Commentary Contraception

!Si, se puede!? For Latinas and Other Uninsured Women, Gaps Remain in Access to Birth Control

Kimberly Inez McGuire

Nearly four in ten Latinos are uninsured. "Si se puede…" can mean "IF she can…" and this conditional statement hints at the obstacles that remain after the HHS decision. IF a Latina can get health insurance, IF she can make it to a provider's office who can provide culturally-competent care in her language, and IF she can obtain and fill her prescription, THEN she will be able to fully enjoy the benefits of no-copay birth control.

It’s about time we had some good news. It’s been a long, hot summer in DC and a rough year of partisan attacks on women’s health in Congress and around the country. Like a cool rain after a long drought, the Department of Health and Human Services (HHS) recommendations that birth control be covered without co-pay brought welcome relief to women around the country.

A refreshing example of sound policy informed by scientific and public health experts, this decision will have profound ramifications for many women and families, and may have special resonance for Latinas, immigrant women, and others who continue to face multiple barriers in accessing birth control. So, that’s the good news.

The not-so-good news? We’re going to need a lot more rain before this drought is over.

In honor of Latina Week of Action for Reproductive Justice 2011, I’m going to celebrate the HHS recommendations, while at the same time keeping in mind the unfinished work of ensuring access to contraception for all Latinas, including immigrant women.

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It is not my intention to undersell the importance of the HHS decision. On the contrary, for too long, a woman’s ability to pay for birth control has determined whether and when she can prevent pregnancy, and including birth control as no-copay preventive care is a big step in the right direction.

And for Latino communities, economic relief of any kind cannot come soon enough. A new study by Pew shows Latino families have been hit hardest by the recession, accounting for the largest single decline in wealth of any ethnic and racial group in the country. These recent economic losses compound longstanding wealth and health disparities experienced by Latinas and their families. For Latinas who do have insurance or will be able to get it under the new exchanges, not having to pay out-of-pocket for their birth control could be transformative: leaving a little more money in the bank each month to help them with rent, tuition, buying groceries, and taking care of the children they already have.

But—and this is a big but—nearly four in ten Latinos is uninsured. And it probably comes as no surprise that lack of insurance is just one of many roadblocks Latinas encounter when they need to access health care, including contraception.

The Spanish phrase “!Si, se puede!” has long been used by Latinos the world over as a political rallying cry—and the two very different meanings of this iconic phrase may be instructive in examining the complex picture of Latinas’ access to reproductive health care. On the one hand, “Si se puede!” means “Yes we can!” an appropriate statement of celebration in the wake of this recent victory. (As in, “Thanks, Secretary Sebelius! Si se puede!!”) On the other hand, “Si se puede…” can also mean “IF she can…” and this conditional statement hints at the obstacles that remain. IF a Latina can get health insurance, IF she can make it to a provider’s office who can provide culturally-competent care in her language, and IF she can obtain and fill her prescription, THEN she will be able to fully enjoy the benefits of no-copay birth control.

For some women, that’s a few too many “ifs.” In addition to being less likely to have insurance, some Latinas, particularly immigrant or Spanish-dominant women, do not know where or how to find safe and accessible reproductive health care in their communities. Immigrant Latinas may be particularly vulnerable to unscrupulous “providers” who offer substandard care or misinformation. Just last week, reports surfaced that a counterfeit emergency contraception (EC) pill had been targeted to Latinas in the US. Other women may be experiencing contraceptive coercion, a form of intimate partner violence where a partner restricts a woman’s access to her birth control pills or refuses to use condoms. So even in a world where birth control is covered and hundreds of Planned Parenthood and other health clinics do provide quality care, some women could still slip through the cracks.

How can we reach the women who may not reap the benefits of the no-copay birth control decision? We can start by giving them more highly-effective options that do not require a provider’s supervision. Removing the age restriction on Plan B® emergency contraception would be a great start, and bringing a daily birth control pill over-the-counter also shows promise. If a woman of any age (or her partner, for that matter!) can pick up her EC or monthly pill pack with the rest of the shopping, more women will have birth control when they need it. (Intrigued? To weigh in with your thoughts on an over-the-counter birth control pill, you can fill out this survey.)

Every woman also needs better education about the full range of birth control options available to her. When unplanned pregnancy does occur, women need access to a full range of services: abortion care, prenatal care, and adoption counseling. Finally, reproductive health care does not exist in a vacuum: women also need social, educational, and economic opportunities, freedom from violence and coercion, and resources to care for their children and loved ones.

For many Latinas, the world I’ve just envisioned is still a long way off.

Our vigilance is needed to make sure that we build on all our victories by continuing to fight for more and better options for women. Just as every woman has different life circumstances that help determine what kind of birth control is right for her, each woman faces different barriers to accessing that birth control—including the need for insurance coverage and many others as well. We need more policymakers to take a cue from HHS Secretary Sebelius, and help create a world where every Latina “se puede,” where every woman has the support, education, and options she needs to plan pregnancy, care for her family, and care for herself.

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