The long-awaited Institute of Medicine committee report, in addition to recommending that insurers be required to cover certain annual screenings and yearly women’s wellness exams without co-pays or deductibles, recommended that the full range of Food and Drug Administration-approved birth control methods, including intrauterine devices and sterilization, be similarly covered.
The recommendation is an important step toward fulfilling one of the essential goals of health care reform: Moving U.S. medicine toward a focus on prevention. When it became law last year, the Affordable Care Act set in motion a large-scale overhaul of the U.S. health care system. But among the questions left unanswered was this: What will actually be covered?
For the past year, the Department of Health and Human Services (HHS) and the IOM have been working toward an answer, considering, among other things, whether birth control qualifies as "preventive medicine." A lot is riding on the answer. If HHS accepts the IOM’s recommendation, birth control will soon be available, without co-pays or deductibles, to millions of American women covered under the new health reform law.
The IOM’s recommendation was based on sound scientific findings that clearly show birth control is preventive medicine. Let’s review just a few of them.
Why Birth Control is Preventive Medicine
First, birth control is essential preventive medicine for women with certain medical conditions. Consider those who take thalidomide as a treatment for lupus. The same drug that helps control their illness causes severe and well-known birth defects when used during pregnancy. Women receiving this treatment must plan their pregnancies in advance, wean themselves off thalidomide for an appropriate period, and resume treatment after giving birth. For women with lupus, effective birth control is the key to bearing healthy children.
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Birth control also can help women with more common conditions avoid complicated pregnancies or life-threatening deliveries. Diabetes, which affects more than 25 million Americans, increases the risk of obstetric complications and birth defects. Thyroid disease also poses serious challenges during pregnancy. To avoid unintended pregnancies, women with these conditions need access to a wide variety of contraceptive options.
Birth control also is essential preventive medicine for the four million women who become new mothers each year. A large and growing body of literature shows that babies born at least 18 months apart tend to be healthier than those born in rapid succession. For instance, a 1999 New England Journal of Medicine study showed that allowing at least 18 to 23 months between pregnancies dramatically reduced the incidence of low birth weight and preterm delivery.
Closely timed births can be risky for mothers, too (N. Engl. J. Med. 1999;340:589-94). In 2000, a BMJ study showed that women who became pregnant less than 6 months after their previous pregnancies were 70% more likely to have their membranes rupture prematurely (BMJ 2000;321:1255-9).
We also know that women who are not prepared to parent and whose pregnancies are unintended are less likely to get prenatal care and are at greater risk for conditions such as premature and low-birth-weight babies.
No discussion of birth control as preventive medicine would be complete without an acknowledgment that birth control helps prevent the need for abortion. According to research from the Guttmacher Institute, contraceptive services provided by Title X–funded clinics in 2008 helped prevent some 973,000 unintended pregnancies, roughly 406,000 of which would have ended in abortion. No physician wants to see abortion as the outcome of a pregnancy that could have been prevented with appropriate use of contraception.
Many women still struggle to pay for birth control while waiting for it to be recognized as essential preventive medicine. The prevention of unintended pregnancy is justification enough. When you consider that birth control also can spare mothers and children life-threatening health risks, the moral math is even easier.
Dr. John McHugh is section vice-chair of the American Congress of Obstetricians and Gynecologists, Orange County, Calif., and medical director of Planned Parenthood of Orange and San Bernardino counties. He said he did not have any relevant financial disclosures.