Birth Control Coverage May Soon Come Without a Co-Pay

(Flickr/brains the head)

Today the New York Times reports that things are looking up for pro-choice advocates who hope to have birth control classified as preventative care under the Affordable Care Act.

Administration officials said they expected the list to include contraception and family planning because a large body of scientific evidence showed the effectiveness of those services. But the officials said they preferred to have the panel of independent experts make the initial recommendations so the public would see them as based on science, not politics.

Making birth control more affordable (that is, without a co-pay under the Affordable Care Act) makes sense when you consider how insurance companies have been putting financial pressure on women:

Brand-name versions of oral contraceptives can cost $45 to $60 a month or more, not including the cost of a doctor visit for a prescription. In recent years, many health plans have increased co-payments for prescription drugs, so even women with insurance may end up paying half the cost of birth-control pills.

While there has been some anticipation among pro-choice advocates that birth control would be classified as such, the push to classify birth control as preventative care has generated some controversy -- mostly in the form of protests from extreme anti-choice groups like the United States Conference of Catholic Bishops (prominent lobbyists favoring the Stupak amendment) and the Family Research Council (which has recently been classified as a hate group by the Southern Poverty Law Center).

But much as these groups have managed to use their influence on issues of abortion, birth control may be an issue that they've already lost on.

According to Guttmacher Institute data, more than 99 percent of all women ages 15-44 who have had sex use at least one form of contraception. The data also estimates that only 7 percent of women are at risk of unintended pregnancy but aren't using some form of contraception. Additionally, 63 percent of sexually active women use some form of what is called temporary birth control (hormonal contraceptions like the pill, the patch, or the NuvaRing, as well as an IUD or condoms). More than 30 percent rely on some form of sterilization.

The number of women actively using some form of birth control while sexually active is so great that the notion of opposing birth control seems crazy or outlandish. And it is. Allowing women to have more control over their bodies through family planning is better for maternal and child health. Pretending otherwise is simply ignoring what's good public policy and good science.

Birth Control Backlash?

(Flickr/jessamyn.n)

New York Magazine recently published a cover story on the 50th anniversary of the pill (something a number of news outlets did months ago), but the story, written by Vanessa Grigoriadis, talks about how wonderful the pill (or the Pill, as she refers to it throughout the piece) is with one giant "but."

The fact is that the Pill, while giving women control of their bodies for the first time in history, allowed them to forget about the biological realities of being female until it was, in some cases, too late. It changed the narrative of women’s lives, so that it was much easier to put off having children until all the fun had been had (or financial pressures lessened). Until the past couple of decades, even most die-hard feminists were still married at 25 and pregnant by 28, so they never had to deal with fertility problems, since a tiny percentage of women experience problems conceiving before the age of 28. Now many New York women have shifted their attempts at conception back about ten years. And the experience of trying to get pregnant at that age amounts to a new stage in women’s lives, a kind of second adolescence. For many, this passage into childbearing—a Gail Sheehy–esque one, with its own secrets and rituals—is as fraught a time as the one before was carefree.

Few things set the feminist blogosphere into rants quicker than birth control -- particularly discussions about the pill -- so I'm reluctant to pile on to what's already been said articulately and wonderfully by women I respect. But I do have a few more things to add.

First of all, while the pill (which includes it's alternative methods of the Nuvaring and the Depo-Provera shot) is very popular, it's only barely the most popular form of birth control. According to Guttmacher Institute, a reproductive health think tank, 28 percent of women choose the pill as their primary form of birth control. It's followed closely by tubular sterilization (27.1 percent), and more distantly followed by the condom (16.1 percent), male vasectomies (9.9 percent, and intrauterine devices, or IUDs (5.5 percent). Incidentally, IUDs, an effective form of birth control, come with hefty upfront costs that are rarely covered by insurance. It's possible IUDs would be more popular if they were more affordable.

In other words, while the pill has changed the world, it's more that the pill was the first such technology to help women take control over their reproductive lives. Other technologies have stepped in to offer a diverse set of choices for women, even if there are few choices for men -- something Grigoriadis, to her credit, takes time to point out.

Even though the story has a lot of great facts on the pill, how it works, and its importance today, what most women object to on reading Grigoriadis' story is the paragraph I highlighted above. Much of the article is devoted to hemming and hawing over women who delay childbearing too long and then struggle to get pregnant.

But that fiction, while convenient, simply isn't true for everyone. While it is true that women increased the average age of their first birth -- by about 3.6 years according to the Centers for Disease Control -- from 1970, the average age of first birth in America is still only 25 as of 2006. This is, of course, wildly subject to other demographic factors, including your race:

And, of course, the state that you live in. In New York state, the state that Grigoriadis says is plagued with women who are delaying their first pregnancy, the average age of first birth is 26.8. Still pretty young. Incidentally the state that has the highest age of first birth is Massachusetts -- 27.7 years -- just a year older and hardly the threat of 38 at which Grigoriadis hinted.

While averages mean that there are women having children at older ages, that also means there are women having babies at younger ages, too. She's choosing to focus on a specific demographic, a fact that she doesn't even bother to acknowledge.

I was also surprised that Grigoriadis didn't mention potential other, more practical, reasons women may be delaying their fist child. After all, America and Australia are the only two industrialized countries that don't mandate paid maternity leave for women. Furthermore, paternity leave is virtually nonexistent, except for among some high-paying professionals. That puts women in a compromised position from the start for asking more help of their partners with children.

What's more women earn less than their male peers, taking longer for women to set aside acceptable "savings" for their new family members. No wonder so many career-driven women want to wait until they've achieved a certain number of things in their careers before they "settle down" to have children.

But ultimately, it's hard for me to stomach this article scaring women that they're not having babies early enough when the reality is she's talking about a very small segment of relatively privileged women who are making choices to procreate later because they must to send their children to the right schools, have the right house with enough bedrooms, and worry over nutrition during pregnancy. And that is something that definitely can't be blamed on the pill.

Abortion Rights Groups Disappointed With Obama, But Reproductive Health Care Still Moves Forward

(Flickr / gnarlsmonkey)

Politico has a story today about how abortion groups feel abandoned by a pro-choice president and Congress that’s largely pro-choice. They used the example of the recent Health and Human Services (HHS) decision to exclude abortion services from the newly created high-risk insurance pools for the otherwise uninsurable.

“We’re stuck in a slow backpedal,” [says] Laura MacCleery, government relations director for the Center for Reproductive Rights. “There needs to be a sense that, while health reform moves us forward, it moves us backwards in terms of reproductive rights.”

While it’s true that abortion rights have taken some hits while Barack Obama has been president, it’s not quite true to say that women have been abandoned in reproductive rights more generally. It is worthwhile to note that the health care reform bill will cover millions more women than previously had access to health insurance. Young women can stay on their parents health insurance until they turn 26 and may not have gaps in coverage that they previously did following graduation from college or high school. Women who have more consistent access to coverage will better be able to have continuous access to birth control and other reproductive health care.

Recent surveys by the Guttmacher Institute, a reproductive health research policy group, noted that the number of abortions became more concentrated among poor women in 2008. Women are, of course, more likely to become pregnant if they don’t have consistent access to birth control. From another report [PDF] called “Preventing Unintended Pregnancy: The Need And the Means,” senior public policy associate Adam Sonfield writes,

[R]esearchers have found serious gaps in private coverage of prescription contraceptive methods; policymakers and advocates have worked over the past decade through legislatures, government agencies, the courts, the media and employers to improve this coverage … And even when private insurance does pay for contraception, women may be required to contribute high copayments …

As Dana Goldstein notes in her recent reporting on this issue, there’s a distinct possibility that HHS will classify birth control as regular preventative care — and that means that insurers could be obligated to provide it without asking for a copay. Again, this could go far for poor women who sometimes have to make difficult monetary decisions between birth control or other daily necessities.

The health care reform legislation also outlawed denying coverage to those with pre-existing conditions, which included pregnancy — a major victory for reproductive rights activists since prenatal care is clearly part of the cannon of reproductive health care needs.

Still it’s hard to deny that for those who are passionate about access to abortion, that particular right has taken a political beading during the Obama administration. The proposed Stupak amendment threatened to eliminate abortion care coverage from private insurance plans (in addition to publicly funded ones like Medicaid that have been illegal under the Hyde amendment, which has been renewed every year since 1976). While the final health care reform bill included a slightly lesser version of the Stupak amendment, put forth by Sen. Ben Nelson (D-Neb.), many pro-choice advocates felt that abortion access shouldn’t have have even been under negotiation during a progressive administration and Congress while pushing forth major progressive reform.

Additionally, abortion rights groups have noticed a dip in fundraising during the Obama administration. NARAL, a pro-choice advocacy group, has only raised $526,431 in the 2010 election cycle compared with the millions they raked in during both Bush administrations, according to the Politico report. This is similar to dips in fundraising during the Clinton administration.

Such frustration expressed by abortion-rights advocates in the Politico article is understandable. After all, abortion rights groups feel they’re on the ropes enough already, and hoped that a pro-choice administration would more boldly advocate for abortion rights. Instead they saw a careful political calculation that used abortion coverage as a bargaining chip. But while abortion rights might be in the “slow backpedal” that MacCleery from the Center for Reproductive Rights described, it is important to remember that the overall health care for women is probably going to be good for women, probably going a long way to help reduce the number of unintended pregnancies and increase access to pregnancy care.

Cross posted.

'Modern Love' But Same Old Perspective

Via Jezebel, this Modern Love column in the New York Times really shows how unequal we really view children and pregnancy. The woman writing the column describes and experience she had with her partner years ago:

I chose to end the pregnancy for what I thought were good reasons, chief among them being my boyfriend’s emphatic unwillingness to be a father. Although his initial reaction to the news was muted, he came out strongly against it once I announced my desire to keep the baby.

Months earlier he’d referred to me as his love, “ma femme,” he called me. But lately things had been dicey.

I argued weakly with him that we could make it work. Without him, I didn’t see a way forward. I had no savings, and no family around to support or encourage me. I was terrified, and not just about being a single parent. I was afraid that with a baby I’d be off the market for good. And I wanted a husband as much as I wanted a baby, if not more. Maybe I knew instinctively that I wasn’t cut out for single parenthood. And I wanted what I wanted: husband, home, baby, in that order.

Even before the pregnancy test I’d been hinting at commitment, and he’d been making evasive noises. We were in “turnaround,” as they say in show business. From the moment I told him I was pregnant, it became my “problem,” as in “What are you going to do about the problem?”

In this scenario, the man simply is unwilling to take on any of the burden of sexual activity. His partner became pregnant, and he asked her what she was going to do about the "problem."

It's true that men are still broadly financially responsible for child support, whether they plan the pregnancy or not, but it's often a long uphill legal battle that can destroy any amicable post-relationship feelings. Becoming a single mother is scary, and not every woman feels like she can do it. That puts women like the author of this Modern Love column in the difficult position of trying to persuade her partner into fatherhood.

It's not an easy battle, but if we can start thinking about the burden of birth control, pregnancy, and abortion as not just issues for women to deal with but also for men to consider when they have sex with their partners, fewer women would be put in difficult positions like this. It's a difficult culture to change, since such things have always been considered the burden of women. Perhaps once male birth control becomes more mainstream, men will begin to think about this differently.

Family Planning

Guttmacher is releasing a big report today on family planning. You can find the study here (PDF), but I also wrote about it on RH Reality Check today.

[A]s a comprehensive study from Guttmacher Institute released today points out, using birth control is a "nearly universal" experience in this country - more than 98 percent of women use birth control at some point during their reproductive lives.

However, the study also revealed that the use of contraceptives is becoming less common in this country for woman who are black, Hispanic, and low-income. Gaps between usage levels among white women and other populations that had been narrowing during the 1980s and early ‘90s have been widening again. Only 7 to 10 percent of white women from 1982 to 2002 (the most recent year data is available) did not use contraception, but rates among black and Hispanic women actually rose to 15% and 12%, respectively, in 2002, figures that had dropped to 10% and 9% in 1995. And the gap isn't just race-based. Now, about 20 percent of women who are at risk of unintended pregnancy who are at or below the poverty line aren't using contraception, a rate that had dropped to just 8% in 1995.

As a result, unintended pregnancy is on the rise for minority and low-income groups. Though the overall national rate of unintended pregnancy has held steady in recent years, falling rates among affluent women masked an increase among poor and low-income women. "Between 1981 and 1994, the national rate of unintended pregnancy fell 14%, from 60 to 51 unintended pregnancies per 1,000 women aged 15-44. But between 1994 and 2001, that overall national rate stagnated. Worse yet, rates among poor and low-income women rose considerably over the latter period, even as they continued to fall among more affluent women, thereby exacerbating already substantial disparities," reported to study.

Go ahead and read the whole thing.

Economy Down, Condom Sales Up

One of my favorite things to blog about is condoms. I haven't had the opportunity in a while, but yesterday's news story about how condom sales are up lately. Some suspect it may be that it's because we're in a depression and people are trying to be extra careful about not getting pregnant when they can't afford a(nother) pregnancy. Historically this isn't such an unusual trend. Last year I read Stephanie Coontz's Marriage, a History: How Love Conquered Marriage and she talked about how marriage and fertility rates dropped dramatically during the Great Depression in the 1920s and 30s -- and that was before they had birth control pills.

Photo by Flickr user by piperkinsvater.

Corrective Ads on Birth Control

I missed blogging about this yesterday because I just got too busy, but the New York Times notes that Yaz, a birth control pill, has been running some rather weird ads lately that "clarify" what the pill does. The ad seems to be a sequel to an ad where women sit around in a club talking about birth control -- don't worry, one of them is a medical student, so she knows about this stuff -- and it depicts one of those actresses issuing a "clarification" for some of the claims Yaz has made.

The thing is, the problem with Yaz's advertising is somewhat systemic of birth control advertising as a whole. Yaz made a point of talking about how the pill made your skin clearer or reduced PMS, rather than touting the pill's primary purpose: to prevent you from getting pregnant. Sarah Haskins did an excellent job of satirizing this phenomenon, but birth control advertising has very little to do with birth control. So, by Yaz making an attempt to bill how the pill has other desirable side effects, the company ended up overstepping its bounds and had to issue clarifying ads. Had the company just stuck with the actual purpose of the pill, they perhaps wouldn't have had to issue an embarrassing correction.

Access to Birth Control

This debate over the family planning money in the stimulus package is silly. Sure, it's easy for conservatives to paint this as a petty attempt to get money for "evil Planned Parenthood," but here's what's really going on.

Birth control is widely popular and supported by most Americans. Social conservatives have passed regulations that say Medicaid, the health care for the poorest children and mothers in America, must obtain a waiver from the federal government to be covered for birth control -- something covered by most insurance providers who aren't Medicaid. Legally, this is simply eliminating the waiver -- and bureaucracy -- and allowing Medicaid to do something it's already allowed to do. The money allocated is just to make the change.

But social conservatives are freaking out. They, apparently, only want wealthy people to have access to birth control. What conservatives fail to point out in their protests over federally funded family planning is that ultimately this is about class. The poorest Americans have no choice but to turn to government subsidized health care -- something that's becoming increasingly unaffordable for most Americans. When we're talking about government subsidized family planning, what we're doing is giving poor people the same access to reproductive services that middle-class and wealthy people already have.

Over the Counter Birth Control?

Via Feministe, (I'm also several weeks behind on this) England is experimenting with distributing non-prescription birth control. Many other countries distribute birth control pills over the counter, including Australia and Brazil, but here in America, some of the leading voices that protest the move to over-the-counter, are women's health advocates. It's something I never really thought about before because here women having to go to the doctor for hormonal birth control pills is Just The Way It Is.

Many young women, however, are afraid of having a visit with a gynecologist appear on their parents' insurance and risk sex without birth control (sometimes even without condoms, but that's a separate issue). I agree that it's a worry that women won't visit doctors as much if birth control is available over the counter, but men often go years without going to the doctor. Women should still be encouraged to visit the doctor regularly -- especially for STD testing, but hormonal birth control is a medication that's been around much longer than many other over-the-counter drugs. Perhaps it's time to subject it to the natural evolution of medication.

Some Bad News ... But Not Surprising

Today, Bush has employed an old conservative trick. He wants to require a certification that won't "discriminate" against doctors, hospitals, or nurses that refuse to provide birth control or abortions. From the NYTimes story:

In the proposal, obtained by The New York Times, the administration says it could cut off federal aid to individuals or entities that discriminate against people who object to abortion on the basis of “religious beliefs or moral convictions.”

But the real fear, according to Cristina Page, is that the Bush administration is redefining birth control as abortion in official Health and Human Services policy:

With this proposal, however, HHS is dismissing medical experts and opting instead to accept a definition of pregnancy based on polling data. It now claims that pregnancy begins at some biologically unknowable moment (there's no test to determine if a woman's egg has been fertilized). Under these new standards there would be no way for a woman to prove she's not pregnant. Thus, any woman could be denied contraception under HHS' new science.

The other rarely discussed issue here is whether hormonal contraception even does what the religious right claims. There is no scientific evidence that hormonal methods of birth control can prevent a fertilized egg from implanting in the womb. This argument is the basis upon which the religious right hopes to include the 40% of the birth control methods Americans use, such as the pill, the patch, the shot, the ring, the IUD, and emergency contraception, under the classification "abortion."

Update: I have more over at pushback.

Someone Tell McCain What His Position On Birth Control Is

I love the title on this Wonk Room post -- "McCain Hates Condoms." They have a good rundown of McCain's position on sex ed and the distribution of birth control:

- Voted to end “the Title X family planning program, credited with helping prevent over 9 million abortions.”

- Voted against funding teen‐pregnancy‐prevention programs and ensuring that “abstinence‐only” programs are medically accurate.

- Voted for the domestic gag rule, which would have prohibited federally funded family‐planning clinics from providing women with access to full information about their reproductive‐health options.

- Voted to take $75 million from the Maternal and Child Health Block Grant to establish a new “abstinence‐only” program that censors information about birth control.

- Declined to help reduce the need for abortion and improve maternal health by opposing effort to require insurance coverage for prescription birth control, improve access to emergency contraception, and provide more women with prenatal health care.

- Voted against legislation that would have prevented unintended pregnancy by investing in insurance coverage for prescription birth control, promoting family‐planning services, implementing teen‐pregnancy‐prevention programs, and developing programs to increase awareness about emergency contraception

Just in case you thought McCain was "moderate" on such issues.

You Can't Find Birth Control Here

Catherine Price does a fabulous job over at Broadsheet of analyzing the small but growing movement of "pro-life pharmacies" that the Washington Post wrote about recently. These pharmacies make a point not to carry condoms, birth control pills, or Plan B (emergency contraception).

[T]he point of being a pharmacist isn't, as these people seem to think, to play God. It's to fill prescriptions. (In an ironic twist, some of the very same pharmacies that won't dispense birth control have no moral qualms about Viagra.) A garbage collector can't refuse to pick up beer bottles for recycling because he or she believes that drinking is wrong ...

But to me there's little use to this. Why would you need to make a collection of pharmacies that are proudly announcing that they don't carry something. Can you imagine Home Depot dispensing advertising that proclaimed, "We don't carry screwdrivers! Come to our store!" On the other hand, it's good they're aggregating a list somewhere so I can be sure to avoid such pharmacies and help put them out of business.

Flickr user blmurch under a Creative Commons license

Columbia Students Lowered Birth Control Costs

The Columbia Spectator reports today that pressure from student activist groups resulted in the student health services center lowering the cost of birth control to make it more affordable. As Campus Progress has reported before, the cost of birth control has shot up in recent months due to the 2005 Deficit Reduction Act. Prescriptions that used to cost $10 now cost $50 or $60 to a lot of college students and recent graduates.

At Columbia, though, the fabulous NuvaRing (a vaginal ring that contains hormones released continuously throughout the month) will drop from $40 to $20 over the summer and regular oral hormonal contraception co-payments will drop from $10 to $5 a month. Thanks to the pressure of a coalition of student groups, birth control at Columbia is once again affordable to students.

Cross posted.

Seasonale Patent

The oral contraceptive called Seasonale, which allows women to have a menstrual cycle only once every three months, has gotten its patent renewed. What this probably means is that a generic version (and therefore less expensive version) of the drug won't be available for several years.

Contraception and Cancer

Kaiser Family Foundation's Daily Women's Health Policy Report highlights a study conducted by the British Medical Journal that shows women who take oral contraceptives for less than 8 years are up to 12 percent less likely to get cancer. But taking oral contraceptives for more than 8 years can increase the risk by up to 22 percent.

There has been a lot of debate about the effect of hormonal birth control on women's overall health. Especially because when birth control was first introduced, the hormonal levels were too high and made many women sick. We've come a long way since 1960, though, and women have safely been using oral contraception for more than 40 years. In some cases, like the study above, it can actually be beneficial to women's health.

Conservative groups, however, may seize on this news to say that women shouldn't be on oral contraceptives because they're bad for them. (I can just imagine the Family Research Council email now.) Even if the use of oral contraceptives for more than 8 years increases the risk of cancer slightly, there are other things--like smoking--that drastically increases the risk of cancer by a lot more.

Cross-posted at campusprogress.org/blog.

The Next Battle for Choice

Via Feministing. While the main focus of the choice discussion is centered on abortions and abortion accesses (which, by the way, is abysmal), Cristina Page, author of How the Pro-Choice Movement Saved America: Freedom, Politics and the War on Sex, has a great piece this week in the Balitmore Sun about the National Right To Life conference. Presidential hopeful Mitt Romney tried to convince pro-lifers that he was their candidate, but meanwhile she noticed some subtle language that indicated that he was willing to continue Bush's work against access to contraception.

No matter that emergency contraception has the same mode of action as the birth control pill and every other hormonal method of birth control. To the anti-abortion movement, contraception is the ultimate corruptor. And so this year, the unspoken rule for candidates seeking the support of anti-abortion groups is that they must offer proof they're anti-contraception too.

Annika blogged earlier today about how even though Plan B is "available" over the counter now, it is in practicality unavailable to many women and girls under the age of 18. This is just one of the many subtle battles that choice faces under rule of conservatives.

Cross-posted at campusprogress.org/blog.