More than 8-in-10 Latinos as well as U.S. adults believe that birth control is an essential part of health care, according to a report released Wednesday by the National Campaign to Prevent Teen and Unplanned Pregnancy as part of their fifth "Thanks, Birth Control Day."
But Latina advocates and groups that support and promote birth control access as part of women's health worry that the Trump administration is making it harder for women to obtain accessible, affordable birth control, through recent rules allowing employers to deny covering birth control coverage and efforts to repeal the Affordable Care Act.
"Their whole plan is to sabotage the ACA, which as a [Latinx] community was a huge step forward to health care access," said Ann Marie Benitez, senior director of government relations for the National Latina Institute for Reproductive Health (NLIRH).
Cost is one of the crucial factors Latinas experience when trying to access birth control and many have come to depend on ACA-approved plans to access them free of cost.
Hypothetically speaking, women who cannot afford out of pocket costs without coverage have government programs and community health centers as a safety net. While there are parts of the country with reasonable access to these types of services, nearly 20 million women live in what the National Campaign to Prevent Teen and Unplanned Pregnancy calls "contraceptive deserts."
In some counties, the ratio of clinics to women is one for every 5000-plus women, and other counties do not even have a publicly funded clinic.
"The regions of the country where some of the contraceptive deserts are most intense, are places where you have a large Latina population, such as Texas," said Ginny Ehrlich, CEO of The National Campaign.
If it becomes harder for Latinas to access birth control, "they will go back to these safety net clinics that are already over stretched and not able to serve the population they are already serving."
Before the ACA, contraceptives represented 30 to 40 percent of out-of-pocket health care spending for women, according to a study led by Nora Becker, MD, PhD and a resident physician in Internal Medicine at Brigham and Women's Hospital.
Planned Parenthood puts the range of birth control co-pays between $15 a month and $50 a month. This translates to $180 a year to $600 a year. If women opted for reversible long term contraception, while more effective and cheaper in the long run, upfront costs could be staggering.
"Women on average were paying $250 upfront. But this amount varied even within one insurer. Some women were paying $700 to $800 upfront," said Becker.
Christina, a Latina in her 20s in New York City, remembers considering an IUD brand that was not covered by her insurance. "They were going to charge me 700-something dollars. I couldn't drop that kind of money," she said.
Planned Parenthood's Gomez says Latinas already have a hard time affording birth control. In 2015, "20.9 percent of Hispanic women lived in poverty," according to the National Women's Law Center.
Fifty-seven percent of young Latinas ages 18-34 struggled to afford birth control before the ACA.
The National Campaign and other groups have pointed out that there has been a historic drop in teen pregnancies, particularly among Latinas; the pregnancy rate among Latina teens decreased 56 percent between 1990 and 2011. Yet 1-in-3 Latinas got pregnant before age 20, about 1½ times more than the national rate.
Latina health advocates say many women are worried their access to birth control is at risk with the constant threat of the ACA repeal and replace.
"After Trump was elected, we saw a 900 percent increase in IUD insertion because women were worried about having access to birth control during his presidential term," says Bridgette Gomez, director of Latinx outreach and engagement for Planned Parenthood.
Denisa has a 2-year-old son and is pregnant with her second child. She and her husband decided to not have any more children for now. She is worried about accessing birth control after she gives birth if insurance coverage policies change. "You have to pay for it monthly. It's like having another mortgage!"
The ACA put contraceptives, along with other services such as vaccinations and cancer screenings, on the list of essential care and preventative services that must be covered by insurers. Hormonal contraceptives help women dealing with excessive menstrual bleeding and pain, lupus, diabetes and heart disease according to the NLIRH.
But the primary use for most women is pregnancy prevention.
"Contraception helps Latinas plan for their families and their well-being. It is truly central to our health," said Benitez, who shared her own experience with contraception. When she and her husband were trying to have their second child, her husband was diagnosed with cancer. Contraception helped her family focus its time and resources on the issue at hand.
"It helps make families stronger," she said. Unintended pregnancies put an additional economic burden on a family resulting in lower health outcomes. Additionally, planning allows women to attain higher education levels and pursue careers before having children, leading to economic stability, according to the Guttmacher Institute.
Last month, the Department of Health and Human Services announced that employers are no longer required to pay for birth control coverage, as stipulated by the Affordable Care Act, if they have religious or moral objections, a result of President Donald Trump's executive order to "Promote Free Speech and Religious Freedom."
According to the HHS, this shift was a reflection of a commitment to upholding constitutional freedoms, and conscience rights fall under this purview.
"No American should be forced to violate his or her own conscience in order to abide by the laws and regulations governing our healthcare system," said Caitlin Oakley, HHS press secretary, in a statement issued the day of the release.
Ana Samuel, a research scholar at the conservative leaning Witherspoon Institute, said that while she has been critical of Trump policies, she agrees with this shift. "I think this administration has honored religious freedom. Freedom of conscience is something I celebrate as a Latina, as a human being," said Samuel.
"Conscience rights have such weight under the American Constitution that if they are abrogated, they must be abrogated in the least restrictive way," said Ashleen Menchaca-Bagnulo, associate professor of political science at Texas State University. The implications of holding this position, said Dr. Menchaca-Bagnulo, is that administrations in the future - regardless of party - will respect the seriousness of conscience rights in their executive actions.
But women's health advocates worry this makes access harder. Because of Obamacare's contraceptive coverage mandate, more than 57 million women were able to obtain birth control without co-payments.
"We are very troubled by the inevitability that these rules will result in women losing coverage of birth control through their health insurance," stated The National Campaign's Ehrlich.
"This has nothing to do with religion. They already had accommodations. This is about taking away fundamental health care - plain and simple," said Gomez.
Benitez said Latinas already face a host of barriers in accessing birth control, "when you add an additional one ... it makes it that much more complicated to access to birth control - something that should be part of basic care for women," Benitez said.
About 57.5 million women receive health care coverage from their own or their spouse's employer according to the Kaiser Family Foundation. "We don't know how many will be affected because it is up to the employer to decide and that is scary," says Gomez.
Dr. Benjamin Sommers, of the Harvard T.H. Chan School of Public Health said that "principle is at stake here — of whether we treat contraception as a general approach to health care. It is a treatment, prevention, medication."
The administration claims only employees of the 200 entities that filed lawsuits will be affected. Notre Dame University, one of the institutions to sue the Obama administration over the HHS mandate, was one of the first and most prominent institutions to take advantage of the new HHS rules. In late October, it announced that it would no longer provide birth control coverage to students and employees. The decision was met with pushback on campus from both students and faculty. Last Tuesday, Notre Dame announced in an email its reversal of this decision.
Two of the university's providers of medical benefits "will now continue to provide contraceptives" and the university will not stop "the provision of contraceptives that will be administered and funded independently," according to a statement.
Laura, a Latina graduate from an elite women's college in Massachusetts, got birth control in college for the first time because her school insurance covered it. Had she not had insurance, "it would have impacted my other expenses since work study is minimal pay," Laura said.
Gomez said her organization knows from organizers on the ground that contraception is always a concern in Latino communities.
"Many have started wondering what it might mean now that they might have to pay out of pocket," she said.