Despite Ongoing Contraceptive Access Challenges, Public Health Workers and Advocates Persist


Despite Ongoing Contraceptive Access Challenges, Public Health Workers and Advocates Persist

by Samantha Berg
April 5, 2021
A provider wearing a hijab while sitting on a bench and reviewing information.

This National Public Health Week, we continue to honor the health care workers and public health professionals on the front lines of the Covid-19 pandemic. But as we embrace their unwavering efforts (virtually, of course), we must also recognize the invaluable work of a specific cohort of public health professionals: reproductive health care providers and the state and local organizations that advocate for them. Because as we know, and as the CDC has recognized, reproductive health is public health.

Over the last year, Power to Decide has conducted research for our state-level contraceptive landscape fact sheets. During this time, we have had the pleasure of speaking with local advocates and clinic workers who serve folks eligible for publicly funded reproductive health care. They work at non-profits around the country, including but not limited to Alliance Chicago, Arizona Family Health Partnership, Brush Foundation and Community Solutions (Ohio), Essential Access (California), Missouri Family Planning Council, Nevada Primary Care Association, the New York Birth Control Access Project, Every Body Texas, and West Virginia Free—as well as for state health departments in Colorado, Delaware, Kentucky, Michigan, Nevada, North Carolina, Ohio, Tennessee, Utah, and West Virginia. These public health workers and advocates are passionate, talented, and unrelenting individuals who work tirelessly to ensure as many patients as possible can receive high-quality care. During the pandemic, they have continued to adapt to ensure folks can still access the care they need, including the full range of contraceptive methods

While these public health workers deserve all our praise, they also deserve more – more resources, more clinics, more funding. Many clinics are currently serving an entire county’s worth of patients, if not more, while trying to fend off attacks on contraception.  

What is a contraceptive desert? It is a county that does not have enough health centers offering the full range of contraceptive methods to serve the number of women eligible for publicly funded contraception. About 19 million women across the United States live in contraceptive deserts, and roughly 1.5 million of them live in counties without a single clinic that offers the full range of methods. 

Folks who live in contraceptive deserts must travel farther to access the full range of methods, and thus face additional barriers. These barriers include paying extra gas or bus fare, spending time away from school, losing wages from missed work, paying for additional childcare, and more. 

Unsurprisingly, the Trump administration’s 2019 changes to the Title X Family Planning Program (Title X), known as the domestic gag rule, exacerbated the barriers that those living in contraceptive deserts already face. The impact of this rule was felt by clinics across the US. More than 900 health centers left the Title X program. In just one year, health centers served 844,000 fewer patients, a 21% decrease. Overall, a total of 34 states were impacted by the gag rule, including six states where all Title X grantees were forced to exit the program. The fallout has affected those who rely most on Title X—people of color, LGBTQ+ people, and people in rural areas—all of whom are already more likely to face barriers when accessing reproductive health care. 

Luckily, there have been some encouraging first steps to repair Title X. The Department of Health and Human Services has committed to beginning the process to get rid of the domestic gag rule in response to a directive from President Biden. And the American Rescue Plan included a one-time investment to bring clinics back into the program. While this is all good news, to fully repair the damage done to Title X and get more people the birth control they need, the program needs significantly more money each year

The effects of the domestic gag rule and ongoing challenges to contraceptive access are not just felt by those who seek reproductive health services. They are also felt by those providing these services. Reproductive health care providers and the state and local organizations that advocate for them are fighting every day to connect real people to high-quality services, but they are overworked and underfunded. Praise them as we should this week, we must also fight for them with the same ferocity they use to fight for us. 

Samantha Berg earned her Master of Public Health and a Certificate in Sexuality, Sexual and Reproductive Health from Columbia University Mailman School of Public Health in May 2020. As the Policy Fellow for PTD, Sam works on state policy and telehealth access, which align nicely with her passion for public health and reproductive justice.