To preserve US contraceptive rights, lawmakers must step up now

Even before the Supreme Court’s decision to overturn Roe v. Wade and Planned Parenthood v. Casey, millions of people already experienced barriers and lack of access to abortion care, but in the weeks since the ruling, lawmakers in more and more states are rushing to enact policies and laws designed to dramatically exacerbate the problem. The crisis caused by the overturning of Roe has only deepened the fault lines that exist within the nation’s health care safety net, rifts that will only grow unless our elected officials use every available tool to meet the moment.

Although it cannot solve the abortion emergency, one critical aspect of our response must be expanding access to quality, affordable birth control. In a world where access to abortion is severely limited, it is even more important for people who want contraception to be able to affordably and easily access it from family planning providers they feel safe with and trust. 

As we join our advocacy partners in their efforts to fight for abortion rights, we must also push Congress and the White House to follow through on several proactive measures to make contraceptive care available to all who want it.

First, Congress must fully fund the Title X family planning program. Title X funds a diverse, nationwide network of health centers that provide high-quality family planning and sexual health care to all, with priority given to people with low incomes or no other options for care. However, this critical component of the public health infrastructure has struggled through numerous obstacles for years — from federal budget cuts to Trump-era program restrictions to COVID. As family planning providers have absorbed these blows, they have not been able to maintain or expand their services to ensure that patients have access to the preventive health care they need and want.

In March of this year, Congress level-funded the Title X program at $286.5 million for its eighth consecutive year, diminishing the Biden administration’s ability to fully rebuild the program following Trump-era restrictions and provider withdrawal. As a result of systemic inequities that exist across the health care system, people who are most affected by abortion bans are the same individuals who disproportionately rely on safety-net family planning providers for care, intensifying the need to scale services up for those patients. There is simply not enough money, however, for the program to meaningfully support every service area across the country, let alone expand to address any increase in need in light of the Supreme Court’s ruling, and as a result, many agencies are being forced to freeze positions, limit services and eliminate agencies from the Title X network.  

Recognizing that broader access to contraception will never be a substitute for abortion care, increasing the availability of contraception for those who want it is nevertheless imperative in this crisis moment. Congress must secure urgent funding for the Title X program by the end of 2022 so that resources to support contraceptive care, cancer screenings and other critical health services can reach communities and people in need more fully.

In July, the Senate considered a bill to fund Title X at $500 million annually for the next 10 years, which would have represented a historic investment in a program that has had a deep impact on people’s lives for more than 50 years. The measure was unfortunately blocked by Sen. Joni Ernst (R-Iowa).

Now that we are approaching the end of this fiscal year, and with providers struggling to keep pace with the demand for care, the next opportunity for Congress to secure a significant funding increase for Title X will happen this fall with an omnibus funding package. In the years that follow, Congress needs to endorse strong annual appropriations that family planning providers can depend on year after year, rather than passing bare-bones funding measures that make it harder for people to get the care they need.

The Biden administration must also enforce Medicaid’s Free Choice of Provider protection. It is imperative that the Centers for Medicare & Medicaid Services (CMS) respond to actions by a growing number of states to prohibit abortion providers from participating in their Medicaid programs. Such actions are illegal. Under Medicaid law, beneficiaries have the right to receive family planning and sexual health care from any willing and qualified provider of their choice. This protection is a lifeline to the 1 in 5 women who are covered under Medicaid, the majority of whom are of reproductive age. 

Some states, such as Missouri, Texas and Arkansas, are in blatant violation of this requirement by terminating contracts with certain family planning providers, while other states have ramped up efforts to chip away at this protection. The Missouri Family Health Council, a longtime Title X grantee, found that since June 2021, the family planning providers that are expected to care for patients who had previously been seen at a Planned Parenthood are stretched far too thin. The average wait time at these locations is more than five weeks for a new patient well-person exam. Some providers have not been able to accept new patients for the past year. Delays like these put people at risk for unintended pregnancies, undetected sexually transmitted infections and more.   

It is time for the Biden administration to step in and enforce the law. Doing so would not only guarantee people access to care in states that have violated this federal protection, but it would send a strong message to other states that targeting providers and the patients they serve will not be tolerated. Longstanding, highly qualified family planning providers play an essential role in helping their patients navigate their own sexual and reproductive health and must receive necessary protection under federal law, something especially crucial now.

Finally, we must codify the rights to privacy and contraception. The Supreme Court’s decision to erase 50 years of abortion rights in this country is only the beginning. We expect that states will quickly move to infringe further upon the right to privacy, including threatening access to contraception and LGBTQ+ rights. This is sobering but not surprising. We have already seen states trying to label certain birth control methods as abortifacients, and lawmakers will seek to use the court’s reasoning in Dobbs v. Jackson Women’s Health Organization to fuel those state policies and future attempts to take away people’s constitutional right to contraception.

Despite the protestations of the court’s majority in Dobbs, it is clear that the right to privacy and to contraception recognized 57 years ago in Griswold v. Connecticut is at significant risk. Congress can safeguard this constitutional protection by enacting the Right to Contraception Act. The House recently passed this bill that would enshrine people’s rights to access a broad range of contraceptive methods and ensure that family planning providers have a right to support their patients with the contraceptive care and education they need without political interference. Unfortunately, the Senate later failed to clear a path for enactment.

At a time when people’s concerns and fears about the care available to them mount, and with people’s health and lives at stake, we need policies that expand access to contraception, not diminish it. The Biden administration and Congress must take bold, swift action to clear every single obstacle so that birth control is available to all who need it. Our nation’s future depends on it. 

Santaisha Hicks, MPA, is board chair of the National Family Planning & Reproductive Health Association.