6 Principles To Support Comprehensive Contraceptive Care

When people have access to comprehensive, inclusive, and high-quality contraceptive care and family planning services, they have more individual, social, political, and economic power. Birth control is a vital and essential public health service. Access to contraception and high-quality contraceptive care has wide-ranging and far-reaching implications for women’s rights and advancement as well as the potential to improve women’s quality of life.

A plethora of research demonstrates that, with improved access to contraception, women have greater educational attainment, increased workforce participation, and higher incomes. In fact, after all women gained the constitutional right to birth control in 1972 under the U.S. Supreme Court’s decision in Eisenstadt v. Baird, there was a massive shift and surge in women’s professional workforce and social participation. This is, in part, because birth control afforded women more reproductive autonomy and supported their ability to make decisions about their own bodies. Furthermore, research demonstrates that access to contraception and family planning services improves maternal and childhood outcomes  for those who do decide to have children.

Unfortunately, however, many systemic barriers stand in the way of better contraceptive care. Although policymakers and advocates have been pushing for changes that reflect the evolving needs of women and people of all genders, the United States is still behind many other countries in terms of quality contraceptive care and access to birth control. Furthermore, the U.S. Supreme Court’s decision to overturn Roe v. Wade spurred a renewed sense of urgency and an imperative for states to ensure equitable access to contraception in the absence of federal protections for abortion.

Below are six guiding principles that state lawmakers should consider when developing policies and measures to support access to birth control and improve contraceptive care and family planning services. While this list is not exhaustive, these principles can create the foundation for advancing contraceptive care and guide support for people’s family planning goals, wants, and needs.

On March 29, 2023, the Women’s Initiative of the Center for American Progress hosted a panel discussion on equitable access to contraception. This discussion informed the development of these six principles, and the author includes in this article quotes from the experts who participated.

1. Contraceptive care should be nondiscriminatory, equity-driven, and coercion-free

First and foremost, access to high-quality contraceptive care should not be dependent on a person’s social identities or characteristics, including but not limited to their race, gender, age, sexual identity, geographic location, disability status, nationality, income, or wealth. It should be nondiscriminatory and equity-driven. Often, however, the most marginalized communities are systemically excluded from accessing the sexual and reproductive health services, supports, and resources they need. This exclusion is compounded by the United States’ complex and racist history of unethical practices against women of color. During the eugenics movement of the 1900s, many women of color, especially Black, Latina, and Indigenous women, were forcibly and coercively sterilized. The attacks on the reproductive freedoms of these women attempted to reduce the populations of their communities; over the course of the 20th century, nearly 70,000 people were forcibly sterilized. Evidence of this medical racism also exists in the decades of biomedical and pharmacological clinical trials and experimentation conducted on people of color, most of whom were low-income patients.

Event panelist Kim Diaz Scott, who serves as the vice president of policy and communications at the National Family Planning and Reproductive Health Association, discussed the importance of making contraception available to everyone without the threat of coercion:

Equitable access for contraception is affordability, coverage, and also accessibility, which means the consideration for the ability to educate and counsel on the full range of contraceptive methods, not just what is hand-picked and chosen by the government. It means considerations for streamlining the process to access birth control … and how can we make birth control accessible to all communities. [I] also want to recognize it also means accessing contraception free of coercion. Our country has a long history of reproductive coercion, and so the right to make personal decisions about contraceptive use [that are] free of coercion is important for all, especially for those that are historically marginalized groups.

A health care system that does not support and center the most marginalized individuals is failing at and falling short of its core mission. Any proposed policy reforms and initiatives geared at improving access to contraception—as well as research into new methods—must confront this history while centering the communities who are most harmed and affected. Policies must also work to dismantle ongoing disparities in and threats to women’s health and uplift equitable changes in care.

Amy Fan, co-founder, president, and chief product officer of Twentyeight Health, spoke at the CAP event about some of the barriers that must be dismantled:

The average wait time for a primary care physician to see a new patient is over four weeks, and that’s even longer for an OB-GYN. So what we see is that, at every step of the process, there are barriers across the board for all women in the U.S. that are even higher for underserved communities. And then when we think beyond that, of how do you physically get to the clinic, what we often see is that for low-income patients, they most often cite that the lack of affordable transportation and inability to take time off of school or work as significant barriers to actually getting to that doctor’s office.

2. Contraceptive care should empower and affirm women in their family planning journeys

Women’s decision to use birth control is often driven by their desire to prevent pregnancy—and research demonstrates that women want to prevent pregnancy for a variety of reasons: concerns about the physical stress or emotional toll; challenges to personal finances; concerns about education and employment; and strain on intimate and personal relationships as well as, generally, for reasons related to personal well-being. No matter the reason for seeking contraceptive care, health care providers should work with patients to empower and affirm their reproductive decision-making and provide the resources and tools they need to succeed.

Providers should advise patients of the full range of Food and Drug Administration-approved, -cleared, and -granted birth control methods in a nonjudgmental, noncoercive way that affirms their autonomy and reproductive decision-making power, as well as prioritize patients’ preferences and unique needs.

3. Contraceptive care should emphasize and ensure quality

Quality is a particularly important factor of sexual and reproductive health care that has long-lasting and wide-ranging influence on people’s health outcomes. High-quality care is associated with increases in continued contraceptive use and decreases in unplanned pregnancies. Quality of care is a multipronged issue, and a number of factors, taken together, can make the difference between poor or high-quality care. These include the quality and accuracy of contraceptive information; the availability of effective counseling on the range of options available, such as on dual-method contraceptive use; providers’ abilities to meet patients where they are and meet their needs; the availability of technology and supplies; and whether there is mutual respect between patients and providers. Additionally, it is necessary for researchers and medical professionals to maintain the momentum toward improving and increasing the contraceptive options available.

4. Contraceptive care must include safeguards for privacy and confidentiality

A core tenet of care should be protecting patients’ privacy and confidentiality at every stage. According to the American Medical Association, privacy encompasses personal space, personal data, personal decision-making and choices, and personal relationships. In general, health care providers have a professional and ethical obligation to protect patients’ sensitive and intimate health information through the HIPAA privacy rule and other institutional rules.

Although consideration for patient privacy and confidentiality is not new, the current political climate has brought heightened attention to the issue, as many states punish and criminalize abortion providers and others who provide reproductive health care. Moreover, technological advancements such as telehealth during the past few years have shone a new spotlight and refocused efforts on patient privacy. Telehealth providers in particular must be forthcoming about how patient data are stored and can be accessed.

5. Contraceptive care must prioritize safety and efficacy in concert with patient needs

It is important that contraceptive care is evidence-based and medically accurate. Providers must receive ongoing training and adequate support so that they are able to offer comprehensive, complete, informed, and inclusive information to their patients, and they must keep up to date on the safety and efficacy of the full range of contraceptive methods. To respect and honor individuals’ autonomy and reproductive freedom, any discussion of safety and efficacy must also value choice. Many people seeking contraception rank “safety and efficacy” high on their lists of priorities, but they rank other sexual-related priorities high as well. Thus, it is imperative that conversations of safety and efficacy are informed by the context of people’s personal lives, experiences, and preferences.

6. Contraceptive care should be easily accessible and available

Finally, an essential part of advancing and improving contraceptive care is ensuring that contraception is easily accessible and available to all. As Tara Mancini, director of public policy at Power to Decide, noted at the CAP event:

There’s 19 million women living in contraceptive deserts, and we know that the greatest barriers fall disproportionately on LGBTQIA populations, people in rural areas, women of color, and young people, of course, as well. … Don’t provide recommendations without consulting the people who are most impacted.

In the long run, these barriers only discourage people from seeking contraceptive care and complicate the care that is provided. Any policy that aims to improve contraceptive care must take into consideration how different groups of people navigate and engage with services, especially at a time when misinformation and disinformation about sexual and reproductive health are rampant and when so much uncertainty and fear exists, even within the health care profession.

Conclusion

Currently, access to birth control and family planning services across the country is dependent on a number of state- and local-level factors and can therefore look very different depending on where someone lives. Such fragmentation is not optimal or conducive to receiving the best care. But policymakers and health care providers have many avenues to bridge these gaps and help women and people of all genders navigate contraceptive care. They can address these issues through the six principles discussed in this article that acknowledge and affirm every person’s right to bodily autonomy and to make their own family planning decisions. These principles can act as a guide toward policy and initiatives that truly promote and advance equitable access to care.