Commentary Contraception

Why Access Remains the Biggest Obstacle to Use of Contraception

Amanda Marcotte

New statistics from the National Center for Health Statistics indicate that the popularity of highly effective, long-acting forms of contraception is growing rapidly. Society is becoming more easy with contraception, and access needs to catch up.

One likely reason anti-choicers have dramatically increased attacks on contraception lately is that Americans are getting better at using it. As long as we have consistent access, we are getting better at using it correctly and avoiding unintended pregnancy. As a Guttmacher study from last year demonstrated, women who do have this consistent access—women with more education and higher incomes—have unintended pregnancy rates that are low enough to be compared to those of Western Europe. It’s only by attacking the access of lower-income women that anti-choicers have succeeded in their obvious-if-disingenuously-denied goal of making sure that the unintended pregnancy rate remains high.

But how long can they hold the line against American women’s growing demands for complete control over their own fertility? New federal statistics show that usage of long-acting and highly effective methods of contraception has risen dramatically:

The National Center for Health Statistics surveyed a nationally representative sample of more than 12,000 women between the ages of 15 and 44 about their birth control methods between 2006 and 2010, and compared those findings to a similar sample of over 10,000 women in 1995. While women’s use of sterilization and the daily birth control pill remained constant — each around 27 percent for both decades — the use of longer-acting hormonal methods like the patch and the ring increased 75 percent, and IUD use jumped by an impressive 600 percent.

The number of women who choose longer-acting birth control methods over the pill are still relatively small. Seven percent of respondents between 2006-10 reported using the patch or the pill, up from 4 percent in 1995, and IUD users rose from just 0.8 percent to 5.6 percent in the same time period.

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Still, these dramatic increases reflect, I believe, shifting mores regarding contraception. While there’s still a lot of diversity over geography, religious belief, etc., there’s been a gradual shift away from women framing their contraception needs as relationship-dependent and towards viewing contraception as preventive medicine. When I was in my late teens and early twenties, my choice to be on the pill regardless of whether or not I was currently in a relationship was frequently seen as a bit odd by my peers. The norm was to only go on contraception when in a relationship. A lot of women feared being seen as too sexually cavalier if they were prepared for the possibility of sex, even though they did end up hooking up with guys. What would happen, then, is they would use condoms when hooking up with a guy, make a commitment, go on the pill for a time, break up, go off the pill lest they be seen as someone who hooks up, hook up with a guy using condoms, and repeat the cycle. They were hooking up, even as they were afraid to be seen as someone who hooks up.

It seems that this kind of self-defeating contraception behavior is fading away, at least among women who have the privilege of access to their choice of contraception. All the hand-wringing about the “hook up culture” distracts from a very important benefit of the growing acceptability of hooking up: It makes it easier for women to keep up with a contraception regime or even get a long-acting method without worrying what it “says” about her. The result is improved use of contraception, such as the high numbers of teenagers who report dual-method contraceptive use.

But, as noted, while people with education and income privileges seem to be getting better about using contraception all the time, people without these privileges find it harder and harder to access contraception at all. Anti-choicers are clearly out to make this disparity much worse, most notably in the ongoing (and often successful) attempts to terminate funding for family planning clinics, especially Planned Parenthood. The result of increasing these disparities will no doubt be to keep the overall unintended pregnancy rate high, which they will then reference when making facetious claims that contraception doesn’t work. That women who are often already struggling to make ends meet are the primary victims of this is just a bonus for conservative forces.

But what this new study and overall trends show, beyond a shadow of a doubt, is that cultural shifts mean that other obstacles to consistent contraception use—such as lack of information or sexualized fears around contraception—are fading away, and access is the most prominent remaining obstacle. Unfortunately, knowing this means that anti-choicers have doubled down their attacks on access, and they need to be fought and called out at every opportunity. Most Americans do not agree with the anti-choice movement on the supposed evils of contraception; while they’ve had many immediate successes attacking contraception access, they do so at the price of being outed as anti-sex fanatics.

Despite the successes that anti-choicers are having in attacking access to contraception, especially for low-income women, there is reason to be hopeful for the long term. For one thing, the Affordable Care Act means that access to reproductive health care is going to expand in some ways, and for those who do have insurance, getting the most effective and long-lasting contraception is easier than ever. This, in turn, will help accelerate the process of mainstreaming the concept of long-acting contraception. Six hundred percent growth of the popularity of the IUD means that there’s a lot of potential there, especially now that it’s free to women who have insurance. Hopefully, in the long run, this will help bring about the cultural attitudes that will end the anti-choice assault on contraception. 

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