In a new report for the US government, recommendations have been made to provide women with free prescription birth control as a part of services covered by new health plans under the Affordable Care Act. In an attempt to support the finest health for women, the Institute of Medicine (IOM) report released on Tuesday made recommendations to the US Department of Health and Human Services’ (HHS) to include eight additional services as necessary. The free contraception service appears to be the most controversial of these.
Owing to gaps in the current guidelines, women’s needs for preventive services are not being met causing them a disproportionate rate of chronic disease and disability. Further, compared to men, women need more preventive care because of “reproductive and gender-specific conditions.” As a result, they end up paying more out of their own pockets.
According to the report, all contraceptive methods approved by the US Food and Drug Administration (FDA), sterilization, and counseling to prevent unintended pregnancies should be covered under health plans. It also states that women need counseling to make them aware that conceiving within 18 months of a previous pregnancy augments the risk of adverse outcomes thereby helping them space their pregnancies.
In 2001, accidental pregnancies accounted for almost half of all pregnancies in the US, says the IOM report. Women who end up with an unplanned pregnancy are more likely to smoke, drink alcohol, be depressed, and experience domestic violence during their pregnancy and less likely to obtain timely antenatal care. Preterm or low birthweight babies are generally born as a result of unintended pregnancies and both these factors increase the risk of developmental and health problems later in life.
Screening for gestational diabetes, testing for HPV as part of cervical cancer screening for women over 30, counseling on STDs, counseling and screening for HIV, counseling on lactation, equipment to promote breastfeeding, annual well-woman care visits to help them access recommended services, and screening and counseling to identify and prevent domestic and interpersonal violence are few of the other recommendations made by the IOM to be covered under health plans.
According to the IOM report, the US has the highest rate of gestational diabetes in the world. Gestational diabetes is a condition that increases birth complications and makes the woman 7.5 times more susceptible to developing type 2 diabetes after pregnancy. The report recommends that the HHS considers health plans where women between the 24th and 28th week of pregnancy are offered free screening for gestational diabetes.
According to the report, if women also received DNA testing for the cervical cancer causing Human Papilloma Virus (HPV) along with their routine Pap smear test, fewer women would die from cervical cancer. Additionally, the chances of identifying women at risk are higher using HPV testing, vaccination, screening, and treatment of precancerous lesions.
The current HHS guidelines already include counseling on lactation as well as the pros and cons of breastfeeding; however, the report says that this should be made more comprehensive to include support such as paying for renting breast pumps, as well as paying for trained professionals to help women start and continue breastfeeding. There is substantial proof that breastfeeding decreases a woman’s risk of developing breast and ovarian cancer, and children being susceptible to a range of diseases.
According to the report, the HHS must establish an ongoing committee that reviews guidelines and recommends changes in the light of modern science. It also urges that this commission should be independent of panels that determine the efficiency of services.
The large nationwide pro-choice group and healthcare provider, Planned Parenthood Federation of America, has received this report well. The IOM recommendation on free prescription birth control was described as “a tremendous stride forward for women’s health in this country,” by their president, Cecile Richards, in a press statement released on Tuesday. She added, “Millions of women, especially young women, struggle every day to afford prescription birth control.”
“Today’s recommendation brings us a step closer to ensuring that all newly insured women under the health care reform law will have access to prescription birth control without out-of-pocket expenses,” she noted.
However, pro-life groups and US Catholic bishops have not received the report well.
According to a statement published by pro-life news channel Lifenews.com, the Director of the Family Research Council’s (FRC’s) Center for Human Dignity, Jeanne Monahan said that the FRC wished to express “strong opposition to the Institute of Medicine’s recommendation to the Department of Health and Human Services that health care plans be mandated to cover no cost-sharing contraceptives, including those that can destroy human embryos such as Plan B and Ella.”
The FRC particularly objects to the fact offering drugs such as Ella “essentially would mandate coverage for abortion”, and that it was not right to give free contraception because this means people who are against it are subsidizing those who are not. There are “no conscience protections for health care plans that object to such coverage, or for health care providers in insurance plan networks who object to prescribing such drugs,” said Monahan.
Meanwhile, IOM recommendation is also facing strong opposition from Catholic leaders in the US.
Cardinal Daniel DiNardo of Galveston-Houston, Chairman of the Committee on Pro-Life Activities of the United States Conference of Catholic Bishops, said that he strongly opposed the IOM recommendation that the HHS “mandate coverage of three particular practices in almost all private health plans: surgical sterilization; all FDA-approved birth control (including the IUD, ‘morning-after’ pills, and the abortion-inducing drug Ella); and ‘education and counseling’ promoting these among all ‘women of reproductive capacity.’ ”
He further added that the IOM decision was in effect “mandate coverage of surgical sterilization and all FDA-approved birth control in private health insurance plans nationwide.”
The IOM committee that wrote the report was chaired by Linda Rosenstock who is the dean at the School of Public Health at University of California in Los Angeles. In her statement she said that “This report provides a road map for improving the health and well-being of women.”
“The eight services we identified are necessary to support women’s optimal health and well-being. Each recommendation stands on a foundation of evidence supporting its effectiveness,” she added.
Sources: IOM; Planned Parenthood; Lifenews.com; US Conference of Catholic Bishops, Secretariat for Pro-Life Activities (via PR Newswire).