On May 9, 2010 women across the country will celebrate the 50th anniversary of the approval of the birth control pill. However, millions of low-income women still lack access to birth control. By Kelsey Snell/Medill News Service
WASHINGTON- On May 9, 1960, the Food and Drug Administration approved the oral contraceptive pill that changed the lives of generations of women. Birth control gave women the choice of when and how to have children. However, five decades later, millions of the country’s poorest women aren’t sharing in the empowerment.
Nearly 59 percent of women in need of subsidized family planning nationwide go without it, according to data from the Guttmacher Institute, a nonprofit reproductive health organization.
“People think you can just go to the corner drug store and have your [family planning] needs taken care of,” said Guttmacher public policy associate Elizabeth Nash. “Unfortunately there are lots and lots of men and women who need subsidized care in this respect.”
The most recent study conducted by Guttmacher was released in 2006, before unemployment skyrocketed and the country sank into a recession. At the time, the national unemployment rate was just 4.7 percent, approximately five percentage points lower than today’s rate of 9.7 percent. But even in 2006, 17.5 million women of reproductive age needed assistance paying for contraception, according to Guttmacher.
“We can only predict that new data is going to be worse,” said Clare Coleman, CEO of the National Family Planning and Reproductive Health Association.
As people across the country are losing jobs—and their health insurance– many more women are either turning to Medicaid or risky behavior.
“Skipping pills is a big phenomenon,” Coleman said. “As the recession gets bigger, more people are falling into low income and staying there longer. They may have thought, ‘I will be okay because I have six months of pills.’ Then they get to the end and don’t have a job. They can’t afford to get the check-up. Then they start going to less effective methods; it’s scary.”
Individual women aren’t the only ones struggling to find room in their budgets for birth control– states are struggling, too.
Family planning funding across the country comprises a patchwork of different funding types that can be complicated, confusing and different from state to state. The state-based options range from private-public partnerships, with providers like Planned Parenthood, to community health centers and private physicians. However, the most common source of funding for subsidized and no-cost birth control was Medicaid, according to Guttmacher.
Percentage of need for publicly funded birth control met by available funds -2006
Roll mouse over each state to see individual percent. Data provided by the Guttmacher Institute.
One of the most successful family-planning programs in the country is in one of the most financially unstable states. For the past 11 years, California’s FamilyPact plan has been providing no-cost family-planning services to women who make less than 200 percent of the national poverty level — about $22,000 for a single woman, according to the U.S. Census poverty threshold.
“We’re serving about 1.8 million Californians today,” said Laurie Weaver, chief of the California Department of Health Office of Family Planning. “The cost of the program benefit is about $311 per year per client. But when we did our last survey in 2002, we were saving the state and federal government nearly a billion dollars every two years.”
The savings are realized by preventing pregnancies in women who would need financial assistance with pre-natal, birthing and post-natal care and, in some instances, extra treatment for pregnancy complications, Weaver said. She estimates that the FamilyPact program helped save the state and federal government upwards of $2 billion.
The system in California is intended to reduce or eliminate as many barriers to accessing assistance as possible. Not only is their income threshold one of the highest in the country, women are enrolled and eligible for services on the same day. They can go to a walk-in clinic and walk out with their birth control. Still, Guttmacher estimates that only 55 percent of women who need services in California are currently receiving them.
But that number is good compared to some states. In North Carolina, only 35 percent of the women who need help in obtaining birth control receive it.
“The challenge around rural areas is funding and confidentiality,” said Paige Johnson, spokeswoman for Planned Parenthood of Central North Carolina. “You’re likely to know someone who is working in your health department. For many people, the fear of being seen or known will prevent them from going to get services.”
North Carolina, like California, is one of the 28 states that have waivers allowing them to use federal Medicaid funds to offset the cost of family planning. However, for the past 15 years the state has had an abstinence-only sex-education system.
According to Johnson the abstinence-only plan wasn’t working. Johnson and a bipartisan group of legislators and advocates recently helped pass a comprehensive sex-education plan that will go into effect this fall.
“It took us two years to really help legislators understand that you start with abstinence and you continue with providing medically accurate information,” she said.
Untangling family planning preventive measures from discussions of abortion was a key step in this process, Johnson said. If the two issues become linked and abortion fights grab headlines, family planning gets lost in the outcry.
In the final health care reform bill passed by Congress, the two issues were ultimately divided – and millions of women will soon have access to the help they need. Medicaid expansion included in the bill will do away with the need for state waivers and patch-work funding systems. Low-income families will have access to the same family planning options across the country.
And while the reform bill may not have enjoyed bipartisan support, federally funded family planning does.
“I think more and more Republicans are certainly coming around to saying that we can separate prevention and planning from abortion,” said Kellie Ferguson, executive director of GOP Choice. “Whether you’re pro- or anti-choice, we all want to see the rate and need for abortion to go down.”
Though the new provisions will begin in 2014, most advocates for family planning funding feel the battle isn’t over.
“It will change public health outcomes, it will lead to a lot of people having better choices,” Coleman said. ““But there are significant challenges. …This isn’t a conversation we can have for one moment in time but a more constant conversation about health conditions.”