Three Ways We Have Expanded Youth Access to Contraception in the United States
By Mandy Ackerman, LMSW, MPH & Jenifer DeAtley, LMSW
It’s important on World Contraception Day to reflect on concrete ways in which we’ve expanded access to contraceptives for young people. Access to contraception is vital for ensuring health and for breaking cycles of poverty. In fact, access to a full range of contraceptive methods and education is critical to the well-being of youth and their communities in preventing sexually transmitted infections (STIs) and unplanned pregnancy. In some communities, contraceptive access for youth is also a means of survival, with pregnancy resulting in more deaths of adolescent females aged 15–19 than any other cause (Save the Children Fund, 2012).
Young people often have limited sources of independent income and grapple with high levels of shame in seeking services, so they need supportive policies, direct access to care, and comprehensive education and skill-building opportunities. Therefore, expanding contraceptive access for youth in a meaningful way requires a holistic approach that considers the needs and wants of young people and that focuses on removing longstanding barriers. By listening to youth’s needs, providing education, and increasing access, we help youth become empowered to make informed decisions about how they can protect themselves in a way that is consistent with their own values and in accordance to their future life plans.
Despite having one of the developed world’s highest rates of teen pregnancy, some exciting progress in the United States is worth noting (Sedgh et al., 2015). As a nation, we are beginning to recognize the importance of providing young people with options and information to properly plan out their lives, including one of the most significant decisions—whether and when to become a parent.
Colorado—Eliminating the Cost Barrier
Since 2008, Colorado has successfully increased youth access to family planning services throughout the state by providing low- or no-cost contraceptive methods, particularly the most effective methods, such as intrauterine devices (IUDs) and implants. IUDs and implants can require multiple doctor visits and have up-front costs as high as hundreds of dollars apiece. By providing these methods and others at an affordable cost and with limited doctor visits needed, young people can more easily access contraception.
In 2014, researchers reported significant drops in the birthrate among teens participants. Additionally, the abortion rate among 15–19-year-olds dropped by more than a third, and the rate of high-risk pregnancies decreased by a fourth (Ricketts, Klingler, & Schwalberg, 2014).
California—Removing the Need for Prescriptions
California recently passed legislation eliminating the need to obtain a prescription to purchase birth control. The new law allows youth and adults to access certain methods directly from a pharmacist without having to see a doctor. As a result of this law, youth no longer need to find transportation and spend money to visit a doctor during often inconvenient hours of operation to access contraception.
Other states, such as Oregon and Washington, have already implemented similar legislation, and several additional states, such as Hawaii and Tennessee, are proposing comparable bills.
Texas—Increasing Knowledge, Awareness, and Skills
Based in Texas, EngenderHealth’s U.S. Program implements comprehensive and inclusive sexual health education with middle and high school–aged youth, both in and out of school. Evaluations of comprehensive sexual health education programs show that these programs not only help youth delay onset of sexual activity, reduce the frequency of sexual activity, and reduce the number of sexual partners, but they also increase condom and other contraceptive use, a key to delaying pregnancy (Kohler, Manhart, & Lafferty, 2008; Lindberg, Santelli, & Desai, 2016).
Gender Matters (referred to as Gen.M by the youth) and RE:MIX, two comprehensive sexual health programs developed and evaluated by EngenderHealth, support healthy decision making by providing holistic information on pregnancy and contraception, in addition to building skills, such as how to negotiate and communicate contraceptive use with a partner and respect your own and others’ sexual limits. The programs also frame contraception in the broader context of sexuality, gender, and relationships and ask young people to consider their future goals and how the decision to become a parent aligns with those aspirations.
World Contraception Day is a global event where lessons learned and best practices in contraceptive access are shared internationally. Beyond this day, it is important to continuously engage in this process and apply successes from countries to inform similar efforts in others. Ultimately, our collective knowledge is essential in increasing access and breaking down the barriers necessary for youth and communities worldwide to live happier, healthier, and more prosperously.
Kohler, P. K., Manhart, L. E., and Lafferty, W. E. 2008. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health 42(4):344–351. doi: 10.1016/j.jadohealth.2007.08.026.
Lindberg, L., Santelli, J., and Desai, S. 2016. Understanding the decline in adolescent fertility in the United States, 2007–2012. Journal of Adolescent Health in press. doi: 10.1016/j.jadohealth.2016.06.024. Accessed at: http://www.jahonline.org/article/S1054-139X(16)30172-0/pdf.
Ricketts, S., Klingler, G., and Schwalberg, R. 2014. Game change in Colorado: Widespread use of long-acting reversible contraceptives and rapid decline in births among young, low-income women. Perspectives on Sexual and Reproductive Health 46(3):125–132. doi: 10.1363/46e1714. Accessed at: http://obgyn.wisc.edu/documents/Game_Change_in_Colorado_Rickets.pdf.
Save the Children Fund. 2012. Every woman’s right: How family planning saves women’s lives. London. Accessed at: http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/EVERY_WOMANS_RIGHT_REPORT_JUNE_2012.PDF.
Sedgh, G., Finer, L. B., Bankole, A., et al. 2015. Adolescent pregnancy, birth, and abortion rates across countries: Levels and recent trends. Journal of Adolescent Health 56(2):223–230. doi: 10.1016/j.jadohealth.2014.09.007. Accessed at: http://www.jahonline.org/article/S1054-139X(14)00387-5/pdf.