Roadmap to increased access to contraceptives


For her capstone project for her master of public health (M.P.H.) degree, Ayla Heder turned her interest in health policy into a process that could better enable women to decide when to have children.

Ayla Heder, M.P.H.’18

“My idea was to create a capstone that would be tangible and could benefit an organization,” she says. 

Recent legislative actions make access to oral contraceptives especially pertinent. In 2017, the Iowa General Assembly ended the joint federal-state Medicaid program and switched to a state-funded system that denies funding for abortion providers, such as Planned Parenthood. Within three months after that change, the number of Iowans enrolled in the state’s family planning program dropped by 50 percent. 

“Legislative changes during the 2017 and 2018 sessions have resulted in less access to affordable, comprehensive family planning services,” Heder stated in her capstone paper. 

Those services include access to oral contraception, the most utilized contraception method in the U.S. To counter that reduced access, especially for young women, low-income women, women of color and those living in rural areas, she proposed in her capstone a process for implementing a “pharmacy access model.” This approach allows pharmacists to prescribe oral contraceptives without consultation and prescription from a health care provider. In 2017, Iowa Senator Janet Petersen (D) proposed legislation to allow the model in the state, but it stalled in a subcommittee. 

Heder worked with the nonprofit Family Planning Council of Iowa to map out a process for getting such legislation passed. Critical steps include increasing support among Republican legislators, uniting key stakeholders – such as health care associations – that support the model and addressing concerns of those that don’t. Also key are increasing public support and creating a diverse group of health care professionals and associations to hammer out details of the legislation. 

Increased access to oral contraception does more than empower women. Heder pointed to 2010 data showing that unintended pregnancies resulted in $21 billion in public expenditures nationwide. In Iowa, 61.5 percent of unplanned births were “publicly funded,” $127.6 million by the federal government and $48.3 million by the state. 

“Reducing the rate of unintended pregnancies is an important public health issue at the state and federal level,” she stated. “These efforts are achieved through education and access to family planning services.” 

Heder, who completed her M.P.H. degree in December, says her capstone and the program in general made for a “great experience.” 

“In the M.P.H. courses, you learn so much. It changed my way of thinking about health to a very well-rounded view,” she says. “The capstone got me excited about state government, which I didn’t expect. I would love to work as a health policy analyst, but at this point I just want to start somewhere in public health to get more experience.”C

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