Rethinking birth control and pregnancy planning as a national priority

The Right to Contraception Act — approved by the U.S. House and awaiting the attention of the Senate — would be a good start toward reducing the nearly 40 percent of pregnancies each year in the United States that are unplanned.

The legislation sponsored by Rep. Kathy Manning (D-N.C.) would establish a statutory right to obtain contraceptives and — crucially — a corresponding right for health care providers to dispense them.

It would protect a range of contraceptive methods, devices and medications, including oral contraceptives, emergency contraceptives and IUDs.

Doing so would empower women and men to decide if, when and under what circumstances they want to become parents.

There’s more to do as well.

We must encourage our elected officials to adopt policies that ensure expanded availability, which increases the chances of an individual’s ability to get on and follow a birth control regimen. We have two immediate opportunities.

One avenue is to allow advanced practice nurses or nurse practitioners across the United States to practice at the full extent of their licenses, training and competencies; and to further extend prescription privileges to pharmacists. (Seven U.S. jurisdictions and Washington, D.C., already authorize pharmacists to prescribe hormonal contraceptives.) These nurses and pharmacists already deliver care in the community and are often deemed the most accessible healthcare providers. This expansion is an effective way to advance sexual health and reduce lingering sexual and reproductive health inequities.

Another option is to remove the prescription requirement for oral contraceptives, a widely used form of birth control. Having to visit a health care professional for birth control can be an obstacle for many women and men who may not have flexible schedules, a regular health care provider or the financial ability to pay for an office visit. We can dismantle these barriers by making oral contraceptives as easy to access as condoms.

More accessible birth control improves health and well-being for all. A report from the Joint Economic Commission noted that more accessible birth control improves economic outcomes and makes women more likely to go to college, graduate and get a job. This isn’t just good for women — it’s good for all of us. 
Right now, contraception isn’t uniformly available or affordable: 19 million American women don’t have reasonable access to a health center offering contraceptive care, according to Power to Decide, whose board I chair. Just over 1 million of these women reside in counties without a health care provider offering full contraceptive services, including IUDs, implants, birth control pills, the shot, the ring, the patch, cervical caps, diaphragms and emergency contraception.

Achieving these goals necessitates a new way of thinking, too. Our default assumption should be that people don’t want an unplanned pregnancy — and that when they do want to get pregnant, they will make that choice deliberately. This perspective, of course, reflects reality.

Data from the Centers for Disease Control and Prevention (CDC) show that at some point in their lifetimes, nearly all women use some form of contraception, and 64.9 percent of American women ages 15 to 49 currently do. Yet, our elected officials continue to enact policies and pass legislation that ignore these facts.

The need for a more reasonable and reality-based approach to contraceptive care in the U.S. is urgent. We have an opportunity to help people make decisions about if and when they become pregnant and to reduce the likelihood of having to decide whether or not to continue a pregnancy. We must take it.

Vincent Guilamo-Ramos is dean of the Duke University School of Nursing, vice chancellor of nursing affairs, and a distinguished professor of nursing at Duke University. He is also chairman of the board of the nonprofit organization Power to Decide.