Post-“Roe,” Birth Control Is More Accessible, But Abortion Is Still Crucial

The U.S. Supreme Court will likely issue a landmark ruling on abortion this year. Justices will be examining whether Mississippi can impose a ban against abortions after 15 weeks.

The case is: Dobbs v. Jackson Women’s Health Organization, challenges the landmark 1973 Roe v. Wade decision that protects women’s right to abortion. Meanwhile, Texas enacted its own restrictive abortion law in September – and other states They are currently working to follow the example of others.

Scott G. Stewart, Mississippi Solicitor General argued before the Supreme Court in December Abortion is not necessary.

“I would emphasize that contraception is more accessible and affordable and available than it was at the time of RoeOr Casey,” Stewart said, in reference to Roe v. Wade Casey v. Planned Parenthood, two landmark abortion court decisions. “It serves the same goal of allowing women to decide if, when and how many children to have.”

So, is it actually easier than ever to get contraception in the U.S. – and does that mean that abortion is no longer necessary?

The short answers are, “no” and “no.”

Even if every person who needed it could obtain contraception, it wouldn’t completely eliminate the need for abortion.

Why getting birth control in America isn’t always easy

Total protection against unwanted pregnancy is impossible to achieveEven with multiple methods, modern contraceptives are highly effective.

There is no 100% effective contraceptive method, and there will always be a need to have an abortion.

First, most contraceptive methods still require a prescription and at least an initial visit to a clinic or a doctor’s office to initiate or maintain treatment. This step alone can prove prohibitive. 21 million American women People who can’t afford to pay for family plans services.

This figure marks a 25% increase over the past two decades – in 2000, 16.4 million American women Girls and women needed help to pay for contraception. This is more than the growth in the total number of sexually active women Contraception is required for teens since 2000.

Second, not all health care providers Keep up-to date with the latest evidence-based guidelines Contraceptive use is not recommended for people with certain medical conditions. Patients may be asked to return for multiple visits or denied their preferred contraceptive method.

Third, many young people do not receive adequate sex educationThe website would also include information about contraception and how you can get it. This is especially true for low-income or marginalized people, such as people of color and non-native English speakers.

The evolution of birth control

1973 was the Year of the Roedoctors could only offer pills, diaphragms or sterilization. Penile withdrawal and other traditional methods have been around for a long time, but they are no longer available. undeniably less effective Rather than using more modern methods.

As a primary care doctor and researcher I am a member of the University of Washington Departments of Family Medicine and Obstetrics and Gynology. two decades of experience Teaching and providing full-spectrum contraceptive services.

I have been able offer my patients a greater variety of highly effective modern contraceptive methods. There are many options today. 18 different methods There are many methods of contraception available, including intrauterine devices and vaginal rings.

While almost everyone in the U.S. uses birth control at one time or another, not all do so consistently. On average, U.S. fertile women need effective birth control for 30 years To avoid unwanted pregnancies.

Measurement of birth control availability

Despite the increase in birth control options, many teens and women still struggle to obtain contraception.

Today, approximately 65% of women and teenage girls Use contraception, marking an a 10 percentage-point increase from 1982 rates.

Today, 34% of women and teens are using the most effective forms Contrary to 23% who did it in 1982, this figure is still a significant percentage of women who have used birth control.

Around 17% of teens use moderately effective methods compared to 15% in 1982. Rest of the population uses less effective contraception or none at all.

While contraception usage has increased in teens and women since the 1980s, data shows a different picture.

Teenage girls between the ages of 15 and 19 are very popular less likely to get contraception Contraception is more popular among older women (only 38.7%) Black and Latina women have lower rates than white women of using contraception.

These divides have been made worse by the COVID-19 epidemic. Black, Latina, and queer women reported higher rates for cancellations and delays in contraception appointments. About 29% of Black women, 38% for Latinas, and 35% for queer women reported higher rates of cancellations and delays in contraception appointments. also reported Feeling anxious about the cost of contraception in July 2020.

One in four women reports it. not using their preferred method They cannot afford birth control. This is because patients are more likely continue to use a birth control method they like.

One other way to measure contraceptive care Take into account the percentage of unintended pregnancies among women between the ages of 15 and 44.

The rate of unintended pregnancies in the U.S. is 30% higher. 45 per 1,000 women, is lower than the average rate across all high-income countries.

Unintended pregnancies in the U.S. have declined to the lowest level since 1981. However, lower-income women are more likely to get pregnant. remain five times Higher-income women are more likely than those with higher income to have a child they didn’t intend for.

More recent data The unintended pregnancies have decreased by 47% in Europe and North America between 1990-1994 and 2015-2019.

There are limitations to birth control

Long-standing practice has been to use public funds to cover family planning services, including confidential contraceptive services. cost-effective intervention Public health.

Family planning reduces unintended pregnancy. Unintended pregnancy can lead to preterm births, infant deaths, and pregnancy-related deaths. higher in the U.S. It is higher than in other countries.

Congress passed two key mandates In the 1970s, public funds were allowed to be used for low- or no-cost family planning services for adolescents as well as low-income women.

However, the budget to fund family planning is not available. less than half It is now a fraction of what it was back in 1980. It is likely that more women will need public support for contraception.

Missouri’s past programs Colorado That provided the full range modern contraceptive methods at no cost Abortion and unintended pregnancies are less common.

In 2010, the Affordable Care Act was implemented. Contraception became more easily available for millions of Americans with private and public insurance. coverage of all contraceptive methods Without a copay

Contraception is not yet available to everyone, but it is more accessible to those who live in states that allow it. did not expand their Medicaid family planning services under the Affordable Care ActThis reduced the criteria for low income women to be eligible under medical assistance coverage for contraception.

Additionally, 1 in 5 privately insured women Women who have to pay out of pocket for birthcontrol are more likely than not to do so.

Yes, we still need to access abortion care.

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

The short answer is, “yes.”

Despite America’s having the lowest abortion rate in 50 years, abortions in America are not rare. About 18% of the estimated 6 million pregnancies in the U.S. each year end in abortion.

2016: Publicly supported providers have access to contraceptive care helped delay or avoid nearly 2 million pregnancies. Access to birth control could be widely spread, which would reduce the number abortions.

However, expanding access will require a new federal and/or state policy. This includes policies that ensure better health care access.

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

Emily M. Godfrey is a recipient of funding from the Society of Family Planning Research Fund as well as the Cystic Fibrosis Foundation. She is a Nexplanon trainer for Organon. She has published an Op-Ed on mifepristone via mail in the Seattle Times.