Now that abortion care is no longer protected by the U.S. constitution, many Americans are wondering where their bodily autonomy stands — and if the Supreme Court keeps to its word, Roe V. Wade is just the beginning.
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At the moment, contraceptives like Plan B and IUDs are looking to be the next battleground for lawmakers, as states attempt to use the Supreme Court decision as grounds for banning emergency contraception. Louisiana has already tried to pass a bill criminalizing the use of IUDs and Plan B, calling both treatments abortion methods, and equating abortion to homicide.
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Elizabeth Ruzzo, founder and CEO of Adyn, a women’s healthcare company that created the first test designed to prevent birth control side effects, believes that the political and ideological push to deny Americans’ right to abortions and possibly contraceptives is rooted in control.
“These motivations are not based on caring about communities or the financial interests of our economy,” says Ruzzo. “Communities are more prosperous when contraceptives are available, but politicians are pushing for this because of power.”
And exercising that power will hurt and cost the lives of the most vulnerable groups in this country, whether they are women of color, trans men, non-binary people or people with disabilities.
“The folks that oppose abortion are also coming for contraception, sex education, trans rights and more,” says Rachel Fey, vice president of public policy at Power to Decide, a nonpartisan organization that advocates for the right to prevent unplanned pregnancy. “And the barriers and assault on contraceptive access have already been happening for quite some time, particularly for people who are struggling to make ends meet.”
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According to the U.S. Census Bureau, 38 million Americans live in poverty, meaning they make less than $13,064 a year individually, or $25,465 for a family of four — and 56% of these Americans are women. Notably, access to contraception has proven to reduce the probability that women will live in poverty and increase their earning potential, as articulated in academic research from “The Effects of Contraception on Female Poverty” and “The Opt-In Revolution? Contraception and the Gender Gap in Wages.”
Meanwhile, the U.S. maternal mortality rate consistently ranks last among industrialized nations and has only increased over the course of the pandemic, reaching 25 deaths per 100,000 live births, with Black and Hispanic women taking the brunt of the surge. By getting pregnant, women are putting their lives on the line in a country without any safety nets, explains Fey.
Even before Roe V. Wade was overturned, birth control access was systematically restricted due to factors like contraceptive deserts, where there is a lack of clinics that offer the full range of contraceptive methods, and insurance companies blocking proper coverage.
“We know that 19 million women who are in need of publicly funded contraception live in contraception deserts,” says Fey. “And we know there are people that are not getting birth control because their health plan is not making it possible for them to navigate the process.”
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Health plans are required to cover at least one method from each of the 18 FDA-approved categories of birth control under the ACA. In practice, this means insurers must cover one option of a non-hormonal intrauterine device, one hormonal intrauterine device, one combination progesterone and estrogen pill, one progesterone-only pill, and so on, until each category is covered. If the attending healthcare provider deems a particular method of birth control is needed that is not on the plan’s formulary (the list of covered prescription drugs), then plans need to offer an exceptions process so that said method can be covered at no cost to the patient. ACA goes as far as to articulate that the exceptions process needs to be “accessible, transparent and sufficiently expedient.”
“We looked at the largest plans in terms of covered lives across the country,” says Fey. “Some plans did reference an exceptions process but didn't tell you where to go to find it. Others referred to a prior authorization process, which does not meet the requirements of the ACA, which states the attending provider is one who decides what particular method is needed. Others had confusing information or no information at all.”
Power to Decide even looked at 48 denial letters from plans sent to patients looking to get their birth control method covered. Fey recalls one letter that asked the patient to try five other methods before they would consider covering her preferred method. In a series of secret shopper calls, Power to Decide researchers also found it difficult to obtain helpful information from customer service lines.
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The stakes only get higher in the context of the Roe V. Wade ruling — if insured Americans already struggle to obtain birth control, what happens if and when restrictive laws enter the picture? It’s been 57 years since married couples have been granted the right to birth control, and less than 50 years since contraceptive rights were granted to everyone, regardless of marital status in the case of Eisenstat V. Baird. But many Americans are still not guaranteed access to family-planning care, and the costs add up, underlines Fey.
According to the Institute for Women’s Policy Research, state-level abortion restrictions cost the U.S. $105 billion per year by reducing labor force participation and earning potential, while also increasing labor turnover and time off among women between 15 and 44 years old. Ruzzo points out that cis-gender men will also be impacted by restricted access to family-planning healthcare since birth control allows both men and women to pursue an education, advance in their careers and improve their economic status for their families decades later.
“Men share responsibility for birth control and planning to avoid unwanted pregnancy,” says Ruzzo. “I would really task the men in this country to use their positions of privilege to uplift reproductive justice, and make it a priority.”
Ruzzo and Fey agree that the federal government has to take action, whether that means making contraceptives available over the counter nationwide, or revising ACA provisions so that health plans are required to cover every contraceptive. In the meantime, Ruzzo believes it is only appropriate to declare a national health crisis in the wake of the Roe V. Wade decision, as many women will be unable to access reproductive care in life-threatening cases of ectopic pregnancies and severe preeclampsia.
“All of this is connected: if you pull that sweater thread with Roe, then you are also undoing other rights, whether you claim to or not,” says Fey. “I can't stress enough how much this ends up being an equity issue. Those who tend to have lower incomes — and because of systematic barriers in this country, they tend to be people of color — will be the ones who are most harmed by these policies.”
