Access to birth control information and services is key to ensuring that everyone has the ability to make decisions about getting pregnant on their own terms and timeline. However, accessing birth control information and services can be difficult for many people. Nearly 20 million women in need of publicly funded contraception live in contraceptive deserts—places that lack reasonable geographic access to a health center that offer the full range of contraceptive methods.
Many of us think of the geographic and financial barriers to birth control services, and while they are important, they are not the entire picture when it comes to equitable access. There are multiple additional dimensions of access barriers including administrative, cognitive, and psychosocial barriers to timely access to birth control information and services. Being aware of these barriers and how they can affect people’s access to contraception can help providers offer high-quality, individualized birth control counseling and care.
Geographic or physical barriers are the distance someone must travel to a clinic, provider office, or health center that has the birth control information and services they need. Strategies to overcome geographic barriers are often the focal point of research and initiatives aimed at health care and contraceptive access. One current strategy to overcome geographic barriers is improving access to telehealth and deliver-to-your-door options for accessing hormonal methods, like the pill, the patch, the ring, and emergency contraception, especially for people living in contraceptive deserts.
Economic barriers refer to the challenges individuals face paying for the birth control method they want. These barriers include both the actual cost of the method and related costs, like unpaid time off of work, childcare, and transportation. Birth control costs, especially for methods like the IUD and implant, can be a significant barrier for people with low incomes and those with inadequate health insurance. While the Affordable Care Act increased access to birth control by mandating that private health insurance plans offer birth control and other services without co-pays or deductibles, not everyone has the coverage they need.
Administrative barriers are the unnecessary rules and regulations that limit access to birth control—think confusing paperwork, inconveniences like restricted clinic hours, need for parental consent, and other impediments that cannot be medically justified. Additionally, providers or organizations can enact administrative barriers that limit same-day access to desired methods, for example requiring pap smears before refilling birth control prescriptions or testing for and receiving results from sexually transmitted infections (STIs) screenings before IUD placement, a practice that is not supported by research or guidelines.
Cognitive, or information, barriers include what people know both about what methods of birth control are available and where to get them. Many people may not be aware of the full range of contraceptive methods, particularly younger women, let alone where to locate them. Providers can guide people to overcome cognitive barriers by connecting them to evidence-based resources like Bedsider.org where they can find detailed, accurate, and easy-to-read information on the wide range of birth control methods and where to get them, including delivered-to-your-door options.
Psychosocial barriers are the extent to which people are limited by psychological, attitudinal, or social factors, like stigma or fear when seeking contraception. Religion, sexual partners, and mental illness are some factors that can deeply influence people’s attitudes towards birth control. People often tend to have very strong, individual opinions, attitudes, and ideas about topics related to sex and family planning. And conversations about pregnancy desires, which have no one “right answer,” can be challenging for providers who are more familiar with the universal outcome goals of chronic disease management, like controlling diabetes or hypertension. However, tools like One Key Question® can help providers universally ask people about their pregnancy desires, respect their potential ambivalence, and provide them with the information and resources they need.
In addition, information about negative birth control side effects, like nausea, weight gain, or moodiness, may cast a bad light on birth control for many people and discourage them from using it. Providers can dispel myths without stating them, emphasize that everyone’s bodies respond differently to birth control methods, and be upfront that birth control can have both positive and negative side effects. Providers can also use shared-decision making to guide patients selecting a birth control method and listen to what is most important about a method for an individual patient.
A perfect example of this is the domestic gag rule that the Trump Administration implemented in August 2019. It is a medically unnecessary administrative barrier that limits access to information creating a cognitive barrier for pregnant people with low incomes coupled with a loss in federal funding for some clinics increases economic and geographic barriers to contraception.
The rule forces health centers to make an impossible choice between continuing to provide high-quality, evidence-based care that respects reproductive autonomy without federal funding or accepting federal funds to keep the doors open for patients who might not have anywhere else to turn with a requirement to withhold information from patients about abortion services. This includes not mentioning that abortion is one of three legal options available to those who are pregnant—or even where they can access abortion services.
Implementation of this rule means that clinics who forego funding may have to charge more for services, creating economic barriers for clients, or close their doors or shorten hours, creating geographic barriers. And clinics who maintain funding are required to limit access to information about the availability of abortion services for people who are pregnant, creating a cognitive barrier for people who are pregnant.
How Providers Can Help
Providers can help expand access to birth control information and services by mitigating barriers in all these domains of access within your work and offering the full range of birth control options. Providers should explore and respect individual client concerns, needs, and attitudes while engaging in contraceptive counseling and care. These conversations can help providers recognize the various domains of birth control access that are affecting an individual patient and ultimately lead to a more comprehensive, balanced, and effective approach to improving access to birth control information and services.