WASHINGTON – As the United States marks a year since the Supreme Court overturned the right to abortion nationwide, reproductive rights advocates said rising barriers to family planning services are leaving millions of women without easy access to contraception.

Though birth control remains legal, campaigners said women and girls face mounting obstacles to access, from long waits for appointments at overstretched clinics to state bills restricting contraceptive access for teenagers.

“There’s a natural connection ideologically around restricting abortion, contraception, and broader sexual reproductive health care,” said Dr Megan Kavanaugh, a researcher at reproductive rights research group the Guttmacher Institute.

“It’s a really concerning trend that we’re seeing.”

Contraceptives have been in focus since the top US court on June 24, 2022, overturned the 1973 Roe versus Wade ruling, which had legalised abortion nationwide.

Conservative justice Clarence Thomas – among those voting with the 6-3 majority in the case – said the court should also reconsider a 1965 decision that established the right of a married couple to use contraception.

The US Department of Health and Human Services said it saw a rise in complaints from women who were wrongly denied insurance coverage for birth control following the ruling.

Rights groups have raised fears that state bans on abortion from the moment of conception could be written or interpreted to include some contraception such as the “morning after pill” or intra-uterine devices (IUDs).

More than 19 million US women of reproductive age already live in contraceptive deserts, according to data by reproductive rights non-profit Power to Decide.

It defines a contraceptive desert as a county without enough health centres offering a full range of birth control methods to meet the needs of all women of reproductive age living there.

“People should have access to both high quality contraceptive services and abortion care in their own community without stigma, shame and unnecessary barriers,” said Mr Raegan McDonald-Mosley, chief executive at Power to Decide.

States target access to contraception

Almost two-thirds of women aged between 15 and 49 in the US use some form of contraception, found the Centres for Disease Control and Prevention.

But for some people, access is already limited.

A dozen states allow some health care providers to refuse to provide contraception services, according to the Guttmacher Institute, while the same number ban the provision of state family planning funds to organisations that provide abortions.

States including Kentucky and Montana brought in laws this year allowing parents to veto reproductive healthcare for their children. In Texas, a judge ruled last year that children need parental consent to get birth control at federally funded clinics.

Reproductive rights experts say appointment waiting times and prohibitive costs also create obstacles for those seeking to avoid pregnancy.

“There are places where people have to wait three or four months, sometimes even longer, just to get a routine visit for contraception,” said Mr McDonald-Mosley.

“Lack of access disproportionately impacts people of colour, people with lower incomes, young people and people who live in rural areas.”

For those without health insurance, birth control can cost up to US$2,000 (S$2,700) a year, according to 2021 research by US online prescription drug platform GoodRx.

President Joe Biden has rolled back restrictions on the national Title X affordable birth control programme that were implemented under his predecessor Donald Trump - but rights campaigners say more funding is needed.

The programme’s funding has flatlined at US$286 million annually, failing to keep up with inflation in costs and rising demand, said KFF, a non-profit focusing on health policy.

Advocates have also raised concerns over states’ funding for crisis pregnancy centres that counsel women against getting abortions.

Nearly 50 bills were introduced in 21 states to increase funding or support of these centres during the 2023 state legislative session, said Ms Callie Wells, a policy counsel at Planned Parenthood.

“They’re regulating comprehensive care providers out of existence, and they’re funding CPC (crisis pregnancy centres), which don’t provide contraception,” said Ms Wells.

Crisis pregnancy centres have said they offer legitimate health services, but that their mission is to steer women with unplanned pregnancies away from abortion.

Critics say they sometimes mislead women, including by wrongly presenting themselves as offering full services including abortion, and giving women inaccurate information about contraception, pregnancy, and abortion.

Push for right to birth control

Pro-choice lawmakers and advocates have pushed for bills that protect the right to birth control.

In 2022, the lower parliament chamber passed the Right to Contraception Act, which would have guaranteed contraceptive access nationwide. A divided Senate, however, blocked the bill.

The bill was reintroduced in the Senate in June by Democrat senators.

Some states are also taking action to expand access to contraceptives with legislation including to fund family planning services and require insurers to cover 12-month supplies of birth control, shows a Guttmacher Institute legislation tracker.

Meanwhile, in May, an advisory panel to the US Food and Drug Administration voted in favour of allowing sales of a contraceptive drug without a prescription, paving the way for the country’s first over-the-counter birth control pill.

Reproductive rights groups said the move would be a major step forward in protecting access to contraception for vulnerable girls and women.

“This would be a game changer, especially for people who live in these contraceptive deserts who could at least have access to the pill,” said Mr McDonald-Mosley. REUTERS