Yes, it’s easier to get birth control than it was in the 1970s – but women still need abortion care

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Emily M. Godfrey, University of Washington

(THE CONVERSATION) A landmark abortion ruling is likely to emerge from the U.S. Supreme Court this year as justices consider whether Mississippi can, in fact, impose a ban on abortions after 15 weeks of pregnancy.

The case, Dobbs v. Jackson Women’s Health Organization, challenges the landmark 1973 decision Roe v. Wade who protects women’s right to abortion. Meanwhile, Texas enacted its own restrictive abortion law in September — and other states are working to follow suit.

Mississippi Solicitor General Scott G. Stewart argued before the Supreme Court in December that the abortion was unnecessary.

“I would point out that contraception is more accessible, affordable, and available than it was in Roe’s or Casey’s day,” Stewart said, in reference to Roe v. Wade and Planned Parenthood v. Casey, two historic court decisions on abortion. “It serves the same purpose of allowing women to decide if, when and how many children to have.”

So, is it easier than ever to get birth control in the United States — and does that mean abortion is no longer necessary?

The short answers are “no” and “no”.

Even if everyone who needed it could obtain contraception, it would not completely eliminate the need for abortion.

Why Getting Birth Control in America Isn’t Always Easy

Complete protection against unwanted pregnancy is impossible to achieve, even with multiple highly effective modern methods of contraception available.

No contraceptive method is 100% effective and the need for an abortion will always exist for several reasons.

First, most birth control methods still require a prescription and at least one initial visit to a clinic or doctor‘s office to initiate or maintain treatment. This step alone can be prohibitively expensive for the 21 million American women who cannot afford family planning services.

This figure represents a 25% increase over the past two decades – in 2000, 16.4 million American women and girls needed help paying for contraception. This increase exceeds the growth in the total number of sexually active women and adolescents who need contraception since 2000.

Second, not all health care providers are aware of the latest evidence-based guidelines regarding the use of contraceptives in people with specific medical conditions. As a result, patients may be unnecessarily denied their chosen contraceptive method or asked to return for multiple visits.

Third, many young people do not receive adequate sex education, which would include information on contraception and how to obtain it. This is especially true among low-income or marginalized populations, including people of color and non-native English speakers.

The evolution of birth control

In 1973, the year of the Roe judgment, doctors could only offer the pill, the diaphragm, the IUD or sterilization. Traditional methods, such as penis removal, have been around since well before 1960, but are undeniably less effective than more modern methods.

As a primary care physician and researcher in the Departments of Family Medicine and Obstetrics and Gynecology at the University of Washington, I have two decades of experience providing and teaching full-spectrum contraceptive care.

I have been fortunate to offer my patients a growing number of highly effective modern contraceptive methods. Today, there are 18 different birth control methods, ranging from intrauterine devices to vaginal rings.

Although almost everyone in the United States uses birth control at some point, not everyone uses it consistently all the time. On average, fertile women in the United States need effective birth control for 30 years to avoid unwanted pregnancies.

Measuring the availability of contraceptives

Although the number of contraceptive options has increased, it remains difficult for many women and adolescent girls to obtain contraception.

Today, an estimated 65% of women and adolescent girls use contraception, representing a 10 percentage point increase from 1982 rates.

And today, 34% of women and teenage girls use the most effective forms of birth control, up from 23% of women who did in 1982.

About 17% of women and adolescents use moderately effective methods, up from 15% in 1982. The rest use less effective contraception or none at all.

While the percentage of women and teenage girls using contraception has increased since the 1980s, a closer look at the data reveals a patchy picture.

Teenage girls aged 15-19 are much less likely to obtain contraception than older women (only 38.7% of girls surveyed this age use it). Latina and black women also have lower rates of contraceptive use than white women.

The COVID-19 pandemic has deepened these divides. Black, Latina, and gay women reported higher rates of birth control appointment delays and cancellations. About 29% of black women, 38% of Latinas and 35% of gay women also said they worried about paying for birth control in July 2020.

One in four women say they do not use their preferred method of contraception because they cannot afford it. This is important because patients are more likely to continue using a birth control method if they like it.

Another way to measure contraceptive care considers the percentage of women aged 15 to 44 who have unintended pregnancies.

The unintended pregnancy rate is 30% higher in the United States, at 45 per 1,000 women, than the average rate in all high-income countries.

While unintended pregnancies in the United States hit the lowest rate in 2011 since at least 1981, low-income women are still five times more likely than high-income women to have a pregnancy they don’t. hadn’t planned.

More recent data shows a 47% decrease in unintended pregnancies in Europe and North America, between the five-year period 1990-1994 and the five-year period 2015-2019.

Limits to contraception

Using public funds to fully cover family planning, which includes confidential contraceptive services, has long been recognized as a cost-effective public health intervention.

Family planning reduces unwanted pregnancies. Unintended pregnancies contribute to pregnancy-related deaths, premature births, and infant deaths, the rates of which are higher in the United States than in other developed countries.

Congress passed two key mandates in the 1970s that authorized the use of public funds for free or low-cost family planning services for poor and low-income adolescents and women.

However, the family planning funding budget is less than half of what it was in 1980. And the number of women who likely need public support for contraception is growing.

Earlier programs in Missouri and Colorado that provided the full range of modern contraceptive methods free of charge reduced unintended pregnancy and abortion rates.

Implementation of the Affordable Care Act in 2010 made contraception more accessible to millions of Americans using private and public health insurance by requiring coverage of all contraceptive methods without a copay.

However, contraception is still not available to everyone, especially among those who live in states that have not expanded Medicaid family planning services under the Affordable Care Act, which lowered eligibility criteria. eligibility of low-income women for medical assistance coverage for contraception.

Additionally, 1 in 5 women with private insurance say they pay out of pocket for birth control, which is not possible for many women.

Yes, we still need abortion care.

Given the wide range of contraceptive choices available today, some Americans, including Mississippi’s Stewart, wonder if abortion is still necessary.

The short answer is yes.”

Although America has the lowest abortion rate in 50 years, abortions in America are not uncommon. About 18% of the estimated 6 million pregnancies in the United States each year end in abortion.

In 2016, access to contraceptive care from publicly supported providers delayed or averted nearly 2 million pregnancies. Widespread access to birth control would reduce the number of abortions.

But expanding access will require definitive new action by the federal and state governments, including implementing policies that ensure better access to health care.

These changes will not completely eliminate the need for safe abortions, which will remain a crucial health service no matter what.

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This article is republished from The Conversation under a Creative Commons license. Read the original article here: – care-174026.

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