Strickland Leads 70 Members on Letter Calling on HHS to Reduce Barriers to Birth Control

Office of Rep. Marilyn Strickland press release.

Congresswoman Marilyn Strickland (WA-10), a leader in the Pro-Choice Caucus, member of the Democratic Women’s Caucus and Black Maternal Health Caucus, along with Representatives Suzanne Bonamici (OR-01) and Jackie Speier (CA-14) led a letter encouraging the Department of Health and Human Services (HHS) to issue guidance requiring insurance companies to cover, without cost-sharing, a 12-month supply of birth control. While the Affordable Care Act requires insurance coverage of contraception without cost sharing, insurance companies often limit coverage to a one- or three-cycle supply, imposing barriers to continuous access. Please find the letter text and the full list of 70 signers attached and below.

“Improving access to a longer supply of birth control supports body autonomy, health, and economic freedom for millions and I am proud to champion this effort to do just that. During a global pandemic, a maternal mortality crisis, and as reproductive rights are under attack, the people who are hurt the most by limited access to contraceptives are those who already experience health inequities in the first place —including people of color, LGBTQ+ individuals, and other vulnerable communities.” said Congresswoman Strickland.

“Access to birth control is essential to reproductive freedom, health, and economic stability,” said Congresswoman Bonamici. “We must make birth control as easy to access as possible, especially at a time when reproductive rights are under attack and health care has been disrupted. Making a 12-month supply of contraceptives available and affordable will reduce barriers and increase autonomy for millions.” 

The letter has been endorsed by Planned Parenthood Federation of America, In Our Own Voice: National Black Women’s Reproductive Justice Agenda, Upstream USA, National Family Planning and Reproductive Health Association.

“Access to affordable contraception is critical to reproductive freedom and health equity. Everyone, no matter their insurance provider or income, should be able to obtain the tools necessary to decide if and when they become a parent, and to manage chronic reproductive health conditions,” said Alexis McGill Johnson, President and CEO of Planned Parenthood Federation of America. “Too often, people of color, the LGBTQ+ community, people with low incomes, and people living in rural communities face greater and sometimes insurmountable barriers to basic health care. We thank Reps. Strickland, Bonamici, and Speier for leading on this issue to improve birth control access for all people.”

“Reproductive Justice demands that women, femmes, and gender-expansive people have the right to make decisions about planning their own families. In fact, a recent poll commissioned by In Our Own Voice found that 92% of respondents believe a woman’s ability to control whether or when she has children is an important part of financial stability for herself and her family,” said Marcela Howell, president & CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda. “We encourage the Department of Health and Human Services (HHS) to issue guidance requiring insurance companies to cover, without cost-sharing, a 12-month supply of birth control to people seeking contraceptive care.” 

“Ensuring health care coverage for a full-year supply of contraception without cost-sharing would eliminate unnecessary barriers to health care, particularly for those who already face difficulties accessing care. Moving forward with guidance on this proposal would represent another important step that HHS could take to expand access to contraception,” said Clare Coleman, President & CEO, National Family Planning & Reproductive Health Association (NFPRHA).

The full letter text can be found below.

Dear Secretary Becerra,

Access to sexual and reproductive care is a health, economic, and racial justice issue. We fully support giving people the resources they need to make the best decisions for themselves and their families. That starts by making reproductive healthcare, including access to contraceptive care, equally available to those who want it. While best practices in contraceptive care have evolved over the past decade, this unfortunately was not adequately reflected in government policy in the previous administration. That is why we are encouraging the Department of Health and Human Services’ (HHS) to issue guidance requiring insurance companies to cover, without cost-sharing, a 12-month supply of birth control. Typically, health insurance companies limit birth control coverage, without cost-sharing, to a one- or three-cycle supply. This policy is a barrier that prevents people from fully accessing birth control when they need it, at their convenience, and fails to meet the intent behind the ACA’s contraceptive coverage requirement.

Contraception has numerous benefits for Black, Latina, AAPI, Indigenous, and other people of color, and increases the ability to improve personal health, economic stability, and educational outcomes. Access to effective contraception has reduced the number of unintended pregnancies, high-risk pregnancies, and maternal and infant deaths. Additionally, contraception has been proven an effective option for addressing fibroids, minimizing endometriosis-related pain, and preventing ovarian cysts. Contraceptive equity is needed now more than ever as draconian laws in states like Texas and Mississippi have nearly banned access to abortion care outright for Black, Latina, AAPI, and Indigenous people. Worse, those who are forced to carry out an unwanted pregnancy must give birth in a country with one of the worst maternal mortality rates in the developed world. In the U.S., Black women are nearly four times more likely than white women to diefrom a pregnancy-related complication and are twice as likely to suffer a near-death experience.

Equitable access to contraceptive care is critical for people of reproductive age, especially amid the COVID-19 pandemic, where new challenges in access have arisen during the ongoing public health crisis. However, inequities in reproductive health care, including access to contraceptive care, have long existed in the United States. The people hurt most by this are those who already face the greatest barriers to accessing health care in the first place —including Black, Indigenous, and People of Color (BIPOC), LGBTQ+ individuals, those working to make ends meet, immigrants, those living in rural communities, and others. According to a 2018 poll by the National Latina Institute for Reproductive Health, 41% of Latina voters under age 45 had gone without the birth control method they wanted in the past two years because of access issues. Additionally, a barrier that low-income people and people living in rural areas experience is the need for repeat appointments to access contraceptive care and trips to the pharmacy to refill their prescription – due to lack of transportation, the inability to take paid time off work, inconsistent work schedules, and other economic justice issues that prevent ease of access. This is of particular concern to those who use contraception with the intention of preventing unintended pregnancies as it can lead to a lapse in birth control usage and a higher risk of pregnancy. In fact, it’s been proven that providing people with a 12-month supply of birth control helps prevent a lapse in usage and reduce the risk of pregnancy. A study conducted by the University of San Francisco in 2011, found that dispensing a 12-month supply of birth control resulted in a 30% reduction in the odds of pregnancy compared with dispensing just one or three packs.

Provider bias, discrimination, and stigma is also often encountered by people of color seeking reproductive health and contraception services – from recommended family planning services, to coercion about contraceptive choices, and the inability to access the full range of contraceptives. The more access an individual has to the contraception of their choice, the more they will be able to make the best decisions for themselves and their families. In the United States, there is a long history of contraception, specifically long-acting reversible contraception (LARC) methods, being promoted at times coercively to people of color and people with low-incomes. As reproductive health technologies were developed, women of color were also subjected to exploitation. The first oral contraceptive, Enovid, was tested on Puerto Rican and Haitian women in the 1950s, before the Food and Drug Administration approved it for distribution in 1960. In the seventies, Mexican American women became unknowing participants in medical testing for contraception. These past examples of racism in contraceptive access still impact communities today. A recent In Our Own Voice: National Black Women’s Reproductive Justice Agenda poll found that 62% of respondents think racism affects the Black community’s ability to have access to affordable birth control. By bringing equity to contraceptive care in our country, we can create ease of access and empower people to self-determine what birth control method is best for them – free of coercion.

Given the evidence and benefits of providing a 12-month supply of birth control to patients who want this option, we encourage the Department of Health and Human Services’ (HHS) to issue guidance requiring insurance companies to cover, without cost-sharing, a 12-month supply of birth control.

Thank you for your time and consideration on this matter and we look forward to hearing from you.

Sincerely,

Marilyn Strickland

Member of Congress

Suzanne Bonamici 

Member of Congress

Jackie Speier

Member of Congress