Author: Morgan Devine, MPH

It’s hard to believe but accessing birth control in the US is not equally fair among women. In
underserved and rural areas, contraception is not just inconvenient; it can be straight-up hard to
get. These women are living in contraceptive deserts, where there are no health centers that
offer a full range of contraceptive options or only one clinic that can be booked out for weeks
and sometimes months in advance. This means women have to fight for their appointments or
travel for hours to get their birth control; and contraception is not the only thing affected. Many
have to miss hours or sometimes days of work and hire expensive babysitters to even make this
happen. Sadly, more than 19 million American women live in contraceptive deserts today. What
this means is that reproductive care has turned into a world of “haves” and “have nots” and
contraception has devolved into a privilege, depending on the zip code, more than a right.

A Day in a Life of a Contraceptive Desert

More often than not, time, stress, planning and compromise are a part of every reproductive
healthcare decision for the insured and uninsured women living in a contraceptive desert. Also,
it’s not just about the distance. One of the biggest challenges women in these areas talk about
is the frequency required for reproductive care visits. Birth control pills mean monthly pick-ups,
shots may have to happen every three months and other forms of contraception call for an in-
person consultation at the very least. For many women, consistent contraceptive coverage
seems out of reach. This assumes the centers or clinics these women are able to find have a
full range of birth controls. Unfortunately, many of these women learn that this is not always the
case and that choosing their contraceptive is more about being a fit for where they live than a fit
for what they need.

Why Long-Acting Contraception Makes Sense

Enough about “what’s hard to do” with birth control in a contraceptive desert and let’s talk more
about “what may help”. Long-acting reversible contraception (LARCs) such as implants and
intrauterine devices (IUDs) can blunt birth control access challenges. These types of
contraception offer women a lower maintenance “set-and-forget” alternative, which makes
sense for those who can’t frequent centers or clinics. If the IUD is an option, once it is placed in
a woman by a provider, most don’t need to come back for check-ins, for years. As research
shows, IUDs are highly effective and low maintenance. It also means women don’t have to run
to the pharmacy for pill pick-ups, arrange multiple clinic visits or deal with uber-long wait times
once they arrive at a clinic. It’s also much more than convenience or continuity of care; it is
about reproductive autonomy for women living in contraceptive deserts.

A Practical Fix for a Societal Problem

Making long-acting contraception the center of contraceptive desert conversations may be a
practical solution for what’s long been considered a societal issue. When as many as 19 million
women lack convenient access to contraceptives, expecting them to rely on regular in person
appointments isn’t realistic. Women’s health experts and leaders need to help women living in
contraceptives overcome the reproductive care roadblocks. Point in fact: women who find a
contraceptive that works for their bodies and their lifestyles, they experience greater satisfaction
and improved healthcare outcomes.

Why Title X Still Matters

Title X is a federal program intended to make reproductive healthcare, including contraception,
more affordable and accessible to people with low incomes. Over the years, it has come to
mean subsidized clinics that offer a wide range of birth control options from pills to long-acting
reversible methods such as implants and IUDs. In underserved communities where women
can’t rely on regular reproductive healthcare, Title X provides a much-needed safety net.

When a Zip Code Doesn’t Dictate Contraception

All of this said, the next phase of reproductive care and contraception must consider where
women really live including city streets, stretches of farmland or migrant housing. It’s a much
bigger proposition than the contraceptive itself. It’s about fortifying funding for reproductive
clinics, supporting Title X or similar programs for the under-served and introducing more low
maintenance birth control options. Why? Because contraception should be about freedom of
choice, not logistics.