In June, when the Supreme Court overturned Roe v. Wade and ended the constitutional right to abortion, women’s health advocates around the country expressed concern that the right to contraception might also be at risk.
“This issue is hugely important to our community,” says Nathan Schaefer, vice president of public policy for the National Hemophilia Foundation. “Many people with bleeding disorders rely on birth control — in a variety of forms (IUDs, pills, etc.) — to control their condition. Without access to birth control, the risk of uncontrolled bleeding, the need for a hysterectomy, or even potentially fatal incidents may increase.”
In addition, pregnancy can be more dangerous in people with bleeding disorders, so they may choose to use hormonal contraceptives to avoid it.
Why Might Contraception Be Banned?
Many myths persist that emergency contraception and IUDs cause abortion, despite scientific evidence to the contrary. “Legislators conflating abortion and certain methods of birth control — in particular intrauterine devices (IUDs) and emergency contraception (EC) — are taking advantage of a lack of knowledge about these methods, and people’s understanding of how birth control works,” states the National Women’s Law Center. “These policymakers are preying upon abortion stigma, believing that if they can convince people that birth control methods are abortion, they can successfully restrict access to birth control — or ban it altogether.”
Another concern is that pharmacists and store clerks may decide not to sell or fill prescriptions for contraceptives if it goes against their religious principles. Over the summer, a Walgreens clerk reportedly refused to sell condoms to a married couple because of his faith. “That could create areas of lesser access to care. This, to me, seems more imminently likely, but who can predict what will occur?” says Shannon L. Carpenter, M.D., M.S., a hematologist at Children’s Mercy Hospital in Kansas City, Missouri.
“It’s unethical for pharmacists to not fill prescriptions that have been written,” adds Maureen Baldwin, M.D., MPH, associate professor of obstetrics and gynecology at Oregon Health & Science University. “In addition, pharmacies are required under federal civil rights law to fill prescriptions without making determinations about the suitability of a prescribed medication for a patient.”
Not Just for Birth Control
Today, providers prescribe hormonal contraception for a wide variety of reasons other than preventing pregnancy. “For people with bleeding disorders, it’s about regulating their menstrual cycles, but it can also help with PMS symptoms, cramps, anemia, endometriosis, ovarian cysts, PCOS (polycystic ovary syndrome), and more,” says Marybec Griffin, Ph.D., an assistant professor at the Rutgers University School of Public Health who studies women and periods. “A ban would impact a lot more than just somebody’s ability to get pregnant. Wherever we see limited access to abortion and limited access to contraception, we see worse health outcomes in a lot of different ways, too.”
Baldwin believes that if hormonal contraception is banned for use in preventing pregnancy, it won’t be banned for all other uses. “There are many hormonal medications that have indications other than contraception. If they are FDA-approved for management of heavy menstrual bleeding, among other things, they won’t be banned for those indications.”
Providers should write the indication that they’re prescribing the medication for on records and documents, Baldwin recommends, and avoid using the terms birth control or contraception unless they are using it for that indication. “This may help with reluctant pharmacists and with patients who are put off by the stigma of birth control,” she says.
Advocacy Is Key
Carpenter urges health care providers, whether they are pro-choice or anti-abortion, to start advocating for their patients. “There are going to be people within the bleeding disorders community who may feel that overturning Roe was the right choice, but that doesn’t mean they can’t still advocate for bleeding disorders patients to get this medication without betraying their beliefs,” she says. “This isn’t a pro-life or pro-choice stance. It shouldn’t be a divisive issue, because this is a documented, evidence-based, FDA-approved treatment for patients who have heavy menstrual bleeding and have bleeding disorders.”
NHF’s Schaefer says patients should be vocal advocates, too: “Contact your elected officials. Write letters, call, email, share on social media. Explain to them that for you, birth control is more than just a measure of reproductive rights — it’s a tool to control your health writ large. Explaining the difference that birth control has made in your bleeding disorder journey can educate others to the many important medical uses of birth control.”
“We have heard from a significant number of chapters that access to reproductive care for women with bleeding disorders is uncertain,” says Kristi Harvey-Simi, NHF’s director of chapter development. “NHF is eager to listen to community members’ concerns and do everything we can to ensure access to health care — both treatment and prevention — is guaranteed, for all people impacted by bleeding disorders.”
For more information about bleeding disorders in women, visit: