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As long-lasting birth control becomes more popular, make sure it's not forced on low-income women

For women trying not to get pregnant, long-acting reversible contraceptives, or LARCs, are among the best options available. No need to worry about taking a pill on time everyday or fumbling for a diaphragm during a moment of passion. LARCs have been found to be 20 times more effective than birth control pills, the patch or the vaginal ring, according to the American Sexual Health Association.

Doctors either insert a T-shaped IUD into a women’s uterus or a thin rod into the upper arm that automatically releases hormones into the body to prevent pregnancy. Such LARCs get rid of the human error factor, which is often associated with unplanned pregnancies. Many of the 3 million or so women who wind up with a surprise bun in the oven each year didn’t use their birth control correctly or had spans of time where they didn’t use any protection at all.

More women are turning to the convenience of LARCS, with use of the contraception increasing five-fold from 2002 to the period between 2011 and 2013, according to the National Center for Health Statistics. It was the third most commonly used method of birth control from 2015 to 2017, behind the pill and sterilization (getting one’s tubes tied), according to federal data released in December.

This is a promising trend as unwanted pregnancies can lead to a host of other life challenges, especially for low-income women and teenagers. Delayed prenatal care may lead to health problems with the baby, such as premature birth. Teenagers facing the stress of motherhood may drop out of school. Moms with limited incomes grapple with the financial stress of raising a child they can’t afford.

The American College of Obstetricians and Gynecologists recommends LARCs, and the Affordable Care Act made them easier to acquire by requiring insurers to cover the costs of the contraception, which was once too expensive for many women.

But as LARCS become more popular, the medical community needs to make sure women are not being coerced into using the longer-lasting contraception methods, but rather something they choose for themselves.

“Often long-term methods are disproportionately pushed to low income women,” said one non-profit worker who serves low-income families in West Baltimore. “Their reproductive rights are just as important as others.”

This is a legitimate concern based on the history of LARCS, which fell out of popularity in the ‘90s before their use resurged in the last decade or so. In particular, the Norplant device, which is now off the market, was seen as being used more as a form of population control than birth control.

During that time, legislators in seven states introduced bills that tried to mandate Norplant use for some women, according to the Guttmacher Institute, a sexual and reproductive health research organization. One bill introduced in Washington would have required women with signs of substance abuse to keep the device in place until she was drug-free for six months. A bill introduced in South Carolina in 1993 would have required a woman with two or more children to have Norplant inserted to begin receiving welfare benefits. Legislators in Mississippi, Ohio and South Carolina wanted to require the device for women with children who were already on welfare. There were also efforts in some states to give women financial incentives to use Norplant, which some thought was an attempt to underhandedly get women of a certain income level to use it.

This concern still exist

s today. While there is no blatantly discriminatory legislation in the works like in the ‘90s, the worry is doctors could steer women toward certain types of birth control, or make it seem like the women’s only option.

Doctors and nurses at Baltimore City clinics remember the past and follow guidelines that involve giving moms their full range of options. We hope other doctors and health departments are doing the same. If women are well-educated about their birth controls choices, they can make the decision that is right for them. The best birth control, they said, is the one that a woman will use consistently.

LARCS make consistency easy and are a good choice for women who actually choose them.

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