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Health care law's results breed hope among doctors for birth control access

The U.S. Supreme Court will hear arguments on March 25 from Hobby Lobby, an Oklahoma-based craft-store chain whose founder once said he would need to “abandon our religious beliefs” to follow the birth control mandate of the Affordable Care Act.

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By Adam Smeltz
Saturday, March 1, 2014, 10:30 p.m.

Sex education hasn't ended them. Neither have public service campaigns or family planning services.

But unplanned pregnancies should begin to decline more rapidly during the next several years because the federal health care law allows cheaper, easier access to birth control, women's health scholars say. About half of pregnancies in the United States are unintended, an overall figure that's nearly unchanged in two decades.

“I think it will make a dent. How much is to be determined,” said Dr. Sonya Borrero, an assistant professor of medicine in women's health at the University of Pittsburgh. “I think all of us are really hopeful this will alleviate some of the barriers to contraceptive use.”

Borrero and other health advocates note promising early indicators. The number of privately insured women who pay no out-of-pocket fees for contraception ballooned last year under the Affordable Care Act, according to the nonprofit Guttmacher Institute in Washington.

By spring, 40 percent of privately insured women on birth control pills paid nothing, up from 15 percent in fall 2012. Among women who use a contraceptive ring, the number climbed from 23 percent to 52 percent, Guttmacher reported.

The pattern should make it easier for women to choose and stick with birth control methods that are most effective for them, crushing “cost barriers” that can keep more useful and lasting contraceptives out of reach, said Adam Sonfield, a Guttmacher analyst.

The institute found increasing numbers of unintended pregnancies among impoverished women, even while rates for teenagers and higher-income women slipped.

Out-of-pocket costs for oral contraceptives can approach $1,000 a year.

“This is about women and couples deciding for themselves how many children they want, if they want children and when they want children,” said Sonfield, a senior public policy associate. “It has to start with the individual.”

New requirement

Provisions of the Affordable Care Act, known as Obamacare, require that private insurance plans cover prescription birth control with no cost-sharing by plan holders. The measure — designed to strengthen preventive care — became law in August 2012, one of the first Obamacare provisions to take effect.

It sparked pending challenges from a cross-section of religious groups and businesses that provide employee insurance coverage, including the Roman Catholic Diocese of Pittsburgh. The groups argue that the legislation violates religious freedoms by forcing them to pay for practices, especially contraception, that they fundamentally oppose.

The U.S. Supreme Court will hear arguments on March 25 from Hobby Lobby, an Oklahoma-based craft store chain whose founder once said he would need to “abandon our religious beliefs” in order to follow the law.

Dana Siperko, 20, of Oakland said a woman should not be affected by her employer's religious orientation. She received a contraceptive implant in her arm that will last for three years. It could have cost her several hundred dollars before the federal health law.

“I know I wouldn't have been able to get it without that,” said Siperko, whose earlier birth control plan cost as much as $100 a month. “It's pretty phenomenal to have your birth control free for three years and not have to do a monthly anything.”

Sales soar

An estimated third of insurance plans escape the birth control mandate under grandfathering provisions, although most plans should meet the requirement by 2015, say doctors , who hope national effects on birth control use and the volume of unintended pregnancies will be clearer by then.

In the meantime, New Jersey-based Merck & Co., a top supplier of birth control, reported sales growth in two products from 2012 to 2013. Sales in the United States of Merck's NuvaRing, a removable contraceptive ring, climbed 16 percent to $426 million. Domestic sales of Implanon, a contraceptive implant, rose 48 percent to $205 million.

Industry observers say it is too soon to know whether the Affordable Care Act is behind those upticks, arguing that a sluggish economy and social factors might be at work. But longer-lasting contraceptive methods such as Implanon, which does not require a daily pill, are gaining popularity as the health care law erases their upfront costs for women, health advocates said.

“When the cost barriers are removed, women are more likely to pick a form that's more effective and lasts longer,” said Jessica Arons, CEO of the Reproductive Health Technologies Project in Washington. She said women using those contraceptives “are going to be protected for longer periods of time and not have to worry whether they're using them properly.”

Arons expects abortion rates to dip as unintended pregnancies ease. About 40 percent of such pregnancies are aborted, but a Washington University in St. Louis study found that women with no-cost access to preferred contraceptives had abortions at less than half the national average rate.

Guttmacher found unintended pregnancies cost taxpayers about $11 billion a year, largely through Medicaid and other publicly financed programs.

About 62 percent of women of reproductive age use contraceptives, according to the institute.

“I think we can all agree we should try to reduce abortions,” said Dr. Gail Herrine, an assistant professor of medicine at Temple University Hospital in Philadelphia. “The best way to do that is to try to reduce unwanted pregnancies.”

Adam Smeltz is a Trib Total Media staff writer. Reach him at 412-380-5676 or

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