Removing Cost Barriers to Prescription Birth Control Is Key to Improving Health Outcomes in the U.S., Say Authors of a New England Journal of Medicine Commentary

Mandatory Insurer Coverage of Contraceptives Could Significantly Lower the Number of Unintended Pregnancies and Decrease Health Care Costs

This week in the New England Journal of Medicine, a group of leading experts in public health and women’s health make a compelling case for including prescription birth control among the preventive services that insurers will have to cover without co-pays or other fees under the Affordable Care Act, beginning in 2012.

Eliminating patient cost sharing for contraceptives would help control health care costs, according to the authors. They note that the average cost of a birth covered by Medicaid was more than $12,600 in 2008 — compared to $257 for a year’s worth of contraceptive coverage. Full coverage of birth control would also help the country meet or surpass two goals of the Healthy People 2020 initiative: a 10 percent increase in the number of pregnancies that are intended and a 10 percent decrease in the number of pregnancies that begin within 18 months of a woman’s last delivery.

“Contraception is the quintessential preventive care service: offering women and men the means with which to plan the timing of their children’s births is fundamental to the health of families and society,” writes the five-author team led by Kelly Cleland, MPA, MPH, a research specialist at Princeton University’s Office of Population Research. Unwanted and mistimed pregnancies have far-reaching consequences for individuals and families, and a negative impact on public health, the authors observe. Past research has shown that children born of unwanted conception are more likely to experience low birth weight, infant mortality, domestic abuse and a lack of sufficient resources for healthy development.

The article — titled “Family Planning as a Cost-Saving Preventive Health Service” — appears online this week, ahead of publication. It comes out just weeks before an Institute of Medicine (IOM) advisory committee issues recommendations to the U.S. Department of Health and Human Services about which services should be covered by insurers without co-pays under the nation’s new health care law.

Nearly half of all pregnancies that occur in the U.S. each year are unintended, and by age 45, roughly 50 percent of American women have had an unintended pregnancy. The majority (52 percent) of unintended pregnancies occur among the roughly 11 percent of women who use no contraceptive methods — many of whom forgo effective birth control because of the cost. A 2004 study found that women who reported cost as a factor in their selection of contraceptive methods were more likely to choose less effective methods such as condoms over highly effective, but more costly, methods such as IUDs. The article’s authors express “hope that the [IOM] committee will support inclusion of family planning services in the array of preventive care services.”

The article’s co-authors are Scott Spear, MD, medical director for Planned Parenthood of the Texas Capital Region and Planned Parenthood Central Texas; Carolyn Westhoff, professor of obstetrics and gynecology at Columbia University Medical Center and Presbyterian Hospital; James Trussell, professor of economics and public affairs and director of the Office of Population Research at Princeton University; and Jeff Peipert, the Robert J. Terry Professor and Vice Chair for Clinical Research in the Department of Obstetrics and Gynecology at  Washington University Medical School, St. Louis, Mo.