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Ensuring Contraception Options Are Accessible and Affordable

Chapter 2 of: Playbook for the Advancement of Women in the Economy

Chapter

Ensuring Contraception Options Are Accessible and Affordable

The development and use of contraception has contributed to improvements in women’s economic stability, and federal and state policymakers must take steps to protect and expand its access.

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Buttons that read "Defend reproductive rights" sit on a table at a park in Franklin, Tennessee, August 2022. (Getty/William DeShazer for The Washington Post)

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Ensuring Contraception Options Are Accessible and Affordable

Kierra B. Jones

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Almost all women of reproductive age in the United States (99 percent) use some form of contraception over the course of their lifetimes.1 Improved access to safe and effective birth control—beginning in the early 1960s, when the U.S. Food and Drug Administration (FDA) approved the first oral contraceptive pill, colloquially known as the pill2—sparked a wave of ever-increasing opportunity and advancement for women. To this day, oral contraceptives are still the most widely used form of reversible contraception, with more than 10 million women using the pill.3

What is contraception?

Contraception, also known as “birth control,” is “any method, medicine, or device used to prevent pregnancy,” as defined by the U.S. Department of Health and Human Services (HHS).4 There are many safe and effective methods of contraception, including, but not limited to: intrauterine devices, implants, oral contraceptive pills, injections, patches, and vaginal rings. 5

For more than 60 years, access to birth control has given many women greater reproductive and bodily autonomy.6 Contraception also gave women the ability to meet their family planning goals by deciding whether, when, and how to have children.7 This advancement in contraception and family planning services helped reduce unwanted pregnancies and improve the health outcomes of women8 and children.9 These factors, in turn, contributed to improved women’s labor force participation,10 increased college attainment and educational outcomes,11 helped narrow the gender pay gap,12 and improved professional career growth among women.13

Women voters rank access to contraception as a priority concern, highlighting that accessible, affordable, and effective contraception is a far-reaching issue directly affecting women.14 According to national polling from the 2022 midterms, 74 percent of women voters placed protecting access to contraception in their top 10 policy priorities for Congress.15 This sentiment is even more prevalent among younger generations,16 as Generation Z and Millennial women may particularly struggle with access to contraceptive care due to factors such as cost, lack of knowledge, and distance from health care providers.17

What’s more, recent and persistent threats to reproductive care threaten to stifle more than 60 years of progress,18 highlighting that now is the time to bolster protections and expand access to contraception. This chapter of the “Playbook for the Advancement of Women in the Economy” details the progress in women’s right to comprehensive contraceptive care, potential threats to that progress, and actions federal and state policymakers can take to protect and expand access to contraception by ensuring comprehensive insurance coverage and improving the affordability of that care.

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The problem

Family planning and birth control is regarded as one of the greatest health achievements of the 20th century,19 even though it was not legally accessible and widely available to all women equally until more than a decade after the FDA approved the pill (under brand name Enovid) for contraceptive use in 1960. In 1965, the U.S. Supreme Court in Griswold v. Connecticut established “a constitutional right to privacy regarding reproductive decisions” for married couples.20 This was followed by the court’s 1972 decision in Eisenstadt v. Baird,21 which established that unmarried couples cannot be treated differently under the 14th Amendment, ensuring that unmarried people can also access contraception.

These two U.S. Supreme Court decisions were monumental in the fight for contraception, but importantly, other health policy changes had to occur to shape and actualize access to contraception on the ground. One of those hallmark advancements was the enactment of the Affordable Care Act (ACA) in 2010, which included a preventive services requirement and contraceptive coverage mandate.22 In its first year alone, the ACA saved women $1.4 billion on birth control pills.23

In 2022, and again in 2024, the Biden administration reaffirmed the mandate,24 which requires most private health plans and Medicaid expansion programs to cover contraceptives with no out-of-pocket-costs.25 Then, in July of last year, the FDA approved the first over-the-counter daily birth control pill, Opill, with no age restriction.26 Eight months after the FDA’s approval, drug manufacturer Perrigo announced that the pill will soon be available at retailers in store and online by the end of the month.27 As the first over-the-counter birth control pill, Opill is pivotal for improving the accessibility of contraception by reducing key barriers such as first having to visit a doctor or get a prescription.28 It has the potential to transform the landscape of family planning care and how women access birth control.

One study estimates nearly one-third of adult women who have tried to access prescription contraception reported experiencing barriers when seeking contraceptive care.29 These barriers today variously include cost and financial concerns, lack of insurance coverage, lack of transportation, living far away or having difficulty getting to a clinic, language barriers, and physicians requiring a pelvic exam before prescribing some forms of birth control. As the first over-the-counter birth control pill available, Opill could be instrumental for women who have difficulty accessing contraceptive and family planning services, but of utmost importance is its affordability and accessibility.30

Yet harmful regulations enacted by the Trump administration still undermine the birth control benefits included in the ACA, as well as aim to dismantle Title X family planning services and remove nondiscrimination protections in health care.31 Many women across the country also are at risk due to the U.S. Supreme Court’s 2022 decision to overturn nearly 50 years of precedent and deny the constitutional right to abortion in Dobbs v. Jackson Women’s Health Organization—the case that overturned Roe v. Wade.32 (see Chapter 1)

These restrictions to reproductive care highlight the urgent need for federal and state policymakers to advance policies that protect and expand access to comprehensive reproductive health care, including contraceptive care.33 This critical need is perhaps most salient now, as an estimated 19 million women of reproductive age live in contraceptive deserts34—areas with limited access to the full range of FDA-approved contraceptive methods. Women in these contraceptive deserts experience systemic and structural barriers to birth control, such as limited transportation, difficulty affording birth control, and lack of available child care options when accessing reproductive health and family planning services.35

Health care resources, services, and providers are not distributed equitably across the country, and this is particularly true of reproductive health care.36 Health care access and affordability concerns are particularly acute for women of color—in particular, Black and Hispanic women—as well as low-income, uninsured and underinsured women, and disabled women; LGBTQIA+ people; immigrant and undocumented women; and other historically marginalized groups.37

History of unethical practices in the development of contraception

Racist38 and unethical practices were used against Black, Latina, Indigenous and Native American, and Asian American women in the development of birth control during the 1900s.39 Nearly 70,000 people—disproportionately women of color—were forcibly and coercively sterilized.40 Furthermore, decades of experimental biomedical and clinical trials were conducted on people of color, disabled people, and low-income people in testing and developing contraceptives. 41

These trials include Harvard University’s birth control trials on women who were institutionalized in Massachusetts and on women in Puerto Rico who were not informed about the potential safety risks and suffered subsequent health complications.42 Additionally, there were many more unconscionable actions being inflicted upon women of color and low-income women in the testing of Norplant—an intrauterine device (IUD)—across the Global South between 1984 and 1991, alongside subsequent legislation in the United States incentivizing the use of Norplant among women who needed public assistance.43

These are just two of many examples of the unethical development and use of birth control. Years of research now demonstrate the benefits of improved access to contraception, but it is crucial also to acknowledge the ways that history was made and how these communities are often the same ones that are excluded from access to contraception today.

The economic, social, and geographic barriers that women face in accessing reproductive health care and services can have rippling and long-lasting effects later in life, including chronic health complications, stymied economic gains and professional advancement, lower wages, and household poverty.44

The economic benefits

Increased access to safe and effective contraceptive methods has contributed to greater educational attainment, increased workforce participation, and higher incomes among women.45 When women have more control to make family planning and childbearing decisions, they have an enhanced ability to pursue their education, career, and professional goals.46

Education

Access to contraception can unlock more education opportunities for women. Both contraception and abortion have been huge catalysts in supporting women’s educational goals.47 Access to contraception improves not only women’s college enrollment rates but also their college completion rates.48 Early research49 indicates that by delaying childbearing and “lowering the incidence of early fertility”50 in the 1960s and 1970s, there was nearly a 5 percentage-point increase in enrollment rates for college-aged women. Further, access to the pill at younger ages was associated with an increase in women’s college completion rates by almost 1 percentage point for women older than age 30.

Additionally, a synthesis of the quantitative literature since that early research was completed shows similar effects, estimating a range of a 12 percent to 20 percent increase in college enrollment correlated with women’s early access to contraception.51 The lack of these educational gains also are evident in college noncompletion rates, in which pregnant and parenting students are less likely than their nonparent counterparts to complete a college degree.52 More than 1 in 5 college learners are parents, and most parenting students are women.53 And just one-third of student parents complete their degree program within six years of enrolling.54

Career and labor force participation

Access to contraception can unlock opportunities in the U.S. labor force and women’s career growth. After the Griswold v. Connecticut and Eisenstadt v. Baird decisions,55 there was a massive shift and surge in women’s professional workforce and social participation.56 A groundbreaking study by Claudia Goldin and Lawrence Katz estimates that early access to the pill drastically improved women’s professional career growth between 1970 and 1990.57 Specifically, access to the pill was associated with a 1.7 percentage-point increase in the share of women in professional careers.58

Additionally, a 2005 foundational study by Martha Bailey on contraception and women’s labor force participation found that the pill significantly reduced the probability of birth before age 22.59 Because of that, early access to the pill increased women’s paid labor and their number of annual hours and weeks worked.60 Taken together, these two studies show that early access to the pill has wide-ranging implications for how women seek, obtain, and sustain employment when they are able to decide if and when they want children.

Wages and poverty

Access to contraception can unlock higher wages. Birth control played a critical role in reducing the gender pay gap because it allowed women to focus on their education and careers.61 Bailey and her co-authors in a more recent study found that by having access to the pill at younger ages, young women saw crucial wage gains later in life.62 In fact, the authors estimate an “8-percent hourly wage premium by age fifty,” suggesting that the pill has direct implications for narrowing the gender gap.63 Furthermore, access to the pill reduces the probability that a woman lives in poverty later on, even when controlling for related factors such as education and employment status.64

The policy recommendations

Comprehensive family planning policies at the federal level have the potential to improve contraceptive access when allocated adequate funding, constructive support, and a robust implementation strategy.65 Moreover, federal policy, in conjunction with state-level initiatives, can bolster access for the millions of women currently facing insufficient family planning services in the United States.

Federal policy recommendations

Federal policymakers have a range of ways they can improve access to comprehensive contraceptive services, specifically:

  • Limit religious exemptions that deny coverage for reproductive health services: To protect patient rights, it is imperative that employers are prohibited from discriminating against employees who need access to contraception, based on religious or moral objections.66
  • Require insurers67 to cover over-the-counter contraceptives68 without a prescription and cost sharing: Along the same lines, it is imperative that the drug companies and the prescription drug system are held accountable to ensure that new women’s health drugs are affordable for all.69
  • Clarify guidance to insurers to ensure health plans are following the Affordable Care Act’s contraceptive mandate: Policymakers need to ensure health plans cover the full range of FDA-approved70 birth control products without cost-sharing provisions, and they should introduce enforcement mechanisms for insurers who repeatedly ignore those guidelines.
  • Endorse and utilize the national contraceptive care measures by the HHS to inform contraceptive care decision-making:71 Policymakers should use measures to set national standards and ensure measures are integrated into federal programs and reporting systems.
  • Invest in and protect the Title X Family Planning Program to ensure that low-income people, young people, and communities of color have access to comprehensive family planning services:72 It is imperative for Congress to preserve Title X and safeguard it from political polarization and ongoing litigation by far-right activists.
  • Expand access and coverage of telehealth services for contraception and other reproductive health services:73 Telehealth is an increasingly utilized, safe, and effective way for people to access certain reproductive health services. Improving licensing for providers to offer those services, broadening the permitted telehealth modalities, fixing Medicaid reimbursement models, improving internet access, and protecting data privacy and digital security are essential to widen the availability of contraceptive care.

State policy recommendations

State lawmakers also have an important role to play in expanding access to contraceptive care and family planning services, specifically:

  • Broaden state pharmacists’ prescriptive authority to prescribe birth control through utilization of statewide protocols, standing orders, or collaborative practice agreements:74 This will allow pharmacists to prescribe and dispense contraception, making contraception more readily available to women through a vital community resource.
  • Extend quantity limits on contraceptive drugs, devices, and supplies: Requiring insurers to cover a one-year supply of contraceptives at one time, also known as one-year dispensing and extended supply policies, can improve access and utilization of birth control.75
  • Broaden eligibility for Medicaid family planning program services: This can be done through Section 1115 Medicaid waivers or state plan amendments, which allow people who are not eligible for full Medicaid coverage to still receive coverage for some family planning services.76
  • Make long-acting reversible contraceptives more accessible by implementing state-tailored initiatives on their provision:77 Long-acting reversible contraceptives are incredibly effective at reducing rates of unintended pregnancies, particularly when administered postpartum and post-abortion.
  • Expand insurance coverage at the state level for thousands of students in higher education affected by certain 2018 HHS rules:78 These rules allow exempting entities—including higher education institutions—to deny coverage of contraceptive services based on religious or moral grounds.79 This needs to change.
  • Implement performance-based quality measures into state-funded health plans and adopt contraceptive quality measures into reporting for the core Medicaid measure sets:80 Quality measures endorsed by the nonprofit National Quality Forum81 would help ensure that patients’ family planning needs are being met and incentivize providers to offer high-quality care to everyone.82
  • Expand access and strengthen comprehensive sex education: This policy initiative would ensure that all students and young adults are given the necessary tools, information, and resources to address their physical, mental, emotional, and social needs, and make informed decisions about their bodies.83

Conclusion

It is abundantly clear that improved access to contraception for more than 60 years has contributed to great strides in the economic advancement of women in the United States. From increased college attainment and career autonomy to higher wages, incremental changes have directly affected how women navigate and excel in a variety of social spheres and professional life. To make further progress, policymakers must continue to push for inclusive, unobstructed access to contraception and comprehensive reproductive care.

The author would like to thank Bela Salas-Betsch, Sara Estep, Rose Khattar, Anona Neal, Sabrina Talukder, Nicole Rapfogel, Andrea Ducas, and Lily Roberts for their contributions to and reviews of this chapter.

Endnotes

  1. Kimberly Daniels and William D Mosher, “Contraceptive methods women have ever used: United States, 1982–2010,” National Health Statistics Reports 62 (2013): 1–15, available at https://pubmed.ncbi.nlm.nih.gov/24988816/.
  2. G.D. Searle and Co., “Enovid Medical Brochure,” OnView, available at https://collections.countway.harvard.edu/onview/items/show/6470 (last accessed November 2023); Suzanne White Junod, “FDA’s Approval of the First Oral Contraceptive, Enovid” (Washington: U.S. Food and Drug Administration, 1998), available at https://www.fda.gov/media/110456/download.
  3. Kimberly Daniels and Joyce C. Abma, “Current Contraceptive Status Among Women Aged 15–49: United States, 2017–2019” (Hyattsville, MD: National Center for Health Statistics, 2020), available at https://www.cdc.gov/nchs/data/databriefs/db388-H.pdf.
  4. U.S. Department of Health and Human Services, “Birth control methods,” available at https://www.womenshealth.gov/a-z-topics/birth-control-methods (last accessed December 2023).
  5. American College of Obstetricians and Gynecologists, “Effectiveness of Birth Control Methods,” available at https://www.acog.org/womens-health/infographics/effectiveness-of-birth-control-methods (last accessed December 2023); Power to Decide, “Find Your Method,” available at https://powertodecide.org/sexual-health/your-sexual-health/find-your-method (last accessed December 2023).
  6. PBS, “A Timeline of Contraception,” available at https://www.pbs.org/wgbh/americanexperience/features/pill-timeline/ (last accessed November 2023).
  7. Sally Steenland and Jessica Arons, “Contraception Is an Economic Issue: Family Planning and the Economy Are Closely Connected,” Center for American Progress, April 2, 2012, available at https://www.americanprogress.org/article/contraception-is-an-economic-issue/; Kate Bahn and others, “Linking Reproductive Health Care Access to Labor Market Opportunities for Women” (Washington: Center for American Progress, 2017), available at https://www.americanprogress.org/article/linking-reproductive-health-care-access-labor-market-opportunities-women/.
  8. John Stover and John Ross, “How Increased Contraceptive Use has Reduced Maternal Mortality,” Maternal and Child Health Journal 14 (5) (2010): 687–695, available at https://doi.org/10.1007/s10995-009-0505-y; Saifuddin Ahmed and others, “Maternal deaths averted by contraceptive use: an analysis of 172 countries,” Lancet 380 (9837) (2012): 111–125, available at https://pubmed.ncbi.nlm.nih.gov/22784531/.
  9. Martha J. Bailey, Olga Malkova, and Johannes Norling, “Do Family Planning Programs Decrease Poverty? Evidence from Public Census Data,” CESifo Economic Studies 60 (2) (2014): 312–337, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206087/.
  10. Martha J. Bailey, “More Power to the Pill: The Impact of Contraceptive Freedom on Women’s Labor-Force Participation” (Nashville, TN: Vanderbilt University, 2005), available at https://ssrn.com/abstract=652521.
  11. Heinrich Hock, “The Pill and the College Attainment of American Women and Men” (Tallahassee, FL: Florida State University, 2005), available at https://paa2006.populationassociation.org/papers/61745; Anna Bernstein and Lindsey Reichlin Cruse, “Improving Success in Higher Education through Increased Access to Reproductive Health Services” (Washington: Institute for Women’s Policy Research, 2020), available at https://iwpr.org/wp-content/uploads/2020/07/CERH-Higher-Ed-brief.pdf.
  12. Martha J. Bailey, Brad Hershbein, and Amalia R. Miller, “The Opt-In Revolution? Contraception and the Gender Gap in Wages” (Cambridge, MA: National Bureau of Economic Research, 2012), available at https://www.nber.org/papers/w17922; Ken Gewertz, “Goldin discusses impact of oral contraceptives on gender equality in the workplace,” The Harvard Gazette, December 5, 2002, available at https://news.harvard.edu/gazette/story/2002/12/by-ken-gewertz/.
  13. Claudia Goldin and Lawrence F. Katz, “The Power of the Pill: Oral Contraceptives and Women’s Career and Marriage Decisions,” Journal of Political Economy 110 (4) (2002): 730–770, available at http://nrs.harvard.edu/urn-3:HUL.InstRepos:2624453; Steenland and Arons, “Contraception Is an Economic Issue.”
  14. YWCA USA and FINN Partners, “YWomenVote2022 – Midterm Election Study” (Washington: 2022), available at https://ywomenvote.org/wp-content/uploads/2022/08/20220826-YWomenVote-Memo-MidtermElectionStudy.pdf.
  15. Ibid.
  16. Ibid.
  17. Advocates for Youth, “New Data: Most Young People Face Barriers to Birth Control Access,” Press release, September 26, 2022, available at https://www.advocatesforyouth.org/press-releases/most-young-people-face-barriers-to-birth-control-access/.
  18. Osub Ahmed, Shilpa Phadke, and Diana Boesch, “Women Have Paid the Price for Trump’s Regulatory Agenda” (Washington: Center for American Progress, 2020), available at https://www.americanprogress.org/article/women-paid-price-trumps-regulatory-agenda/; Maggie Jo Buchanan, “In Dobbs, By Overturning Roe and Denying the Right to an Abortion, the Supreme Court Has Attacked Freedom,” Center for American Progress, June 24, 2022, available at https://www.americanprogress.org/article/in-dobbs-by-overturning-roe-and-denying-the-right-to-an-abortion-the-supreme-court-has-attacked-freedom/.
  19. Centers for Disease Control and Prevention, “Ten Great Public Health Achievements – United States, 1900-1999,” April 2, 1999, available at https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm.
  20. Planned Parenthood Action Fund, “Griswold v. Connecticut,” available at https://www.plannedparenthoodaction.org/issues/birth-control/griswold-v-connecticut (last accessed November 2023).
  21. Eisenstadt v. Baird, 405 U.S. 438 (March 22, 1972), available at https://supreme.justia.com/cases/federal/us/405/438/.
  22. American College of Obstetrics and Gynecology, “The Affordable Care Act and Reproductive Health,” available at https://www.acog.org/practice-management/payment-resources/affordable-care-act-reproductive-health (last accessed November 2023); Mary Tschann and Reni Soon, “Contraceptive Coverage and the Affordable Care Act,” Obstetrics and Gynecology Clinics of North America 42 (4) (2015): 605–617, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576988/.
  23. Nora Becker and Daniel Polsky, “Women Saw Large Decrease In Out-Of-Pocket Spending For Contraceptives After ACA Mandate Removed Cost Sharing,” Health Affairs 34 (7) (2015), available at https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.0127; Sarah Kiff, “Report: Obamacare has saved women $1.4 billion on birth control pills,” Vox, July 7, 2015, available at https://www.vox.com/2015/7/7/8907389/obamacare-birth-control-savings.
  24. U.S. Department of Human Health and Human Services, “HHS, DOL, and Treasury Issue Guidance Regarding Birth Control Coverage,” Press release, July 28, 2022, available at https://www.hhs.gov/about/news/2022/07/28/hhs-dol-treasury-issue-guidance-regarding-birth-control-coverage.html.; U.S. Department of Health and Human Services, “HHS Secretary Xavier Becerra Announces New Actions to Increase Contraceptive Care Coverage on 51st Anniversary of Roe v. Wade,” Press release, January 22, 2024, available at https://www.hhs.gov/about/news/2024/01/22/hhs-secretary-xavier-becerra-announces-new-actions-increase-contraceptive-care-coverage-51st-anniversary-roe-v-wade.html#:~:text=The%20Departments%20issued%20guidance%20to,effective%20family%20planning%20practices%2C%20and.
  25. Jamila Taylor and Nikita Mhatre, “Contraceptive Coverage Under the Affordable Care Act,” Center for American Progress, October 6, 2027, available at https://www.americanprogress.org/article/contraceptive-coverage-affordable-care-act/; Usha Ranji and others, “Medicaid Coverage of Family Planning Benefits: Findings from a 2021 State Survey” (San Francisco: Kaiser Family Foundation, 2022), available at https://www.kff.org/report-section/medicaid-coverage-of-family-planning-benefits-findings-from-a-2021-state-survey-report/#:~:text=Prescription%20Contraception,-The%20survey%20asked&text=States%20that%20have%20implemented%20the,ACA’s%20preventive%20services%20coverage%20requirement.
  26. U.S. Food and Drug Administration, “FDA Approves First Nonprescription Daily Oral Contraceptive,” Press release, July 13, 2023, available at https://www.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive.
  27. PR Newswire, “Perrigo Commences Shipments of Opill® to Retailers Nationwide, Empowering Millions to Enter a New Era of Reproductive Health Access in the United States,” Press release, March 4, 2024, available at https://www.prnewswire.com/news-releases/perrigo-commences-shipments-of-opill-to-retailers-nationwide-empowering-millions-to-enter-a-new-era-of-reproductive-health-access-in-the-united-states-302077710.html.
  28. Kierra B. Jones, “The First Over-the-Counter Birth Control Pill Marks a Pivotal Moment in Birth Control Access,” Center for American Progress, March 4, 2024, available at https://www.americanprogress.org/article/the-first-over-the-counter-birth-control-pill-marks-a-pivotal-moment-in-birth-control-access/.
  29. Kate Grindlay and Daniel Grossman, “Prescription Birth Control Access Among U.S. Women at Risk of Unintended Pregnancy,” Journal of Women’s Health 25 (3) (2002): 249–254, available at https://doi.org/10.1089/jwh.2015.5312.
  30. Kierra B. Jones, “Putting Health Over Profit: How Pharma Can Make Medicine More Affordable for Women,” Center for American Progress, October 16, 2023, available at https://www.americanprogress.org/article/putting-health-over-profit-how-pharma-can-make-medicine-more-affordable-for-women/.
  31. Ahmed, Phadke, and Boesch, “Women Have Paid the Price for Trump’s Regulatory Agenda.”
  32. Buchanan, “In Dobbs, By Overturning Roe and Denying the Right to an Abortion, the Supreme Court Has Attacked Freedom.”
  33. Center for American Progress, “Toward a Collective Vision for Improving Contraceptive Access,” March 29, 2023, available at https://www.americanprogress.org/events/toward-a-collective-vision-for-improving-contraceptive-access/.
  34. Power to Decide, “Contraceptive Deserts,” available at https://powertodecide.org/what-we-do/access/contraceptive-deserts#:~:text=Lack%20of%20Access%20%3D%20Lack%20of%20Power%20to%20Decide&text=Living%20in%20a%20contraceptive%20desert,the%20full%20range%20of%20methods (last accessed December 2023).
  35. Nambi Ndugga and Samantha Artiga, “Disparities in Health and Health Care: 5 Key Questions and Answers” (San Francisco: Kaiser Family Foundation, 2023), available at https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/; Center for Reproductive Rights and others, “Systemic Racism and Reproductive Injustice in the United States: A Report for the UN Committee on the Elimination of Racial Discrimination” (Washington: 2022), available at https://reproductiverights.org/systemic-racism-and-reproductive-injustice-in-the-united-states/.
  36. Ibid.
  37. Terri-ann Monique Thompson and others, “Racism Runs Through It: Examining The Sexual And Reproductive Health Experience Of Black Women In The South,” Health Affairs 41 (2) (2022), available at https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01422; Emily DiMatteo, Osub Ahmed, and Villisa Thompson, “Reproductive Justice for Disabled Women: Ending Systemic Discrimination” (Washington: Center for American Progress, 2022), available at https://www.americanprogress.org/article/reproductive-justice-for-disabled-women-ending-systemic-discrimination/; Center for Reproductive Rights and others, “Systemic Racism and Reproductive Injustice in the United States.”
  38. Yolanda Suarez-Balcazar and others, “Reproductive Justice for Black, Indigenous, Women of Color: Uprooting race and colonialism,” American Journal of Community Psychology (2022): 1–11, available at https://onlinelibrary.wiley.com/doi/full/10.1002/ajcp.12650.
  39. Marcela Howell, Jessica Pinckney, and Lexi White, “Contraception Equity for Black Women” (Washington: National Black Women’s Reproductive Justice Agenda, 2020), available at http://blackrj.org/wp-content/uploads/2020/04/6217-IOOV_ContraceptiveEquity.pdf; Erin Blakemore, “The First Birth Control Pill Used Puerto Rican Women as Guinea Pigs,” History, May 9, 2018, available at https://www.history.com/news/birth-control-pill-history-puerto-rico-enovid; Lisa Ko, “Unwanted Sterilization and Eugenics Programs in the United States,” PBS, January 29, 2016, available at https://www.pbs.org/independentlens/blog/unwanted-sterilization-and-eugenics-programs-in-the-united-states/.
  40. Fresh Air, “The Supreme Court Ruling That Led To 70,0000 Forced Sterilizations,” NPR, March 7, 2016, available at https://www.npr.org/sections/health-shots/2016/03/07/469478098/the-supreme-court-ruling-that-led-to-70-000-forced-sterilizations#:~:text=All%20told%2C%20as%20many%20as,were%20deaf%2C%20blind%20and%20diseased.
  41. Harriet A. Washington, Medical Apartheid (New York: Penguin Random House, 2006).
  42. Drew C. Pendergrass and Michelle Y. Raji, “The Bitter Pill: Harvard and the Dark History of Birth Control,” The Harvard Crimson, September 28, 2017, available at https://www.thecrimson.com/article/2017/9/28/the-bitter-pill/.
  43. Elizabeth Jekanowski, “Fall 2018 Journal: Voluntarily, for the Good of Society: Norplant, Coercive Policy, and Reproductive Justice,” Berkeley Public Policy Journal, August 23, 2018, available at https://bppj.berkeley.edu/2018/08/23/norplant-coercive-policy-and-reproductive-justice/; Jessica Portner, “Baltimore Plan To Offer Norplant Raises Ethical, Medical, and Legal Questions,” Education Week, December 16, 1992, available at https://www.edweek.org/education/baltimore-plan-to-offer-norplant-raises-ethical-medical-legal-questions/1992/12.
  44. Aliza Adler and others, “Changes in the Frequency and Type of Barriers to Reproductive Health Care Between 2017 and 2021,” JAMA Network Open 6 (4) (2023): e237461, available at https://doi.org/10.1001/jamanetworkopen.2023.7461; Center for Reproductive Rights and others, “Systemic Racism and Reproductive Injustice in the United States”; United Nations, “Denial of Reproductive Rights Kills or Harms Millions of Women,” Press release, May 28, 1997, available at https://press.un.org/en/1997/19970528.pop647.html.
  45. Bahn and others, “Linking Reproductive Health Care Access to Labor Market Opportunities for Women”; U.S. Joint Economic Committee, “The Economic Benefits of Birth Control and Access to Family Planning” (Washington: 2022), available at https://www.jec.senate.gov/public/_cache/files/bb400414-8dee-4e39-abd3-c2460fd30e7d/the-economic-benefits-of-birth-control-and-access-to-family-planning.pdf.
  46. Steenland and Arons, “Contraception Is an Economic Issue”; Bahn and others, “Linking Reproductive Health Care Access to Labor Market Opportunities for Women.”
  47. Bernstein and Reichlin Cruse, “Improving Success in Higher Education through Increased Access to Reproductive Health Services.”
  48. Ibid.; Institute for Women’s Policy Research, “New resource summarizes economic research on the effects of access to contraception on women’s education and work,” Press release, September 26, 2019, available at https://iwpr.org/contraception-access-increases-womens-educational-attainment-and-earnings/.
  49. Hock, “The Pill and the College Attainment of American Women and Men.”  
  50. Ibid., p. 7. The author defines “early fertility” as “giving birth to a child at or below age 21.”
  51. Anna Bernstein and Kelly M. Jones, “The Economic Effects of Contraceptive Access: A Review of the Evidence” (Washington: Institute for Women’s Policy Research, 2020), available at https://iwpr.org/wp-content/uploads/2020/07/B381_Contraception-Access_Final.pdf.
  52. Bernstein and Reichlin Cruse, “Improving Success in Higher Education through Increased Access to Reproductive Health Services.”
  53. Melissa Emrey-Arras and others, “Higher Education: More Information Could Help Student Parents Access Additional Federal Student Aid” (Washington: Government Accountability Office, 2019), available at https://www.gao.gov/assets/gao-19-522.pdf.
  54. Bernstein and Reichlin Cruse, “Improving Success in Higher Education through Increased Access to Reproductive Health Services.”
  55. Eisenstadt, Sheriff v. Baird, 405 U.S. 438 (March 22, 1972), available at https://tile.loc.gov/storage-services/service/ll/usrep/usrep405/usrep405438/usrep405438.pdf.
  56. Planned Parenthood Federation of America, “The Birth Control Pill: A History” (Washington: 2015), available at https://www.plannedparenthood.org/files/1514/3518/7100/Pill_History_FactSheet.pdf.
  57. Goldin and Katz, “The Power of the Pill.”
  58. Ibid.
  59. Bailey, “More Power to the Pill.”
  60. Ibid.
  61. Kate Sheppard, “The Pill Makes Women Richer,” Mother Jones, March 28, 2012, available at http://motherjones.com/mojo/2012/03/pill-makes-women-richer.
  62. Bailey, Hershbein, and Miller, “The Opt-In Revolution? Contraception and the Gender Gap in Wages.”
  63. Ibid.
  64. Stephanie P. Browne and Sara LaLumia, “The Effects of Contraception on Female Poverty,” Journal of Policy Analysis and Management 33 (3) (2014): 602–622, available at https://doi.org/10.1002/pam.21761.
  65. Laura E. T. Swan, “The impact of US policy on contraceptive access: a policy analysis,” Reproductive Health 18 (235) (2021), available at https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01289-3.
  66. Shilpa Phadke, Jamila Taylor, and Nikita Mhatre, “Rhetoric vs. Reality: Why Contraception Matters to Women,” Center for American Progress, November 15, 2017, available at https://www.americanprogress.org/article/rhetoric-vs-reality-access-contraception-matters-women/; Heidi Williamson and Claire Markham, “President Trump Wants to Restrict Access to Contraception Under the Guise of Religious Liberty,” Center for American Progress, June 22, 2017, available at https://www.americanprogress.org/article/president-trump-wants-restrict-access-contraception-guise-religious-liberty/; Executive Office of the President, “Executive Order 14076: Protecting Access to Reproductive Healthcare Services,” Federal Register 87 (133) (2022): 42053–42055, available at https://www.federalregister.gov/documents/2022/07/13/2022-15138/protecting-access-to-reproductive-healthcare-services.
  67. Fran Kritz, “Your Insurance May Soon Cover These OTC Products,” Verywell Health, October 24, 2023, available at https://www.verywellhealth.com/preventive-non-prescription-insurance-coverage-proposal-8367554.
  68. Kierra B. Jones, “5 Important Facts About Over-the-Counter Birth Control,” Center for American Progress, October 24, 2022, available at https://www.americanprogress.org/article/5-important-facts-about-over-the-counter-birth-control-pills/.
  69. Jones, “Putting Health Over Profit.”
  70. U.S. Food and Drug Administration, “Birth Control,” available at https://www.fda.gov/consumers/free-publications-women/birth-control (last accessed November 2023).
  71. U.S. Department of Health and Human Services Office of Population Affairs, “Contraceptive Care Measures,” available at https://opa.hhs.gov/research-evaluation/title-x-services-research/contraceptive-care-measures (last accessed November 2023).
  72. Bahn and others, “Linking Reproductive Health Care Access to Labor Market Opportunities for Women.”
  73. Osub Ahmed, “States Must Expand Telehealth To Improve Access to Sexual and Reproductive Health Care” (Washington: Center for American Progress, 2020), available at https://www.americanprogress.org/article/states-must-expand-telehealth-improve-access-sexual-reproductive-health-care/.
  74. Kierra B. Jones, “Advancing Contraception Access in States Through Expanded Pharmacist Prescribing” (Washington: Center for American Progress, 2023), available at https://www.americanprogress.org/article/advancing-contraception-access-in-states-through-expanded-pharmacist-prescribing/.
  75. Kierra B. Jones, “Advancing Contraception Access in States Through One-Year Dispensing and Extended Supply Policies” (Washington: Center for American Progress, 2023), available at https://www.americanprogress.org/article/advancing-contraception-access-in-states-through-one-year-dispensing-and-extended-supply-policies/.
  76. Kierra B. Jones, “Advancing Access to Contraception Through Section 1115 Medicaid Waivers and State Plan Amendments” (Washington: Center for American Progress, 2023), available at https://www.americanprogress.org/article/advancing-access-to-contraception-through-section-1115-medicaid-waivers-and-state-plan-amendments/.
  77. Osub Ahmed, “13 Ways States Can Protect and Advance Women’s Health” (Washington: Center for American Progress, 2018), available at https://www.americanprogress.org/article/13-ways-states-can-protect-advance-womens-health-rights/.
  78. IRS, Employee Benefits Security Administration, and U.S. Department of Health and Human Services, “Religious Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act,” Federal Register 83 (221) (2018): 57536–57590, available at https://www.federalregister.gov/d/2018-24512; IRS, Employee Benefits Security Administration, and U.S. Department of Health and Human Services, “Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act,” Federal Register 83 (221) (2018): 57592–57631, available at https://www.federalregister.gov/d/2018-24514.
  79. Laurie Sobel, Alina Salganicoff, and Caroline Rosenzweig, “New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women” (San Francisco: Kaiser Family Foundation, 2018) available at https://www.kff.org/report-section/new-regulations-broadening-employer-exemptions-to-contraceptive-coverage-impact-on-women-issue-brief/; Natalie Gontcharova, “What You Should Know About Trump’s New Anti-Birth Control Rules,” Refinery29, November 13, 2018, available at https://www.refinery29.com/en-us/2018/11/216868/trump-administration-new-rules-contraceptive-coverage.
  80. Kierra B. Jones, “Advancing Access to Contraception in States Through Quality Measures and Person-Centered Contraceptive Counseling” (Washington: Center for American Progress, 2023), available at https://www.americanprogress.org/article/advancing-access-to-contraception-in-states-through-quality-measures-and-person-centered-contraceptive-counseling/.
  81. National Quality Forum, “Perinatal and Reproductive Health 2015-2016 Final Report” (Washington: 2016), available at https://www.qualityforum.org/Publications/2016/12/Perinatal_and_Reproductive_Health_2015-2016_Final_Report.aspx.
  82. Jones, “Advancing Access to Contraception in States Through Quality Measures and Person-Centered Contraceptive Counseling.”
  83. Ahmed, “13 Ways States Can Protect and Advance Women’s Health.”

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Chapter 2 of: Playbook for the Advancement of Women in the Economy

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