Arizona Public Health Association (AzPHA)
Resolution: Universal Access to Contraception

Effective Date: October 3, 2018
Based on APHA Approved Policy Number: 20153 on November 3, 2015

Abstract
This resolution supports the universal right to contraception access in Arizona (AZ) and the United States. Contraceptive use confers significant health benefits through reductions in unwanted and high- risk pregnancies, maternal and infant morbidity and mortality, unsafe abortions, and medical therapy. These benefits are so significant that universal access to contraception is accepted internationally as an essential human right.

Frequent barriers to access include financial, geographical, and sociocultural factors. Considering these barriers, as well as contraceptive failure rates, this policy supports the universal human right to voluntary, informed, affordable access to the full range of modern contraceptive methods, including emergency contraception. In addition, it urges health providers and health funding systems to ensure the right to contraception through services including comprehensive evidence-based counseling, language translation, and referrals as needed. Finally, it urges governments and donor agencies to support contraceptive technology research as well as strategies to facilitate use and acceptability.

Relationship to Existing AzPHA Resolutions
Through its resolutions, policies and advocacy, AzPHA has long supported the right to contraception access. However, AzPHA has no up-to-date comprehensive resolution addressing the necessity and public health benefits of universal, informed, and voluntary access to the full range of contraceptive methods. Previous resolutions provide basic foundations for this proposed contraception resolution and many are outdated.

The intent of this resolution is to update AzPHA’s long standing position on access to contraception and
when adopted, will replace previously approved topic-related resolutions and serve as the basis for
AzPHA’s education and advocacy efforts on this topic. The following resolutions are being recommended for updating and replacement by this new universal access to contraception resolution.

Resolution Title Date
Support for Local Birth Control Clinics 1938
Proper Medical Supervision in Birth Control Clinics 1938
Proposed Resolution by APHA on Male Involvement in Family
Planning 1981
Adolescent Access to Comprehensive, Confidential Reproductive
Health Care 2005

At the center of this proposed AzPHA resolution is the fundamental belief in an individual’s right to informed and voluntary choice of contraceptive methods during her or his life cycle for pregnancy prevention, delay of a pregnancy, disease prevention, or medical treatment. This right to contraception includes the right to information on the effectiveness of all methods, as well as their side effects,

reversibility, and other related issues, to enable voluntary and informed contraception choice.[1–4]
Ideally, a person’s literacy or income level or place of residence would not limit informed contraceptive choice.[1,4,5] This comprehensive resolution on universal access to contraception contributes to
AzPHA’s mission to improve public health and achieve equity in health status; it is an essential
component of AzPHA’s priority to ensure rights to health and health care.

Problem Statement
The development of safe, effective contraception is widely considered to be one of the greatest public health achievements of the 20th century.[6] Contraception allows individuals to safely space and limit their pregnancies and reduces unintended pregnancies, unsafe abortions,[7] and maternal morbidity and mortality.[8] Contraception also improves birth outcomes, slows population growth, and improves socioeconomic status.[9–12] Contraception plays a pivotal role in the well-being and health of women and gives individuals control over their sexuality, fertility, and reproduction.

Many contraceptive methods reduce the risk of endometrial and ovarian cancers, are therapeutic agents for menstrual-related disorders, and have other proven health benefits.[12] Evidence has shown definitively that the relative risk associated with use of any tested method of contraception is significantly lower than the risks from pregnancy, childbirth, and unsafe abortion.[13]

Evidence-Based Strategies to Address the Problem
With universal access to contraception, individuals make choices resulting in positive public health outcomes. There is extensive historical and evolving evidence over the past 60 years, both domestically and internationally, supporting many strategies to improve contraception access and use. Studies [14– 17] have shown the success of the following strategies:

● Comprehensive, evidence-based sexuality and contraception education and counseling without bias, discrimination, or coercion;
● A focus on antenatal, childbirth, and postpartum visits as key opportunities to reach clients for family planning services;
● Advocacy and community outreach projects engaging multiple disciplines and including social media, social and community gathering locations, peer-to-peer engagement, behavioral modification programs, condom negotiation training, and group engagement;
● Voluntary and client-centered choices of contraceptive methods;
● Availability of community-based reproductive health services;
● Low- or no-cost provision of contraception and reproductive health services;
● Adequate and accessible referral systems in the case of conscientious objection; and
● Safe and affordable access to emergency contraception and legal abortion.

These strategies have demonstrated higher rates of effective contraception use, lower unintended pregnancy rates, and improved birth spacing. Use of these findings to drive health policies has demonstrated the same results on a larger scale.

Whereas AzPHA Supports Universal Rights to Contraception Access;

The AzPHA urges protection and fulfillment of rights to safe, voluntary, confidential access to the full range of contraceptive methods without barriers, regardless of age, marital status, gender identity, ethnicity, sexual orientation, religious background, socioeconomic status, geography, health status (including chronic disease, especially HIV/AIDS), nationality, immigration status or other demographic characteristics.

Whereas AzPHA Strives to Ensure Universal Access to Evidence-Based Contraceptive Information and Services;

The AzPHA supports comprehensive and evidence-based reproductive health education curricula for doctors, nurses, clinicians, and non-clinicians providing primary health care so that relevant content on all currently available contraceptive methods is routinely integrated into the education of all individuals involved in the delivery of contraceptive services.

The AzPHA urges health systems to address the main barriers to access to contraception in their local/national context, such as legal, financial, and geographical factors; gender-based violence; and sociocultural factors. Also, measures should be taken to ensure implementation of referral systems for contraceptive or abortion services in cases of conscientious objection.

The AzPHA supports the right of all individuals to evidence-based, comprehensive contraceptive counseling and education free from personal bias, including information on risks, benefits, effectiveness, proper usage, alternatives, and adverse effects, accompanied by a comprehensible, culturally/linguistically appropriate informed consent process.

The AzPHA urges that health policies and regulations guarantee universal access to emergency contraception in cases of sexual violence, rape, contraception failure, and other instances of unprotected sexual intercourse.

The AzPHA supports the principle of voluntary and informed choice under all circumstances and opposes practices that coerce or exert undue pressure to use contraception or to use methods unacceptable to the user.

The AzPHA urges governments and organizations to respect, protect, and fulfill sexual and reproductive health and rights, including actions to make modern contraception and safe legal abortion available, accessible, and affordable for all Arizonans.

Whereas AzPHA Advocates to Ensure Adequate Funding of Universal Contraception;

The AzPHA urges that health funders and payers, public and private, cover the cost of all contraceptives that have been shown to be effective in preventing pregnancy or are medically indicated.

The AzPHA advocates adequate government and private funded programs and services aimed at prevention and management of unintended pregnancies (for all women and men, regardless of citizenship status) that include contraceptive methods, access to emergency contraception and legal and safe abortion.

Whereas AzPHA Supports Contraceptive Access through Research and Development;

The AzPHA urges the continued development of contraceptive technology to improve the safety, effectiveness, and acceptability of methods for both men and women. AzPHA further urges new, ongoing, and increased funding (from both public and private sources) to support research designed to address factors enhancing or limiting voluntary and informed contraceptive use in diverse cultural and social settings.

Therefore, be it resolved that the AzPHA supports and advocates for the rights to universal access and delivery of contraception services throughout Arizona, including ongoing comprehensive education, funding, use of evidenced-based information and services, and research efforts for such services.

References

1. United Nations Population Fund and Center for Reproductive Rights. Briefing paper: the right to contraceptive information and services for women and adolescents. Available at: http://www.unfpa.org/resources/rights- contraceptive-information-and-services-women-and-adolescents. Accessed December 15, 2015.

2. Cook RJ, Dickens BM, Fatahalla MF. Reproductive Health and Human Rights: Integrating Medicine, Ethics and Law. Oxford, England: Oxford University Press; 2003.

3. Population Reference Bureau. Contraceptive evidence: questions and answers. Available at: http://www.prb.org/pdf13/contraceptive-evidence-2013.pdf. Accessed December 15, 2015.

4. Hardee K, Kumar J, Newman K, et al. Voluntary, human rights–based family planning: a conceptual framework. Stud Fam Plann. 2014; 45:1–18.

5. Singh S, Darroch JE. Adding it up: the costs and benefits of investing in sexual and reproductive health. Available at: http://www.unfpa.org/adding-it-up. Accessed December 15, 2015.

6. Centers for Disease Control and Prevention. Achievements in public health, 1900–1999: family planning. MMWR Morb Mortal Wkly Rep. 1999;48:1073–1080.

7. Peipert JF, Madden T, Allsworth JE, Secura GM. Preventing unintended pregnancies by providing no-cost contraception. Obstet Gynecol. 2012;120:1291–1297.

8. Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012;380:149–156.

9. Conde-Agudelo A, Rosas-Bermudez A, Kafury-Goeta A. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA. 2006;295:1809–1823.

10. Zhu B. Effect of inter-pregnancy interval on birth outcomes: findings from three recent US studies. Int J Gynaecol Obstet. 2005;89(suppl 1):S25–S33.

11. Wendt A, Gibbs CM, Peters S, Hogue CJ. Impact of increasing inter-pregnancy interval on maternal and infant health. Paediatr Perinat Epidemiol. 2012;26(suppl 1):239–258.

12. Maguire K, Westhoff C. The state of hormonal contraception today: established and emerging non-contraceptive health benefits. Am J Obstet Gynecol. 2011;205(suppl 4):S4–S8.

13. Hatcher RA, Cates W, Trussel J, Nelson A, Kowal D, Policar M. Contraceptive Technology. 20th ed. New York, NY: Ardent Media; 2011.

14. Secura GM, Madden T, McNicholas C, et al. Provision of no-cost, long-acting contraception and teenage pregnancy. N Engl J Med. 2014;371:1316–1323.

15. Harper CC, Rocca C, Thompson K, et al. Reductions in pregnancy rates in the USA with long-acting reversible contraception: a cluster randomized trial. Lancet. 2015;386:562–568.

16. Canning D, Schultz PT. The economic consequences of reproductive health and family planning. Lancet. 2012;380:165–171.

17. Tavernise S. Colorado’s effort against teenage pregnancies is a startling success. Available at: http://www.nytimes.com/2015/07/06/science/colorados-push-against-teenage-pregnancies-is-a-startling- success.html. Accessed December 15, 2015.

170~2018_(1) AzPHA Resolution Universal Access to Contraception (medication, reproductive health)

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