A provision of the health care reform package is intended to increase access to contraception.
Credit: Tomas Daliman, Shutterstock
In the United States, nearly 50 percent of pregnancies are unintended. A new health care rule — which stirred controversy due to its implications for church-affiliated organizations' coverage of contraception — has the potential to significantly reduce accidental pregnancies by increasing access to birth control, according to public health experts.
And the accommodation made by President Barack Obama on Friday (Feb. 10) — making insurers rather than the church-affiliated organizations responsible for contraceptive benefits — won't change this, they say.
"It will have a huge effect," said Diana Greene Foster of the Bixby Center for Global Reproductive Health at the University of California, San Francisco. "It is not the entire solution, but it is such an obvious first step."
Reducing unintended pregnancies is a well-established public health goal. They are associated with a variety of health issues for both mother and child from maternal depression to birth defects. There are also economic consequences, particularly for teen mothers who are less likely to graduate from high school, according to the U.S. Department of Health and Human Services.
By fully covering the spectrum of contraceptives and eliminating copayments, the rule would give women the option of picking the method of birth control best suited for them, regardless of cost, according to Adam Sonfield, a senior public policy associate at the Guttmacher Institute.
The most effective forms of contraception are long-acting, like intrauterine devices and implants that are put under the skin. Both can last for years, eliminating the possibility that a woman will miss a dose or use the inconsistently, according to Sonfield.
"They are extremely effective in the long run, but in the short run, they often have high upfront costs," Sonfield said. "Rates of unintended pregnancies are many times higher among poor women, [so] this has the potential to really help with that."
The rule originates with the health care overhaul, which Obama signed into law in 2010, and it packages contraception along with other preventive care. It exempts churches and houses of worship from offering insurance that covers contraception. Earlier this year, Obama rejected an exemption to this coverage for organizations with religious affiliations, such as, a Catholic hospital or school. This sparked accusations that the rule violated religious liberty by forcing institutions to buy something they opposed. (The Catholic Church considers deliberate contraception a sin.) [8 Ways Religion Impacts Your Life]
Nowadays, most American families want two children. This means the average women will spend five years pregnant, recovering from pregnancy or trying to become pregnant and three decades trying to avoid becoming pregnant, according to the Guttmacher Institute. (This assumes she is sexually active throughout.)
"People are going to have sex," said Carol Hogue, a professor of epidemiology and the Terry Professor of Maternal and Child Health at Emory University. "When contraception is easily available, free or inexpensive, and it is widely known how to get it and how to use it, abortion rates plummet, because the only way couples control their fertility effectively without abortions is through contraception."
A program in California demonstrates the potential benefit of increasing access to contraception, according to Foster, who is a demographer in UCSF's department of obstetrics, gynecology & reproductive services. In 2007, contraceptives offered by the state's Family PACT program averted an estimated 286,700 unintended pregnancies which would have included 122,000 abortions, according to data she provided.
In addition to reducing abortions and teen pregnancies, and providing other health services like screenings for cancer and sexual-transmitted diseases, the state's program has proven quite cost effective, according to Philip Darney, director of the Bixby Center at UCSF.
According to the Bixby Center's cost benefit analysis of the program for 2007, each averted pregnancy saved the public sector about $14,111 in costs for both the woman and the child, from conception to age 5.
Why it happens
According to the Guttmacher Institute, just over half (52 percent) of unintended pregnancies result from couples not using contraception, while 43 percent result form incorrect or inconsistent use, and the remaining 5 percent result from failure of the method.
The National Survey on Family Growth offers a different take. Between 2006 and 2008, women who had experienced unintended pregnancies said they had not used birth control for the following reasons: (The 842 women who responded could select more than one reason.)
- 14 percent did not expect to have sex
- 44 percent did not think they could get pregnant
- 16 percent were worried about the side-effects of birth control
- 17 percent had a male partner who objected
- 23 percent didn't mind if they became pregnant
As the sizable percentage of women who say they "didn't mind" the prospect of getting pregnant demonstrates, there's nuance hiding within the term "unintended pregnancy."
Researchers typically divide them into two catagories: mistimed pregnancies, typically meaning they happen too soon, before a woman is ready, and unwanted, meaning the woman has no desire to have a child.
"The definitions seems simple and straightforward, but in reality, they are complex," said Roger Rochat, a professor in the Rollins School of Public Health at Emory University. For instance, a teenager may say she never wants to become pregnant, but over time, she may change her mind, he said.