Many barriers still impede women’s access to contraceptive care, and physicians can do more to address them, according to a policy statement and a list of 18 recommendations from the American College of Obstetricians and Gynecologists.
The policy statement, released on Dec. 22 by the ACOG Committee on Health Care for Underserved Women, details many of the reasons why contraceptive care continues to fall short of being an “integral component of women’s health care” and why nearly half of pregnancies in the United States are unintended. High on the list are lack of knowledge, misperceptions, and exaggerated concerns about the safety of contraceptive methods (Obstet. Gynecol. 2015;125:250-5).
These misconceptions exist not just among patients, but among clinicians, the ACOG committee wrote. For instance, many clinicians are “uncertain about the risks and benefits of IUDs and lack knowledge about correct patient selection and contraindications.”
Similarly, many patients have unfounded concerns that oral contraceptives cause major health problems or that IUDs carry a high risk of infection. Many also mistakenly believe that most contraceptives are abortifacients.
Ob.gyns. can do their part to eliminate access barriers by not requiring routine pelvic examinations or cervical cytology before initiating hormonal contraception.
“The prospect of such an examination may deter a woman, especially an adolescent, from having a clinical visit that could facilitate her use of a more effective contraceptive method than those available over the counter,” the committee wrote.
Likewise, it’s excessive to require one appointment to discuss long-acting reversible contraception (LARC) methods and a second appointment to place the device. LARC methods are highly effective but underutilized, especially by adolescent and nulliparous women, according to the committee statement.
Another way that physicians can help prevent unintended pregnancies is to ensure that women are able to undergo permanent sterilization procedures immediately post partum, if they choose. Many women are prevented from doing so because of limited operating room availability, lack of motivation or coordination among the health care team, a mistaken perception of increased risk if such procedures are done in the postpartum setting, and misplacement of sterilization consent forms.
Other major barriers to accessing contraception are related to insurance coverage. High out-of-pocket costs, deductibles, and copayments for contraception limit its use. Even women with good private health insurance that “covers” contraception pay approximately 60% of the cost, compared with only 33% of the cost of other medications. And many insurers limit the number of contraceptive products that can be dispensed at one time.
“Insurance plan restrictions prevent 73% of women from receiving more than a single month’s supply of contraception at a time, yet most women are unable to obtain contraceptive refills on a timely basis,” ACOG wrote.
Additionally, some insurers, clinics, and pharmacies require women to fail on certain contraceptive methods before allowing them to try a more expensive method, such as an IUD or implant.
The opinion statement offers 18 recommendations for improving access to contraception, including full implementation of the Affordable Care Act’s requirement for insurance plans to fully cover all Food and Drug Administration–approved contraceptives, removal of age restrictions to increase access to emergency contraception, and adequate payments to physicians for providing contraceptive services.