The latest federal attacks on health equity will exacerbate longstanding barriers to contraceptive care, including costs and gaps in health insurance coverage, health care provider shortages, and discrimination in health care. Especially taken together, recent efforts to cut Medicaid funding; withhold Planned Parenthood and Title X Family Planning program funding; and eliminate diversity, equity, and inclusion (DEI) programs jeopardize access to contraceptive care. The cumulative impact will be most acute for people with low incomes, people of color, and other communities already pushed to the margins.
Cost and Gaps in Health Insurance Coverage
Issues of contraceptive affordability, challenges securing coverage, and the prescription requirement for many methods hold far too many people back from getting contraceptive care. Cost is a major roadblock to access, especially for those who are uninsured or underinsured. With millions at risk of losing their health insurance due to the disastrous Republican budget bill, the cost of contraceptive products and services will become an even more widespread concern – and likely prohibitive. Medicaid pays for 75% of publicly funded family planning care, including contraception; stripping people of this coverage means cutting them off from care.
Even for people with insurance, there are high out-of-pocket costs, plans that exclude contraceptive coverage, and plans that deny contraceptive coverage to varying extents. What’s more, the Supreme Court’s recent decision in Medina v. Planned Parenthood South Atlantic will make it harder for people with Medicaid coverage to obtain contraceptive care at Planned Parenthood if they live in states that exclude clinics that provide abortion care from their Medicaid programs. This puts people at greater risk of losing affordable access to trusted, culturally responsive contraceptive care.
Provider Shortages
Reproductive health provider shortages are also driving contraceptive access difficulties. Providers have been forced to shift the care or services they provide, relocate, or stop offering care altogether in response to restrictive state abortion laws and criminalization risks. These circumstances have led to clinic closures as well as longer travel and wait times for services. The ensuing need to travel greater distances for care compounds logistical obstacles, including having to take often unpaid time off work to travel to a provider, transportation and childcare costs, and more.
Additional clinic closures expected to result from the Trump administration freezing Title X funds and “defunding” Planned Parenthood will only exacerbate provider shortages and barriers to reproductive health care. This will disproportionately impact contraceptive access for women of color, women who have low incomes, and women who live in rural or medically underserved areas – groups that especially rely on these safety net services.
Discrimination in Health Care
“Refusal laws” and “conscience protections” at the federal and state level restrict contraceptive access and function as licenses to discriminate. These policies allow providers to deny patients access to reproductive health services and allow employers or schools to refuse to provide contraceptive coverage based on religious or moral objections. Particularly in rural areas where religiously-affiliated hospitals may be the sole provider available, denials of care constrain contraceptive access.
Furthermore, the medical establishment’s historical and ongoing discrimination against and mistreatment of Black and brown people, disabled people, and LGBTQ people, among other marginalized groups, has negative impacts on contraceptive access. These dynamics reduce patients’ confidence that their interactions with providers will be respectful, confidential, and free of bias and coercion. As a result, patients can be less likely to seek out care and be forthcoming about their symptoms and medical history. This hinders care coordination and delivery and undermines health outcomes and contraceptive equity. Research shows that Black women, Hispanic women, women with low incomes, and women without insurance are less likely to receive high-quality, patient-centered contraceptive counseling.
Trump’s anti-DEI agenda will only worsen medical discrimination and contraceptive inequities. On day one, President Trump signed an executive order terminating all diversity, equity, inclusion, and accessibility policies and programs in the federal government. The administration cited support for DEI among Title X providers as justification for withholding funding from the program. Public and private actors are being punished for efforts to increase diversity in medical education and the health care workforce, educate medical students and professionals on implicit bias and cultural competence, and promote equitable access and treatment within health care – all of which affect contraceptive equity.
Millions already struggle to get the contraceptive care they need. We urgently require public policy and health system reforms that foster patient-centered, affordable, and equitable access to contraceptive care to address this range of challenges and health disparities.
