The other day, I had a craving for coconut ice cream.

Stick with me here (and no, I’m not pregnant–this was just a garden variety gluttony)

I was dying for it, and in a stroke of luck I didn’t have to rush home to my kids that day, I had the chance to fully indulge myself. Of course, now that I had the opportunity to indulge, I went to four different stores looking for some and then I finally gave up. I had the motivation to drive all over creation to find it, the time and the ability to seek it out, and the money to pay for it once I found it but I STILL couldn’t get what I wanted when I wanted it.

That’s just life sometimes, and as a mother I’ve realized that’s life more often than not. But my great unfulfilled quest to find coconut ice cream made me think of a study I’d just read in the New England Journal of Medicine. Yes, I know. When you work in public health your brain never shuts off about this stuff.

Heading home without my ice cream was no big deal, but what if I’d been looking for something else instead. The only impact of me not getting my ice cream was that I was disappointed and Haagen-Dazs lost a sale. But what if I’d been looking for something of life-changing importance and I wasn’t able to get it? Let’s imagine we’re talking about birth control.

I know this seems like a stretch, but like I said, stick with me here.

A lot of us take the ability to control our reproduction as a given, since many of us use something to limit the size of our families. But what if we suddenly lost access to any of the devices or mechanisms we use to limit the sizes of our families? You might think that this loss of access would impact only the women without access, but as that study I mentioned before points out, it impacts everything – from the birth rate to taxes.

Birth control

Contraceptive access drops considerably when women’s health services aren’t available to those who need them most.

In 2011, Texas lawmakers eliminated funding for any health care affiliates in their state-run system that provided abortion services. It’s important to note that this change didn’t just de-fund state funding for abortion services; it de-funded the entities that provide them. This is important because that meant that any provider that provided abortion services in addition to other health services lost all of their state funding, regardless of whether or not that provider was an OB/GYN practice, a hospital system, or Planned Parenthood. Health care providers had two options: stop performing abortions and receive state funding, or only accept patients with private insurance.

While the bill had the intended consequence – not surprisingly – of reducing the number of abortion providers in the state (the number of providers went from 42 to 18, and let’s face it, in a state the size of Texas, 18 clinics might as well be 1 clinic), it also meant that thousands of women using state insurance lost access to reproductive health services that didn’t include abortion. That included clinics like Planned Parenthood which at the time was the single largest provider in Texas, serving around 50,000 patients (!!!) a year.

So what does that mean for women’s health?

As it turns out, when you make something really, really hard to get, people don’t get it. And they don’t use it.

Back to my ice cream metaphor for a moment. The consequences on me, for my just-out-of-reach ice cream were minimal – I was disappointed, but there wasn’t any damage (in fact, you could argue that I was better off for not being able to find that high calorie/high fat treat). But for the women of Texas – particularly the low-income and rural women who often do not have the financial means, transportation, or resources to research and find a new provider and get the essential services they need to maintain their health and reproductive power – the effects were, and are dramatic.

Between 2011 and 2014, the number of Medicaid-covered births in Texas jumped 27%, according to the study. The estimated number of claims for the most effective methods of birth control (long-acting, reversible contraceptives like the implant and IUD) dropped nearly 40%,  and the estimated number of claims for injectable contraceptives dropped just over 30%.
Even more troubling is the rate of women who failed to get their follow-up contraceptive shots. Injectable contraceptives like the Depo-Provera shot have to be administered every three months to maintain efficacy, a long-acting method but one that’s not automatically dispersed the way that an implant or IUD does, as they remain in the body. With Depo, a patient must return to her doctor four times a year to get a new shot and if she returns late, or not at all, any sex past that follow-up deadline is essentially unprotected. When local and readily available clinics like Planned Parenthood left the picture for these patients, the percentage of women who received their follow-up shots dropped by nearly 50%.

In other words, a lot of women CDCwere left without feasible options to control their reproductive health, and the result was that unplanned pregnancies in the state substantially increased. I know – not exactly a shocker.

While the study couldn’t show a direct causal relationship, the correlation between the three variables (state funding for Planned Parenthood, reduced access to birth control, and Medicaid-covered-births) is so strong it would have to be an awfully big coincidence if the variables weren’t somehow related. The researchers themselves connected the dots loosely, saying the association points to the “likely consequences of proposals to exclude Planned Parenthood affiliates from public funding in other states.”

But what we do know is this.

We know that pregnancy planning in general, and the use of birth control in particular, are directly linked to a wide array of benefits to women, men, children, and society. This includes fewer unplanned pregnancies and abortions, more educational and economic opportunities for young women, improved maternal and infant health, greater family well-being, and reduced public spending.

We know that the most effective, longest-lasting methods of birth control are the IUD and implant, followed by the other long-term acting methods (the shot, the patch, and the ring). And, as a result of this study, we know that when those methods are made increasingly difficult to access, their use drops and – whether coincidence or not – births rise.

We also know that the average cost for one Medicaid-covered birth in 2010 was $12,770 and, in comparison, the annual per-client cost for contraceptive care was a measly $239.

Regardless of where you stand on the abortion issue, we know that access to long-lasting methods of birth control actually reduce the rate of abortions by half. It seems like if the goal in Texas was to both reduce the number of abortions performed as well as unwanted pregnancies, increasing funding to huge women’s healthcare providers like Planned Parenthood would have been a good place to start. As we’ve established, making it easier for people to access the tools they want and need makes it more likely they’ll use them.

What I don’t know?

Why on earth would anyone would actively prevent ready and easy access to birth control.


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Categories: Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning