OPINION: Expanding contraceptive access for Alaskans isn’t bad policy

The incidence of teen and unintended pregnancies in the United States has been rapidly declining since the 1990s, but this improvement has not been felt equally across the board. American Indian/Alaska Native teens have seen the least amount of improvement in unintended pregnancy rates and are disproportionately disadvantaged in regard to access to birth control methods and education. Despite the initiative and support of public health groups across the state, lawmakers in Alaska have shot down attempts to improve birth control access in rural Alaska communities.

Barriers to health care access exist in many Alaska communities, but none feel this disadvantage more than the more than 12,000 people in rural villages without a nearby medical center. Many of these residents lack transportation and linkage to community resources in major cities. House Bill 17, originally introduced in January 2023, aimed to increase access to oral contraceptive pills in rural Alaska communities by allowing residents to obtain 12 months of oral contraceptives at a time, and requiring insurance companies to pay for this duration of medication. This would allow rural Alaskans to cluster their health care visits when possible and decrease the need to return to a pharmacy every 1-3 months.

The bill was passed in May of this year, then subsequently vetoed by Gov. Mike Dunleavy on Sept. 4 on the basis that forcing insurance companies to pay for 12 months of birth control was “bad policy.”

While it is true that other forms of birth control exist, and popular long-acting reversible contraceptives are covered by most insurance, most typically require more than one visit to obtain and all require a physician’s expertise to reverse. Oral contraceptives are more than 99% effective when used correctly, and require very little instruction to begin and discontinue.

In addition, Alaska allows minors to access birth control without parental consent, but this may be impossible for minors in rural villages that require more assistance in reaching health care services. Often, prescribers are willing to prescribe oral contraceptives with less oversight than other forms of birth control, and may even be willing to prescribe oral contraceptives during a telehealth or virtual visit, negating the need to see the patient in office at all.

Decreasing the incidence of teen and unintended pregnancy has been shown to have positive effects on overall maternal and infant health, rates of poverty, and formal education attainment. Prescribers, pharmacists and lawmakers in Alaska have the ability to work together to increase access to oral contraceptives for teens in rural Alaska villages, thereby positively affecting the overall health of the population and providing for a brighter future in the Last Frontier.

Ashley Sheetz is a public health master’s student in Anchorage with a strong personal interest in women’s health and reproductive rights.

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