Rural, communities of color and low-income New Mexicans in some areas of the state face greater barriers when deciding if, how and when to become parents.

According to Power to Decide, a Washington D.C. based reproductive rights organization, 134,850 women between the ages of 13 and 44 live in a contraceptive desert in New Mexico.  The nonprofit defines a contraceptive desert as a place where women lack reasonable access in their counties to a health center that offers the full range of contraceptive methods.

Rachel Fey, director of public policy for Power to Decide, told NM Political Report this is important because women usually change contraceptive methods during their reproductive years.

“People have the response, ‘What’s the problem? Go buy condoms. It’s no big deal.’ But it doesn’t work for everyone. Just because a person is low income shouldn’t change what kind of options that person has to take care of their health,” Fey said.

Fey said a young woman might not be able to afford an intrauterine device (IUD) because of the upfront costs, which Planned Parenthood says can be up to $1,300. So she might instead opt for a different method but then later switch to an IUD since it’s cheaper over time than other methods and 99 percent effective.

Fey also said having the full range of contraception is important because if a woman doesn’t like the contraception she’s using, she’s less likely to stick with it. According to Power to Decide, 55 percent of New Mexican women said in 2010 that they had experienced an unplanned pregnancy.

Every woman, including rural and low-income women, should be able to return to her doctor or clinic and switch methods, Fey said.

“For lots of women it takes a few tries to find the method right for them,” Fey said. “Multiple trips to a provider is something urban women can do.”

But for a woman trying to make ends meet, traveling long distances to try a new birth control method can be prohibitive, Fey said.

According to the New Mexico Department of Health, there are 69 clinics that get at least some public funds that offer at least a few contraceptive methods. 

There are 64 such clinics that provide “the broad range” of contraceptive methods, Mari Anixter, DOH communications director, said in an email. Every New Mexico county except for Catron and Harding counties has a family planning clinic, the department said.

Some counties – Valencia, San Juan, Bernalillo, Eddy, Lea and Doña Ana – have multiple public health clinics, Anixter wrote in the email.

In fact, there are six health centers in Doña Ana County that carry all contraceptive methods but those six centers are serving 47,300 women and girls who are reproductive age, according to Power to Decide.

Of those 47,300 females, 20,580 are in need of public assistance to obtain contraception. In nearby Otero County the situation isn’t any better. There is one health clinic that offers all contraceptive methods for Otero County residents. That county is home to 12,480 women and girls who are between the ages of 13 and 44.

Of that, 3,860 Otero County women and girls are in need of public assistance for contraception.

Similarly, for the 13,290 women and girls who are between the ages of 13 and 44 and living in Chaves County, there is one health clinic that has the full range of contraception available. There are 4,640 women and girls who need public assistance to obtain contraception in that county, according to Power to Decide.

Adriann Barboa, the field director for social justice organization Forward Together, said that because New Mexico is a poor state, “it’s not surprising that so many are without contraception because they can’t afford it or can’t afford to get it.”

The Navajo Nation

There are 6,540 women and girls statewide who live in a county that does not contain a single public health care facility that offers the full range of contraceptive methods, according to Power to Decide.

The vast majority of those females live in McKinley County, much of which is part of the Navajo Nation. The rest live in either Catron or Harding counties.

Joshua Barnett, Indian Health Services public affairs specialist, said by email that all IHS pharmacies stock a wide range of contraception. He said that includes birth control pills, patches, rings, injections, implants, IUD’s and emergency contraception.

He also said the same range of contraceptive options are recommended for health care clinics run by tribes and urban native organizations but they are independently managed and thus, don’t have to follow IHS recommendations.

But Fey said the clinics, not just the pharmacies, should stock all contraceptive methods.

“It’s important that pharmacies be able to fill prescriptions for the full range of birth control methods but it’s not a substitute for clinics being able to offer those methods on site,” Fey wrote in an email.

Kat Sánchez, policy associate for women’s rights group Young Women United, said Native Americans should have the ability to decide for themselves if, how, and when to become parents – all the more so given the past. 

“Historically, they’ve had the least access to contraception,” Sánchez said. “Couple that with the U.S. history of forced sterilization and child removal. That was not a long time ago. It was as recent as the ‘70s.”

Wins for reproductive rights

Reproductive rights advocates say New Mexico is doing a number of things right.

Sánchez said New Mexico has “some of the best contraception laws in place.”

Fey said New Mexico has one of the most generous family planning Medicaid expansions in the U.S. Individuals who earn up to 255 percent of the federal poverty level are eligible for family planning care under New Mexico’s Medicaid. That’s a little more than $30,000 as an annual income for an individual.

In 2015, 72 percent of New Mexican births were funded by Medicaid, according to Power to Decide. Advocates say that could be because of New Mexico’s generous family planning.

But according to the Annie E. Casey Foundation, which has been tracking child poverty since the 1990s, 27 percent of New Mexico’s children in 2017 were in poverty and 36 percent of New Mexico’s children had parents in 2017 who lack secure employment.

The New Mexico legislature passed a bill in 2017 that allows pharmacists to prescribe birth control. Fey said it’s too soon to tell yet how that’s going. The grocery store Kroger announced in late October that its pharmacists would be able to prescribe contraception starting immediately in a number of states, including New Mexico. Kroger goes under brand names such as Ralph’s, Smith’s, City Market and others.

The New Mexico legislature passed a bill earlier this year that many say is a real win for reproductive rights.

House Bill 89 doesn’t go into effect until January 1, 2020, but when it does, women will be able to get six months worth of contraception that requires a prescription if they carry private insurance and up to 12 months under Medicaid.

HB 89 also codified that a patient seeking contraception will not have to provide a co-pay for coverage. Advocates say that is important since the Affordable Care Act is under attack at the national level.

School-based health clinics

New Mexico also has school-based health clinics and some of those help to fill gaps when it comes to contraception.

There are 75 school-based health clinics in New Mexico and there are an additional seven that are near a school campus, said Nancy Rodriguez, executive director of NM Alliance for School-Based Health Care.

Every county but four — Torrance, Roosevelt, Union and Harding — has at least one school health clinic, Rodriguez said.

The school-based health clinics provide some medical services for students and, in some cases, their families. But those clinics do not have to provide reproductive health services.

Rodriguez said that while all of the school-based health clinics provide reproductive counseling, 90 percent offer contraceptive prescriptions or medications and devices. But in 10 percent of the clinics, contraception is not available. She said those clinics are located in more conservative counties.

“There’s nothing to require them to provide that care,” Rodriguez said.