Healthcare Policies Must Work for Women, Not Against Them

Challenges to accessing healthcare are not new for women; however, in the past year, several new roadblocks have hindered women’s access. These roadblocks span the gamut from the COVID-19 pandemic to policy changes that have impacted the fabric of women’s healthcare access. Also looming are significant changes to federal and state policies that threaten to roll-back the access women have gained to healthcare over the past decade as well as a pending lawsuit before the Supreme Court that could decimate access for millions of people.

Passage of the Affordable Care Act (ACA) in 2010 resulted in significant improvements to equitable access to healthcare for women. When the ACA was implemented in 2018, just 11% of women (10.8 million) were uninsured, whereas prior to ACA, 18% (~20 million women) were uninsured.[1] Not only did women gain insurance coverage rights with ACA, women were no longer charged higher premiums just for being women, pregnancy coverage denials were ended and women’s preventive health services were now included in basic coverage. Yes, you read that correctly, women in the past have been denied insurance coverage for basic care including pregnancy.[2] These positive strides under the ACA are threatened today due to recent and upcoming Supreme Court rulings.[3]

The COVID-19 pandemic also poses a major obstacle for women seeking comprehensive health care. According to the University of Southern California’s ongoing coronavirus survey, job losses, additional childcare duties and mental distress have all disproportionately affected women since the start of the pandemic.[4] Furthermore, job loss as a result of the pandemic has led to loss of health insurance for many women. For Black women and other women of color, the effects of COVID-19 have been even more damaging, further highlighting the inequities in the healthcare system.[5]

As already noted, even with the ACA in effect, 10.8 million women remain uninsured in the US. But 2020 has been rapidly rolling back the number of women able to get access to insurance and medications. On July 8, the Supreme Court ruled to uphold the Trump Administration’s regulations allowing employers and insurers to decline providing contraception coverage because of religious or moral objections. Implementation of these rules will immediately and significantly decrease contraceptive access for 70,500 to 126,400 women.[6]

In November, the Supreme Court will hear a case that has the potential to overturn the entire ACA and with it critical provisions for women’s health. This would have far reaching impacts on women’s access to care, with an estimated 68 million women with preexisting conditions and the approximately six million women who become pregnant annually excluded once again from healthcare insurance and therefore affordable access to healthcare.[7]

As of May 2020, an estimated 27 million people across the U.S. lost health insurance because of COVID-19.[8] For women, losing insurance could mean losing their ability to affordably access healthcare including well women visits, cancer screening, pregnancy care and essential reproductive healthcare services like birth control. Access to family planning is even more important during the coronavirus pandemic since pregnant women have been found to experience more severe complications from COVID-19.[9] No matter the unique situation, all women should feel confident in their ability to access healthcare, no matter their race, income, disability or health need.

We have an urgent need to address health disparities arising from race, disability and income levels. Racism is a public health issue that has been brought to the forefront by COVID-19. Due to inequitable care in the healthcare system, people of color often experience increased negative health outcomes.[10] Specifically, disparities between white women and women of color exist when it comes to birth control use, caused by barriers such as cost, structural racism, and cultural stigma.[11] This is evident in the rate of unplanned pregnancies: Black women are almost two and a half times more likely to have an unplanned pregnancy than white women, even after controlling for differences in income level.5 We need changes across our healthcare system to ensure that women of all races and socioeconomic status can access birth control.

Additionally, people with disabilities are often erased from conversations about birth control. We’ve seen that self-reported cognitive disabilities (“serious difficulty concentrating, remembering, or making decisions”), as well as physical disabilities, are significant predictors of birth control choices.[12] In fact, use of the pill is less common among people with physical disabilities. Women living with disabilities need to be visible in the conversation about reproductive health and access to birth control.

One positive trend is a rapid increase in the use of telehealth services. In April of this year, telemedicine visits accounted for 69 percent of all appointments.[13] Telehealth medicine can be particularly useful for people whose work and/or family schedules make it difficult to get to doctors’ offices and/or pharmacies during normal business hours. This form of access will continue to be important even as public transportation, daycare centers and offices fully reopened.

There are excellent resources for those seeking birth control and other reproductive healthcare services. Here at Medicines360, we developed a three-part webinar series to provide information on the birth control options, the best ways to get birth control and the policy considerations that could impact access.

The fight for women’s healthcare access, including birth control access, will take a collective effort on all levels. To make this a reality for all, we need policy solutions that will:

  • Defend gains for women’s health under the ACA, including coverage expansions and no-copay preventive services like birth control and protecting pregnancy coverage;
  • Preserve and build on innovative solutions to expand access for underserved women, like increased flexibility for telehealth; and
  • Invest in policies and programs designed to address the root causes of systemic inequality in our health system, especially as they relate to women of color, women with low incomes and women living with disabilities.

Women must have the right and ability to equitably obtain and afford healthcare throughout their lives. Women must have the right to choose if and when they want to get pregnant and be able to get quality care when they are pregnant.[14] Policies on women’s health – both existing and newly created – should uphold these basic human rights. We’re dedicated to supporting the fight to protect access to healthcare for all women.


[1] https://www.kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/

[2] Waxman HA, Stupak B. Coverage denials for pre-existing conditions in the individual health insurance

market [Internet].Washington (DC): US House of Representatives; 2010 https://oversight.house.gov/sites/democrats.oversight.house.gov/files/documents/Memo-Coverage-Denials-Individual-Market-2010-10-12.pdf

[3] https://www.npr.org/sections/health-shots/2020/09/21/915000375/the-future-of-the-affordable-care-act-in-a-supreme-court-without-ginsburg

[4] USC News, COVID-19 has hit women hard, especially working mothers, https://news.usc.edu/171617/covid-19-women-job-losses-childcare-mental-health-usc-study/

[5] Essence.com, ESSENCE Releases ‘Impact Of COVID-19 On Black Women’ Study, https://www.essence.com/health-and-wellness/essence-covid-19-black-women-study/

[6] Department of the Treasury, Religious Exemptions and Accommodations for Coverage of Certain

Preventive Services Under the Affordable Care Act; Final Rule, https://www.govinfo.gov/content/pkg/FR-2018-11-15/html/2018-24512.htm

[7] https://www.americanprogress.org/issues/healthcare/news/2020/06/24/486768/health-care-repeal-lawsuit-strip-coverage-23-million-americans/

[8] Garfield R, Claxton G, Damico A, & Levitt L.  Eligibility for ACA Health Coverage Following Job Loss, https://www.kff.org/coronavirus-covid-19/issue-brief/eligibility-for-aca-health-coverage-following-job-loss/

[9] Ellington S, Strid P, Tong VT, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020. MMWR Morb Mortal Wkly Rep. 2020 Jun 26; 69(25): 769–775. doi: 10.15585/mmwr.mm6925a1

[10] https://www.americanprogress.org/issues/race/news/2020/05/04/484339/workers-color-disproportionately-risk-serious-complications-coronavirus/; Gee GC, Ford CL. Structural Racism and Health Inequities: Old Issues, New Directions. Du Bois Rev. 2011;8(1):115-132. doi:10.1017/S1742058X11000130

[11] Gunderson A, Reducing Racial Disparities in the US by Increasing Contraception Coverage. Chicago Policy Review (Online). 2017. https://search.proquest.com/docview/1977984017?fromopenview=true&pq-origsite=gscholar

[12] Mosher W, Hughes RB, Bloom T, Horton L, Mojtabai R, Alhusen JL. Contraceptive use by disability status: new national estimates from the National Survey of Family Growth. Contraception. 2018;97(6):552-558. doi:10.1016/j.contraception.2018.03.031

[13] Ross C. Telehealth grew wildly popular amid Covid-19. Now visits are plunging, forcing providers to recalibrate. STAT. 2020. https://www.statnews.com/2020/09/01/telehealth-visits-decline-covid19-hospitals/

[14] https://www.cdc.gov/nchs/maternal-mortality/index.htm

About Medicines360

Medicines360, located in San Francisco, California, is a nonprofit global women’s health pharmaceutical organization with a mission to catalyze equitable access to medicines and devices through product development, policy advocacy, and collaboration with global and US partners. Medicines360, through its subsidiary Impact RH360, launched the Avibela Project to expand access to hormonal IUDs in low- and middle-income countries. For more information, visit medicines360.org

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AVIBELA can be made available in the following 88 countries

  1. Algeria
  2. Angola
  3. Bangladesh
  4. Belize
  5. Benin
  6. Bhutan
  7. Botswana
  8. Burkina Faso
  9. Burundi
  10. Cambodia
  11. Cameroon
  12. Cape Verde
  13. Central African Republic
  14. Chad
  15. Comoros
  16. Costa Rica
  17. Cuba
  18. Democratic Republic of the Congo
  19. Djibouti
  20. Dominica
  21. Dominican Republic
  22. Egypt
  23. El Salvador
  24. Equatorial Guinea
  25. Eritrea
  26. Ethiopia
  27. Gabon
  28. Ghana
  29. Grenada
  30. Guatemala
  31. Guinea
  32. Guinea-Bissau
  33. Haiti
  34. Honduras
  35. India
  36. Indonesia
  37. Ivory Coast
  38. Jamaica
  39. Kenya
  40. Lao PDR
  41. Lesotho
  42. Liberia
  43. Libya
  44. Madagascar
  45. Malawi
  46. Malaysia
  47. Maldives
  48. Mali
  49. Mauritania
  50. Mauritius
  51. Mayotte
  52. Morocco
  53. Mozambique
  54. Myanmar
  55. Namibia
  56. Nepal
  57. Nicaragua
  58. Niger
  59. Nigeria
  60. Pakistan
  61. Panama
  62. Papua New Guinea
  63. Philippines
  64. Republic of the Congo
  65. Rwanda
  66. Sao Tome and Principe
  67. Senegal
  68. Seychelles
  69. Sierra Leone
  70. Somalia
  71. South Africa
  72. South Sudan
  73. Sri Lanka
  74. Kitts and Nevis
  75. Lucia
  76. Vincent & the Grenadines
  77. Sudan
  78. Swaziland
  79. Tanzania
  80. Thailand
  81. The Gambia
  82. Timor-Leste
  83. Togo
  84. Tunisia
  85. Uganda
  86. Vietnam
  87. Zambia
  88. Sri Lanka

Tina Raine-Bennett, MD, MPH, FACOG

Chief Executive Officer

Tina Raine-Bennett, MD, MPH, is CEO of Medicines360. Previously, she served as a senior research scientist at the Kaiser Permanente Northern California Division of Research and the research director of the Women’s Health Research Institute. She is a Board-Certified Obstetrician Gynecologist who received her medical training at the University of California, San Diego, and post-graduate residency training and MPH at the University of Washington in Seattle, where she also completed a Robert Wood Johnson Clinical Scholars Fellowship. She was also senior staff physician at Kaiser Permanente and has a special interest in family planning and adolescent reproductive health.

As the director of the Women’s Health Research Institute, Dr. Raine-Bennett focused on expanding research on women’s health within the Division and translating women’s health research into clinical practice and policy within the Ob/Gyn departments in Northern California. She also promoted the involvement of clinicians in research designed to improve the health outcomes and healthcare experiences of women at Kaiser Permanente and women in general.

Prior to Kaiser Permanente, Dr. Raine-Bennett was a professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at University of California, San Francisco (UCSF). She was based at San Francisco General Hospital where she was also the medical director of the New Generation Health Center, a UCSF affiliate site that provides community-based reproductive health services. Dr. Raine-Bennett’s research has focused on contraceptive methods and on elucidating factors that influence contraceptive choice and continuation, and she was principal investigator on NIH grants to assess hormonal contraceptive use predictors and develop interventions to improve contraceptive access.

Her past and current research on emergency contraception has focused on the safety of making emergency contraception more accessible and she conducted a pivotal clinical trial to make emergency contraception available to teens without a prescription. She served on the editorial board of Obstetrics and Gynecology and has over 100 peer-reviewed publications. She was the Treasurer of the Board of Directors for the Society of Family Planning and Society of Family Planning Research Fund. She has also served as an examiner for the American Board of Obstetrics and Gynecology, and on national committees for the American College of Obstetrics and Gynecology and the National Medical Board of Planned Parenthood Federation of America.