By Myung Oak Kim
As a 20-year-old college student, Emma Carpenter faces a dilemma common among young women: how to access and pay for birth control.
The Denver native gets oral contraceptives, through the health clinic on the University of Colorado – Boulder campus where she is entering her senior year. Emma’s pills initially cost her $50 a month, so she switched to a cheaper pill, which carries more side effects, but costs only $20 a month.
Emma says she considers herself fortunate to have the awareness and the financial means to regularly use contraception. One of her friends can’t afford the drugs. Emma believes that all women, especially those with limited income, should have access to affordable or, preferably, free birth control.
“I feel like if a woman chooses to be safe and take responsibility for her sexual health, that that should be supported and made easy. It should not be a struggle for any woman,” Carpenter said.
The fact is, however, that many women today struggle to use birth control, which is why the rate of unplanned and unwanted pregnancies remains high. Despite clear and longstanding government initiatives to improve family planning, millions of American women face unplanned pregnancies each year.
About half of all pregnancies in Colorado and across the country are unplanned or unwanted, and many of those result in abortion, according to government reports.
In 2006 alone, more than 14,000 pregnancies in Colorado were unwanted (as opposed to mistimed) and almost the same number of pregnancies were aborted, according to a study by the Guttmacher Institute, a reproductive health research and advocacy organization based in New York. . Unmarried, low-income and minority women, and women ages 18 to 24 and without a high school diploma have substantially higher rates of unintended pregnancy. Numerous studies show that unintended pregnancies often lead to unhealthier babies and mothers, a higher likelihood of family turmoil, domestic violence, low education rates and poverty.
For decades, the United States has been heading down the path of reducing – and even removing – the cost of birth control for women as a way to prevent unwanted pregnancies. New federal regulations that will remove co-pays and deductibles for birth control for certain women have drawn strong responses from advocates on both sides of the reproductive health issue. Pro-choice groups hail the news as one of the most important improvements in women’s health in decades. Pro-life groups decry the law, and predict a rise in promiscuity and a rush on pharmacies for birth control and medications that induce abortion.
Public emotion aside, even supporters of the new law say that making birth control more affordable, or even free, will not eliminate the problem of unwanted pregnancies. Removing the financial barrier will get more women to the clinic to see a doctor to get birth control. But that doesn’t mean women will have sufficient knowledge and dedication to avoid pregnancy. As a case in point, birth control is already free through Medicaid and a federal family planning program, and yet, a significant number of women don’t take advantage of the benefit.
“Cost is just part of the issue,” said Emilie Ailts, executive director of NARAL Pro-Choice Colorado. “It is equally but no more important than many other factors in bringing a woman to take action, to use contraception and to get committed. One of the problems in Colorado is simply finding a way to get it. Some people have to drive 100 miles or more to a pharmacy.”
Recent studies show that many women misunderstand the types of birth control that are available and how they work. Social pressures and misinformation about birth control create barriers. And then there’s the problem of consistently using the drugs.
Long history of family planning programs
The United States government has pushed for improved family planning and access to birth control for decades. The government established the Title X Family Planning Program in 1970 to pay for these services, spending about $300 million in 2008, mostly at local clinics. Many national medical and public policy organizations support easier access to birth control as a way to improve health and social outcomes for women, children and society as a whole. There is also a growing push to increase birth control usage to save money.
A June 2011 study by the Brookings Institutionestimated the cost of unintended pregnancy at $9.6 billion to $12.6 billion annually. Taxpayer savings by preventing unintended pregnancies would be $4.7 billion to $6.2 billion a year.
“The prevention of unintended pregnancy represents an important opportunity for the public to reap substantial savings, especially given the current fiscal climate,” the report said. “The enactment or expansion of cost-effective policies to prevent unintended pregnancies is therefore a timely and sensible strategy.”
A 2011 study by the Guttmacher Institute, showed that more than 1 million births in 2006, or 64 percent of all births resulting from unintended pregnancy, were publicly funded. In Colorado, more than $160 million in taxpayer funds were spent on the more than 16,000 births from unintended pregnancies that year.
The Affordable Care Act is expected to reduce costs for birth control and other women’s health services. On Aug. 1, the Department of Health and Human Services (HHS) adopted recommendations from the Institute of Medicine to include birth control, well-woman visits, support for breastfeeding equipment and domestic violence screening in the spectrum of women’s preventive care that will be covered without co-pays or deductibles in new private health plans starting in August 2012.
Controversy roils over reducing birth control costs
Vicki Cowart, president and CEO of Planned Parenthood of the Rocky Mountains, said the changes will allow more women
access to birth control. It also will enable them to pick the option that works best for them, rather than settling for what they can afford, and will help them avoid gaps in use.
Leslie Hanks, vice president of Colorado Right to Life, said the new law will cause more women to use birth control, which she believes carries “grave health risks.” She and other pro-life advocates assert that the new law will cover abortion-inducing drugs, known as abortifacients – a claim that HHS denies.
“Why do we care so little for the health of women and their innocent children being lost to these abortifacients?” Hanks said.
Gualberto Garcia Jones, who led a recent unsuccessful Colorado ballot initiative to redefine personhood, opposes the new law on many fronts.
“The recommendation that this is necessary as preventive care – that begs the question of whether pregnancy is a disease,” Garcia Jones said. “Most people would say that pregnancy is not a disease.”
The new regulations allow religious institutions that provide insurance to their employees the choice of whether to cover contraception services.
Talese Holston works as a health educator for the Take Control Birth Control program, a joint effort of Denver Health and the Prevention First Colorado Coalition. The program seeks to increase birth control use in northeast Denver through social marketing, outreach and counseling. She counsels seven or eight women a day at the Park Hill Family Health Center, providing birth control when requested.
Holston said three main factors lead to unwanted pregnancies: financial barriers, lack of information and apathy. She said making birth control free will help.
She scoffed at the claim that free contraceptives will cause more promiscuity or a rush to pharmacies.
“I don’t see any virgins,” said Holston. “People are going to have sex anyway, whether or not birth control is free. The difference is whether or not it’s protected sex.”