July 19, 2011 — The Institute of Medicine on Wednesday is expected to offer recommendations to HHS about which preventive health care services for women should be covered by new health plans under the federal health reform law (PL 111-148), NPR's "Shots" reports. Stakeholders are especially interested to see if IOM will recommend that contraception be included in the provision, a decision that would require health plans to offer birth control without cost-sharing by consumers (Rovner, "Shots," NPR, 7/18). HHS has until August to make a final decision (Women's Health Policy Report, 3/9).
Deborah Nucatola, an ob-gyn and senior director for medical services at the Planned Parenthood Federation of America, said that half of all pregnancies in the U.S. annually are unintended, and "if we could prevent an epidemic of this proportion, [then] that should be justification enough that contraception is preventive care."
Nucatola said that providing no-cost access to contraception would provide benefits beyond pregnancy prevention. "We can also use it as essential preventive medicine for the four million women who have babies every year in the U.S.," she said, adding that infants "born at least 18 months apart are going to be healthier than those born closer together, and closely timed births are risky for their mothers, too."
Jeanne Monahan, director of the Family Research Council's Center for Human Dignity, said, "There are two reasons we oppose the inclusion for contraceptives as a preventive service." According to Monahan, requiring insurers to cover contraception violates the conscience rights of people who oppose artificial contraception for religious reasons. She added, "Say for example that I had a problem with it; I would be paying into a plan that would be covering" contraception, so "in a way I would be forced to pay for it myself." Monahan also claimed that emergency contraception pills, which prevent pregnancy, are a form of abortion that prevents the implantation of a fertilized egg into a woman's uterus.
Nucatola contested Monahan's claim, saying, "If people want to postulate on the theoretical risk of prevention of implantation, they're entitled to do that, but there is no scientific evidence that that is a mechanism of action." Neither of the two EC pills approved by FDA can end a pregnancy that has already begun, "Shots" reports ("Shots," NPR 7/18).
New York Times Opinion Piece Calls for Affordable Contraception
"Our health care system could save billions -- and improve the health of women and families -- by placing birth control within every woman's reach," Vanessa Cullins, an ob-gyn and vice president for medical affairs at PPFA, writes in a New York Times opinion piece. "Instead, health insurers continue to charge fees that make it difficult, sometimes impossible, for women to prevent unintended pregnancy," she states.
"Cost often determines whether a woman is able to choose and maintain her most appropriate method of birth control, especially during hard times," she continues. High cost is "one reason our country has such high rates of unintended pregnancy and abortion," Cullins writes. A recent survey by Planned Parenthood found that one in three female voters has struggled to pay for a birth control prescription at some point and, as a result, has used birth control inconsistently.
Cullins explains that making contraception affordable "would also improve health" by increasing timely prenatal care and "save taxpayers money," in part by reducing teenage pregnancies. She concludes, "Today's system of co-payments and deductibles for birth control compromise the health of families, wastes money and sends a terrible message to women" that says, "when it comes to planning your family, you're on your own. It's time to change that" (Cullins, New York Times, 7/18).