Every day, patients and health care providers across the state make decisions about contraceptives that are not based on medicine. Instead, confusing, outdated and burdensome policies dictate access to these essential health care services. These policies can impact this highly personal choice more than someone’s preference — or even the effectiveness of a birth control method.
One example patients encounter far too often is the lengthy process to access long-acting reversible contraceptives (LARCs).
LARCs, which include IUDs and implants, are considered the most effective at preventing pregnancy but can have an up-front cost of up to $1,000 per device. This means that providers who want to offer same-day access to LARCs must take on the financial burden of purchasing devices from a manufacturer with their own capital. Since coverage for contraceptives varies drastically by health plan, the risk of not being reimbursed if the claim is denied by the patient’s insurance is high.
As a result, most providers in New Jersey require two visits for a patient to receive a LARC. At the first visit, the patient and provider select a method of birth control. If an IUD is chosen, it is then ordered through the patient’s insurance and delivered to the office. Then, the patient returns for a second visit for the device to be inserted.
This process can take weeks. In that time, many things can happen: a patient’s insurance can change; they can become pregnant; or they can be unable to return for another visit due to employment, child care or transportation issues. If a patient does not return for the second visit, the provider’s office might not be reimbursed for the abandoned device.
Discouraging contraceptive choice
The complex, lengthy, costly ordering and reimbursement process for LARCs discourages many family-planning providers from offering these effective options. This can force patients to choose a different provider, face a lapse in contraceptive use or select an alternative — and possibly less effective — form of birth control altogether.
According to March 2020 data from Power To Decide, over 400,000 women in New Jersey live in contraceptive deserts, which are counties where there is no reasonable access to a health center that offers all forms of birth control.
Limited access to patient-centered contraceptive care can result in higher rates of unplanned pregnancies and poor maternal and infant health outcomes. These barriers to care restrict personal autonomy over an individual’s body and reduce their ability to decide if and when they want to have children.
The New Jersey Health Care Quality Institute recently released valuable resources as part of the New Jersey Reproductive Health Access Project (NJ-RHAP). These resources are designed to support providers by clarifying complex policies and sharing best practices to increase access to high-quality comprehensive services.
Changing state-level policies
Supporting providers to increase access to contraceptive care is essential. But the truth is, provider education can only move the needle so far. To truly dismantle barriers to birth control, it is essential to address state-level policies that limit access to services.
The burdensome process to obtain LARCs is just one example of many barriers to birth control in New Jersey. State policies around dispensing limits for oral contraceptives, facility requirements for LARC services, limited formularies for contraceptives and other similar policies prevent providers from delivering comprehensive contraceptive care.
It is essential that policies that place unnecessary restrictions on contraceptives are updated and that health plans across the state facilitate access to quality care. The state, health plans and health systems all play an important role in increasing a provider’s capacity to ensure patients can receive the birth-control method of their choice.
We cannot settle for providing “adequate” reproductive health care in our state. We have the ability and obligation to guarantee meaningful access to all forms of contraception across New Jersey. As we rebuild and recover from the COVID-19 crisis, it is more important than ever for New Jersey to ensure that quality reproductive health services are accessible to everyone.
Support and education for our providers is critical, but we must also address systemic barriers to contraception. I encourage our elected officials to create lasting policy changes that will improve outcomes and empower individuals to make reproductive health decisions that are best for themselves and their families.