Access to the full array of modern contraceptive methods is fundamental to the rights, health and well-being of individuals, their families, and society. Unfortunately, such access cannot be assumed to be either adequate or improving in the United States. Recent, and anticipated, reproductive policy changes are reshaping contraceptive access in the U.S. Dobbs v Jackson Women’s Health, the Supreme Court case that overturned the constitutional right to abortion, has affected both abortion and contraceptive access, through clinic closures and changes in the contraceptive workforce.
Compounding this, it is widely anticipated that the Trump Administration will reinstate the policies implemented in its first term, including sharp reductions in funding to Title X clinics, a major backbone of publicly funded contraception in the U.S. The Coalition to Expand Contraceptive Access and others have noted that the current contraceptive workforce cannot meet current or future demand, and that novel approaches are needed to expand access. Other contemporary innovations include over-the-counter sales of a progestin-only pill, telehealth contraceptive services, and pharmacy prescribing, all which are promising but remain inadequate to address the problem.
An added strategy may be to offer contraceptive provision into our Emergency Departments (EDs). With approximately 29 million ED visits annually by women aged 15 to 45, and a potential contraceptive-providing workforce of 48,000 physicians and 26,000 advanced practice providers, EDs are uniquely positioned to provide critical reproductive health services in this new policy landscape. EDs are highly accessible across the U.S. population, supply is relatively stable, and they have a long-established role as a safety net for health care needs that fall between the cracks. Further, EDs are increasingly staffing telehealth services, expanding their accessibility and reach within the community.
Hospital maternity care services are in decline and maternal and contraceptive care deserts are expanding across the U.S. Therefore, EDs—particularly those in rural settings—face the reality that patients seeking reproductive services will rely more on emergency care settings. EDs already address many preventive and health maintenance care functions, particularly for prescription refills, chronic disease management, and addressing substance use disorders. Extending this capacity to contraceptive care could serve as another critical bridge to gaps in access.
A growing body of evidence suggests that patients find the ED to be an acceptable place for receiving contraception, with many patients expressing interest in initiating or changing their contraceptive method during an ED visit. Programs designed to integrate contraceptive counseling and provision into ED workflows—through standardized screening, patient education, and clinician training—may help address unmet needs, but the feasibility, acceptability, and quality of such programs still needs to be studied.
Preliminary studies have shown promise that EDs can help improve equitable access to contraception. High unmet need for contraception has been identified among ED patients, with one analysis demonstrating that more than a third of sexually active women, who did not desire pregnancy within the next year, were not using a method of contraception. Research has found high acceptability for receiving contraceptive counseling and methods among both adolescent and adult patients in the ED. In one study, more than half of surveyed patients, including those facing systemic barriers, expressed interest in receiving contraceptive counseling or methods in the ED. Pilot programs have similarly been well received by ED clinicians, who recognize the need for and importance of the work.
A Call for Research and Policy Action
If EDs are to take on an expanded role in contraceptive care, more research is needed to understand how to optimize their effectiveness. Key questions include:
- How to best integrate contraceptive services into ED workflows;
- How these services impact patient-centered outcomes;
- What systemic barriers must be addressed to support ED clinicians and to overcome specialty-specific cultural obstacles to including contraceptive counseling and provision into usual practice; and
- The broader implications of restricted access to reproductive health care on emergency care practices and maternal health outcomes, particularly among Medicaid recipients and other populations at risk of experiencing poor health outcomes.
Investments in ED-based reproductive health programs have the potential to address immediate gaps in care while informing long-term strategies for health system innovation. Policymakers and health care leaders must act to ensure that emergency departments are equipped to meet this growing demand, with the ultimate goal of building a more equitable and comprehensive reproductive health care system.
This post has been co-authored by one of AcademyHealth’s Reproductive Health Senior Scholars in Residence, Dr. Maria Rodriguez, who provides thought leadership on reproductive health issues within the health services research field and provides expert guidance to the Research Community on the Equity Impacts of Dobbs.
Supported by the Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy. The views presented here are those of the author and not necessarily those of the Commonwealth Fund, its directors, officers, or staff.