Right. Fifty percent is an unacceptable failure rate for anything. So what are we to make of the fact that half of the pregnancies in the U.S.—about three million, according to the National Program to Prevent Teen and Unplanned Pregnancy—are unintended?
It certainly is a signal that something is wrong with the way we deal with contraception, whether it’s a problem of access, poverty, psychology or comprehension. The first two could certainly start to be addressed with the help of the Mikulsi Amendment, which Senator Barbara Mikulski (D-Maryland) submitted to ensure better preventive health care for women under the Patient Protection and Affordable Care Act (the health care bill) which passed last March.
“The insurance companies take being a woman as a pre-existing condition,” Senator Mikulski has said, and this longtime champion of our health and well-being included mammograms, pelvic exams, counseling and other preventive care at little or no cost. Contraception is not mentioned specifically but Senator Mikulski has said it was clearly intended as part of the amendment. A panel made up of members of the Institute of Medicine will advise the Department of Health and Human Services which will decide by August what exactly will get covered and whether contraception will be included.
Women certainly want it to be. NPR's Julie Rovner reports that “More than 70 percent of those polled earlier this summer said prescription birth control should be covered under preventive health care, including 77 percent of Catholic women, 72 percent of GOP women votes and 60 percent of male voters.” The polling was done by Hart Research for Planned Parenthood.
Why It Would Help
Removing the cost burden of contraception would certain help women, more of whom have been pushed into poverty since the economic decline. According to Legal Momentum, women in 2009 were “32 percent more likely to be poor than adult men,” with women’s poverty rate surpassing men’s at 13.9 percent to 10.5 percent. This economic strain is showing in our birth control choices. Minnesota Daily’s Sarah Neinaber wrote that “a study conducted by the Guttmacher Institute, a health research firm, found that 55 percent of women ages 18-34 have at one time in their life struggled to manage the costs of birth control.” Kimi Yoshino, writing for the Los Angeles Times, says that economic woes, including lost insurance, are causing more women to delay pregnancy, seek long-term contraception and look to clinics for help with contraception and abortion costs. Many clinics are seeing a dramatic increase in abortions, including those in Colorado and Illinois. “At Oakland-based ACCESS, which helps poor women who are seeking reproductive healthcare, about 72 percent of calls are from women considering abortions, up from 60 percent last year,” Yoshino writes.
If Holland is any example contraception without copay will certainly help. Deborah Kotz, senior writer for U.S. News and World Report, writes that Holland, which provides publically funded contraception, also has the world’s lowest abortion rate.
Finally, ob-gyn and family planning expert Dr. David Grimes, put it in a nutshell for the AP: "There is clear and incontrovertible evidence that family planning saves lives and improves health," and "Contraception is a prototype of preventive medicine."
Stressed in Every Way
Isadora Alman, a psychotherapist and blogger for Psychology Today whose relationship column, “Ask Isadora,” ran for 25 years in national newsweeklies, cites the stress of a surprise pregnancy first on the list of issues regarding better access to contraception.
“I see so many stressed young families, or not so young— breeding age— whose sex lives have gone down the tubes, or one has lost interest, or they’re so at each other’s throats, they’re so exhausted … I have not seen many bundles of joy in many years,” she says. “Remember they’re coming to see me, a relationship therapist: I’m sure there are some happy families out there! But I don’t get to see them.”
If a couple is already having problems, the exhaustion and whacked-out hormones of a pregnancy are not going to help.
“There was a couple who was in to see me earlier this week and she said, “You know life wasn’t half as awful before we had the second child,” and I had to bite my tongue not to say “Duh!” If a couple is already seeing a therapist, Alman says, they need to work out the issues between them before considering something as serious as a pregnancy.
“The more stressed one is,” she says, “the less able you are to be a good parent, a good partner, a good worker, a good professional. “It affects all aspects of one’s life.”
As for no-copay contraception? “I’m in favor of it! Anything that makes sex less stressful for modern people today, I’m in favor of.”
How It Will Work
“For basically every woman birth control is a routine cost, just like a pelvic exam, just like groceries,” says Tait Sye, spokesperson for Planned Parenthood. Including it as routine health care just makes sense. Using myself as an example, Tait explains how it would work.
In 2014 when health insurance exchanges are set up, he explains, I would choose and enroll in a plan, which I would pay into but receive a tax credit if I’m under a certain income level (the credit will go towards paying the premium). Then I’d have an insurance card which I could take to my doctor; she would prescribe birth control pills and swipe the card so I could go to a pharmacy and get the pills, co-pay free. Current costs of birth control vary according to method (but a nice roundup is in Kimberly Palmer’s The Real Cost of Birth Control in US News).
This would be a big improvement for me, since I’m self-employed, haven’t had insurance in years and currently pay $25 a month for birth control pills— and even that sometimes is a serious strain.
Preventing Prevention?
Of course anything so clearly sound and helpful is bound to have critics. Among those who are against including contraception as preventive health care are US Council of Catholic Bishops, which sent a letter to the U.S. Department of Health and Human Services voicing their opposition.
“I’ve forgotten what comedian I saw the other night who said if you’re against gay marriage, then don’t marry a gay person! If you’re against birth control don’t use it!” says Isadora Alman. “And deal with the consequences. It is an essential part, to me, of a healthy life—being able to have control of your family planning.”
Agreed. And while we’re at it, can we get some no-co-pay vasectomies as well? It takes two to create an unintended pregnancy and men deserve better access to control of their fertility, too.