i, sandwich

by cathyjwilson
Editor’s Pick
JULY 21, 2011 4:22PM

It's time to repave the bumpy road to birth control access

Rate: 7 Flag

This blog was submitted to the National Women’s Law Center and Planned Parenthood’s Birth Control Blog Carnival (BCBC) — view all the BCBC posts here.

If the obstacles to birth control accessibility were like potholes in the road, things like social stigma and conscience clauses would be cracks compared to the sinkhole that financial barriers are to women seeking contraception. A great help to smooth this road to accessibility would be its inclusion in preventive services under the Patient Protection and Affordable Care Act (PPACA), a move that would mean women no longer need to pay copays for birth control.

I actually used to think copays weren't so bad -- I was on my dad's insurance plan in college, and I was prescribed a birth control that had a generic, $5 form. Five bucks every month? Even as a college student that was affordable. Then I graduated, got dropped from my dad's insurance plan, and to boot my OB/GYN was concerned about the brand I was taking. My periods could be lighter, shorter, why don't I try something new?

Sure, I thought -- what could be bad about that? And then in addition to my prescription, I got a coupon to use at the pharmacy. You know your birth control is expensive when your OB/GYN hands you a card that will cap your birth control copay. It cost me $24 for this brand, which didn't have a generic form. This pill had too many ill side effects, so I got switched to another no-generic brand that cost $35 per month. Somehow, the cost of my birth control managed to increase 700 percent in less than a year.

I was lucky in that, despite a three-month bout of unemployment, I never had to go without birth control to pay other bills or expenses. But that isn't the case for everyone -- in fact, the cost of this preventive health measure actually prevents a lot of women from either starting to take or regularly taking birth control because of high copays.

Some people want to argue about the merits of calling birth control "preventive," that it implies pregnancy is a disease -- those arguments are nothing but games of semantics that, by the way, ignore that some items already included as preventive services under PPACA are not directly preventing diseases, either. Birth control is the epitome of preventive -- it prevents unplanned pregnancies, prevents the risks then associated with unplanned pregnancies because women don't know they're pregnant, and inevitably prevents abortions.

I've had experience with the other accessibility roadblocks, too -- a friend of mine couldn't get a prescription from any doctor in her doctor's office because one of the doctors had religious objections to birth control (and for some reason it was OK for the entire office then to deny writing the prescriptions because of this?); I have felt awkward asking for birth control because I was young and felt my OB/GYN would stun me with judgmental eyes. But to avoid or breakthrough these roadblocks just to be met with a copay that could exceed $50 every month? A copay that could equal or surpass, say, your electric bill? A copay that for other preventive health services doesn't exist? It's like staring at the road wondering, "Why are they filling all these other potholes and just ignoring this huge one in the middle of the road?"

And it's essential for women's health that this pothole be filled because a different one is rapidly growing, courtesy of politicians who have set their sights on attacking women's health. Their attempts to defund organizations like Planned Parenthood -- which overwhelmingly works to provide low-income women with affordable contraception and health services like breast cancer screenings, pap tests, and STI testing -- serve as the latest obstacle to affordable birth control and healthcare. In this atmosphere, a detour in the form of eliminated copays is welcome and necessary -- Jezebel's Erin Gloria Ryan put it best when she said that this possibility seems like "a glimmer of hope that maybe the government doesn't actually hate us after all."

The Institute of Medicine has recommended to Department of Health and Services Secretary Kathleen Sebelius that birth control be included as a preventive health service, and I really, really, sincerely hope that it is. Cost is a huge roadblock for people who want to take but can't always afford preventive measures, so lifting this barrier would be a monumental for women's healthcare and contraceptive access. 

Want to urge the Department of Health and Human Services to accept the IOM's recommendations? Sign the petition here.


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Thank you for sharing this information about the move to make birth control covered under preventive health services...it would be a very helpful and forward-thinking change. I signed the petition you linked to at the end of your post...thanks so much for the link!

Great post! :)
rated, signed and facebooked.
It amazes me how the social conservatives rail against abortion and then are opposed to important measures like birth control which will cut down on abortions. These people are unyielding religious zealots. Your article is very sensible and quite correct Cathy. I agree that for the most part the co-pays are not onerous. But if you are very poor as most of these women are, then the elimination of co-pays is crucial. Furthermore the attack on Planned Parenthood in Congress due to the tiny amount of abortions they provide is mindless. This organization is vital to poor women and all women. I am tired of these narrow minded politicians who pander to this small but vocal moral minority. Excellent article Cathy.
Thank you for writing on this subject. So important! Pro-choice, always and forever.
Thanks for all the kind comments, and thanks to everyone who signed the petition!

And Howard, I agree -- it never ceases to amaze me how anti-choicers don't see the contradictions in the their statements. It's often, well, don't abort your baby, but if you keep your baby, we're going to complain that you need financial assistance from the government to do so. Or like you said, unplanned pregnancies and abortions are bad, but so is birth control, which prevents those things from happening.
Politicians are not trying to DEFUND Planned Parenthood. Planned Parenthood is perfectly free to get as much funding as it likes, just not from the government. So, in the interest of intellectual honesty, one should say that politicians, some, are trying to cut the GOVERNMENTAL funding for Planned Parenthood.

If you all fee so strongly about PP, I suggest you start a group to help it get more voluntary funding and open your checkbooks.
Sorry, "fee" should have been feel.
Howard, not just a "tiny amount".

How Many Abortions does Planned Parenthood Perform Each Year?

In 2006, Planned Parenthood performed 289,750 abortions, or approximately 23% of all abortions, making them the largest abortion provider in the United States. Even as the overall national abortion rate goes down, Planned Parenthood continues to perform more abortions every year.

From "Abortion Facts"

Sources: Planned Parenthood Federation of America. Planned

Parenthood Federation of America 2005-2006 Annual Report. http://www.lifeissues.org/pp/report_05-06.pdf.

Planned Parenthood Federation of America. Planned Parenthood Federation of America 2006-2007 Annual Report. http://www.plannedparenthood.org/files/AR_2007_vFinal.pdf.
First I want to know where you live that a $50 co-pay is more than your electric bill?

May I suggest that if you can't afford your co-pay maybe you should be eating at home more, cut out the night life, quit smoking or any off dozens of other things that you change to save $50 a month. For the vast, vast majority of us you need to decide what is of a higher importance to us.

If you can't/won't make the changes them maybe you can look at other methods of birth control. If, I spent $50 a month on condoms I wouldn't be able to get anything else done because of being in bed. If all else fails, nobody ever died because of not having sex.
YESSSSSSSS! Congratulations on the EP. Well deserved. Now maybe you will get more attention and comments on OS!


To comment on the post itself:

Well and cogently argued. I'd love to see your response to Barbara Joanne and Catnlion's comments.

My response to my fellow commenters:

Catnlion, I'm Canadian, not American, so I can't comment on utility bills in the States. I would imagine, though, given the desperate state of many people scraping by on whatever work they can get since the last recession (which isn't really over yet), that $50 a month is a hell of a lot of money for birth control when you're working one or two minimum-wage jobs just to get by. Cathy may be middle class (making assumptions here), but an increasing number of people aren't.

Your statement that "For the vast, vast majority of us you need to decide what is of a higher importance to us" is unclear, and I therefore hesitate to criticize (in the constructive sense, I mean). If you're suggesting that birth control should be a personal, not public, responsibility, I'd like to point out that the social costs of dealing with the children who result from unintended pregnancies are huge. The cost and logistics of raising an extra child or two can mean the difference between borderline working-class existence and a life on public assistance (which costs the government money!). Even if you eliminated welfare, you'd still have to deal with the costs of law enforcement and incarceration that result from poverty.

(I'm not even going to touch the issue of birth control in preventing abortion, but that's a non-financial factor [for the U.S. government, because of the Hyde amendment) that I'd consider important.)

Your statement that "If all else fails, nobody ever died because of not having sex" is true, but not really applicable. People DO have sex, and even if they SHOULD abstain if they can't afford or access birth control, people have sex. It's one of our top biological drives, and it's very hard to resist. Also, in some cases, sex isn't a choice: women may be sexually assaulted or, in tough situations, have sex when they don't really want to. In my view, it's a non-starter.

From a cost-effectiveness point of view, government funding for birth control is analogous to to providing publicly funding schooling: the investment is worth the returns, both financially and socially.

Barbara Joanne:

I think I've addressed any implied arguments that lie behind your exhortation that we should "fund PP out of our pockets/checkbooks" with my response to Catnlion.

Regarding your comments on Planned Parenthood: First, thank you for providing references. I went and looked up the figure you mentioned, and it's accurate - more than a quarter million abortions in 2006.

1. Only 3% of PP's services are abortions. A whopping 97% are NOT abortion: contraception (38%), STD prevention, testing and treatment (29%), cancer screening and prevention (19%), other women's health services (10%) and other (1%). Defunding PP is, in the main, not an attack on abortion, but an attack on women's health, most of all.

2. Your comment strongly implies an assumption that abortion is wrong. Your implied argument would be stronger if you made an explicit case for that.

Please note that although I'm both strongly feminist and pro-choice, I have no intention of mocking or insulting either of you. The sh*t that flies back and forth between the extremes of this conflict is something I want no part of, and gets us (all of us) exactly nowhere.

Thank you for provoking thought at this early hour of the morning, Cathy and commenters!
@Catnlion: Lots of people I know have an electric bill that is about $30-$50, conserving for air conditioning.

The issue with scraping together $50 every month for a co-pay is that it (1) assumes there is extra income to be scraped together (e.g. assuming the person is out partying and can just cut back on alcohol, which might not be the case for everyone, like people or families living paycheck-to-paycheck on essentials?); and (2) it is not a stable way to ensure birth control every month. So you live paycheck to paycheck and decide that if you never eat out, you can scrape together the $50. Oops, then your car malfunctions and to fix it, it'll cost $300. It's not just as easy as forgoing pizza every month.

And yes, condoms are cheap (but as a woman who can get pregnant, I prefer double methods), and people could stop having sex, but that is a really unrealistic argument. People should just stop eating at McDonalds and obesity would disappear. OK, that's logical, but is it practical? Sure we can just say, "Don't have sex," and say, "I told ya so" when people get pregnant, but it's not really a practical solution.

@Barbara Joanne: Trying to take away government funding from an organization that saves taxpayer money is a step backward, though. Yes, word-wise, they are trying to defund governmental spending, but for every $1 of funding to PP, taxpayers save $4. And abortions in respect to the rest of PP's services, as MediGeek pointed out, are only 3 percent (a tiny amount).
This sums it all up I think: "Birth control is the epitome of preventive -- it prevents unplanned pregnancies, prevents the risks then associated with unplanned pregnancies because women don't know they're pregnant, and inevitably prevents abortions."

Amazes me how people don't get it. Or don't want to get it.
Thank you for your polite response. I am afraid I do not see why PP cannot fund itself. And I still think for the sake of clarity we ought to be straight about what some politicians are trying to do: they are trying to stop GOVERNMENT funding of PP, they are not trying to stop funding of PP. I don't think, with all due respect, you have explained why PP should not be expected to fund itself via its own fund-raising activities. You might not LIKE this, but it is how many other agencies, companies, charities, etc., are funded. There is nothing holy about PP. (I don't care if government funding is more cost-effective and I strongly suspect that it can't be shown. I also suggest, using common sense, that it is probably not cost-effective because very few organizations at the government table ARE cost effective. BTW, I think schools are a perfect example. For example, love em or hate em, Catholic schools in the US do more with less consistently. But even if government funding of PP were cost-effective, it is not the government's job to fund a private clinic. )

And, by the way, my opposition to PP as regards your post is the opposition to a private entity being funded (partially) by the government. My opposition here is not based on abortion. However, I gave those stats (and I appreciate you confirming them) in response to a commentator here who had, I felt, the wrong numbers in regard to PP's abortions.
So, I repeat, if people are upset that government funding for PP may cease, they can get out their checkbooks and/or start an organization to help fund it.

Cathy, I don't know if it is cost effective, but as said, I don't care. It is not the government's job to fund this private organization. People who need help when birth control fails should turn to privately-funded organizations such as PP, they should turn to them before that, if they need BC, and they should not turn to the government for that other four dollars you speak of it, the government, paying when BC fails or is not used.
Thank you.