Audrey Swee
Paper #2
Section 30
10/14/14
Available and Affordable Contraceptives
Approximately half of all pregnancies in the United States are unintentional, 43% of
which end in abortion, according to a 2006 study.1 Unintended pregnancies may stress a
woman's finances and also may interrupt her life goals, especially when the pregnancies occur in
women younger than 25, most of whom have not completed their education. The rate of
unintended pregnancy is greater among women whose income is below the poverty line than
those with income equal to or above the poverty line. Additionally, unintended pregnancy rates
are greater for cohabiting women than those who are married or non-cohabiting.2 Contraceptives
effectively reduce the risk of pregnancy in a variety of ways when used properly. However,
nearly half of unintended pregnancies are due to improper use of contraceptive methods. The
other half consists of women who are not using any form of contraception.3 Either women are in
properly educated on the method they use, or they are using a method that is not best suited for
their lifestyle. The most effective way to decrease the percentage of unintended pregnancies in
the United States is to provide women with affordable contraceptive methods as well as educate
them on the different contraceptives available.
Prices on many of the most effective contraceptive methods are cost prohibitive. The
price tag on some of these methods exceeds what many women can afford. For example, a long-
1
Lawrence Finer and Mia Zolna, “Unindended pregnancy in the United States: Incidence and disparities, 2006,”
National Center for Biotechnical Information, http://www.ncib.nlm.gov/pmc/articles/PMC338192 (retrieved
September 28, 2014).
2
Jeffrey P. Levine, Diana Ramos, and Joan Slager, “Reducing the Impact of Unintended Pregnancies (UIPs) on the
US Health System,” Contemporary OB/GYN,
http://dbprox.slcc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2012678872
&site=eds-live (retrieved September 28, 2014).
3
Ibid.
2
active reversible contraceptive method (LARC) with one of the lowest rates of unintended
pregnancy as typically used outside of medical experiments is the Intrauterine Device (IUD),
which can cost between $500 and $1000.4 Since women who earn very little are at higher risk of
unintended pregnancy, healthcare providers and insurance companies must make effective birth
control affordable in an attempt to reduce the risk of unintended pregnancy in this targeted
population. The Contraceptive Choice Project in St. Louis, Missouri, recognizes this issue and
has taken the next step. Funded by the Susan Thompson Buffett Foundation, this cohort study
provides a large sum of women with their choice method of contraception at no cost, targeting
women who are at high risk (poor, young, highly sexually active, and/or black).5 Seventy-five
percent of these participants chose a LARC method, which proved to be the most satisfying
method of contraception when compared to the satisfaction of those who chose non-LARC
methods.6 The Choice Project demonstrates that at-risk women desire to control their fertility and
show interest when presented with affordable or free methods of contraception. The study also
shows that long-term, highly effective methods are the most satisfying. If women had access to
and education about these satisfying methods, it is more likely that women will choose them.
The Choice Project is successfully designed to help women on a local level.
Nationally, the Patient Protection and Affordable Care Act (PPACA), though
controversial in terms of religious freedom, is a federal policy to make insurance affordable and
also to enforce that health insurance providers cover contraceptive methods.7 According to
4
Planned Parenthood Federation of America Inc., “Birth Control,” Planned Parenthood,
http://www.plannedparenthool.org/health-info/birth-control (retrieved September 28, 2014).
5
Janine Spain, et al, “The Contraceptive CHOICE Project: recruiting women at highest risk for unintended
pregnancy and sexually transmitted infection,” National Center for Biotechnical Information,
http://www.ncib.nlm.nih.gov/pubmed/20831439 (retrieved September 28, 2014).
6
The Contraceptive Choice Project, Washington University School of Medicine,
http://www.choiceproject.wustl.edu/ (retrieved September 28, 2014).
7
Peter West-Oram, “Freedom of Conscience and Health Care in the Unites States of America: The Conflict Between
Public Health and Religious Liberty in the Patient Protectionand Affordable Care Act,” Health Care Analysis 21.3
3
regulations as mandated by the PPACA, the Department of Health and Human Services (DHHS)
is required "to adopt a list of preventative services for women ... That must also be covered
without cost sharing. in August 2011 DHHS Announced that these would include all FDAapproved contraceptives, counseling about domestic violence and STI's, and screening for
[HPV], HIV, and gestational diabetes."8 Under these guidelines women across the nation with
many insurance policies now have access to free, FDA-approved contraceptives. A huge concern
for government officials is the $11 billion of United States taxpayer money that covers
unplanned births.9 By offering free birth control nationwide, the cost to care for children from
unintended pregnancies should decline, allowing these funds to be better allocated. The PPACA
has a huge influence on decreasing the number of unintended pregnancies.
Informing women on the different methods of birth control is one important step in the
right direction for preventing unintended pregnancy. Women need to know which options of
birth control are available to them in order to choose which method best suits their behavior.
Abstinence is the only absolute practice to control pregnancy: if sperm have no access to an
ovum, a woman cannot become pregnant. Because it is free and 100% successful, abstinence is
the most desirable method to end unintended pregnancies. However urging women to refrain
from engaging in sexual activity is hopeless, and despite enforcement, women will not remain
abstinent. This is why birth control is crucial to preventing unintended pregnancies. For women
who have no difficulty in keeping a strict routine, the birth control pill is appropriate. With
(2013): 237-247,
http://dbprox.slcc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2012214401
&site=eds-live (accessed September 28, 2014).
8
Debra Stulberg, “The Patient Protection and Affordable Care Act and Reproductive Health: harnessing Date to
Improve Care,” Journal of Health Politics, Policy & Law 38.2 (April 2013):441-456,
http://dbprox.slcc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2012060340
&site=eds-live (retrieved September 29, 2014).
9
The Contraceptive Choice Project.
4
perfect use, which means taking the pill at the save time daily, the failure rate is less than 1%.
When used improperly and inconsistently, the failure rate is around 9%.10 Women who are not as
rigid in routine will have better success with an implant, when the failure rate (less than 1%)
cannot be affected based on lifestyle, because the one-time implant can last up to three years.11
The best option for women not planning to have children for many years is an IUD which can
last up to seven or twelve years, depending on which type. Finally, a women who never desires
to have children or is finished having children can have tubal sterilization, commonly known as
having her “tubes tied.” This is meant to be a permanent procedure to prevent any future
pregnancies.12 There are many other methods that women may choose from depending on their
desires. Knowing her options, a woman can make the decision herself to know which is best for
her.
There are health concerns for some women with certain contraceptives, which further
supports why women should understand their options and which method is best for them. One of
the more prevalent concerns that women have is weight gain, which can occur with many
hormonal birth control methods. Many contraceptives do not involve hormonal changes,
including condoms, birth control sponges, cervical caps, and more. These generally have higher
failure rates than hormonal birth controls, but they are much better than the alternative—not
using any birth control method, which has a failure rate of 85%.13 Another concern is the change
that some contraceptives have on the body. Some can affect the vaginal microbial flora of
women who suffer from infections that disrupt the existing bacterial environment, like urinary
tract infections. However, research suggests that women prone to these sorts of infections may
10
Planned Parenthood Federation of America Inc., “Birth Control.”
Ibid.
12
Ibid.
13
Schiffert Health Center, “Contraceptive Methods: Failure Rates,” Health Center,
11
5
choose the birth control pills over the cervical cap or diaphragm spermicide. The pills have a less
significant effect on the vaginal microbial flora than the other two methods. Because there are so
many contraceptive options, there is no reason for women at high risk of unintended pregnancy
not to choose one method or another.
When women are informed about the different types of contraceptives available, they can
appropriately choose a method that is right for them. Whether women are worried about
expensive or chemically undesirable contraceptives, there is an option. Whether they are worried
about reversible or irreversible methods, they have a choice. If they are worried about lifestyle
changes, they have a variety of options to fit their specific needs. Once women know their
options and are educated on the manner of use and effectiveness of every option, then women are
more likely to choose an appropriate method for their lifestyle. Women need the option to be in
control of their fertility. When they can’t afford contraceptive methods, something must be done
to make these methods available to them. The Choice Project and health insurance providers
under the PPACA are providing for women free methods of contraception. When women are
educated and provided with affordable forms of birth control, the amount of unplanned
pregnancies with shrink. Then this is accomplished, women will likely have more success in
attaining their life goals.