BARRIERS TO CONTRACEPTION ACCESS—EVEN IN BLUE STATES

BARRIERS TO CONTRACEPTION ACCESS—EVEN IN BLUE STATES

The U.S. Supreme Court’s June decision in Dobbs v. Jackson Women’s Health Organization, which struck down Roe v. Wade, is expected to lead to bans or severe restrictions on abortion in more than half of all U.S. states.

“In many of these states, the legislation is so sweeping, it will also impact emergency contraceptives like Plan B—also known as the morningafter pill—and possibly prescription birth control,” says Dima M. Qato, Hygeia Centennial Chair at the School of Pharmacy and a senior fellow at the USC Schaeffer Center for Health Policy & Economics.

States like California can expect a dramatic increase in demand as women cross state lines to receive reproductive care. “One estimate from the Guttmacher Institute predicts people seeking abortion services or contraceptives in California will increase by 3,000%—from 46,000 to 1.4 million people annually,” Qato says. Barriers to Reproductive Care Even in states without contraceptive restrictions, barriers exist to accessing Plan B. In California, pharmacists may deny emergency contraceptives to customers who don’t have a prescription, Qato notes.

Research she and colleagues published in Health Affairs in 2020 demonstrates the resulting disparities in access. “We found that only 1 in 10 pharmacies in Los Angeles County provided pharmacist-prescribed contraception, and even fewer pharmacies provided this service for women and girls living in predominantly Black or Latinx and low-income neighborhoods—including those with high unintended pregnancy rates,” she says.

Even if all pharmacies implemented pharmacist-prescribed contraception, many adolescent girls and undocumented immigrant women could still encounter barriers to accessing it, she explains. “We found that nearly three-fourths of pharmacies impose identification and age restrictions not required by law,” she says.

And while the Affordable Care Act requires insurance providers to cover contraception, these protections do not apply to the uninsured, who may be unable to afford the $40–50 cost per pill for Plan B.

Policy Solutions Needed “While well-intentioned, dispensing mandates only help women who secure prescriptions,” Qato says. “Most women traveling from a state with restrictive access to drugs like Plan B will likely not be able to get a prescription.” So in addition to dispensing mandates, she suggests the use of Title X funding to cover contraceptive costs for low-income or uninsured women.

“Women are likely already traveling to states like California to purchase contraception,” Qato says. “They should not face the additional burden of barriers at the pharmacy counter.”