Read: The different stakes of male and female birth control
Under the Affordable Care Act, many women in the United States have gained access to free birth control, but some still have to pay in certain circumstances. Insurance companies don’t need to cover brand-name contraceptives, just generic versions. Short-term, often low-cost insurance plans aren’t required to cover contraception at all. Religious employers can apply for an exemption that allows them to drop contraceptive coverage from their plan. And women without insurance have no choice but to pay for birth control out-of-pocket, or go without.
Nearly 65 percent of women ages 15 to 49 currently use some form of contraception, according to the most recent available data from the Centers for Disease Control and Prevention. The cost of birth control can vary dramatically depending on the type. According to Planned Parenthood, IUDs can cost up to $1,300, and hormonal pills can cost up to $50 a month, or $600 a year. When factoring in the cost of an annual visit to a gynecologist or other doctor, the bill can be even higher.
Many common forms of birth control can be obtained only through a doctor, and as a result, many women bear the brunt of the costs, in terms of both time and money, including setting up appointments, getting refills, and paying for contraception. These burdens are even heavier for poor women, especially those living in “contraceptive deserts,” areas with limited access to birth-control clinics. Sharing the cost of contraception with a partner can help alleviate some of that financial strain and symbolically demonstrate that a couple views preventing pregnancy as a joint responsibility. When Torres and Phillips decided that they were going to split the cost of Phillips’s IUD, they devised a payment plan in which Torres would Venmo Phillips $200 each month, for three months. Phillips told me that while she views sex as a “shared endeavor,” the duty to prevent pregnancy is “fundamentally unequal,” in that she “can get pregnant and he cannot.” She added: “I had to go in and have a legitimate medical procedure, cramp up, and bleed extra for a year. And he got to have condomless sex with, basically, abandon.”
Katrina Kimport, a medical sociologist at the University of California at San Francisco, told me it’s not surprising that few heterosexual couples share the cost of birth control. She studies women’s experiences with abortion and contraception, and pointed out that the most highly effective, long-acting, and commonly used forms of birth control—for example, IUDs and oral contraceptives—physically operate in women’s bodies. In her research, Kimport has found that even when women visit family-planning clinics, medical professionals frame preventing pregnancy as a female responsibility. As a result, both partners in a relationship may assume by default that women should be in charge of maintaining, and paying for, contraception.
Financial costs are just one of the burdens of preventing pregnancy. There are also mental, physical, and emotional tolls to consider. “It takes time to go to the doctor, go through the physicals, and go to the pharmacy,” Julie Fennell, a sociologist at Gallaudet University in Washington, D.C., told me. “It’s not a huge deal, but it is something that adds up, especially if you’re poor and you have limited access to these things.” Even after acquiring a prescription or getting an IUD insertion, the work isn’t done—a person may have to remember to take a pill at the same time every day or go to the pharmacy once a month. There are common side effects such as depression, weight gain, and irregular bleeding, and rare, debilitating ones such as pelvic inflammatory disease, blood clots, and ovarian cysts. “I don’t think there’s any broad social discourse that encourages empathy for the difficulty that some women face in successfully contracepting,” Kimport said. In fact, she has observed “an overall downplaying of the effects of side effects and how disruptive they can be.”