A growing number of women’s health advocates are urging bolder and potentially transformative steps toward greater "contraceptive convenience," with the aim of making contraceptive use easier and more sustainable for women, according to a new Guttmacher policy analysis. These advocates argue that many of the ways in which contraceptives are made available in the United States are no longer grounded in the reality of current scientific advancements or modern women’s lives.
Research shows that half of all adult women at risk of unintended pregnancy are inadequately protected because, over the course of a given year, they don’t use contraceptives at all, use them inconsistently or incorrectly, or have a gap in use lasting more than a month. A complex web of reasons contributes to women’s difficulties in using contraceptives, ranging from method dissatisfaction to life disruptions. Advocates of a contraceptive convenience agenda are pushing for measures to break down many of the medical and societal barriers to better use.
"In a variety of ways, society makes women’s contraceptive access needlessly hard, and it can and should be made easier. By stripping away layers of medical intervention or requirements that are outmoded or unnecessary, we can go beyond current efforts to make contraceptive service delivery more user friendly," says Sneha Barot, author of the new analysis. "For instance, many women’s health experts have concluded that a number of hormonal contraceptives—including the birth control pill—should be available to women directly at pharmacies, without the requirement of a doctor’s prescription. Such steps would make contraceptives easier to obtain and use without interruption, and would also decrease other financial and logistical hurdles."
Barot’s analysis points out, however, that proposals to "demedicalize" contraception also raise serious concerns. For example, removing the prescription requirement for oral contraceptives could make pills unaffordable for low-income women if it also resulted in the removal of private insurance and Medicaid coverage. Likewise, eliminating the need to go to doctors or family planning clinics for contraceptives could jeopardize access to other preventive health services normally provided in these settings. Minority communities, especially, could be affected, potentially aggravating existing inequalities.
"Any efforts to push for over-the-counter status would need to resolve serious challenges —including cost and access to health care—that marginalized populations would be facing," says Barot. "To make contraceptives easier to use, even without the benefit of instructions from a doctor, would also mean revamping package labeling to make it more comprehensible and accurate."
Barot further notes that a number of other measures also need to be pursued to truly make contraceptives easier for women to obtain and use. One of the most important of these is to create a fundamental shift in societal attitudes toward contraception, so that users will face fewer restrictions—and more support.
"Making access to and use of contraceptives easier is not trivializing an important reproductive health issue or promoting irresponsible attitudes or behavior—quite the opposite," says Barot. "‘Convenience’ in the area of contraceptive access would translate into practical and meaningful support for women who are trying to avoid unwanted pregnancies, improve their health, and better plan their lives."
Click here to read "Making the Case for a ‘Contraceptive Convenience’ Agenda," by Sneha Barot, in the Fall 2008 issue of the Guttmacher Policy Review.
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