The kudos about the 50th anniversary of the FDA’s approval of the birth control pill are well deserved. Timely access to contraceptive services has vastly improved maternal and child health, and has been the driving force in reducing rates of unintended pregnancy and abortion in this country. Women’s ability to control our fertility has helped us achieve personal, educational and professional goals and made us a critical component of the nation’s success.
Bottom line: For most women, whether they choose to be mothers or not, avoiding unintended pregnancy is possible only with consistent use of reliable, effective contraception. And we can credit the birth control pill with making that much easier for women.
But 50 years after the pill was approved, half of all pregnancies in the United States are unintended. You read that right: 50 percent. So while we celebrate the ways that contraceptive use has liberated women, revolutionized American society and improved women’s health and well-being, let’s also recognize that this work is not nearly done.
It is hard to fathom how a nation as rich as ours can fail so utterly to address such a basic health care need, especially when there are tangible ways to reduce unintended pregnancy. We can promote the use of long acting contraceptives that are easy to use and highly effective. We can eliminate cost as a barrier to access to family planning services. We can recognize that, in a poor economy, the unmet need for subsidized reproductive health services goes up as fewer women can afford prescription contraception. And we can and should take steps to make it available to all.
Enter health care reform – a double-edged sword. Its enactment dealt a significant blow to abortion access, which some women facing unintended pregnancy will choose. But it also holds great promise to address the unmet need for contraceptive services.
How? Here is one way. By 2014, health reform will expand Medicaid eligibility to all Americans with a family income at or below 133 percent of the federal poverty level. This provision will vastly expand access to comprehensive health care, including no-cost family planning services, for millions of Americans.
Here is another. For reproductive age women the news is even better – the law allows states to act quickly and more easily to expand access to family planning services for low-income women who would otherwise not be covered through Medicaid. Effective immediately, states have the option to expand Medicaid eligibility for family planning services up to the same eligibility they use for pregnant women without having to go through the cumbersome federal waiver process. Most states typically provide coverage to pregnant women at or near 200 percent of poverty – levels far above eligibility for all other populations.
And one more: A provision requiring new health plans sold in and outside of the new exchanges to cover, with no cost-sharing, a broad range of preventive health services. The Department of Health and Human Services is tasked with translating this requirement into coverage specifications by September. For women this means coverage and no-cost sharing for a broad range of women’s preventive health services. Authored by Senator Barbara Mikulski, this provision will address women’s unique health care needs by improving access to affordable preventive services such as family planning services and counseling.
50 years after the pill was approved, the next great step in improving women’s health could be health care reform – but realizing its promise will require ensuring adequate funding for family planning health centers, creating a well-trained public health workforce, and reversing its anti-choice provisions.
The Centers for Disease Control and Prevention was right to recognize family planning as one of the “Ten Great Public Health Achievements in the 20th Century.” Now, as we celebrate the little pill that started it all, let’s finish the job by making all reproductive health services available to women and making unplanned pregnancies truly rare.
