Let’s Get it Right With Black Women and Emergency Contraception

Sometimes, politics trumps common sense. A recent study analyzing media coverage of emergency contraception (EC), also known as the morning-after pill, concluded that the politics of EC overshadowed critical public health information in news articles. The dearth of public health information about EC is especially important for Black women, who are at greater risk of unintended pregnancy and for whom certain types of EC may be less effective.

In 2013, news broke that research shows emergency contraceptive pills made with the hormone levonorgestrel, like Plan B One-Step®, may be less effective in women over 165 pounds and completely ineffective in women weighing over 176 pounds. The average weight of Black women in the United States is 187 pounds. EC pills made with the chemical compound ulipristal acetate, sold under the brand Ella® in the United States, are more effective in women of higher body weights but efficacy is thought to decline at higher weights. In the scientific community, there is an ongoing debate regarding the exact weights and effects but experts agree that there is a risk of EC not working in women of higher body weights.

For Black women, who are more likely to be overweight or obese and more likely to lack financial access to daily birth control, access to Ella® and the copper intrauterine device (IUD) marketed as ParaGard® in the United States are critically important. ParaGard® is the most effective type of EC regardless of weight and is 99 percent effective at preventing pregnancy when inserted within 5 days of unprotected sex. The IUD is also a form of EC that may be the hardest to get. It must be inserted by a provider and if not covered by insurance, could cost nearly $1,000. Many women don’t have that kind of cash on hand.

The Affordable Care Act (ACA), which expands insurance coverage of all FDA-approved forms of contraception, may change the issue of access, but that process could be frustratingly slow. While ACA has reduced uninsured rates for Black people, they are still more likely than white people to lack insurance coverage.

Furthermore, in “State of Birth Control Coverage: Health Plan Violations of the Affordable Care Act,” the National Women’s Law Center reports that insurance companies are not fully following the new legislation and regulations. Specifically, insurance companies are limiting which contraceptive methods they provide coverage for, are only covering generic products, and are imposing other arbitrary restrictions. Fortunately, in May 2015 the federal government released new guidance for private health insurance companies to clarify what contraceptive methods and services plans must cover.

Still, political forces continue to seek to disrupt women’s access to contraception by undoing ACA. As early as this week, the U.S. Supreme Court will announce its decision in the case King v. Burwell – a case that could leave millions of Americans uninsured, impacting financial access to contraception.

Lack of information and limited financial access to contraception among Black women is something that must be addressed. Black women, like all women, deserve access to the resources they can use to prevent pregnancy, plan for healthy families, and fully experience reproductive agency. We’re not there yet, but hope is on the horizon.