The Contraception Crisis: Unveiling America’s Deserts

More than 19 million women of reproductive age (15-49 years) living in the US are in need of publicly funded contraception and live in contraceptive deserts. Contraceptive deserts are defined as, “counties where the number of health centers offering the full range of contraceptive methods is not enough to meet the needs of the county’s number of women eligible for publicly funded contraception” (Power to Decide, 2024). Minimum need is further defined as at least one health center for every 1,000 women in need of publicly funded contraception (Jerich, 2022). Around 1.2 million of these women live in a county without a single health center that offers the full range of contraceptive methods. Significant proportions of the United States can be characterized as contraception deserts. There is also high variability across geographic locations. However, historically marginalized racial groups and those experiencing poverty are disproportionately represented in contraception deserts which is an obstacle to fully achieving Sustainable Development Goal 5 (SDG 5) which works to achieve gender equality and empower all women and girls. 

One clear trend of contraceptive deserts is that they are more prevalent in the middle of the country than along the coasts, yet there are still extreme contraceptive deserts placed throughout the entire United States. According to the country’s SDG 2021 Report, major challenges remain in every single state pertaining to contraceptive deserts! 23 states, almost half of the U.S. states, have less than 100 health centers. The states that have less than 100 centers are as follows, in ascending order: Wyoming (13), New Hampshire (27), Delaware (29), South Dakota (30), Rhode Island (37), North Dakota (40), Nevada (41), Hawaii (41), Montana (42), Vermont (42), Kansas (43), Nebraska (46), Iowa (59), Utah (69), Maine (70), Connecticut (73), Alaska (74), Kentucky (80), Idaho (86), New Jersey (90), Alabama (91), West Virginia (91), Wisconsin (97). There are 19 states that are more in the middle of the spectrum that have 100-200 health centers. The last eight states are those with the most health centers (more than 200). This means that only 16% of states in the entire U.S. have at least 200 health centers. Compared to the 332 million people living in the country, the number of health centers seems drastically insufficient. The states with more than 200 health centers are as follows: Washington (208), Illinois (224), Pennsylvania (225), Florida (270), Georgia (284), New York (372), Texas (400), California (1,146). All these states have at least some coastline, which pertains to the trends observed with contraceptive deserts.  

Title X , a program passed in 1970 under the US Department of Health & Human Services, is the only federal program specifically focused on providing affordable reproductive health care to American residents. Due to more recent state and federal regulations introduced through Title X, many budget cuts and reproductive health clinic closures (e.g., Planned Parenthood) have majorly impacted access across the nation. The bar graph below shows some examples of how the Title X regulations affected women in certain states. In each state, the number of women served declined by anywhere from 25% in Nebraska to 98% in New York.

These declining trends, as a result of the Title X regulations, exhibit the increasing need for contraception in the majority of states within the U.S. While sometimes these statistics can be hard to understand or picture, here are some real stories of real women struggling from contraceptive deserts:

“Delilah lives in Northern Texas, a contraceptive desert. In her county and the dozen counties around her there are no health centers. To consult with her doctor about changing pill brands she must travel for nearly seven hours and go more than 400 miles to a county with two health centers.”

“Maya lives in a county in Arizona with eight health centers. But the wait time at each means that she needs to request an appointment three weeks in advance for a consultation. Because her preferred birth control method is an IUD, she also needed to wait a week before returning to have the IUD inserted.”

“Leah lives in Ohio and though she has access to a clinic, she has to take time off work to go to her appointment. With a smaller paycheck this month she has to wait to replace her car's battery so she can afford to pay her babysitter while she's at the doctor.”

“Betsey Tilson, one of the top health officials in the state of North Carolina, said accessing the health care system can be difficult — even for those with resources. “Even me, trying to access the health care system for my daughter for contraceptive care — we had barrier after barrier,” Tilson said. These women are only a few out of the thousands who are struggling to get access to care and access to resources for their sexual and reproductive health.” 

Achieving SDG 5 requires a comprehensive, multi-prong approach that will take a lot of effort, time and participation. Data shows that contraceptive deserts are prevalent but not inevitable. The most effective way to get rid of contraceptive deserts is to enact change at the policy level. Bringing awareness surrounding these deserts and health center deficits to your state-level Title X networks can mitigate inequitable access to federal resources.

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References:

2023 Gender Equality and Women’s Empowerment Policy. U.S. Agency for International Development (USAID). (2023, March 29). https://www.usaid.gov/gender-policy

Contraceptive Deserts. Power to Decide. (2024). https://powertodecide.org/what-we-do/contraceptive-deserts#:~:text=Contraceptive%20deserts%20are%20defined%20as,in%20need%20of%20publicly%20funded

Jercich, K. (2022, February 21). Millions Live in “Contraception Deserts” – Can Telehealth Help? Healthcare IT News. https://www.healthcareitnews.com/news/millions-live-contraception-deserts-can-telehealth-help

Kreitzer, R., Smith, C., Kane, K., & Saunders, T. (2022). Prevalent But Not Inevitable: Mapping Contraception Deserts Across The American States. Contraception, 116, 70. https://doi.org/10.1016/j.contraception.2022.09.009

Leal Filho, W., Kovaleva, M., Tsani, S., Țîrcă, D.-M., Shiel, C., Dinis, M. A., Nicolau, M., Sima, M., Fritzen, B., Lange Salvia, A., Minhas, A., Kozlova, V., Doni, F., Spiteri, J., Gupta, T., Wakunuma, K., Sharma, M., Barbir, J., Shulla, K., … Tripathi, S. (2022). Promoting Gender Equality Across the Sustainable Development Goals. Environment, Development and Sustainability, 25(12), 14177–14198. https://doi.org/10.1007/s10668-022-02656-1

Longman, M. (2020, November 18). 19 Million Women Live In A Contraceptive Desert. Are You One Of Them?. Refinery29. https://www.refinery29.com/en-us/2020/11/10176933/birth-control-access-restrictions-contraceptive-deserts

Smith, C. W., Kreitzer, R. J., Kane, K. A., & Saunders, T. M. (2022, February 3). Contraception Deserts: The Effects of Title X Rule Changes on Access to Reproductive Health Care Resources: Politics & Gender. Cambridge Core. https://www.cambridge.org/core/journals/politics-and-gender/article/contraception-deserts-the-effects-of-title-x-rule-changes-on-access-to-reproductive-health-care-resources/95E2B5D348C73CEF8F98644E67D60CD6