Questions about contraception access, options and cost linger following Dobbs decision

The U.S. Supreme Court’s Dobbs v. Jackson Women’s Health decision last summer and subsequent action by several states has led to questions about contraceptive options and access.

“Some feel that the right to contraception is at stake in light of Justice Thomas’s concurrence in Dobbs, suggesting that the court revisit Griswold, which granted the right to contraception,” says Alina Salganicoff, Ph.D., senior vice president and director of women’s health policy for KFF. “In addition, there are concerns about the implications of abortion bans that grant personhood at the moment of fertilization, not to mention broad-scale misinformation about the mechanism of action of many commonly used contraceptives.

“But there also have been many promising new developments over the past decade that offer opportunities to expand contraceptive options and access.”

Salganicoff moderated a panel discussion of “What is the future of contraceptive care in a post-Roe world?” a Dec. 13 webinar sponsored by KFF. Brittni Frederiksen, Ph.D., associate director of the KFF women’s health policy program, presented information from the 2022 KFF Women’s Health Survey. Among the key findings:

• Although the ACA has required contraceptive coverage for more than a decade, many people still do not know about the policy and some privately insured females still are paying for their contraceptives. Four in 10 females of reproductive age do not know that most insurance plans are required to pay the full cost of birth control for women.
• Although 70% of females with private insurance say their insurance covered the full cost of their most recent birth control method, a quarter say they paid at least part of the cost out-of-pocket. Of those who paid out of pocket, 16% say it was because they wanted a certain brand of contraception that was not covered by their plan (even though their plan should cover it if their provider recommends it for them).
• Cost can be a barrier to contraceptive use for some. One in 5 uninsured females of reproductive age say they had to stop using a contraceptive method because they couldn’t afford it. “There are a lot of different facets to access, and affordability is a huge component of that,” says Amy Fan, cofounder and president of Twentyeight Health.

Related: Is birth control at risk? GOP says no, evidence says yes

• One-fourth of females who are using contraception are not using their preferred method. The leading reason for this is concern about side effects, a theme that comes up in many aspects of contraceptive care. “What stood out to me was that a quarter of people were not using their preferred method,” says Dr. Sonya Borrero, director of the Center for Innovative Research on Gender Health Equity. “I am curious whether the reasons for not using the preferred methods are different by income level. If there is a difference, it could suggest diminished autonomy or access for people with lower incomes.”
• Just 30% of females say they received all the information they needed before choosing their birth control method. This is even lower among Asian/Pacific Islander females. “People are not getting the methods they want, as well as people not getting the education they need to make decisions about their contraceptives,” says Kami Geoffray, J.D., president of Geoffray Strategies.
• A sizable minority of people who might benefit from emergency contraception pills don’t know where to get them or that they’re available over the counter. “The fact that 6 in 10 birth control users say they would be willing to use OTC pills is really fascinating,” says Victoria Nichols, project director of Free the Pill. “It’s even more fascinating that 2 in 5 reproductive-age females say they would be willing to use OTC birth-control pills if they weren’t required to have a prescription.”

Frederiksen summarized six key takeaways from the study:

• Affordability – Cost remains a barrier to use for some people, particularly those who are uninsured or have low incomes.
• Availability – Most people don’t have access to a 12-month contraceptive supply.
• Informational needs – Persistent gaps exist in knowledge about the ACA and aspects of methods.
• Coverage – Some people with coverage still are paying out-of-pocket.
• Patient-centered care – Care centered on patient needs and preferences is falling short.
• Receptivity to new sources – Avenues for obtaining contraceptive methods are expanding, but brick-and-mortar providers still dominate.