Bitter Pill

by Heather Herndon

It sounds like an April Fools’ joke: After consulting with a doctor and making the decision to begin oral contraceptives, a woman goes to her pharmacy and learns that her health-insurance policy, which covers other prescriptions, does not pay for contraception.

Unfortunately, it happens every day, and it is not funny for the millions of women of reproductive age who spend many times more in out-of-pocket costs for health care than men do. Much of the gender gap in health-care costs is attributable to reproductive health-care expenses.

The truth is, denying contraceptive coverage is not only an economic issue, but a public health-care problem. More than half of all pregnancies in the United States are unintended, and half of those pregnancies end in abortion.

A woman faced with an unintended pregnancy is less likely to seek prenatal care in the critical first trimester. In fact, the National Commission to Prevent Infant Mortality estimated that 10 percent of infant deaths could be prevented if all pregnancies were planned.

There is a clear correlation between the use of contraception to plan pregnancies and the improved health of women and children, including fewer incidences of low-birth-weight babies and miscarriages. Intentional spacing of pregnancies allows families to prepare themselves physically, emotionally and economically for a child. This increases the likelihood that the family will have sufficient resources dedicated to the child’s healthy development.

The high rate of unintended pregnancies in the United States, which is considered an anomaly in the developed world, is due in large part to birth-control options that are limited, expensive and hard to access. This is painfully true locally, as a recent Ladies Home Journal poll of cities with populations of more than 300,000 ranked Philadelphia 196 out of 200 for women’s health care.

Currently, only 33 percent of large group-health plans cover oral contraceptives. Why? Surely not for financial reasons, because in comparison to the potential adverse outcomes to women and infants of unplanned pregnancies, the cost of covering prescription contraceptives is minimal at best. Not only is the provision of contraceptive options consistent with health-insurance plans’ focus on wellness and prevention, but the cost of providing these services ultimately pays off for the plans in savings on health-care expenses.

Support for contraceptive coverage is clear: Ninety percent of Americans support family planning to prevent unintended pregnancies. Nearly two-thirds support requiring insurance policies to cover the most effective methods of contraception. But, less than 20 percent of traditional health plans and 40 percent of managed-care plans cover the five most frequently used methods of prescription contraceptives. With so much public support for family planning and contraception, why are there still roadblocks to such basic health-care services for women?

The courts are beginning to look at this question and recognizing the fundamental unfairness of denying coverage for contraceptives. In the first federal case of its kind, a defendant employer (Bartell Drug Co.) was ordered to include prescription-contraception coverage in its health plan.

The judge ruled that excluding coverage for prescription contraception from an otherwise comprehensive employee health plan constitutes sex discrimination in violation of Title VII of the Civil Rights Act of 1964.

This case rejected the argument that prescription contraception is different from other prescription drugs, writing “[T]he availability of affordable and effective contraceptives is of great importance to the health of women and children.”

For many years, health-care services such as prenatal care, childbirth, mammography and even childhood immunizations were considered nonessential.

Now that these services are universally accepted as necessary care, they too are fully covered by insurance. Coverage for contraception and the ability to plan parenthood is a natural next step.

Consider Viagra. Within two months of its FDA approval, more than half of the prescription plans were covering it. Why? Because men asked their insurers for it, and now women must do the same. The website www.covermypills.org tells how. The tide is turning for requiring this coverage, and Pennsylvania should get on the boat. The health benefits of prescription contraception coverage to women and children are no joke.

Heather Herndon is vice president for public affairs for Planned Parenthood Southeastern PA. If you would like to respond to this Slant or have one of your own (850 words), contact Howard Altman, City Paper interim editor, 123 Chestnut St., Phila., PA 19106 or e-mail altman@citypaper.net.




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