and reproductive health access,” Redd predicts.
Even if states do not pass laws banning some contraceptives, there are other policies that make it difficult — if not impossible — for some women to obtain the contraceptive of their choice. For example, Iowa opted out of a Medicaid family planning program in 2017 and set up its own contraception program. Researchers from Pew Trust found that the share of patients not using any contraceptive method increased from 9% to 15%.4
About 50 million women between the ages of 15 and 49 years use some form of contraception. But those with low income largely rely on Planned Parenthood or other publicly funded clinics to pay for their birth control pills, LARC, and other methods. Medicaid is the largest funding source for free contraception.6
If states ban some forms of contraception, patients could still access many methods via telehealth services. “There was a huge uptake in telehealth and telemedicine over the pandemic, and there were tons of people who got their prescriptions through telemedicine,” Redd says.
But the Dobbs ruling has created a legal quagmire for reproductive health and other providers, Redd notes. Even health discussions that mention abortion — and, theoretically, banned contraceptives — could be treacherous for clinicians.
“There are resources clinicians could point out to patients, but only to the extent they’re legally allowed to and to the extent they’re aware of those resources,” Redd explains. “We can hypothetically think about it, but I’d be interested to hear from clinicians about what is doable and what is going on in their offices.”
Robert A. Hatcher, MD, MPH, chairman of the Contraceptive Technology Update editorial board, says, “It’s hard to imagine this is anything but an all-out attack on the availability of voluntary contraceptives, emergency contraceptive services, and sex education in the states now enacting harsh restrictions on the performance of abortions.”
REFERENCES
- Boone R. Idaho universities disallow abortion, contraception referral. Associated Press. Sept. 27, 2022.
- Planned Parenthood Great Northwest. Planned Parenthood response to University of Idaho’s ban on birth control. Sept. 26, 2022.
- Rice WS, Redd SK, Luke AA, et al. Dispersion of contraceptive access policies across the United States from 2006 to 2021. Prev Med Rep 2022 May 13;27:101827.
- Ollove M. Some states already are targeting birth control. Pew Stateline. May 19, 2022.
- Advisory Board. Is Plan B still legal? In some states, confusion abounds. June 17, 2022.
- Vestal C. New research shows state restrictions reduce contraception use. Pew Stateline. Sept 22, 2022.
Faster than most reproductive health providers could have anticipated, some abortion-ban states, politicians, and institutions have attacked contraception access. Some predict a coordinated attack on contraception in 2023 in states that have already toyed with the idea of banning emergency contraception and IUDs.
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