The Contraception Failure

Nearly all American women will use contraception at some point in their lives. Birth control is the most effective way to lower the unintended pregnancy rate, and the best way to decrease the abortion rate. But in an increasingly polarized political debate about abortion rights, anti-contraception sentiments have crept in. Sometimes they are blatant -- earlier this June for example, anti-choice groups sponsored a national day of protest against the birth control pill. But usually, they are more insidious and come in the form of systematically and routinely denying women access to contraception. The grounds of the reproductive rights debate are shifting -- and most Americans don't seem to know it.

For the last three and a half decades, the big battle in women's health has been abortion. Anti-choice activists attack Roe v. Wade at every turn and purposefully chip away at abortion rights. But as anti-choice groups expand their net to oppose basic birth control, they have a helping hand in the myriad political, financial and practical access issues that American women face in trying to prevent unwanted pregnancy.

The average American woman spends about three decades of her life trying to avoid pregnancy, and only a few years trying to become or being pregnant. And while the general belief is that contraception is only a pharmacy away, the United States still has one of the highest unintended pregnancy rates in the developed world. Why is it that in a country where 98 percent of sexually active women have used a form of contraception, nearly half will have an unintended pregnancy? According to the Guttmacher Institute, a research organization for sexual and reproductive health, one of the major contributing factors is simply a lack of access -- economic gaps, racial disparities and insurance status all play a role in determining women's access to birth control. And they all seem to have slipped under the public radar.

While the anti-choice movement and its allies in office attack reproductive rights through policy, and while legislation like the Deficit Reduction Act jacks up birth control prices, what goes unnoticed is the fact that many American women are fighting a battle on the ground -- in their everyday lives -- in a struggle to simply acquire appropriate reproductive health care.

Katharine O'Connell, an assistant clinical professor of OB/GYN at Columbia University Medical Center who also works at Columbia's Title X-funded family planning clinic, said that something as simple as getting an appointment can be a barrier to women's access. A recent Guttmacher study found that significant life changes for women, such as moving, can create gaps of time without contraception use, which in turn lead to an increased risk of unintended pregnancy. If a newly relocated woman finds a clinic in her city, for example, she may have to wait as long as six months before she actually sees a doctor.

When she finally does get an appointment, the waiting time at a clinic is often several hours. "This means time off from school, time off from work that many women can't afford to take," O'Connell said. And the first question asked at a health clinic usually concerns health insurance. Many centers, O'Connell said, won't see women who don't have insurance, and many private offices won't even see women who are on Medicaid.

According to the National Institute for Reproductive Health's Low-Income Access Program, an organization that works toward increasing access to reproductive health care for women who face financial barriers, Medicaid is the largest source of public funding for family planning in the country -- more than 7 million women rely on Medicaid for birth control, gynecological services and STI testing and treatment. In fact, 70 percent of adults on Medicaid are women.