Consider This from NPR - As States Ban Abortion, Demand For Contraceptives Is Rising

Episode Date: July 18, 2022

Interest in birth control and emergency contraception has surged since the U.S. Supreme Court overturned the right to abortion. But safe and reliable birth control isn't always easy to access. Now the FDA is considering whether to make birth control pills available without a prescription. If approved, it would be the first over-the-counter oral contraceptive in the U.S. We also hear from NPR's Nell Greenfieldboyce about the most popular form of contraception for women in the U.S. - permanent contraception, colloquially known as "getting your tubes tied" - and why barriers to access leave many requests for this procedure unfulfilled. In participating regions, you'll also hear a local news segment to help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

This message comes from Indiana University. Indiana University performs breakthrough research every year, making discoveries that improve human health, combat climate change, and move society forward. More at iu.edu slash forward. Since Roe v. Wade was overturned, we've seen an increase in demand for emergency contraception and birth control. And now the FDA is considering whether to make birth control pills available without a prescription. Increasing access to contraception does not solve the big problem that was created by Roe versus Wade being overturned. But I certainly can see there being an urgency to making sure that anyone who wants birth control in this

really confusing and chaotic time be able to have access to it. And that means over-the-counter. That's Dr. Jenny Villavicencio of the American College of Obstetricians and Gynecologists. She says the evidence shows over-the-counter options are safe. The science and the data has for a while shown that birth control is very safe to be offered over-the-counter and doesn't need a prescription. She also says this would be beneficial because it would help reduce the barriers to contraception access. Barriers like getting a prescription or refills, not having a regular doctor, trouble getting an appointment, or being nervous to go. Even just logistical challenges. work, getting childcare, driving, parking, all of those things, then going to the pharmacy to pick up your prescription. It also incurs financial costs, particularly if you are underinsured or

uninsured. And of course, many of these are barriers that impact low-income people disproportionately. If the FDA approves an over-the-counter pill, it would become the first oral contraceptive available in the U.S. without a prescription. There are other contraceptive options available with a prescription, like IUDs, birth control rings, injectable shots, that is shots that can be prescribed via telemedicine and administered at home. That was a really great option during the pandemic when people were not visiting clinics as often. Now, that's a niche method. Not everyone's going to want it, but that could be good for people in this post-war world who

might have to travel for care. We have to think of contraceptives that people can get outside of the clinic now. It's really important. Cynthia Harper is a contraception researcher at the University of California, San Francisco, and she says that these telemed options can really help address some of the barriers to access. She also wants more awareness around emergency contraception options, also known as the morning-after pill. Plan B emergency contraception prevents ovulation, like the birth control pill, so fertilization never happens. Like, you don't need a prescription for Plan B. It's over the counter. But it's not always

available. And when it is, it's not always easy to access. Most of the time, it wasn't really on the shelf. It was either behind the counter or in one of those lock boxes, like really constraining access. Dr. Sonia Barrero is a professor of medicine at the University of Pittsburgh who focuses on reproductive health equity. In 2018, she sent a team of medical students to pharmacies across western Pennsylvania to see what they actually had on hand. And they found a third of the pharmacies didn't stock Plan B at all. And when they did stock it, it was usually kept behind lock and key,

which can be a big deterrent for people. So you can imagine, especially for a teen, going and asking for one of these products, being concerned about potential judgment, can be a significant barrier to purchasing. Consider this. Even before the Supreme Court overturned Roe v. Wade, there were barriers to accessing reliable and affordable birth control. Now, as many states move to ban or restrict access to abortion, there is an even greater demand for contraceptives. Coming up, we look at the barriers to the most common form of contraception used by women in the U.S., a permanent procedure commonly known as getting your tubes tied. From NPR, I'm Elsa Chang. It's Monday, July 18th.

This message comes from WISE, the app for doing things in other currencies. Send, spend, or receive money internationally, and always get the real-time mid-market exchange rate with no hidden fees. Download the WISE app today or visit WISE.com. T's and C's apply. It's Consider This from NPR. Here's what we know about demand for contraceptives since the Supreme Court overturned Roe. Doctors and women's health clinics are reporting an increase in the number of people seeking long-lasting birth control. And when it comes to emergency contraceptives, demand is up too. Retailers like

Amazon and some drugstore chains even placed a limit on the number of Plan B doses someone could buy. There's also been a surge in interest in permanent methods, sterilization procedures for both women and men. Dr. Doug Stein is a urological surgeon in Florida who has performed thousands of vasectomies, the male sterilization procedure. We do not see men in visits preliminary to their vasectomy visit. They go to our website, they read over our vasectomy information page, and then if they like what they see, they can submit an online registration. And during the first three weeks in June, our numbers averaged 55 per week. Starting on the Friday that was June 24th, the number was 150. So it was virtually a tripling of the number of registrations that came in. Permanent contraception is actually the most

common form of birth control used by women in the U.S., colloquially known as getting your tubes tied. And now, with abrupt bans on abortion happening all over the country, there's more interest in the procedure. Melanie Makin is a maternal fetal medicine specialist in Hawaii, and she says she often sees pregnant women who say, after this baby, I'm done. Individuals really know, like, I want my tubes out. This is the last child for me. My husband is not going to get a vasectomy. You know, I've either tried IUDs or some other form or the pill, and it just didn't work for me. They want the surgery performed right after birth, when they're already in the hospital.

But NPR's Nell Greenfield-Boyce reports this window of opportunity is often missed. The tubes, of course, are the fallopian tubes, which carry eggs from the ovaries. Surgeons can cut, block, or remove them. Rachel Flink is an obstetrician-gynecologist in upstate New York. She says for many women, the few days of hospitalization after childbirth are a rare chance to get this surgery done. Someone's able to watch their baby. They've already made other child care arrangements. There's no transportation issues. She says these practical matters are important because this type of birth control is frequently relied on by people who tend to be poor, with lower levels of education,

and public health insurance or no insurance at all. They're more likely to fall into groups of people who have difficulty accessing the health care system later. Flink says if someone wants their tubes tied and this doesn't happen during the brief hospitalization after childbirth, there's real consequences. About half of women who don't have their desired postpartum sterilization procedure will get pregnant in the next year. So the stakes are high, especially in places where it's now much harder to get an abortion. And here's the trouble. A lot of women leave the hospital without getting the tubal surgery they requested. For example, Flank and some colleagues did a study at Strong Memorial Hospital in Rochester and found that the majority of women who asked for

this procedure weren't able to have it. They were discharged from the hospital with their tubes intact. I certainly had a sense that we weren't completing all of them or close to all of them, but the fact that it was fewer than half, I think, was a little bit of a shock. Those findings are consistent with studies in other hospitals, which have found that about 40 to 60 percent of requests go unfulfilled. There's a lot of reasons why. Sometimes it's that the operating rooms are just too full, so a procedure that doesn't seem like an emergency isn't a priority. Sometimes doctors believe the patient is too overweight for the surgery, even though

research says it's safe, or they'll try to talk a younger patient out of it, arguing that she might change her mind. If the hospital has a religious affiliation, the surgery could be prohibited. And then there's paperwork, specifically one piece of paper that seems to really be causing problems. Those who are requesting a federally funded of Medicine. She says this consent form is required by Medicaid, which pays for nearly half of all births in the U.S. The form has to be signed at least 30 days before tubal surgery. Basically what this does is create a mandatory 30-day waiting period for people who rely on public funding for their health care. Private insurance doesn't require a waiting period.

So it definitely creates kind of a two-tier system. That makes it harder for people on public assistance to get this kind of birth control. If a woman signs the consent form too late or delivers unexpectedly early or loses her copy of the form and it's not on file, well, Medicaid won't pay for the operation. This does impact a significant number of people with Medicaid. This consent form and the waiting period were created back in the 1970s as the nation grappled with an ugly history of coercive sterilizations, which especially targeted the poor and people of color. The threat of reproductive abuse hasn't completely gone away.

There's been recent accusations of unnecessary surgeries at an immigrant detention center, for example. But Barrero says it's not clear that the current Medicaid regulations are the best way to protect the vulnerable. Because we have a lot of evidence showing that they're creating barriers for the people that they were intended to help. Her research suggests that these barriers result in over 29,000 unintended pregnancies each year. Some places are trying new approaches. Kavita Arora is a physician at the University of North Carolina who studies access to tubal surgery. She says a couple years ago, West Virginia, to my knowledge, became the first state that actually waived the waiting period

completely for female permanent contraception. She says if a woman wants her tubes tied but Medicaid won't pay because she hasn't waited 30 days, West Virginia covers it with state funds. And so it really creates, in essence, a natural experiment. And one hospital has made a similar change with dramatic effects. John Byrne is now with the University of Texas Health Science Center at San Antonio. He's worked other places. And when he was at Parkland Hospital in Dallas, he saw the number of tubal surgeries and thought,

Wow, a lot of women are able to have this procedure done here. That's because Parkland Hospital had set up a system that included a dedicated operating room, a team of surgeons, plus an anesthesiologist, and money to pay for it whenever Medicaid wouldn't. They really wanted to make sure that patients, if they wanted or requested that a procedure be done, that we do everything in our power to offer that. He and some colleagues just published a study showing at this hospital, nearly 90% of women who asked for their tubes to be tied after childbirth actually had the procedure. And when the operation didn't happen, it was almost always because the patient had decided against it.

That was NPR science correspondent Nell Greenfield-Boyce. You also heard reporting in this episode from NPR's Alison Aubrey and Maria Godoy. It's Consider This from NPR. I'm Elsa Chang. This message comes from Indiana University. Indiana University is committed to moving the world forward, Consider This from NPR. I'm Elsa Chang. and prepares students to become global citizens by teaching more languages than any other university in the country. Indiana University. Nine campuses. One purpose. Creating tomorrow today.