This article contains a correction.
On Monday, U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced a historic development in women’s health: Insurance companies must cover fundamental preventive health services for women at no additional cost.
The new HHS guidelines are based on the much-anticipated report by the National Academy of Sciences’ Institute of Medicine, “Clinical Preventive Services for Women: Closing the Gap,” which was released less than two weeks prior. Based on the medical evidence, the committee of experts concluded that preventive care for women should include, among other things, the full range of contraceptive methods approved by the Food and Drug Administration. The report confirms what we already knew: Contraception is basic health care for women.
The IOM report identified two primary reasons for recommending coverage of the full range of FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity: preventing unintended pregnancies and promoting healthy birth spacing. Each woman’s circumstances may require a particular type of birth control, so all contraceptive options must be available. This comprehensive coverage allows a woman and her doctor to determine which method is most appropriate for her unique situation.
The bottom line is that complete insurance coverage of contraception will have a direct beneficial impact on women’s health and well-being. Below, we examine HHS’s decision in more detail.
Known benefits
Unintended pregnancies can pose substantial health risks for women and their children. Women experiencing an unintended pregnancy may not immediately be aware that they are pregnant. They are therefore more likely to delay or not receive prenatal care, or to engage in behavior that could endanger their pregnancy.
Research by the Guttmacher Institute shows that increased contraceptive use corresponds to significant declines in unintended pregnancy and abortion. Publicly funded family planning services helped women avoid 1.94 million unintended pregnancies in 2006.
When women are able to plan the number and timing of their pregnancies, both maternal and child health outcomes are improved. Short intervals between births are linked with low birth weight and preterm birth—both of which are risk factors for infant mortality. Similarly, maternal health is connected to women’s pre-pregnancy health status. For instance, chronic conditions such as diabetes require women to closely monitor their health prior to and during pregnancy.
Wide support
Women have long recognized the benefits of access to family planning methods. There are nearly 62 million women of reproductive age in the United States, and according to the Guttmacher Institute, 62 percent of those women are currently using a contraceptive method. Moreover, among women of reproductive age who have ever had sexual intercourse, more than 99 percent have used at least one contraceptive method.
The American public also supports women’s access to contraception. The majority of Americans—roughly three-quarters—believe that both private and public health insurance should cover the costs of birth control. Another study found that more than 80 percent of Americans favor expanding access to birth control for women who cannot afford it. Recent research conducted by Lake Research Partners found that Americans strongly believe in the importance of family planning as a basic preventive measure. This consensus crosses all demographic and political lines.
Why “no additional cost” matters
The elimination of co-pays and deductibles for family planning services will significantly affect women’s ability to access birth control and use it effectively. Women often cite financial issues as a barrier to obtaining or consistently using birth control. The most recent recession has made access to contraception even more difficult for women who did not have financial security before the economic downturn.
Financial constraints have caused women to forgo their reproductive health priorities by skipping pills, delaying getting a prescription filled, going off the pill for at least a month, and obtaining fewer pill packs at one time. According to a study by the Guttmacher Institute of women with household incomes under $75,000,* 8 percent of women surveyed said that they sometimes did not use birth control in order to save money. And 18 percent of women using the pill reported inconsistent use as a cost-cutting measure.
Religious exemption
Pursuant to the health reform law, new health plans will need to include coverage of several preventive services for women without cost sharing. But where contraception is concerned, some plans are exempt from coverage requirements. The HHS guidelines specify that certain religious employers are not required to cover contraceptive services.
Under the HHS guidelines, a religious employer is one that:
(1) Has the inculcation of religious values as its purpose
(2) Primarily employs persons who share its religious tenets
(3) Primarily serves persons who share its religious tenets; and
(4) Is a nonprofit organization under specific sections of the Internal Revenue Code
Courts in California and New York interpreted nearly identical language to apply to a narrow group of religiously affiliated employers. Even so, the conscience of individual patients, not institutions, should be paramount in determining what appropriate medical care is for them.
Beyond contraception
While coverage for contraceptive methods has gotten all the attention, HHS recognized the need to fully cover a number of preventive services for women including:
- DNA testing for the Human papillomavirus, or HPV, for women over 30
- Counseling for sexually transmitted infections
- Counseling and screening for human immune-deficiency virus, or HIV
- Screening for gestational diabetes
- Breastfeeding support, supplies, and counseling
- Screening and counseling for domestic violence
- Annual well-woman visits
Taken together, increased access to these preventive services will result in demonstrably greater health and well-being for women.
Jessica Arons is Director of the Women’s Health and Rights Program and Alex Walden is a Policy Analyst at American Progress.
*Correction, February 14, 2012: This article originally did not specify that the Guttmacher Institute study only surveyed women with household incomes under $75,000. However, the average annual income for working adults ages 18–34 is $27,458.