Birth Control Matters to Me

Name

Email address*

ZIP Code*

Do you personally use birth control?

Gender:

Why is birth control important to you personally? It can be because you use it yourself or because you are the parent, partner or sibling of someone who relies on it.

What is the one message you would want members of Congress and the media to know about the impact birth control coverage has on your life?

Optional information

You can use my first name and state only.
I'm willing to talk to members of the media about my story.
I'd be willing to record a video of myself telling my story and submit it to UltraViolet online.

For millions of us birth control is a deeply serious issue. It helps us to have control over our lives, bodies, financial security and health. Members of Congress and the media need to hear our stories. Can you share them here and we'll make sure they do? NOTE: We will not share your name or address, the stories you submit here will be completely anonymous unless you tell us otherwise.

UltraViolet