As a women’s health care physician for more than 30 years I fully understood the importance of quality affordable and accessible health care. That is why I am joining patients, providers, and other medical organizations in speaking out against the administration’s regulation that will threaten contraceptive access for women everywhere, particularly in underserved rural communities.
I spent my formative years in a rural farm community in eastern North Carolina with a population of fewer than 300 people. Many families in my community and around the country did not have the privilege of prioritizing health care over basic needs of daily living. Many of these challenges continue to persist today and access to care often requires miles of travel from the local community.
I find that most people understand the importance of contraception. What some don’t realize is the tremendous difficulty many women face in accessing reliable contraception. Women, especially those who live in remote communities, can face transportation challenges or simply lack the means to pay for the birth control method that’s right for her. Women are 35 percent more likely to live in poverty, and low-income women are disproportionately affected by unintended pregnancy and its consequences, including depression, financial burdens, domestic violence, delay in prenatal care and babies born with increased risk of birth defects, low birth weight and poor mental and physical functioning and early infant death.
In North Carolina – the state with the second-largest rural population in the nation – 54 percent of pregnancies by women aged 15 to 44 in 2011 were unintended, higher than the national average. That is why we must not chip away at the contraceptive coverage guarantee established in the Affordable Care Act.
For the first time in history, more than 62 million women have affordable access to all forms of birth control with no cost-sharing, including oral contraceptive pills that can cost upward of $50 per month and highly effective, long-acting reversible contraception such as IUDs that can cost as much as $1,000. During this time, the United States achieved a 30-year low in the unintended pregnancy rate, including among teens. We must not turn back the clock on women’s health after such tremendous gains and, the fact is, cost is a significant barrier. Even with contraceptive coverage, women still pay roughly 60 percent of out-of-pocket health care costs. Before the ACA, about 40 percent of their total out-of-pocket costs were just for birth control.
The ACA’s no-copay contraceptive coverage gives all women the opportunity to achieve and thrive, without their health threatened or their life course changed because of an unplanned pregnancy. Contraceptive coverage also makes economic sense for the country. The rate of unintended pregnancies can be five times higher for women living below the poverty level and, in 2010, unintended pregnancies cost the government approximately $21 billion.
In my home state alone, nearly 75 percent of unplanned births were publicly-funded, with federal and state governments spending nearly $860 million on unintended pregnancies. An investment in contraception is one the best examples we have of a health care cost-saving measure. The Medicaid program, which already provides no-cost contraceptives to eligible individuals, is proof. Every $1 spent on publicly funded family planning services saves $7 that would have been spent on maternity and infant care.
However, as a physician, I know the ability to avoid pregnancy amounts to more than just dollars and cents. It can be lifesaving for women who already face serious medical conditions such as heart disease, diabetes and high blood pressure. As we work to improve our nation’s health care system, our government must not take any action that would leave our patients worse off than they are today. And we start by not eliminating services and protections for the people who need them the most.
Haywood L. Brown, MD, FACOG is the president of The American Congress of Obstetricians and Gynecologists and F. Bayard Carter Professor of Obstetrics and Gynecology at the Duke University School of Medicine.