Black women are underserved when it comes to access to birth control. The Roe decision could make the situation worse.

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The Supreme Court’s decision to strike down abortion rights nationwide last week underscored the importance of access to birth control, which is already proving difficult for many women of color due to discrimination, stigma and systemic barriers in the health system.

While the ruling doesn’t directly affect access to birth control, legal experts say states and municipalities that seek to ban abortion at the time of conception can also challenge contraceptives like Plan B and devices. intrauterine. Some state lawmakers have already taken steps to try to restrict birth control. In Tennessee, U.S. Senator Marsha Blackburn, a Republican, earlier this year called Griswold v. Connecticut, the 1965 case that guaranteed access to birth control for married people, “constitutionally unstable.” (A spokeswoman for Blackburn told the Washington Post in June that she “does not support banning birth control, nor has she called for a ban.”)

“The hardest burden is going to fall largely on black women who already have insurmountable challenges just getting health care in this country,” said Jennifer Driver, senior director of reproductive rights for the State Innovation Exchange, a center national resources and strategy. impact of the decision. “And now it’s going to be even more difficult.”

Black women disproportionately face a number of reproductive health issues, such as fibroids and polycystic ovary syndrome, where contraception or reproductive surgery is needed, said Dr. Brandi Shah, a practicing family physician at Birmingham, Alabama.

Following Friday’s decision, Shah said health care providers need to prepare for the potentially increased demand for birth control. Getting more trained providers — especially those who understand the historical traumas experienced by people of color, which can influence their contraceptive choices — dispelling myths and misperceptions, as well as providing contraceptive support and counseling are also crucial, she added.

“I think it’s naïve of us to believe it’s going to end there,” Krystal Redman, executive director of Spark Reproductive Justice Now in Atlanta, said of the decision. In addition to triggering laws that will ban abortion outright in some states, the move will prompt state legislatures “to begin rolling out policies that may restrict access to other forms of contraception.”

A one-month dose of hormonal birth control pills
A one-month dose of hormonal birth control pills.Rich Pedroncelli/AP

Why contraceptive gaps exist

Driver, an Alabama native, recounted the challenges of getting reproductive health care when she was a sophomore at Stillman College in Tuscaloosa. She said she had to drive two hours to a clinic to get an intrauterine device because her university’s health center did not provide contraception at the time – and the only clinic in the neighborhood had been closed. During this period in 2005, “they were closing clinics in predominantly black areas in the heart of Alabama,” Driver said.

“It’s not just that they closed the clinic, but they didn’t tell us where we could go,” she said. “If we had known, we could have just walked over the bridge or much closer – but that was intentional,” she said, to promote abstinence, which created barriers to access to health care.

There are many reasons why black women are particularly underserved when it comes to accessing birth control, especially in rural areas or healthcare deserts, where transportation to distant providers is difficult to manage, noted Redman. She added that many black women say they are not heard by their providers when standing up for their own bodies.

According to an April report from the Pew Research Center, black women between the ages of 18 and 49 were more likely to have had multiple negative experiences when seeking health care. These experiences ranged from being rushed by a healthcare provider to not being taken seriously about their pain, among other issues.

Some additional factors preventing individuals from accessing birth control, Power to Decide CEO Raegan McDonald-Mosley said, include dwindling funding for the Title X program, which many family planning programs and centers rely on. health. The result is the closure of centers or limited access to low-cost services, which can disproportionately impact people of color, she added. Additionally, there is an increased reliance on telehealth services, which have many benefits but require people to have access to the internet or a smartphone.

While policies like the Affordable Care Act help many people access birth control for free, there are huge barriers to contraceptive access for those without health insurance, said McDonald Mosley. For example, birth control methods such as intrauterine devices or contraceptive implants can cost uninsured people thousands of dollars.

As organizations continue their efforts to provide resources to women of color, others, like public health educator Wendasha Jenkins Hall, are taking this opportunity to continue educating black women about their reproductive and sexual health through the through social media and his podcast.

Following the leak of the ruling in May, Hall said she received few questions about abortion, but more questions related to reproductive health and how the body works. Many black women and women (a term used by Hall to describe those who are capable of childbearing but who may not identify as female) do not receive comprehensive sex education, she added. According to a 2019 report by the Black Girls Equity Alliance, of the 25 states with the largest black populations, only 11 require sex education and only three of those 11 require the information taught to be medically accurate. Hall attributed the lack of sex education, in part, to the way sex and sexuality are talked about in a negative way — especially in the black church, where she grew up.

“So we always talk about disease prevention. We always talk about preventing unwanted pregnancies,” she said. “We don’t talk about sexuality because it’s something that can be healthy, something that you can enjoy. It is something that can be done safely.

Hall said the court ruling will likely continue to promote abstinence-only education and push the narrative of how “getting pregnant and having a baby is going to ruin your life,” she said. Hall, who has a daughter and a son, said she was concerned about the effects of the ruling and its impact on her own daughter’s reproductive rights.

“We have to save ourselves a lot of times in these situations,” Hall said. “No one is coming to save us. They clearly don’t care about us. It is therefore a real awareness. Really let black women and other people know what reproductive justice really is.

What actions are taken

Many organizations are also working to advocate for legislation that would address barriers in the reproductive landscape for black women. Each year, Power to Decide runs a social media campaign called “#ThxBirthControl” to normalize discussions around contraceptives, McDonald-Mosley said. Data from an opinion poll conducted by the organization in 2021, among 1,000 adults aged 18 to 45, showed that about 7 in 10 people were concerned about access to contraception.

“The reality is that more than 90% of people who are able to procreate at some point in their lives will use birth control,” McDonald-Mosley said, citing numbers that match data from a 2013 report from the Centers for Disease Control and Prevention. “We should be able to talk about it without stigma and the more people talk about it, the more people can get information about the good things about birth control, as well as the risks, as well as the challenges of getting it. . that we can better overcome these challenges.

An examination room at the Jackson Women's Health Organization
An exam room at the Jackson Women’s Health Organization in Jackson, Mississippi, on June 21.Rogelio V. Solis/AP

The organization ensures that individuals can access resources such as Bedsider, which lists available family planning clinics and centers nationwide. Power to Decide also connects individuals to contraceptive telehealth services where they can get a year’s supply of birth control pills, while helping individuals cover birth control costs through its BCBenefits fund.

To counter looming restrictions on abortion and, potentially, birth control, the State Innovation Exchange is working with state lawmakers to expand legislation on contraception, abortion and telehealth. Driver said one of the bills recently passed in his state of South Carolina, called the Pharmacy Access Act, grants pharmacies the ability to dispense contraceptives without a prescription. Other bills supported by the organization include SB413 in New Jersey, which requires Medicare to cover contraceptive prescriptions for 12 months.

At the federal level, last year the United States House of Representatives introduced the Birth Control Access Act, a bill that requires pharmacies to comply with rules guaranteeing women access to FDA-approved contraceptives, such as Plan B. The bill, sponsored by Sen. Cory Booker, a Democrat, has been referred to the Senate Health, Education, Labor and Pensions Committee and will not has not yet been adopted.

Black women are underrepresented in state legislatures, Driver said, which prevents the creation of policies that reflect the needs of black women, and that’s something her organization is trying to change.

“The complete overturning of Roe v. Wade removes bodily autonomy, and black women understand that,” Driver said. “We understand the role this country has played in damaging our bodies – and we understand that we thrive when we are able to decide how we want to parent, when we want to parent, and the communities and structures that need to be around us, so that we can be parents in complete safety. Our responsibility is really to help legislators understand this point.

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