When I first moved to the United States from Britain, I used the pill, like many women, as a short-term solution while waiting for an IUD appointment. Once, as I looked forward to a multi-week trip, I headed to the pharmacy during my lunch break to get next month’s supply—but my pharmacist informed me that I couldn’t have another month’s supply until my current packet was half completed. I explained that I was traveling for more than three weeks and needed the new packet now, but he told me to call my insurance company.
“Look,” I finally shouted, after ages on the phone, all while standing in busy pharmacy, exasperated at the short-sightedness of the system, “you can let me get another packet of pills now or you can deal with the health costs of an unintended pregnancy later. You choose!”
They let me have the pills.
While this may be a familiar experience for women in the U.S., it was brand new to me. In Britain, women can essentially access their contraceptive of choice when and where they want it—and it’s usually free. I’ve spent most of my life fighting to expand contraceptive choice around the world, but I suddenly faced a new realization while standing at that pharmacy counter: when it comes to family planning, choice is only one part of the equation. Convenience in family planning is not trivial, or a “nice-to-have.” It is essential.
Taking a pill every day is a viable option for some, but it can be tedious and difficult to maintain for others. Prescriptions and monthly trips to the pharmacy add additional hassles and can feel virtually impossible for women who are juggling their jobs, childrearing and often the bulk of household chores. For women who lack the ability to take time off work, who can’t get child care or who live in more remote areas, monthly visits to the pharmacy or a family planning clinic may be impossible.
Convenience plays a fundamental role in a woman’s reproductive choices. You can’t take a pill if you do not have the time to pick up the pill from the pharmacy. This is one of the reasons the Population Council, the nonprofit research organization I lead, first developed the IUD. Approved for use some 20 years ago, its increasing popularity in the U.S shows that convenience is of huge interest. Women gravitate to IUDs as a “carefree” option, providing three to 10 years of protection after insertion. It also makes it remarkably effective.
But the IUD also requires a trip to the doctor to insert and remove—which takes time, money and available health services. Some women aren’t sure if or when they want to try and conceive. Now, a new option on the horizon offers the convenience of a long-acting method, but the control of a short-acting method.
The FDA recently approved Annovera, the first one-year contraceptive that is fully under a woman’s control. Also developed by my colleagues at the Population Council, the approval of Annovera isn’t just a professional win for me. After 20 years of research, I hope Annovera can be a catalyst to bring convenience and user-control to the fore of the contraceptive decision-making process.
A soft, reusable flexible silicone ring, Annovera can be inserted and removed by a woman herself for up to 13 menstrual cycles—giving a whole year of protection from unintended pregnancy—and it doesn’t require refrigeration, which is good for women who travel (like me!), and in lower-resource settings where electricity may not be in regular supply.
Helping meet family planning needs is no trivial matter. Unintended pregnancies are associated with delayed and inadequate prenatal care, are more likely to lead to premature births and have low-birth-weight infants and are connected to increased physical and mental health risks for mom and baby alike. Overlay all these with with socio-economic factors, and we find that unintended pregnancies are most likely among younger women ages 18 to 24, lower-income women, unmarried women and minority women.
These are the exact women whose ability to access reproductive health services is often the first to be curtailed—and for whom convenience, choice and control may seem like a fantasy.
It’s no secret that we’re currently in a tenuous climate for women’s reproductive rights in the U.S. With the contraceptive coverage mandate in the Affordable Care Act at risk, and Title X funding in peril, it’s unclear what the landscape will look like for contraceptive coverage and access, even by the end of 2018. While there is a growing movement to make contraception available over-the-counter in the U.S.—as it is in much of the rest of the world—right now, you still need a prescription for contraception. While that will still be true for Annovera, when it is available in late 2019 or early 2020, at least you don’t need to go back to the pharmacist or your doctor to get a repeat prescription or refill. You have contraceptive care, that you alone control, for the next year.
Convenience can only be considered trivial in matters of contraception if the realities of women’s lives are considered trivial, too. If the last two years have shown us anything, it’s that women are fiercely committed to controlling their destinies, and the development and FDA approval of a new contraceptive method is a step toward giving all of us a little more autonomy.
Now, more than ever, that’s anything but trivial.