I was eight months pregnant when I found out that my OB-GYN did not, under any circumstances, prescribe birth control. Prior to that point in my pregnancy, I hadn’t thought to ask because it hadn’t occurred to me that a doctor who served Medicaid patients would deny them birth control based on the religious beliefs of the institution.
The office was attached to a Catholic hospital, the same one where I would have my baby, and due to Catholic doctrine, they did not prescribe birth control. Instead, the doctor in front of me said brightly, “We offer a full year class on family planning using the rhythm method. It’s very good.”
At eight months pregnant, I was already 11 months too late to use that as birth control after the baby. My husband and I would have to rely on condoms which, though inexpensive, were an added line item in our budget and a hassle to keep in stock after five years of monogamy and going without.
I am not Catholic but the hospital, an institution, not a live person, was, and that was enough to deny me necessary healthcare. I’m not alone in this problem: a large number of the hospitals in the United States are affiliated with the Catholic church and for some people, it is their only option for care due to location.
There are other hospitals in my area; however, I couldn’t switch. This hospital was the only one that took my insurance and my insurance was the only Medicaid option my primary care doctor took, and I didn’t want to lose her because she was so wonderful.
From hospitals all the way down to neighborhood pharmacists, denying people control of their reproductive choices is a favorite pastime of those who support anti-choice legislation and lifestyles. For people who are on Medicaid or state-sponsored insurance, this issue becomes even more trying.
What is Medicaid?
Medicaid is a type of health insurance offered through the government. Each state has its own eligibility requirements but in general, it is need-based. Households must fall below a certain income level to be eligible. These requirements may have allowances for various situations such as disability or pregnancy that make otherwise ineligible households or persons eligible. In our case I was pregnant, had changed jobs, and we could not afford the insurance that was available for purchase, so we were granted Medicaid.
Medicaid contracts with various insurance providers, providing people with some choice. This allows them to choose their doctors, sometimes even keep their doctors if they happen to take the insurance. But not all doctors want to work with the Medicaid system or will work with one of the multiple insurances offered by Medicaid, which is how I wound up in my situation.
I was on the only insurance my primary care provider would take and the OB-GYN who did not offer birth control was the only one that took my insurance. I was stuck. I had my baby and we made monthly trips to the local pharmacy to stock up on whatever condoms were on sale that month. Afterall, as any new parent knows, we had a new baby; we had to save money where we could!
PCOS and birth control
Fast forward to two and a half years later when my period suddenly disappeared. After coming pretty regularly, it suddenly didn’t show up for two months. Of course, I thought the worst (for us) that somehow, I was pregnant. Those condoms were on sale for a reason!
Two pregnancy tests, one after the first missed period and a second a month later when my period still hadn’t come, both came back as negative. I called the gynecologist and they couldn’t see me for a month so, instead, I scheduled an appointment with my primary care doctor.
In the two weeks it took me to get in to see her, my period came and I started to think something else was wrong with me. I started to wonder if I had PCOS (Polycystic Ovarian Syndrome). Sure, I had been able to have my children without any problems but there were other issues. My missing period, my discolored skin, the ever-growing beard I plucked at daily.
My PCP confirmed my suspicions and we began a treatment plan right away: one that included a daily dose of birth control. Not just to regulate my hormones but because she respected that I did not want to have another child. If I hadn’t had my PCP, I don’t know how I would have been able to treat this, I don’t know what I would have done.
If my options on Medicaid hadn’t allowed me to keep my doctor, I would only have my OB-GYN at the hospital with restrictive birth control practices. How would I have gotten the proper care for this diagnosis? What if I just didn’t know I could see my PCP for reproductive issues? And what if I had taken the rhythm method training the gynecologist had offered me?
With my PCOS diagnosis, that obviously would have been a disaster. I don’t ovulate as regularly as other people. How do you find a rhythm for something that is unpredictable?
My story has a happy ending because I had options. Many people on Medicaid take what doctors they can find and hope for the best. Since the offices that work with this program tend to be limited, patients are faced with long waits to see a doctor, like the one I encountered when I tried to schedule with my gynecologist. You can always find a doctor’s office on Medicaid, however, they may not be the ones best suited for your needs.
A vulnerable population with limited options
Once a patient is on Medicaid, they’re often stuck with the care they’re initially given. Due to travel or scheduling restrictions, many patients cannot go elsewhere, where a physician may be better suited to help them. Although people on Medicaid do have better health options and outcomes than those who have nothing at all, when it comes to reproductive health, barriers in receiving proper birth control and family planning options can lead to further mental and physical harm for people as they cannot always control when they will have children.
This is especially damning for people on Medicaid as they are already part of a vulnerable population. They live in or near poverty and may be dealing with disability of their own or a family member’s. The act of finding new doctors, changing insurance, moving health records, etc., is a huge strain on already strained people.
This system is hurting vulnerable people. No one should be told they can’t make choices for their body due to someone’s else’s beliefs and no one should be locked into those choices due to lack of access.