When Bijoux, 41, got married in 2009, she knew she wanted to enjoy wedded bliss for a while without adding baby joy to the mix. She did her research, talked to her OB/GYN, and decided that an intrauterine device (IUD) would best empower her to build the life she wanted and protect her from an unintended pregnancy. That’s when her roller coaster ride began.
As of 2019, over 65% of women in the U.S. use a form of contraception to prevent pregnancy or treat various reproductive conditions, among other reasons. Black women are less likely to use contraception and are at a higher risk for unplanned pregnancies, making access to birth control crucial to the fight for women to own their reproductive health. But many health disparities prevent them from getting the care they need to decide if, when, and how to start a family.
“As both a woman of color and an obstetrician/gynecologist for over 20 years, I know too well the barriers that plague those who look like me when trying to access quality health care or exercise their reproductive and family planning rights,” said Dr. Ashanda Saint Jean, assistant professor of Obstetrics and Gynecology at New York Medical College. These barriers to access can include cost, lack of insurance or adequate coverage, unemployment or underemployment, and issues interacting with the medical system.
Unemployment changed Bijoux’s access to her birth control. “For a while, I didn’t have insurance before the Affordable Care Act, so I had a prescription for birth control that I would take up through my local health department,” she said. This meant she had to get an annual checkup at a department with doctors who she said were “not that good at treating you like a person.”
Historically, Black women have faced racial discrimination at the hands of reproductive healthcare providers, leading to an ongoing mistrust of the doctors they depend on for their birth control prescriptions. Black women between the ages of 18-49 are more likely to report having a negative experience with their healthcare provider. And even getting to the doctor’s office to refill prescriptions can pose a hardship for those who lack transportation, childcare, or the ability to take time off work.
Bijoux had to pick up her birth control prescription from her local county health department “like clockwork” every month to make sure she was protected against an unintended pregnancy. When she found a job, however, she no longer qualified for free birth control through her local health department. “I think I did, actually, a few times, pay full price out-of-pocket,” while she was working, she said. Having her birth control when she needed it meant paying more than $200 for peace of mind. A 2024 survey reported that 1 in 5 women had to discontinue using their birth control because they were uninsured. Changes in income, insurance coverage, and employment can instantly change women’s ability to get the method of birth control that works for them.
The Affordable Care Act was a game-changer for Bijoux and millions of women trying to control their reproductive lives. Starting in 2014, the Affordable Care Act expanded optional Medicaid coverage to people whose income falls below 138% of the federal poverty level. Today, that coverage can vary per state and also depends on immigration status. In 2021, Medicaid covered 64% of all births to Black mothers, underscoring its importance in improving health disparities that disproportionately affect Black women. Lower-income women who need birth control may fall into a “Medicaid coverage gap” if they reside in one of the 10 states that have yet to adopt the program’s expansion. But enrolling in Medicaid, maintaining coverage, and getting appointments can be complex to navigate for those who rely on the program for healthcare.
Over-the-counter birth control could be an attractive option for women who are unable to meet their healthcare needs through the Affordable Care Act. There are also people and organizations everywhere dedicated to helping Black women and their families take charge of their health and well-being—including Bijoux herself.
At her managing position with a nonprofit in Arkansas, Bijoux helps to level the court for low-income families, providing them with resources for family planning in a state that has the highest maternal mortality rate in the nation. Her organization steps in to be part of their village. Using culturally sensitive, trauma-informed methods, she believes that increasing birth control access gives mothers “an opportunity to think about what they would like and what they can handle.”
As for Bijoux herself, birth control puts the ball in her court, so she can live her best life as a divorcée, plant mom, Pokémon enthusiast, and soul singer. “Using birth control gave me the time I needed to choose whether or not I wanted to even have children,” she said. And in the space to make that decision, she has found the freedom to build a life she loves.
Dara T. Mathis is a freelance writer who reports on reproductive and mental health, parenting, and Black history. A recipient of the 2024 American Mosaic Journalism Prize, she has contributed health-focused writing to SELF Magazine and the New York Times. Her work on this initiative supports Level The Court’s purpose to empower Black women to own their reproductive health journeys.
