To Lorena Barrientos, the idea that politicians would reduce women’s access to contraception is baffling.
“Do they understand if they cut that off that lots more people are going to be pregnant?” she said.
Barrientos, a 28-year-old woman who I met near her home in New Hampshire, had serious complications when she was pregnant. Her daughter, who’s almost three now, was born three months early. Her doctor has told her that if she gets pregnant again, she’ll have to be on bed rest for the whole nine months. Even so, the pregnancy would still be risky. So, although she wishes she could have another child someday, she uses an IUD to make sure it doesn’t happen—not just for her own sake, but for her daughter’s.
“You can’t be in bed for nine months with a little one,” she said.
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Barrientos said she used to work as a pharmacy tech and a line cook, but chronic health problems forced her to quit. She gets her health insurance through Medicaid, which pays the full cost of long-term birth control.
If she had to pay out of pocket, she said, there’s no way she could afford the IUD—it has an upfront cost of around $1,000.
“By the time I pay my bills and my rent, I’m broke,” she said.
This year, Congress is pursuing an array of plans that would reduce access to family planning resources. Repealing the Affordable Care Act could mean employers no longer have to offer plans that cover contraceptives, and defunding Planned Parenthood would eliminate the only place to find free and low-cost family planning in many communities. And for women like Barrientos, a rollback of the Medicaid expansion—and transformation of the entire program into state block grants—would endanger access to all sorts of care.
Lydia Mitts, senior policy analyst with the health care advocacy group Families USA, said that before the ACA millions of women struggled to afford birth control. Many had to pay the entire cost out of pocket, and copays were a struggle for people living paycheck to paycheck before the mandate required insurers to cover the full cost.
“It was a win for women’s healthcare, but it was also a win for families and women’s ability to plan when they want to start a family,” Mitts said. “I think everyone wants to be empowered to make those big life decisions and kind of pursue their dreams at the pace that makes sense for them and their spouse and their children.”
Empirical evidence backs up what most parents—and people who aren’t yet ready to become parents—are well aware of: Being able to choose when to have kids leads to healthier families. Kids and their parents are physically and mentally better off, and families are more stable financially. Researchers found that children born in areas with federally-funded reproductive health care clinics were 4.2 percent less likely to live in poverty as children and 2.4 percent less likely to experience poverty as adults.
The current leaders in Congress argue that their policies, which rely heavily on a free-market approach, empower families to make their own decisions free of government coercion. But the ACA mandates and Medicaid expansion, along with providers like Planned Parenthood, are giving women long-term contraception options that used to be hard to come by. Data from states like Texas show what happens when those services are cut—the state has seen a 36 percent decline in the use of long-acting contraceptive methods, a rising birth rate, and an uptick in maternal mortality.
In a particularly distressing twist, the same policy changes that would reduce access to birth control would also make it harder to receive prenatal care. The U.S. Department of Health and Human services has found that, before the ACA, 62 percent of individual market enrollees didn’t have coverage for maternity care. Many women also lacked insurance altogether, putting them at much greater risk for serious health problems during pregnancy.
“It’s challenging to listen to discussion about eroding women’s access to birth control at the same time as eroding their access to care if they end up pregnant,” Mitts said. “We want to make sure women have the reproductive care they need, and then health care they need to have a healthy family, have a healthy baby.”
That seems like common sense to a lot of people. Just a few blocks away from Lorena Barrientos’s home, I ran into Michele Dumont. She recalled going to Planned Parenthood back in the 1980s to get her birth control pills and braving a line of protestors who were angry that the clinic also offered abortions.
“I already had two children in diapers, and I definitely didn’t want a third in diapers,” she said.
Dumont said her children are grown now, but she thinks a lot about people she knows who could be hurt if their family planning options disappeared.
“Believe me, they would not want to see me in Congress,” she said.
Correction: This article originally stated that Barrientos’s daughter was born three weeks premature. She was born three months premature.