Speaking Out About Birth Equity and Contraceptive Access


Speaking Out About Birth Equity and Contraceptive Access

November 3, 2021
A drawing of an empty stage with four chairs set up for a panel discussion.

In October, our CEO, Dr. Raegan McDonald-Mosley, spoke at two conferences—HLTH 2021 and The Child Poverty Action Lab—on birth equity and contraceptive access, respectively. Both of these issues are important to Power to Decide as we know that not all people actually have the power to decide the circumstances under which they get pregnant or have a child. 

Given both topics’ importance, we’re sharing an abridged version of her remarks at both events. 

HLTH 2021 Panel, “Pathways to Birth Equity”

Dr. Joia Crear-Perry, founder of the National Birth Equity Collaborative, defines birth equity as “the assurance of the conditions of optimal births for all people with a willingness to address racial and social inequalities in a sustained effort.” 

In the United States, more than 700 women each year die of complications related to pregnancy, two-thirds of which are preventable. And maternal mortality is not a burden shared equally among all. Black birthing people experience the highest rates of maternal morbidity and mortality of any racial or ethnic group. They are three to four times as likely to die from pregnancy/birth-related causes. 

These disparities are not the result of any inherent differences between racial groups, but rather, the result of persistent systemic racism and bias in health care and society at large. Implicit biases and racism are known to exist both at the level of the health care system and at the individual provider level. We also know that a longstanding patriarchal approach to women’s reproductive health has had detrimental effects including not listening to a person about their own life, body, and needs. All of this must change. 

Solutions include, but are not limited to, safe and supported birth; equal maternity care; and enhancing supports such as access to doula care, paid family leave, and affordable childcare for families before and after birth. We need to invest in and support comprehensive reproductive health care, including safe, legal abortion to promote better maternal and infant health outcomes.   

At Power to Decide, we are investing in a future where birth equity for all is realized by: 

  • Ensuring contraceptive access, regardless of zip code. 
  • Asking people about their reproductive health goals and helping them realize them. 
  • Advocating for abortion as a part of the full spectrum of reproductive health services. 

Furthermore, in partnership with more than 40 organizations, we conducted research on reproductive well-being. Reproductive well-being means that all people have equitable access to the information, services, systems, and support they need to have control over their bodies, and make their own decisions related to sexuality and reproduction throughout their lives. It is centered on equity, autonomy, and agency and it goes beyond reproductive health care, body parts, and services. It embraces a broader scope of physical, mental, and emotional well-being across the life course. 

Reproductive well-being is what all people deserve, but not all people experience. 

We know that reproductive well-being resonates with people. When asked how they would want to experience it we heard that they want to be: 

  • Seen and Understood: People want to be trusted by their providers and met where they are. They want their experiences, cultures, and desires to be respected. They want to receive information without judgment from providers who recognize that there is no ‘right’ answer to complex decisions. 
  • Autonomous: People want the freedom and safety to experience sexuality on their own terms, as long as it is consensual and does not harm others. They want the power to make their own decisions about if, when, and under what circumstances to get pregnant and have a child. 
  • In control: People want to receive access to all information and options available so they can make informed decisions. With this information they can create a healthy future for themselves and a healthy start for the next generation, if they choose to have or raise children. 
  • Surrounded by communities and systems of support: People want reproductive well-being to be an essential component of overall health and well-being, not only in health care, but in society in general. People want it to be understood, discussed openly, and pursued by all. 

The Child Poverty Action Lab Speech, “Contraceptive Access”

There are over half a million women of reproductive age in Dallas County and almost half of them have no health insurance. Without a systemic and comprehensive approach to break down barriers and increase access, the problem will likely get worse. 

In fact, in recent surveys from the Kaiser Family Foundation nationwide, almost 40% of women have reported having difficulty accessing contraception and other reproductive health services during the pandemic. And this number was even higher for women of color, people with low incomes and for young people. 

We know this work can be done, and it can have profound impacts for individuals, families and for the broader community and society. When I was starting my fellowship at Family Planning at Johns Hopkins in 2008, the CHOICE Project was just wrapping up its data collection in St. Louis. The researchers conducted this study with nearly 10,000 Women in St. Louis and provided contraception counseling and any method of the woman's choosing. And in a very short period of time, the teen pregnancy lowered dramatically, as did abortion and birth rates. 

In addition, the Colorado Family Planning Initiative has been very successful. From 2009 to 2014, LARC use among Title X clients went from 6% to 30%, the state saw nearly a 50% reduction in teen birth and abortion, and unintended pregnancy rates fell by 40% among those age 15-19 and 20% for those age 20-24.

The Delaware Contraceptive Access Now project has partnered state officials and Upstream USA with health centers and community organizations to provide training and technical assistance aimed at ensuring all patients have access to the full range of birth control methods in a single visit. In 2010, prior to the start of this project, 57% of all pregnancies in Delaware were unintended. But between 2014-2017, there was a simulated 24% decrease in unplanned pregnancies among Title X patients age 20-39.

Lastly, the Take Control Initiative in Tulsa, Oklahoma has been working since 2010 to increase access to contraception for people who live in the Tulsa area. They're working deliberately to address systemic barriers to care, including direct cost of care, transportation, language, and other logistical barriers. The program has been able to document over a 50% reduction in the abortion rate, as well as over a 50% reduction in teen births. These projects have all been able to achieve astounding impacts in short periods of time. 

Lost in the data, though, is the actual impact on people. It's important to think about what's behind the statistics to think about the 17 year old that was able to finish high school and go on to higher education, to think about the 15 year old that was able to space out her pregnancies until she was able to recover from postpartum depression, and be ready to financially support another child, the 20 year old who had almost given up on the providers that she was seeing in the entire medical system, until she was able to find a trust her center where she felt heard, listened to and valued, where she was able to get the care that she needed in a timely fashion. And without unnecessary barriers and hurdles.

Access to quality contraception care, including the full range of methods from a provider that centers the patient's needs and respects their autonomy is a racial justice and equity issue. It is a reproductive justice and equity issue.