Is Birth Control Under Attack?

Abstract / Summary

Originally published in Zócalo Public Square.

There are few things in America as universal as contraception. More than 99% of reproductive age women—and by extension, their partners—have used it at some point in their lives, to prevent pregnancy and for a whole range of other health reasons. This is true across religion, geography, age, and sexual orientation or gender identity. If measured by our behavior, contraception is something that we as a country have long agreed is an important and routine part of how we live our lives.

As a social scientist who has spent the past two decades studying how and why people use contraception, my work has been defined by a distinct tension. Slowly and methodically, more contraceptives—designed for more people with various needs and preferences—have become available. But as access to new methods has expanded, so too have the attacks on contraception and related health care. While these attacks are longstanding, today they feel more overt: I’m concerned that contraceptive access in the United States is on a precarious path.

Given the ubiquity with which Americans use contraception, these attacks seem paradoxical. But they are part of a much broader political strategy to limit bodily autonomy.

One consistent theme in my research is that federal and state restrictions that ostensibly target abortion have impacts far beyond abortion access. You cannot seek to restrict or regulate one aspect of sexual and reproductive health without tightening other types of care and people’s overarching reproductive freedoms. This reflects the realities of how people live their lives: It is impossible to silo one aspect of our health from our overall well-being.

The most popular methods of contraception in the U.S. among reproductive-aged women are permanent sterilization (“getting your tubes tied”), the birth control pill, condoms, and intrauterine devices, or IUDs. (While data collection often focuses on contraceptive users who identify as women—including most of the studies referred to in this piece—many users who are not women also rely on contraception.) At the same time, about one-fourth of current and prospective contraceptive users say they would rather be using another (or any) method of contraception. In other words, we know there is often a gap between the contraceptive methods people are using and the methods they wish they could be using. Abortion restrictions, and their numerous ripple effects, may be widening that gap.

When the Supreme Court overturned Roe v. Wade in the Dobbs v. Jackson Women’s Health Organization decision in 2022, there was a direct and immediate impact on abortion access.

As a country, we’ve long shown that using contraception is routine, important, and ubiquitous.
Two years later, there’s a growing body of evidence documenting Dobbs’ far-reaching consequences on the delivery of other types of sexual and reproductive health care as well. Patients report lower quality contraceptive care following the decision, meaning their conversations with providers are less likely to specifically address their needs. They’re also having trouble accessing the methods that they want to use, due to insufficient clinic availability and cost, among other barriers. Meanwhile, providers in states with and without abortion bans report increases in patients seeking contraceptive care, and there are documented increases in people receiving long-acting reversible contraceptives, like IUDs and implants, as well as permanent methods of contraception, including vasectomies and tubal ligation. What we still don’t know is whether these changes reflect people’s true preferences or whether they represent constrained choices being made in an environment in which people recognize that their reproductive freedoms are threatened.

The strategy behind those threats is one we’ve seen before; it mirrors the strategy used by the anti-abortion movement, which chipped away at abortion access piece by piece. These are both part of a campaign targeting bodily autonomy more generally, which includes access to gender affirming and infertility care.

Following the anti-abortion playbook, the campaign against contraception is intentionally aimed at restricting access for certain communities and methods. At the beginning of the summer, there were eight bills proposed in six states that would have limited young people’s access to contraception through requirements around parental consent; while most didn’t make it out of legislatures this year, in Texas and Tennessee, such laws are now in place. Some states are already reducing coverage for contraceptives through public programs like Medicaid, which provide insurance to many people with low incomes. And in states including Oklahoma and Indiana, bills reflect language falsely claiming methods like emergency contraception and IUDs facilitate abortions, despite clear scientific evidence that these methods prevent pregnancy, rather than terminate it. Lawmakers in these and other states are leveraging language in ongoing abortion bans to attempt to restrict these contraceptives.

Each of these individual attacks perpetuates and exacerbates longstanding inequities in who can access their desired contraception and whose reproduction—and health—American society values. In a recent study, we found that young people, sexual and gender minorities, people born outside the U.S., and lower income people were less likely to be using their preferred method of contraception post-Dobbs as compared to their less marginalized counterparts.

We also know that the way people are accessing sexual and reproductive health care is changing dramatically, from clicking through an app on their phones to select their contraception via telehealth to being able to purchase the first-ever over-the-counter birth control pill. But research tracking these changes—which delves into the most intimate aspects of people’s lives—is becoming increasingly challenging to conduct. People understandably worry about how their information is used and who has access to it, concerned that data related to pregnancy and menstruation could be used against them. This could be a harbinger of poorer quality data that, at best, capture only a narrow slice of the population, and, at worst, inaccurately represent people’s lived experiences.

There is no one best method of birth control or one best avenue for getting it. The more options we have and the more ways people have to access them, the closer we’ll get to closing the gap between the contraceptives people are using and those they want to be using. Systems-level solutions—like making sure that all forms of contraception are covered via public and private insurance plans and increasing funding to sexual and reproductive health care programs that center patients’ needs and perspectives—must be a key focus of efforts to close that gap.

Those efforts must also recognize that a threat to one aspect of sexual and reproductive health care is a threat to our entire ability to have autonomy over our bodies and to live the lives that we each desire. As a country, we’ve long shown that using contraception is routine, important, and ubiquitous. But it’s not enough for contraceptive use to be nearly universal. Contraceptive access—to whatever method desired—should be, too.