One of the most impactful medical interventions for women was the wide dissemination of birth control starting in the 1960’s. The ability to delay and plan pregnancy opened opportunities for countless women and continues to do so today. Women who access contraception before age 21 are significantly more likely to graduate college than those who do not.
In addition, it is responsible for more than 30% of the increase of women in skilled careers from 1970-1990.
It is estimated that 1/3 of wage gains made by women since the 1960s is attributed to access to contraception.
It also leads to better health outcomes for women and children. Children born immediately after family planning methods became widely available were less likely to be born into poverty and more likely to be enrolled in high school at age 16.
Birth control has also been associated with lower teen pregnancy rates as well as lower rates of ovarian and endometrial cancer.
As we think about these immediate threats to women’s health, the undercurrent of biases many thought had dissipated rise to the surface. The recent changes to Title X funding assumes that women cannot make their own decisions about what is right for their bodies and their lives. Policies rooted in these biases have a real and lasting impact on women’s health.
The federal government expanded the availability of family planning and comprehensive health services to low-income families with the passage of Title X in 1970. The program, while prohibiting agencies from using federal funds to pay for abortion services in the vast majority of cases, provided family planning services to over 4 million patients in 2018 through community health centers and state public health departments.
In early 2018, the Trump administration issued a rule, which went into effect this week, that changes the criteria for providers who receive funding through the Title X program. It requires full financial and physical separation from abortion services. In practice, this means clinics are required to separate entrances, billing systems, front desk staff and exam and waiting rooms. This is most often not financially feasible and essentially prohibits any clinic that performs abortions from receiving Title X funding. In addition, providers must either offer primary care or be in close proximity to a primary care provider. This could mean many rural clinics would not be eligible for funding.
The rule further prohibits the providers from making referrals for abortions and eliminates the requirement that providers present patients with a full range of family planning methods. Providers are required to provide information on natural family planning and infertility, but can choose to not inform patients about the most clinically effective birth control methods, such as birth control pills, IUDs and condoms. Several states, including Massachusetts, as well as advocacy groups have filed lawsuits seeking to reverse these rule changes. These cases are currently pending.
The equity issue at play here is not simply about the legality and/or morality of abortion. Rather it is about who is able to access the medical care that will enable them to live their healthiest life. Planned Parenthood, which served over 40% of Title X patients, has announced that it will pull out of the program. In some states, like Massachusetts, the state will increase state funding to keep clinics open. However, even in these states, this is not a feasible long-term solution. If not reversed, it will leave a gap in care for too many low-income women and men.
Reproductive rights are an integral component of equity for women. The Title X restrictions are one example of how quickly gains in access to high quality care and information can be reversed.