The Federal Government Should Ensure Every American Has Access to a Range of Contraceptive Options
Contraception confers the ability to decide when and if to have a child, giving those women the agency to live their lives as they wish. The majority of American women aged 18-49 are using contraception, and 90% use it across their lifetime. However, one in six (17%) women who desire to avoid pregnancy report that they are not using conception. The reasons for this discrepancy include cost and lack of access to providers of contraception. Although access to contraception has significantly improved, not everyone is able to afford the birth control they desire. The Affordable Care Act requires most private insurances to cover contraceptives without cost sharing and Medicaid classifies contraceptive coverage as mandatory for all states, many women still pay some out of pocket cost for contraception and others fall through the coverage gaps. Additionally, more than 19 million women live in “contraception deserts,” which are areas where they may not have access to a provider offering a range of contraceptive methods.
I believe it is the role of the federal government to ensure access to the full range of contraceptive options. Rice (2001) discusses that an argument for government involvement in healthcare is that it increases fairness. He recalls “equalization of capabilities” perspective of Amartya Sen, which is that people should have the “freedom to choose between alternative lives” (Rice 2001). At any point in their reproductive lifetime, women have two basic “alternative lives” they can pursue; they can become pregnant, or they could avoid pregnancy. Without a contraceptive method that works for them, women do not have the luxury of choosing the second path of avoiding pregnancy—they lack the freedom to choose between alternative lives. If the government’s role is to equalize capabilities, then providing access to birth control fits under that responsibility.
Nathan (2005) argues that federalism is the ideal model for building a system of basic healthcare coverage. He suggests that the “state-push factor,” when a policy or program in one state is successful that it will inspire confidence in such a program in other states, is an important advantage of state-led healthcare (Nathan 2005). Additional states will then choose whether they want to pursue a similar program which can be adapted to their specific needs. While there is merit to this argument, I do not think that this model should be considered for expanding birth control coverage. First, like-minded states would adopt a program that provides greater access to contraception, while others will be steadfast in rejecting such a program. Additionally, I do not believe it is necessary that a program expanding access to birth control to require adaptation at the state level; a single nationwide policy would work as there is nothing that would necessitate different contraceptive options for one state over another.
A specific action that the federal government can fill the gaps in contraceptive access would be to expand the Title X Family Planning Program, which funds contraceptive care for low-income women. This expansion would necessitate removing the Trump Administration’s gag rule. This would restore and increase funding to providers, such as Planned Parenthood, and enable them to provide contraception to more people who cannot afford it. The program would earn back its funding through the money it saves by providing contraception; analysis shows that for every dollar invested in Title X, seven dollars are saved (Gold and Hasstedt, 2017).
Do others think that policymakers would approve a potentially costly program on the basis that it has the potential to save seven times the amount it spends?
References
https://www.plannedparenthoodaction.org/issues/health-care-equity/title-x
Gold, R. B., & Hasstedt, K. (2017). Publicly funded family planning under unprecedented attack. American Journal of Public Health, 107(12), 1895–1897. https://doi.org/10.2105/AJPH.2017.304124
Nathan, R. P. (2005). Federalism and health policy. Health Affairs (Project Hope), 24(6), 1458–1466. https://doi.org/10.1377/hlthaff.24.6.1458
Rice, T. (2001). Individual autonomy and state involvement in health care. Journal of Medical Ethics, 27(4), 240–244. https://doi.org/10.1136/jme.27.4.240
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