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Literature Review 4
<br />BARRIERS TO CONTRACEPTIVE ACCESS
<br />Women across America are not using contraceptives due to side effects, costs, and challenges
<br />associated with accessing it. In one study exploring the barriers to contraceptive use, 40 percent
<br />of women reported difficulty using or accessing birth control methods (Grossman, 2015). In
<br />another study, “30 percent of women who had ever tried to obtain a prescription for hormonal
<br />contraception reported difficulties obtaining the prescription or refills” (Grossman, 2015).
<br />Further, a literature review summarized 16 qualitative studies determining reasons why some
<br />women do not use contraceptives, despite not wanting to get pregnant. Over half of the studies
<br />focused on low-income women, who stated many factors, including personal reasons such as fear
<br />of side effects and procedural reasons such as forgetting to take the oral contraceptive every day.
<br />Additionally, some women perceived that they were at low risk of pregnancy, or had personal
<br />beliefs that it is wrong to use contraceptives. Other factors were interpersonal reasons, such as
<br />the male partner’s opposition to contraception, and societal reasons, such as cost, lack of health
<br />insurance coverage, and difficulty accessing contraception services (Ayoola, Nettleman, and
<br />Brewer 2007). Furthermore, another study was conducted in Boston from 2007 to 2009 in which
<br />in-depth interviews and focus group discussions were conducted with 45 low-income women
<br />(Dennis and Grossman, 2012). Overall, while many participants reported that obtaining
<br />contraceptives was easy, others reported that various barriers deterred them from consistently
<br />from using oral contraceptives. These barriers included unaffordable copays, restrictions on the
<br />number of packets of pills they could receive at one time, the time required to go to a clinic or
<br />doctor’s office, and concerns about the safety of contraceptives (Dennis and Grossman, 2012).
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<br />COSTS
<br />The biggest barrier for women accessing birth control pills from clinicians was unaffordable
<br />copay and clinic visits (Dennis and Grossman, 2012). Some women reported they had to stop
<br />using birth control pills because they could no longer afford it, even with insurance. One study
<br />done along the border of Mexico showed 40% of women said cost played a big role in
<br />determining why they chose to get pills from a Mexican pharmacy, rather than a clinician (Potter
<br />et al., 2011). Women of different ages and education levels would prefer having over the counter
<br />options, so long as they are available at low costs (Potter et al, 2010). One study showed that
<br />women would pay at most $20, on average, for over the counter oral contraceptives (Grossman
<br />and Grindlay et al., 2013). A concern raised by women was the question of whether insurance
<br />would still cover the cost of oral contraceptives if they become over the counter (ibid). Prior
<br />research has shown that consumers’ costs increase when medications become over the counter
<br />(Sullivan, 2005). However, costs may not increase if birth control pills require a pharmacist
<br />prescription, rather than becoming fully over the counter. Prescription requirements also deterred
<br />women from using the pill (Dennis and Grossman, 2012).
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<br />Contraceptives can be extremely costly, both for women who have health insurance and those
<br />who are uninsured. This poses a large barrier to contraceptive use; in a recent study of women
<br />seeking abortion for an unintended pregnancy, nearly one in four reported that they did not use
<br />contraceptives because of cost (Homco, Peipert, Secura, 2009). In 2012, the Center for American
<br />Progress found that for uninsured women, the potential annual cost of oral contraceptives was
<br />$1,210 (Kelberg, 2015). Other methods of contraceptive use, such as contraceptive implants and
<br />IUDs are also extremely expensive. For instance, the average price for an IUD or implant
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