Only half of U.S. counties have what the National Campaign calls “reasonable access”—one publicly funded birth control clinic for every 1,000 low-income women. And then there are other areas the group calls “contraceptive deserts,” a term borrowed from the “food desert” concept in health policy. They’re places where low-income women seeking IUDs or implants have few places to turn. (The map uses the best information the National Campaign could obtain, but it might be missing some private providers who accept Medicaid, if they’re not in the National Campaign’s database.)
Meanwhile, not all public or private clinics provide IUDs and implants. These LARCs are credited with contributing to the precipitous recent drop in teen pregnancy rates, and because they require no refills, reminders, or check-ups for years, LARCs are ideal for teenagers and for women in rural areas. After Colorado invested in providing LARCs to low-income women in the state, unintended pregnancies fell by 27,000 each year.
“If you go to the first map, there are clinics present in most places,” said Ginny Ehrlich, the chief executive officer at the National Campaign. “This isn’t a matter of building new clinics, it’s a shift in terms of perspective in what providing contraceptive services means, and focusing on most effective methods.”
Not all clinics can afford to staff a doctor who knows how to insert IUDs, said Kinsey Hasstedt, a senior policy manager with the Guttmacher Institute. “If you don’t have funding to pay the provider competitively, it’s hard to bring them in the door,” she added. What’s more, not all doctors are trained to insert LARCs, and the devices, which can cost about $800, are expensive for clinics to stock. A 2012 study found that fewer than half of family physicians were trained to offer IUDs. The numbers aren’t much better for pediatricians, who are supposed to offer the devices to sexually active teens.
Even if providers are trained, “if they don’t do [IUDs] after the training, they might forget how or not have the confidence to offer them,” said Eve Espey, chair of the Department of Obstetrics and Gynecology in the University of New Mexico School of Medicine.
Finally, some doctors still harbor outdated misconceptions about IUDs. Rachel Schulson runs the Step Ahead Foundation in Chattanooga, Tennessee, which connects women seeking LARCs and other birth control with clinics willing to provide it. Some women were told by their doctors that IUDs are only for women who have already had children, Schulson told me. One 28-year-old woman told Schulson, “I asked my doctor about this, and she said I have to be married.”