Contraceptive Access Initiative Can Help People in Suburban, Rural Areas
May 1, 2025
By Melinda Young
When and how people obtain contraception is tied to their level of social deprivation, a new study finds.1 “What we found in the study that was interesting was that people who came from areas of high deprivation with not as many resources in the community for them really preferred in-person care, and they also opted more often for long-acting reversible contraception (LARC),” says Tracey Wilkinson, MD, MPH, an associate professor of pediatrics and obstetrics and gynecology, department of pediatrics, division of children’s health services research at Indiana University School of Medicine in Indianapolis.
“There are so many efforts to improve access, and what is important is this study is showing that not one thing will work for everyone,” she adds. “When you’re looking at large metro areas like [in] Indiana with large rural and suburban areas, you need to make sure you’re providing access to people from many different communities.”
Indiana has a statewide contraceptive access initiative that works to improve contraceptive access over a large geographic area. The access initiative pays for everyone to obtain contraception, regardless of their insurance or income, Wilkinson says. “When you come to our clinic, your contraceptive is paid,” she says. “Capturing copays, asking for income verification require administrative loading we didn’t have the capacity to do.”
It was simpler and possibly cheaper to just provide contraception for free to everyone who needed it. And the initiative’s funding comes from different sources, including a small amount from state funds, she notes. “There was more money designated in the state budget for a new pig barn at the state fair than there was for women’s contraception,” Wilkinson says.
The contraceptive initiative was underway before the U.S. Supreme Court overturned Roe v. Wade. It was also before Indiana banned most abortions through state law. Abortion bans have had a negative impact on unintended pregnancies, maternal mortality, and infant mortality in some states, according to recent research.2 “There is a much higher likelihood now of unintended pregnancies continuing to parenthood,” Wilkinson says.
“We’re trying to measure outcomes that are more patient-focused and patient-centered because larger public health impacts are being pushed and pulled by all these other decisions being made or by changes to access,” she says. The initiative served about 1,200 people in 2024. It provides unlimited visits, and its services are offered at clinic sites across the state.1
“There are 15 site partners and telehealth, and we’re always working on getting more in-person sites on board to increase our reach,” Wilkinson says. “It’s important to have in-person care options. People might prefer it or really want it, and forcing them into telehealth is not sufficient to increase access for everyone.”
The partners include a mix of Title X clinics, health departments, and partnerships with federally qualified health centers (FQHCs). “We work hard to partner with people who can provide that standard of care we have that provides all contraceptive options on the same day,” she explains. “That’s the focus of the program — to get care, including family planning and contraception, on the same day, and it’s for free.”
The initiative engages in community outreach to make sure people know that free contraception is available. “We attend community events, give presentations, put ads online, have billboards, and put posters in clinics,” Wilkinson says. “We do a lot of work to make sure the community knows we are there; we make sure people are hearing about it from trusted sources.”
The initiative’s services are available to any person capable of pregnancy. “We have helped people who were above 49 years old who were desperate,” she says. “We do serve teenagers and focus our care on adolescents to make sure they can access care confidentially, which is a federal Title X protection.”
Any group that works on reproductive health and improving contraception access needs a wide funding stream to succeed, and they need to work with elected officials, Wilkinson notes. “It’s important to hold policymakers’ feet to the fire when they’re limiting access to comprehensive reproductive healthcare, like abortion,” she adds. “They should make sure patients — at the minimum — have access to contraception.”
Birth control is not a replacement for access to abortion care because birth control can fail and it might not be for everyone, she says. “It’s not the solution when they’re restricting abortion,” Wilkinson says.
In states with abortion bans, there can be unanticipated contraception access roadblocks. For example, Indiana lawmakers passed legislation for postpartum contraception, but it excluded intrauterine devices (IUDs). This was a response to an anti-abortion lobby against IUDs.3,4
The legislation’s purpose was to make sure hospitals offered postpartum patients LARC before they were discharged. But then legislators took IUDs out of the bill, leaving the contraceptive implant as the only required option.3,4 “All the data showed that women preferred IUDs postpartum, and it is important to keep all the options on the table,” Wilkinson says.
“The battle was fierce because a lot of people who I think of as allies believed some access was better than no access, and hospitals could do the right thing if they wanted to do it,” she explains. “They could still provide IUDs, but they were not mandated to do that; they were mandated to do implants.” And the mandate did not apply to the state’s religious hospitals. Still, the anti-abortion lobbyists succeeded in taking away IUDs.4
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Bernard C, Edmonds BT, Kean K, et al. The association of social deprivation index and contraceptive care in a statewide contraceptive access initiative. Contraception. 2025; Jan 20:220833. [Online ahead of print].
2. Srinivasulu S. Insights: The impacts of abortion bans on maternal health. Reproductive Health Access Project. Jan. 28, 2025. https://www.reproductiveaccess.org/resource/insights-the-impacts-of-abortion-bans-on-maternal-health/
3. McNamee L. Clarifications on HEA 1426 (Long acting reversible contraceptives). E-Reports 5-9-2024. Indiana State Medical Association. https://www.ismanet.org/ISMA/Resources/e-Reports/5-9-24/HEA_1426.aspx
4. Molloy MC. What you need to know about Indiana’s controversial birth control bill. MirrorIndy. March 1, 2024. https://mirrorindy.org/indiana-birth-control-iuds-implants-reproductive-rights-fight/
Indiana has a statewide contraceptive access initiative that works to improve contraceptive access over a large geographic area.
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