Lack of Access = Lack of Power to Decide
More than 19 million U.S. women in need do not have reasonable access in their county to a public clinic that offers the full range of contraceptive methods. They live in what we call contraceptive deserts. For young people who intend not to get pregnant, living in a contraceptive desert creates a significant roadblock on the path to opportunity.
The map below provides a visual description of where women in need can access birth control—and where they can’t—across the country. As the map moves from dark blue to yellow to red, services decline.
Birth Control Access by the Numbers
More than 67 million women age 13 to 44 live in the United States. Of that number, more than 19 million women in need live in contraceptive deserts, meaning they lack reasonable access to a public clinic with the full range of methods. “Reasonable access” is defined as at least one clinic or provider for every 1,000 women in need of publicly funded contraception. Seeing a provider, accessing trusted information, and finding the right birth control becomes nearly impossible.
Deep in the heart of those deserts, nearly 2 million women in need live in counties without a single public clinic that offers the full range of contraceptive methods. It’s time to bring these deserts back to life and restore the power to decide for the people living there.
About the Birth Control Access Map
The Birth Control Access Map depicts access in each U.S. county in two views: the availability of publicly funded clinics that provide any form of birth control, and that of clinics that offer the full range of methods (using the availability of both the implant and the IUD as a marker).
When there are zero publicly funded clinics in a county, the colors reflect the number of women in need of publicly funded contraception who live in that county, ranging from yellow (fewer women living there) to red (more women living there). When clinics are present in a county, they are represented in shades of blue, with the darkest blue representing “reasonable access,” which is defined as meeting the aforementioned ratio of clinics or providers to women in need in that county.
Contraceptive deserts are defined as counties where the number of public clinics offering the full range of methods is not enough to meet the needs of the county’s number of women eligible for publicly funded contraception, defined as at least one clinic for every 1,000 women in need of publicly funded contraception. We consulted the ratios developed by Richard Cooper, M.D., of the University of Pennsylvania Wharton School, one of the leading physician utilization and supply experts in the United States, in his Hospital-Specific Physician Requirements Model. Dr. Cooper’s model, developed in 2012, indicates the number of physicians in various specialties that a community can support and is “demand based.” The numbers are based on national figures and are not necessarily universally applicable, but they are among the most accurate we have to study supply and demand. Those counties with one clinic per 1,000 women are shown by the darkest blue, counties with one clinic per 2,000 women are shown by the middle blue shade, and those with one clinic per 5,000 women are shown by the lightest blue.
The maps include more than 16,000 clinics and providers. The data come from more than 10 verified sources, including Title X clinics, Planned Parenthood, the Indian Health Service, and the National Association of County and City Health Officials, as well as from providers who identify themselves as places for women in need to access services. Power to Decide, the campaign to prevent unplanned pregnancy, manages this nationwide compilation of data, which also includes Puerto Rico. The vast majority of publicly funded clinic locations are included on these maps, as well as private providers and other health care sites that have made themselves known to us. Any site or provider can register its location and services here. The data on the number of women in need of publicly funded contraception come from the Guttmacher Institute.
We continually update our information, but the landscape of contraceptive access is constantly changing. The database has limited listings of private providers even though some private providers do accept Medicaid and could, in theory, offer the full range of methods to women in need. Further, as pharmacies become sources of direct access (without a prescription) to a wider range of contraception in the United States in places like California, Oregon, and Tennessee—and online—we will begin to build a database of those locations. However, no pharmacy or online source offers direct access to the full range, and most effective forms, of contraception—the focus of our heat maps.
Access View Limitations
The current view is only one way of looking at access: by the proximity of a publicly funded clinic and the availability of the full range of methods for women in need. The color chart doesn’t depict the population of women who are not in financial need of or eligible for publicly funded contraceptive services and supplies, yet may still need to rely on such clinics. Included in this group are women who may not want to use their insurance for privacy reasons or who travel to a location out of their area to hide their contraceptive from their partner—an all-too-common story—so as to avoid birth control sabotage or coercion.
Many other barriers can stand in the way of a person’s access, and we would like to represent those in the future, including lack of same-day service, cost, unavailability of a same-gender provider, lack of a pleasant environment, or a poor customer service rating. In addition, our current view of proximity is limited in that it does not represent one’s ability to access transportation to get to a clinic or pharmacy. In many areas of the country, a high percentage of people lack access to a vehicle or other form of transportation, thus making more important the availability of close-by clinics and pharmacies. In addition, people who cannot afford health care and who often are missing from the system face knowledge gaps, which represents another kind of access barrier. Often people in this cohort go to a local pharmacist to ask questions about a wide range of health issues, but in many areas of the country getting to a pharmacy, or any provider, to ask a question is difficult. We seek to represent this lack of access on a map in the future.