The Right Prescription

Birth Control for All?

The Institute of Medicine has some new ideas on the definition of "preventive care."

By 7.28.11

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If the federal government takes the Institute of Medicine's (IOM's) advice, every American will soon be required to purchase health insurance that includes coverage for birth control.

The IOM recently recommended that the government define birth control -- including the controversial "morning after pill" and the abortion-inducing pill ella -- as "preventive care," which all insurance providers must cover without copays or additional fees under the rules of Obamacare.

Some proponents of the definition of birth control as "preventive care" even say that such a definition would advance conservative goals, because easier access to the pills would prevent unwanted pregnancies and abortions, particularly among low-income women. But will providing free birth control with every health insurance plan really address these problems?

A 2002 study published by the Guttmacher Institute suggests not. The study found that only 12% of women who were not using contraception and subsequently had abortions from 2000-2001 stated that lack of access to contraception was their reason for nonuse. (A much more common reason for nonuse was the belief that the women were at low risk of getting pregnant.)

Dr. Linda Rosenstock, the chairman of the committee responsible for the IOM's recommendation, dismissed a questioner's concern about this issue during a live Q&A on the Washington Post website, saying such considerations were beyond the scope of the committee's charge.

The notion that free birth control for all would discourage abortions should also be doubted because distinguishing between performing a "conventional" abortion and administering the morning after pill or ella is a dubious endeavor. Even if abortion rates were to "decline" after the provision of free birth control, if the use of these pills saw a corresponding increase, the appearance of decline would be misleading: Surgical abortions would simply be replaced with drug-induced ones.

On the subject of unwed mothers' prominence in poor communities, an article published by the Heritage Foundation reports, "Research on lower-income women who have become pregnant outside of marriage… reveals that virtually none of these out-of-wedlock pregnancies occurred because of a lack of knowledge about and access to birth control."

Thus, the cry from Planned Parenthood's vice president of medical affairs, Vanessa Cullins, in a recent New York Times op-ed that "health insurers continue to charge fees that make it difficult, sometimes impossible, for women to prevent unintended pregnancy" may be a little far-fetched.

Moreover, the IOM's deliberations about birth control may not have been as neutral as they were made to appear. Although the purported reason the government consulted the IOM on this issue was to ensure "nonpartisanship," Americans United for Life issued a press release last week reporting that Planned Parenthood -- hardly a disinterested spectator in the "reproductive rights" debate -- was invited to contribute to the IOM's discussion on whether birth control should be defined as preventive care. And economist Anthony Lo Sasso, the one committee member who dissented from the IOM's final decision, accused the organization of taking too subjective an approach to determining its recommendations.

Lo Sasso writes in his dissent that the committee did not have sufficient time to effectively review evidence about the "preventive" services in question. In fact, he states:

 … the committee process for evaluation of the evidence lacked transparency and was largely subject to the preferences of the committee's composition. Troublingly, the process tended to result in a mix of objective and subjective determinations filtered through a lens of advocacy.

He goes on to call the committee's "evidence evaluation process" a "fatal flaw," especially given the policy significance of its decision.

Lo Sasso also criticizes the committee for failing to conduct cost-benefit analysis of mandating coverage for contraceptives.

In their response to Lo Sasso's dissent, the other committee members call his views on the committee's conduct "inaccurate." The response states that cost-benefit analysis was (again) beyond the scope of its charge. It goes on to emphasize that the committee members have diverse perspectives and experience, and that none of them join Lo Sasso in his indictment of the committee. The five-sentence reply, however, offers no substantive defense of the evidence evaluation process to which Lo Sasso objected.

Regardless, the responsibility now resides with the Department of Health and Human Services to determine whether it will accept IOM's recommendation and for the first time mandate nation-wide coverage of (and taxpayer funding for, insofar as government money subsidizes those who cannot buy insurance on their own) a contraceptive.

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About the Author

Lucia Rafanelli is an editorial intern at The American Spectator.