Innovations in Service Delivery

Thanks to advances in technology and policy, contraceptives are more widely available and easier to use today than ever before. Yet, for too many people, unnecessary barriers to access remain. Logistical hurdles, such as inconvenient hours at health clinics or prescription requirements for safe and easy-to-use methods, are more than just nuisances – for some women, they can add up to prevent them from getting the health care they need. Small but innovative changes to service delivery methods could have a major impact on the lives of everyday women, their families, and their health and well-being.

RHTP works with policymakers, health care providers, pharmacists, and advocates to ensure that obtaining and using contraceptives, as well as accessing other reproductive health care, is as simple as possible.

Contraceptive Counseling and Education

All people should be able to make decisions about the contraceptive method that is best for them free from coercion and discrimination. However, inequality and disparities in power – across age, race, ethnicity, gender, geography, education, income, sexual orientation, and disability (among other identities) – have often resulted in policies and practices that fail to meet the unique needs of individuals or to respect their dignity and autonomy. Indeed, there are numerous examples of programs that have made birth control, sterilization, or abortion available to low-resourced women, while sacrificing the principles of self-determination and informed and voluntary consent in the name of tackling poverty.

Unfortunately, attitudes that prioritize public health outcomes over individual patient needs are not relegated to the past, but continue to influence current patient-provider dynamics. For instance, healthcare providers are often quick to recommend the birth control method that is most effective, without considering other factors influencing a woman’s contraceptive selection criteria such as cost, accessibility, or how discreet the method is. Therefore, a provider’s focus on efficacy can overshadow a patient’s actual needs.

As the SisterSong Collective explains:

The reproductive justice framework – the right to have children, not have children, and to parent the children we have in safe and healthy environments – is based on the human right to make personal decisions about one’s life, and the obligation of government and society to ensure that the conditions are suitable for implementing one’s decisions is important for women of color.

It represents a shift for women advocating for control of their bodies, from a narrower focus on legal access and individual choice (the focus of mainstream organizations) to a broader analysis of racial, economic, cultural, and structural constraints on our power.

Reproductive Justice addresses the social reality of inequality, specifically, the inequality of opportunities that we have to control our reproductive destiny. Our options for making choices have to be safe, affordable and accessible, three minimal cornerstones of government support for all individual life decisions.

As such, the reproductive justice framework can provide a useful lens through which to examine contraceptive counseling practices to ensure they empower each individual to make the best decisions for their unique identities and experiences. RHTP advocates for contraceptive counseling that is informed by reproductive justice principles, knowing that when women are provided meaningful options and complete information, they will choose the method that is best for their circumstances, resulting in optimal outcomes at both the individual and population level.

Oral Contraceptives Over-the-Counter

To access oral contraceptives (OCs or “the pill”) in the US, a person must obtain a prescription from a health care provider to be filled at a pharmacy or may receive the pills directly at a family planning clinic. Though birth control pills can now be purchased online, they still require a prescription from a health care provider. For many people, this system creates unnecessary barriers to OCs.

If OCs were available over-the-counter (OTC), meaning without a prescription, consumers could purchase birth control pills in the same manner they purchase aspirin, vitamins, or allergy medication, to name a few. This would mean that people could visit the store at their leisure and according to their own schedules – rather than having to visit a medical office. It also would mean greater privacy for the consumer, who may feel more comfortable purchasing birth control pills directly rather than involving a provider. OTC birth control pills also would mean being able to get them when and where you need them. For example, if a woman lost her pills or forgot to pack them on a trip, rather than having to track down her health care provider to call in a refill, she could simply buy what she needed at the nearest pharmacy or market.

OCs are already available OTC in many nations throughout the world and research shows that women can self-screen to determine if an OTC pill is a safe choice for them. Leading health organizations such as the American College of Obstetrics and Gynecologists, the American Academy of Family Physicians, and the American Public Health Association, among others, have endorsed the effort to move an OC OTC.

RHTP believes that if and when the US Food and Drug Administration approves a birth control pill for sale OTC, such a pill should be affordable and covered by health insurance. Under the Affordable Care Act and many components of the Medicaid program, prescribed contraceptive methods must be covered without cost-sharing, such as co-pays or deductibles. RHTP is working to ensure that this benefit is not lost once a pill becomes available for purchase without a prescription.

Additionally, young people often face insurmountable barriers to healthcare – privacy concerns, lack of transportation, and the need to miss school to visit a provider, to name a few. Therefore, in order to provide meaningful access for everyone, an OTC pill should be available without an arbitrary and medically-unnecessary age restriction, which would impede access not only for minors but also for adults who might not possess identification (such as immigrants, low-income women, and people with disabilities).

To further the goal of moving a pill OTC, RHTP serves on the Steering Committee of the Oral Contraceptives Over-the-Counter Working Group. The OCs OTC Working Group is a coalition of reproductive health, rights, and justice organizations, nonprofit research and advocacy groups, university-based researchers, and prominent clinicians who share a commitment to providing all women of reproductive age easier access to safe, effective, acceptable, and affordable contraceptives. The working group was established in 2004 to explore the potential of OTC OCs to reduce disparities in reproductive health care and to increase opportunities for women to obtain a safe, effective method of contraception, free of unnecessary barriers, as part of a healthy sexual and reproductive life.

Telemedicine

A newer, alternative method of delivering contraception is through telemedicine. Telemedicine allows women to receive health care such as medication abortion or prescriptions for contraception by means of telecommunication through devices such as computers or mobile phones. The use of telemedicine gives women who live in rural areas or low-income women who cannot afford to travel to clinics the ability to access these services. It can also save women the costs of medically-unnecessary in-clinic visits.

Yet despite its proven safety and efficacy, states have passed laws restricting the use of telemedicine for reproductive healthcare – singling out abortion in particular and targeting it compared to other fields that routinely use telemedicine to expand access to healthcare. RHTP advocates for greater inclusion of telemedicine technology in reproductive healthcare and opposition to state restrictions on the use of telemedicine in the reproductive arena.

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