Are You Living in a Contraceptive Desert?

The term ‘contraceptive desert’ refers to an area that lacks reasonable access to a clinic that does not have a full range of birth control methods. There are 19.5 million women (but remember, it isn’t just women who require access to contraception), who have low-incomes and lack reasonable access to a clinic in their county that offers a full range of birth control methods. Within those 19.5 million women live 1.6 million women that live in a county that does not have a single clinic that offers a range of contraceptive methods. Rachel Fey with Power to Decide talks to us about contraceptive deserts in the U.S. and why it is extremely important to expand access to birth control.

Contraceptive deserts disproportionately burden low-income people, because accessing birth control in these locations require taking time off, out-of-pocket costs, finding transportation, and more. It’s also rare that one person has used the same birth control method for their entire lives, and people switch up their methods at different times. That’s why it is vital that clinics offer a full range of contraceptive methods, including long-acting reversible contraceptives like IUDs, barrier methods, injections, and others. There is a large range of costs for these methods, too. Power to Decide and Bedsider’s BCBenefits program helps to cover common costs associated with accessing birth control!

There have been countless attacks on clinics that help provide low-income folks and young people with access to birth control. Millions of people rely on Title X federal funding for sexual and reproductive health care every year. The Trump administration’s “domestic gag rule” on Title X forces clinics to choose between performing, counseling, and referring for abortion care or receiving the federal funds they need to keep their doors open. The gag rule is currently being challenged in court, but is right now in effect. Nearly 900 clinics are no longer able to use Title X funding, which is money that could be used to purchase and distribute contraceptive methods for people around the U.S.

Links from this episode

Power to Decide on Twitter
Power to Decide on Facebook
Interactive Contraceptive desert map
Factsheet on Title X “domestic gag rule”
Bedsider.org
BCBenefits
The Trump Administration has Forced Planned Parenthood Out of Title X episode

Transcript

Jennie: Welcome to rePROs Fight Back a podcast on all things repro. I'm your host Jennie Wetter. In each episode, I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode, I will be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for repros to fight back.

Read More

Jennie: Hi everyone and welcome to this week's episode of RePROs Fight Back. Before we get started, just a little bit of housekeeping. We are excited to announce that we have recently added to our website transcripts of all of our episodes. So if you go to the specific episode pages, you will see transcripts available on those pages and we want to make sure that the podcast is as accessible as possible for everyone. So we thought it was really important to add a transcript so that people who are not able to listen are able to get the information. So hopefully you all enjoy this new addition. Okay. So this week on RePROs Fight Back, we are going to talk about contraceptive deserts, what they are and why the Title X gag rule is making them worse. Helping me talk about that today, I'm excited to have Rachel Fey with Power to Decide here with me. Hi Rachel. Thank you so much for doing this.

Rachel: Thank you so much for having me. I'm excited to talk to you. It's so much fun.

Jennie: I feel like I'm always like, I'm so excited to talk about really horrible things.

Rachel:I know we sometimes in our, in our field we're happy when a number comes out bad enough that at least we think we can get policy makers to care about it. But at the same time we have to be real. That number is bad because people don't have what they need when it comes to their reproductive health care. And that's just a really frustrating thing to come up against a lot. So I hear you.

Jennie: Yeah. Okay, so we're going to talk about contraceptive deserts. So maybe we should start at the very beginning. What is the contraceptive desert?

Rachel: So I'm really glad you asked. I think of contraceptive deserts really simply as when somebody does not have reasonable access to a clinic that offers the full range of birth control methods and the way Power to Decide looks at this is a ratio of one provider or clinic to 1000 people. And we focus on low income people because it's really important to look at who would face inordinate barriers if they have to travel further to a clinic if a requires more time off or if the clinic doesn't have the method that they want. So there are 19.5 million women who have low incomes and in this case, unfortunately we're only able to give you a number of women. We know that it's not just people who identify as women, but when you hear me use that phrase, it's cause that's the data we have. There's 19.5 million women who lack reasonable access to a clinic in their county that offers the full range of contraceptive methods. These women make less than 250% of the federal poverty level, which to give you a sense is a little over $30,000 for an individual. So not a lot of money. These are people who often struggle to find enough gas money to make it to and from work. They may live in real rural areas or they may live in urban areas and have to take four buses to get to another part of their city in order to access the care they need. So these are really serious problems. Sometimes there may be lots of clinics in the city. When you look at how many women need those clinics, it's not reasonable access. Within that 19.5 million women are 1.6 million women who live in counties without a single clinic that offers the full range of methods.

Jennie: I'm sorry, what was that number again?

Rachel: 1.6 million. So of that 19.5 million, 1.6 million women are really, really up a creek. There's not a single clinic. It's not a matter of whether they have reasonable access and their wait times might be longer or the hours are limited. It's really about them not having any clinic they can go to in their county that offers the full range of methods. So a lot of times the Power to Decide where you hear things like, well, what's the big deal? You could just go to Walmart and get some pills. It's really a big deal to have the full range of methods. And I think if you talk to anyone with reproductive organs about what they need, they will tell you that everybody's body is different and what works for one person does not work for another. And so finding that method that works for you, that meets your healthcare needs, that meets your lifestyle needs, that meets your goals for family planning is really critical. And you and I are privileged enough to have that kind of access. It shouldn't just be us, it should be everybody that has that kind of access.

Jennie: Absolutely. So you've already started to touch on it. Like what do we mean when we say a full range of methods?

Rachel: Yeah. I want to talk about why it's so important, like what that means and why it's so important. I remember a few years ago at Power to Decide, we did some research with focus groups of young women and asked about their birth control journeys. We asked them to actually draw them out and almost no young woman, and we're talking about women mostly in their twenties had been on just one method their entire life. Some of them had been on a pill and moved to the ring. Some had tried a patch and then gone to an IUD. Some were using condoms now, but in the past had wanted to use something else. It's really, really different for everyone and I can tell you as a 40 year old woman, my journey has been really different and so not everything is right for every person and not everything's right for every person at every time. I always tell this story because I think it helps more privileged women to identify with this, but I have a friend who was doing her medical in psychiatry and she worked crazy hours and she told me, she was like, I didn't know sometimes when I walked out the door of the hospital, whether it was day or night outside, if I had had to remember to take a pill at the same time every day, I would probably be pregnant while I was even doing my residency. She said instead, she used an IUD which was really cohesive to her lifestyle at the time while she was trying to finish this really intensive residency. Now she and her husband don't want to use an IUD because they're ready for baby number two pretty quickly and she's, you know, good with that. But that's just one example. Even in privileged world where we really need the full range of methods. Now imagine working a shift job where again, you don't know if it's day or night when you're leaving or you work odd hours or imagine that you struggle to remember to take a pill every day. But an IUD is an easy way to not have to think about it. Imagine that you need a non-hormonal method because your body has adverse reactions to hormones. Well then there's non-hormonal barrier methods and there's also non hormonal IUD. So you know, everybody is different and every woman, every person deserves to go to a clinic and have the full range of options available to them. In our research, the way we defined the full range of options was clinics that offered onsite access to [inaudible] and the implant. Those are typically the hardest methods to stock on site. So if they were able to offer those onsite, we would use that as a proxy for their ability to offer the full range of methods. I was just thinking that, so people often are just like, what? It's like, you know, $2 to go get a condom or whatever. Right? Like why do we have to pay for your method? But I think what people don't realize when we're talking about a full range of methods, we're talking about a huge range in cost.

Jennie: Oh my God, yes.

Rachel: And one thing I always like to point out to people is condoms are not actually cheap when you think about it because you need one condom per sexual act. And so that can really add up. And PS there might be reproductive health providers or like don't say sexual act. There must be a better word. I am not a reproductive health provider, but I think everybody knows what I mean. One condom each time you're having sex, right? So you know, given that fact, you know, yeah it might only be a couple of dollars for a pack of condoms, but if you're going through a month with you know, a regular partner or you like to have a lot of sex or you know, God bless you, but whatever, that can add up to more than some pills costs even out of pocket. So I think people don't really think about this. You know, I applaud any store that's offering some generic pills at $4 but again, that's not going to be right for everyone. I happen to know cause I was curious what pills were offered at Walmart for $4 and none of them are the one that I need just as an example. So I think it's really critical that everybody have those kinds of choices because when people have those choices, they can stick with a method because it's actually working for them. And sticking with a method is the key to helping people achieve their own reproductive health goals, their own family size goals, et cetera. So that's really critical. The only other thing I would say is that right now on our Bedsider website, and if folks don't know bedsider.org I invite you to go there and learn everything you want to ever learn about any method of birth control that's on the market right now. We've got videos of people talking about the method, why they like that method, you know the pros and cons of it. You can look up where the nearest clinic is that offers that method on site. You can also find where you can find an abortion provider. We're here for sort of all of your needs and to help you get smart on whatever it is you need to get smart on before you walk through the doors of a clinic. And one of the things Bedsider now is offering is something called BC benefits. BC benefits is basically a birth control support fund. So right now if you make less than 250% of the federal poverty level, we will get you a coupon code for a delivered to your door service that's operating in your state and you can have birth control pills delivered to your door. In the future. We will also have reimbursements for things like the cost of gas to get to and from the clinic or ride share services, things like that. That'll be rolling out as well as for the cost of other methods that you receive at a clinic. Right now we're just doing delivered to your door as we roll this out, but we invite anybody who is struggling right now with the cost of their birth control to at least explore if that can help them. And for those of you for whom cost is not an issue, we would really love it if you consider making a donation to BC benefits and helping other women get the access they need to the birth control they want.

Jennie: Yeah. And we'll make sure to include all of that information in the show notes that people have easy access to.

Rachel: Awesome. It's one of those things we shouldn't have to build, but we do. Yeah. So, well I think BC benefits sounds amazing, but also amazing is the information on the Bedsider or talking about what the different forms of birth control are and what they mean. Because I mean, I know sex ed around the country is not always the best obviously and very localized. I mean, I've met people, I grew up in New York city and I had what people would call comprehensive sex ed, but it certainly wasn't good sex ed. It was a lot of here's a picture of an STI and I don't have sex. And if you do, here's how to put a condom on a banana. You know, it was, I guess it was sex positive, but I don't think that it made much of a difference. And I think no matter what kind of sex ed you get, we can all be lifelong learners so to speak. And sometimes the things that you learn in high school are not the things you're thinking about or need to know about later on when a particular issue presents itself and Bedsider is sort of here to be that, that place where you can go with for reliable, safe and accurate information and new methods come out. They do. We constantly get outreach from pharmaceutical companies and others that have methods and development to give us a heads up when they're near the end of the process. I don't want to tease too much, but I think you know, in the future you may see another patch on the market. I hear rumors about another ring. Yes. I'm so not up on all this, but Bedsider is so you don't have to worry about that. And if you look back…

Jennie: Oh, we had an episode the summer where I talked to Julia Bunting at Population Council and she talked about some of the new methods that they are developing, including some multipurpose prevention technologies.

Rachel: That's so cool they are not just pregnancy prevention but STI and HIV.

Jennie: I love that.

Rachel: So yeah, so all of that information is on Bedsider and a whole heck of a lot more. For example, as we enter open enrollment for ACA marketplace plans, you can learn about what the deadline is in your state, things to be aware of to make sure you're not just buying a junk plan, but a real plan that's going to get you good coverage, including no copay coverage of birth control. Which by the way is still the law of the land though. For all of you out there with employer health plans or plans you bought on the marketplace. You know, if you're having any trouble getting birth control coverage tactic Bedsider or you know, talk to our colleagues at the law center who have covered her hotline. Yeah, I'm going to plug my friends over there, but yeah. Yes, you should know that that's still out there. And we provide a lot of information like that to help you not just learn about birth control but get the birth control you need, which is so important because you know, the desert is not just not being able to get it. Like there's different things that are impacted. Your ability to access birth compactly are deserts, which by the way is an interactive map. So I'm going to make sure that you have this Jennie for the show notes, but you can literally hover over your county and pull up information about how many low income women there are, who need reproductive healthcare, how many are living in deserts, um, sort of where your county is on the spectrum of good or bad in terms of access. You can also look at statewide data. So it's, it's really cool. I'm a nerd and I love a good heat map. I mean, data visualization is so sexy. How sexy is data visualization? So I really, I really encourage you to check it out. Our maps are only showing the access problem so they don't even cover the coverage problem. Right? So it's all well and good if you have great access, but if you can't afford it, then it's like having your face pressed up against the glass at the store. That must be nice, but I can't get it. So these are parallel problems and ensuring that everyone really has the power to decide if when and under what circumstances they get pregnant and have a child.

Jennie: You need to solve both problems.

Rachel: Absolutely. The deserts are a way of visualizing what kinds of barriers above and beyond coverage people face when they're trying to get their care. But there's a lot of other things that they face. For example, if you're parenting and you need to arrange childcare just to get to your visit, well that's a cost. If you need to take time off from an hourly job, that doesn't pay you for your time off, that's a cost. If you barely can fit enough gas in your tank to get to and from work and now you've got a deviate, you know, several miles because there isn't anything in your county that offers the method you need, that's a cost. So I think sometimes we forget that it's not just, oh, do have health insurance and does the health insurance cover the method. But all those other things that go into getting care that really pile up as barriers, particularly on people who are struggling to make ends meet.

Jennie: And you know also we talked about like a county where it's a problem, but it's not just your county. It could be the one next to you and the one next to that.

Rachel: Absolutely. In fact, I'm just staring at the map right now and looking at counties in Montana and you know, my geography isn't perfect having grown up in Manhattan. But I can tell you that I'm pretty sure that Montana is huge. And so these counties are very large. But if you live in, let's hover over this for a sec. Bear with me. I'm going to click on the state of Montana. So if you live in Phillips County, Montana, which borders Canada, then you live in a contraceptive desert. There are no clinics in your county and over 4,000 women who need access. That county is going to be from a mileage standpoint, large right next door, there's a county with one clinic but there's over 6,400 women who need services in that clinic. Plus probably a lot of the women in the neighboring counties, everything to the East of Blaine County, Montana that has good access has next to no access. So again, if you look at states and you see, you know on our map, you know super dark purple is as good as it gets and bright red is like the absolute worst, but there's a lot in between where it's still not reasonable access and that's why we get that number of 19.5 million, which seems like how is that possible? Well it's possible because a lot of people might be relying on that one clinic, which kind of leads me to my next point. We've seen a lot of attacks on the birth control safety net. And when I say the safety net, I mean a network of clinics that take public insurance like Medicaid that receive federal and state funds to help provide low income people with birth control access, but not just low income people. I can tell you as a college student, I went to a clinic that received a lot of these funds that was part of that safety net. Millions of women rely on this safety net every year and I don't know how familiar your listeners are, so I'll do sort of a quick overview, but it's helpful. There's this thing called the domestic gag rule. It sounds really bad or maybe like a really kinky sex act, but it's not just introducing some reproductive health humor here. The domestic gag rule has a long history, but this is actually the first time it's been put into place and what the Trump administration has done is say to any provider that's getting federal family planning funding through a program called Title X, that they cannot refer their patients for abortion. They cannot provide abortions even with other funds at the same site. That they're providing family planning services and that they cannot even be required to counsel women who present as pregnant about the full range of their options, which we call non-directive counseling. I'm sorry, but if 16 year old me got pregnant, showed up at a clinic, I want someone to tell me all my options, not just the one that that person thought was right for me. So the gag rule has sort of forced safety net family planning providers into an impossible choice. And I just want to say whichever way they go on this, we understand. And just be, and those that decide to take the money does not mean they agree with it. Jennie: No, that is one misconception that I think sometimes you hear, but it's like Rachel said, it's an impossible choice. It's an impossible choice.

Rachel: I mean, I just think of a lot of states where there are a lot of fake clinics out there and I think we know that if the current Title X grantee who provides great birth control coverage, decided not to take the Title X money, then it's just going to go to a fake clinic. And how are women any better off that way so they're making these horrible impossible choices between trying to find a way to sort of maintain services in a way that they feel is ethical when you've got this really medically unethical rule in place. When I say medically unethical, the American Medical Association, which in political terms is not an organization that weighs in on reproductive health or rights much at all, they oppose this, they've signed on to court priests about this because in their mind it should not be the government telling providers what they do and do not tell their patients. That's a violation of medical ethics to withhold information from a patient. This whole regulation is awful and it's currently being challenged in court and I continue to pray to the legal gods that there is a legal resolution of this, but in the meantime it is in effect and the impact of that began rolling out in late August and to date we've seen basically nearly 900 clinics and that's just the ones we can track. My guess is it's probably more than 900 clinics, but nearly 900 clinics that are no longer able to use Title X funding. So what does that mean? Well, if you're a clinic that's serving people who are low income, you rely on Title X funding to help you purchase contraceptive methods at below market value so that you can then provide them inexpensively to your patients. You rely on Title X funding to do simple things like pay the rent or keep the doors open. So it's not just the women who get, or people who get Title X services from these clinics, it's also the Medicaid patient who has coverage but needs a place to go with that Medicaid card. So the impact is really great that nearly 900 clinics as spread over an additional 390 counties that were not complete contraceptive deserts before that, but are now, there are 8.7 million women living in those counties. So that's 8.7 million low income women, some of whom have covered, some of whom don't, but all of whom rely on the doors to that clinic staying open that are impacted. Now it's important to know that right now we are not aware of, I think maybe only two out of those 900 clinics that have actually closed their doors as a result of this. But some clinics are able to maintain the same low costs for their patients for the short term, but don't know how they're going to make it in the longterm. Some clinics are already reducing hours or the number of providers that they have at their clinic. Other clinics are charging larger copays or just aren't able to stock certain methods that they were able to stock before. So the effect is real and it's happening right now. So I want to be clear, I don't want women to feel like they can't go to these clinics to get their care. They can and those doors are open, but the whole safety net is struggling and they're struggling because they've been forced with this impossible choice. So one thing that I think is really important for your listeners to know is that the gag rule has widespread impacts on anyone who has ever struggled to make ends meet. And I think all of us, even if we're not there right now, have been in that place at some point in our reproductive lives. And it's critical that we not leave people up a creek at that time. That is, that is how people lose their reproductive autonomy.

Jennie: So there's a couple of things you can do cause there's always things you can do, right?

Rachel: I love having things people can do. So the first one, and probably not the first guest on your podcast to say this, but contact your members of Congress. It turns out they've got some power here. So if you go to Power to Decide and at the top, click on the tab, get involved, it'll route you to our action center where you can contact your members directly about Title X we make it super easy for you to do it. I, I would be shocked if it takes you more than two minutes. So definitely include that.

Jennie: We'll make sure you got our direct link right to that.

Rachel: So that is a simple, easy thing you can do. It'll go to your Congressman and to your two senators. And then secondarily we would encourage you to share it with your friends and family, post it on social, get people contacting their members. The other thing you can do is give to BC benefits. It's really important as we go into this new world, even if the courts resolve this, there's some damage that's been done to this network and we don't know exactly when it's going to get resolved. And in the meantime there's people out there who need birth control right now and don't have the means to afford it. So BC benefits is how we are providing that service right now and trying to fill some of the gaps. So you know, we hit a limit every month with BC benefits. If we don't have enough money in the pot, we have to tell people, we'll email you as soon as money becomes available the following month. So the more that we get to BC benefits, the less we have to do that. So we really encourage people to donate. And then also if you know someone who's struggling to get birth control to see if BC benefits might help them. So that's what you can do to help.

Jennie: I also think, don't you have something fun coming up that people can take part in?

Rachel: I do. So on November 13th it is Thx Birth Control day. This is an annual day where we get to shout out everything that's awesome about birth control. And I mean everything. People talk about how much they love their method to what birth control has made possible for them. You know, policy makers tend to be policy-ish about their tweets, but I've seen some awesome influencers talk about you guys. You don't even know how much I love my IUD. I love my IUD more than you know, almost anything else in my life. So you know, it's your chance to help us make the point loudly and in a concentrated way that birth control is beloved, that almost all women in America have used it at some point in their lives. We all love it. We all need it. We love what it makes possible for us and our families. And so if you go to powertodecide.org, you will find a whole digital toolkit for ways you can participate in Thx Birth Control day. You can get Thx Birth Control day T shirts which are very fun. They're all super fun. Um, I think my favorite was when my friend was eight months pregnant wearing a tee shirt that said in nine months, the only thing I'm going to be is more awesome.

Jennie: I do love that one. I also love, let's not make a baby. That one's awesome.

Rachel: Um, Oh God, there's a few. There's, there's one that's uh, like a Ron Burgundy from Anchorman and I can't remember exactly what it says, but it's something like, you know, it's kind of a big deal. Like there's so many good ones. We have digital postcards you can post and share. I think one year we even had a birth control, like animated song. Anyway, check it all out…there’s dog shirts. Actually our CEO has a dog who's adorable and the first year that she was our CEO, she's been here a while now, so we can't call her new, but at the time she was new, which is like, well, do we have any dog shirts? And our digital team was like, no we don't, but we can make that happen. And then everybody loved the picture. She posted so much, we started stocking them in the store. So now you can get dog shirts and lots of fun stuff and buttons. They have different methods of birth control on them. I'm not kidding. It's all kinds of fun swag. But the ideas are really serious one, which is to shout out birth control because this just shouldn't be controversial. The fact that it is is just, pardon me, but BS. So there's my pitch. November 13th, Thx Birth Control day. Go to powertodecide.org to get involved.

Jennie: Well that feels like the perfect place to stop.

Rachel: I guess so. I hope I wasn't too quick for your podcast but you know I can, I can wax on about birth control access for as long as the day is. But I think you guys know the important things. So to review contraceptive deserts— bad that there are so many women in them. Gag rule, super bad cause it makes it even worse. So contact your members of Congress and give to BC benefits and then shout out birth control on Thx Birth Control day which is November 13. Mark your calendars. Do people mark calendars anymore?

Jennie: I don't know, I do. I’m old fashioned and I really, I use paper.

Rachel: Me too. Don't you get just a sense of satisfaction when you physically check something off in a to do list and I just, it helps me remember it like if I write it versus type it, I don't know. Like you can write, remember to call your member of Congress or remember to email your member of Congress cause Power to Decide has made it super easy to do, and tell them how much the gag rule sucks. But try not to use foul language when you do that. Guys, like seriously, we've had a few where we're like, guys, you can't write that. They're not going to read it. Yeah, so you know, avoid the death threats and foul language. Just be passionate. Exactly. Thank you so much for having me on.

Jennie: Thanks Rachel.

Rachel: Thanks. Bye.

Jennie: Thanks for listening everybody to get the links that Rachel mentioned, including all the information for Thx Birth Control day, make sure to check out our show notes, which have not only the new transcripts, but we'll have all the links we talked about. Thanks for listening and we'll see you next episode. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROs Fight Back . If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

take action