Dr. Cynthia Harper: Birth control
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Some states are taking steps to increase access to birth control, while other are imposing new restrictions.
On October 17, 2024, SciLine interviewed: Dr. Cynthia Harper, a professor of obstetrics, gynecology, and reproductive services at the University of California, San Francisco. See the footage and transcript from the interview below, or select ‘Contents’ on the left to skip to specific questions.
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Introduction
[0:00:19]
CYNTHIA HARPER: I’m Cynthia Harper. I’m a professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco School of Medicine. I study contraception in the United States, and I primarily focus on young people, their access to care, and equitable care.
Interview with SciLine
What changes have occurred in access to contraception since the Dobbs decision overturned the right to abortion in the United States?
[0:00:49]
CYNTHIA HARPER: Ironically, since the Dobbs decision overturned Roe v. Wade in the United States, access to contraception has actually become slightly more restrictive, and we might hope that contraceptive services would become more available to people who wanted to prevent pregnancy, especially in those abortion ban states, but really across the country. But this has not happened.
Why has contraception become less available?
[0:01:23]
CYNTHIA HARPER: Actually, the restrictions on abortion care have affected contraceptive care because a lot of the specialty clinics—say, the Planned Parenthoods and other clinics that community clinics that offer birth control to people—have been under siege. And then a lot of the abortion ban states, they’ve actually shut down and moved to the border or moved to other states. So, this has affected how much contraceptive care is available to people throughout our country.
How does emergency contraception, commonly known as the “morning-after pill,” work?
[0:02:03]
CYNTHIA HARPER: The emergency contraceptive pills actually prevent ovulation—just like regular birth control pills—and so pregnancy doesn’t occur. That’s how they work. Even though people worry about it, they worry that it’s abortion. Emergency contraception is not abortion. It acts much more like the regular birth control pill. Also, the IUD can be offered for emergency contraception, and that’s very effective if somebody were interested in an IUD. That is something that really nobody knows. In all of our research, we found that only four, or 5%, so over 95% of young women do not know that the IUD can be used as emergency contraception.
What can you tell us about the new over-the-counter “Opill” birth control pill, including its safety, effectiveness, and key points people should know?
[0:03:00]
CYNTHIA HARPER: It has very few reasons why you can’t take it on your own. That is because of the hormones that are in it. It’s a progestin-only pill, and a lot of the pills that we’re more familiar with in the United States are combined hormonal pills—they have estrogen and progestin, and the estrogen component can have contraindications, cardiovascular effects for some people that the progestin pill does not have. It’s just incredibly safe, so the FDA approved it in July 2023 to go over the counter. It now is available throughout the country in pharmacies. Look for it. It’s a little box that says “Opill.” And a lot of groups and people were still fighting to have it covered by state contraceptive programs. So, people who might not be able to afford the over-the-counter price. Can use insurance and contraceptive publicly funded contraceptive programs to purchase it.
Can you share your team’s research on how policies like insurance programs and sex education affect college students’ access to birth control?
[0:04:16]
CYNTHIA HARPER: We have conducted a large study with over 2000 young women who are sexually active in Texas and California. We found—not surprisingly—in Texas to have much more restrictive access to contraception. That really policies do matter, and it hits the people the hardest who are uninsured. So, Texas and California have very similar demographic compositions of their populations in terms of race and ethnicity, and proportion of U.S.-born and foreign-born, people with language barriers. We found that in Texas it’s more difficult for people who were uninsured to access contraception than in California state that has programs specifically or has more generous programs. Texas also has some programs for people, but they aren’t quite as—they don’t cover quite as much.
What role do healthcare providers, including those in primary care, play in providing contraceptive services?
[0:05:22]
CYNTHIA HARPER: The reason primary care has become so critical is that specialist providers such as Planned Parenthood, some of these under-resourced community family planning community clinics, have not had—particularly in the restricted states—have not had the funding and have been under fire. So many of them have shuttered in the years since the fall of Roe. So, the—in other countries, primary care is used to providing contraception for people, but in our country, we have more specialization, and we’re part of this big move to try to have primary care providers trained and able to offer all contraceptive services to their patients.
What different avenues can patients seek contraception?
[0:06:20]
CYNTHIA HARPER: We also train the primary care providers to educate their patients about contraceptive at all access points—at the pharmacy, online—to give them the information and the education they need to be able to seek contraception and through telehealth. For example, young people, we’ve done studies that show that they still don’t quite know that they can have contraceptive access through telemedicine, and this is a really important avenue today. After the pandemic, telemedicine grew considerably, and a lot of clinics are using it to provide contraception, but people don’t know yet.
