The big mistake of rolling back on contraception

The Trump administration’s recent announcement of a possible rollback in contraception coverage represents a huge blow to health care for America’s women. As an obstetrician/gynecologist, I have witnessed first-hand the enormous benefits my patients have been able to appreciate because of increased affordable access to contraception.

Allowing more employers to withhold contraceptives from health insurance plans under the premise of religious or moral beliefs will create an undue burden on women and families. Downstream repercussions include a potential rise in unintended births, an increase in maternal mortality, a deleterious effect on the economic stability of American families, as well as a disruption in the quality of community health.

One of the more meaningful components of the Affordable Care Act was to consider contraceptives a preventive health service for women. This means zero co-payment for purchase of contraceptives, and services do not apply to a woman’s deductible.

Today, most women have no-cost contraceptive coverage — the proportion has fallen from 21 percent pre-Obamacare to 3 percent. This applies to all forms of contraception, including oral contraceptives, which can cost hundreds per year, as well as intrauterine devices (IUDs), which usually require more than $1,000 in upfront costs. The American Congress of Obstetricians and Gynecologists (ACOG) advocates the use of Long-Acting Reversible Contraception (LARC) methods such as IUDs as the most effective way of reducing unintended births.

For the first time in decades, the unintended birth rate in the U.S. has started to decline, primarily because of the increased adoption of LARCs. A repeal in coverage for these highly effective forms of contraception will almost certainly result in a reversal of this trend.

A rise in unintended pregnancy yields a parallel increase in adverse neonatal outcomes, primarily due to the fact that infants of unintended pregnancies are less likely to receive prenatal care and are more likely to have low birth weight. This translates into high risks of maternal mortality and greater health care costs for the care of these infants.

Contraceptive coverage saved women an estimated $1.4 billion on birth control pills alone in 2013, according to the National Women’s Law Center. While the Trump administration claims this proposal will affect “only” 120,000 women, it is a very slippery slope for additional employers to object to contraceptive payment based on the vague terminology regarding a “sincerely held religious or moral objection.” Given the opportunity to reduce health care costs, it is likely that more employers will take advantage of loopholes like this to withhold coverage.

Given that 90 percent of women will use birth control in their lifetime, plus the fact that contraceptive options are used not only for birth control but also for numerous non-contraceptive benefits, withdrawing coverage is likely to significantly affect the general health and well-being of a great number of women.

We must not allow our current administration to reverse the significant progress we have made in advancing health care for women in our nation, not to mention this proposal screams gender bias since contraception is disproportionately the responsibility of women.

A rise in unintended pregnancy yields a parallel increase in adverse neonatal outcomes.