Contraceptive Equity

What is Contraceptive Equity?

Contraceptive equity means that every person can make their own decisions about pregnancy prevention, and contraceptive care is easily accessible and covered at minimal costs in all health programs.¹ It requires acknowledging the critical role that family planning plays in improving health outcomes and economic security for people of reproductive age and their families, while simultaneously addressing this country’s history of reproductive coercion.

Historical Context of Reproductive Oppression

Family planning services are deeply connected to the long history of reproductive oppression in the United States. From slavery, where Black women’s bodies were exploited through forced childbearing and rape, to the eugenics movement that aimed to control marginalized populations, the legacy of reproductive control is rooted in systemic inequity.² This continued through harmful practices like forced sterilizations, which disproportionately targeted women of color, low-income women, immigrant women, women with disabilities, and incarcerated women.

For decades, Black women have faced coercive contraceptive practices and policies, misinformation about contraceptive side effects, and unethical testing of new contraceptive methods (e.g., the Pill, Norplant, Depo-Provera). Family planning decisions were often made for Black women, not by Black women, with the goal of either controlling Black women’s reproduction or advancing contraceptive research at Black women’s expense.
These practices are not just part of our distant past. Recent examples include:

• In the 1990s, coercive state policies attempted to force women with low incomes to accept sterilization or the Norplant implant to receive public benefits or avoid incarceration
• Between 2006 and 2010, the California Department of Corrections and Rehabilitation sterilized nearly 150 female inmates without proper approval
• As recently as 2017, a Tennessee judge was reprimanded for offering to reduce convicted women’s jail sentences if they got sterilized

Contraceptive Access: Benefits and Current Challenges

Achieving true reproductive justice means confronting these historical inequities through an intersectional lens that addresses systemic barriers to reproductive health services and the right to bodily autonomy. Access to contraception has brought significant benefits to women’s health worldwide, reducing unintended pregnancies, high-risk pregnancies, and maternal and infant deaths. For Black women, girls, and gender-expansive individuals, contraception plays a vital role in enhancing personal health, economic stability, and educational outcomes.

Family planning is associated with improved social and economic outcomes including educational attainment, workforce participation, income, and family stability.³ These benefits extend beyond individuals to strengthen communities and reduce health disparities.

Ongoing Challenges to Contraceptive Equity

However, reproductive oppression persists, particularly for Black women, girls, and gender-expansive individuals, who continue to face provider bias, coercion in contraceptive choices, and limited access to a full range of contraceptive options. Bias, stigma, and discrimination still impact those seeking family planning services.

These barriers are manifestations of systemic racism that influence whether Black women have health insurance, what types of contraception are covered by their insurance, and how accessible contraception—and health care itself—are in their communities.⁴ Statistics indicate that Black women use contraception at different rates than women of other racial/ethnic backgrounds, due in part to these structural barriers.
Public opinion research shows that an overwhelming majority of Black people (92%) agree that contraception is part of women’s basic health care, and the same percentage agree that a woman should be able to get birth control through her health insurance, regardless of her employer’s views. Almost two-thirds of respondents (61%) believe that racism affects the Black community’s ability to access affordable contraception.

Reproductive Justice Framework for Contraceptive Equity

To advance contraceptive equity, policies must be intersectional, addressing both access barriers and the coercion experienced by marginalized groups. Reproductive justice can only be achieved through an overhaul of policies that center the needs of women, girls, and gender-expansive individuals, ensuring that comprehensive, quality healthcare is a fundamental right for all.

Reproductive Justice is the human right to control one’s body, sexuality, gender, and reproductive choices.⁵ That right can only be achieved when all women and girls have the complete economic, social, and political power and resources to make healthy decisions about their bodies, families, and communities.

True contraceptive equity requires acknowledging the critical role that family planning plays in improving health outcomes and economic security for people of reproductive age and their families, while simultaneously addressing this country’s history of reproductive coercion. It means ensuring that every person can make their own decisions about pregnancy prevention, with contraceptive care that is easily accessible and covered at no cost in all health programs.

Key Policy Recommendations to Increase Equity in Contraception Access

Comprehensive policy reform is needed to achieve true contraceptive equity. Key recommendations include:

Federal Policy Recommendations

• Increase federal funding for the Title X program to expand access to pregnancy, STI, and HIV testing and other sexual and reproductive health services⁶
• Fund programs that combat anti-Black racism and expand diversity and cultural competency training for health care professionals
• Provide prescription contraceptives at no cost and reimburse for contraceptive counseling
• Support legislation like the Affordability is Access Act, which would require health insurance plans to cover FDA-approved over-the-counter oral contraceptives without cost-sharing
• Support the Access to Birth Control Act, which would ensure that people can access contraception in a timely manner by prohibiting pharmacies from refusing to fill valid prescriptions

State Policy Recommendations

States can follow the model of comprehensive contraceptive equity laws like the state of Maryland’s, which:

• Eliminates most co-payments for birth control
• Lifts pre-authorization requirements for IUDs and implants
• Provides equity in contraception access for men by broadening coverage of vasectomies without co-payments
• Ensures insurance coverage for over-the-counter contraceptive medications, including emergency contraception
• Allows individuals to receive six months of birth control at one time

Healthcare System Recommendations

• Prevent insurers from erecting service barriers via medical management techniques
• Ensure that all contraceptive methods are covered without excessive cost-sharing like deductibles and co-pays
• Provide patient-centered, culturally competent care that respects individual autonomy in contraceptive decision-making
• Address provider bias through comprehensive training and accountability measures

The Path Forward

Access to contraceptive information and services is essential, but not enough to ensure Reproductive Justice. Many challenges facing Black women—and other communities most impacted by racism, economic injustice, and gender discrimination—stem not from unintended pregnancy, but rather from social and economic disparities.⁷

People must have accurate information, access, and provider trust in order to make their own best decisions about their bodies and lives. To accomplish this goal, it is essential that women have affordable health insurance coverage of all contraceptive options, as well as comprehensive, accurate, and culturally competent information and delivery of services.

It is critical that advances in contraception not repeat practices that risk coercing or pressuring women into accepting or rejecting any specific contraceptive method. True contraceptive equity can only be achieved when every person has the freedom, resources, and support to make their own reproductive health decisions without interference or barriers.

Join us in the fight for contraceptive equity and reproductive justice. Your donation today helps us advocate for policy change, educate communities, and ensure that all people, especially Black women, girls, and gender-expansive individuals, can access the contraceptive care they need without barriers or discrimination. Together, we can build a future where reproductive autonomy is a reality for everyone. Donate now to support this critical work.

---

¹ National Health Law Program: https://healthlaw.org/contraceptive-equity/.

² In Our Own Voice: National Black Women’s Reproductive Justice Agenda: Contraceptive Equity for Black Women: https://blackrj.org/wp-content/uploads/2020/04/6217-IOOV_ContraceptiveEquity.pdf.

³ Planned Parenthood of Maryland: Maryland Contraceptive Equity Act: https://www.plannedparenthood.org/planned-parenthood-maryland/get-involved-locally/action-network/maryland-contraceptive-equity-act.

⁴ In Our Own Voice: National Black Women’s Reproductive Justice Agenda: Contraceptive Equity for Black Women: https://blackrj.org/wp-content/uploads/2020/04/6217-IOOV_ContraceptiveEquity.pdf.

⁵ In Our Own Voice: National Black Women’s Reproductive Justice Agenda: Contraceptive Equity for Black Women: https://blackrj.org/wp-content/uploads/2020/04/6217-IOOV_ContraceptiveEquity.pdf.

⁶ In Our Own Voice: National Black Women’s Reproductive Justice Agenda: Contraceptive Equity for Black Women: https://blackrj.org/wp-content/uploads/2020/04/6217-IOOV_ContraceptiveEquity.pdf.

⁷ Planned Parenthood of Maryland: Maryland Contraceptive Equity Act: https://www.plannedparenthood.org/planned-parenthood-maryland/get-involved-locally/action-network/maryland-contraceptive-equity-act.