Birth Control Accessibility: Vital for More Than Just Contraception

The Supreme Court decision in Dobbs v Jackson Women’s Health Organization on June 24, 2022, has thrown those in the reproductive health space into a state of confusion and uncertainty for how to best provide care for their patients.

Although this particular case focused on the right to an abortion, the right to privacy, the basis for the Roe v Wade ruling and court rulings that established the right to contraception, has been a talking point of particular importance when confronting the ramifications of the decision published on June 24. Yet, birth control is not used exclusively for its contraceptive benefits, which could spell dangerous consequences if the right to access birth control is revisited.

Various health experts have expressed concern over the future of contraceptive accessibility, which can pose problems for those who use it daily for various medical ailments. The importance of providing access to contraception methods has never been more vital, not just for the right for a woman to choose when to have a child but for a woman’s right to effective health care.

Contraceptive Care Threatened

The biggest news on June 24 was what it meant for accessibility of abortion care for women. However, a statement made by Justice Clarence Thomas caught the eye of several health experts and journalists.

In his concurring statement,¹ Thomas said that the Supreme Court should “reconsider all of this Court’s substantive due process precedents, including Griswold, Lawrence, and Obergefell,” due to substantive due process decisions being “demonstrably erroneous” in light of this decision. Legal experts² pointed to this concurring statement as laying the groundwork for the future challenging of birth control access, starting with intrauterine devices and Plan B.

Reporters for Today³ highlighted that Roe v Wade was decided based on the right to privacy, which is not explicitly stated in the Constitution but has been the basis of many judicial decisions, stating the due process clauses of the 5th and 14th Amendments. The overturning of Roe v Wade calls into question other judicial decisions made on the same line of thought, including cases that permitted married and unmarried women to access birth control.

The outlawing of abortion in certain states has also had rippling consequences on birth control accessibility, even without laws expressly forbidding it. FiveThirtyEight⁴ found that the closure of multiple Planned Parenthood facilities in states that no longer permit abortion services has left certain areas at a distinct disadvantage in accessing birth control.

Nearly half of Planned Parenthood’s patients were covered by Medicaid in 2019, putting low-income individuals at notable risk of losing a valuable resource in contraceptive care. Planned Parenthood provides⁵ birth control pills to those with a prescription, among other contraceptive care offered at its sites.

Although the consequences of Dobbs v Jackson Women’s Health Organization has primarily focused on the contraceptive aspects of care, the medical aspects of limited access to birth control can be just as dire for women who need to be able to use contraception for more than avoiding pregnancy. Limiting access to birth control had potential to also leave women reeling from lack of care for numerous disorders and diseases.

Contraception: A Needed Medical Treatment

Contraceptive treatments, while mostly known for preventing pregnancy, are used to treat far more than that.

Jasmine Patel, MD, MSc, FACOG, assistant clinical professor at the University of California, Irvine, explained there are numerous health benefits to the birth control pill.

“It helps with patients who have painful or heavy periods. It helps people who have specific medical conditions, such as fibroids or leiomyomas. It helps people with endometriosis or adenmyosis,” she said.

She also emphasized the benefits of birth control in preventing endometrial, ovarian, and colorectal cancers; improving bone density; and preventing periods for any amount of time.

Nisha Verma, MD, MSc, FACOG, the Darney-Landey fellow at the American College of Obstetricians and Gynecologists, said other methods of birth control can also be medically beneficial.

“There are methods, like the Depo shot, for people who have sickle cell disease; it decreases your number of sickle cell crises. And also the [depo provera] shot increases your seizure threshold and makes [patients] less likely to have seizures,” she said. “The list [of medical benefits] really is endless.”

Both doctors said that birth control was effective regardless of age, whether the patients is a teenager or a woman going through menopause.

“For a lot of these kids, these young girls, if they have excessive hair growth or acne, those are things that can be really detrimental and devastating to a lot of teenage girls,” said Verma. “I have teenagers on sports teams; they don’t want to have to miss school or miss practice for a week every month because their periods are so terrible.”

Patel emphasized that the benefits of birth control come from the hormones themselves that are in the pill, with some adverse effects of diseases or disorders being helped through use of the pill.

“Some people have this dysautonomia, where their nerves don’t fire at the right time. So when they stand up from sitting, their blood pressure and pulse don’t increase to adjust to gravity and, therefore, they pass out. This condition especially gets worse with the hormonal cycling around a period,” Patel said. “So I have given several of my patients with this condition birth control, and that’s helped their symptoms with dysautonomia significantly.”

She added that there aren’t any other medications that use hormones to address medical conditions in the same way or the same dosage as birth control. Other medications can provide temporary relief, such as taking aspirin for menstrual migraines, but she emphasized that getting to the root of the problem was better for the patient in the long run.

“If we know that menstrual migraines are caused by hormones, why are we going to give the wrong medication for it? We should be addressing the cause of the problem, rather than just putting a band aid on it… That’s kind of why other medications that could be used for these conditions may not necessarily be the best fit,” she said.

Birth control has proven to be a vital medical treatment for women with various ailments. With a medication that has so many benefits, birth control access is important for women across the country to get proper health care.

Contraception Access Needed in a Post-Roe World

The overturning of Roe v Wade has had numerous experts concerned about future access to contraceptives. Given the numerous stated benefits of birth control on ailments primarily affecting women, keeping nationwide access is a primary concern for gynecologists and women’s health experts.

“I think the consequences of limiting access to birth control in general are disastrous…because physicians routinely use birth control methods to treat gynecologic and even other conditions that don’t have really great alternatives,” said Patel.

As of the writing of this article, there has been no indication of laws written to ban contraception. However, it is important to remain vigilant in watching narratives that politicians or lawmakers push in the future, as these can threaten women’s health care.

“Currently, birth control is still legal. We have seen that some politicians are attempting to come after emergency contraception and really leaning into these myths and false narratives about how emergency contraception is abortion, even though it absolutely isn’t,” said Verma. “But that’s definitely a concern that we’ve had on what the downstream effects are going to be, what politicians are going to come after next.”

References

1. Dobbs, State Health Officer of the Mississippi Department of Health, et al, vs Jackson Women’s Health Organization, et al. 945 F3d 265 (2022).
2. Bendix A. Birth control restrictions could follow abortion bans, experts say. NBC News. June 24, 2022. Accessed September 27, 2022. https://www.nbcnews.com/health/health-news/birth-control-restrictions-may-follow-abortion-bans-roe-rcna35289
3. Jacoby S. Could birth control be banned? how overturning Roe affects birth control. Today. May 3, 2022. Accessed September 27, 2022. https://www.today.com/health/womens-health/overturning-roe-v-wade-threaten-birth-control-access-rcna27092
4. Potts M. How limiting access to abortion limits access to birth control. FiveThirtyEight. July 13, 2022. Accessed September 27, 2022. https://fivethirtyeight.com/features/how-limiting-access-to-abortion-limits-access-to-birth-control/
5. How do I get birth control pills? Planned Parenthood. Accessed September 27, 2022. https://www.plannedparenthood.org/learn/birth-control/birth-control-pill/how-do-i-get-birth-control-pills