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Removing Barriers to Contraceptive Access

Systems failures frustrate women who seek access to evidence-based, cost-effective contraceptive care.
While the Affordable Care Act (ACA) was supposed to guarantee access to contraception at no out-of-pocket (OOP) costs, taking care of the first barrier, the reality has not lived up to the letter of the law. The last 2 barriers are also pervasive.
Women's Experiences and Overcoming Barriers

In a follow up to her initial article about IUDs, Kliff shared her own experience and readers’ reports of the challenges they faced in accessing IUDs. These stories reveal the lived realities that contribute to the high rates of unintended pregnancy in the United States, and describe how women’s efforts to access effective contraceptives continue to be undermined by barriers within the healthcare financing and delivery systems, in spite of policies intended to improve contraceptive access.

My own story is similar to Kliff’s and those who wrote to her. When I first sought out an IUD in 2004, I had a difficult time finding a clinician that would provide this method. My primary care provider would not provide an IUD for a woman who was unmarried and had not had children, in spite of evidence indicating that this method was both safe and highly effective for women like me. She referred me to an obstetrician-gynecologist, who also refused to provide this method for the same reasons. As a researcher in this field, armed with peer-reviewed publications and clinical guidelines, I was frustrated that my access was denied by  clinicians whose reticence was based on history and anecdote, rather than best practices.
More recently, in 2015, in the post-ACA era, when contraceptives are ostensibly available without cost sharing, I paid $100 in OOP costs related to the 2 visits required by my clinic (but not based in evidence) for an IUD insertion. Standing at the check-in desk before my appointments, I argued weakly, bringing up the ACA language on my smart phone, but the administrative assistant that was tasked with collecting fees told me that she was not authorized to exempt me from the hefty co-payment.  She suggested I call my health plan. I handed over my credit card and sighed. I did call my health plan, but—more than 6 months later—I have not made any progress toward recouping those costs.
The barriers Kliff and I faced, and those faced by women with more limited resources and knowledge, represent a failure of our healthcare financing and delivery system to provide easy access to evidence-based contraceptive care that is cost effective. Who pays the price for these failures? We all do—most especially the women whose quest for contraception ends in frustration, or worse—in unintended pregnancy.  

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