Black women are underserved when it comes to birth control access. The Roe decision could make that worse.

·8 min read

The Supreme Court’s ruling to gut nationwide rights to abortion last week has highlighted the importance of access to birth control, which already proves difficult for many women of color due to discrimination, stigma and systemic barriers in the health care system.

While the decision does not directly impact access to contraception, legal experts say that states and municipalities that are aiming to ban abortion at the point of conception may also challenge contraceptives like Plan B and intrauterine devices. Some state legislators have already taken steps to try to restrict birth control. In Tennessee, U.S. Sen. Marsha Blackburn, a Republican, earlier this year called Griswold v. Connecticut, the 1965 case that ensured birth control access to individuals who were married, “constitutionally unsound.” (A spokesperson for Blackburn told The Washington Post in June that she “does not support banning birth control, nor did she call for a ban.”)

“The hardest burden is going to largely fall on Black women who already have insurmountable challenges just getting health care in this country,” Jennifer Driver, senior director of reproductive rights for the State Innovation Exchange, a national resource and strategy center, said about the impact of the decision. “And now it’s going to be even harder.”

Black women disproportionately deal with a number of reproductive health challenges, like fibroids and polycystic ovary syndrome, where contraception or reproductive surgery is necessary, said Dr. Brandi Shah, a family physician practicing in Birmingham, Alabama.

Following Friday’s decision, Shah said that health care providers need to prepare for the potential heightened demand of birth control. Getting more trained providers — especially those who understand the historical traumas experienced by people of color, which may influence their contraceptive choices — mitigating myths and misperceptions, along with providing contraceptive support and guidance are also crucial, she added.

“I think that it’s naive for us to believe that this will just stop here,” Krystal Redman, the executive director of Spark Reproductive Justice Now in Atlanta, said about the decision. In addition to triggering laws that will ban abortion outright in some states, this decision will prompt state legislatures “to begin to roll out policies that can potentially restrict access to other forms of contraception.”

A one-month dosage of hormonal birth control pills (Rich Pedroncelli / AP)
A one-month dosage of hormonal birth control pills (Rich Pedroncelli / AP)

Why contraception gaps exist

Driver, who is originally from Alabama, recounted the challenges of getting reproductive health care when she was a sophomore at Stillman College in Tuscaloosa. She said she had to drive two hours to a clinic to get an intrauterine device because her university’s health center did not provide contraception at the time — and the only clinic in the neighborhood had been shuttered. During this period in 2005, “they were closing clinics in predominantly Black areas in the heart of Alabama,” Driver said.

“It’s not just that they closed the clinic, but they didn’t actually tell us where else we could go,” she said. “Had we known, we could have just gone across the bridge or a lot closer — but it was intentional,” she said, to promote abstinence, which created barriers in accessing health care.

There are plenty of reasons why Black women are especially underserved when it comes to birth control access, especially in rural areas or health care deserts, where transportation to far-flung providers is difficult to wrangle, Redman noted. She added that many Black women report not being heard by their providers when they advocate for their own bodies.

According to an April report from the Pew Research Center, Black women between the ages of 18 to 49 were more likely to have had multiple negative experiences when seeking health care. These experiences ranged from being rushed by a health care provider to not being taken seriously about their pain, among others problems.

Some additional factors that prevent individuals from accessing birth control, said Power to Decide CEO Raegan McDonald-Mosley, include decreased funding from the Title X program, which many family planning programs and health centers rely on. The result is the closing of centers or a limited access to low-cost services, which can disproportionately impact people of color, she added. Additionally, there is an increased reliance on telehealth services, which has many benefits, but requires people to have internet access or a smartphone.

While policies like the Affordable Care Act help many access to birth control for free, there are huge barriers in getting access to contraception for those who do not have health insurance, McDonald-Mosley said. For example, birth control methods like intrauterine devices or contraceptive implants can cost thousands of dollars for the uninsured.

As organizations continue their efforts in providing resources for women of color, others, like public health educator Wendasha Jenkins Hall, are using this opportunity to continue educating Black women about their reproductive and sexual health through social media and her podcast.

Following the leaked decision in May, Hall said she received few questions about abortion, but more questions related to reproductive health and how the body works. Many Black women and femmes (a term Hall used to describe those capable of reproduction but who may not identify as women) don’t receive comprehensive sex education, she added. According to a 2019 report by the Black Girls Equity Alliance, out of the 25 states with the largest  Black population, only 11 mandate sex education and only three of those 11 require that the information taught is medically accurate. Hall attributed the lack of sex education, in part, to the ways sex and sexuality are spoken about in a negative way — especially in the Black church, which she grew up in.

“So we’re always talking about preventing disease. We’re always talking about preventing unintended pregnancy,” she said. “We don’t talk about sexuality as it being something that can be healthy, something that you can enjoy. It’s something that can be done safe.”

Hall said the court’s decision will likely continue to promote abstinence-only education and push the narrative of how “getting pregnant and having a baby will ruin your life,” she said. Hall, who has a daughter and a son, said that she worries about the effects of the decision and how it will impact her own daughter’s reproductive rights.

“We have to save ourselves a lot of times in these situations,” Hall said. “No one is coming to save us. They clearly don’t care about us. So, it really is about raising awareness. Really letting Black women and femmes and other people know what reproductive justice actually is.”

What actions are being taken 

Many organizations are also working to advocate for legislation that would tackle barriers in the reproductive landscape for Black women. Each year, Power to Decide holds a social media campaign titled, “#ThxBirthControl” to normalize discussions around contraceptives, said McDonald-Mosley. Data from public opinion polling conducted by the organization in 2021, among 1,000 adults between the ages of 18 and 45, showed that approximately 7 out of 10 people were concerned about access to contraception.

“The reality is, over 90% of people capable of reproduction at some point of their life will use birth control,” McDonald-Mosley said, mentioning figures that correspond with data from a 2013 report from the Centers for Disease Control and Prevention. “We should be able to talk about it without stigma and the more that people talk about it, the more that people can get information about the good things about birth control, as well as the risks, as well as the challenges with getting it so that we can more adequately overcome those challenges.”

An examination room at the Jackson Women's Health Organization (Rogelio V. Solis / AP)
An examination room at the Jackson Women's Health Organization (Rogelio V. Solis / AP)

The organization ensures that individuals can access resources including Bedsider, which lists clinics and family planning centers available across the country. Power to Decide also links individuals to telehealth services for contraception where they can get a year’s supply of birth control pills, while also helping individuals cover birth control-related costs through its fund BCBenefits.

To counter the restrictions on the horizon when it comes to abortion and, potentially, birth control, the State Innovation Exchange is working with state lawmakers to expand contraception, abortion and telehealth legislation. Driver said one of the bills recently passed in her state of South Carolina, called the Pharmacy Access Act, grants pharmacies the ability to distribute contraception without a prescription. Other bills the organization supports include SB413 in New Jersey, which requires Medicare to cover prescriptions for contraceptives for 12 months.

On the federal level, last year the U.S. House of Representatives introduced the Access to Birth Control Act, a bill that requires pharmacies to comply with rules to ensure women can access FDA-approved contraceptives like Plan B. The bill, sponsored by Sen. Cory Booker, a Democrat, was referred to the Senate’s Committee on Health, Education, Labor and Pensions and has not yet passed.

Black women are not adequately represented in state legislatures, Driver said, which prevents the creation  of policies that reflect the needs of Black women, and is something that her organization is trying to change.

“The entire overturning of Roe v. Wade removes bodily autonomy, and Black women understand that,” Driver said. “We understand the role that this country has played in harms against our bodies — and we understand that we thrive when we are able to decide how we want to parent, when we want to parent, and the communities and structures that need to be around us, for us to parent safely. Our responsibility is really helping legislators understand that point.”